Background of the topic:

Out Patient Department is the first point of contact with the patient and serves as an
window to any healthcare service provided to the community. The care in OPD indicates the
quality of services of a hospital and is reflected by the patients satisfaction and their
perception about the time spent. Many patients get their first impression of hospital from the
outpatient department. The OPD is also popularly known as shop window of hospital.
Everything is done to create an atmosphere of friendliness and welcome. OPD is the busiest
service area in the hospital, the public relation in the OPD are most important, as all the
patients and their relatives who visits the hospital approach the staff posted in OPD. There
can be different types of patients: new patient, revisit patient, emergency cases, referred
patients, fixed appointment patients etc all these have to be dealt in a proper manner. The
behavior often with people decides success or failure of the hospital and also the reputation.
Hence the planning of physical facilities, its infrastructure, nature and behavior of OPD staff,
the authority rested in various functionaries, the responsibility assigned to various people and
the availability of resources are very important.

A well managed out patient service ensures not only good relations, but enhances the patient
flow to hospital. It ensures patient satisfaction and the satisfaction of the patients relatives.
With emergence of new concepts in the healthcare industry today, like medical tourism and
contracting in healthcare, these are two diverse concepts, but we have to synergize these two.
This holds true in hospital functioning in public sector. The people are ill, at the same time
they dont want to leave it to the choice of hospital. The patient of today and tomorrow will
not remain in the receiving end. He wants to be chooser. Now it is up to these hospitals to
provide them the options. The hospitals of today are comparable with five star hotels in much
aspect. There are people who love to go to dhabas for meals and at the same time there are
also good numbers of people who want to go to five star hotels for their meals. The human
needs remain almost similar as far as the amenities are concerned. Under this condition we
are concerned and obsessed to think in similar manner. The OPD is defined as a part of
hospital with the allotted physical facilities and medical and other staff in sufficient number
with regular schedule hours, to provide care for patients who are registered as inpatients.
Ambulatory medical care provided to patients who are not confined to beds. Clinics,
specialist clinics, polyclinics, health centers or hospitals where such a care is provided in a
OPD of a hospital, is called out patient care.

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The health care industry is under increased pressure from not only national political forces,
but also from the competitive marketplace, to manage patient services more efficiently. The
impact of restructuring the delivery of health care through OPDs, IPD and Emergency
services will cause significant changes in the entire health care system, resulting in a shift of
overall hospital management philosophy. Traditionally, the objective of hospitals has been to
stress high occupancy, growth in admissions and increased cases load. The most critical
challenge for hospitals will be to provide quality health care in the most efficient and cost-
effective manner possible. This includes getting the patient well and out of the hospital
quickly. The viability of hospitals will depend on their success in responding to changing
payer demands. A hospital and its OPD is an integral part of a social and medical
organization, the function of which is to provide for the population complete healthcare, both
curatives and preventive and whose outpatient services reach out to the family and its home
environment. The hospital is also a centre for the training of health workers and bio-social
research. Opportunities in Indian health sector provide extensive research and objective
analysis in India. With global revenues of an estimate $ 2.8 trillion, the health care is the
worlds largest industry. Indias high population makes it an important player in the industry.
Based on the insurance regulatory and development authority, the Indian health care industry
has the potential to show the same exponential growth that the soft ware and health care have
shown in the past decade. The hospital OPD is the allied subsector of health care in India.
These establishments have an organized medical staff of physician, Nurses and other health
professionals, technologists and technicians. Health care service centers use specialized
facilities and equipments that form a significant and integral part of the production process.
Various service segments have been briefed along with growth drivers, critical success
factors, issues and challenges and regulatory environment.

Hospitals OPDs have passed through various stages of development from centers of the
religious practices in the fifteenth century where the care providers were the clergy and nuns
to the Hi-Tech institutions of the twentieth century which are managed by the professional,
constantly striving for the highest quality of care. The expansion of medical knowledge and
technological development has flooded the hospital OPDs with many specialties and super
specialties, leading to a hierarchy of staff from highly qualified super specialists to the house
keeping worker with divers reasoning, varied perceptions of medical care and dissimilar
experiences. Simultaneously, with the increase in literacy rate, improved socio-economic
states and easily accessible medical care, public have increased their experience and demands

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which have resulted into reduced level of satisfaction of the people. This has lead to an
increased strain on the service providers, both in private sector and government setup to cope
with these expectations and demands of patients visiting the OPDs.

Growth and development of the industry:

Health care industry in developing world is all set to grow exponentially and India with its
inherent qualities can become the global hub for healthcare services. It is being touted as the
next big boom and the sector is expected to grow rapidly over the next decade, to reach a
level of Rs 6200 billion by 2018, largely spurred by an increased corporate presence in the
sector. The healthcare industry has two segments public healthcare and private healthcare.
Government healthcare infrastructure primarily caters to serving the semi-urban. With the
liberalization of entry norms in the Indian healthcare market has paved the way for private
players. The Government of India is offering several incentives to private organizations,
including subsidized land and tax benefits. Economic reforms have also significantly raised
the standards of living of a large percentage of the population and the middle class segment is
creating increased demand for modern healthcare treatments. The combination of specialty
healthcare services in both OPDs and IPDs with low cost advantage has led to a regular
inflow of foreign patients. Corporate hospitals and increase foreign investments have
completely changed the face of Indian healthcare. The national accreditation board for
hospitals and healthcare providers (NABH) setup the ministry of health under the quality
council of India has finalized the guidelines for accreditation of hospitals and other healthcare
service providers and A.J. Hospital and Research center has already got accreditated.

Out Patient Service system:

It is easy to see outpatient services in the light of general systems approach. The
environment is the surrounding community that the outpatient department serves. The input
to the organization is of two kinds: Human and natural resources. The human resource
includes professionals, non-professionals, administrative staff and patients. The natural
resource involves money, equipments and supplies. The patient (input) are then processed
through the application of medical knowledge and treatment. After being restored to the best
possible health, the patients are again returned to the community (output). The feedback
process occurs when the healthcare agency or the OPD learns whether the community is
satisfied with the result, the type, the amount cost, care given etc. The below figure explains
the same.

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 FEEDBACK satisfied

Dissatisfied

Newspaper editorials

Questionnaire responses

INPUT OUTPUT
Healthcare
Human resource and provider Individual restored to
best possible health
Natural resources

ENVIRONMENT

Needs and demands of

community

Chart 1.1: OPD system

In this highly competitive era, clinics/ Hospitals give their patients appointment so as
to minimize on the time spent at the Hospitals. The reasonable waiting time for a patient on
appointment is about 10 minutes. In A.J. hospital OPD, the core importance of giving patients
appointment was not being met. According to a baseline survey done in December 2014, the
average the waiting time for patients on appointment was 40 minutes while those without
appointment were waiting for 90 minutes instead of the recommended 30 minutes. It was for
this reason that a continuous quality improvement project at A.J. hospital was proposed to
assess why patients were being delayed and thereafter institute countermeasures aimed at
reducing the patients waiting time at the facility as a means of improving health service
delivery and increase patients satisfaction. The project ran from December 2014 to March
2015. In this particular project we study the perceptions of patients regarding hospital OPD
service. The patient is the boss and we all work for him only, treat him with proper respect
and human dignity. Prolonged waiting time is one of the major problems in OPDs. And the
different measures to overcome it have been studied in detail in reference to A. J. Hospital.
To have a good level of patient satisfaction, one of the important factors is quality. Quality is

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the number one priority in the health care and quality improvement should be healthcares
essential business strategy. A.J. Hospital and research centre is a 250 bedded multi-specialty
hospital located in the city of Mangalore with all basic healthcare services under one roof.
The hospital is working towards providing good and successful customer service. The OPD
of A.J. Hospital has been introduced with the aim to provide successful customer service
oriented structured systems with good internal environment to create a positive customer
experience through variety of strategies that include dcor, displays, customer amenities and
customer services. Hospital also provides other basic desires for comfort, convenience,
safety, entertainment and information which are anticipated and addressed.
Conceptual framework:
WHO definition of hospital:

The hospital is an integral part of social and medical organization, the function of which is to
provide for the population complete health care , both curative and preventive and whos
outpatient services reach out to the family and its home environment. The hospital is also a
centre for training of health workers and bio social research

Types of Hospital:

Hospitals usually are distinguished from other types of medical facilities by their ability to
administer and care for inpatients and the others often are described as a clinic.

