waiting times surveys (wts) at 1 2 and 3 facilities in ... · waiting area with chairs room 1 with...
TRANSCRIPT
Waiting Times Surveys (WTS)
at 10 20 and 30 Facilities
in Western Cape
Gavin Reagon
Ehimario Igumbor
School of Public Health of UWC
Information Officers City Health and MDHS
Quality Assurance Officers PGWC
Health Research
• Basic Biomedical Sciences research
• Clinical Research
• Epidemiology
• Clinical Epidemiology
• Health Systems and Policy Research
• Routine Large Scale Surveys
Routine Health Information
Systems
• Facility Based Information
• Mortality and Births
• Population Census
• Surveillance
• Situational Analysis
• Longitudinally updated records (staff, facilities, finances)
• Routine Large Scale Surveys
Value of a WTS
(What it Mainly Measures)
• Measures Waiting Times
• Identifies the immediate Causes of Long Waiting Times (and suggests solutions for these)
• Measures Service Times
• Measures Workload accurately
• Measures Quality of Care (partially)
• Measures Systems Efficiency
Methodology
1. All outpatients, casualty patients, and direct admissions to wards seen on an average day are included in the survey (inpatients already admitted are excluded)
2. All patients are tracked from the time they arrive at the facility till the time they depart (or are admitted to the wards) via a patient time-sheet
3. At every point at which a patient receives a service the times are recorded
4. Staff complete a staff time-sheet which tracks the time they spend at the service points they work at.
5. Short questionnaire completed by staff and patients
Waiting Area with
Chairs
Reception
DOTS
Room
Entrance
Entrance
Gate in
Boundary
Wall
Main
Entrance
Entrance
Consulting
Room 1 with PN
Consulting
Room 2 with PN Counseling
Room
Consulting
Room 1 with EN
Observation
Room
Dressing Room
Dentist
Dentist’s
Reception
09h01
09h24
09h26
9h33
Waiting Area with
Chairs
Reception
DOTS
Room
Entrance
Entrance
Gate in
Boundary
Wall
Main
Entrance
Entrance
Consulting
Room 1 with PN
Consulting
Room 2 with PN Counseling
Room
Consulting
Room 1 with EN
Observation
Room
Dressing Room
Dentist
Dentist’s
Reception
09h01
09h24
09h26
9h33
09h37
10h23
10h33
10h59
Waiting Area with
Chairs
Reception
DOTS
Room
Entrance
Entrance
Gate in
Boundary
Wall
Main
Entrance
Entrance
Consulting
Room 1 with PN
Consulting
Room 2 with PN Counseling
Room
Consulting
Room 1 with EN
Observation
Room Dressing Room
Dentist
Dentist’s
Reception
09h01
09h24
09h26
9h33
09h37
10h23 10h33
10h59
11h09
11h06
Calculating Waiting and Service Times
Arrival Time 9:01
Service Point
Time
In
Time
Out
Service
Time
Waiting
Time
Reception 9:24 9:26 2 min 23 min
Observation
Room
9:33 9:37 4 min 7 min
Consulting
Room PN
10:23 10:33 10 min 46 min
Dressing Room 10:59 11:06 7 min 26 min
Complete ST 23 min
Complete WT 102 min
Departure Time 11:09 Dead Time 3 min
Staff Form for Staff Present during the Waiting and Service Time Survey
