Opinions and Suggestions on Reducing Waiting Time for Outpatient Patients at Mosh Accord Hospital

Abstract

Background: This article addresses the issue of longer patient waiting time in the outpatient department (OPD) of a super specialty hospital. Due to longer waiting times at OPD, patients had to suffer and their treatment was getting delayed. This problem was solved with the Lean Six Sigma (LSS) method. The entire process, from patient registration todrug delivery, is included in the project. In the process, steps that do not create added value are determined and implemented. This process improvement study looked at shortening the patient waiting time between registration and outpatient department at Accord hospital Moshi. The mean waiting time was calculated in OPD for various departments from the survey collected. The patients were dissatisfied with only one bus provided which can be improved by increasing the number of vans. The registration department has the mentioned giving priority to the Appointment patients and hence the Walk - in patients have to wait case registration hence online appointments can be implemented and the number of staffs can be increased by providing proper training about the administration. The patients were satisfied in diagnosis and pharmacy departments with the services provided to them. The delay in billing department is because time taken to get the lab reports which can be reduced by increasing the number of staffs in the laboratory and radiology department. Overall, 62% of the patients were satisfied with the services provided by the hospital. Patients attending each hospital are responsible for spreading the good image of the hospital and therefore satisfaction of patients attending the hospital is equally important for hospital management. Various studies about outpatient service have elicited problems like overcrowding, delay in consultation, proper behavior of the staff etc. The study reveals the average spend by the patients and also expresses their view towards the hospital and hospital’s services provided by the hospital and the total consumed on each activity. In this study, it was found patients constitute of all age groups and genders among which most of them were females. Study depicts that average no. of patients coming to OPD each day as walk - in is more in comparison to the appointment patients. Administrative staffs are quite concerned towards the patient’s expectation. They serve the suggestion box for patients and make sure to respond to the suggestion satisfactorily. Queuing method is followed for reducing waiting time in OPD. Study depicts that OPD always starts on time and the doctors mostly comes on time. Patients also come on scheduled appointment time sometimes getting delayed. Since Reception center being the primary bottleneck of the system, by increasing another server here, the system may be made to work in steady state. The possibility of clubbing function of Reception center with the registration may also be explored since this could cut down one additional node and a total process time of 10 minutes approximately for each patient. However, it was evidently proved through the simulations that having a single refraction chamber with 8 or even 6 technicians, the hospital could reduce waiting time up to 25 percent, as well as better utilization of resources. Advanced simulations using simulators would help the administrators to visually see what happens when we change the resources in the system. In healthcare Queue modeling can be applied in the areas wherever queue is involved such as rationing, scheduling, Bed allocation, laboratory design, and so on. Aim: Patient waiting time for healthcare services is identified by the World Health Organization (WHO) as one of the key measurements of a responsive health system. Patient waiting time is the amount of time for patients seeking care at healthcare units before being attended for consultation and treatment. It is globally agreed that a well - designed healthcare service management system should not have patients to wait long time for appointment and consultation. Lengthy waiting time has long been considered frustrating to patients and thus appears to be a consistent and significant potential cause of patient dissatisfaction. A strong inverse relationship between patient satisfaction and waiting time has been demonstrated by many studies [5–10]. As healthcare solutions become more personalized and consumer driven, the need to provide overall patient satisfaction is becoming more important. The project is to quantify the waiting time and identify the factors associated with waiting time for services offered at the general outpatient department in order to find with evidenced based solutions of solving the problem of long waiting time. Subjects and methods: Data Collection Methods: The data will be collected using both by primary data collection methods as well as secondary sources. Primary Data: Most of the information will be gathered through primary sources. The methods that will be used to collect primary data are: Questionnaire, Interview. Secondary Data: Secondary data will be collected through: Text Books, Magazines, Journals, Websites. Method Used to Present Data: Data Analysis & Interpretation – Classification & tabulation transforms the raw data collected through questionnaire in to useful information by organizing and compiling the bits of data