1. General: The best know type of hospital is the general hospital, which is setup to deal
with many kinds of disease and injury, and typically has an emergency department to
deal with immediate and urgent threats of health. A general hospital typically is the
major health care facility in its region with large number of beds for intensive care
and long term care; and specialized facilities for surgery, plastic surgery, childbirth,
bioassay laboratories, and so forth.
2. Specialized: Types of specialized hospitals include trauma centers, rehabilitation
hospitals, childrens hospitals, seniors (geriatric) hospitals, and hospitals for dealing
with specific medical needs such as psychiatric problem ( psychiatric hospital ),
certain disease categories, and so forth.
3. Teaching: A teaching hospital combines assistance to patients with teaching to
medical students and nurses and often is linked to a medical school, nursing school or
university.

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 4. Clinics: A medical facility smaller than a hospital is generally called a clinic and often
is run by a government agency for health services or a private partnership of
physicians ( in nations where private practice is allowed ). Clinic generally provides
outpatient services.

Definition of Out Patient Department: It is the first point of contact between the hospital
and the community and which, in many instances, can make or mar the reputation of the
hospital. The importance of the OPD lies in the following:

It contributes to reduction in morbidity and mortality.

It is a stepping stone for health promotion and disease prevention.
It helps reduce the number of admission to inpatient wards, thus, conserving scarce
beds.
It acts as a filter for inpatient admissions, ensuring that only those patients re admitted
who are most likely to benefit from such care.
Types of OPD:
Basically the OPD can be of two types:
1. Centralized: In this all the OPDs of clinical departments of the hospital are grouped
together in the form of OPD complex. It will include all diagnostic, therapeutic and
utility areas concerning OPD. The consultants from different departments come to this
area for OPD work.
2. Decentralized: Here the OP care is provided in respective departments of the hospital.
Similarly, the therapeutic and diagnostic services are also provided department wise.
The specialty clinics are more suitable for this type of OPD like department of
Ophthalmology, ENT, etc.
Key terms used in OPD:
1. Service time: It is the time taken by the doctor to diagnose the patients illness and
instructing him/her, and includes taking history, examination, making case note and
prescription writing, and signing requisitions for special medicines or investigations.
2. Unit of service: It is the measurable part of the volume of service rendered in
diagnostic or therapeutic facilities of the hospital, expressed in terms of time and
quantity.
3. OP visit: A persons visit at OPD to receive service. The visit may be new patient
visit or repeat patient visit.

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 4. General outpatient: A person not referred by other physician who comes to the OPD
on his own and is given diagnostic and /or therapeutic services on an outpatient basis,
for other than emergency condition.
5. Referred outpatient: A person referred to the OPD by a private practitioner or other
physicians from one clinical discipline to the other, for specific diagnostic or
treatment procedures and who will return to the referring physician for further care
and disposal.
6. Emergency outpatient: A person requiring emergency care as result of sudden severe
illness or accident.
Waiting time:
When you are ill or in pain, there is nothing more frightening or frustrating than having to
wait for treatment. Too many patients face long wait times for health services. Not only does
this hurt the patients, it makes all of them wonder if our public health care system is broken.
In fact, in places where there are for profit parallel systems, wait times are as long or longer.
The good news is that wait times are fixable, and the solutions are found in the public health
care system. By changing some of the ways that we now carry out important health services,
we can cut wait times dramatically, improve patient care and reduce costs. There are many
complex reasons for longer wait times, and there is not one single cause. Thats why reducing
wait times will require system-wide improvements.
Reasons for longer wait times:

Poorly organized services inefficiencies, lack of coordination among all those

involved in delivering services and poor planning slow down the system and create
bottlenecks in providing surgeries and other services.
Shortages of health care workers if patients cant get to see a doctor quickly (or at
all) they turn to emergency rooms (ERs), extending wait times in ERs.
Physicians dont work in teams most doctors offices work alone, so all
appointments and procedures leading up to surgery are managed individually, leading
to delays and inefficiencies at every step.
Cuts to hospital services between 1988 and 2002 there were 64,000 hospital beds
cut.
The need for more long-term care and home care under-funding of home care
and residential long-term care has increased inappropriate and preventable
hospitalization and adds pressure on emergency rooms.

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 Better outcomes when we improve services, more people can benefit from them
(e.g. many patients now have surgeries that would have been too dangerous a few
years ago).

Chart 1.2: Fish bone model Reasons for prolonged waiting time

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The public health care solutions:

To reduce wait times, we need to make important system wide improvements in our health
care system. Many of these changes have already been tried successfully in some regions of
the country.

Fund the public solutions governments need to make system-wide improvements

based on the successful projects in public hospitals and clinics that are dramatically
reducing wait times.
Put patients before profits it seems obvious, but when efficient and appropriate
patient care is made a priority, administrative and clinical practices improve and wait
times are shortened.
Common waiting lists all patients waiting for certain surgeries go into a single list
for the first available surgeon. Patients could still choose their surgeon, but they might
have to wait longer.
Better coordination by staggering start-time for surgery and standardizing surgical
equipment and procedures including pre-screening and tests. Where this has been
tried, wait times dropped 75% and the number of surgeries completed increased by
136%.
Expand team work establishing teams of health care providers including
physicians, nurses, nurse practitioners and other health professionals eliminates
duplication, improves coordination and makes better use of scarce resources.
Modernizing electronic information systems so everyone in the health care team
has timely access to accurate and up-to-date patient information and there is no
unnecessary waiting for patient records.
Improve community care by putting resources into long term care, home care and
home support, we can keep people healthier and out of hospital, and relieve the
pressure on hospital beds.
Improve access to family health care when patients can get timely access to
family health care teams, through community clinics and urgent care centers, the wait
time in ERs drops dramatically.

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Problem solving in Hospitals: Cause and effect model

See the below figure, the reason for prolonged waiting time are many like patient factor,
clinical factor, faulty appointment system, equipment factor, etc. If counter measures are
taken at right time, then there are good possibilities to reduce the patient waiting time in the
hospital. And this leads to various out comes like: Improved quality of health service
delivery, Increased patient satisfaction, Improved image of the hospital

Patient factors Appointment scheduling

Do not keep appointments system
Do not communicate if unable to come Not co-ordinate
Come late Packed appointments
Have preconceived idea of being delayed No streamlined appointment system

COUNTER MEASURES
Health education
Hold a time management seminar for all staffs
Buy more instruments
Start packing instrument according to procedures
Start a tray set-up system for different procedures
Start using a standard appointment system in the clinic
Design and pin-up appointment posters
Have a running commentary played in the clinic

Clinician factors
Come late for work Equipments/Instruments
Start working late The essential ones not being enough
Do many procedures on one patient Not sterilized fast enough
Not sensitized on time management Not packaged according to procedures

Reduced patient waiting time in the hospital

Out come
Improved quality of health service
delivery
Increased patient satisfaction
Improved image of the hospital

Chart 1.3: Cause and effect model

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Current scenario:

The reach of technological innovation continues to grow, changing all industries as it

evolves. In healthcare, technology is increasingly playing a role in almost all processes, from
patient registration to data monitoring, from lab tests to self-care tools. Devices like smart
phones and tablets are starting to replace conventional monitoring and recording systems, and
people are now given the option of undergoing a full consultation in the privacy of their own
homes. Technological advancements in healthcare have contributed to services being taken
out of the confines of hospital walls and integrating them with user-friendly, accessible
devices. The following are some technological advancement in healthcare that have emerged
over the last ten years.

