Six Sigma Concepts in OPD: Process Mapping and Waiting Time

Six Sigma Concepts in OPD Process Mapping and Waiting era news report on Process part, Waiting magazine Based onSix Sigma Concepts in OPDDr Geetika VermaDr Geetika Verma, Manold agement Trainee, Department of Patient C are Services, Fortis Memorial look into Institute, Gurgaon. repealThis study focuses on to identify the various procedures at the outpatient clinic as well as to investigate the possible operational problems that may lead to excessive patients hold eon. A patients experience in postponement cartridge holder will radi annunciatey influence his / her perceptions on quality of the service. The study was carried out in Fortis Memorial Research Institute, Gurgaon (Haryana) for three months. The subjects were outpatients who came to the outpatient clinic in FMRI. Data was analysed using the six sigma approach.Significant reduction in postponement cadence was achieved in the outpatient services of department by using the six sigma approach. Doctors were on time in OPD to reduce the delay in the OPD. Patients were coordinated well to the doctors.Keywords Lean Six Sigma, Waiting time, Process mapping cosmosPatients waiting time has been defined as the length of time from when the patient entered the outpatient clinic to the time the patient actually received his or her perception.Process mapping is a nameflow diagram to bring forth a clearer understanding of a bidding or series of parallel processes. It views the system from the patient sentiment following their journey across organisational boundaries. It helps staff understand how complex and confusing processes appear to the patient. It is organisation specific. It is diag no.tic and used as a basis for redesign, actively involving frontline staff in the process. (Shows how things actually are).Fig. 1 Patient ProcessAim Of the StudyThe two main objectives of the study wereTo study the patients waiting time in the outpatient clinic, with a view to identify the factors that affect waiting time and recommend ways of minimising the delayTo use the six sigma technique to identify the delay and emend management capabilities.Research ScopeThis research was make at the outpatient clinic in FMRI. The research methods chosen were toDirectly observe the patients.Interview the patients.Interview the people intricate in managing the work process.Literature Research time lag TIME define as the total time from registration until relateation with a doctor.REGISTERATION TIMEDefined as waiting time from the moment patients submit a clinic card or referral letters at the counter until getting a call from the counter. During this time the payment process and record classification are made. Registration time is part of patients waiting time.SIX SIGMAFirst introduced by Motorola in 1986, Six sigma is a method to measure the quality of a process to fulfil customers needs which approaches perfection. Data and statistical analysis were used to identify taints in processes and reduce v ariation. With Six sigma, defects in a process can be measured by identifying the best method to eliminate defects and approach zero defect.Customers satisfaction is the main factor. A new and more than effective method has to be adopted to ensure customers satisfaction.Six Sigma specifies a very high well-worn of quality achievement. It utilizes a variety of existing project management, statistical and analytical tools. Several toolkits of the six sigma were applied during this studyDescriptive statisticsStatistical image shows characteristics of quiet data. At this level, data will be presented using the best presentation tools such as histogram, pie charts or differents.Flow chartChart shows description and successiveness of the process done.Cause and effect diagramDiagram shows the relationship of a cause that gives rise to a certain problem.MethodologyMEASURABLES1.Total waiting time for the consultation.2.Time interpreted for Investigations.SAMPLE SIZEThis study conducted at the outpatient clinic, FMRI, was an exploratory and evaluation study. Respondents of this study were selected patients, staffs and doctors at the outpatient clinic.Table 1 Sample SizeRetrospective data of 4500 patients was analysed for waiting time during the period August- October 2013.Voice Of Patients was obtained from cl patients.TYPE OF DATA AND COLLECTION METHODSSeveral variables monitored in this study were data on patients waiting time work process, number of doctors available and number of staffs at the registration counter.Three major collection methods were used in the studyThe first method was observation. Data were sedate through direct observation on the subjects involved in the various working processes in FMRI. Measurements of time spent from registration until consultation by a doctor were made using a stopwatch.The second method is through interview. In carrying out this research, some of the management staff and doctors were interviewed to obtain information o n the working process in the hospital.Voice of patients (VOP) was obtained using standardized questionnaire.DMAIC METHOD (DEFINE-MEASURE-ANALYSIS-IMPROVE-CONTROL)The Six Sigma method which consists of the five steps ofDefineMeasureAnalysis emendControl(DMAIC) is the roadmap to achieve the objectives of this study.DMAIC STEPSFig. 