1. ABSTRACT
 This paper examined the queuing system at the consultation rooms and surgical units of The
Aga Khan University Hospital. Departments use single as well as multiple channels depending
upon the inflow of patients. Data on the number of patients entering into each surgical
department and the corresponding service times taken were recorded and analyzed. It was
found that by using all the 11 (instead of 8) consultation room the average waiting time
becomes almost zero. The paper also established the efficiency of patients service and
concluded that it would be advisable to employ more surgeons for the economical and efficient
working of the hospital.
INTRODUCTION OF AGA KHAN UNIVERSITY HOSPITAL
 The Aga Khan Hospital Nairobi (AKH, N) was established in the year 1958. In July 2003, Aga Khan
University Hospital(AKUH, N) became the first hospital in East Africa to be awarded the
prestigious ISO 9001:2000 by the International Organization for Standardization.
 AKUH, N is a premier provider of ambulatory care and quality inpatient services, including
critical care. The AKUH, N is a private, not-for-profit institution committed to making high caliber
healthcare and medical education accessible to all. It has a patient welfare program that offers
financial assistance to uninsured and low-income patients who would otherwise be unable to
afford the medical they require.
 AKUH-N has been expanded in recent years, including increases in the number of beds. The
simultaneous expansion of ambulatory services and day care allows for the provision of more
cost-effective care. Programs for the development of clinical specialities, including cardiology,
oncology, paediatrics, orthopaedics, and traumatology, are increasing the range of secondary
and tertiary services which these hospitals are able to offer their patients. The expansion
programs emphasise the introduction of new diagnostic services, which will improve the
function of the hospital as a referral center
SURGICAL CARE IN KENYA WITH REFERENCE TO GLOBALIZATION
 Patients are seeking facilities that use low labor costs to gain competitive advantage in the
marketplace. Proponents of medical tourism argue that a global market in health services will
promote consumer choice, foster competition among hospitals, and enable customers to
purchase high-quality care at medical facilities around the world.
 Economics effectively calibrates the rise of medical tourism. For instance, A hole in the heart
operation in the US may cost around $70,000, the operation in Bangalore, India would cost
$4400. Open heart surgery may cost about $70,000 in Britain and up to $150,000 in the United

2. States, but in India’s best hospitals it costs between $3000 and $10,000 depending on how
complicated it is.
 Distance offers anonymity. Some medical procedures, such as sex changes, have become small
but significant parts of medical tourism, especially in Thailand
 Distance also offers alternatives. Certain operations may not be available in origin countries.
 Kenya in particular offers a variant final form of “transnational retirement”. The establishment
of overseas nursing homes, where patients effectively stay permanently were converted hotels,
as the tourism market declines, have been turned into homes for east African Asians, retiring
and returning from the UK, or for Japanese in Thailand and the Philippines.
 As per the records available in the year 2002, Kenya spent 5.1% of its gross domestic product on
health care. This was well below the high-income OECD (Organization for Economic Cooperation
and Development) countries’ average of 9.8% for the same period.
 Generally, the Central Province and Nairobi are deemed to have the best facilities where as the
North Eastern Province is found to be the most under developed.
 Among the Kenyans who are ill and do not choose to seek care, 44% were hindered by cost.
Another 18% were hindered by the long distance to the nearest heath facility.
 The under- financing of the heath sector has reduced its ability to ensure an adequate level of
heath care for the population. Thus, the provision of health and medical care services in Kenya is
partly dependent on donors and partly on private health care sector. There are also other
factors inhibiting Kenya’s ability to provide adequate health care for its citizens. These include:
inefficient utilization of resources, the increasing burden of diseases, and the rapid population
growth.
STATEMENT OF THE PROBLEM
 The Aga Khan University hospital is one among the largest and most efficient private hospitals in
Kenya. This is because they guarantee quality health care due to qualified staff. However, the
greatest challenge faced by their clientele is the time they have to spend from the time they
arrive for their doctor’s appointment to the time they actually get to be served. We therefore
seek to establish the average time spent by a patient before service so that depending on this
the hospital can either add or reduce its staff.
OBJECTIVE
 The main objective was to find out how sensitive a model is in terms of change in profit margins
with respect to the number of surgeons.
The specific objectives were to:
 Find the optimum number of surgeons that would increase the profits and minimize costs of the
hospital under study.
 Determine whether the queuing time will decrease by adding a surgeon.

3.  Simulate and try to obtain the outcomes for the following year.
PURPOSE OF STUDY
By studying the queuing system of AKUH the information obtained can be useful in:
 Management –this will be in deciding how many surgeons to employ in each of the surgical
departments on the basis of its patient scope.
 Potential clients -By comparing the time spent in the hospital as compared to other hospitals
especially those in the public sector, they can choose to remain loyal to or seek alternative
services elsewhere.
 Academicians - They can practically appreciate the application of Queuing Theory in real life
situation.
LITERATURE REVIEW
 A study conducted at the Delhi-Gurgaon Toll Plaza by Anand (Sept 2012) showed that current
toll gates have only one clearance feasibility at a point in time, so a maximum of 16 vehicles can
be in the process at a time. Introduction of multiple toll booths allows for multiple clearances in
a single cycle at a faster rate. He hypothesized that it may take up to 4 toll booths in a lane to
reduce the queue length to a manageable number.
 Studies concerning appointment scheduling of outpatient services exist for over 50 years. The
first to present an extensive work dealing with this problem was Bailey (1952) from Holland,
who stated the importance of a well designed appointment policy and presented quantitative
tools to improve the performance of appointment-based systems in terms of controlling both
customers’ waiting time and server’s idle time. One aspect of behavior of customers that
influences the overall efficiency of such systems is the phenomenon of no-shows. Despite the
extensive work done on appointment systems in health care, the issue of no-shows has been
studied very little. The first to address the subject in an analytic approach was Mercer in (1960)
studied the non-equilibrium distribution of the queue length and gives also the results for the
equilibrium distribution. He assumes that customers are scheduled to arrive at a queue on an
equally spaced schedule, but may arrive at any time after the start of the interval on which they
are scheduled, or not arrive at all. Mercer (1973) further studied the distribution of the queue
length for other models differing in the arrival process and service process, i.e., batch scheduling
and general service time.
Kaandrop and Koole (2006) defined a local search scheduling algorithm and proved that it converges to
the optimal schedule in respect to their defined objective function - a weighted sum of the average
expected waiting times of customers, idle time of server and tardiness in schedule. The algorithm is
flexible and can incorporate no-shows