1. The electronic health record: While the EHR has already created big strides in the
centralization and efficiency of patient information, it can also be used as a data and
population health tool for the future. "There's going to be a big cultural shift over the
next several years of data-driven medicine," says Waco Hoover, CEO of the Institute
for Health Technology Transformation in New York.
2. mHealth. Mobile health is freeing healthcare devices of wires and cords and enabling
physicians and patients alike to check on healthcare processes on-the-go. An R&R
Market Research report estimates the global mHealth market will reach $20.7 billion
by 2019, indicating it is only becoming bigger and more prevalent. Smartphones and
tablets allow healthcare providers to more freely access and send information.
Physicians and service providers can use mHealth tools for orders, documentation and
simply to reach more information when with patients, Mr. Sturman says.
3. Telemedicine/telehealth. Studies consistently show the benefit of telehealth,
especially in rural settings that do not have access to the same resources metropolitan
areas may have. A large-scale study published in CHEST Journal shows patients in an
intensive care unit equipped with telehealth services were discharged from the ICU 20
percent more quickly and saw a 26 percent lower mortality rate than patients in a
regular ICU. Adam Higman, vice president of Soyring Consulting in St. Petersburg,
Fla., says while telemedicine is not necessarily a new development, it is a growing
field, and its scope of possibility is expanding.
4. Portal technology. Patients are increasingly becoming active players in their own
healthcare, and portal technology is one tool helping them to do so. Portal technology

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 allows physicians and patients to access medical records and interact online. Mr.
Sturman says this type of technology allows patients to become more closely involved
and better educated about their care. In addition to increasing access and availability
of medical information, Mr. Hoover adds that portal technology can be a source of
empowerment and responsibility for patients. "It's powerful because a patient can be
an extraordinary ally in their care. They catch errors," he says. "It empowers the
patient and adds a degree of power in care where they can become an active
participant."
5. Self-service kiosks. Similar to portal technology, self-service kiosks can help
expedite processes like hospital registration. "Patients can increasingly do everything
related to registration without having to talk to anyone," Mr. Higman says. "This can
help with staffing savings, and some patients are more comfortable with it."
Automated kiosks can assist patients with paying co-pays, checking identification,
signing paperwork and other registration requirements. Mr. Higman says there are
also tablet variations that allow the same technology to be used in outpatient and
bedside settings. However, hospitals need to be cautious when integrating it to ensure
human to human communication is not entirely eliminated. "If a person wants to
speak to a person, they should be able to speak with a person," he says.
6. Remote monitoring tools. At the end of 2012, 2.8 million patients worldwide were
using a home monitoring system, according to a Research and Markets report.
Monitoring patients' health at home can reduce costs and unnecessary visits to a
physician's office. Mr. Higman offers the example of a cardiac cast with a pacemaker
automatically transmitting data to a remote center. "If there's something wrong for a
patient, they can be contacted," he says. "It's basically allowing other people to
monitor your health for you. It may sound invasive but is great for patients with
serious and chronic illnesses."
7. Sensors and wearable technology. The wearable medical device market is growing
at a compound annual growth rate of 16.4 percent a year, according to a Transparency
Market Research report. Wearable medical devices and sensors are simply another
way to collect data, which Dr. Chopra says is one of the aims and purposes of
healthcare. He says sensors and wearable technology could be as simple as an alert
sent to a care provider when a patient falls down or a bandage that can detect skin pH
levels to tell if a cut is getting infected. "Anything we are currently using where a

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 smart sensor could be is part of that solution," Dr. Chopra says. "We're able to take a
lot of these data points to see if something abnormal is happening."
8. Wireless communication. While instant messaging and walkie-talkies aren't new
technologies themselves, they have only recently been introduced into the hospital
setting, replacing devices like beepers and overhead pagers. "Hospitals are catching
up to the 21st century with staff communicating to one another," Mr. Higman says,
adding that internal communication advancements in hospitals followed a slower
development timeline since they had to account for security and HIPAA concerns.
9. Real-time locating services. Another growing data monitoring tool, real-time
locating services, are helping hospitals focus on efficiency and instantly identify
problem areas. Hospitals can implement tracking systems for instruments, devices and
even clinical staff. Mr. Higman says these services gather data on areas and
departments that previously were difficult to track. "Retrospective analysis can only
go so far, particularly in places constantly changing like emergency departments," he
says, but tracking movement with a real-time locating service can highlight potential
issues in efficiency and utilization.
10. Pharmacogenomics/genome sequencing. Personalized medicine continues to edge
closer to the forefront of the healthcare industry. Tailoring treatment plans to
individuals and anticipating the onset of certain diseases offers promising benefits for
healthcare efficiency and diagnostic accuracy. Pharmacogenomics in particular could
help reduce the billions of dollars in excess healthcare spending due to adverse drug
events, misdiagnoses, readmissions and other unnecessary costs.

All these recent technologies help us to provide quick service to our patients, so as to reduce
the prolonged waiting time in the OPD and Hospital as a whole.

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Research design
Objectives:

Fixing the objective is like identifying the star. The objective decides where we want to go,
what we want to achieve and what is our goal or destination.
To study patient perception regarding prolonged waiting time in OPD in A.J.
Hospital.
To determine the flow of patient and the average time spent by the patient in OPD of
A.J. Hospital.
To identify the factors those are responsible for high waiting time in OPD of A.J.
Hospital.
To recommend appropriate suggestions to optimize the prolonged OPD waiting time
in A.J. Hospital
Statement of The Problem:
A survey done in A.J. hospital during the months of December 2014 to March 2015, found
that on average after registration of the patients, the new patients would wait for ninety
minutes while those on appointment would wait for forty minutes before being called into the
clinical rooms to see the doctors. Both patients on appointment and those on the queue would
on many occasions show their discontentment with the long waiting time at the clinic. Some
patients would openly grumble, shout at the staff and some would get so agitated and walk
out in protest, unattended to. This project was under taken in A.J. hospital and research centre
OPD to reduce the average patient waiting time for both the line patients and those on
appointment. Reducing patients waiting time in the hospital will-
Improve the quality of health service delivery.

Increase patients satisfaction.

Help the hospital not only to retain its clients but also attract new ones.

Improve the general image of the Hospital.

Methodology:
Research methodology in a way is a written game plan for conducting research. Research
methodology has many dimensions. It includes not only the research methods but also
considers the logic behind the methods used in the context of the study and complains why
only a particular method of technique has been used.

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Data Collection Methods:
The data will be collected using both by primary data collection methods as well as
secondary sources.
Primary Data: Most of the information will be gathered through primary sources.
The methods used to collect primary data are:
Questionnaire
Interview
Secondary Data: secondary data will be collected through:
Text Books
Magazines
Journals
Websites
Method use to present data:
Data Analysis & Interpretation: Classification & tabulation transforms the raw data collected
through questionnaire in to useful information by organizing and compiling the bits of data
contained in each questionnaire i.e., observation and responses are converted in to
understandable and orderly statistics are used to organize and analyze the data:
Simple tabulation of data using tally marks.
Calculating the % of the responses.
Formula used = (number of responses / total responses) * 100
Graphical analysis by means of pie-charts, bar graphs etc.
Testing the hypothesis with chi-square test.
Research Design: The research designs used in this study are both Descriptive.
Number of Respondents: Total samples of 50 respondents who respond to the
questionnaires.
Sampling Technique: The technique used for conducting the study is convenience sampling
technique as sample of respondents will be chosen according to convenience.
Stastical Tools: The tools use in this study is MS-WORD to prepare pie- charts and graphs
also used to write the whole project report.
Scope of Study:

Study limited only to 50 respondents.

Study conducted refers to A.J. hospital and research center only.

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 Entire OPD is considered as a whole for study, it is not divided into particular
departments.
Only patients perception is studied through questionnaire.

