Workload balancing: staffing ratio analysis for primary care redesign

Xiang Zhong, Hyo Kyung Lee, Molly Williams, Sally Kraft, Jeffery Sleeth, Richard Welnick, Lori Hauschild, Jingshan Li

Research output: Contribution to journalArticlepeer-review

11 Citations (Scopus)


The objective of this paper is to investigate the staffing composition of chief care providers (e.g., physician (MD)) and support staff (e.g., medical assistant (MA)) under various task assignment settings to achieve the optimal operational efficiency. Specifically, we examine the effects of workload shifting and identify the proper ratio of MDs to MAs to attain an effective and efficient service level. Based on a Markov chain based framework that characterizes care providers’ activities during patients’ primary care clinic visits, analytical investigation and numerical experiments are conducted. The results articulate that the optimal staffing ratio is achieved when the workloads of MDs and MAs are balanced. To validate the findings under generic primary care clinic settings, discrete event simulation models are developed and extensive experiments are carried out. The sensitivity study elucidates that the balanced-workload optimality is not affected by system variations in patient volume, as well as arrival and service time distributions.

Original languageEnglish
Pages (from-to)6-29
Number of pages24
JournalFlexible Services and Manufacturing Journal
Issue number1-2
Publication statusPublished - 2018 Jun 1
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2016, Springer Science+Business Media New York.


  • Analytical model
  • Discrete event simulation
  • Length of visit
  • Primary care redesign
  • Staffing ratio
  • Workload balance

ASJC Scopus subject areas

  • Management Science and Operations Research
  • Industrial and Manufacturing Engineering


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