CWAIT TIMES

INTHE DEPARTMENT OF OBSTETRICS AND GYNECOLOGY

Tamaria ConnerCarla Preston

Instructor: Dr. Richard CoffeyUniversity of Michigan Hospitals

Department of Management Systems

Industrial and Operations Engineering 481Special Projects in Hospital Systems

Date: April 23, 1987

C INIRODUCTIO1L

The admirnstration of the Department of Obstetrics and Gynecology and

the University of Michigan Hospitals’ Ambulatory Care Services decided to

perform a major time study to assess room utHization and patient wait

time within various clinics. This report will present the actions taken, the

findings, and recommendations, as determined by the project team, in order

to improve the effectiveness of the outpatient clinics. A methodology to

determine the factors resulting in wait times was developed and

implemented based on the following procedures: patient flow process,

observance of the current system, and staff interviews.

BACKGROUND/CURRENT SITUATION

The purpose of this project was to examine patient wait times in the

OB/GYN outpatient clinics. Further emphasis was placed upon determing

whether the problem of wait times was inherently related to the time

spent in waiting rooms, examining rooms, or to other variable factors in

the system which have been identified through the analysis.

OBJECTIVES

C

The objectives of this project were to prepare a methodology in order to

collect information from both obstetrics patients and gynecology patients

as to their opinions on the clinics as a whole. Further emphasis was

focused on developing and conducting a time study and system analysis into

the overall patient process in order to improve the efficiency of the

operations. From the findings, the team determined the average wait times

in both the waiting room and examining room by analyzing various factors.

C

C Information concerning current wait times was to be gathered through

observations, interviews and the usage of a data collection form with an

emphasis on patient feedback. The data sheets were designed to incorporate

various areas in order to further identify those patients who are subjected

to variable wait times. The goals of this project were to discover factors

which would: (1) be robust of variable factors that might affect the

system, (2) determine if and how wait times affect patient return visits,

(3) determine what is considered by the patients to be an acceptable wait

time, and (4) determine a method in which to maximize the measure of

efficiency in the system.

AFFECTED DEPARTMENT

The key issue in this project was to determine the individual and

overall problems affecting the system and the most effective manner in

which to resolve these problems. Environmental factors affecting this

project which could not be altered concerned the presence of different

physicians on varying days and shifts. These variables can not be “fixed”

because each provider operates differently and determines the number of

patients he will see on any given day. Another enviornmental problem

which was not within our control is the time that patients are required to

spend in the Mott/Holden/Women Hospital financial counseling department.

SCOPE OF PROJECT

The scope of this project entailed the documentation of patient

appointment times, time spent in the waiting room, and the time spent in

the examining room. A methodology of patient feedback and data supplied

2

in the survey and scheduling procedures was examined. During the course

of the project, the functioning of the clerical staff and their impact on the

system was evaluated as a possible factor affecting the overall process.

AEPRQAHE

The examination of wait time problems in the OB/GYN clinics was

implemented in three key phases. The first phase involved observing the

general process of the system (both general and detailed flowcharts can be

found in the appendix). The second phase conducted was to identify

problems through data analysis (the data form used can be found in

appendix). The final phase completed consisted of recommending

solutions/alternatives that could enhance clinical operations (a detailed

description of the methodology utilized is located in the appendix). The

approaches used in this project were a time study and system analysis

techniques. Those involved in this project included: the OB/GYN staff and

the Management Systems staff.

METHODOLOGY

A time study and system analysis was done during the time period of

January,1987 thru April, 1987 in the OB/GYN outpatient areas. The data

collection lasted two weeks; from March 23,1987 to April 3,1987. A total

of 165 surveys were evaluated. A decision was made to schedule the study

in both clinics during a “ ical” two-week period. This implies that the

study was conducted with tr usual number of providers and during a period

when there were no holidays.

ln order to observe the current clinical process, the project team took

tours of the designated areas. Both detailed and general flowcharts of the

3

Datent flow were evaluated To onent the clirucal staff, the project team

explained the purpose of the study, described the data collection

procedures, and enlisted their support in distributing the surveys. The

clinical personnel was also interviewed in order to determine their

feedback on the operations of the clinics.