contained in each questionnaire i. e., observation and responses are converted in to understandable and orderly statistics are used to organize and analyze the data: Simple tabulation of data using tally marks. Calculating the percentage of the responses. Formula used = (name of responses / total responses) * 100. Graphical analysis: By means of pie charts bar graphs etc. Number of Respondents: Total samples of 110 respondents will contact who respond to the questionnaires. Sampling Technique: The technique will be used for conducting the study will convenience sampling technique as sample of respondents will be chosen according to convenience. Statistical Tools: The tools used in this study will MS - EXCEL, MS - WORD. MS - EXCEL use to prepare pie charts and graphs. MS - WORD was used to prepare or write the whole project research. A cross - sectional, observational study conducted at Accord Hospital Moshi from 24th April 2023 to 24th may 2023 for the period of 1 month, A total 110 patients enrolled for study purpose include those patients who seeking the treatment from various Outdoor Patients Departments running in this hospital.15 Patients randomlyselected fromeach of nine OPDswithfollowinginclusionandexclusion criteria. Inclusioncriteria: Allageandbothsex of patients attending various outpatients’ departments(OPDs). Forpediatricpatient responsewasnotedfrom attendant. Exclusion criteria: Those patients seeking emergency Medical Services, those who refuse to participate, Medical Students and Hospital Staff. Population and Sample Design: We have taken a full month data from the system that consists of a mix of all hospital cases for the month. In this study patient’s evaluationwasstartedwhilepresenting at hospitaldispensary. Eachpatientwasrandomlyselectedwithinclusionandexclusioncriteria. Thepurpose of thestudywasexplained to eachparticipantbeforeinterviewing. Clinicaldatafromeachpatientwill be recorded to identifythetype OPDs. Datawascollected in perform, pretested Performa containing patient's demographic details like patient's name, age, sex, address. Other part of the Performa contained which OPD they visited, time spent in searching the OPD, time spent for investigation, waiting time at OPD, time spent at dispensary and inquired whether he/she is satisfied with hospital staff and health care services available in this institute.15 patients randomly selected from each of nine OPDs. Total 110 patients were interviewed. Datawasenteredandanalyzedwiththehelp of MS Excel- 2008 and an appropriate statistical test wasappliedwhenneeded. Theresearchdesign of this project is Descriptive which is a type of research that focuses on providing an accurate description of the variables in the problem model. Theprimary dataarethosewhicharecollected as freshandforthefirsttimeandthushappen to be original in character. Forthisstudydata is collected throughobservation method. The secondary data are those which are collected by and readily available from other sources like journals, reports, website, newspaper, magazine, books, etc. Results: The study entitled - “A RECOMMENDATION ON REDUCING WAITING TIME IN THE OUT - PATIENT DEPARTMENT AT
ACCORDHOSPITALMOSHI” wasundertakenwithmainobjectives to deminetheflow of patientandaveragetimespent in the OPD, to identify thefactors thoseareresponsible forhighwaitingtimeand to recommendappropriatesuggestions to optimize thewaiting in OPD. Thestudy is conducted in a 150 bedded multi - specialty hospital at Moshi. This esteemed institute is well knownfor its multitude of services. Thehospital is equipped withal moderntechnologies and renderingexcellentservices at an affordablecost. Analysis of datawasdonethroughtablesandgraphsshowingthenumber of respondentsandtheirrespective percentageandpercentagebardiagramswereusedfortheinterpretation of the results. Theresult showsthataverage no. of patients coming to OPDeachday as walk in (100 - 150) is more in comparisons to the appointment patients (20 - 30) approx. The study shows that the waiting time spent by the patients in reception for registration is much less in case of maximum no. of patients compared to lesser no. of patients whose waiting time exceeds more than 30 min. This represents the efficiency of the registration process in the OPD. Study depicts that the average waiting time spent in OPD for consultation is around 30 minandtimetakenduringconsultation is 20 - 30min which states that OPD of the hospital functions satisfactorily. It is found that the time consumedduring investigation viz, radiology is more maximum no. of patients is dissatisfied with the functions of the Radiology department. Patients had to wait for long to collect thereports. Studyrevealedthatbillingand cashpaymentconsumes 25 - 30 minwhichitselfserves as dissatisfaction forthepatients. Collection of reports consumes least time i. e., 10 - 15min. The study shows that maximum no. of patients are satisfied with the punctuality of the staffs in attending to their needs. Administrative staffs are quite concerned towards the patients’ expectation. They serve the suggestion box for patients and make sure to respond to the suggestion satisfactorily. Queuing method is followed for reducing waiting time in OPD. Studydepicts that OPDalways starts on time and the doctors mostly comes on time Patients also come on scheduled appointment time sometime getting delayed. Preference for consultation is always given to the appointment patients andrecords