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Mathematical modeling and the redesign of a teaching ambulatory clinic.

Mathematical modeling was utilized in the planning and decision-making process involved in reorganizing a teaching clinic to effect continuity of care. The model interrelated physicians, time and space, facilitating value judgments and decisions. After examining multiple model runs, the authors finally selected a per-clinic-session doctor mix of 5 interns, 2.3 residents, and 1.6 fellows. Group productivity by model simulation was 14.6 pts/hour, utilizing 10.1 rooms. Subsequently, 90 house officers were each assigned to the clinic one-half day a week on a continuing basis. Time-motion data, from 10 sessions five months after the change, showed that during one week 353 patients were seen at a rate of 13.9 patients per hour in the rooms and time available. The fact that the reorganization was successful and the outcomes remarkably similar to model predictions has engendered confidence in the role of modeling in the planning process.