Facility name CHC Date:
Staff
Code:
Arrival Time
Staff
Category
Service Section Time
In
Time
Out
Time
In
Time
Out Time In
Time
Out Time In
Time
Out
Tea Break
Lunch Break
Reception
Weighing &
Preparation
Consulting Room PN
Pharmacy
TB Dots Room
Emergency _Trauma
Administration
Management
Outreach Activities
Meetings, Workshops
and Training
Other Clinical
Other Non-Clinical
Departure Time
Staff Form for Staff Present during the Waiting and Service Time Survey
Facility name CHC Date:
Staff
Code:
Arrival Time 07:03
Staff
Category
Service Section Time
In
Time
Out
Time
In
Time
Out Time In
Time
Out Time In
Time
Out
Tea Break
Lunch Break
Reception
Weighing &
Preparation
Consulting Room PN 07:09 09:59
Pharmacy
TB Dots Room
Emergency _Trauma
Administration
Management
Outreach Activities
Meetings, Workshops
and Training
Other Clinical
Other Non-Clinical
Departure Time
Staff Form for Staff Present during the Waiting and Service Time Survey
Facility name CHC Date:
Staff
Code:
Arrival Time 07:03
Staff
Category
Service Section Time
In
Time
Out
Time
In
Time
Out Time In
Time
Out Time In
Time
Out
Tea Break 10:00 10:21
Lunch Break
Reception
Weighing &
Preparation
Consulting Room PN 07:09 09:59 10:25 11:38
Pharmacy
TB Dots Room
Emergency _Trauma
Administration
Management
Outreach Activities
Meetings, Workshops
and Training
Other Clinical
Other Non-Clinical
Departure Time
Staff Form for Staff Present during the Waiting and Service Time Survey
Facility name CHC Date:
Staff
Code:
Arrival Time 07:03
Staff
Category
Service Section Time
In
Time
Out
Time
In
Time
Out Time In
Time
Out Time In
Time
Out
Tea Break 10:00 10:21
Lunch Break 12:00 12:30
Reception
Weighing &
Preparation
Consulting Room PN 07:09 09:59 10:25 11:38 13:05 13:30 14:10 15:45
Pharmacy
TB Dots Room
Emergency _Trauma 12:40 13:00
Administration 15:45 16:17
Management
Outreach Activities
Meetings, Workshops
and Training 13:30 14:00
Other Clinical
Other Non-Clinical
Departure Time 16:30
Results
Complete Waiting Time Hosp OPD 2008
Facility Name 5% 25% Med
ian
75% 95%
Groote Schuur
Hospital
14 92 178 250 392
Tygerberg Hospital 16 92 193 275 452
Red Cross Hospital 6 46 114 180 297
Worcester Hospital 6 125 187 255 349
Complete Waiting Time Emergency in minutes
Facility Name 5% 25% Med
ian
75% 95%
Groote Schuur
Hospital Wed
5 52 173 321 583
Groote Schuur
Hospital Sat
5 10 67
188 441
Tygerberg Hospital
Thurs
3 10 36 141 225
Tygerberg Hospital Sat N/A N/A N/A N/A N/A
Facility Name 5% 25% Med
ian
75% 95%
Red Cross Hospital Wed 3 20 55 185 151
Red Cross Hospital Sat
5 19 83 157 322
Worcester Hospital Wed 2 35 96 196 376
Worcester Hospital Sat
7 24 98 213 427
Complete Waiting Time Emergency in minutes
Facility Type Shortest Median
Waiting Time
Longest Median Waiting
Time
2005 2007 2005 2007
Clinics 2 min 7 min 99 min 203 min
CHCs 27 min 20 min 263 min 215 min
CHC and
