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  • 1. Can we start?Good morning everybody, and thank you for your coming today.Id like to start by introducing myself, my name is wadha al breaiki , and Iam working at Tawam hospital as a team leader for user support in ITdepartment.Today I am going to talk about polyclinic waiting time problems and itssolutions.I have chosen to speak about this topics because I am one of the patientswho suffering from this problem and need immediately solution toresolve 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 topicIn the next section I will show you the results of the studyIn part three I am going to explain the current process and proposedprocessAnd 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 wasformally opened on 17th December 1979. Johns Hopkins MedicineInternational (JHMI) took over the management of Tawam hospitalIn March 2006. The hospital in affiliation with Johns Hopkins MedicineInternational, and is offering a high-quality healthcare; in a sociable andsympathetic environment.
  • 2. One of the most critical challenging of Tawam Hospital is patient waitingtime which defined as the length of time from entering the patient into theoutpatient clinic till the time when the patient actually received his or herprescription.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 toenter the clinic until leaving the clinic. In Tawam Hospital, OutpatientPolyclinics are clinics that patients get treatments, follow-ups, and get adiagnosis. 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 yearInefficient staffing or poor organization may cause an extremelywaiting time. To reduce this problem we need real tools and organizedprocedures addition to a strong budgeting.For the real tools Tawam hospital implement one of the important systemover the world, Health Information System or (HIS) which is a systemfocus on developing effective electronic patient health care throughqualified physicians, Nursing, laborites, pharmacist & administrativeservices (Registers). See figure (1) However, this system does not serve
  • 3. the patients only, it also helps the staff by linked them all together andkeep them updated 24 hours a day /7 days a week as shownThere are several benefits from using the HIS which can besummarized in the following table (1).Table 1. The benefit of using HISNo. Benefits Details1. 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
  • 4. 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 capabilities3. Safety The care provided will be safer because vital clinical information (current and historic) regarding the patient’s diagnosis and
  • 5. 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 andreasons that affect waiting time and recommend solutions to reduce thedelay.4. Methodology:To achieve our goal, two questionnaires have been designed, one for thepatients to measure how much time they spent on it since they arrived tothe clinic till they leave it. The other questionnaire is for specialist
  • 6. (physician, Nursing and register) to measure how the HIS helps them toprovide patients with high quality service as well as measure howefficient their work, accurate and reliable. For the specialists I used twoways to distribute the Survey, one way is by email them and the otherway is going to the concern clinic and distributes the survey. For thepatients I have selected 5 clinics in the polyclinic with the highest peakwhich are Ob/Gyn, Pediatric, Medicine, Surgery and Orthopedic, and Iasked the help from their staff to record the time that each patient hasspent 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 dataand an SPSS program to make the analysis.The result of the first questionnaire about the HIS program showedthat different medical and paramedical are satisfied with the program,80% of the different specialist agreed that the health informationsystem provides them with the strong support to do their work in aprofessional way. After reviewing the data collected from the sample,we found that HIS is not the main reason of delaying patient waitingin the clinics.I have divided the results of the first questionnaire to the 3 groups,each group contain 4 questions.
  • 7. Questions 1 to 4 measure how the system is easy to use. As you see inthe figures, most of the participants (purple color) agreed that HISsystem is comfortable to use. In Q (1) about 75% said that the way inwhich data come is suited with task they want to perform comparingto 6% who disagreed. In Q (2) 86% agree with statement that said themessages displayed by the software are easy to understand comparingto 2% disagreed. In Q (3) 58% agree that It is easy to retrieve theinformation about a certain entry field comparing to 10% who cant. inQ(4) 52% agree with statement that said "It’s easy for me to moveback and front between different screens comparing to 12% disagreed.Questions 5 to 8 measures the designed of the system, It can bedemonstrated from figure (8) that 50% of participants either agree orstrongly agree on the statement that clarify the HIS software isdesigned in way that help employees to do their work in easy way,while 2% are disagreed with them. According to the results shown infigure (9), about 70% of participants either agree or strongly agreewith statement that describes that the employee can expect whichscreen will come next comparing to 2% who cant. The results infigure (10) shown that most of participants (66%) were neutral whilethe rest agreed with this statement that “I can easily restore everythingto its previous state, if a mistake was made in completing a form.
