Study suggests that doctors spend less time with tardy patients in busy clinics.
A study examining doctor and patient behavior at three Johns Hopkins Medicine outpatient clinics has found evidence that clinicians spend more face–to–face time with patients when the clinic is on schedule and less when the clinic is running late.

The researchers say the retrospective study, summarized in a report published Oct. 1, 2016, in BMJ Open journal, confirms for health care services what is a commonly observed phenomenon in grocery store and bank teller lines: Once lines get backed up, service providers become less consistent in their behaviors and "shortchange" time spent with customers in order to catch up.

Williams says the new research was inspired by the results of previous studies, which showed that enforcing patient punctuality reduced variability in patient wait time. The new investigation, he says, was specifically designed to learn whether physicians' behaviors also affected clinic efficiency.

For this study, the Johns Hopkins team gathered data on patient appointment time, patient arrival time, patient interactions in the clinic and physician–patient interaction from a low–volume pain management clinic, a medium–volume academic pain management clinic and a high–volume radiation oncology service. In all, 23,635 patient–doctor interactions were examined.

The patients at each clinic were sorted into three groups: Group A was composed of those who arrived at the clinic and were present in the examination room before their scheduled appointment time; group B was composed of those who arrived before their appointment time but were not in the examination room until after their appointment time, indicating that the clinic was congested; and group C was composed of those who arrived at the clinic after their appointment time. While many physicians believe that all patients receive the same level of service, analysis of the data revealed that the average time that physicians spent with each group varied.

For the low–volume clinic, the average processing time for groups A, B and C were 38.31, 26.23 and 29.50 minutes, respectively. For the medium–volume clinic, these values were 65.59, 53.53 and 50.91 minutes, respectively. And for the high–volume clinic, the study reported 47.51, 17.59 and 47.90 minutes for groups A, B and C, respectively. While intuition may suggest that adapting behavior to catch up with the clinic’s schedule will help the clinic run smoother, the researchers found that it harms the efficiency of a clinic by adding unpredictable time variability to the system.

To explore the implications of the findings, the researchers plugged their data into a computer model known as discrete event simulation, which artificially expands the sample size to thousands more theoretical patients.

Calculating the impact of their data sample on a computer model of 10,000 doctor–patient sessions, the researchers found that even if patient tardiness is eliminated, physician behavior would cause the clinic to run behind schedule.

This led the researchers to conclude that while patient punctuality is a real factor in lengthening wait times, physician behavior may have a larger impact on the clinic's efficiency.

To further test their conclusions, the researchers again turned to their computer model to create a clinic in which all patients were treated as though they were in group B, receiving the average amount of face–to–face time with physicians. In this model, the researchers saw that both the average time it took to get patients from check–in to checkout and the variability in those times among patients could be reduced by changing clinician behavior to be more consistent across all patients.