Waiting Times Surveys (WTS)
at 10 20 and 30 Facilities
in Western Cape
Gavin Reagon
Ehimario Igumbor
School of Public Health of UWC
Information Officers City Health and MDHS
Quality Assurance Officers PGWC
Health Research
•
•
•
•
•
Basic Biomedical Sciences research
Clinical Research
Epidemiology
Clinical Epidemiology
Health Systems and Policy Research
• Routine Large Scale Surveys
Routine Health Information
Systems
•
•
•
•
•
•
Facility Based Information
Mortality and Births
Population Census
Surveillance
Situational Analysis
Longitudinally updated records (staff,
facilities, finances)
• Routine Large Scale Surveys
Value of a WTS
(What it Mainly Measures)
• Measures Waiting Times
• Identifies the immediate Causes of Long
Waiting Times (and suggests solutions for
these)
• Measures Service Times
• Measures Workload accurately
• Measures Quality of Care (partially)
• Measures Systems Efficiency
Methodology
1. All outpatients, casualty patients, and direct
admissions to wards seen on an average day are
included in the survey (inpatients already admitted
are excluded)
2. All patients are tracked from the time they arrive at
the facility till the time they depart (or are admitted
to the wards) via a patient time-sheet
3. At every point at which a patient receives a
service the times are recorded
4. Staff complete a staff time-sheet which tracks the
time they spend at the service points they work at.
5. Short questionnaire completed by staff and
patients
Entrance
Gate in
Boundary
Wall
Reception
09h26
Consulting
Room 1 with PN
Consulting
Room 2 with PN
Counseling
Room
09h24
09h01
Entrance
Main
Entrance
Waiting Area with
Chairs
Consulting
Room 1 with EN
Dentist’s
Reception
Entrance
Dressing Room
Dentist
DOTS
Room
Observation
Room
9h33
Entrance
Gate in
Boundary
Wall
Reception
09h26
Consulting
Room 1 with PN
Consulting
Room 2 with PN
Counseling
Room
09h24
10h23
09h01
Entrance
10h33
Main
Entrance
Waiting Area with
Chairs
Dentist’s
Reception
Consulting
Room 1 with EN
09h37
Entrance
Dressing Room
Dentist
10h59
DOTS
Room
Observation
Room
9h33
09h26
Gate in
Boundary
Wall
Entrance
Consulting
Room 1 with PN
Reception
09h24
10h33
Consulting
Room 2 with PN
Counseling
Room
10h23
Entrance
09h01
Main
Entrance
Waiting Area with
Chairs
11h09
Dentist’s
Reception
11h06
Dentist
10h59
Dressing Room
Consulting
Room 1 with EN
09h37
DOTS
Room
Observation
Room
Entrance
9h33
Calculating Waiting and Service Times
Arrival Time 9:01
Service Point
Reception
Observation
Room
Consulting
Room PN
Time Time Service Waiting
In
Out
Time
Time
9:24 9:26
2 min
23 min
9:33 9:37
4 min
7 min
10:23 10:33
10 min
46 min
Dressing Room 10:59 11:06
7 min
26 min
Complete ST
23 min
Complete WT
Departure Time 11:09
102 min
Dead Time 3 min
Staff Form for Staff Present during the Waiting and Service Time Survey
Facility name
CHC
Staff
Category
Arrival Time
Service Section
Tea Break
Lunch Break
Reception
Weighing &
Preparation
Consulting Room PN
Pharmacy
TB Dots Room
Emergency _Trauma
Administration
Management
Outreach Activities
Meetings, Workshops
and Training
Other Clinical
Other Non-Clinical
Departure Time
Staff
Code:
Date:
Time
In
Time
Out
Time
In
Time
Out
Time In
Time
Out
Time In
Time
Out
Staff Form for Staff Present during the Waiting and Service Time Survey
