Optimizing Patients Flow and Resources Utilization in the Out-patient Department of a Public Hospital; A Case Study of Yusuf Dantsoho Memorial Hospital, Kaduna
Chapter One
AIM/OBJECTIVES
The main aim of this study is to optimise the female section of the out- patient department (OPD) of Yusuf Dantsoho memorial hospital (public hospital);
- To examine using waiting line model patients flow in the out-patient department of Yusuf Dantsoho memorial
- To determine the performance measures of the
- To examine the effect of varying these parameters on the
CHAPTER TWO
LITERATURE REVIEW
INTRODUCTION
Understanding waiting lines or queues and learning how to manage them is one of the most important areas in operations management. It is basic to creating schedules, job design, and inventory levels and so on. In our service economy we wait in line every day from driving to work, to checking out at the super market. We also encounter waiting lines at factories, jobs waiting lines to be worked on at different machines and machines themselves wait their turn to be over hauled. Every waiting line situation is a trade-off decision. The manager must weigh the added cost of providing more rapid service (more traffic lines, additional landing strips etc.) against the inherent cost of waiting i.e. hospital administration want queues that are short enough so that patient don’t become unhappy and either leave “without buying or buy but not return”. However managers are willing to allow some waiting if a significant saving in service balances waiting costs.
(Adedayo et al 2006). To achieve this manager need to optimise available resources (doctors, nurses etc.), waiting time and other queuing parameters within a complex system such as hospitals using tools like mathematical modelling, linear programming, queuing theory and simulation. These instruments can be used for optimizing the performance of system.
RELATED PAST WORKS
Queuing theory was developed by A.K Erlang in 1904 to help determine the capacity requirement of the Danish telephone system (Brockmeyer et al. 1948). It has since been applied to a large range of service industries including banks, airlines and telephone call centres (Brewton 1989, Stern and Hersh 1980, Halloran and Bryne 1986, Brusco et al, 1995 and brigand et al 1994), as well as emergency systems such as police patrol, fire and ambulances (Chelst and Barlach 1981, Green and Kolesar 2001, Taylor and Huney 1989). Umar I, et al (2011), identified that the amount of time a patient waits to be seen is one factor which affects the utilisation of health care services. Patient satisfaction has emerged as an increasingly important parameter in the assessment of quality of health care; hence, healthcare facility performance can be best assessed by measuring the level of patient’s satisfaction. This was a cross-sectional descriptive study carried out at the out patients’ departments of the Usmanu Danfodiyo University, Sokoto. A total of 384 new patients were randomly selected into the study. A set of pretested questionnaires was used to extract information from the respondents; descriptive statistics was used for analysis. A total of 118 (31%) of the patients waited for less than an hour in the waiting room, while 371 (96.6%) spent less than 30 min with the doctor. More than half, 211 (55%) of the respondents were satisfied with the service delivery in the hospital, while only 63 (16%) of the respondents admitted to being given health talks while waiting to be seen by the doctor. Although majority of the patients waited for more than 1 h before being attended to, more than half of them were however satisfied with the services rendered to them. There is the need for health care institutions and providers to put in place measures aimed at reducing waiting time and ensuring patient satisfaction.
Nilesh Sheath and Dr. Prashant Makwanna (2016), highlighted the role of providing appropriate medical care to patients within time limits as an important factor for healthcare organization to increase patient satisfaction. Patients are generally dissatisfied with long waiting times and it leaves negative effects on patients. Furthermore, queuing theory and modelling is an effective tool that can be provided to make decisions on requirements of staffing for good performance with regards to queuing challenges in hospitals. This analysis should be useful in other hospitals in India and other countries regarding on the usefulness of queuing theory and modelling as a tool for improved decision making with regard to the queuing challenges that are faced by hospitals. From the study server utilisation was 120.83% in case 1 with 3 doctors and 90.63% in case 2 with 4 doctors i.e. patients had spent less time in the queue and system utilization is good. Same when compared with case 3 server utilisation is very good as case 2. Also, from the results analysed the waiting time in queue also decreased. From the case 2 waiting time is Wq= 0.038 hour and in case 3, Wq=0.010. It was observed from the results of the study that the number of servers necessary to better serve is 5. This is the appropriate number of servers that can serve the customers without waiting long in queue.
The Institute of Medicine (IOM) recommends that, at least 90% of patients should be seen within 30 min of their scheduled appointment time (O’Malley MS et al 1983), This is, however, not the case in most developing countries, as several studies have shown that patients spend 2-4 h in the outpatient departments before seeing the doctor (Singh H et al 1999, Ofilli AN and Ofowve CE 2005). A source of dissatisfaction with health care reported by patients is having to wait a long period of time in the clinic, and several studies have documented the negative association between increased waiting time and patient satisfaction with primary care (Huang XM 1994), The duration of waiting time varies from country to country, and even within country it varies from centre to centre. Long waiting times have been reported in both developed and developing countries. In the USA, an average waiting time of about 60 min was found in Atlanta (Dos Santos LM et al 1994) and an average of 188 min in Michigan. In Nigeria, an average waiting time of about 173 min was found in Benin (Dansky KH and Miles J 1997), while in University College Hospital Ibadan, a mean waiting time of 1 h 13 min was observed (Bamgboye EO et al 1994), Time spent waiting is a resource investment by the patient for the desired goal of being seen by the physician and therefore may be moderated by the outcome.
