Framework For E-Appointment Systems Design: R. Azouzi, P. Forget, S. D'Amours

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Proceedings of the

4th International Conference on Information Systems, Logistics and Supply Chain


CREATIVE LOGISTICS FOR AN UNCERTAIN WORLD
ILS 2012 – Quebec (Canada), August 26-29

Framework for E-Appointment Systems Design


R. Azouzi1,3*, P. Forget2,3, S. D’Amours1,3
1
FORAC, Université Laval, Québec – Canada (riadh.azouzi@forac.ulaval.ca; sophie.damours@gmc.ulaval.ca)
2
Université du Québec à Trois-Rivières, Trois-Rivières – Canada (pascal.forget@uqtr.ca)
3
CIRRELT – Canada

Abstract: The current situation in the service industries, public or private, demands efficiency and customer
satisfaction in service delivery. These two demands intersect in scheduling of appointments. Despite the availability of
computers and Internet access, wired or wireless, deployment of online services for scheduling appointments is found to
be rare in the province of Quebec. Consumers and service organizations face many challenges in using Internet for
scheduling appointments. These challenges are partially dealt with by software providers who offer commercial e-
appointment solutions. This paper aims to investigate the design requirements of such solutions, based on a literature
review. We present a review of the main characteristics of available commercial e-appointment solutions and propose a
framework of the factors affecting the adoption of these systems in the service industry.

Keywords: E-appointment, system design, adoption framework

1 Introduction E-appointment systems are web services interfaces to


application functionality that enable the consumer to see
in real-time what appointment periods are available and
Today, the service sector (also referred to as tertiary to set up or cancel appointments. Some systems can
sector) is becoming the largest economic sector in many send the consumer an appointment reminder by e-mail.
postindustrial societies. The current situation in the Despite the availability of computers and Internet
service industries demands efficiency and customer access, wired or wireless, in almost every household and
satisfaction in service delivery. These two demands public place in both urban centers and rural areas of
intersect in the scheduling of appointments. Quebec, deployments of online services for scheduling
Appointment scheduling is an adjusted form of a appointments are rare. Why are these systems not
queuing process, where appointment times regulate the adopted? What are the factors affecting their adoption?
arrival process of customers to the service organization,
in such a manner that the utilization of personnel and Consumers and small and mid-size service
equipment-based service resources is maximized and organizations face many challenges in using Internet for
customer waiting time is reduced. In addition to being a scheduling appointments. This paper aims to investigate
fundamental aspect of the effectiveness of service the design requirements for solutions to these
delivery, appointment scheduling is a keystone for challenges, based on a literature review. Section 2
generating new business avenues. Indeed, in several presents a literature review about the appointment
industrial sectors, services are only delivered via scheduling problem, e-appointment systems in the
appointments and at the customer site. service industry and the different characteristics
affecting the effectiveness of e-appointment systems. In
More than two decades ago, e-appointment (also Section 3, a comparison of available commercial
referred to as online appointment scheduling), emerged solutions is made, based on the main characteristics
as a new online service that promised to attract and hold found. Section 4 proposes an adoption framework of e-
customers while reducing overall customer service appointment systems in service industry, based on
expenses. Thus, both quality and productivity in the adoption factors found in literature. Finally, conclusions
service sector were improved. are drawn.

* Corresponding Author : riadh.azouzi@forac.ulaval.ca


ILS’2012 - August 26-29, 2012 - Quebec - Canada

2 Literature review certain purpose (e.g. business meeting, medical


treatment)”.

