Service design at diagnostic service centers

We study a service design problem in diagnostic service centers, call centers that provide medical advice to patients over the phone about what the appropriate course of action is, based on the caller's symptoms. Due to the tension between increased diagnostic accuracy and the increase in waiting times more in-depth service requires, managers face a difficult decision in determining the optimal service depth to guide the diagnostic process. The specific problem we consider models the situation when the capacity (staffing level) at the center is fixed, and when the callers have both congestion- and noncongestion-related costs relating to their call. We develop a queueing model incorporating these features and find that the optimal service depth can take one of two different structures, depending on factors such as the nurses' skill level and the maximum potential demand. Sensitivity analyses of the two optimal structures show that they are quite different. In some situations, it may (or may not) be optimal for the manager to try to expand the demand at the center, and increasing skill level may (or may not) increase congestion. (c) 2012 Wiley Periodicals, Inc. Naval Research Logistics, 2012