The data forms were given to the patient directly. This methodology

was employed in order to determine the feasibility of conducting a study

based entirely on information provided by patients. The patients were

given the form upon check-in, asked to complete the questions during their

visits, and requsted to return the surveys upon time of check-out. The goal

of the collection form was to make the data collection form

“user-friendly,” to relieve the added burden of the staff if they had to aid

the patient in completing the form, and finally, to communicate directly

with the patient.

C. The data was analyzed according to different procedures as deemed

significant by the project team. There were nine different categories

evaluated based on information obtained from the survey. These categories

included: appointment time, day of the week, providers, patient feedback

on acceptable wait time limits in both the exam room and wait room, time

spent in the waiting room and examining room, time to park the car, and

inquiry as to phone registration. At the conclusion of the study, the data

collected was coded and inputed into a MacIntosh Plus computer using

Cricket Graph software. After the the desired factors were categorized,

the following methods were utilized in order to analyze the data: averages,

percentages, and variances and finally, a comparison between the OB/GYN

clinics was evaluated.

4

FINDINGS

One of the primary goals of this study was to determine the degree to

which patients were satisfied with the services and wait times that were

being experienced in the two clinics in the Department of Obstetrics and

Gynocology. The data revealed that in both the OB and GYN clinics, as

expected, that patient satisfaction and the amount of time the patient

spent waiting were inversely proportional; i.e. the longer the patients spent

waiting to be seen by their providers, the more dissatified they became

with the wait times.

It was felt that issuance of a completely objective survey might

neglect the provision of very important feedback from the patients in the

OB and GYN clinics. To assist in the collection of subjective data, a

comment section was provided on the survey. Also, while collecting data,

the members of the project team were able to converse with several

C patients. Through the comments recorded on data forms and the one-to-one

correspondences with patients, additional information was obtained

suggesting that while many patients are not satisfied with being forced to

wait long periods of time, they are understanding as to the personal

attention that the providers are giving to each patient.

Appointment times were observed and analyzed in order to ascertain

whether there were excessive peak times during the course of the work

day, and if so, to determine when these busy times occurred in both the OB

and GYN clinics. The data revealing that wait times were at a maximur

between 10-11 A.M. and between 3-4 P.M. Appointments scheduled between

1:00 and 3:00 in the afternoon experienced average wait times of only ten

to fifteen minutes.

5

As in the breakdown of the appointment times, a peak time was

determined for the five days (Monday thrdugh Friday) during which

outpatient services are administered in these clinics. It was established,

through data collected, that Monday has the most excessive times and

Friday seems to present minimal wait times.

The GYN clinic presently registers some of its patients by telephone.

The patients who indicated that they registered by phone, spent an average

of ten fewer minutes in the wait room as compared to the patients who had

not registered over the telephone.

Because the study was only conduàted during a two-week period,

generalizations had to be made from the findings because of the limitations

of patients during this time period. Furthermore, sources of error resulted

because many patients were not wearing watches, and also because

clerical functions were not analyzed in detail. The team limited the

( implications of the results to quantitative aspects of the outpatient

operations. It is further probable that inefficiencies and delays in this

portion of the room wait times will require further evaluation.

RECOMMENDED .ALIERNATIVESIHYPOTHESIS’

The patient wait times in the waiting room and the examination room

utilization study indicated that there is a feasiable and workable technique

for collecting and evaluating data regarding the patient process. Of a total

of 175 data collection rms, ten were discarded due to incompleteness.

Our findings suggest mat the following recommendations be implemented

for the variable wait times present in both clinics:

(6

(1). An overall phone registration policy. Thisshould minimize the inconvenience of patients havingto visit the clinic for just this purpose. This shouldminimize the workload of the staff by having to fiWout the history form with the patient. Also, those.patients who were reached by telephone should alsohave reminder appointment cards mailed to them.

(2) If the above is not implemented, an alternativesolution is to have the patient come in earlier on thescheduled appointment day and complete the historyform. Furthermore, the patient if able should fill outtheir own forms so that the staff workload can befocused on other matters.

(3) Quality Circle Techniques (semi-regularly) forthe staff. This offers an opportunity for smallinterdisciplinary groups (receptionists, nurses,providers, and others) to suggest improvementsthrough discussions of current operational problemsand to prioritize action.

