Improving outpatient service quality in department of orthopedic surgery by using collaborative approaches

Abstract

Nowadays, patient satisfaction is an important service quality index for many hospitals. In many Asian countries, healthcare system has a mixed-type registration which accepts for both walk-in patients and scheduled patients. It is different from western countries which accept only scheduled patients. A long waiting time (WT) of outpatient clinics is caused by this complex registration system. A survey questionnaire of patient satisfaction showed that the long waiting time is the most dissatisfied service quality for healthcare providers. This study focused on improving clinical services by using collaborative approaches to reduce outpatient waiting time for the healthcare providers. The collaborative approaches are scheduling approach with results presented in this paper and agent-based collaborative control system which is currently in progress. We collected and observed data for two months from real world situation and used data from hospital database for building and validating simulation models. Seven scheduling scenarios are performed: scenarios I adjusted proportion between walk-in patients and scheduled patients, scenario II-VI adjusted patient sequencing, and scenario VII adjusted late rate and applied a late policy for late patients. The scenario I (adjusting the proportion: 10% for walk-in patients and 90% for scheduled patients) has the highest percentage of waiting time improvement (average: 37.13 % for walk-in patients and 50.82 % for scheduled patients) compared with the other scenarios. The overall results show that adjusting proportion of patient scenario and patient sequencing scenario can improve patient waiting time in the mixed-type registration and are possible to apply to any outpatient clinics.

Factors determining perceptions of fairness in access to hospital outpatient departments in Taiwan

“…Regarding consultation queues, a balanced sequence and three unbalanced sequences were chosen according to real consultation situations and the real world simulation study. 5 The ratios of walk-in patients to scheduled patients were 1:1 and 3:1. Both of the ratios occurred on the conditions of no priority for any patients and priority for the first 20 walk-in patients.…”

“…The principles of distributive fairness contain a need-based principle, an equality-based principle and an equity-based principle, 14,[19][20][21][22] which vary according to context. 19 For the proportions of registrations, an approximately balanced proportion and an extremely unbalanced proportion were chosen on the basis of real situations and a real world waiting time simulation study in mixed-type registration system, 5 respectively, 60% and 90% for walk-in patients. Because medical resource is scarce, walk-in patients were more likely to feel over rewarded and guilty in 90%.…”

“…In order to improve the quality of outpatients, researchers have mostly studied the effect of factors on reducing the waiting time of patients in the department by simulations, such as queue structures and proportions of registrations in a mixed registration system. [3][4][5] But outpatient departments should consider not only reducing waiting time but also improving the fairness to patients. 6,7 How to decide on the relative proportions of registrations that are walk-in or are scheduled appointments is controversial.…”

“…Reducing waiting time is one way to improve satisfaction with outpatient services. 8,9 Studies have examined the effect of factors on reducing waiting time by simulations [3][4][5]10 such as the proportions of registrations, ways of queuing and policies on late patients in a mixed registration system. Short waiting time does not necessarily imply fairness for patients.…”

Using the Integration of Discrete Event and Agent-Based Simulation to Enhance Outpatient Service Quality in an Orthopedic Department

“…Gul and Guneri applied a DES model to determine the optimal staff level to reduce the patient average length of stay (LOS) in an emergency department, as well as to improve patient throughput and utilization of resources [ 25 ]. Lu et al [ 26 ] employed DES to improve outpatient service quality in an orthopedic surgery department. Kim et al [ 27 ] improved a mental health clinic design by using DES.…”