2.1 Appointment scheduling in service Technically, it is usually assumed that the service
industries consumer (the appointment seeker) is at the Internet
front end and the service provider at the rear end of an
Service industries involve the provision of services to Internet-based scheduling application integrating the
businesses as well as to final consumers. Ideally, the relevant information, with regard to the availability of
service should be provided during an appointment (time the resources of the service provider. Thus, in the
and location) convenient to both the service consumer diagram depicted in Figure 1, one can assume that the
and service provider. While in general the service interactions between the customer and the scheduling
provider or the service consumer could propose the function take place over the Internet. As such, the
appointment time, practical experience shows that appointment scheduling system can be made available
service providers present available options (time slots 24 hours a day, with fewer staff. Also, the
and locations) to the service consumer with room for inconveniences related to traditional appointment
negotiation in some cases (Douwe et al., 2009). Indeed, making, such as waiting time on the phone or the need
the service provider faces a variety of problems. It may to show up in person at the service provider site in order
have to deal with the reservation of resources, meeting to obtain an appointment, should be relieved.
rooms or other facilities (e.g., assignment of doctors or
medical equipment in clinics, assignment of officers and 2.3 Factors that affect online
offices in government services, or assignment of planes
to gates in airports). Accordingly, appointment setting appointment scheduling systems
or scheduling requires a detailed administrative
program. Several researchers have investigated the different
factors that affect the effectiveness of an on-line
More specifically, appointment scheduling requires appointment system (see Table 1 for an overview).
interactions between several decision-making functions Already in the early 2000’s, Tilley et al. (2002)
(scheduling, forecasting, yield management, database), established that the migration to web services, such as e-
usually within an elaborate information system that also appointment services) would be accompanied by issues
includes the customer. Figure 1, adapted from Pinedo of cost, timing, flexibility, control, etc. Goldstein (2001)
(2008), illustrates these interactions. An extensive focused on the scheduling function in an e-appointment
database that contains all the relevant information system. He used the concepts of operations management
regarding availability of resources and (potential) to infer the factors that affect the daily production goal
customers is usually required. of the service provider (in this case, a dental practice).
He determined that the appointment scheduling system
should effectively handle emergencies, “no shows”
(customers who do not show up or who cancel on short
notice), “repeated offenders” (customers that are
notorious for cancelling at the last minute or who are
constantly late), down times, and new customers. Also,
Goldstein determined that the appointment scheduling
system should ideally be automated and connected to
the main service management systems or software used
to manage many of the clerical, administrative, and
accounting tasks traditionally carried out manually.

In order to determine the technical and organizational


Figure 1: Information flow diagram in a service system requirements which must be taken into account during
(adapted from Pinedo, 2008) the development of a web-based application for e-
appointment, Klischewski (2003) started by
2.2 Online appointment scheduling in conceptualizing the appointment-making process. He
found that three phases are required to make an
service industry appointment: information gathering, appointment
negotiation (core phase), and appointment confirmation
When the service consumer and the service provider / modification / cancellation. Then, he focused on the
interact through the Internet in order to schedule an
core phase and determined that the main challenges are
appointment, they do so using an e-appointment system. a detailed understanding of the current appointment-
Klischewski (2003) defines an e-appointment system making process of the organization seeking an e-
more formally as: “[…] an Internet-mediated agreement appointment system.
between two or more parties as social subjects (person
or institution) to interact at a certain time and place for a
ILS’2012 - August 26-29, 2012 - Quebec - Canada

Authors Factors / Issues


Tilly et al. (2002) Short-term cost; Long-term cost; Timing; Flexibility; Maintenance, Support staff; Return-on-
investment
Goldstein (2001) Emergencies; Repeat offenders; Down time; New customer; Connection to main management system

Klischewski (2003) Detailed understanding of the appointment-making process; Communication between distributed
software components; Organizational circum stances which support the e-appointment application

Silvestre et al. (2009) Infrastructure financing/ROI demonstration; Collaboration among large and small service providers;
Government role in sponsoring R&D
Javed et al. (2011) Multi-tenancy (Cloud computing); security
Douwe et al. (2009) Business process understanding; Secure communications; Organizational issues (e.g. misuse, staff
resilience); Regulatory issues (e.g. Channel delivery, privacy)