(4) Changes in resources to schedule patientappointments. The implementation of computer aidedprocedures for patients and doctors. This processwill make it easier to read and revise.

(5) Staffing workloads revised through severaltechniques. Possible revisions include:

(a) Staggered shift times in order to maximizethe number of staff during peak hours.Accomplished through flex-time andnon-standard length shifts.

(b) Float pools developed in ambulatory care.(c) Part-time and temporary staff which could

be after hours to do needed tasks.(d) Interdepartmental workloads between the

OB/GYN clinics. Cross train staff formaximum efficiency.

7

(6) Don’t over schedule. Patients feel rushed andexcessive wait times occur.

(7) Use the parking information supplied as abasis. There is a need for a parking simulation.

(8) Detailed analysis of the actual time spentwith provider. An evaluation into the optimumtargeted values that are acceptable.

(9) Further analysis in order to calculate roomutilization information through check-in timeversus wait times.

(10) Evaluation into the causes of variable waittimes should be given further attention into thefollowing areas:

(a) clinical flow(b) staffing(c) other factors to improve room utilization.

(11) Compare wait room and exam room times at the• University of Michigan clinics to those of other

hospitals to compare statistics.

CONCLUSIONS/EXPECTED IMPACT

Through the identification of the factors effecting wait times in the

outpatient areas, there is the potential to decrease these wait times in

order to produce a better patient flow and improved service. The

operational changes which may result will be able to provide for an overall

improved service. These changes wh impact the system are registration

and scheduling procedures. There is the possibility of increasing the

revenue with the addition of more patients and also by retaining patients

who may not have returned because of dissatisfication with excessive

8

wait times. Through detailed analysis by the OB/GYN staff potential cost

( effectiveness benefits can be ascertained by impiementing the optimum

levels discovered in the system which could influence and/or eliminate

the causes of wait times.

C

9

C

OBSTETRICS GENERAL FLOWCHART

REGISTER

NO

PATI ENT OB PS.K

WAIT TIMELOBBY

YES

EXAMINEDNO

YES

1.NURSE HISTORY2.PROVIDER

OBSTETRICS FLOWCHART DETAILED

NEWPATIENT

NO

YESMWHADMITTNDESK

1 .REGISTER2.PATIENT FOLDER3.M-CARE CARD

1 .FAMILY2.MAP

HISTORV

(

_

YES

NO

1. NURSE HISTORY2.INSURANCE3.PAYMENT4.APP’T SLIP

FINANCIALCOUNSELING

OB DESK

LDDITIONALFORMS

CHART PLACEDIN APPROPRIATEPROVIDER SLOT

YES

NURSE

NO1. MEDICAL HISTORY

ESCORTEDTOEXAM ROOM

1.VARIOUS PROCEDURES

VISIT

1.CLERK INPUTS INTO COMPUTER

‘N

PREP PATIENTS

PROVIDEREXAMINES

SCHEDULE NEW

CONSULTWITHPROVIDER(

GYNECOLOGY GENERAL FLOWCHART

C

YESMWH

DESK

GYN

DESK

LOBBY WAIT TIME

RESCHEDULE

YNFCOLOGY DETAILED FLOWCJIARI

\‘

PATIENT GO TO MHW DESK—_—— EINANCIAL

COUNSEliNG

____________________

I.REGISTER [MEDICAL HISTO!Y2.EOLDER PREPARED 2 INSURANCEJ.M-CARE CARD lSU[D IPAYMENT

4.LEGALITIES

— GYNECOLOGYDF5K

LREGI5TER

• /V /

/ N.VVW

YES1 W!TH

NURSE

/

NO : L MEDICAL HISTORY

CCONSULTATION

W1iHPROViPIR

tODDY WA!1 ROOM

________

ESCORT PATIENTTIME

TO EXAM ROOM

PREP PAT 1ENTS

LVARIOUS PROCEDURES

PATENTEXA1NFD UYrrm I

NEULtJR6ERY1 NO SCHEDJJJJI ME

1L

VIStT

1UThtKOUT

1’