Facility name
Arrival Time
Service Section
CHC
Staff
Category
07:03
Time
In
Time
Out
07:09
09:59
Tea Break
Lunch Break
Reception
Weighing &
Preparation
Consulting Room PN
Pharmacy
TB Dots Room
Emergency _Trauma
Administration
Management
Outreach Activities
Meetings, Workshops
and Training
Other Clinical
Other Non-Clinical
Departure Time
Staff
Code:
Date:
Time
In
Time
Out
Time In
Time
Out
Time In
Time
Out
Staff Form for Staff Present during the Waiting and Service Time Survey
Facility name
Arrival Time
Service Section
Tea Break
CHC
Staff
Category
07:03
Time
In
Time
Out
10:00
10:21
07:09
09:59
Time
In
Time
Out
10:25
11:38
Lunch Break
Reception
Weighing &
Preparation
Consulting Room PN
Pharmacy
TB Dots Room
Emergency _Trauma
Administration
Management
Outreach Activities
Meetings, Workshops
and Training
Other Clinical
Other Non-Clinical
Departure Time
Staff
Code:
Date:
Time In
Time
Out
Time In
Time
Out
Staff Form for Staff Present during the Waiting and Service Time Survey
Facility name
Arrival Time
CHC
Staff
Category
07:03
Time
In
Time
Out
Tea Break
10:00
10:21
Lunch Break
12:00
12:30
07:09
09:59
Emergency _Trauma
12:40
13:00
Administration
15:45
16:17
13:30
14:00
Service Section
Staff
Code:
Date:
Time
In
Time
Out
Time In
Time
Out
Time In
Time
Out
10:25
11:38
13:05
13:30
14:10
15:45
Reception
Weighing &
Preparation
Consulting Room PN
Pharmacy
TB Dots Room
Management
Outreach Activities
Meetings, Workshops
and Training
Other Clinical
Other Non-Clinical
Departure Time
16:30
Results
Complete Waiting Time Hosp OPD 2008
Facility Name
5% 25% Med 75%
95%
ian
Groote Schuur
Hospital
Tygerberg Hospital
14
92
178
250
392
16
92
193
275
452
Red Cross Hospital
6
46
114
180
297
Worcester Hospital
6
125
187
255
349
Complete Waiting Time Emergency in minutes
Facility Name
5% 25% Med 75% 95%
ian
Groote Schuur
Hospital Wed
5
52
173
321
583
Groote Schuur
Hospital Sat
5
10
67
188
441
Tygerberg Hospital
Thurs
3
10
36
141
225
Tygerberg Hospital Sat N/A N/A N/A
N/A N/A
Complete Waiting Time Emergency in minutes
Facility Name
5% 25% Med 75% 95%
ian
Red Cross Hospital Wed
3
20
55
185
151
Red Cross Hospital Sat
5
19
83
157
322
Worcester Hospital Wed
2
35
96
196
376
Worcester Hospital Sat
7
24
98
213
427
Facility Type
Clinics
CHCs
CHC and
Clinic
Shortest Median
Waiting Time
Longest Median Waiting
Time
2005
2007
2005
2007
2 min
7 min
99 min
203 min
27 min
20 min
263 min
215 min
29 min
39 min
225 min
178 min
2 min
7 min
263 min
215 min
All Facilities
Causes of Long Waiting Time
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
Workload (overloaded)
Arriving in Big Batches
Mismatch
Long Service time (inappropriately)
Inefficiency (in prioritising patients)
Logistics
Flow
Queuing
Gaps between seeing patients
Waiting for ward/ICU/theatre bed (Emerg Units)
Long Diagnostic & Monitoring time (Emerg Units)
Main Causes of Long Waiting Time
at Hospital OPDs
1. Arriving in Big Batches early in the morning
2. Mismatch mainly at clinician service points
3. Workload (overloaded) mainly at pharmacy
Main Causes of Long Waiting Time
at CHCs
1. Arriving in Big Batches early in the morning
2. Mismatch mainly at Reception and Clinician
service points
3. Inefficiency in prioritising patients