Clinic 29 min 39 min 225 min 178 min
All Facilities 2 min 7 min 263 min 215 min
Causes of Long Waiting Time
1. Workload (overloaded)
2. Arriving in Big Batches
3. Mismatch
4. Long Service time (inappropriately)
5. Inefficiency (in prioritising patients)
6. Logistics
7. Flow
8. Queuing
9. Gaps between seeing patients
10. Waiting for ward/ICU/theatre bed (Emerg Units)
11. Long Diagnostic & Monitoring time (Emerg Units)
Main Causes of Long Waiting Time
at Hospital OPDs
1. Arriving in Big Batches early in the morning
2. Mismatch mainly at clinician service points
3. Workload (overloaded) mainly at pharmacy
Main Causes of Long Waiting Time
at CHCs
1. Arriving in Big Batches early in the morning
2. Mismatch mainly at Reception and Clinician
service points
3. Inefficiency in prioritising patients
4. Workload (overloaded) mainly at pharmacy
Main Causes of Long Waiting Time
at Clinics
1. Arriving in Big Batches early in the morning
2. Mismatch mainly at Reception and Clinician
service points
3. Inefficiency in prioritising patients
Main Causes of Long Waiting Time
at Hospital Emergency Units
1. Waiting for ward/ICU/theatre bed
2. Long Diagnostic & Monitoring time
(Insufficient Senior Staff)
3. Workload (overloaded)
Main Causes of Long Waiting Time
at Hospital OPDs
1. Arriving in Big Batches early in the morning
2. Mismatch mainly at clinician service points
3. Workload (overloaded) mainly at pharmacy
wc Groote Schuur Hospital : E OPD Central Reception Counter
Waiting Time, Service Time & No of Patients Arriving By Arrival Time
No specific time set to 00.00 - 00.59, No appointment set to 23.00 - 23.59
0
20
40
60
80
100
120
00:0
0 -
00:5
9
01:0
0 -
01:5
9
02:0
0 -
02:5
9
03:0
0 -
03:5
9
04:0
0 -
04:5
9
05:0
0 -
05:5
9
06:0
0 -
06:5
9
07:0
0 -
07:5
9
08:0
0 -
08:5
9
09:0
0 -
09:5
9
10:0
0 -
10:5
9
11:0
0 -
11:5
9
12:0
0 -
12:5
9
13:0
0 -
13:5
9
14:0
0 -
14:5
9
15:0
0 -
15:5
9
16:0
0 -
16:5
9
17:0
0 -
17:5
9
18:0
0 -
18:5
9
19:0
0 -
19:5
9
20:0
0 -
20:5
9
21:0
0 -
21:5
9
22:0
0 -
22:5
9
23:0
0 -
23:5
9
ArrivalTime
Tim
e (
min
ute
s)
0
20
40
60
80
100
120
140
160
180
200
No
of
Pa
tie
nts
Arriv
ing
an
d N
o o
f
Ap
po
intm
en
ts
Median Waiting Time Median Service Time No of Patients Arriving No of Patients with appointment
ArrivalTime
Data
wc Groote Schuur Hospital : E OPD Central Reception Counter
Snapshot of Patients Waiting and those Receiving a Service at any Point in Time
0
10
20
30
40
50
60
70
80
00
:00
01
:00
02
:00
03
:00
04
:00
05
:00
06
:00
07
:00
08
:00
09
:00
10
:00
11
:00
12
:00
13
:00
14
:00
15
:00
16
:00
17
:00
18
:00
19
:00
20
:00
21
:00
22
:00
23
:00
SnapshotTime
No
of
Pati
en
ts
0
2
4
6
No
of
Sta
ff a
t S
ervic
e P
oin
t
Sum of PatsServ Sum of PatsWait Sum of StaffCount
SnapshotTime
Data
Worcester Hospital : OPD Reception Get Folders
Waiting Time, Service Time & No of Patients Arriving By Arrival Time
No specific time set to 00.00 - 00.59, No appointment set to 23.00 - 23.59