Limitations of Study:

Difficulty in data collection

Study may get influenced by Patient bias

Time consuming

Review of Literature:

A report Reducing patient waiting time in Mengo Hospital dental Clinic by Nannozi Mary
Juliet (2013) explains as such, an Outpatient Department represents a complex system
through which many patients with varying needs pass each day. An effective appointment
system is a critical component in controlling patient waiting times within clinic sessions.
Current waiting times are often unacceptable and place great stress on clinic staff. In the out-
patient department, the main indicator of quality assurance for patients is waiting itself;
patients should be attended to within an acceptable time. The using of simulation in
healthcare industry is now a new story. Simulation allows significant exploration of multiple
options, without spending enormous amounts of money on staff, training, equipment, and
most importantly, without risking possible degrading in the level of healthcare. It has been
utilized by many various outpatient services.
Waiting time: Defined as the total time from registration until consultation with a doctor.
There were two waiting times, the first is time taken to see a doctor and thesecond is time to
obtain medicine. (Jamaiah Hj Mohd Sharif and Suriani Sukeri 2003) . Patient waiting time is
generally known as the length of period taken from when the patient enters the waiting room
or the consulting room until when the patient actually leaves the hospital/clinic. Due to, the
fact that medical procedures take varying time depending on the complexity of the treatment
procedure. Registration time: Defined as waiting time from the moment patients submit a
clinic appointment card or referral letters at the counter until getting a call from the counter
(WL Lim, MD, Manaes, 2001). During this time the payment process and record
classification are made. Registration time is part of patients waiting time.
WORK FLOW IN OPDS:
Reducing waiting time in Out Patient Services of Large University teaching Hospitals
report by Prof. Dinesh T.A, Prof. Dr. Sanjeev Singh (2013) - The flow diagrams given below
show the sequence of actions that take place in regular OPDs.
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 The chart 2.1 shows that procedure for new appointment, fixed appointment and
revisit patients. It also shows, in case of emergency whether the patient has to be
referred to specific doctor (cardiologist) or require emergency admission.
The chart 2.2 shows that if the patient is requested for further investigations like blood
tests, ECG/Echo or radiology department then, what are the procedures followed in
that departments.
The chart 2.3 shows the continued procedure in OPDs once the patient comes back
from investigation centers with reports to revisit the doctor. The flow ends with either
of these results: - Patient goes home with medication, Reference to another
department, Schedule tests for another day, Advice for admission, Schedule
admission for another day. Any delay in continuity of these procedures may lead to
prolonged waiting time in OPD.

Chart 2.1: OPD procedure for new appointment, fixed appointment and revisit
patients.

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 Chart 2.2: OPD procedure for patients who are sent for investigations

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 Chart
2.3: OPD procedure for patients who revisit with their investigation reports to
the doctor, for medication or admission.

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Study on outpatient waiting time in Hospital university Kebangsaan Malaysia through six
sigma approach- reported in (2006) explains as follow.
Outpatient department in any hospital is considering being shop window of the hospital. An
outpatient service is the most important services provided by all the hospitals as it is the point
of contact between a hospital and the community. It is ambulatory care centers which provide
to all members of a community the whole scope of services that are needed to keep them in
good state of health directed or by referral to more qualified institutions. Many patients gain
their first impression of the hospital from the OPD. A neat and clean hospital with necessary
information boards and proper directions generally provide good image. Out-patient services
are the most important services provided by all the hospital as it provides services to a large
number of patients at a low cost. Successful and efficient management of hospital can lighten
the burden on the patient words.
Causes of long waiting time: Long waiting time can be identified through cause and effect
method. There were four major elements that influence the waiting time such as availability
of facilities and equipment, human resources, number of patient crowd and delay in
registration process (see chart 2.4).

Chart 2.4: Cause and effect of long waiting time

a) Cause and effect of delay in registration

The main cause of the long waiting time is time taken for registration (see chart 2.5). A few
processes have to be carried out by the counter staff during registration. The first process is to
enter data into computers based on the patients appointment card so as to obtain the
reference number of the patient. Then the record staff would search for the patients medical

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record in the record room. Improper record management and poor filing system affect the
search time leading to a longer waiting time for patients. Work process involving record
keeping would also affect registration time. Other factors include the experience and
efficiency of staff. Insufficient computer facilities at the registration counter and lack of
skilled staff and nurses can also cause delays. There were new patients that came to the
hospital for first appointment as well as the follow up patients who already had appointments.
However, only the date of treatment was stated in the appointment card while time was not
specified for the follow-up patients. As a result, many problems arose when all of the patients
come at the same time. In addition, mixing up of registration cards between patients with and
without appointment causes delays because more time is needed for sorting purposes.

Chart 2.5: Cause and effect of delay in registration procedure

b) Cause and effect of insufficient number of doctors:

Insufficient number of doctors would increase patients waiting time. Disproportionate
number of doctors and patients would cause a bottleneck in the queue for service (see chart
2.6). When this study was carried out, only six doctors were at work, while nine examination
rooms were available. This implies an inefficient utilization of available resources. There
were a number of factors that caused the insufficient number of doctors on duty. For
example, there were doctors who double up as lecturers, doctors on call and doctors doing
further studies. Therefore, a well-planned schedule should be in place so that patient care is
not adversely affected.

21 | P a g e
Chart 2.6: Cause and effect of insufficient number of doctors

c) Cause and effect of insufficient number of counter workers:

Staff at the counters also provides service to the patients. Throughout the study, only three
staff were on duty at a time. Each staff had their own specific duties. One staff will be in
charge of keying in patients data. The second will be in charge of receiving payments while
the third will be responsible in retrieving patients files. The number of counter staff is not
adequate compared to the number of patients, thus leading to a long waiting time for service.
Proper organization of work and division of tasks among staff would greatly reduce waiting
time. The majority of the staff at the counter have 5 years working experience. From the
observations and feedback obtained during the interview, they were not motivated to change
nor adopt the new system of work due to various reasons such as age, level of education,
salaries and bonus (see chart 2.7).
Chart 2.7: Cause and effect of insufficient number of counter workers

22 | P a g e
Understanding Patient Wait Times at the LV Prasad Eye Institute, By Ali Kamil, and
Dmitriy Lyan, (2013) - Based on their work on the ground and subsequent application of
system dynamics to determine the cause for variability and long service times, they showed
that: Given a fixed OPD capacity, patient wait times are largely a function of service demand,
scheduling, and resource-specific factors;

Demand and scheduling factors include the complexity of patient cases, their volume,
and the way they are scheduled in a given day; factors impacting resource allocation
and utilization include patient workup time, patient investigation time, and the
operating hours of the OPD clinic;
To accommodate larger daily volumes of patients, providers reduce the time they
spend with each patient, thereby undermining the quality of care provided and
increasing the likelihood of medical errors; and
Walk-in patients are the source of variability in the system and cause the established
schedule at LVPEI to deviate.

Given the fixed OPD capacity and service staff, we recommended that LVPEI consider
allocating blocks of time in the day dedicated specifically for walk-in patients and follow-up
patients. Increasing awareness and enforcing adherence to an appointment-based scheduling
system will enable predictable patient wait and service times.

A Time Motion Study in the Immunization Clinic of a Tertiary Care Hospital of Kolkata,
West Bengal, Amitabha Chattopadhyay, Ritu Ghosh,(2012) - A time-motion study is a
business efficiency technique combining the time study work of Frederick Winslow Taylor
with the motion study work of Frank and Lillian Gilbreth. It is a major part of scientific
management (Taylorism) A time and motion study is used to determine the amount of time
required for a specific activity, work function, or mechanical process. Few such studies have
been reported in the outpatient department of institutions, and such studies based exclusively
on immunization clinic of an institute is a rarity. The result of study as follows, median time
was the same for both initial registration table and nutrition and health education table (120
seconds), but the vaccination and post vaccination advice table took the highest percentage of
overall time (46.3%).

23 | P a g e
COMPANY PROFILE
Origin of the Trust

Laxmi Memorial Trust was established in the year 1991 by the well known
industrialist and philanthropist Mr. A. J. Shetty in memory of his beloved mother, late Laxmi
Shetty. The trust has established a multi campus network of Medical, Paramedical and
Management education institutions. These institutions enjoy a high reputation, well known
for their academic excellence, discipline and conducive academic environment. The trust has
been active in the field of medical education for the last fifteen years.

