Using simulation to improve the operational efficiency of a multi-disciplinary clinic.

A recent trend in health care is to provide patients with the benefits of multi-disciplinary care during a single clinic visit. The University of Michigan Breast Care Center is a leading example of a multi-disciplinary clinic which has served the Midwest United States since 1985. A hallmark of the Breast Care Center operation is a patient care conference immediately following the clinical evaluation sessions, where each case is discussed by a group of experts for immediate evaluation and generation of recommendations. The Center has experienced significant increases in the number of patient visits over the nine years since its inception. The patient mix, initially all new patients, has matured, and returning patients are now a significant portion of the clinic load. Unfortunately, the success of the Breast Care Center strained its smooth operation. Physicians were unable to attend the patient care conference because the clinical evaluation sessions were too busy, and this undermined the quality of the care recommendations generated. Patients were complaining about long waits in the Breast Care Center and delays in getting their next appointment. To examine these operational problems and to suggest corrective actions, a simulation study was conducted. This paper reports the results of this study. Our findings provide interesting insights into the operation and management of multi-disciplinary clinics.