Improving Patient’s Waiting Time; A significant predictor of clients’ satisfaction

Written by Prince Assandoh-Mensah in 2017

Patient waiting time in healthcare delivery centres continue to be one of the significant predictors of overall client satisfaction, among other factors such as friendliness of staff and satisfaction of the consultation process (Peprah, 2014; Fenny et al, 2014). Many patients seek healthcare at the General Out Patient Department (GOPD) with expectations of being attended to by qualified doctors and nurses, obtaining cheaper and affordable drugs and receiving efficient and quality service. If these expectations remain unmet, the demand and patronage for care at health care delivery centres is usually affected.

Though in recent times, there is high rate of patient satisfaction (Emelumadu et al, 2012; Singh, 1999) in areas such as patient-provider relationship, patient-provider communication, accessibility and hospital environment, a high number of patient continue to show gross dissatisfaction with patient waiting time and hospital bureaucracy (Ioh et al, 2012).

Patients continue to face lengthy waiting time in most hospitals. Though it’s a pandemic, developing countries seems to be on the rise. A study done in Nigeria showed the average patient waiting time to be 168 minutes (Oche & Adamu 2013). In Ghana, it takes an average of 4hours to seek care in healthcare delivery centres (Van den Boom, 2004).

However, greater proportion of patient waiting time is usually spent before and after consulting with a medical practitioner (and not the consultation itself) as it takes only an average of seven minutes (7min) for consultation (Oche & Adamu 2013). It has been identified that, it takes a patient an average of 78minutes for booking and registration (Oche & Adamu 2013) and after registration, a patient can spend more than 1hour before seeing a medical practitioner (Emelumadu et al, 2012). This suggests that it can probably take a patient an average of 138 minutes (2hours 18min) before seeing a doctor.

Many patients have also expressed dissatisfaction with the services provided at the pharmacy/dispensaries as they have to wait for long periods of time before receiving their medications. Singh et al (1999) writes that “the greatest needs for improvement were perceived to be in pharmacists and doctors services; with particular reference to waiting time. In a comparative study done on patient satisfaction in Ghana, pharmacy/dispensaries received worst ratings among patient enrolled in National Health Insurance Scheme.

Though most research do not consider time spent at the clinical laboratories, the increase use of laboratory services at the GOPD level and the introduction of laboratory confirmation before treatment for diseases such as malaria has rather worsen the situation for patient (in regards to waiting time). Patients now have to wait for several minutes, sometimes hours for their laboratory results to be ready before getting full treatment from doctors.

• CAUSES

The cause of long waiting time may differ from one country to another and even in the same country, from one facility to another. (Oche & Adamu 2013) identified in their study four reasons adduced for long waiting time. Among these are

• Too many patients
• Availability of few doctors
• Few filling and records clerks
• Jumping of queues by patients or staff members

In a study conducted by Ameh et al (2013), respondents brought out some suggestions to decrease time spent on the queue in hospitals. These suggestions include

• That more doctors be employed
• That doctors should come to work on time
• That first-come first-served be observed strictly
• Records staff should desist from collecting bribes from patients in order to place their cards before others.

These suggestions point out the persistence of problems such as inadequate doctors, lateness of doctors on duty, improper adherence to the first-come first-served principle and bribery and corruption found among records staff and some patient; as a some of the reasons for long patient waiting time.

1. IMPACTS

The negative impact of long waiting time is enormous and thus calls for the need for all stakeholders to revisit the canker. It is the major cause of client’s dissatisfaction in hospitals. Emelumadu et al (2012) concluded in their research that, “the waiting time for obtaining the patients card and doctors’ consultation appeared to be acceptably long in this hospital and some respondents were not satisfied with the services rendered.’

In a research conducted in Ghana on hospital waiting time and demand for malaria care (Waki, 2013), the following were established

• Waiting time generally tend to reduce demand for health care from the hospital. Long waiting time at hospitals has a negative direct effect on the demand for health care for malaria from the hospital.
• Indirectly waiting time also reduces the demand for health care for higher income earners and the employed. This is because these categories of people are likely to have higher opportunity cost of time.
• Also, due to long waiting time, individuals use informal sources of health care such as self-medication in treating malaria.

Longer waiting time also has serious economic repercussions on the individual, companies and the nation at large. It takes more than half of one’s working hours in a day to seek for health care at the GOPD.

• REDUCING PATIENT WAITING TIME

Going forward, there is the need take a multi-disciplinary approach in dealing with the long patient waiting time due to its multi-sectorial cause and nature. As such, there is the need for all disciplines or department within the Out Patient Department of the hospital to unite with one force to tackle the menace.

This may involve both infrastructural and attitudinal changes and on top of it all, commitment of the workers at hand. Among these include

• Assigning of Enough Human Resources to the Out Patient Department

The Out Patient Department is the face of every hospital and at far end contribute immensely to the facility in terms of both financial and marketing commitment. It serves the highest proportion of patients that troop to the hospital daily to seek for care. Moreover, most patient rates a hospital according to the care received at the OPD. It is the backbone of every hospital.

Keeping patients for long periods of time at the OPD only brings the hospital’s name under repute. One reason that has been link to this is the lack of enough health worker force at the OPD especially in departments such as the Records/Registration department, Pharmacy departments, Clinical laboratories and also medical practitioners.

There is therefore the need to assign adequate health worker force to the OPD to reduce the patient waiting time. Assigning more worker force basically reduces the burden on each worker thereby reducing efficiency and effectiveness.

