Ninda Nurseha Amalina

Ninda Nurseha Amalina, Heungjo An

Patient no-shows disrupt outpatient clinic operations, reduce productivity, and may delay necessary care. Clinics often adopt overbooking or double-booking to mitigate these effects. However, poorly calibrated policies can increase congestion and waiting times. Most existing methods rely on fixed heuristics and fail to adapt to real-time scheduling conditions or patient-specific no-show risk. To address these limitations, we propose an adaptive outpatient double-booking framework that integrates individualized no-show prediction with multi-objective reinforcement learning. The scheduling problem is formulated as a Markov decision process, and patient-level no-show probabilities estimated by a Multi-Head Attention Soft Random Forest model are incorporated in the reinforcement learning state. We develop a Multi-Policy Proximal Policy Optimization method equipped with a Multi-Policy Co-Evolution Mechanism. Under this mechanism, we propose a novel τ rule based on Kullback-Leibler divergence that enables selective knowledge transfer among behaviorally similar policies, improving convergence and expanding the diversity of trade-offs. In addition, SHapley Additive exPlanations is used to interpret both the predicted no-show risk and the agent's scheduling decisions. The proposed framework determines when to single-book, double-book, or reject appointment requests, providing a dynamic and data-driven alternative to conventional outpatient scheduling policies.

Ninda Nurseha Amalina, Kwadwo Boateng Ofori-Amanfo, Heungjo An

Unattended scheduled appointments, defined as patient no-shows, adversely affect both healthcare providers and patients' health, disrupting the continuity of care, operational efficiency, and the efficient allocation of medical resources. Accurate predictive modelling is needed to reduce the impact of no-shows. Although machine learning methods, such as logistic regression, random forest models, and decision trees, are widely used in predicting patient no-shows, they often rely on hard decision splits and static feature importance, limiting their adaptability to specific or complex patient behaviors. To address this limitation, we propose a new hybrid Multi-Head Attention Soft Random Forest (MHASRF) model that integrates attention mechanisms into a random forest model using probabilistic soft splitting instead of hard splitting. The MHASRF model assigns attention weights differently across the trees, enabling attention on specific patient behaviors. The model exhibited 93.56% accuracy, 93.67% precision, 93.56% recall, and a 93.59% F1 score, surpassing the performance of decision tree, logistic regression, random forest, and naive Bayes models. Furthermore, MHASRF was able to identify key predictors of patient no-shows using two levels of feature importance (tree level and attention mechanism level), offering deeper insights into patient no-show predictors. The proposed model is a robust, adaptable, and interpretable method for predicting patient no-shows that will help healthcare providers in optimizing resources.