4. Workload (overloaded) mainly at pharmacy
Main Causes of Long Waiting Time
at Clinics
1. Arriving in Big Batches early in the morning
2. Mismatch mainly at Reception and Clinician
service points
3. Inefficiency in prioritising patients
Main Causes of Long Waiting Time
at Hospital Emergency Units
1. Waiting for ward/ICU/theatre bed
2. Long Diagnostic & Monitoring time
(Insufficient Senior Staff)
3. Workload (overloaded)
Main Causes of Long Waiting Time
at Hospital OPDs
1. Arriving in Big Batches early in the morning
2. Mismatch mainly at clinician service points
3. Workload (overloaded) mainly at pharmacy
0
Median Waiting Time
Median Service Time
ArrivalTime
No of Patients Arriving
ArrivalTime
Data
No of Patients with appointment
23:00 - 23:59
22:00 - 22:59
21:00 - 21:59
20:00 - 20:59
19:00 - 19:59
18:00 - 18:59
17:00 - 17:59
16:00 - 16:59
15:00 - 15:59
14:00 - 14:59
13:00 - 13:59
12:00 - 12:59
11:00 - 11:59
10:00 - 10:59
09:00 - 09:59
08:00 - 08:59
07:00 - 07:59
06:00 - 06:59
05:00 - 05:59
04:00 - 04:59
03:00 - 03:59
02:00 - 02:59
01:00 - 01:59
00:00 - 00:59
Time (minutes)
120
180
100
160
80
140
120
60
100
80
40
60
20
40
20
0
No of Patients Arriving and No of
Appointments
wc Groote Schuur Hospital : E OPD Central Reception Counter
Waiting Time, Service Time & No of Patients Arriving By Arrival Time
No specific time set to 00.00 - 00.59, No appointment set to 23.00 - 23.59
200
wc Groote Schuur Hospital : E OPD Central Reception Counter
Snapshot of Patients Waiting and those Receiving a Service at any Point in Time
80
6
60
40
30
2
20
SnapshotTime
Data
Sum of PatsServ
Sum of PatsWait
SnapshotTime
Sum of StaffCount
23:00
22:00
21:00
20:00
19:00
18:00
17:00
16:00
15:00
14:00
13:00
12:00
11:00
10:00
09:00
08:00
07:00
06:00
05:00
04:00
03:00
02:00
0
01:00
10
00:00
No of Patients
4
50
0
No of Staff at Service Point
70
10
0
0
Median Waiting Time
Median Service Time
ArrivalTime
No of Patients Arriving
ArrivalTime
Data
No of Patients with appointment
23:00 - 23:59
22:00 - 22:59
21:00 - 21:59
20:00 - 20:59
19:00 - 19:59
18:00 - 18:59
17:00 - 17:59
16:00 - 16:59
15:00 - 15:59
14:00 - 14:59
13:00 - 13:59
12:00 - 12:59
11:00 - 11:59
10:00 - 10:59
09:00 - 09:59
08:00 - 08:59
07:00 - 07:59
06:00 - 06:59
05:00 - 05:59
04:00 - 04:59
03:00 - 03:59
02:00 - 02:59
01:00 - 01:59
140
80
120
70
100
60
80
50
40
60
30
40
20
No of Patients Arriving and No of
Appointments
20
00:00 - 00:59
Time (minutes)
Worcester Hospital : OPD Reception Get Folders
Waiting Time, Service Time & No of Patients Arriving By Arrival Time
No specific time set to 00.00 - 00.59, No appointment set to 23.00 - 23.59
0
Median Waiting Time
Median Service Time
ArrivalTime
No of Patients Arriving
ArrivalTime
Data
No of Patients with appointment
23:00 - 23:59
22:00 - 22:59
21:00 - 21:59
20:00 - 20:59
19:00 - 19:59
18:00 - 18:59
17:00 - 17:59
16:00 - 16:59
15:00 - 15:59
14:00 - 14:59
13:00 - 13:59
12:00 - 12:59
11:00 - 11:59
10:00 - 10:59
09:00 - 09:59
08:00 - 08:59
07:00 - 07:59
06:00 - 06:59
05:00 - 05:59
04:00 - 04:59
03:00 - 03:59
02:00 - 02:59
01:00 - 01:59
00:00 - 00:59
Time (minutes)
800
450
700
400
600
350
500
300
400
250
200
300
150
200
100
100
50
0
No of Patients Arriving and No of
Appointments
wc Tygerberg Hospital