• Provision of Adequate space for work

Assigning more health worker force is just not enough; there is the need to provide them with adequate and comfortable space for them to be able to discharge their duties. In most instances, there is this problem of inadequate consulting rooms for doctors. This can probably be counteracted by (though not the best practice) pairing of doctors in one consulting room or engaging in some form of expansion works to create more rooms them.

• Proper Adherence to laid down System of Operation

One of the reasons adduced for long patient waiting time is jumping of queue by patients or staff members (Oche & Adamu 2013). Queues are usually formed at various entry points to most units such as to the records/registration unit, nurses table, consulting rooms, laboratory units and pharmacies. These queues are formed to help in the smooth running of the clinic with the basic principle of ‘first-come first served’ underpinning it.

If some of these laid down system are flouted by staff members or some patients, it consequently affects the waiting time of others. Thus protocols laid down at the hospital must be enforced strictly without fear or favour. Staff members who need medical attention can wait and see the doctor during periods the place is less busy.

However, it must also be emphasized that at the OPD, patients are normally triaged to identify urgent and emergency cases for possible early treatments. In situations like that enough information must be given to those in the queue waiting to receive similar medical attention. Ideally every patient must be informed about triage on arrival at the nursing unit.

• Avoidance of Unhealthy Working Attitudes

Unhealthy working attitudes such as lateness to work, engaging in activities not related to job assignment whiles at post, over-spending of break hours and several other things that consequently prolong the waiting time must be avoided.

Also, the habits of receiving of tips and gifts whiles at post must be discouraged. These items may appear as mere gifts but one may be tempted of reciprocating the kind gesture of the patient which may end up at the detriment of another patient.

• Reducing OPD Bureaucracy

On the average a patient is likely to move to about 5 units (this is even more in most cases) within the OPD in order to seek for medical help for an ailments that would have taken him/her less than 5minutes to self-medicate. From Records/Registration department to Cash Office, to Nurses Units, to Consultation room and to Pharmacy departments… among other departments like X-ray departments and the numerous laboratory units.

The back and forth movements from one departments to the other even make it worse. Sometimes, one has to visit a single department more than twice before exiting the hospital. These things do not only prolong patient waiting time but breeds frustrations among the patients. In order to curb this problem, different departments can be put together or placed in proximity to each other to help prevent long waiting time.

• Health Education

Waiting time can be put to good use by providing health education on specific diseases. This can be presented as a health talk by health personnel. If health education is made an integral part of the OPD services and done effectively, patients will no longer regard waiting time as wasting time. This will help relieve boredom and also afford patients the opportunity to ask questions about their health.

Ayayi et al (2002) writes ‘the provision of health education on specific health issues constitutes an acceptable and useful way of utilising waiting time in the Out Patient Department. This may further improve the health education services provided at such clinics.’⁵

AREAS FOR FURTHER RESEARCH

Almost all the research reviewed were done in health facilities using manual system of processing information (i.e. the use of the folder system) and did not include health facilities using digital or computerised means of processing information.

In an era where a lot of hospitals are moving to computerised means of processing patient information, further research or analysis could be aimed at evaluating patient waiting time in such facilities.

REFERENCES

Ameh N, Sabo B, Oyefabi MO. Application of queuing theory to patient satisfaction at a tertiary hospital in Nigeria. Niger Med J. 2013 Jan;54(1):64-7. doi: 10.4103/0300-1652.108902.

Ajayi IO. Patients’ waiting time at an outpatient clinic in Nigeria–can it be put to better use? Patient Educ Couns. 2002 Jun;47(2):121-6.

Emelumadu OF, Ndulue CN. Patients characteristics and perception of quality of care in a teaching hospital in Anambra State, Nigeria. Niger J Med. 2012 Jan-Mar;21(1):16-20. https://www.ncbi.nlm.nih.gov/pubmed/23301441

Fenny AP, Ernemark U, Asante FA & Hansen KS. Patient satisfaction with primary healthcare- a comparison between the Insured and Non-insured under the National Health Insurance Policy in Ghana. Global Journal of Health Science, Vol 6 No.4, 2014 ISBN 1916-9736. E-ISSN 1916-9744.

Iloh GU, Ofoedu JN, Njoku PU, Odu FU, Ifedigbo CV & Iwuamanam KD. Evaluation of patients’ satisfaction with quality of care provided at the National Health Insurance Scheme clinic of a tertiary hospital in South- Eastern Nigeria. Niger J Clin Pract. 2012 Oct-Dec;15(4):469-74. doi: 10.4103/1119-3077.104529.

Oche M O & Adamu H. Determinants of patient waiting time in the general outpatient department of a tertiary health institution in North Western Nigeria. Ann Med Health Sci Res [serial online] 2013 [cited 2016 Oct 26];3:588-92. Available from: http://www.amhsr.org/text.asp?2013/3/4/588/122123

Peprah AA. Determinants of patient’s satisfaction at Sunyani Regional Hospital, Ghana. International Journal of Business and Social Research. Volume-4 January 2014

Singh H, Haqq ED & Mustapha N. Patients’ perception and satisfaction with healthcare professionals at primary care facilities in Trinidad and Tobago. Bull World Health Organ. 1999; 77(4) 356-360.

Van den Boom, G. J. et al (2004), Health care provision and self-medication in Ghana. Institute of Statistical, Social and Economic Research (ISSER), University of Ghana, Legon.

Waki T. (2013), Hospital Waiting Time and Demand for Malaria Care. A Case Study of the Kumasi Metropolis in Ghana. A Thesis Submitted to the Department of Economics, Kwame Nkrumah University of Science and Technology, Kumasi, in Partial Fulfilment of the Requirements for the Award of Master of Philosophy in Economics. http://hdl.handle.net/123456789/5538