Can we start?

Good morning everybody, and thank you for your coming today.

I'd like to start by introducing myself, my name is wadha al breaiki , and I am working at Tawam hospital as a team leader for user support in IT department.

Today I am going to talk about polyclinic waiting time problems and its solutions.

I have chosen to speak about this topics because I am one of the patients who suffering from this problem and need immediately solution to resolve this problem from the roots.

I will speak for 20 minutes.

The presentation divided into 4 parts:

In the first part I will give you overview about the topic

In the next section I will show you the results of the study

In part three I am going to explain the current process and proposed process

And in the last part I will give you the recommendation and conclusion.

Now let us turn to the point one.

Tawam Hospital is one of the leading hospitals in the UAE. It was

formally opened on 17th December 1979. Johns Hopkins Medicine

International (JHMI) took over the management of Tawam hospital

In March 2006. The hospital in affiliation with Johns Hopkins Medicine

International, and is offering a high-quality healthcare; in a sociable and

sympathetic environment.

One of the most critical challenging of Tawam Hospital is patient waiting

time which defined as the length of time from entering the patient into the

outpatient clinic till the time when the patient actually received his or her

prescription.

Waiting time is One of the vital measurements for clinic’s efficiency.

Waiting time is defined as the time period that would take for a patient to

enter the clinic until leaving the clinic. In Tawam Hospital, Outpatient

Polyclinics are clinics that patients get treatments, follow-ups, and get a

diagnosis. Those clinics contain different clinics spread over a 3-floor-

bulding that contains 11 wings which can serve up to 200,000 patients’

visits per year

Inefficient staffing or poor organization may cause an extremely

waiting time. To reduce this problem we need real tools and organized

procedures addition to a strong budgeting.

For the real tools Tawam hospital implement one of the important system

over the world, Health Information System or (HIS) which is a system

focus on developing effective electronic patient health care through

qualified physicians, Nursing, laborites, pharmacist & administrative

services (Registers). See figure (1) However, this system does not serve

the patients only, it also helps the staff by linked them all together and

keep them updated 24 hours a day /7 days a week as shown

There are several benefits from using the HIS which can be

summarized in the following table (1).

Table 1. The benefit of using HIS

No

.

Benefits Details

1. Access The HIS Electronic Health Record is a

patient-centric record of care which will be

easily accessible to clinicians, 24 hours a

day, seven days a week.

Health records will be shared efficiently,

securely and confidentially between linked

Hospitals and PHCs.

Patient information will be stored and

updated electronically with important

safeguards to protect patient confidentiality.

2. Clinical Diagnostic results will be accessible to

clinicians faster than with paper-based

methods – via Inbox alerts and HIS Results

viewers.

No more handwriting headaches!  All

orders, notes and prescriptions will be on-

line and legible.

Reduced duplicate clinical testing as

Physicians will be alerted of duplicate test

entries in real-time.

More accurate clinical data will improve

reporting capabilities

3. Safety The care provided will be safer because vital

clinical information (current and historic)

regarding the patient’s diagnosis and

treatment (such as current medication,

details of previous operations, test results

and allergies) will be available to all

authorized clinicians.

Reduction of multiple (possibly conflicting)

records due to a single source of accurate

up-to-date patient information.

4. Patients Reduced “repeated” patient questioning

because of access to updated, current data.

3. Aims of research:

The main objectives of this Studying are to identify the factors and

reasons that affect waiting time and recommend solutions to reduce the

delay.

4. Methodology:

To achieve our goal, two questionnaires have been designed, one for the

patients to measure how much time they spent on it since they arrived to

the clinic till they leave it. The other questionnaire is for specialist

(physician, Nursing and register) to measure how the HIS helps them to

provide patients with high quality service as well as measure how

efficient their work, accurate and reliable. For the specialists I used two

ways to distribute the Survey, one way is by email them and the other

way is going to the concern clinic and distributes the survey. For the

patients I have selected 5 clinics in the polyclinic with the highest peak

which are Ob/Gyn, Pediatric, Medicine, Surgery and Orthopedic, and I

asked the help from their staff to record the time that each patient has

spent at each process since he/ she arrives to the clinic till he/ she leaves.

Moreover, to analysis these questionnaires I used excel to enter the data

and an SPSS program to make the analysis.

The result of the first questionnaire about the HIS program showed

that different medical and paramedical are satisfied with the program,

80% of the different specialist agreed that the health information

system provides them with the strong support to do their work in a

professional way. After reviewing the data collected from the sample,

we found that HIS is not the main reason of delaying patient waiting

in the clinics.

I have divided the results of the first questionnaire to the 3 groups,

each group contain 4 questions.