Waiting Time, Service Time & No of Patients Arriving By Arrival Time
wc Tygerberg Hospital
Snapshot of Patients Waiting and those Receiving a Service at any Point in Time
1000
900
800
600
500
400
300
200
SnapshotTime
Data
No of Patients Receiving a Service No of Patients Waiting for a Service
SnapshotTime
23:00
22:00
21:00
20:00
19:00
18:00
17:00
16:00
15:00
14:00
13:00
12:00
11:00
10:00
09:00
08:00
07:00
06:00
05:00
04:00
03:00
02:00
0
01:00
100
00:00
No of Patients
700
0
Sum of MedWaitTime
ArrivalTime
Sum of MedServTime
ArrivalTime
Data
Sum of NoOfPats
23:00 - 23:59
22:00 - 22:59
21:00 - 21:59
20:00 - 20:59
19:00 - 19:59
18:00 - 18:59
17:00 - 17:59
16:00 - 16:59
15:00 - 15:59
14:00 - 14:59
13:00 - 13:59
12:00 - 12:59
11:00 - 11:59
10:00 - 10:59
09:00 - 09:59
08:00 - 08:59
07:00 - 07:59
06:00 - 06:59
05:00 - 05:59
04:00 - 04:59
03:00 - 03:59
02:00 - 02:59
01:00 - 01:59
00:00 - 00:59
Time (minutes)
1080
450
972
400
864
350
756
300
648
250
540
200
432
324
150
216
100
108
50
0
No of Patients Arriving and No of Appointments
wc Groote Schuur Hospital
Waiting Time, Service Time & No of Patients Arriving By Arrival Time
wc Groote Schuur Hospital
Snapshot of Patients Waiting and those Receiving a Service at any Point in Time
1080
972
864
648
540
432
324
216
SnapshotTime
Data
No of Patients Receiving a Service No of Patients Waiting for a Service
SnapshotTime
23:00
22:00
21:00
20:00
19:00
18:00
17:00
16:00
15:00
14:00
13:00
12:00
11:00
10:00
09:00
08:00
07:00
06:00
05:00
04:00
03:00
02:00
0
01:00
108
00:00
No of Patients
756
0
Median Waiting Time
Median Service Time
ArrivalTime
No of Patients Arriving
ArrivalTime
Data
No of Patients with appointment
23:00 - 23:59
22:00 - 22:59
21:00 - 21:59
20:00 - 20:59
19:00 - 19:59
18:00 - 18:59
17:00 - 17:59
16:00 - 16:59
15:00 - 15:59
14:00 - 14:59
13:00 - 13:59
12:00 - 12:59
11:00 - 11:59
10:00 - 10:59
09:00 - 09:59
08:00 - 08:59
07:00 - 07:59
06:00 - 06:59
05:00 - 05:59
04:00 - 04:59
03:00 - 03:59
02:00 - 02:59
01:00 - 01:59
00:00 - 00:59
Time (minutes)
600
120
500
100
400
80
300
60
200
40
100
20
0
No of Patients Arriving and No of
Appointments
Worcester Hospital
Waiting Time, Service Time & No of Patients Arriving By Arrival Time
Worcester Hospital
Snapshot of Patients Waiting and those Receiving a Service at any Point in Time
250
150
100
SnapshotTime
Data
No of Patients Receiving a Service No of Patients Waiting for a Service
SnapshotTime
23:00
22:00
21:00
20:00
19:00
18:00
17:00
16:00
15:00
14:00
13:00
12:00
11:00
10:00
09:00
08:00
07:00
06:00
05:00
04:00
03:00
02:00
0
01:00
50
00:00
No of Patients
200
0
Median Waiting Time
Median Service Time
ArrivalTime
No of Patients Arriving
ArrivalTime
Data
No of Patients with appointment
23:00 - 23:59
22:00 - 22:59
21:00 - 21:59
20:00 - 20:59
19:00 - 19:59
18:00 - 18:59
17:00 - 17:59
16:00 - 16:59
15:00 - 15:59
14:00 - 14:59
13:00 - 13:59
12:00 - 12:59
11:00 - 11:59
10:00 - 10:59
09:00 - 09:59
08:00 - 08:59
07:00 - 07:59
06:00 - 06:59
05:00 - 05:59
04:00 - 04:59
03:00 - 03:59
02:00 - 02:59
01:00 - 01:59
00:00 - 00:59
Time (minutes)
500
450
400
100
350
80
300
250
60
200
150
40
100
20
50
0
No of Patients Arriving and No of
Appointments
wc Red Cross Childrens Hospital
Waiting Time, Service Time & No of Patients Arriving By Arrival Time
120
