Outpatient services are increasingly recognised as an important component of health care provision and may be improved through the application of modern management techniques. We have performed a time and role audit of consultation and waiting times in two medical clinics using different queuing systems: namely, a serial processing clinic where patients wait in a single queue and a quasi-parallel processing clinic where patients are directed to the shortest queue to maintain clinic flow. Data collected were used to construct a (...) computer simulation of patient flows in clinic. Assessment of patient satisfaction in the clinic process was determined using a self-administered questionnaire. Mean waiting time was shorter in the quasi-parallel processing clinic: 26 (SD 17) minutes compared with 36(24) minutes in the serial processing clinic. In the serial processing clinic 61% of patients waited more than 30 minutes compared with 41% in the quasi-parallel processing clinic. In the serial processing clinic 8% of 142 patients surveyed complained of the time spent waiting. The computer simulation we produced was able to determine waiting times with different clinic structures. The simulation showed that reductions in waiting time up to 30% might be achieved by changing our serial processing clinic to a quasi-parallel processing one. Performance of medical outpatient clinics can be improved by examining and changing clinic management. Computer simulation of outpatient clinics offers a means of assessing the impact of such changes on waiting time in clinic and on waiting lists. (shrink)

Knowledge must forever govern ignorance, and a people who would be their own governors must arm themselves with the power which knowledge gives. Popular government, without popular information, or the means of acquiring it, is but a Prologue to a Farce or a Tragedy—or perhaps both.—James Madison, 1815.

In making a contribution, a person's life gains meaning. A small contribution affects a few people for a short time, while a large contribution affects many people for a long time. Within the framework of an abstract, computational world, a metric on contributions is defined. Simulation of the computational model shows the critical role of gradualness. Gradualness can be supported by human-computer systems in which the computer does the copying and arithmetic, and the human applies a rich understanding of the (...) world. The role of gradualness in the research areas of machine learning and hypertext is highlighted. (shrink)