: LRL3ER NEEDED

CONSULTATION WITH‘r.;-i- rr

‘I

[CATEGORIZE TYPE PATiENT2SURGCAL iNFORMATION3.LEGALIT(ESkHEALTH HISTORY5.PAYMEN1 AGREEMENT

‘The Departmeiit of Obstetric$ at (yncco1ogy is eaamining patientWait times in our outpatient areas. ‘We are iiiteresteI in trijing toimprove our services. From the information tluit you provide on this

C survey, we hope to be able to develop a better system which wifffurthermeet your needs. ‘We welcome any and alt comments that you wish toadd. ‘The completed survey wilT be confidential. ‘Tfiank. you for yourtime anti cooperation..

fMarch, 1987

Please answer the following questions while gou are waitingto see jour doctor or midwife.

Date

____________

1) How much time did it take for you to park your car?

_______

mm

r 2) Where did you park?

____________________________________

3) How long did it take for you to find the OB/GYN clinic? mm4) Were the directions to the OB/GYN clinic clear?

_________________

5) Is this your first visit to the OB/GYN clinic?

______________________

Is your appointment in the OB clinic or the GYN clinic?

____________

6) What was your scheduled appointment time? - : A.M. I RM7) Which doctor or midwife is your appointment with?8) Did you register on the telephone?

_____________

If so, did you find this service to be beneficial?

9) How much time did you spend waiting in the waiting room?

____

(1) 10 minutes or less

____

(2)11 to2O minutes

____

(3) 21 to 30 minutes

____

(4) 31 to 40 minutes

____

(5) 41 to 50 minutes

____

(6) 51 to 60 minutes

____

(7) more than 1 hour. (How much time?)

10) How satisfied were you with the amount of wait time in the

waiting room?

____

(1) Very satisfied

_____

(2) Satisfied

_____

(3) Neutral

_____

(4) Dissatisfied

_____

(5) Very dissatisfied

11) How much time did you spend waiting in the exam room before

seeing your doctor or midwife?

____

(1) 10 minutes or less

___

(2)11 to2O minutes

____

(3) 21 to 30 minutes

____

(4) 31 to 40 minutes

____

(5) 41 to 50 minutes

C

____

(6) 51 to 60 minutes

____

(7) more than 1 hour. (How much time?)

___________

C 12) How satisfied were you with the amount of wait time in the

exam room?

(1) Very satisfied

(2) Satisfied

(3) Neutraj

(4) Dissatisfied

(5) Very dissatisfied

Please add any Other comments that You may have.

CLINIC SCHEDULING SYSTEM

CODE: ****= OPEN SLOT

NP=NEW PATIENTRV=RETURN ViSIT

NR=NEW PATIENTS AND RETURN VISITS

U

I RESOURCE: OBGRETHNR [ER: PRESTON ICLINIC: OBSTETRICS I I DATE ;APRIL 2219877

F PROVIDER: P GREEN LWEEK OF::JULY 10,1987

FROM-TO PATIENT NAME TYPE FROM-TO PATIENT TYPE

8:00-8:15 JONES, PAT8:15-8:30 SMITH,JOAN fl8:30-8:458:45-9:009:00-9:15 BLUE,LEE BL9:15-9:30 RED,ANN9:30-9:45 * * * * * * * *

0.45.10:00 PINK,VAL fly.J:00-10:15 PURPLE,JYL

10:15-10:30 DOE,JANE liE1 0:30-1 0;45 * * * * * * * *

10:45-11:0011:00-11:15 BROWN,DEE flu11:15-11:30 GREEN,FLO1 1 :30-11 :4511:45-12:00 YELLOW,GLO tIP.12:00-12:1512:15—12:30 * * ** * * *

CLINIC:OBSTETRICSWEEK OF:APRIL 19.1987

r- USER:PRESTON

DAY PROVIDER EXAM ROOM CONSULT ROOM TIME

1.TEAMIII 1-5 1 ,3.,5 AM2.ANSBACKER 7-9 2,4 AM3.DUNLAP 6 6 AM4.ELKINS 8-9 6 PMMON 5.TEAMU 6-7 2,4 PM6.JONES 4-5 5 PM7.COLP 2-3 3 PM&DUNLAP 1 1 PM