Members of the trust:

The Trust is constituted under the charitable trust act. The members are:

Mr. A. J. Shetty
Mrs. Sharada Shetty
Mr. Prashanth Shetty
Dr. Prashanth Marla
Dr. Amitha Marla
Institutions run by the trust:

A. J. Institute Of Medicals Sciences

A.J. Institute Of Dental Sciences
Laxmi Memorial College Of Physiotherapy
Laxmi Memorial College of Nursing
Laxmi Memorial Institute of Nursing
Laxmi Memorial Institute Of Paramedical Sciences
Moti Mahal College Of Hotel Management
A. J. Institute Of Management
A. J. Institute Of Hospital Management
A.J. Hospital and Research Centre:

A.J. Hospital & Research Centre, Mangalore was established in the year 2001. It is
one of the most advanced tertiary care centers of coastal Karnataka. With an excellent team
of highly qualified medical professionals and state-of-the technology, supported with
paramedical and nursing staff, the hospital has emerged as a shining symbol of hope for
availing quality healthcare at an affordable cost. The hospital is designed and built according
to the international standards to provide-world class facilities.

24 | P a g e
AJ Hospital was set up with the objective of providing world class healthcare facilities and to
make the best of the heath care available in the coastal region of Karnataka. AJ Hospital and
Research Center is a 700-bedded super-specialty hospital, specializing in more than 20 major
medical disciplines, embracing new technologies to offer high level healthcare that matches
the best in the country. Hospital is supported by a team of highly qualified and experienced
doctors, nursing, and paramedical staff.

AJ Hospital and Research Center came into existence in the year 2001, with the
mission of providing world class healthcare facilities in Mangalore. It was AJ Shetty's dream
to make the best of healthcare available in the coastal region of Karnataka. AJ Hospital is
completing 13 years of its service to the society.

Mission:

The hospital constantly strives to:

Achieve customer satisfaction by compassionate attitude and quality healthcare

services
Provide comfortable and a risk free environment for the patients
Bring quality healthcare within the financial reach of every individual
Attain excellence in medical education and research
Provide comfortable and safe working environment for the employees
Vision:

AJ Hospital and Research Center is committed to bring quality medical care of the highest
standard within the reach of every individual. To realize this dream of quality healthcare for
all, the hospital strives for excellence in medical services, health education, and research.

Quality policy:

AJ Hospital & Research Center is committed to achieve customer satisfaction by excelling in

service & patient care

AJ Hospital & Research Center is also committed to practice safe & ethical medicine by
deploying best of technology

Services/facilities offered

Patient care: All categories of beds ranging from general ward to super deluxe (suites) are
available.
Emergency care: Equipped emergency/trauma care is available with well-trained doctors
and support staff.
International services: Catering to a good number of overseas patients.

25 | P a g e
 Corporate services: Empanelled to provide healthcare to the employees of large
corporates in Mangalore.
Medical milestones/key achievements:

Cardiac: Many first of its kind interventional procedures as well as surgeries have been
done, and is being ranked as one of the most sought after referral centers for cardiology in
this region. The cardiac surgery department has been performing complicated surgeries with
excellent results.

Neurology: AJ hospital has established an advanced, state-of-the-art, comprehensive stroke

unit, where thrombolytic therapy (both intravenous and intra arterial) is being carried out by
the neuro intervention unit. The stroke unit was launched in May 2008. Highest number of
stroke patients fully recovered with total reversal of paralysis and are leading a normal life.

Plastic, reconstructive, and aesthetic surgery: Conducted many first of its kind and critical
reconstructive surgeries with excellent results. Post surgery, patients have resumed to their
normal activities.

Urology/nephrology: First hospital to carry out the renal transplant at Mangalore.

Corporate tie-ups:

The corporate clientele include Bharati Shipyard Limited, Campco, Canara Bank, Coast
Gurad, Corporation Bank, Gwasf Quality Castings (P) Ltd., HDFC, HPCL, Hindustan
Unilever Limited, IOCL, Ircon International Ltd., Karnataka Bank Ltd., KPCL, Karnataka
Fire & Safety Department, Karnataka Police, L & T, MCF, MMTC Ltd., MRPL, Punjab
National Bank, RMC Readymix, Sampoorna Suraksha, Shipping Corporation of India, State
Bank of India, State Bank of Mysore, state government employees, Tecnimont ICB Pvt. Ltd.,
United Breweries, Vijaya Bank, Vijayananda Printers Ltd., and Wartsila India Ltd..

The hospital is also recognized for treating beneficiaries covered under various government
schemes and has tie-up arrangement with insurance companies/TPAs. AJ Hospital runs
outreach clinics in the suburbs of Mangalore.

Accreditations:

ISO 9001-2000 certification by TUV

NABH - under process.
Expansion of specialties:
Oncology: Plans to install latest linear accelerator for cancer therapy along with brachy
therapy unit

Healthcare conferences:

AJ Hospital regularly conducts Continued Medical Education and social awareness programs.

At present the hospital has the following super specialty services:

26 | P a g e
 Intervention cardiology & cardiac surgery
Urology, Andrology, Nephrology & Renal transplantation
Plastic, Microvascular & Cosmetic Surgery
Neurology & Neurosurgery
Neonatology & Peadiatric Surgery
Gastroenterology
Sports Medicine & Joint Replacement & Arthroscopy
Pulmonary & Critical Care
The hospital is also equipped with exclusive:
64 slice multi detector CT Scan, MRI & Colour Doppler
Digital Cath Lab
Nuclear Medicine for isotope studies
Center for Urodynamic studies & Lithotropsy Dialysis and CRRT Machine
Round-the-clock ultra modern clinical lab facility in association with Gokula Metropolis
The hospital has all the basic specialty services of General Surgery, General medicine,
Paediatrics, Obstetrics, Pulmonary Medicine, Anesthesiology, ENT, Ophthalmology,
Dermatology, Psychiatry, Dentistry & Physiotherapy.
SWOT Analysis of the Organization:

Strengths Weakness

Opportunities Threats

Strengths:

Quality of doctors, nurse and staff.

Medical facilities, equipments and infrastructural facilities.
Ambience and the general atmosphere of the hospital.
Attitude of the staff, even the menials (human touch).
Specialization.
Reasonable pricing.
Brand name.
Weaknesses:

The patients are completely at the mercy of the doctors.

Non-clinical staff training is impossible.

27 | P a g e
Opportunities:

More training to the staff to improving their medical knowledge.

To improve the developed facilities.
To become more specialized in various fields.
Hospital is located near the Mangalore city.

Threats:

The government is reducing the grants given to hospitals they are making it
impossible to the poor people.
Increasing competitions.
Unawareness among public about all the facilities.
Protection from terrorism

28 | P a g e
Analysis and Interpretation
Table No 4 .1. The Age Group of the Respondents

AGE GROUP NO. OF RESPONDENTS PERCENTAGE

BELOW 20 5 10

20-30 6 12

30-40 17 34

Above40 22 44

TOTAL 50 100

Chart No. 4.1. The Age Group of the respondents.

AGE GROUP

10%
12%
44%
BELOW 20
20-30
30-40
34%
Above40

Above diagram consist of five classes of different age groups. Here 44% respondents
belongs to above 40 year age groups, 12% respondents fall in the age group of 20-30 years.
Other 34% respondent are in the class 30-40 years. The age group of below 20 consists only
10% of respondents. Here majority of patients belong to the group of above 40 years.

29 | P a g e
Table No 4.2.The Gender of the Respondents

GENDER NO.OF.RESPONDENTS PERCENTAGE

MALE 25 50

FEMALE 25 50

TOTAL 50 100

Chart No 4 .2. The Gender of the Respondents

25

20

15 50% 50%

10

0
MALE FEMALE

From the above table we found that proportion of male is equal compare to female i.e. 50%
male respondents and 50% female respondents.

