Student Dissertation

Agency : Quality, Health Services, Turn Around Time, India

Objective : 1. To study the process in OPD. 1. To determine TAT in OPD. 2. To assess the bottlenecks in the processes. 3. To recommend interventions to reduce the TAT. 4. To carry out Impact Study of interventions.

Background : Turn Around Time for elective care have been considered a serious problem in many health care systems since it acts as a barrier to efficient patient flows. It is an important indicator of quality of services offered by hospitals. It is a tangible aspect of practice that patients will use to judge health personnel, even more than their knowledge and skill. As with many tertiary healthcare centre Eternal Hospital encounters an expanding patient load, greater patient expectations and increasingly complicated patients who require services from a multitude of health providers. Such rising demands amidst limited resources cause inefficiencies and long waiting times for consultation. This results in low patient satisfaction and an unpleasant experience. OPD is considered the shop window of the hospital and patient’s impression of the hospital generally begins here.

Methodology : 1. Study type & design: It is a Qualitative, Analytical, Applied and Empirical type of study with Quasi experimental design using Separate Sample Pretest - Posttest. 2. Type of data and collection method: Primary data collected by observation. 3. Sample size: 10% of the total OPD patients. 4. Sampling technique: Systematic random sampling technique. 5. DMAIC (a) Define: Process flow of OPD patients was defined and was sub-divided for ease of study. The Upper Specification Limits were also fixed at this stage. (b) Measure: Waiting time was determined using Time Motion Study. (c) Analysis: Factors leading to delay were analysed. (d) Improve: Some interventions to reduce TAT were implemented. (e) Control: TAT was again determined to assess the impact of these interventions.

Findings : ï‚· It was observed that prior to the interventions average waiting time before a patient got his billing done was 12 minutes while after interventions it was reduced to 9 minutes. ï‚· The maximum waiting time was reduced from 50 minutes to 21 minutes after interventions. ï‚· Before interventions 27% patients had to wait for more than 15 minutes which was the Upper Specification Limit (USL) for billing while post interventions this reduced to only 8% (Sigma level increased from 2.12 to 2.90). ï‚· The average time between patient’s first billing and second billing (billing for investigation after meeting the doctor) was reduced from 1h 10 min to 56 min (20% reduction). ï‚· Earlier about 60% patients had to wait for more than 60 min (USL) before second billing while after interventions this section was reduced to 44%. The Sigma level increased from 1.24 before interventions to 1.65 after these.

Recommendations : This project clearly demonstrates the Six Sigma methodology as an effective tool in defining inefficiencies and improving patient flow. As this is still one of the preliminary quality improvement project, efforts to continually track, examine, and further improve turn-around times will go a long way in improving patient’s experience at Eternal Hospital.