2 DMAIC StepsPROCESS FLOW IN FMRI OPDFig 3 Outpatient FlowStudy was carried out in the GENERAL OPD FMRI Outpatients of 50 per day.Simple Random sampling was followed.Period of Study AUGUST 2013 TO NOVEMBER 2013.STATISTICAL TOOLS1. Process Map-Flow Chart that shows description and sequence of the process done.2. Cause and Effect Diagram Diagram that shows the relationship of a cause that gives rise to a certain problem.3. Affinity Diagram- Business tool used to machinate ideas and data.4. Descriptive statistics- Analysis of data that helps describe, show or summarize data in a meaningful way.Results And ConclusionDEFINEThis is the first step that refers to delimitate the goals of the project. Process improvement goals may be aimed at increasing market share, the output of a particular department, bringing nigh improved employee satisfaction as well as customer satisfaction and so on.The goal has to align the patient demands and the strategic goals of the organization. Data mining methods can be used to date prospective ideas for project implementation.In other words, businesses are designing a road map for achieving the targets and goals of the organization.Problem StatementThree months retrospective data from the department indicates that in August 2013 only 66.64% of patients were seen in spite of appearance 15 minutes by the physician. In September 2013 this reduced marginally to 59.68% and in October 2013 this was found to be 61.68%.OPD WAITING TIME PERCEPTION OF PATIENTSFor understanding perception of patients on OPD waiting time, VOC was collected from 150 patients in the OPD.Questionnaire for OPD Patients1. Did you take a n troth for OPD visit?a) Yesb) No2. How did you get the appointment? Through telephone or direct?3. argon you satisfied with the way your phone call was handled?a)Yesb)No4. What instruction was given by the counter staff at the time of appointment/ reach?5. How did you feel at the reception?a) Very good b)Goodc)Badd)Very bad6. How much time it took at the reception, to attend you?a)0-10 minsb)10-20 minsc)20-30 minsd)30 mins7. At what time you were asked to report at the counter and when did you reach the OPD reception?8. Did some(prenominal) staff brief you regarding the workflow in OPD?a)Yesb)No9. How long you switch been waiting in OPD?a)0-10 minsb)10-20 minsc)20-30 minsd)30 mins10. Did any information regarding waiting time in OPD was given to you, at the time of appointment?a)Yesb)No11. How much time it took for you to interact with doctor after your arrival?a)0-10 minsb)10-20 minsc)20-30 minsd)30 mins12. Are you aware of the existing appointment system in FMRI?a)Yesb)No13. W hat is your perception on waiting time in the hospital?14. What would you suggest to reduce waiting time in OPD?15. Any other suggestions?How long have you been waiting in the OPD for Consultation (Observations)It was observed that 20% patients take front appointment to consult the doctor whereas 80% patients come Walk- in to consult the doctor.Fig 4 Appointment for OPD Visit67% patients who come to consult the doctor take prior appointment on the telephone whereas 33% comes directly to get the appointment.Fig 5 Appointment SystemIt was found that 75% of the patients were satisfied with the telephonic call handled whereas 25% patients werent satisfied.Fig 6 Satisfaction LevelAs per as the behavior of the reception of the staff is concerned, it was found that out of 150 patients, 20 patients felt very good behavior 90 patients felt good, 25 patients felt bad and 15 patients felt very bad behavior from the side of meat of reception staff.Fig 7 Reception Staffs behaviorWhen process f low was observed to capture the waiting time, it was found that out of 150 patients, 50 patients were tended to(p) within 10 minutes 70 patients were attended within 10-20 minutes 25 patients were attended within 20-30 minutes and 5 patients were attended more than 30 minutes.Fig. 8 Time taken to attend the patients75% patients felt that they were briefed regarding workflow in OPD whereas 25% patients felt that they werent.Fig.9 Briefing Regarding Workflow in OPDRegarding waiting time it was that out of 150 patients, 60 patients had to wait up to 10 minutes 5 patients had to wait within 10-20 minutes, 15 patients had to wait within 20-30 minutes and 30 patients had to wait more than 30 minutes.Fig. 10 Waiting Time in OPD93% patients felt that they were well informed regarding waiting time in OPD whereas 7% patients felt that they werent informed well.Fig. 11 Information regarding Waiting TimeAs per as interaction with doctor after arrival is concerned, out of 150 patients 98 patien ts interacted within 10 minutes, 12 patients interacted within 10-20 minutes, 26 patients interacted within 20-30 minutes and 14 patients interacted more than 30 minutes.Fig. 12 Time taken for consultation to doctor51% patients were found aware regarding existing appointment