CHAPTER THREE
RESEARCH METHODOLOGY
The basis for research usually comes up as a result of enquiries in finding answers to the various questions surrounding man. Research has been used over time to find answers to problems seeking resolutions. Therefore, research is a problem induced activity; research is simply the process of arriving at a dependable solution to problems through the planned and systematic collection, analysis and interpretation of data.
Introduction
The method used is the conceptual framework which the whole research is based, for this research work; data was sourced predominantly from primary data for Yusuf Dantsoho Memorial Hospital.
The out-patient department of the hospital consist of basically two sections, the records and the consultation area where nurses take the vitals as the patients are waiting in line for their turn to see the doctor for consultation.
Methods of Data Collection
Primary Data
A form of data collection process was designed to gather valid, reliable or expert in formation through responses or interviews to a planned sequence of enquiries. Advantages of primary data.
- It’s flexibility due to the fact that questions could be reframed toenhance ability to respondents.
- It saves time, since it is a direct way of data
- Personal contacts help ease interviewees when answering questions, thereby providing reliable
Secondary Data
Secondary data can be defined as information from other sources for another purpose. This information is normally published for public and administrative use.
CHAPTER FOUR
DATA PRESENTATION AND ANALYSIS
The data for this study will be presented in this chapter. This chapter would seek to prove the importance of queuing theory in the optimisation of system parameters i.e. (waiting time, service time, system idle time etc.) in the outpatient department of public hospitals. The data collected from the records and the consultation unit of the female section at the out-patient department of Yusuf Dantsoho Memorial Hospital from Monday (23rd of May 2016) to Friday (27th 05-2016) was analysed.
The mean arrival rates ( ) and the mean service rates ( ) would be calculated from the data collected and their results used in measuring the performance of the entire system.
CHAPTER FIVE
SUMMARY, CONCLUSION and RECOMENDATION
Summary
This study seeks to prove queuing theory as a tool for optimising patient’s flow and resources utilisation in the female section of the outpatient department of Yusuf Dantsoho Memorial hospital Kaduna as a case study. The study consists of five chapters. The first was the general introduction of the subject matter i.e general problem of the topic, research questions, aims and objectives scope and the limitations of the study. The second chapter presents the relevant literature review of the using queuing theory as a tool for optimising patients flow and resources utilization in the OPD of clinics. The third chapter dealt with the methodology of the research. The fourth chapter is the presentation of results and discussion; finally the last chapter highlighted the findings, implications and potential recommendations.
The study has established that at the OPD department (female section) of Yusuf Dantsoho memorial hospital has an average of 3 doctors working at a time, considering their effective working time. The average daily arrival rate is approximately 43 patients per hour and the service rate averages 15 patients per hour. Data analysed from questionnaires administered to patients determined that average waiting time before seeing a doctor of about 60% of patients to be between 1-2 hours which is in the same range with similar studies conducted within and outside the country (e.g. Bamgboye EO et al 1994, Dansky KH and
Miles J 1997 and Dos Santos LM et al 1994). Using the queuing model for windows software, five scenarios modelled ( for 3, 4, 5, 6 and 7doctors), established that optimum system performance will be achieved with five doctors effectively working for the number of hours the study was conducted in contrast to the prevailing situation that has an average 3 doctors at post working for the same number of hours.
Conclusion
In conclusion, an attempt has been made through this study to optimise patients flow and resources utilisation at female section of the OPD in Yusuf Dantsoho Memorial hospital, Kaduna for a period of 5 days, Monday (23rd -05-2016) to Friday (27th -05-2016), has proven that queuing theory is a very useful tool for evaluating the performance parameters of the various sections of the OPD which allows for easy trade-offs between utilisation and wait time and allows for better decisions relating to staffing and potential waiting times for patients. The parameters computed in this project are mean arrival rate, mean service rate. The utilisation factor of the system and average time a patient spends in the system.
It was observed that patients had to wait longer than necessary at both sections of the OPD in Yusuf Dantsoho Memorial hospital especially on appointment day’s i.e. Monday, Tuesday and Thursday. In general long queues were observed over the period of the study which resulted in overcrowding and congestion in the hospital.
Recommendations
Based on the findings and conclusions drawn above, one may wish to offer the following, recommendations that will assist management of public hospital and specifically management of Yusuf Dantsoho memorial hospital optimise patients flow and reduce congestion in the OPD.
- The hospital should put in place system such that 5 doctors effectively consult in the female section of the OPD during peak hours (6am to 12noon) for optimal performance instead of an average of 3 doctors which is presently the
- Improving the efficiency of the servers at both sections of the OPD so as to reduce waiting and congestion as well as minimise patient’s length of stay.
- The priority rule (FCFS) should strictly be adhered to, as it was observed in the course of the study about 28.9855% complained that some hospital staffs ignored this rule, thereby impacting negatively on the performance of the system by increasing the average wait time of the patients which becomes a hindrance to the free flow of traffic in the
- Health information management system should be introduced in the recordssection of the OPD this will go a long way in reducing the wait time in the records by easing the retrieval of patient’s information and subsequently leads to a decrease in the overall wait time of patients in the OPD.
In view of the these recommendations I believe if followed will go a long way in assisting hospital managers in effectively utilising resources (staffs) in other to reduce congestion experienced in the OPD of public hospitals.
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