1.MIDWIVES 8-9 6 AM2.DUNLAP 6 4 AM3.PELISH 7 2 AM

TUE 4.TEAMIII 1-5 1,3,5 AM5.TEAMH 6-9 2,4,6 PM6.MCNEELEY 3-5 3,5 PM7.HOPKINS 1,2 1 PM8

1.ANSBACHER 6-9 2,3,4 AM2.DILTS 3,4,5 3,5 AM3.BARCLAY 1,2 1 AMC ED 4.**H0PKINS 6,7,8,9 3 PM5.ROBERTS/DILTS 3 2,4,6 PM6.COLP 1,2 5 PM7.**MORLEY 5 1,3 PM8.***** **

1.TEAMIt 6-9 2,4,6 AM2.PELJSH 5 * * * * * AM3.DUNLAP 1,2 3 AM

THUR 4.ANSBACHER 3,4 1 AM5.TEAMII 6-9 5 AM6.DUNLAP 3 2,4,6 PM7.MCNEELEY 4 5 PM8.*****

1,.2 1 PM

***

1.TEAMII 6-9 2,4,6 AM2.DUNLAP 5 5 AM3.ROBERTS 1,3 1,3 AM4*OPEN 4 ***** AM5.TEAMUJ 6-9 2,4,6 PMFRI 6.COLP 3 5 PM7.MORLEY 1,2 1,3 PM8.*****

C*****OPEN SPACEHOPKINS -ROOM SWHEN MORLEY IS HERE

fln

0

C)

C)

1)U

))_

)i:

)

Ut.

’jN

)

CC

)C

))

C)

()

C)

C)

)C

.I

C)

Ui

(1]

K11

C)

C)

U)

U)

CC

Cr;

U)

c

C

t’ LZ

4

lAC

K

z 1-p 0 D C-, 3 ID In Jo rD iC E3

F)C

.c

/ fT m Oi Cc

CDoctor Code Number

ANSBACHER 1

AYERS 2

BARCLAY 3

BOWDLER 4

BROWN 5

COMPTON 6

GARVIN 7

HAYASHI 8

HOLDER 9

JONES 10

KAY 11

MALCOLM 12

MCNEELEY 13

MUSTARD 14

PELISH 15

RANDOLPH 16

Any doctor 17

Midwife 18

Don’t know 19

Jones and McNeeley 20

Ayers/Brown 21

House 22

Barclay/Compton/Pelish 23

Nurse 24

Eu 1or r1u ilfl

Doctor Code Number

ANSBACHER 1

AYERS 2

BEEMER 3

BOWDLER 4

0MPT0N 5

DILTS 6

DUNLAP 7

ELKINS 8

FENNER 9

HEFNER 10

HOLDEN 11

JAMES 12

JONES 13

KIPERZSTOK 14

McNEELEY 15

MORLEY 16

MYGARD 17

PELISH 18

PORTZ 19

PUNCH 20

RANDOLPH 21

ROBERTS 22

Resident 23

C Don’t know 24

fl

0 rr —1

Cl)

C

o*.

0E

E

Wait time vs. Wait Feedback (ob)

I

S Wait room time

I

W. feedback

w

w

C:

EXAM WAlT ROOM TIME&EXAM FEEDBACK VS. PRQ VIDER

4

3

2

1

0

D- EXAM TIME+- E. FEEDR4CK

2 3 6 7 8 Q 10 11 12

DOC/M1D

fl.:....

Provider vs. Exam Wait Time & Exam Feedback (OB)

LU

><LU

0

-D- EXAM TiME-.‘ E. FEEDBACK

13 14 16 18 19 20 21 22 23 24

DO CIM ID

C

0

LU

I.

