Asymptotically Optimal Appointment Scheduling in the Presence of Patient Unpunctuality

TL;DR

This paper develops an asymptotically optimal appointment scheduling policy considering patient unpunctuality, using fluid approximation and numerical schemes, validated through simulations on real data.

Contribution

It introduces a novel fluid control problem approach for large-scale scheduling with unpunctual patients, providing an asymptotically optimal policy and a practical numerical solution.

Findings

Optimal schedules can involve block booking despite continuous unpunctuality distributions.

The proposed policy achieves asymptotic optimality in large patient systems.

Numerical schemes effectively approximate complex fluid control problems.

Abstract

We consider the optimal appointment scheduling problem that incorporates patients' unpunctual behavior, where the unpunctuality is assumed to be time dependent, but additive. Our goal is to develop an optimal scheduling method for a large patient system to maximize expected net revenue. Methods for deriving optimal appointment schedules for large-scale systems often run into computational bottlenecks due to mixed-integer programming or robust optimization formulations and computationally complex search methods. In this work, we model the system as a single-server queueing system, where patients arrive unpunctually and follow the FIFO service discipline to see the doctor (i.e., get into service). Using the heavy traffic fluid approximation, we develop a deterministic control problem, referred to as the fluid control problem (FCP), which serves as an asymptotic upper bound for the original queueing control problem (QCP). Using the optimal solution of the FCP, we establish an asymptotically optimal scheduling policy on a fluid scale. We further investigate the convergence rate of the QCP under the proposed policy. The FCP, due to the incorporation of unpunctuality, is difficult to solve analytically. We thus propose a time-discretized numerical scheme to approximately solve the FCP. The discretized FCP takes the form of a quadratic program with linear constraints. We examine the behavior of these schedules under different unpunctuality assumptions and test the performance of the schedules on real data in a simulation study. Interestingly, the optimal schedules can involve block booking of patients, even if the unpunctuality distributions are continuous.