of thearrival, departureand waiting time of patients is maintained. Identifytheresult onthebasis ofobservational studyandcountingthe realtimeat OPDanddataanalysisdone bytotal no.ofminutesdivided bytotal no. ofpatientsobservationthancalculatethe OPDwaitingtimeandconsultation time. OPD Waiting Time: Total no. of Minutes: 1103 Minutes. Total no. of patients: 100. Consultation Time: Total no. of Minutes: 1189 Minutes. Total no. of patients: 100. Calculation: Average OPDWaitingtime: 1103/100= 11.03 minutes. Average Consultationtime: 1189/100 = 11.89minutes. Suggestion and Recommendations: Patient satisfaction assessment should be conductedregularly. In OPDs, complaint andsuggestion box should be kept, so that patients can freely put their complaints and suggestions. Number of counters and staffs in pharmacy must be increased to avoid long waiting time for the patients. Number of staffs should be increased in the depts., with large no. of patients. Number of registration counters should be increased because during the peak hours it may result in the negative image of the hospital in themind of the patients. Thewaiting area should be more spacious. Hospital should give separate outpatient feedback form. Regarding the design of the OPD, the registration counter and enquiry desk should be open and near to the entrance of OPD and emergency dep., all the diagnostic dept. should be near to the consultancy rooms. Divide the whole OPD into two sections, one for the Surgical OPDs and anotherfortheother OPDsalongwithseparatenursestations. It helpspatients to findtheirwaymoreeasilywithoutanyconfusion. Hospitalauthoritiesshould appoint more qualified and senior staff in OPD. Parking of vehicles should be free of cost for the patients and their attainders. A help desk facility should be provided nearby the registration counter for thepatient’s convenience in finding OPDs. Signboard directing various OPDs and other departments should be in local language, located at properlyvisible sites or create somecolor- codingmethodforeasyaccess of OPDs. Allocating juniordoctors in OPDswithsenior Doctors’re - planned the doctor's schedule for the day. Instead of visiting the ward first in the morning, doctor visits the ward once the crowd in the OPD is reduced. Allocating juniordoctors in OPDs with seniordoctors where there is ahuge crowd. Allocating junior doctors in OPDswithseniordoctorswhere the doctors require more time for consulting. Conclusions: This process improvement study looked at shortening the patient waiting time between registration and outpatient department at Accord hospital Moshi. The mean waiting time was calculated in OPD for various departments from the survey collected. The patientsweredissatisfied withonlyonebusprovidedwhichcan be improved by increasingthenumber of vans. Theregistrationdepartmenthasthementioned giving priority to the Appointmentpatients andhencethe Walk- in patientshave to waitcase registration henceonlineappointmentscan be implemented and the number of staffs can be increased by providing proper training about the administration. The patients were satisfied in diagnosis and pharmacy departmentswiththeservicesprovided to them. Thedelay in billing department is becausetimetaken to get the lab reports whichcan be reduced by increasing thenumber of staffs in the laboratoryand radiology department. Overall, 62% of thepatients were satisfied with the services provided by the hospital. Patients attending each hospital are responsible for spreading the good image of the hospital and therefore satisfaction of patients attending the hospital is equally important for hospital management. Various studies about outpatient service have elicited problems like overcrowding, delay in consultation, proper behavior of the staff etc. The study reveals the average spend by the patients and also expresses their view towards the hospital and hospital’s services provided by the hospital and the total consumed on each activity. In this study, it was foundpatients constitute of all agegroupsandgendersamong which most of them were females. Study depicts that average no. of patients coming to OPD each day as walk - in is more in comparison to the appointment patients. Administrative staffsarequiteconcernedtowardsthepatient’sexpectation. Theyservethesuggestion box forpatientsandmakesure to respond to thesuggestionsatisfactorily. Queuing method is followed for reducing waiting time in OPD. Study depicts that OPD always starts on time and the doctors mostly comes on time. Patients also come on scheduledappointmenttimesometimesgettingdelayed. Since Receptioncenterbeingtheprimarybottleneck of thesystem, by increasinganother server here, the systemmay be made to work in steady state. Thepossibility of clubbing function of Reception center with the registration mayalso be explored since this could cutdownoneadditionalnodeandatotalprocesstime of 10 minutesapproximatelyforeachpatient. However, it wasevidentlyproved through the simulations that having a single refraction chamber with 8 or even 6 technicians, the hospital could reducewaiting time up to 25 percent, as well as better utilization of resources. Advanced simulations using simulators would help the administrators to visually see whathappens when we change the resources in the system. In healthcare Queue modeling can be applied in the areas wherever queue is involved such as rationing, scheduling, Bed allocation, laboratory design, and so on.