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Table No 4.3. The Occupation Of The Respondents.

OCCUPATION NO.OF.RESPONDENTS PERCENTAGE

SALARIED 13 26
BUSINESS 8 16

HOUSE WIFE 20 40

STUDENT 2 4
PROFESSIONAL 1 2

RETIRED 2 4
OTHER 4 8

TOTAL 50 100

Chart No 4.3. The Occupation Of The Respondents.

Occupation

4%
2% 8%
4% 26% SALARIED
BUSINESS
HOUSE WIFE
STUDENT
16%
40% PROFESSIONAL
RETIRED
OTHER

The above graph shows that 26% of the respondents are salaried people ,16% of the
respondents were Business people, 40% of the respondents are house wives , 2% of the
respondent were Professional ,4% of the respondents are retired people ,4% of the
respondents are students and rest were comes under other occupations.

31 | P a g e
Table No 4.4.The Education Level Of The Respondents.

EDUCATION LEVEL NO. OF RESPONDENTS PERCENTAGE

35 70
UNDER GRADUATE

13 26
GRADUATE

1 2
POST GRADUATE

1 2
OTHER

50 100
TOTAL

EDUCATION LEVEL
2% 2%

26%
UNDER GRADUATE
GRADUATE

70% POST GRADUATE

OTHER

Chart No 4.4. The Education Level Of The Respondents.

Above graph represents educational levels of the respondents. 70% of the respondents are
under graduates, 26% of the respondents are graduates, 2% of the respondents are post
graduates and only 2% of the respondents comes under other education.

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Table no 4.5 Prior appointments taken by the respondents.

APPOINTMENT TAKEN NO. OF RESPONDENTS PERCENTAGE

YES 36 72

NO 14 28

TOTAL 50 100

Chart No 4.5. The appointment taken by the Respondents

Appointment taken

NO
28%
Yes
No

YES
72%

As per the graph presented above, 72% of them visited OPD with prior appointment system.
Whereas, 28% of the respondents came directly to the OPD without pre-appointment time
may be due to lack of information or time.

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Table no 4.6: Mode of appointment taken by the respondents.

MODE OF APPOINTMENT NO. OF RESPONDENTS PERCENTAGE

TELEPHONE 22 44

DIRECT 28 56

TOTAL 50 100

Chart No 4.6.The mode of appointment taken by the Respondents

Mode of appointment
30

25

20
56%
15
44%
10

0
Telephone Direct

Above graph represents mode of appointment of the respondents 44% of the respondents said
that they got appointment through telephone and 56% of the respondents came directly to
OPD for appointment.

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Table no 4.7: Respondents satisfaction with phone calls handling system

RESPONDENTS NO OF RESPONDENTS PERCENTAGE

SATISFIED

Yes 18 81.82

No 4 18.18

TOTAL 22 100

Chart No 4.7. Respondents satisfaction with phone calls handling system

Satisfaction with phone call response

NO
18.18%

Yes
No

YES
81.81%

Above graph represents satisfaction of the respondents over phone call handling 81.81% of
the respondents said they are satisfied with way of handling phone calls and 18.18% of the
respondents said they are not satisfied.

35 | P a g e
Table no 4.8: Respondents satisfaction with information given in the counter

RESPONDENTS SATISFIED NO OF RESPONDENTS PERCENTAGE

Yes 26 92.86

No 02 7.14

TOTAL 28 100

Chart No 4.8. Respondents satisfaction with information given in the counter

Satisfaction with the informations given

NO
7.14%

Yes
No

YES
92.86%

Above graph represents satisfaction of the respondents over information given in the counter
92.86% of the respondents are satisfied with response of the receptionist but 7.14% of the
respondents were not satisfied.

36 | P a g e
Table no 4.9: Presence of instruction / direction board in the OPD

DIRECTION BOARD NUMBER OF PERCENTAGE

IN OPD RESPONDENTS

Yes 42 84

No 8 16

TOTAL 50 100

Chart No 4.9. Presence or absence of direction board in OPD

50

40

30
Yes
20
No
10
84%
0
16%
Yes
No

Above graph represents whether the direction board was present in OPD and 84% of the
respondents said the direction board helped to reach OPD quickly and 16% of the
respondents said they did not see any sign boards.

37 | P a g e
Table no 4.10: Time taken to attend patient/ patient party at reception

TIME TAKEN NUMBER OF RESPONDENTS PERCENTAGE

Less than 5 min 11 22

5 to 15 min 20 40

15 to 30 min 8 16

More than 30 min 11 22

TOTAL 50 100

Chart no 4.10: Time taken to attend patient/ patient party at reception

Time taken

22% 22%
Less than 5 min
5 to 15 min
16%
15 to 30 min
40%
More than 30 min

Above graph represents the time taken to attend patient at the reception counter and 40% of
the respondents said it took 5-15 minutes for receptionist to attend, 22% said time taken was
less than 5 minute, other 22% said receptionist took more than 30 minutes and 16% of the
respondents said 15-30 minutes was taken to attend them.

38 | P a g e
Table no 4.11: Time of report at OPD reception

TIME OF REPORT NUMBER OF PERCENTAGE

RESPONDENTS

Reached on time 26 52

Reached before time 13 26

Reached late 11 22

TOTAL 50 100

Chart no 4.11: Time of report at OPD reception

Time of report
30
52%
20
26%
22% Reached on time
10
Reached before time
0
Reached late
Reached on time
Reached before
time Reached late

Above graph represents the time of report of patient at the reception counter and 52% of the
respondents reached on time, 26% reached before time, other 22% said they reached late to
OPD.

39 | P a g e
Table no 4.12: OPD workflow explained at reception

WORKFLOW NUMBER OF PERCENTAGE

EXPLAINED AT OPD RESPONDENTS

Yes 26 52

No 24 48

TOTAL 50 100

Chart no 4.12: OPD workflow explained at reception

Opd workflow explained

No 48%

Yes
No

Yes 52%

23 23.5 24 24.5 25 25.5 26 26.5

Above graph represents whether the workflow in OPD is explained at the counter, about 52%
of the respondents said that the work flow was explained at the reception, and 48% said it
was not been explained to them at reception during appointment.

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Table no 4.13: Waiting time in OPD

WAITING TIME IN OPD NUMBER OF PERCENTAGE

RESPONDENTS

Less than 5 min 00 00

5 to 15 min 13 26

15 to 30 min 20 40

More than 30 min 17 34

TOTAL 50 100

Chart no 4.13: Waiting time in OPD

Waiting time in OPD

0

26%
34% Less than 5 min
5 to 15 min
15 to 30 min
More than 30 min

40%

Above graph represents Waiting time in OPD and 40% respondents said that they waited 15-
30minutes, 34% told that they waited more than 30 minutes, 26% of respondents had to wait
for 5-15 minutes.

41 | P a g e
Table no 4.14: Interactive time with doctor

INTERACTIVE TIME WITH NUMBER OF PERCENTAGE

DOCTOR RESPONDENTS

Less than 5 min 7 14

5 to 15 min 17 34

15 to 30 min 13 26

More than 30 min 13 26

TOTAL 50 100

Chart no 4.14: Interactive time with doctor

Interactive Time With Doctor

18

16

14 34%
12

10 26% 26%
8

4
14%
2

0
Less than 5 min 5 to 15 min 15 to 30 min More than 30 min

Above graph represents interactive time with Doctor 34% of respondents said that they spoke
to the Doctor for 5-15minutes, 26% said that the interaction was for15-30 minutes, 26% said
that they got more than 30minutes to speak, 14% of them felt it was too less ie, less than 5
minutes.