wc Red Cross Childrens Hospital
Snapshot of Patients Waiting and those Receiving a Service at any Point in Time
250
150
100
SnapshotTime
Data
No of Patients Receiving a Service No of Patients Waiting for a Service
SnapshotTime
23:00
22:00
21:00
20:00
19:00
18:00
17:00
16:00
15:00
14:00
13:00
12:00
11:00
10:00
09:00
08:00
07:00
06:00
05:00
04:00
03:00
02:00
0
01:00
50
00:00
No of Patients
200
23:00:00 - 23:59:00
22:00:00 - 22:59:00
21:00:00 - 21:59:00
20:00:00 - 20:59:00
19:00:00 - 19:59:00
18:00:00 - 18:59:00
17:00:00 - 17:59:00
16:00:00 - 16:59:00
400
200
3000
150
2000
100
50
1000
0
0
Patients
MedServTime
15:00:00 - 15:59:00
14:00:00 - 14:59:00
13:00:00 - 13:59:00
12:00:00 - 12:59:00
MedWaitTime
11:00:00 - 11:59:00
10:00:00 - 10:59:00
09:00:00 - 09:59:00
08:00:00 - 08:59:00
07:00:00 - 07:59:00
06:00:00 - 06:59:00
05:00:00 - 05:59:00
04:00:00 - 04:59:00
03:00:00 - 03:59:00
02:00:00 - 02:59:00
01:00:00 - 01:59:00
00:00:00 - 00:59:00
Minutes
Patient Numbers, Waiting Times and Service Times by Arrival Time for Cape Town in August 2005
NoOfPats
6000
350
5000
300
250
4000
0
Sum of MedWaitTime
ArrivalTime
Sum of MedServTime
ArrivalTime
Data
Sum of NoOfPats
23:00 - 23:59
22:00 - 22:59
21:00 - 21:59
20:00 - 20:59
19:00 - 19:59
18:00 - 18:59
17:00 - 17:59
16:00 - 16:59
15:00 - 15:59
14:00 - 14:59
13:00 - 13:59
12:00 - 12:59
11:00 - 11:59
10:00 - 10:59
09:00 - 09:59
08:00 - 08:59
07:00 - 07:59
06:00 - 06:59
05:00 - 05:59
04:00 - 04:59
03:00 - 03:59
02:00 - 02:59
01:00 - 01:59
00:00 - 00:59
Time (minutes)
1620
1080
4000
900
3000
720
540
2000
360
1000
180
0
No of Patients Arriving
Complete Survey - All Facilities - All Service Points
Waiting Time, Service Time & No of Patients Arriving By Arrival Time in August 2007
6000
1440
5000
1260
Main Causes of Long Waiting Time
At Hospital OPDs
1. Arriving in Big Batches early in the morning
2. Mismatch mainly at clinician service points
3. Workload (overloaded) mainly at pharmacy
wc Groote Schuur Hospital : E Consultant ANC Triage
Snapshot of Patients Waiting and those Receiving a Service at any Point in Time
80
4
75
70
60
3
50
45
40
2
35
30
25
20
1
15
10
SnapshotTime
Data
Sum of PatsServ
Sum of PatsWait
SnapshotTime
Sum of StaffCount
23:00
22:00
21:00
20:00
19:00
18:00
17:00
16:00
15:00
14:00
13:00
12:00
11:00
10:00
09:00
08:00
07:00
06:00
05:00
04:00
03:00
02:00
0
01:00
5
00:00
No of Patients
55
0
No of Staff at Service Point
65
10
0
0
Median Waiting Time
Median Service Time
ArrivalTime
No of Patients Arriving
ArrivalTime
Data
No of Patients with appointment
23:00 - 23:59
22:00 - 22:59
21:00 - 21:59
20:00 - 20:59
19:00 - 19:59
18:00 - 18:59
17:00 - 17:59
16:00 - 16:59
15:00 - 15:59
14:00 - 14:59
13:00 - 13:59
12:00 - 12:59
11:00 - 11:59
10:00 - 10:59
09:00 - 09:59
08:00 - 08:59
07:00 - 07:59
06:00 - 06:59
05:00 - 05:59
04:00 - 04:59
03:00 - 03:59
02:00 - 02:59
01:00 - 01:59
300
70
250
60
200
50
40
150
30
100
20
No of Patients Arriving and No of
Appointments
50
00:00 - 00:59
Time (minutes)
wc Groote Schuur Hospital : E Consultant ANC Triage
Waiting Time, Service Time & No of Patients Arriving By Arrival Time
No specific time set to 00.00 - 00.59, No appointment set to 23.00 - 23.59
Service Times
Tygerberg
No
Service
Point
195 C5 B
East
Mammae
Clinic Dr.
