DDHA 8203 Week 11 Operations Proposal Example

Fund a Weekday Same-Day Team for $171,000 and Close Saturday Walk-In Hours: An Operations Proposal That Names Who Loses, by How Much, and When It Would Be Reversed

Student Name

Walden University

DDHA 8203: Advanced Healthcare Operations Management

Instructor Name

Month Day, Year

Fund a Weekday Same-Day Team for $171,000 and Close Saturday Walk-In Hours: An Operations Proposal That Names Who Loses, by How Much, and When It Would Be Reversed

Recommendation

Kestrel Point Outpatient Center should spend $171,000 a year, plus $18,000 once, to run a same-day access team on weekday afternoons and evenings, and should fund most of it by closing its Saturday morning walk-in clinic. This proposal recommends that single option. It does not offer three balanced alternatives, because doing so would hand the decision back to the reader without the analysis behind it. Kestrel Point is a composite multispecialty outpatient center with fourteen primary care clinicians, part of a regional health system.

The Operating Problem

The center's patients cannot get same-day primary care appointments on weekdays. In the twelve weeks ending in August, 31% of patients who called before 10:00 asking to be seen that day for an acute problem were offered no appointment at the center and were directed to urgent care or the emergency department. That figure comes from the center's call log and is an internal observation, not a published finding. Over the same period, the health system's claims data show that the center's attributed patients made 1,140 emergency department visits on weekdays for conditions the system classifies as low acuity, such as urinary symptoms, minor injuries and upper respiratory illness.

The published evidence suggests that many such visits could be handled elsewhere. Weinick et al. (2010) put the share of U.S. emergency department visits that urgent care centers or retail clinics could have handled somewhere from 13.7% to 27.1%. A patient whose own practice can see them the same day is likely to need neither.

At the same time, the center's Saturday walk-in clinic, open from 8:00 to 13:00, is used lightly. Over the same twelve weeks it saw a mean of 29 patients each Saturday, about 5.8 an hour, with two clinicians and two medical assistants scheduled. Weekday demand for same-day care is many times larger. Murray and Berwick (2003) argue that delays in primary care persist when supply and demand are mismatched in time, and that practices reduce delay by putting capacity where demand actually falls. The center has capacity on Saturday mornings and demand on weekday afternoons.

What the Money Funds

The same-day team would consist of one nurse practitioner and one medical assistant working from 12:00 to 20:00 Monday through Friday, seeing only patients who call that day. At a schedule of 20-minute visits, the team adds about 22 same-day visits a day, or about 110 a week.

Recurring commitments are separated from one-time spending because they behave differently in the budget. The $18,000 fit-out is spent once. The $171,000 recurs every year and should be approved only if the review described below supports continuing it.

Table 1

Cost of the Recommendation

Salaries are from the system's 2026 compensation bands; the Saturday savings are the scheduled hours of two clinicians and two medical assistants, which would be reassigned to weekday sessions rather than eliminated.

Who Gets Worse Service, and by How Much

Closing Saturday walk-in hours makes service worse for one identifiable group: the roughly 29 patients a Saturday who use the clinic now. The center's records show that about 60% of them are employed adults who report that they cannot leave work on weekdays, and about a quarter are parents bringing children with minor illnesses. For these patients, the nearest alternative on a Saturday morning is an independent urgent care center 13 miles away, compared with a median of 4 miles to Kestrel Point. Their travel distance roughly triples. Urgent care visits also carry a higher copay under most of the health plans the center accepts, typically $50 to $75 compared with $25 to $35 for a primary care visit, so many will pay more out of pocket.

This proposal does not call that loss temporary. Some Saturday users may shift to the new weekday evening hours, which end at 20:00, but the center has no evidence about how many can, and the proposal does not assume it. O'Malley et al. (2012), studying after-hours care in the United States, found that coordination between after-hours services and patients' usual primary care is often weak, which means patients who go elsewhere on Saturdays may lose continuity as well as convenience. The center should accept that cost knowingly.

The case for accepting it is the difference in scale. The Saturday clinic serves about 29 patients a week. The same-day team would serve about 110, most of whom are now being turned away or sent to an emergency department.

Implementation

The steps, dates and owners are as follows. The medical director approves the change and notifies the Saturday clinic's patients and staff by November 30. Human resources posts the nurse practitioner position by November 15, with a target start date of January 19, 2027. Facilities completes the exam room fit-out by January 8. The practice manager rebuilds the scheduling template so that same-day visits are released only on the day, and trains call center staff to book them, by January 15. The Saturday clinic's final session is January 16, and the team's first day is January 19. Signage at the center and messages through the patient portal explain the change and list nearby Saturday options for at least three months.

Review Date and the Condition for Reversal

The center's operations committee will review the change on July 30, 2027, after six full months. Three measures will be compared with the twelve weeks before the change: the share of morning same-day requests turned away, weekday low-acuity emergency department visits by attributed patients and the number of former Saturday users who have not visited any of the system's clinics in the six months.

The change will be reversed, and Saturday walk-in hours restored, if either of two conditions is met. The first is that the turned-away share has not fallen below 15%, which would mean the team is not reaching the demand it was designed for. The second is that weekend emergency department visits by attributed patients have risen by more than 10%, which would suggest that the Saturday closure has shifted care to a more expensive setting rather than removing it. If neither condition is met, the team continues and the next review takes place a year later.

Conclusion

The center should fund a weekday same-day team at a net cost of $171,000 a year and $18,000 once, paid for largely by closing a lightly used Saturday clinic. About 29 patients a week will lose a nearby Saturday option and will travel roughly three times as far, often at a higher copay. About 110 patients a week will gain same-day care at their own practice. The change starts January 19, 2027, and will be reversed after review on July 30 if it does not cut the turned-away share or if weekend emergency visits rise.

References

Murray, M., & Berwick, D. M. (2003). Advanced access: Reducing waiting and delays in primary care. JAMA, 289(8), 1035-1040. https://doi.org/10.1001/jama.289.8.1035

O'Malley, A. S., Samuel, D., Bond, A. M., & Carrier, E. (2012). After-hours care and its coordination with primary care in the U.S. Journal of General Internal Medicine, 27(11), 1406-1415. https://doi.org/10.1007/s11606-012-2087-4

Weinick, R. M., Burns, R. M., & Mehrotra, A. (2010). Many emergency department visits could be managed at urgent care centers and retail clinics. Health Affairs, 29(9), 1630-1636. https://doi.org/10.1377/hlthaff.2009.0748