LU

10 12 11 2 is 13 1 3

DOCTOR

Doctor vs. Wait time in 08 exam room

06 7 14 8

C

8

w 6

4

2 A

Provider vs. Overaji Wait Time(o1)

S WAIT TIMEEXAM TIME

13 14 16 18 19 20 21 22 23 24

DOCMID

Cricket Graph Data OBDATA Sun, Apr 26, 1987 8:01 PM

PARK CAR APPT flME 0CC/MID PHONEREG WAIT TIME W. FEEDBACK

1 *** *4*

2 11 *** *4* *4*

3 10 10 19 Y 1 24 10 10 2 N 1 15 10 10 6 N 1 16 5 10 14 N 1 17 2 2 9 N 1 48 15 2 23 N 1 19 3 2 19 Y 1 1

10 15 3 2 Y 1 111 8 3 2 N 1 112 2 3 2 Y 1 113 10 3 1 N 1 114 N/A 3 18 Y 1 115 5 3 23 N 1 116 2.5 4 2 N 1 117 5 5 10 N 1 118 D.K. 5 11 N/A 1 119 30 5 2 N 1 220 5 5 7 Y 1 121 N/A 6 23 N 1 122 2 6 23 N 1 123 0 6 18 Y 1 224 5 6 8 N 1 325 5 6 18 N 1 126 5 6 18 Y 1 1

5 7 19 N 1 128 5 7 19 V 1 329 N/A 7 13 N 1 130 2 7 18 N 1 131 3 7 3 N 1 132 10 7 19 V 1 133 10 7 18 V 1 134 10 7 23 V 1 235 20 7 19 N 1 136 N/A 7 24 V 1 137 5 7 18 N 1 138 3 8 19 N 1 239 N/A 8 18 V 1 140 5 1 19 N 2 241 5 1 19 V 2 242 5 1 19 N 2 243 5 10 9 N 2 244 5 10 19 N 2 345 5 2 19 V 2 246 D.K. 2 19 N 2 247 15 2 19 N 2 148 20 4 2 V 2 249 N/A 5 21 N 2 250 100 5 19 N 2 451 10 6 19 N 2 2

15 8 23 N 2 2N/A 9 14 N 2 3

54 7 10 12 N 3 255 10 10 2 V 3 356 60 3 19 N 3 2

Cricket Graph Data OBDATA Sun, Apr 26, 1987 8:01 PM

EXAM TIME EFEEDBACK DAY

I * * * * * * TH2

.** M3 1 2 T4 1 1 M5 1 1 M6 1 1 M7 3 4 M8 1 1 M9 1 1 M

10 2 1 F11 1 3 F12 2 1 F13 2 2 F14 1 1 F15 2 2 TH16 1 1 TH17 1 1 W18 1 1 W19 1 1 W20 2 2 W21 1 1 W22 2 1 W23 1 2 W24 2 3 W25 1 1 W26 1 1 W

2 1 W28 2 3 W29 1 1 T30 1 1 M31 1 1 M32 1 1 M33 1 1 T34 1 2 T35 1 1 M36 1 1 M37 1 1 M38 1 1 M39 1 2 M40 1 1 TH41 2 2 T42 2 2 T43 3 4 M44 2 4 M45 2 2 M46 1 2 M47

*** *** F48 2 1 W49 1 1 W50 1 2 W51 1 1 W

1 1 M1 1 T

54 2 2 M55 2 2 T56 2 3 F

Cricket Graph Data OS DATA Sun, Apr 26, 1987 8:01 PM

PARK CAR APPT TIME DOG/MID PHONE REG WAIT TIME W. FEEDBACK

5 3 19 N 3 212 4 16 V 3 2

59 5 4 19 N 3 460 5 6 6 V 3 261 5 8 19 N 3 262 3 8 8 N 3 263 5 1 19 N 4 364 3 1 22 N 4 465 5 10 19 N 4 566 3 7 19 N 4 367 5 1 19 V 5 268 3 2 19 N 5 469 5 3 19 N 6 570 2 10 2 N 7 371 10 3 19 N 7 572 N/A 4 20 N 7 173 N/A 8 8 N 7 3747576777879808182

3

84858687888990919293949596979899

1 001011 021 031041 051 06107

3‘J9

110111112

Cricket Graph Data OR DATA Sun, Apr 26, 1987 8:01 PM

EXAM TIME E. FEEDBACK DAY

(7 3 2 F1 2 TH

59 *** W60 1 1 W61 4 3 M62 2 2 T63 2 2 M64 3 3 M65 2 4 M66 1 2 T67 2 2 TH68 2 3 F69 3 5 F70 5 4 M71 5 5 TH72 1 1 TH73 2 3 T7475767778798081

C82

1001011 021 031 041 051 061 07

( 8“NtJ9

110111112

C)

0 0

C

Phone Rc/strftf/n,’y V5 W,/f Room & Ex Room (OYN.)