Waiting Times
Nu
mb
er
of
Act
ual
Staf
f
Equivale
nt
Staff
Patie
nts
Seen
Worklo
ad as
Patient
s Seen
per
Staff
per
Day
% Staff
Time
Spent
Attendi
ng to
patient
Med
5
%
75
%
4
0.5
14
25.8
87%
12
6 15
95%
Med
5
%
75%
95%
Pos
sibl
e
Log
isti
cs
Pro
ble
m
45
87
5
165
199
Y
U
ns
pe
cif
ie
d
0
Median Waiting Time
ArrivalTime
Median Service Time
ArrivalTime
Data
No of Patients Arriving
23:00 - 23:59
22:00 - 22:59
21:00 - 21:59
20:00 - 20:59
19:00 - 19:59
18:00 - 18:59
17:00 - 17:59
16:00 - 16:59
15:00 - 15:59
14:00 - 14:59
13:00 - 13:59
12:00 - 12:59
11:00 - 11:59
10:00 - 10:59
09:00 - 09:59
08:00 - 08:59
07:00 - 07:59
06:00 - 06:59
05:00 - 05:59
04:00 - 04:59
03:00 - 03:59
02:00 - 02:59
01:00 - 01:59
00:00 - 00:59
Time (minutes)
250
6
150
4
100
50
2
0
No of Patients Arriving
wc Tygerberg Hospital : C5 B East Mammae Clinic Dr.
Waiting Time, Service Time & No of Patients Arriving By Arrival Time
8
200
wc Tygerberg Hospital : C5 B East Mammae Clinic Dr.
Snapshot of Patients Waiting and those Receiving a Service at any Point in Time
4
3
No of Patients
10
2
5
SnapshotTime
Data
Sum of PatsServ
Sum of PatsWait
SnapshotTime
Sum of StaffCount
23:00
22:00
21:00
20:00
19:00
18:00
17:00
16:00
15:00
14:00
13:00
12:00
11:00
10:00
09:00
08:00
07:00
06:00
05:00
04:00
03:00
02:00
01:00
0
00:00
1
0
No of Staff at Service Point
15
Service Times
Worcester
No
Service Point
17 Doctor
Orthopae
dics OPD
Waiting Times
Nu
mb
er
of
Act
ual
Staf
f
Equivale
nt
Staff
Patie
nts
Seen
Worklo
ad as
Patient
s Seen
per
Staff
per
Day
% Staff
Time
Spent
Attendi
ng to
patient
Med
5
%
75
%
4
2.2
58
26.3
65%
10
3 15
95%
Med
5%
75%
30
11
2
38 140
95%
Po
ssi
bl
e
Lo
gi
sti
cs
Pr
ob
le
m
191
Y
U
n
s
p
ec
ifi
e
d
0
Median Waiting Time
Median Service Time
ArrivalTime
No of Patients Arriving
ArrivalTime
Data
No of Patients with appointment
23:00 - 23:59
22:00 - 22:59
21:00 - 21:59
20:00 - 20:59
19:00 - 19:59
18:00 - 18:59
17:00 - 17:59
16:00 - 16:59
15:00 - 15:59
14:00 - 14:59
13:00 - 13:59
12:00 - 12:59
11:00 - 11:59
10:00 - 10:59
09:00 - 09:59
08:00 - 08:59
07:00 - 07:59
06:00 - 06:59
05:00 - 05:59
04:00 - 04:59
03:00 - 03:59
02:00 - 02:59
01:00 - 01:59
00:00 - 00:59
Time (minutes)
300
250
40
200
35
30
150
25
20
100
15
50
10
5
0
No of Patients Arriving and No of
Appointments
Worcester Hospital : Doctor Orthopaedics OPD
Waiting Time, Service Time & No of Patients Arriving By Arrival Time
No specific time set to 00.00 - 00.59, No appointment set to 23.00 - 23.59
50
45
Worcester Hospital : Doctor Orthopaedics OPD
Snapshot of Patients Waiting and those Receiving a Service at any Point in Time
40
5
35
25
3
20
2
15
10
1
SnapshotTime
Data
Sum of PatsServ
Sum of PatsWait
SnapshotTime
Sum of StaffCount
23:00
22:00
21:00
20:00
19:00
18:00
17:00
16:00
15:00
14:00
13:00
12:00
11:00
10:00
09:00
08:00
07:00
06:00
05:00
04:00
03:00
02:00
0
01:00
5
00:00
No of Patients
