Six Sigma Concepts in OPD: Process Mapping and Waiting Time – Best Study Guides(2022)

Study on Process mapping, Waiting Time Based on Six Sigma Concepts in OPD

Abstract

This study focuses on to identify the various procedures at the outpatient clinic as well as to investigate the possible operational problems that may lead to excessive patients’ waiting time. A patients’ experience in waiting time will radically influence his / her perceptions on quality of the service. The study was carried out in Fortis Memorial Research Institute, Gurgaon (Haryana) for three months. The subjects were outpatients who came to the outpatient clinic in FMRI. Data was analyzed using the six sigma approach. Significant reduction in waiting time was achieved in the outpatient services of department by using the six sigma approach. Doctors were on time in OPD to reduce the delay in the OPD. Patients were coordinated well to the doctors.

Keywords:
Lean Six Sigma, Waiting time, Process mapping

1. Introduction
   

Patients’ waiting time has been defined as “the length of time from when the patient entered the outpatient clinic to the time the patient actually received his or her perception”.

Process mapping is a workflow diagram to bring forth a clearer understanding of a process or series of parallel processes. It views the system from the patient perspective following their journey across organisational boundaries. It helps staff understand how complex and confusing processes appear to the patient. It is organisation specific. It is diagnostic and used as a basis for redesign, actively involving frontline staff in the process. (

Shows how things actually are).

Fig. 1: Patient Process

2. Aim Of the Study

The two main objectives of the study were:

1. To study the patients’ waiting time in the outpatient clinic, with a view to identify the factors that affect waiting time and recommend ways of minimising the delay
2. To use the six sigma technique to identify the delay and improve management capabilities.

3. Research Scope
   

This research was done at the outpatient clinic in FMRI. The research methods chosen were to:

• Directly observe the patients.
• Interview the patients.
• Interview the people involved in managing the work process.

4. Literature Research
   

• WAITING TIME
  

Defined as the total time from registration until consultation with a doctor.

• REGISTERATION TIME
  

Defined as waiting time from the moment patients submit a clinic card or referral letters at the counter until getting a call from the counter. During this time the payment process and record classification are made. Registration time is part of patient’s waiting time.

• SIX SIGMA
  

First introduced by Motorola in 1986, Six sigma is a method to measure the quality of a process to fulfil customers’ needs which approaches perfection. Data and statistical analysis were used to identify defects in processes and reduce variation. With Six sigma, defects in a process can be measured by identifying the best method to eliminate defects and approach zero defect.

Customers’ satisfaction is the main factor. A new and more effective method has to be adopted to ensure customers’ satisfaction.

Six Sigma specifies a very high standard of quality achievement. It utilizes a variety of existing project management, statistical and analytical tools. Several toolkits of the six sigma were applied during this study:

• Descriptive statistics

Statistical image shows characteristics of collected data. At this level, data will be presented using the best presentation tools such as histogram, pie charts or others.

• Flow chart

Chart shows description and sequence of the process done.

• Cause and effect diagram

Diagram shows the relationship of a cause that gives rise to a certain problem.

5. Methodology
   

1. MEASURABLES
   

1.Total waiting time for the consultation.

2.Time taken for Investigations.

2. SAMPLE SIZE
   

This study conducted at the outpatient clinic, FMRI, was an exploratory and evaluation study. Respondents of this study were selected patients, staffs and doctors at the outpatient clinic.

Table 1: Sample Size

RESPONDENTS	TOTAL
Patients	50 each day
Doctors	15
Nurses	5
Administrative staff	7

1. Retrospective data of 4500 patients was analysed for waiting time during the period August- October 2013.
2. Voice Of Patients was obtained from 150 patients.

3. 
   TYPE OF DATA AND COLLECTION METHODS
   

Several variables monitored in this study were data on patients’ waiting time work process, number of doctors available and number of staffs at the registration counter.

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Three major collection methods were used in the study:

• The first method was
  
  observation
  
  . Data were collected through direct observation on the subjects involved in the various working processes in FMRI. Measurements of time spent from registration until consultation by a doctor were made using a stopwatch.
• The second method is through
  
  interview
  
  . In carrying out this research, some of the management staff and doctors were interviewed to obtain information on the working process in the hospital.
• 
  Voice of patients
  
  (VOP) was obtained using standardized questionnaire.