  • 8. Figure (11) showed that about 56% of the participants agreed that HISis 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% ofparticipants agree with statement that said “I am able to adjust theamount of information (data, text, graphics, etc.) displayed on-screento my needs comparing to 8% disagreed.figure (13) shows that 80%of participants either agree or strongly agree on the statement that thesoftware is easily to remember even if they stopped using it for longtimes unlike 4% who disagree with them. The results in figure (14)revealed that 72% respondents either agree or strongly agree on thestatement that describe the general opinion about the HIS program.Furthermore, 30% of them were neutral and only 8% of theparticipants was disagree.In this slide I will show you the results of the second questionnairethat designed for the patients to measure the time spend it since theyarrives the clinic till they leave it.Distribution of patients by time interval from registration to be assessedby Nurse was also recorded. Table (16) showed that 64% of patients
  • 9. waited to be assessed for less than 30 minutes, 26% between 31to 60minutes and 10% more than 60 minutes.The waiting time from Nurse Assessment to physician consultationranged from 3minute (minimum) to 82 minutes (maximum). According tothe results shown in Table 17, about 56% of patients waited less than 30minutes, 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 than30 minutes to get the required service. 18% waited between 31 to 60minutes and 80% waited more than 60 minutes.All the clinics in the polyclinic follow the same processes when thepatients arrive till they leave. To understand this whole process we took apediatric 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 fromits roots.The Following chart shows in details the workflow for the patient visit inthe Pediatric clinic (Fig.17).As you see in the flowchart the patient start the process by attending theclinic, if he/ she uninsured he go direct to the registration if not he shouldto 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
  • 10. procedure the doctor provide the patients with follow up appointment insome-case there are some procedures need to be done for the patients likex-ray, the porter take him to the required place and the nurse or thetechnician do the procedure then the results checked by the doctor.This is a general procedures should every patients pass it when he visitany clinics in the polyclinic.One of the simple tools used to understand the problems is a processmapping which refers to activities involved in defining exactly what abusiness entity does, who is responsible, for what standard a processshould be completed and how the success of a business process can bedetermined. In our case, we have sited this process map in order toidentify how many steps the patient is going through, where are theHands-off , what is the total time for the process, and the areas delayswhere we can identify our bottleneck and try to manage it.Our process mapping showed that the whole process for insured patientstakes around 138 minutes while uninsured patients take around 116minutes, so the difference between them is 22 minutes.Therefore we can divide the whole process into two categories, (task timeand wait time). Task time is the time that the patients get the service
  • 11. during his/ her visit to the clinic. In our case the total of the task time foruninsured patient is 57 minutes and for an insured patient is 79Waiting time is the time that the patient spends before takes the requiredservices, it starts when the patient arrives at the clinic regardless of theappointment time.Table (19) showed the approximately time that the patient is waiting inthe queue before taking the required service.From above we can notice that the waiting time is approximately equal tothe task time, by going back to the mapping process it is obvious that thewaiting time for consultation was the longer than the waiting time by 34minutes, to know the reasons, we have asked some of our sampleselements 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).
  • 12. According to the results of this study, we suggest 4- step solutions toresolve this problem from the roots,8.1. Stakeholders:First of all we have to define the stakeholders who are involved in thisoperation and affect the whole process and activities, table (20) describesthe main stakeholders in the polyclinic and we set them according to theirimportance.Table 20. Stakeholders of the PolyclinicNo Stakeholders Description.1. Patient Is the target of the hospital; Tawam hospital mission, vision and value focus on the patients 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
  • 13. 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 We can call them the unknown soldiers; polyclinic is registration run and managed by them. They are the first line staff 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 Urges and coordinates staff to make sure that efficient
  • 14. Manager nursing services are provided, and quality standards are met.5. Patient He deals mainly with patient services and complaints. Affairs All patients concerns are conveyed to him through a Manager built up system.6. Hospital Provide full support to any idea comply with the CEO: 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.
  • 15. 8.2. Re-Design of the current process:To achieve our target and solve this problem we have to redesign theprocess in a way that matches our capacity with demand and eliminate thewasteful steps.The Following flow-chart is the proposal workflow for the new design ofthe pediatric clinic (Fig.19).The international standard of patient said that the patient should be seenwithin 30 minutes upon their arrival, by implement this standard in ourcase 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 physicians 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.
  • 16. The following 4 groups in Table (21) are defined as the main reasons forthe problem and each group contains underlying factors lead to theproblem.No. Groups Factors1. 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
  • 17. 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 cansummarize them in the following points.
  • 18. Decrease the waiting time between claim and cashier by joiningthem into one office, and make them as one step rather than of 2steps.Decrease the waiting time between nursing assessment andphysician by making sure that the doctor arrives on time and forcethem by setting policy, monitor their attendance and report it to thetop management.Decrease the numbers of overbooks by expanding the clinic andincreases 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 educatingpatients.Reduce the interruption of physicians by not transferring telephoneinquiries.Control patient’s arrival by adhering to the written policy related tothe registration and scheduling.Make the patients busy during the waiting time by providing themsome activities.
  • 19. 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 thatWe can conclude from all above that process mapping is exciting and asimple toll to solve the problem based on the perceptions of patients andstaff. This tool helped us to identify the major bottleneck and find outwhich areas that need improvement. It focuses directly on providing highquality service to the patients in a short time.Thank you very much for your attention and If there are any questionsplease feel free to ask.