0
20
40
60
80
100
120
140
00:0
0 -
00:5
9
01:0
0 -
01:5
9
02:0
0 -
02:5
9
03:0
0 -
03:5
9
04:0
0 -
04:5
9
05:0
0 -
05:5
9
06:0
0 -
06:5
9
07:0
0 -
07:5
9
08:0
0 -
08:5
9
09:0
0 -
09:5
9
10:0
0 -
10:5
9
11:0
0 -
11:5
9
12:0
0 -
12:5
9
13:0
0 -
13:5
9
14:0
0 -
14:5
9
15:0
0 -
15:5
9
16:0
0 -
16:5
9
17:0
0 -
17:5
9
18:0
0 -
18:5
9
19:0
0 -
19:5
9
20:0
0 -
20:5
9
21:0
0 -
21:5
9
22:0
0 -
22:5
9
23:0
0 -
23:5
9
ArrivalTime
Tim
e (
min
ute
s)
0
10
20
30
40
50
60
70
80
No
of
Pati
en
ts A
rriv
ing
an
d N
o o
f
Ap
po
intm
en
ts
Median Waiting Time Median Service Time No of Patients Arriving No of Patients with appointment
ArrivalTime
Data
wc Tygerberg Hospital
Waiting Time, Service Time & No of Patients Arriving By Arrival Time
0
100
200
300
400
500
600
700
800
00:0
0 -
00:5
9
01:0
0 -
01:5
9
02:0
0 -
02:5
9
03:0
0 -
03:5
9
04:0
0 -
04:5
9
05:0
0 -
05:5
9
06:0
0 -
06:5
9
07:0
0 -
07:5
9
08:0
0 -
08:5
9
09:0
0 -
09:5
9
10:0
0 -
10:5
9
11:0
0 -
11:5
9
12:0
0 -
12:5
9
13:0
0 -
13:5
9
14:0
0 -
14:5
9
15:0
0 -
15:5
9
16:0
0 -
16:5
9
17:0
0 -
17:5
9
18:0
0 -
18:5
9
19:0
0 -
19:5
9
20:0
0 -
20:5
9
21:0
0 -
21:5
9
22:0
0 -
22:5
9
23:0
0 -
23:5
9
ArrivalTime
Tim
e (
min
utes)
0
50
100
150
200
250
300
350
400
450
No
of P
atie
nts A
rriv
ing
an
d N
o o
f
Ap
po
intm
en
ts
Median Waiting Time Median Service Time No of Patients Arriving No of Patients with appointment
ArrivalTime
Data
wc Tygerberg Hospital
Snapshot of Patients Waiting and those Receiving a Service at any Point in Time
0
100
200
300
400
500
600
700
800
900
1000
00:0
0
01:0
0
02:0
0
03:0
0
04:0
0
05:0
0
06:0
0
07:0
0
08:0
0
09:0
0
10:0
0
11:0
0
12:0
0
13:0
0
14:0
0
15:0
0
16:0
0
17:0
0
18:0
0
19:0
0
20:0
0
21:0
0
22:0
0
23:0
0
SnapshotTime
No
of P
atie
nts
No of Patients Receiving a Service No of Patients Waiting for a Service
SnapshotTime
Data
wc Groote Schuur Hospital
Waiting Time, Service Time & No of Patients Arriving By Arrival Time
0
108
216
324
432
540
648
756
864
972
1080
00:0
0 -
00:5
9
01:0
0 -
01:5
9
02:0
0 -
02:5
9
03:0
0 -
03:5
9
04:0
0 -
04:5
9
05:0
0 -
05:5
9
06:0
0 -
06:5
9
07:0
0 -
07:5
9
08:0
0 -
08:5
9
09:0
0 -
09:5
9
10:0
0 -
10:5
9
11:0
0 -
11:5
9
12:0
0 -
12:5
9
13:0
0 -
13:5
9
14:0
0 -
14:5
9
15:0
0 -
15:5
9
16:0
0 -
16:5
9
17:0
0 -
17:5
9
18:0
0 -
18:5
9
19:0
0 -
19:5
9
20:0
0 -
20:5
9
21:0
0 -
21:5
9
22:0
0 -
22:5
9
23:0
0 -
23:5
9
ArrivalTime
Tim
e (
min
ute
s)
0
50
100
150
200
250
300
350
400
450
No
of
Pati
en
ts A
rriv
ing
an
d N
o o
f A
pp
oin
tmen
ts
Sum of MedWaitTime Sum of MedServTime Sum of NoOfPats
ArrivalTime
Data
wc Groote Schuur Hospital
Snapshot of Patients Waiting and those Receiving a Service at any Point in Time
0
108
216
324
432
540
648
756
864
972
1080
00:0
0
01:0
0
02:0
0
03:0
0
04:0
0
05:0
0
06:0
0
07:0
0
08:0
0
09:0
0
10:0
0
11:0
0
12:0
0
13:0
0
14:0
0
15:0
0
16:0
0
17:0
0
18:0
0
19:0
0
20:0
0
21:0
0
22:0
0
23:0
0
