Client flow through the Women, Infants, and Children Public Health Program

The Women, Infants, and Children (WIC) Program, managed by the county boards of health, provides nutrition, limited physical examinations, and food vouchers for pregnant women and for children with nutritional deficiencies. Because federal guidelines for the WIC program leave little maneuvering room to improve the delivery of services, we analyzed the client flow through a WIC clinic in the Atlanta metropolitan area to determine how that flow could be managed more efficiently. The challenge facing the WIC clinic was to increase the efficiency of their operation in an environment characterized by resource constraints, rigid regulations, and dysfunctional client behavior. In a limited physical space, the WIC clinic was expected to provide a number of sequential services to a client population that failed to arrive or arrived late 40 percent-50 percent of the time. The provision of services was further complicated by walk-ins, which were not only common but, according to federal guidelines, also must be accommodated. To analyze the clinic's problem, we used the General Purpose Simulation System for personal computer (GPSS/PC) to simulate client flow through the clinic. Estimates of the average amount of time a client spent in the clinic as well as average waiting times at each station and clerk and nurse utilization rates were generated assuming a variety of staffing levels. For comparison purposes, each version of the model was run with a 20-minute time lag before a late appointment was filled, and then a one-minute lag. The data used for the simulation were collected by clinic personnel during February 1994. It included the number of clerks and nurses available; the waiting time to see clerks and nurses for walk-ins and appointments; the waiting time to get WIC vouchers; the number of appointments met; the number of appointments missed; and the total time in the clinic for walk-ins and appointments. In all three versions of the model that were estimated, the results of the simulations revealed that reducing the time before a late appointment was filled significantly decreased the time spent in the clinic, on average, for all clients. Furthermore, the time spent waiting for both clerks and nurses decreased, the utilization of the clerks decreased, and the utilization of the nurses increased in two of the three estimations.