Table 1: Factors affecting e-appointment systems design

Silvestre et al. (2009) investigated consumer adoption of system. On the other, in a multi-tenant model, the
on-line health services (web-based appointment customer uses the same application to schedule
scheduling is one among other important online health appointments with different service providers. Several
services). They used a modified version of Davis’ service providers integrate a web portal. Their data are
technology acceptance model (TAM) (Davis, 1989). hosted in a single server but virtually partitioned. Javed
TAM is used to explain or predict the use of a system by et al. (2011) determined that multi-tenancy is critical for
assessing user motivation, which is directly influenced the development of efficient and convenient e-
by the actual system’s features and capabilities. User appointment systems that are widely adopted by service
motivation is reflected by two factors: perceived consumers and by service providers.
usefulness (degree to which a person believes that using
the new system will facilitate the completion of his Douwe et al. (2009) introduced the concept of “one-stop
tasks), and perceived ease of use (degree to which a e-appointment services” applied to government services.
person believes that using the system will be free of One-stop e-appointment services enable citizens to
effort). While TAM is a highly cited model, researchers schedule appointments for services offered by
however do not agree on its effectiveness (Chuttur, government from a single point, regardless of the
2009). Silvestre et al. added perceived system quality as agency offering such services. This concept addresses
another predictor of usage to the basic TAM. This similar problems to those investigated by Javed et al.
predictor applies to factors such as the speed, reliability, (2011) and where multi-tenancy was found to be a
and aesthetic appeal of innovations. The modified critical technological factor. Douwe et al. (2009)
model was applied to data obtained from an e-mail identified four critical factors: the need for clear
survey among members registered to use the web-site of understanding of the business process; the need to
a non-profit organization providing on-line health provide a technical infrastructure supporting secure
services. The authors determined that infrastructure communications between the one-stop government
financing, collaboration among small and large service portal and service providers; addressing organizational
providers, and government involvement are the critical issues ; and addressing regulatory issues.
factors for the adoption of online services in the health
care sector. 3 Comparative study of commercial
Javed et al. (2011) investigated the problems associated products
with different architectures of e-appointment systems
for the health sector. They compared the hosted client- There are several resources available on the Internet that
server (web-based application service provider) and the provide an abundance of directories of software reviews
Software as a Service (SaaS)-hosted architecture. The with products categorized by subject descriptors
former architecture follows a single-tenant model, while (Langford, 2010). Table 2 presents the main website
the latter follows a multi-tenant model. Multi-tenancy is giving such reviews, with the features compiled. For
a principle in software architecture where a single instance, Capterra (2010), a website for appointment
instance of the software runs on a server, serving and scheduling software reviews, summarizes the
multiple client organizations (tenants). It is known to be features of many different appointment scheduling
an essential attribute of cloud computing (Rimal et al., softwares available on the market. These features can be
2009). In a single tenant model, a person who would viewed as factors that influence the effectiveness of
like to schedule several appointments with different appointment software in responding to the specific
services providers would have to access different customer requirements. However, this site makes the
systems, remember each system’s password, and distinction between software for appointment
familiarize himself with each provider’s appointment scheduling and software for scheduling. While the
ILS’2012 - August 26-29, 2012 - Quebec - Canada

Authors Features
Appointment scheduling Requirements understanding; Online and offline versions of software; Pricing models; Support terms; Training
software on use of software; Upgrading the software ; Any refunds/money back in case of dissatisfaction; Free
appointment scheduling software options; Type of appointment scheduling software

www.capterra.com/ Custom User Interface; Customizable Fields; Customizable Functionality; Customizable Reporting; Data
appointment-scheduling- Import/Export; Legacy System Integration; Mobile Access; Multi-Currency ; Multi-Language; Reporting; Software
software Development Kit;

www.capterra.com/ Accounting Integration; Appointment Management; Attendance Management; Automated Scheduling;


scheduling-software Automatic Reminders; Calendar Management; Calendar Sync with Google; Class Scheduling; Client Website
Integration; Custom User Interface; Customizable Branding; Customizable Fields; Customizable Functionality;
Customizable Reporting; Data Import/Export; Digital Signage; Document Management; Document Templates;
Email Integration; Employee Database; Employee Scheduling; For Flight Schools; Group Scheduling; Helper
Applications; Hot Desking; Instant Messaging; Legacy System Integration; Meeting Room Booking; Mobile Access;
Multi-Currency; Multi-Language; Multi-Location Support; Online Payment Processing; Remote Access; Reporting;
Reservations Management; Resource Management; Room Booking; Room Control; Sales Reporting; Software
Development Kit; Sync with Microsoft Outlook; Task Management; Tentative Approval; Time Clock Integration;
Time Zone Converter; Travel Management; Videoconference Syncing; Webex Integration

Table 2: Examples of characteristics included in software reviews

former is specialized in scheduling periods between These features work well, which is why they have
service providers and clients, the latter is defined as become somewhat redundant. However, some solutions
tool-oriented towards the automation of the scheduling offer even more features, functionality, and scalability
of events, employees, rooms and other resources within that make them suitable for enterprises on an
larger organizations. This may explain the large number international scale (large companies in different
of factors or features (in general, technical and industries). There are also websites that are specifically
functional integration features) that can be specified. designed for health care and government services. Table
Nevertheless, both categories of software offer 3 presents a comparison of some commercial e-
appointment scheduling functions. Another site, appointment solutions that are believed to be
Appointment scheduling software (2008), suggests a representative of the different categories of e-
buying guide. The factors underlined in this guide appointment solutions available on the market. We
provide general tips that link the requirements of the present three main categories: generic solutions,
organization seeking to purchase an appointment solutions for the health care industry and solutions for
scheduling software with the type of solutions available government services. This comparison was made on the
on the market. basis of the features claimed by many commercial e-
appointment solutions. Some cells are in grey when no
In fact, the market is filled with appointment scheduling information could be verified.
solutions for different business types, including medical
services, psychotherapists, personal trainers, skin care, In general, online appointment scheduling is offered as
accountants, personal services, photographers, pet a capability for customer self-scheduling (e.g. allowing
groomers, counseling, medical scheduling, customers to schedule and cancel their own
chiropractors, spas, church events, hairdressing and appointments using a secure login), automated
manicure salons, tutoring and education scheduling, day reminders/confirmation, staff scheduling (e.g. allowing
care and driving schools. Many solutions may be used at staff to view or change their schedule). Communications
academic institutions and universities for booking most commonly occur via the website that can be
academic advising sessions and testing, scheduling accessed using a personal computer. However other
study rooms, reserving athletic facilities and equipment, channels, such as e-mail, text messaging or automatic
and an assortment of other tasks. Most of the websites phone calls/voice messaging, are often available. Data
offer many of the same features that other e- exchanges can be secured, using encryption techniques
appointment solutions provide. It is hard to believe that such as SSL. Some solutions are available for
software providers could develop a specific solution for integration in the customer website and different
every specific market and still be profitable. In reality, customization possibilities are offered (text, colours,
however, software providers develop generic solutions photos, logos, layout styles, etc). Others provide the
that they might afterwards customize for specific service provider with analysis and reporting tools
business types. (including statistical, sales and loyalty) and with
marketing functionalities (e.g. e-mail marketing, user
satisfaction surveys, etc).
ILS’2012 - August 26-29, 2012 - Quebec - Canada