SnapshotTime
No
of P
atie
nts
No of Patients Receiving a Service No of Patients Waiting for a Service
SnapshotTime
Data
Worcester Hospital
Waiting Time, Service Time & No of Patients Arriving By Arrival Time
0
100
200
300
400
500
600
00:0
0 -
00:5
9
01:0
0 -
01:5
9
02:0
0 -
02:5
9
03:0
0 -
03:5
9
04:0
0 -
04:5
9
05:0
0 -
05:5
9
06:0
0 -
06:5
9
07:0
0 -
07:5
9
08:0
0 -
08:5
9
09:0
0 -
09:5
9
10:0
0 -
10:5
9
11:0
0 -
11:5
9
12:0
0 -
12:5
9
13:0
0 -
13:5
9
14:0
0 -
14:5
9
15:0
0 -
15:5
9
16:0
0 -
16:5
9
17:0
0 -
17:5
9
18:0
0 -
18:5
9
19:0
0 -
19:5
9
20:0
0 -
20:5
9
21:0
0 -
21:5
9
22:0
0 -
22:5
9
23:0
0 -
23:5
9
ArrivalTime
Tim
e (
min
utes)
0
20
40
60
80
100
120
No
of P
atie
nts A
rriv
ing
an
d N
o o
f
Ap
po
intm
en
ts
Median Waiting Time Median Service Time No of Patients Arriving No of Patients with appointment
ArrivalTime
Data
Worcester Hospital
Snapshot of Patients Waiting and those Receiving a Service at any Point in Time
0
50
100
150
200
250
00:0
0
01:0
0
02:0
0
03:0
0
04:0
0
05:0
0
06:0
0
07:0
0
08:0
0
09:0
0
10:0
0
11:0
0
12:0
0
13:0
0
14:0
0
15:0
0
16:0
0
17:0
0
18:0
0
19:0
0
20:0
0
21:0
0
22:0
0
23:0
0
SnapshotTime
No
of P
atie
nts
No of Patients Receiving a Service No of Patients Waiting for a Service
SnapshotTime
Data
wc Red Cross Childrens Hospital
Waiting Time, Service Time & No of Patients Arriving By Arrival Time
0
50
100
150
200
250
300
350
400
450
500
00:0
0 -
00:5
9
01:0
0 -
01:5
9
02:0
0 -
02:5
9
03:0
0 -
03:5
9
04:0
0 -
04:5
9
05:0
0 -
05:5
9
06:0
0 -
06:5
9
07:0
0 -
07:5
9
08:0
0 -
08:5
9
09:0
0 -
09:5
9
10:0
0 -
10:5
9
11:0
0 -
11:5
9
12:0
0 -
12:5
9
13:0
0 -
13:5
9
14:0
0 -
14:5
9
15:0
0 -
15:5
9
16:0
0 -
16:5
9
17:0
0 -
17:5
9
18:0
0 -
18:5
9
19:0
0 -
19:5
9
20:0
0 -
20:5
9
21:0
0 -
21:5
9
22:0
0 -
22:5
9
23:0
0 -
23:5
9
ArrivalTime
Tim
e (
min
utes)
0
20
40
60
80
100
120
No
of P
atie
nts A
rriv
ing
an
d N
o o
f
Ap
po
intm
en
ts
Median Waiting Time Median Service Time No of Patients Arriving No of Patients with appointment
ArrivalTime
Data
wc Red Cross Childrens Hospital
Snapshot of Patients Waiting and those Receiving a Service at any Point in Time
0
50
100
150
200
250
00:0
0
01:0
0
02:0
0
03:0
0
04:0
0
05:0
0
06:0
0
07:0
0
08:0
0
09:0
0
10:0
0
11:0
0
12:0
0
13:0
0
14:0
0
15:0
0
16:0
0
17:0
0
18:0
0
19:0
0
20:0
0
21:0
0
22:0
0
23:0
0
SnapshotTime
No
of P
atie
nts
No of Patients Receiving a Service No of Patients Waiting for a Service
SnapshotTime
Data
Patient Numbers, Waiting Times and Service Times by Arrival Time for Cape Town in August 2005
0
50
100
150
200
250
300
350
400
00:0
0:0
0 -
00:5
9:0
0
01:0
0:0
0 -
01:5
9:0
0
02:0
0:0
0 -
02:5
9:0
0
03:0
0:0
0 -
03:5
9:0
0
04:0
0:0
0 -
04:5
9:0
0
05:0
0:0
0 -
05:5
9:0
0
06:0
0:0
0 -
06:5
9:0
0
07:0
0:0
0 -
07:5
9:0
0
08:0
0:0
0 -
08:5
9:0
0
09:0
0:0
0 -
09:5
9:0
0
10:0
0:0
0 -
10:5
9:0
0
11:0
0:0
0 -
11:5
9:0
0
12:0
0:0
0 -
12:5
9:0
0
13:0
0:0
0 -
13:5
9:0
0
14:0
0:0