30
0
No of Staff at Service Point
4
Main Causes of Long Waiting Time
at Hospital OPDs
1. Arriving in Big Batches early in the morning
2. Mismatch mainly at clinician service points
3. Workload (overloaded) mainly at pharmacy
Service Times
Service
Point Schuur
NumbeHospital
Equivale
wc
Groote
Workloa
d as
Patients
Seen
per Staff
per Day
% Staff
Time
Spent
Attendin
g to
patient
99%
Waiting Times
r of
Actual
Staff
nt Staff
Patient
s Seen
OPD
Pharmacy
Triage
Pharmacist
5
1.1
461
432.2
OPD
Pharmacy
Enter &
Label
11
3.1
453
144.4
80%
1
1
2
5
23
4
38 68
Y
Too
little
space
OPD
Pharmacy
Picking
Meds
12
3.9
452
115.1
58%
1
1
2
4
15
1
25 51
N
OPD
Pharmacy
Check
Meds
9
3.2
444
139.2
1
1
3
5
16
3
23 41
N
OPDPharm
acy
Dispense
8
1.4
390
287.6
1
1
1
2
22
6
30 43
N
84%
75%
(150)
Med
5%
75
%
95
%
Med
5%
75
%
95
%
Possibl
e
Logistic
s
Problem
1
1
1
2
24
1
32 54
Y
Too
little
space
Main Causes of Long Waiting Time
1. Arriving in Big Batches early in the morning
Solution: Dynamic Staggered Appointment System
2. Mismatch mainly at clinician service points
Solution: Dynamic Staggered Appointment System
3. Workload (overloaded) mainly at pharmacy
and Emergency Units
Solution: Appoint more staff
Summary Table of Interpreted
Results and Recommended
Actions for Every Service Point
Service Point
Name
Median
Waiting
Time**
Qual
ity
of
Care
##
Perc
ent
Resi
dual
Staff
Capa
city$$
Comment
ary
Casual Factors for High Waiting Time
Present
Ina
ppr
opr
iate
Arri
val
Pat
ter
ns
S21 Reception
Eye Clinic
Low
A to
E
Mis
mat
ch
Ov
er
wo
rk
ed
In
eff
ici
en
cy
S21 Eye Clinic
Nurse
(Specialist)
Low
A to
E
A to
E
Lo
gi
sti
cs
Fl
o
w
Hi
gh
Se
rvi
ce
Ti
m
e
Ill
og
ica
l
qu
eu
in
g
Doing well in keeping
waiting Times low.
Keep it up.
44%
S21 Eye Clinic
Nurse (General)
High
44%
12%
Suggested Actions
X
X
X
Staff may
not have
filled in all
the patient
forms.
1. Remove mismatch
by giving patients
appointments to arrive
later.
2. Improve efficiency
by prioritising
attending to patients
who are waiting to be
seen.
Staff was
working at
reception
while
patient
was
waiting.
Avoid mismatch .
Conclusions
• Waiting Time Survey is Easy to conduct
• Staff participation is fundamental to success
• Waiting Time survey is Low cost with High
Benefit
• Survey not only Measures, but also shows how
to Solve challenges of High Waiting Time
• Implementing solutions to reduce Waiting Time
is Key.
• Monitoring implementations is easy, quick,
cheap
Sustainability of Future
Waiting Time Surveys
• Highly possible since have Customised Survey
Tools
– Database (semi-automated)
– Data Collection Tools
– Report templates
• Highly possible since have Standardised
Survey Procedures
– 70% of future survey’s work already done
– Should be quick (output in 6 to 8 weeks) and
cheap
• Need to Train Staff to implement the surveys
Thank You
Gavin
Ehi
[email protected]
[email protected]