University Health Services

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Managing Business Operations

Case 2

University Health Services: Walk-In Clinic

Group Members

Eng Jui Goy

Chaweewan Gatepithaya

Hui Man Yin Merina

Kwa Hwee Lay Clarie

Michael Ong

Question 1:

Pre-Triage Problems:

1. Waiting Time between sign-in and treatment is long

a. Everyone, regardless of urgency, ha to see the nurse before consultation with physician. Urgent cases

b.

22% of the patients had to wait for more than 35mins before first contact with a nurse. Patients who requested specific physicians waited an average of 40 minutes to see the desired physician

c. Length of wait was not related to the nature of the visit. (Prescription renewal or referral cases)

d. Linear processes with no diversification of tasks. MDs were unable to handle the incoming cases as fast as other resource (NPs, Receptionist).

2. Inconsistency and variation in treatment due to different skills and experience level of individual nurses

a. urses individually decide extent of care for a patient Patients with similar illness might be treated differentlycaus reduction in confidence or dissatisfaction among patients.

3. duplicated efforts or resources in terms of time spent, questions asked and answered, also physical examinations for patient who would eventually see the MD.

Triage System Success:

1. require

Patients who warrant immediate care are able to receive prompt attention and treatment, triage system significantly shorten their waiting time.

2. Workload on the nurses are eased as nurses no longer need to see every patient who visits the clinic as patients treated by Nurse Practitioner dropped from 40% to 28% (Exhibit 6)

3. Usage of the standard AVF form (Exhibit 7) shortens the front-desk registration process. Reason of patient’s visit are recorded on the AVF, reducing duplicating checks and questioning.

Triage System Failure:

1. Despite a more systematic approach of triaging the patients based on their conditions, the average process time increased from 64.9mins (pre-triage) to 69.1mins (post-triage). (Table 1)

a. Number of patients treated by physicians increased from 41% to 48% (Exhibit 6) after the implementation of the triage system which could be due to an increase in “walk-in appointments” which decreases the physicians’ availability.

b. Capacity utilization indicated that MD is the bottleneck that resulted in long waiting time with an average of five sessions exceeding 100% utilization daily. (Table 18)

2. Triage coordinators followed a guideline (Exhibit 8) to triage the patients which ensure the streaming of patients is done in an orderly and guided manner regardless of the triage coordinators on duty, hence achieve uniformity in the performance of the triage.

Question 2:

Reasons for long-waiting time:

1. Clinic was unable to effectively allocate manpower based on past trends to solve the problem of over-utilization of MDs (Table 18) which caused delay in the process.

2. The walk-in appointments were taking large amount of capacity. Assuming no walk-in appointments were allowed, the utilization of MDs would be in the acceptable range for most sessions except for the morning peak sessions (Table 22).

Average Capacity Utilization: (Average of all sessions in the week of Table 17 – Table 21)

Medical Doctor
Bottleneck!
Nurse Practitioner
Triage coordinator
Nurse Practitioner’s room
Physician’s room

111.8%
84.9%
47.7%

78.8%
58%

Recommendations:

1. Ban “walk-in appointments”: appointments should be arranged during MD’s reserved time for appointments. Walk-in clinics should purely be allocated for walk-in patients.

2. Extend consultation hours for MDs or increase number of MDs on duty but that would incur extra labour cost. There might also be a lack of MDs who are willing to extend their consultation hours. Also, increasing the number of MDs...
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