0 -
14:5
9:0
0
15:0
0:0
0 -
15:5
9:0
0
16:0
0:0
0 -
16:5
9:0
0
17:0
0:0
0 -
17:5
9:0
0
18:0
0:0
0 -
18:5
9:0
0
19:0
0:0
0 -
19:5
9:0
0
20:0
0:0
0 -
20:5
9:0
0
21:0
0:0
0 -
21:5
9:0
0
22:0
0:0
0 -
22:5
9:0
0
23:0
0:0
0 -
23:5
9:0
0
Min
ute
s
0
1000
2000
3000
4000
5000
6000
Pati
en
ts
MedWaitTime MedServTime NoOfPats
Complete Survey - All Facilities - All Service Points
Waiting Time, Service Time & No of Patients Arriving By Arrival Time in August 2007
0
180
360
540
720
900
1080
1260
1440
1620
00:0
0 -
00:5
9
01:0
0 -
01:5
9
02:0
0 -
02:5
9
03:0
0 -
03:5
9
04:0
0 -
04:5
9
05:0
0 -
05:5
9
06:0
0 -
06:5
9
07:0
0 -
07:5
9
08:0
0 -
08:5
9
09:0
0 -
09:5
9
10:0
0 -
10:5
9
11:0
0 -
11:5
9
12:0
0 -
12:5
9
13:0
0 -
13:5
9
14:0
0 -
14:5
9
15:0
0 -
15:5
9
16:0
0 -
16:5
9
17:0
0 -
17:5
9
18:0
0 -
18:5
9
19:0
0 -
19:5
9
20:0
0 -
20:5
9
21:0
0 -
21:5
9
22:0
0 -
22:5
9
23:0
0 -
23:5
9
ArrivalTime
Tim
e (
min
ute
s)
0
1000
2000
3000
4000
5000
6000
No
of
Pati
en
ts A
rriv
ing
Sum of MedWaitTime Sum of MedServTime Sum of NoOfPats
Drop Page Fields Here
ArrivalTime
Data
Main Causes of Long Waiting Time
At Hospital OPDs
1. Arriving in Big Batches early in the morning
2. Mismatch mainly at clinician service points
3. Workload (overloaded) mainly at pharmacy
wc Groote Schuur Hospital : E Consultant ANC Triage
Snapshot of Patients Waiting and those Receiving a Service at any Point in Time
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
80
00
:00
01
:00
02
:00
03
:00
04
:00
05
:00
06
:00
07
:00
08
:00
09
:00
10
:00
11
:00
12
:00
13
:00
14
:00
15
:00
16
:00
17
:00
18
:00
19
:00
20
:00
21
:00
22
:00
23
:00
SnapshotTime
No
of
Pati
en
ts
0
1
2
3
4
No
of
Sta
ff a
t S
ervic
e P
oin
t
Sum of PatsServ Sum of PatsWait Sum of StaffCount
SnapshotTime
Data
wc Groote Schuur Hospital : E Consultant ANC Triage
Waiting Time, Service Time & No of Patients Arriving By Arrival Time
No specific time set to 00.00 - 00.59, No appointment set to 23.00 - 23.59
0
50
100
150
200
250
300
00:0
0 -
00:5
9
01:0
0 -
01:5
9
02:0
0 -
02:5
9
03:0
0 -
03:5
9
04:0
0 -
04:5
9
05:0
0 -
05:5
9
06:0
0 -
06:5
9
07:0
0 -
07:5
9
08:0
0 -
08:5
9
09:0
0 -
09:5
9
10:0
0 -
10:5
9
11:0
0 -
11:5
9
12:0
0 -
12:5
9
13:0
0 -
13:5
9
14:0
0 -
14:5
9
15:0
0 -
15:5
9
16:0
0 -
16:5
9
17:0
0 -
17:5
9
18:0
0 -
18:5
9
19:0
0 -
19:5
9
20:0
0 -
20:5
9
21:0
0 -
21:5
9
22:0
0 -
22:5
9
23:0
0 -
23:5
9
ArrivalTime
Tim
e (
min
ute
s)
0
10
20
30
40
50
60
70
No
of
Pa
tie
nts
Arriv
ing
an
d N
o o
f
Ap
po
intm
en
ts
Median Waiting Time Median Service Time No of Patients Arriving No of Patients with appointment
ArrivalTime
Data
Tygerberg Service Times Waiting Times
No Service
Point
Nu
mb
er
of
Act
ual
Staf
f
Equi-
vale
nt
Staff
Patie
nts
Seen
Worklo
ad as
Patient
s Seen
per
Staff
per
Day
% Staff
Time
Spent
Attendi
ng to
patient
Med 5
%
75
%
95% Med 5
%
75% 95% Pos
sibl
e
Log
isti
cs
Pro
ble
m
195 C5 B
East
Mammae
Clinic Dr.