*SAAQclic is a government agency in the province of Quebec (Société de l’assurance automobile: www.saaq.gouv.qc.ca/saaqclik)

Table 3: Comparison of different commercial e-appointment solutions

Some solutions providers offer free, professional and In Table 3, we allocated a feature to an e-appointment
business versions of their e-appointment sites. They can solution if the provider of this solution claims it on his
be set on the available functionalities (e.g. maximum website or in any documentation available to the public.
number of appointments, limited staff and users, However, it is clear that the robustness or the level of
available access channels, limited analysis and reporting sophistication of the claimed feature can vary
tools). However, some solutions providers might offer significantly from one solution provider to another. For
sophisticated tools for managing customers (e.g. instance, the feature “Telephone monitoring” is marked
maintaining customer lists, payment information and for DayClips, ClickRDV and Bonjour-Santé solutions.
purchase history), managing staff (e.g. creating staff However, it varies significantly from one solution to
member profiles, assigning individual staff logins, another: all three solutions pretend to offer an automatic
maintaining individual schedules), or managing waiting way for synchronizing e-appointments with
lists. Some solutions might be more convenient for appointments made using the traditional way of making
mobile services where salesmen or tradesmen who need appointments (i.e. by fixed phone or in-person visits)
to travel to their customers’ sites in order to give the and thus maintains a master agenda, but only the last
requested services. Such solutions will include travel two offer a true calling center that can be operated in
management capabilities (e.g. for verifying customer parallel with making appointments via the Internet.
address, pinpointing it on a map and planning the
service provider route). From this comparison, it appears that in generic
solutions, appointment booking is conceived of as a
ILS’2012 - August 26-29, 2012 - Quebec - Canada

