From Long to Short Waiting Time
“Good morning”, I greeted whiles opening the door to the consulting room. Few of them responded and not in a friendly manner.
I entered the room, threw myself into the swivel chair and took a deep sigh. “what a busy day it would be” I soliloquized.
I heard whispers of worry, emanating from the corridors where the patients sit. It is only 8:45am and they have already started complaining. “How would I even tell them the Specialist won’t be able to start at 9:00am today?” I questioned. I know that will cause an uproar! I answered jovially.
This was the state of my clinic few months ago. My patients were always aggrieved for waiting for long hours before seeing their specialist. Averagely, they spent not less than 5hours before seeing the doctor, that means, all the productive hours of the day are spent in the hospital. That had its own repercussions!
But today, my patients are smiling. They are happy to see their specialist. An average of 5hours waiting time has been reduced to only 60minutes. I am going to share with you how I made this possible.
Background
I work in a district-level size hospital in the capital city of Ghana. This year I was assigned to the Outpatient Department, specifically one of the busiest specialist clinics. Patients come from different part of the country (as far as Eastern, Ashanti, Volta, Central and Western region) to attend the clinic. Common with many specialist clinics across the country, to be seen early, and at times, to be seen at all (when there is limit), patients would have to report exceedingly early.
Daddy’s Experience
My Dad was a victim of this system when I was in college. He had to travel about 82km to see a specialist in one of the tertiary hospitals in the country. To be seen and not exceed the daily limit, he must report to the clinic before 5:00am whereas consultation starts after 8:00am. At times he wakes up as early as 1:00am, prepare and walk through the dark to the bus terminal; risking his life to get medical attention. This is what I foresaw my patients go through every clinic day.
Stakeholder Involvement
My first approach was to talk all stakeholders to the problem. I wanted to know whether they perceive something wrong with the current status quo. It was a bit divided though. Some of the patients wish something is done about it whereas a majority still believed in the ‘first come, first served’ mantra. I remember one of the team members also said, “a patient must always come to wait for the doctor, not the vice versa”. The general sense I got after the consultation was, “Yes, something can be done but what.”
The Plan
I thought of couple of systems but settled on the appointment system though it had its own challenges. Besides, it was not new to the clinic; was implemented and failed some time ago. Needed to be well planned to convince other stakeholders to buy the idea.
The Study
I did a mini and informal study. I had to study the total hours used for consultation, average period (number of minutes) of consultation per patient, actual waiting time for each patient, actual time for the start of the clinic (consultation) and the total number of patients seen per clinic. I had to study this for three consecutive weeks.
With this, I was able to know the number of patients I can assign per clinic and the number of patients I can assign to be seen per every hour plus some few things that could help me plan the clinic very well.
Request for Support
I sold the idea to all the stakeholders including the records unit, the specialist team and my bosses, the outpatient department nursing management. They all agreed to give it a try and offer their support.
I needed two notebooks and a dedicated phone number to start with. One of the notebooks will be used for general booking of walk-in patients to be assigned date and time later whereas the other notebook was for patients who have been assigned date and time. My boss provided both books and informed the other staff about the initiative. At least, they will assist in booking of walk-in patients.
The records unit also pledge their support to the initiative. They promised to open the folders of only patients with assigned date and time. I was given appointment booklet to give them.
The specialist team also pledged their support. They promise to ensure that all patient have appointment date and time before leaving the consulting room. And most importantly, the patients promised to heed to the exact appointment and time.
The Beginning
It did not start without challenges. However, after first week of implementation, it was like a bicycle descending a hilly road; everything was smooth, and all stakeholders were happy. As I write this, we are in the 6th week of implementation and I promise to keep us all updated with time. The best part of it is that our patients are happy, they do not have to travel at dawn to the clinic.
Written by Prince, RN