42 | P a g e
Table no 4.15: Patient satisfaction with doctor and treatment

PATIENT SATISFACTION NUMBER OF PERCENTAGE

WITH DOCTOR RESPONDENTS

Excellent 14 28

Very good 23 46

Good 13 26

Poor, uncomfortable 00 00

TOTAL 50 100

Chart no 4.15: Patient satisfaction with doctor and treatment

Doctor and his treatment

0

26% 28%
Excellent
Very good
46% Good
Poor, uncomfortable

Above graph represents Doctor performance, 46% patient said their doctor was very good in
treatment, 28% said that doctors performance was excellent and 26% of patients felt that
doctor was just good.

43 | P a g e
Table no 4.16: OPD Environment

CLINICAL ENVIRONMENT NUMBER OF PERCENTAGE

RESPONDENTS

They are clean 42 84

They need to be cleaned better 8 16

TOTAL 50 100

Chart no 4.16: Clinical Environment

CLINICAL ENVIRONMENT

50
40
30
20 84%
10
0 16%
They are clean

They need to be cleaned better

Above graph represents cleanliness in OPD and 84% of respondents felt that OPD is neat and
clean where as 16% respondents complained and said that OPD needs to be cleaned better.

44 | P a g e
Table no 4.17: Overcrowd in laboratory

OVER CROWD IN LAB NUMBER OF PERCENTAGE

RESPONDENTS

Yes 29 58

No 21 42

TOTAL 50 100

Chart no 4.17: Overcrowd in laboratory

overcrowded in laboratory

42% Yes
No
58%

Above graph represents overcrowd in laboratory, 58% respondents said that it was
overcrowded in lab which leads to delay in OPD and 42% of the patients told that it was not
crowded in lab.

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Table no 4.18: Staff response in laboratory

STAFF RESPONSE IN LAB NUMBER OF PERCENTAGE

RESPONDENTS

Respond to queries 41 82

Indifferent to patents 4 8

Busy in own work 3 6

Non responding 2 4

TOTAL 50 100

Chart no 4.18: Staff response in laboratory

Staff response in lab

45

40

35 82%
30

25

20

15

10

5
8% 6% 4%
0
Respond to queries Indifferent to patents
Busy in own work Non responding

Above graph represents staff response in lab, 82% respondents said staff immediately
respond to queries, 8% said they are indifferent, 6% said staff are busy with their own work,
4% said them to be non responding.

46 | P a g e
Table no 4.19: sufficient technicians in lab

SUFFICIENT NUMBER OF NUMBER OF PERCENTAGE

TECHNICIANS RESPONDENTS

Yes 34 68

No 16 32

TOTAL 50 100

Chart no 4.19: sufficient technicians in lab

Sufficient number of technicians

32%
Yes
No

68%

Above graph represents Sufficient number of staff in lab, 68% respondents said that there is
sufficient staff in lab, 32% of respondents complained that there is no sufficient technicians
in laboratory and this has lead to delay in OPD.

47 | P a g e
Table no 4.20: Waiting time in laboratory

WAITING TIME IN LAB NUMBER OF PERCENTAGE

RESPONDENTS

Less than 5 min 10 20

5 to 15 min 10 20

15 to 30 min 21 42

More than 30 min 9 18

TOTAL 50 100

Chart no 4.20: Waiting time in laboratory

Waiting time in lab

18% 20%
Less than 5 min
5 to 15 min
15 to 30 min
20% More than 30 min

42%

Above graph represents waiting time in laboratory, 18% of respondents said they waited
more than 30minutes, 20% of patients waited for 5-15minutes, 20% respondents had to wait
for less than 5 minutes but where as 42% of them had to wait more than 30 minutes.

48 | P a g e
Table no 4.21: Appropriate solution to reduce waiting time in OPD as suggested by the
respondents

Root cause Counter Practical Method Tick the

appropriate
measure
solution to reduce
waiting time in
OPD
-
Limited Ensure Start a central set up tray system of
essential equitable instruments for the procedures
instruments use of the 5
scarce Scarce instruments marked and
instruments prioritized in re-sterilization process
-
Buy some more instruments
11
Staff not Sensitize Conduct a seminar on Time
sensitized on and create management
time awareness
management

No Streamline To design a standard appointment

streamlined the system that ensures:
appointment appointment A fixed number of appointments for 15
system system each doctor
4
Each doctor has slots for seeing new
patients
7
Similar procedures are not appointed
at the same time
2
No system Devise an Use patient appointment cards to
for informing information remind them
and flow system -
reminding Use Posters
patients 12
Use a running commentary

Above table shows that most of the respondents felt the need for fixed number of appointments in
OPD in order to reduce waiting time, other few of them told to use a running commentary in OPD
to call out the name of patient according to their token number and other few told to conduct a
seminar on time management even sometimes appointments given for same time may lead to great
problem in OPDs.

49 | P a g e
Table no 4.22: Hospital patient care system

HOSPITAL PATIENT NUMBER OF PERCENTAGE

CARE SYSTEM RESPONDENTS

Excellent 12 24

Very Good 19 38

Good 18 36

Poor and need to improve 1 2

TOTAL 50 100

Chart no 4.22: Hospital patient care system

Hospital patient care

20 38%
36%
18
16
14
24%
12
10
8
6
4
2 2%
0
Excellent Very Good Good Poor and need to
improve

Above graph represents Hospital patient care system, and 38% of respondents told it was
very good, 36% of patients said just good, 24% of them told it was excellent and only 2% of
respondents said there is need to improve.

50 | P a g e
Calculation of Chi-Square:

1) Variables given Sex and the prior appointment taken by the patients

SEX PRIOR APPOINTMENT TAKEN TOTAL

Male Yes No
25
15 10

Female 21 4 25

TOTAL 36 14 50

Null Hypothesis: There is no relationship between sex and prior appointment taken.

Alternative Hypothesis: There is relationship between sex and prior appointment taken.

Level of Significance is 5% (or 0.05).

Degree of freedom = (R-1)*(C-1)

= 1x1

=1

Calculation of expected values:

Formula used: Expected frequency = Row Total * Column Total

Grand Total

25*36 / 50 = 18

25*14 / 50 = 07

25*36 / 50 = 18

25*14 / 50 = 07

51 | P a g e
Calculation of Chi-Square:

Original Expected O-E ( O-E )2 ( O-E )2 / E

Frequency (o) Frequency (E)

15 18 -3 9 0.5

10 07 3 9 1.286

21 18 3 9 0.5

4 07 -3 9 1.286

X2 = 3.572

The table value for Chi-Square at 1 degree of freedom and 5% level of significance is 7.88.

Inference: Calculated value for Chi-Square (3.572) is less than the table value (7.88), thus the
null hypothesis is accepted. i.e, There is no relationship between sex and prior appointment
taken.

2) Variables given Age and the time report at the OPD

AGE TIME OF REPORT AT OPD TOTAL

On time Before time Came late

<20 YEARS
5 - - 5

20-30 YEARS 4 1 1 6

30-40 YEARS 7 8 2 17

>40 YEARS 10 4 8 22

TOTAL 26 13 11 50

Null Hypothesis: There is no relationship between Age and time of report.

Alternative Hypothesis: There is relationship between Age and time of report..

Level of Significance is 5% (or 0.05).

52 | P a g e
Degree of freedom = (R-1)*(C-1)

= 3x2

=6

Calculation of expected values:

Formula used: Expected frequency = Row Total * Column Total

Grand Total

5*26 / 50 = 2.6

6*26 / 50 = 3.12

6*13 / 50 = 3.12

6*11 / 50 = 1.32

17*26 / 50 = 8.84

17*13 / 50 = 4.42

17*11 / 50 = 3.74

22*26 / 50 = 11.44

22*13 / 50 = 5.72

22*11 / 50 = 4.84

Calculation of Chi-Square:

ORIGINAL EXPECTED O-E ( O-E )2 ( O-E )2 / E

FREQUENCY FREQUENCY
(O) (E)

5 2.6 2.4 5.76 2.215

4 3.12 0.88 0.77 0.246

1 3.12 -2.12 4.49 1.439

1 1.32 -0.32 0.10 0.075

7 8.84 -1.84 3.38 0.382

53 | P a g e
8 4.42 3.58 12.81 2.898

2 3.74 -1.74 3.02 0.807

10 11.44 -1.44 2.07 0.180

4 5.72 -1.72 2.95 0.515

8 4.84 3.16 9.98 2.061

X2 = 10.818

The table value for Chi-Square at 6 degree of freedom and 5% level of significance is 18.5.

