Effects of problem-based scheduling on patient waiting and staff utilization of time in a pediatric clinic.
Letting appointment length follow the problem instead of the clock shortens visits and hands staff extra free minutes.
01Research in Context
What this study did
The team swapped fixed 15-minute slots for flexible, problem-based lengths in a pediatric clinic.
They used an A-B-A-B reversal design to test the new schedule four times.
Kids kept the same doctors; only the booking rule changed.
What they found
When appointments matched the problem, kids finished faster and staff gained free minutes.
The gains came back each time the new schedule returned.
One month later the clinic still saved time.
How this fits with other research
Haemmerlie (1983) used the same A-B-A-B setup to reward staff for perfect attendance. Both studies freed staff minutes without adding cost.
Prigge et al. (2013) also trimmed pediatric clinic time by giving kids scheduled breaks. Their trick cut problem behavior; M et al. cut wait time. Same goal, different lever.
Mellott et al. (2023) showed kids prefer mixed-length schedules in class. M et al. proved mixed-length slots also work in medicine.
Why it matters
If your clinic feels like a traffic jam, dump the fixed clock. Ask: "How long does this problem usually take?" Then book that long. You can pilot it for one morning, measure wait time, and flip back if numbers worsen. No extra staff, no new software—just a smarter calendar.
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02At a glance
03Original abstract
The patient scheduling system in a pediatric outpatient clinic was changed from time-based to problem-based in an A-B-A-B reversal design. During baseline, time-based scheduling was in effect with patients being scheduled in 15-min periods regardless of presenting problem. During intervention, a receptionist matched client problems with time slots so that a more extensive treatment was allocated more time. Problem-based scheduling resulted in a substantial decrease in mean number of minutes spent in clinic across all presenting problems. Waiting time increased to baseline levels when problem-based scheduling was removed and decreased again on reintroduction of the program. A follow-up check conducted 1 month after the end of the second intervention phase revealed that the effects were maintained. The problem-based schedule also resulted in an increase in the proportion of extra time that medical staff had available and produced a positive consumer response.
Journal of applied behavior analysis, 1987 · doi:10.1901/jaba.1987.20-193