4 0.5 14 25.8 87% 12 6 15 45 87 5 165 199 Y
U
ns
pe
cif
ie
d
wc Tygerberg Hospital : C5 B East Mammae Clinic Dr.
Waiting Time, Service Time & No of Patients Arriving By Arrival Time
0
50
100
150
200
250
00
:00
- 0
0:5
9
01
:00
- 0
1:5
9
02
:00
- 0
2:5
9
03
:00
- 0
3:5
9
04
:00
- 0
4:5
9
05
:00
- 0
5:5
9
06
:00
- 0
6:5
9
07
:00
- 0
7:5
9
08
:00
- 0
8:5
9
09
:00
- 0
9:5
9
10
:00
- 1
0:5
9
11
:00
- 1
1:5
9
12
:00
- 1
2:5
9
13
:00
- 1
3:5
9
14
:00
- 1
4:5
9
15
:00
- 1
5:5
9
16
:00
- 1
6:5
9
17
:00
- 1
7:5
9
18
:00
- 1
8:5
9
19
:00
- 1
9:5
9
20
:00
- 2
0:5
9
21
:00
- 2
1:5
9
22
:00
- 2
2:5
9
23
:00
- 2
3:5
9
ArrivalTime
Tim
e (
min
ute
s)
0
2
4
6
8
No
of
Pa
tie
nts
Arriv
ing
Median Waiting Time Median Service Time No of Patients Arriving
ArrivalTime
Data
wc Tygerberg Hospital : C5 B East Mammae Clinic Dr.
Snapshot of Patients Waiting and those Receiving a Service at any Point in Time
0
5
10
15
00:0
0
01:0
0
02:0
0
03:0
0
04:0
0
05:0
0
06:0
0
07:0
0
08:0
0
09:0
0
10:0
0
11:0
0
12:0
0
13:0
0
14:0
0
15:0
0
16:0
0
17:0
0
18:0
0
19:0
0
20:0
0
21:0
0
22:0
0
23:0
0
SnapshotTime
No
of
Pa
tie
nts
0
1
2
3
4
No
of
Sta
ff a
t S
erv
ice
Po
int
Sum of PatsServ Sum of PatsWait Sum of StaffCount
SnapshotTime
Data
Worcester Service Times Waiting Times
No Service Point Nu
mb
er
of
Act
ual
Staf
f
Equi-
vale
nt
Staff
Patie
nts
Seen
Worklo
ad as
Patient
s Seen
per
Staff
per
Day
% Staff
Time
Spent
Attendi
ng to
patient
Med 5
%
75
%
95% Med 5% 75% 95% Po
ssi
bl
e
Lo
gi
sti
cs
Pr
ob
le
m
17 Doctor
Orthopae
dics OPD
4 2.2 58 26.3 65% 10 3 15 30 11
2
38 140 191 Y
U
n
s
p
ec
ifi
e
d
Worcester Hospital : Doctor Orthopaedics OPD
Waiting Time, Service Time & No of Patients Arriving By Arrival Time
No specific time set to 00.00 - 00.59, No appointment set to 23.00 - 23.59
0
50
100
150
200
250
300
00:0
0 -
00:5
9
01:0
0 -
01:5
9
02:0
0 -
02:5
9
03:0
0 -
03:5
9
04:0
0 -
04:5
9
05:0
0 -
05:5
9
06:0
0 -
06:5
9
07:0
0 -
07:5
9
08:0
0 -
08:5
9
09:0
0 -
09:5
9
10:0
0 -
10:5
9
11:0
0 -
11:5
9
12:0
0 -
12:5
9
13:0
0 -
13:5
9
14:0
0 -
14:5
9
15:0
0 -
15:5
9
16:0
0 -
16:5
9
17:0
0 -
17:5
9
18:0
0 -
18:5
9
19:0
0 -
19:5
9
20:0
0 -
20:5
9
21:0
0 -
21:5
9
22:0
0 -
22:5
9
23:0
0 -
23:5
9
ArrivalTime
Tim
e (
min
ute
s)
0
5
10
15
20
25
30
35
40
45
50
No
of
Pa
tie
nts
Arr
ivin
g a
nd
No
of
Ap
po
intm
en
ts
Median Waiting Time Median Service Time No of Patients Arriving No of Patients with appointment
ArrivalTime
Data
Worcester Hospital : Doctor Orthopaedics OPD
Snapshot of Patients Waiting and those Receiving a Service at any Point in Time
0
5
10
15
20
25
30
35
40
00:0
0
01:0
0
02:0
0
03:0
0
04:0
0
05:0
0
06:0
0
07:0
0
08:0
0
09:0
0
10:0
0
11:0
0
12:0
0
13:0
0
14:0
0
15:0
0
16:0
0
17:0
0
18:0
0
19:0
0
20:0
0
21:0
0
22:0
0
23:0
0
SnapshotTime
No
of
Pa
tie
nts
0
1
2
3
4
5
No
of
Sta
ff a
t S
erv
ice
Po
int
