Pediatric Orthopaedic Clinic Review

Problem

The Pediatric Orthopaedic Clinic at the children’s hospital of Western Ontario provides specialized pediatric services to children living around or near Ontario, Canada or as far away as the United States. With rising complaints about the patient wait times, management agreed to review the process and look for ways to reduce the waiting times by 20 percent.

1. What are the activity utilizations? Direct labor utilization?

In order to calculate the utilization rates, data that was retrieved and analyzed from patient surveys and time studies. Utilization rates were calculated as separate divisions and by the particular job title. To calculate the utilization rates for individual job functions, the number of total hours spent on the process was divided by the number of total hours available for work for the particular worker(s). Doing so, utilization rates were 74.07% for clerks, 81.83% for the main three nurses, 83.42% for technicians, 75.83% for radiologist, 57.25% for the extra nurse, 110.43% for the surgeon, 92.24% for the senior resident, and 90.04% for the cast technician (Appendix A). Similarly, to calculate the utilization rate for individual divisions, the number of total hours spent in the division was divided by the number of total available hours for that division. The corresponding utilization rates for the divisions were 67.43% for reception/front desk, 69.83% for radiology, 28.63% for x-ray hand off, and 97.57% for examination room (Appendix B).

2. What is the effect of variability? How can it be controlled?

The Radiology Department is used by the Pediatric, Urology and Chest Clinic and the ER. This leads to varying demands that depend on patient arrivals for each department which causes variability in the amount of time a patient has to wait to get treated. The more patients, the more likely the wait time will increase. One way to control this variability would be to improve scheduling of the clinic with the other departments. Test can be preformed to see when the machines are the used the least amount of time and try to schedule appointments then. Also additional equipment purchases and staff may be considered to reduce the effect of variability.

3. Where is the bottleneck? Where are the capacity constraints?

When looking to the bottleneck in the process, things to be considered where wait times and utilization rates. Using this logic, we determined that there may be bottlenecks in the radiology department and the examination room. In the radiology department, the patient wait time is almost double that of the other wait time. In the examination room, it was observed that the staff are over utilized or close to being utilized; the surgeon’s utilization is over 110%. The bottleneck has been determined to be the examination room, where the surgeon in particular has been working over capacity at over 110%. The examination room is also the capacity constraint because it limits the throughout.

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4. What is the economic cost of waiting?

In order to compute the economic cost of waiting, an assumption was made about the average annual salary and hours worked during the week; an average annual salary of $44,000 and 40 work hours a week were used. The cost to a new patient and a follow up patient is $22.91 and $21.15 per day, respectively. The total daily economic cost to all patients per day is $1,662.34. (See appendix C).

5. What are your recommendations?

Change Hours of Operation

One of the biggest complaints by parents is that they are losing money by foregoing work to take their children to the hospital. By changing the hours of operation to later in the day where the average parent is finished with work, it would help eliminate the economic cost of coming to the doctor. It may also help improve waiting times since the hospital may not be as busy later in the day.

Consider Additional Equipment Purchases

Although there is a high upfront cost to additional equipment, it should still be considered because of the improvement it will have in patient satisfaction and reducing lead times. The clinic must weigh the value of improved satisfaction with the economic costs of purchasing the additional equipment.

Distant Patients

Patients traveling from far away should be allowed to get x-rays done somewhere closer to them to reduce the amount of time they have to wait when they do get to the clinic. Similarly, once the initial diagnosis and tests are conducted, the clinic should recommend other clinics or physicians to conduct follow-up appointments. This would reduce the number of patients the surgeon would see and thus he will not be over utilized.

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Appendix A:

Staff Utilization Time Working Time Available Total Utilization

Clark 400 540 74.07%

Nurse 626 765 81.83%

Extra Nurse 146 255 57.25%

Technician 801 960 83.42%

Radiologist 364 480 75.83%

Surgeon 282 255 110.43%

Senior Resident 235 255 92.24%

Cast Technician 230 255 90.04%

Appendix B:

Department Utilizations Time Working Total Time Available UtilizationFront Desk

Clerk 400 540 74.07%

Nurse 480 765 62.75%Total Front Desk 880 1305 67.43%

Radiology Dep'tTechnicians 801 960 83.42%Radiologists 364 480 75.83%X-Ray Dev. 511 960 53.23%

Total Radiology 1676 2400 69.83%X-Ray Hand Off

Nurses 146 765 19.08%Addt'l Nurse 146 255 57.25%

Total X-Ray Hand Off 292 1020 28.63%Examination RoomSurgeon 282 255 110.43%Senior Resident 235 255 92.24%Cast Technician 230 255 90.04%

Total Examination 746 765 97.57%

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Appendix C:

Economic Cost of WaitingAnnual Salary $44,000Annual Salary per minute - @ 52 weeks, 40 hrs/wk $0.35Economic Cost of Waiting - New Patients $22.92Economic Cost of Waiting - Old Patients $21.15Economic Cost of Waiting - Old Patients w/o X-Ray $8.81

Total Cost of Waiting per Day $1,662.3

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Appendix D:

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