system in FMRI whereas 49% patients were found unaware.Fig. 13 sentience regarding appointment system in FMRIMEASUREThis grade refers to the analysis of the existing system with various measurement techniques for the defects and levels of perfection that exist. In this step, accurate prosody have to be used to define a baseline for further improvements.This helps in understanding whether any progress has been achieved when process improvements are implemented.To identify broad(prenominal) level process map the SIPOC has been done.Table 2 SIPOCThe various processes involved in the particular project have been described in detail in flow chartFig.14 Process Flow Chart NO YES Revisit New VisitValue Analysis A va lue analysis was done based on the flow chart and the processes were categorized into Value added, Operational Value Added Activity and Non Value Added Activities.Table.3 Value AnalysisANALYZEThe analyze phase was undertaken to determine any disparity that may exist in the goals set and the current performance levels achieved. The understanding of the relationship between cause and effect is prerequisite to bring about any improvements, if needed. Brainstorming session was carried out and all the causes were listed in the affinity diagram. The Fish Bone Diagram was prepared.The causes which got from the brain storming session have been segregated into non controllable causes, direct improvement causes and controllable and likely causes. Its fish bone diagram for controllable causes only.Table.4 Analysis PhaseCAUSE AND EFFECT diagramFig.15 Cause and effect diagramCauses were then ranked on the basis of severity and event as per criteria given.Table.5 Ranking of causes on the basis of severity and occurrenceA modified Failure Mode and Effects Analysis (FMEA) were carried out for Occurrence and Severity only. The top Risk Priority Number was considered for further analysis, using 5WHY.Single Registration counterTime taken to process blood test onlyTime taken to process blood test and other Investigations.DATA ANALYSISAs per analysis of data, following observations were madeMonth August-As per observations,Average Time = 13 minutes.No. of patients seen 15 minutes = approx. 13% of no. of patients seen 15 minutes = 25.48%Fig. 16 Observation in Month AugustMonth September-It was observed,Average Time = 17 minutes.No. of patients seen 15 minutes = approx. 17% of no. of patients seen 15 minutes = 32.70%Fig. 17 Observation in Month SeptemberIt was noticed that there was slight increase in the average time, no. of patients seen more than 15 minutes and %age of no. of patients seen more than 15 minutes. The main reasons behind it areDelay in Doctors in time( e.g. Doc tor in OT/ On Rounds)Delay in Investigations.Long consultation time.Month October-It was observed,Average Time = 15 minutes.No. of patients seen 15 minutes = approx. 16% of no. of patients seen 15 minutes = 30.19%.Fig. 18 Observation in Month OctoberIn this month slight improvement was observed as the average time, no. of patients seen more than 15 minutes and its %age decreased slightly.This was due toDoctors requested to be on time so that patients cant feel inconvenient.Complete consultation on time.COMPARISON AMONG MONTHS AUGUST, family OCTOBERTable.5 Comparison among Months August, September OctoberIt was observed when compared the data of three months thatAverage waiting time was decreased followed by slight increase.Maximum time for the consultation has decreased within three months.Minimum time was approximately zero in these three months.Fig. 19 Comparison among months August, September OctoberIMPROVEImprovements in existing systems are requirement to bring the organiz ation towards achievement of the organization goals. Creative development of processes and tools brings about a new lease on life for the organizations processes and takes them nearer to organizational objectives. Various project management and planning tools can be used to implement these new techniques and processes. Appropriate usage of statistical tools is important to measure the data, which is necessary to understand improvements done and any shortcomings that may exist.The solutions with their respective Causes are shown belowTable.6 Causes SolutionsCONTROLControl phase is the last step in the DMAIC method. This phase is about sustaining the changes made in the Improve phase to guarantee lasting results. The best controls are MONITORING, appropriate CHECKS and balance the quality system for the long run.RecommendationsSegregated OPD counters for billing. set-apart nursing station for the departments to reduce waiting time.OPD schedule to be blocked for the time duration whe n the doctors are in procedure or on rounds.Time slot for appointments to be increased from 10 to 20 minutes per doctor.Conclusion Significant reduction in waiting time was achieved in the outpatient services of the department. Doctors were on time in OPD to reduce the delay in the OPD. Patients were coordinated well to the doctors. Further data analysis will help to monitor and control the waiting time and process flow in the OPD.