Sum of PatsServ Sum of PatsWait Sum of StaffCount
SnapshotTime
Data
Main Causes of Long Waiting Time
at Hospital OPDs
1. Arriving in Big Batches early in the morning
2. Mismatch mainly at clinician service points
3. Workload (overloaded) mainly at pharmacy
wc Groote Schuur Hospital
Service Times Waiting Times
Service Point Numbe
r of
Actual
Staff
Equivale
nt Staff
Patient
s Seen
Workloa
d as
Patients
Seen
per Staff
per Day
% Staff
Time
Spent
Attendin
g to
patient
Med 5% 75
%
95
%
Med 5% 75
%
95
%
Possibl
e
Logistic
s
Problem
OPD
Pharmacy
Triage
Pharmacist
5 1.1 461 432.2 99% 1 1 1 2 24 1 32 54 Y
Too
little
space
OPD
Pharmacy
Enter &
Label
11 3.1 453 144.4 80% 1 1 2 5 23 4 38 68 Y
Too
little
space
OPD
Pharmacy
Picking
Meds
12 3.9 452 115.1 58% 1 1 2 4 15 1 25 51 N
OPD
Pharmacy
Check
Meds
9 3.2 444 139.2 84% 1 1 3 5 16 3 23 41 N
OPDPharm
acy
Dispense
8 1.4 390 287.6 75%
(150)
1 1 1 2 22 6 30 43 N
Main Causes of Long Waiting Time
1. Arriving in Big Batches early in the morning
Solution: Dynamic Staggered Appointment System
2. Mismatch mainly at clinician service points
Solution: Dynamic Staggered Appointment System
3. Workload (overloaded) mainly at pharmacy and Emergency Units
Solution: Appoint more staff
Summary Table of Interpreted
Results and Recommended
Actions for Every Service Point
Service Point
Name
Median
Waiting
Time**
Qual
ity
of
Care##
Perc
ent
Resi
dual
Staff
Capa
city$$
Casual Factors for High Waiting Time
Present
Comment
ary
Suggested Actions
Ina
ppr
opr
iate
Arri
val
Pat
ter
ns
Mis
mat
ch
Ov
er
wo
rk
ed
In
eff
ici
en
cy
Lo
gi
sti
cs
Fl
o
w
Hi
gh
Se
rvi
ce
Ti
m
e
Ill
og
ica
l
qu
eu
in
g
S21 Reception
Eye Clinic Low A to
E 44%
Doing well in keeping
waiting Times low.
Keep it up.
S21 Eye Clinic
Nurse (General)
High A to
E 44% X X
Staff may
not have
filled in all
the patient
forms.
1. Remove mismatch
by giving patients
appointments to arrive
later.
2. Improve efficiency
by prioritising
attending to patients
who are waiting to be
seen.
S21 Eye Clinic
Nurse
(Specialist)
Low A to
E 12% X
Staff was
working at
reception
while
patient
was
waiting.
Avoid mismatch .
Conclusions
• Waiting Time Survey is Easy to conduct
• Staff participation is fundamental to success
• Waiting Time survey is Low cost with High
Benefit
• Survey not only Measures, but also shows how
to Solve challenges of High Waiting Time
• Implementing solutions to reduce Waiting Time
is Key.
• Monitoring implementations is easy, quick,
cheap
Sustainability of Future
Waiting Time Surveys
• Highly possible since have Customised Survey Tools
– Database (semi-automated)
– Data Collection Tools
– Report templates
• Highly possible since have Standardised Survey Procedures
– 70% of future survey’s work already done
– Should be quick (output in 6 to 8 weeks) and cheap
• Need to Train Staff to implement the surveys