Inference: Calculated value for Chi-Square (10.818) is less than the table value (18.5), thus
the null hypothesis is accepted. i.e, There is no relationship between Age and time of report at
OPD.

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Findings:

At the completion of the project, We found that outpatient services have elicited problems
like overcrowding, delay in consultation; improper behaviors of the staff etc. administrative
staffs have to show concern towards the patients expectation and they should serve the
suggestion box for patients and make sure respond to the suggestion satisfactorily.
We found that 44% of respondents belong to age group above 40years, 12% of respondents
fall in the age group of 20-30 years. Other 34% of respondent are in the class 30-40 years.
The age group of below 20 consists only 10% of respondents. Here majority of patients
belong to the group of above 40 years.

We also found that proportion of male is equal compare to female i.e. 50% male respondents
and 50% female respondents were given the questionnaires.

Classification on the basis of occupation, 26% of the respondents are salaried people ,16% of
the respondents were Business people, 40% of the respondents are house wives , 2% of the
respondent were Professional ,4% of the respondents are retired people ,4% of the
respondents are students and rest were comes under other occupations.

The chart reads that 70% of the respondents are under graduates, 26% of the respondents are
graduates, 2% of the respondents are post graduates and only 2% of the respondents comes
under other education.

According to study 72% of the respondents visited OPD with prior appointment system.
Whereas 28% of the respondents came directly to the OPD without pre-appointment time and
this may lead to prolonged waiting in OPD.

Study says that 44% of the respondents got appointment through telephone and 56% of the
respondents came directly to OPD and got their pri-appointment.

During study it was found that 81.81% of the respondents were satisfied with the handling of
phone calls by the receptionist and 18.18% of the respondents told that they were not satisfied
with the response.

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Project says 92.86% of the respondents are satisfied with information given at the counter
during appointment to reduce waiting time and 7.14% of the respondents said that they were
not satisfied with the response.

Study says presence of direction boards in OPD can reduce Waiting time and 84% of the
respondents agreed to this and 16% of the respondents did not agree.

It was found that 40% of the respondents said it took 5-15 minutes for receptionist to attend
them, for 22% of them it was less than 5 minute, other 22% said it took more than 30 minutes
for the receptionist to attend and 16% of the respondents said for them it was 15-30 minutes.

It was found that 52% of the respondents reached OPD on given time of appointment, 26%
reached before time, other 22% said they reached late to OPD which directly effects
prolonged waiting in OPD.

About 52% of the respondents said that they were explained regarding the work flow in OPD
and this helps to reduce waiting time were as, 48% of them said it was not been explained to
them.

Respondents said 40% of them waited 15-30minutesi OPD, 34% of them waited more than
30 minutes, 26% of respondents waited from 5-15 minutes. So its found that majority of them
had to wait more than 15minutes in OPD.

Interaction with doctor is very important in OPD were as 34% of respondents said they got
only 5-15minutes to speak, 26% of patients interacted for 15-30 minutes, 26% were happy
and said they got more than 30minutes, 14% felt bad as their time of interaction was less than
5 minutes.

Doctor and his/her performance give good image to the hospital, 46% of patients said that
treatment was very good, 28% of respondents said it was excellent and 26% of patients felt it
was just good.

Clinical Environment adds to the hospital image and 84% of respondents said hospital is neat
and clean where as 16% of respondents complained and said that OPD needs to be cleaned in
better ways.

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Overcrowd in lab may lead to delay OPD also and it was told by 58% of respondents that
there was crowd in lab and 42% of patients said there was no over crowd in lab leading to
delay.

By study we found that 82%of respondents said that laboratory staffs immediately respond
to queries, 8% of the patients said staff are indifferent to them, 6% of respondents said staff
are busy with their own work, 4% of respondents directly complained saying that they were
non responding.

Insufficient technicians in lab may lead to delay in clinical tests and this directly effects OPD
waiting time but 68% of respondents said staff is sufficient in lab, were as 32% of patients
said there is no sufficient technicians in laboratory.

18% of respondents waited in laboratory for more than 30minutes,20% of them waited for 5-
15minutes, 20% of patients were made to wait for less than 5 minutes and 42% of them
waited 15-30 minutes.

Study says most of the respondents felt the need for fixed number of appointments in OPD in
order to reduce waiting time, other few of them told to use a running commentary in OPD to call
out the name of patient according to their token number and other few told to conduct a seminar
on time management for counter staffs and some suggested that even sometimes appointments
given for same time may lead to great problem in OPDs.

Hospital patient care system is very important and study says that 38% of respondents have
said patient care in A.J. Hospital is very good, 36% of them said its just good, 24% of
respondents opine that patient care is excellent and only 2% of respondents said there is need
to improve.

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Recommendation/ Suggestion:
These are some key observations and suggestions to improve the hospital facilities:
a. Registration process
The registration system should be improved. For example, unifying assignments based on
importance
and avoiding work that could lengthen registration time will improve the registration process.
Improving the record searching process, displaying information of facilities and improving
working environment will also smoothen the registration process. The consultation time
should also be stated in the appointment card and the usage of computers will optimize the
number of patients per hour.
b. Insufficient doctors
A doctors ability to properly handle problems would improve patient care and reduce
treatment time. A more reasonable salary and a well planned schedule would improve the
doctors performance and effectiveness.
c. Number of staff at counter
A better working shift schedule should be made to balance workload among staff. There
should be at least one staff assign to provide information to patients while others handle new
cases. In addition, a smaller number of staff with high competence would help to lessen the
problem of having insufficient staff at the counter. Staff remuneration is important because
heavy workload and low salary will de-motivate and decrease staff productivity and
satisfaction towards work. Work related to training should be done regularly and supervision
from superiors will also improve staff capability and increase morale among workers.
The waiting area will be more spacious and hospital should give separate outpatient feedback
form.

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Conclusion:
Staff sensitisation and flexible appointment system was to be the key in reducing patient
waiting time in A.J. Hospital and Research centre. A simple intervention like sensitizing staff
members on time management and human behavior can greatly improve their commitment to
work. As such, staff would endeavor to report and start working early; they learn to prioritize
issues and became more time conscious as they work on the patients.

Re-organizing the appointment scheduling such that each doctor sees fewer appointment
patients and has slots for queue patients ensured that patients on queue are not too delayed
yet, at the same time those on appointment could also be seen in their respective time slot.
This may lead to a generalised marked improvement in reducing patients waiting time in A.J
Hospital and research Center.

Use of patient appointment card is also a good system as it remind patient regarding exacting
day and time of appointment. So that there is no hurry or anticipation regarding attending
doctor on time.

Use a running commentary in hospitals is of great help to reduce patient confusion regarding
token numbers and queue formation in OPD. It also reduces staff burden as they are often
questioned by patient and party about their turn.

Audio-visual display can also be used in order to show Doctors visiting time, number of
prior-appointments; token numbers can be displayed in screen to avoid confusion among
patients.

Communication is very important at every level of Hospital. A good rapport between patient
and staff is very important as it builds a sense of commitment in both patient as well as staff.
Thus, a strong emotional bound is built between the two.

Communication between a Doctor and Patients is more important as it fills the patient with
confidence. A self confident patient is half cured. And it is very necessary that sufficient time
of interaction is to be given to each patient for clinical examination and to clear their queries.
Once a patients gets confident about his/her doctor they never change their doctor for rest of
their life. So, each and every patient is precious for a hospital.

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Thus, we can conclude saying that; the ultimate goal of a Hospital is to satisfy its customers
(i.e, patient and their family) with proper treatment and care. Each and every patient is
important for the progress of hospital and we need to take care that every patient is treated
equally, as they have the right to get treated well.

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