Questions 1 to 4 measure how the system is easy to use. As you see in

the figures, most of the participants (purple color) agreed that HIS

system is comfortable to use. In Q (1) about 75% said that the way in

which data come is suited with task they want to perform comparing

to 6% who disagreed. In Q (2) 86% agree with statement that said the

messages displayed by the software are easy to understand comparing

to 2% disagreed. In Q (3) 58% agree that It is easy to retrieve the

information about a certain entry field comparing to 10% who can't. in

Q(4) 52% agree with statement that said "It’s easy for me to move

back and front between different screens comparing to 12% disagreed.

Questions 5 to 8 measures the designed of the system, It can be

demonstrated from figure (8) that 50% of participants either agree or

strongly agree on the statement that clarify the HIS software is

designed in way that help employees to do their work in easy way,

while 2% are disagreed with them. According to the results shown in

figure (9), about 70% of participants either agree or strongly agree

with statement that describes that the employee can expect which

screen will come next comparing to 2% who can't. The results in

figure (10) shown that most of participants (66%) were neutral while

the rest agreed with this statement that “I can easily restore everything

to its previous state, if a mistake was made in completing a form.

Figure (11) showed that about 56% of the participants agreed that HIS

is easy to be adopted only 4% are disagreed with them.

Questions from 9 to 12 measures how the end users deal with system,

According to the results shown in figure (12), only 48% of

participants agree with statement that said “I am able to adjust the

amount of information (data, text, graphics, etc.) displayed on-screen

to my needs comparing to 8% disagreed. figure (13) shows that 80%

of participants either agree or strongly agree on the statement that the

software is easily to remember even if they stopped using it for long

times unlike 4% who disagree with them. The results in figure (14)

revealed that 72% respondents either agree or strongly agree on the

statement that describe the general opinion about the HIS program.

Furthermore, 30% of them were neutral and only 8% of the

participants was disagree.

In this slide I will show you the results of the second questionnaire

that designed for the patients to measure the time spend it since they

arrives the clinic till they leave it.

Distribution of patients by time interval from registration to be assessed

by Nurse was also recorded. Table (16) showed that 64% of patients

waited to be assessed for less than 30 minutes, 26% between 31to 60

minutes and 10% more than 60 minutes.

The waiting time from Nurse Assessment to physician consultation

ranged from 3minute (minimum) to 82 minutes (maximum). According to

the results shown in Table 17, about 56% of patients waited less than 30

minutes, 34% between 31 to 60 minutes, and 10 % more than 60 minutes.

The results in Fig. (15) show that only 2 % of the patient waited less than

30 minutes to get the required service. 18% waited between 31 to 60

minutes and 80% waited more than 60 minutes.

All the clinics in the polyclinic follow the same processes when the

patients arrive till they leave. To understand this whole process we took a

pediatric clinic as an example to help us to find how the process works,

where is the problem and what should we do to solve this problem from

its roots.

The Following chart shows in details the workflow for the patient visit in

the Pediatric clinic (Fig.17).

As you see in the flowchart the patient start the process by attending the

clinic, if he/ she uninsured he go direct to the registration if not he should

to go to the insurance office and cashier office then to the registration,

after that he do the assessment then see the doctor, if there is no

procedure the doctor provide the patients with follow up appointment in

some-case there are some procedures need to be done for the patients like

x-ray, the porter take him to the required place and the nurse or the

technician do the procedure then the results checked by the doctor.

This is a general procedures should every patients pass it when he visit

any clinics in the polyclinic.

One of the simple tools used to understand the problems is a process

mapping which refers to activities involved in defining exactly what a

business entity does, who is responsible, for what standard a process

should be completed and how the success of a business process can be

determined. In our case, we have sited this process map in order to

identify how many steps the patient is going through, where are the

Hands-off , what is the total time for the process, and the areas delays

where we can identify our bottleneck and try to manage it.

Our process mapping showed that the whole process for insured patients

takes around 138 minutes while uninsured patients take around 116

minutes, so the difference between them is 22 minutes.

Therefore we can divide the whole process into two categories, (task time

and wait time). Task time is the time that the patients get the service

during his/ her visit to the clinic. In our case the total of the task time for

uninsured patient is 57 minutes and for an insured patient is 79

Waiting time is the time that the patient spends before takes the required

services, it starts when the patient arrives at the clinic regardless of the

appointment time.

Table (19) showed the approximately time that the patient is waiting in

the queue before taking the required service.

From above we can notice that the waiting time is approximately equal to

the task time, by going back to the mapping process it is obvious that the

waiting time for consultation was the longer than the waiting time by 34

minutes, to know the reasons, we have asked some of our samples

elements why the patient s have to wait for a long time to be consulted,

then we can summarize the answers in the following points:

The consultant did not arrive on time.