simple problem that involves matching of time of 2003). Other factors are related to security, such as
parties and handling negotiations as exceptions. This addressing secure systems and communications
conception is different in the solutions for the health (Douwe, 2009; Klischewski, 2003) and safeguarding
care industry, where appointment booking seems to be against misuse (Klischewski, 2003). These factors are
more complex: it is conceived of as an operations mainly to avoid unwanted access to the e-appointment
management issue where the scheduling problem is system information, attempts to fill the schedule with
subjected to constraints of different kinds. Some fake customers or multiple booking by unaware users,
solutions providers attempt to handle some issues that all leading to important losses of money. Although not
have been identified as key by some researchers, for present in the literature, we add three more factors,
instance, emergencies, no shows, repeated offenders which are: reliability of the system against repeated
(see the previous section). Regarding the solutions used failures, vendor support in case of failure and
in government services, which could be proprietary or knowledge of the existence of such systems.
not, it is hard to find public information. Our first
impression however is that the solutions are not very The economic aspects that interest service providers are
flexible from the service consumer perspective and are mainly related to how much money can be saved using
designed for a specific purpose, for a specific public such systems and how much money is needed to make
service. them work. In fact, these adoption factors are exactly
the same for the adoption of any technology. In more
4 Framework of adoption factors for precise words, the economic adoption factors are the
opportunities to save costs (Klischewski, 2003) and the
e-appointment solutions estimated return on investment (Klischewski, 2003;
Silvestre, 2009; Tillev, 2002). Silvestre et al. (2009)
Based on the review of existing e-appointment solutions mentioned government (financial) involvement in
and characteristics available, it appears that a service technological initiatives as an adoption factor. Other
provider have a high variety of possibilities to choose factors not cited in the literature would be the potential
from, more or less generic, more or less flexible, all to increase consumer satisfaction, related to
designed to increase quality of service and decrease improvement in quality of service, and increased
costs. However, as claimed before, few e-appointment productivity related to the reduction of time dedicated to
services are offered to the public, specifically in appointment scheduling labour.
Quebec. This reveals the existence of non-adoption
factors, explaining the low adoption of such technology As concerns the organizational aspects, Douwe (2009)
in services. mentioned organizational issues that need to be solved.
Klischewski (2003) proposed organizational
Following the literature review presented in Section 2, circumstances supporting e-appointment, such as
we propose a framework of factors affecting the openness to new technologies. Other factors are related
adoption of e-appointment solutions in public and to regulatory issues, such as privacy, in specific
private service industries (Figure 2). From the angle of industries (Douwe, 2009; Klischewski, 2003). Indeed,
adoption, two players are represented: the service information from appointments does not have the same
provider and the service customer (or user). Both privacy importance in all industries (e.g. health care vs.
players experience the appointment service in a different hairdressing). Klischewski also mentioned intra-
way. Thus, both present different factors affecting their organizational existing factors, such as pre and post-
use (or not use) of e-appointment services. Also, the appointment, and variety of appointment types.
different adoption factors can be categorized into three
general aspects: technological, economical and 4.2 Service customer domain
organizational/social aspects. This leads to a framework
of six different boxes. The service customer side is more concerned with the
relative advantage of making appointments online over
4.1 Service provider domain more traditional ways. For the technological aspects, we
refer to the TAM (Technology Acceptance Model),
On the service provider side, the main concern is proposed by Davis (1989). In this model, an important
technological. This is translated by different authors in aspect is the perceived ease of use for the user. This
different ways. Flexibility and control was proposed by perception is related to the presentation and the
Tilley (2002), as a way to permit a high degree of marketing surrounding the e-appointment service. Also,
adaptability of solutions. Other technological issues are Davis mentioned the importance of the training,
related to the fit with existing systems , such as documentation and support offered to the user, online
automated and connected to management systems (live or not) or offline. Later, Rogers (1995) proposed a
(Goldstein, 2001, Klischewski, 2003), availability of revised version of the TAM model, including the
technical infrastructure (Klischewski, 2003), perceived system quality, related to the perception by
organizational responsibility to support and operate the the client that the system will work well or not.
e-appointment system (Klischewski, 2003) and (Klischewski, 2003) added the perceived security about
standardized access to calendar data (Klischewski, who will use the appointment information and how.
ILS’2012 - August 26-29, 2012 - Quebec - Canada

Figure 2: Framework of factors affecting the adoption of e-appointment solutions

The economic aspects of service customers are mainly make available a large number of e-appointment
related to perceived usefulness, also derived from the systems, offered for different activity sectors and
TAM (Davis, 1989). Translated into the e-appointment presenting a variety of characteristics, they do not seem
context, the perception of usefulness is related to the to answer at this moment.
decrease in waiting time, effort and costs. For a
customer, the need to wait next to the phone or to go In order to offer a basis for the design of e-appointment
physically to a place (by car or by other means of system answering needs and permit the investigation of
transportation) involves effort and costs. Another way, e-appointment adoption by service organizations, this
not mentioned in literature, to favour the adoption of e- paper has presented an actual portrait of the commercial
appointment is to offer discounts or privileges to these solutions and their respective characteristics. Then,
customers. Privileges can be associated to reserved based on a literature review on general technology
period of service, only available to online booking. adoption and specific e-appointment adoption, we
proposed an adoption framework, dividing factors into
Finally, the social aspects of adoption for customers are service provider and service customer domains, and
related to their attitude towards new technologies and categorizing them in technological, economic and
their past experience with e-technologies (Davis, 1989). organizational/social aspects.
Also, Silvestre et al. (2009) mentioned the importance
of marketing activities carried out by the service From this point, different research initiatives should be
provider to propose the e-appointment service to the pursued. First, the adoption framework needs to be
public. validated with service organizations. Then, a
differentiation can be made between public and private
service organizations concerning the adoption factors.
5 Conclusion Also, other characteristics, not presented by vendors or
in the literature, can influence the adoption of the
Although e-appointment systems represent a promising technology: real-time feedback, degree of automation,
approach to increase quality of service and reduce costs resource adjustment, overbooking strategies, etc. These
for public and private service organizations, offers from must be investigated to understand their impact on the
service providers are few. Although solution vendors adoption model.
ILS’2012 - August 26-29, 2012 - Quebec - Canada

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