ZI -

4 c

PHONE R[GiSTRA ION

C

h’if RaDii [L’ii vs. Waft Room reec ‘OYN)

H

2-’

V

2 3

W. FFED!Mc(

FL

CDy Owypa// Wa/I Times ‘6YNI

I i -

EXAM :t-

DAY

DOC IrTj D

•i.A;-; r:• ry

Provmep ¶:9f’fff’L!9LU1mfL??!LC’

z

1CY

2 3 s 6 7 ; o H

C a Proyfrj,,-S (Lc-71) V Over// Waft Ii’im

DX /‘7 ID

p-

I—.

Provider v. Overall Wait Time

w

0

• WAIT TIMEEX4y

1 2 56

DOC/M,D

7 10

.)

> 7:

Ii-,

_.4

__

..

..

-J

.:

*:.rrj

-i

:rq

*(!.ji’9

i.C

)ii.)

-‘-3

--

*...

....

‘4

...

...

..

.__

uIi...(,.’)L

iiL

fl(),ø-...

4’.’J

44

4

‘4-

-.)‘-J,

-—

.-•

—-•

.iri-.):

t.:’’!

-,1

54

4.4 4:--<

:.-<

--:-c<

:‘,

SS

S‘4

S+

S‘4

$s

..)(4

.

.5’

ri

SS

p-i

ii4

4‘4

.4,

..c.;

-—

---.c

’J--.

.--

‘-i

t’.3...

.S

..i

4ts..

”•t.

,

ry4

-!

S+

‘4-‘

.4

.i......f.

.r,:.J

s•

..c•

-“-

-.D

c-i

‘4‘4

‘44

‘4‘4

’‘4

44

‘4I.-

‘344.’....

--‘I—

--

DAY

w

3 V.

p..

C

.3 w

:7 www

‘.7

— L

43

9.

9.,

fr-i

503

YL

ait

;.s.

i-

ZJ1

I?

T

1’ 1

..•

CM-a

-0

‘)P

)(A

C’I

vacn

hI)C

ncq

ocq

cIl?

’cJIK

,cacJ,

t.;

t .3 1) .4

1%)

•flC

)C

JlflC

MhIflr3ip3C

n..

..ifl

...(q......J..

—P

3C

’C4

CM

MC

M—

—.; C.,

..•).a%

3..

bje

.(3

1’1

(.3

(.)

•P

3•

b3

(3—

C’fl%

IC

flJ

%—

..(J

•-fl)--’otJv3n..J.t4I

•‘•‘%

-)P

c’4

paIh

s%

0 d’

Cl’

ft

—.

C<

<<

C.C

tF

4.C

R.V

:r<

<’<

.cx

zr<

<c.cre-c

•.M

I(fltt.jP

4..•....c4........p.J.

ii.‘

tC’I

•-h-’aM

•..-

•t%

)t.3

C4

•-

P3C

’l•t.t4

$’t4

t)

•--I)—

..M

P3—

fl

—r

‘S

2>

q‘

...p

3j.

•--k

)P

.lN

)-.u

C4

cfl

•M

•.

—C

It_.t

.J...

_It

t.l

-it

r’i

ft

C)

Ci

C’

.n(4,

.•.t

MM

.’P

).C

4C

MJC

.I(3C

Mtup,a)

•an

t.Jk

)M

afl

7’

.3...

—

DAY

SYh DesZA ron. #pr 27, 1981 5:08 Afl

61526364656667a.

707;

74-tS

7677757Q5081528354r1:,8755899091

•. .

• .

r

Fc

TNF

••..:

FF

.

F

rF

‘4I,

‘.4

HPA

‘Sii

. ... —

‘A

‘4 :I’

‘A

HM‘F

rH11

HLA •

‘AI,

‘flC.’Vt t*tflX

I • •

• 1•

•14 I; —

—•‘fl

_s_•.•

‘.. ‘ I p .,•I

••

A. —

4

•••‘•• Its

•,•‘

a— S

•

C:. tt‘.....? :ct(_.:...:1,:.nrr.. :;.•i t:.1_:..t.It::[

y:t;

• )•r4

s:.. .