The physician is busy with inpatient rounds and consultation at the

hospital

Staff shortage (he/ she the only one available in his/ her specialty).

According to the results of this study, we suggest 4- step solutions to

resolve this problem from the roots,

8.1. Stakeholders:

First of all we have to define the stakeholders who are involved in this

operation and affect the whole process and activities, table (20) describes

the main stakeholders in the polyclinic and we set them according to their

importance.

Table 20. Stakeholders of the Polyclinic

No

.

Stakeholders Description

1. Patient Is the target of the hospital; Tawam hospital mission,

vision and value focus on the patient's satisfaction.

Mission:

To provide a continuum of quality health care which

meets the needs and expectations of the UAE

population and the surrounding GCC countries."

"Vision:

Tawam Hospital believes in treating all Patients,

Visitors and Employees with Respect, Dignity and

Equality, guided by UAE laws and respect for

patients' rights."

"Values:

Tawam Hospital will provide high quality, affordable

medical services delivered in a friendly, safe and

caring environment which meet JCIA Standards of

Care."

From above we conclude that patient satisfaction is

very important and necessary in measuring the

efficiency of health care delivery.

2. Nursing and

registration

staff

We can call them the unknown soldiers; polyclinic is

run and managed by them. They are the first line

soldiers who receive patients, implement policies and

ensure that process runs as planned.

3. Physicians Is the health care provider, without their support, the

hospital will not succeed in solving the problem of

waiting time.

4. Nurse

Manager

Urges and coordinates staff to make sure that efficient

nursing services are provided, and quality standards

are met.

5. Patient

Affairs

He deals mainly with patient services and complaints.

All patients concerns are conveyed to him through a

Manager built up system.

6. Hospital

CEO:

Provide full support to any idea comply with the

mission, vision and value and serve to solve the

problem of the delay as the hospital mission is patient

focused.

7. Porter Porters are needed when the patient need to move

from one place to another especially if there is a

procedure required such as X-ray, and so on.

8.2. Re-Design of the current process:

To achieve our target and solve this problem we have to redesign the

process in a way that matches our capacity with demand and eliminate the

wasteful steps.

The Following flow-chart is the proposal workflow for the new design of

the pediatric clinic (Fig.19).

The international standard of patient said that the patient should be seen

within 30 minutes upon their arrival, by implement this standard in our

case we can achieve the following:

Reducing the time form insurance verification to cashier from 13

minutes to 5 minutes,

Reducing the waiting time of registration to nurse assessment from

14 minutes to 5 minutes.

Reducing the waiting time from nurse assessment to physician's

consultation from 34.5 minutes to 15 minutes.

Cutting of unnecessary steps by joining the cashier and the claim

officer this will decrease the number of steps for the uninsured

patients by 1.

The following 4 groups in Table (21) are defined as the main reasons for

the problem and each group contains underlying factors lead to the

problem.

No. Groups Factors

1. Patients a. The patients not show up on time,

they attending late or early for their

appointments.

b. Increased number of overbooked.

c. Increased number of patients who

come as a walk in, either to refill their

medication prescription, or they

missed their appointment.

2. Staff d. Shortage of staff

e. The late arrival of the doctors to the

clinic due to some important issue

such as calling them for emergency

cases.

3. Administration

f. Interruption of clinics by the VIP

patients’ visits that necessitate the use

of the examination room.

4. Resources g. Shortage of staff: we have two

registers records around 100 patients

in one day.

h. Lack of specialized clinics

. Recommendation:

Our recommendation is based on the results of the research and we can

summarize them in the following points.

Decrease the waiting time between claim and cashier by joining

them into one office, and make them as one step rather than of 2

steps.

Decrease the waiting time between nursing assessment and

physician by making sure that the doctor arrives on time and force

them by setting policy, monitor their attendance and report it to the

top management.

Decrease the numbers of overbooks by expanding the clinic and

increases the numbers of physicians.

Decrease the numbers of walk-in by adhering to the written policy;

develop a system for refill of prescriptions and by educating

patients.

Reduce the interruption of physicians by not transferring telephone

inquiries.

Control patient’s arrival by adhering to the written policy related to

the registration and scheduling.

Make the patients busy during the waiting time by providing them

some activities.

Maintain a good customer services practice such as notify patients

about the accurate estimate of waiting time and apologize for any

delay.

10. Conclusion: In conclusion I would like to say that

We can conclude from all above that process mapping is exciting and a

simple toll to solve the problem based on the perceptions of patients and

staff. This tool helped us to identify the major bottleneck and find out

which areas that need improvement. It focuses directly on providing high

quality service to the patients in a short time.

Thank you very much for your attention and If there are any questions please feel free to ask.