DMAIC METHOD (DEFINE-MEASURE-ANALYSIS-IMPROVE-CONTROL)
The Six Sigma method which consists of the five steps of:

• Define
• Measure
• Analysis
• Improve
• Control

(DMAIC) is the roadmap to achieve the objectives of this study.

DMAIC STEPS

Fig. 2: DMAIC Steps

PROCESS FLOW IN FMRI OPD:

Fig 3: Outpatient Flow

Study was carried out in the GENERAL OPD FMRI Outpatients of 50 per day.

Simple Random sampling was followed.

Period of Study
AUGUST 2013 TO NOVEMBER 2013.

4. STATISTICAL TOOLS

1.

Process Map

-Flow Chart that shows description and sequence of the process done.

2.

Cause and Effect Diagram

– Diagram that shows the relationship of a cause that gives rise to a certain problem.

3.

Affinity Diagram-

Business tool used to organize ideas and data.

4.

Descriptive statistics-

Analysis of data that helps describe, show or summarize data in a meaningful way.

6. 
   Results And Conclusion
   

• DEFINE
  
  

This is the first step that refers to defining the goals of the project. Process improvement goals may be aimed at increasing market share, the output of a particular department, bringing about improved employee satisfaction as well as customer satisfaction and so on.

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The goal has to align the patient demands and the strategic goals of the organization. Data mining methods can be used to find prospective ideas for project implementation.

In other words, businesses are designing a road map for achieving the targets and goals of the organization.

Problem Statement:

Three months retrospective data from the department indicates that in August 2013 only 66.64% of patients were seen within 15 minutes by the physician. In September 2013 this decreased marginally to 59.68% and in October 2013 this was found to be 61.68%.

OPD WAITING TIME – PERCEPTION OF PATIENTS

For understanding perception of patients on OPD waiting time, VOC was collected from 150 patients in the OPD.

Questionnaire for OPD Patients:
1. Did you take an appointment for OPD visit?

a) Yesb) No

2. How did you get the appointment? Through telephone or direct?

3. Are you satisfied with the way your phone call was handled?

a)Yesb)No

4. What instruction was given by the counter staff at the time of appointment/arrival?

5. How did you feel at the reception?

a) Very good b)Goodc)Badd)Very bad

6. How much time it took at the reception, to attend you?

a)0-10 minsb)10-20 minsc)20-30 minsd)>30 mins

7. At what time you were asked to report at the counter and when did you reach the OPD reception?

8. Did any staff brief you regarding the workflow in OPD?

a)Yesb)No

9. How long you have been waiting in OPD?

a)0-10 minsb)10-20 minsc)20-30 minsd)>30 mins

10. Did any information regarding waiting time in OPD was given to you, at the time of appointment?

a)Yesb)No

11. How much time it took for you to interact with doctor after your arrival?

a)0-10 minsb)10-20 minsc)20-30 minsd)>30 mins

12. Are you aware of the existing appointment system in FMRI?

a)Yesb)No

13. What is your perception on waiting time in the hospital?

14. What would you suggest to reduce waiting time in OPD?

15. Any other suggestions?

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How long have you been waiting in the OPD for Consultation (Observations):

• It was observed that 20% patients take prior appointment to consult the doctor whereas 80% patients come Walk- in to consult the doctor.

Fig 4: Appointment for OPD Visit

• 67% patients who come to consult the doctor take prior appointment on the telephone whereas 33% comes directly to get the appointment.

Fig 5: Appointment System

• It was found that 75% of the patients were satisfied with the telephonic call handled whereas 25% patients weren’t satisfied.

Fig 6: Satisfaction Level

• As per as the behavior of the reception of the staff is concerned, it was found that out of 150 patients, 20 patients felt very good behavior; 90 patients felt good, 25 patients felt bad and 15 patients felt very bad behavior from the side of reception staff.

Fig 7: Reception Staff’s behavior

• When process flow was observed to capture the waiting time, it was found that out of 150 patients, 50 patients were attended within 10 minutes; 70 patients were attended within 10-20 minutes; 25 patients were attended within 20-30 minutes and 5 patients were attended more than 30 minutes.

Fig. 8: Time taken to attend the patients

• 75% patients felt that they were briefed regarding workflow in OPD whereas 25% patients felt that they weren’t.

Fig.9: Briefing Regarding Workflow in OPD

• Regarding waiting time it was that out of 150 patients, 60 patients had to wait up to 10 minutes; 5 patients had to wait within 10-20 minutes, 15 patients had to wait within 20-30 minutes and 30 patients had to wait more than 30 minutes.

 

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