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PurposePhysician lateness and service interruptions are a significant problem in many health care environments but have received little attention in the literature. The purpose of this paper is to design appointment systems that reduce waiting times of the patient while maintaining utilization of the physician at a high level.Design/methodology/approachEmpirical data from time studies and surveys of medical professionals from multiple outpatient clinics are used to motivate the study. Simulation optimization is used to simultaneously account for uncertainty and to determine (near) optimal scheduling solutions.FindingsAs lateness increases, it is shown that, in general, appointment slots should be shorter and pushed later in the session. Conversely, as interruptions rise, appointments in the middle of the session should be longer. These findings are fairly consistent over a variety of environmental conditions, including clinic sizes, service time variance, and costs of physician time compared to patients' time.Practical implicationsThis paper demonstrates that the dome/plateau‐dome scheduling patterns that have been found in prior studies work well under many of the new factors modeled here. This is encouraging because it suggests that a generalizable pattern is emerging in the literature for the range of environments studied in these papers and this research provides guidance as to how to adjust the pattern to account for the factors studied here. In addition, it is shown that some environments will perform better with a different pattern, which the authors denote a "descending step" pattern.Originality/valueThis paper differs from most prior studies in that the complexity of environmental variables and stochastic elements of the model are simultaneously accounted for by the simulation optimization algorithm. The (very few) prior papers that have used simulation optimization have not addressed the factors studied here.

This study attempts to understand the usage of computerized accounting information system (CAIS) and its impact on the performance of SMEs in Somalia. Survey questionnaire is designed and distributed to selected SMEs in the capital city of Mogadishu, Somalia. The results of CAIS's impact are discussed from four components of balanced scorecard and internal control perspectives. The results of this study may provide knowledge about the impact of usage CAIS for SMEs performance in Somalia and also provide some suggestions to the Somalian government on assistance needed for accounting reporting to improve further SMEs in Somalia. Based on finding, internal business process recorded the highest score i.e mean of 4.13 out of 5.00. It is implied that SMEs responded with challenging ICT business environment with adopting CAIS to improve its bottom line which is business processes.

Saint Joseph Hospital, in Denver, has developed a computerized Diagnosis Profile System which provides a composite profile of health care services provided to its patient populus by the physicians and supporting staff. Practical use of these profiles is aimed at providing positive and negative feedback as an on-going evaluation tool in measuring specific health service utilization and the associated costs for those services performed. Increasing requirements of the government, accrediting groups, third party payors and specialty board recertification make this type of computerization necessary and possible. Benefits are derived through the assistance given the medical staff in performing a concurrent review of patient care for selected diagnoses and through providing current information on trends in the delivery of care and services.