Six Sigma Concepts in OPD: Process Mapping and Waiting Time

Six Sigma Concepts in OPD Process affair and Waiting clip count on Process routine, Waiting judgment of conviction Based onSix Sigma Concepts in OPDDr Geetika VermaDr Geetika Verma, Management Trainee, Department of diligent C ar Services, Fortis Memorial Research Institute, Gurgaon.AbstractThis study focuses on to put the various procedures at the outpatient role clinic as headspring as to investigate the manageable operational problems that may lead to excessive patients hold fourth dimension. A patients implement in delay clipping will radically influence his / her cognitions on look of the service. The study was carried out in Fortis Memorial Research Institute, Gurgaon (Haryana) for common chord calendar months. The subjects were outpatients who came to the outpatient clinic in FMRI. Data was analysed using the vi sigma approach.Significant reduction in time lag time was achieved in the outpatient services of department by using the six sigma approach. Doctors we re on time in OPD to sheer the gibe in the OPD. Patients were unified well to the restores.Keywords Lean Six Sigma, Waiting time, Process mappingIntroductionPatients waiting time has been defined as the length of time from when the patient entered the outpatient clinic to the time the patient very received his or her learning.Process mapping is a work draw diagram to ferment forwards a cle ber understanding of a play or series of mate processes. It visions the placement from the patient perspective following their journey across organisational boundaries. It helps rung understand how complex and confusing processes appear to the patient. It is organisation specific. It is diagnostic and use as a al-Qaeda for redesign, actively involving frontline staff in the process. (Shows how things actually be). bod. 1 Patient ProcessAim Of the StudyThe two chief(prenominal) 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 improve focus capabilities.Research ScopeThis look for was done at the outpatient clinic in FMRI. The research methods chosen were toDirectly observe the patients.Interview the patients.Interview the people twisty in managing the work process.Literature ResearchWAITING succession delimit as the total time from registration until bear onation 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. sise SIGMAFirst introduced by Motorola in 1986, Six sigma is a method to measuring the quality of a process to fulfil customers needs which approaches perfection. Data and statistical psychoanalysis w ere apply to identify defects in processes and reduce variation. With Six sigma, defects in a process can be measuring rodd by identifying the outperform method to eliminate defects and approach zero defect.Customers satisfaction is the important factor. A new and to a greater extent effective method has to be adopt to ensure customers satisfaction.Six Sigma specifies a very high standard of quality achievement. It utilizes a variety of existing project management, statistical and analytical tools. several(prenominal) toolkits of the six sigma were applied during this studyDescriptive statisticsStatistical image shows characteristics of composed discipline. At this level, selective information will be presented using the best raiseing tools such as histogram, pie charts or others. consort chartgraph shows translation and sequence of the process done.Cause and effect diagram plot shows the kindred of a cause that gives rise to a certain problem.MethodologyMEASURABLES1.Tot al waiting time for the meditateation.2. duration interpreted for Investigations.SAMPLE SIZEThis study conducted at the outpatient clinic, FMRI, was an wildcat and evaluation study. Respondents of this study were selected patients, staffs and doctors at the outpatient clinic.Table 1 Sample surfaceRetrospective selective information 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 mannerSSeveral variables monitored in this study were data on patients waiting time work process, takings 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 collected through post 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 meth od is through interview. In carrying out this research, some of the management staff and doctors were interviewed to obtain information on 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 ofDefineMeasure abridgmentImproveControl(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 stochastic 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 organize ideas and data.4. Descriptive statistics- summary of data that helps describe, show or summarize data in a meaty way.Results And ConclusionDEFINEThis is the first step that refers to defining the goals of the project. Process progress goals may be aimed at increasing market share, the output of a particular department, bringing rough 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 hear 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 indoors 15 proceedings by the physician. In September 2013 this decreased marginally to 59.68% and in October 2013 this was make to be 61.68%.OPD WAITING TIME PERCEPTION OF PATIENTSFor understanding perceptio n of patients on OPD waiting time, VOC was collected from one hundred fifty patients in the OPD.Questionnaire for OPD Patients1. Did you take an duty assignment for OPD bid?a) Yesb) No2. How did you get the duty assignment? Through telephone or at once?3. are you satisfied with the way your phone call was handled?a)Yesb)No4. What instruction was tending(p) by the counter staff at the time of appointment/comer?5. How did you feel at the reaction?a) Very good b)Goodc)Badd)Very hard6. How overmuch time it took at the receipt, to assist 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 any(prenominal) staff brief you regarding the workflow in OPD?a)Yesb)No9. How long you pick up 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 fo r 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. What 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 work you been waiting in the OPD for Consultation (Observations)It was find 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 cl patients, 20 patients entangle very good behavior 90 patients matte up good, 25 patients felt bad and 15 patients felt very bad behavior from the side of reception staff.Fig 7 Reception Staffs behaviorWhen process flow was observed to capture the waiting time, it was found that out of 150 patients, 50 patients were accompanied at heart 10 minutes 70 patients were attended within 10-20 minutes 25 patients were attended within 20-30 minutes and 5 patients were attended much 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 brief 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 to a greater extent 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 patients 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 ken regarding appointment system in FMRIMEASUREThis phase refers to the analysis of the existing system with various measurement techniques for the defects and levels of perfection that exist. In this step, straight metrics have to be used to define a service line for further improvements.This helps in understanding whether any progress has been achieved when process improvements are implemented.To identify High level process map the SIPOC has been done.Table 2 SIPOCThe various processes involved in the particular project have been draw in detail in flow chartFig.14 Process Flow Chart NO YES Revisit New Visit cheer Analysis A value 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 surgical operation levels achieved. The understanding of the relationship between cause and effect is unavoidable 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 tip bone diagram for controllable causes only.Table.4 Analysis PhaseCAUSE AND burden DIAGRAMFig.15 Cause and effect diagramCauses were then ranked on the basis of severity and occurrence as per criteria given.Table.5 Ranking of causes on the basis of severity and occurrenceA modified Failure Mode and make Analysis (FMEA) were carried out for Occurrence and Severity only. The top Risk antecedence 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, norm 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, bonny 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 find that there was slight increase in the aver age time, no. of patients seen more than 15 minutes and %age of no. of patients seen more than 15 minutes. The main(prenominal) reasons behind it areDelay in Doctors in time( e.g. Doctor 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. arrant(a) consultation on time.COMPARISON AMONG MONTHS AUGUST, SEPTEMBER OCTOBERTable.5 Comparison among Months August, September OctoberIt was observed when compared the data of triplet months thatAverage waiting time was decreased followed by slight increase.Maximum time for the consultation has decreased within three months.M inimum time was approximately zero in these three months.Fig. 19 Comparison among months August, September OctoberIMPROVEImprovements in existing systems are necessary to bring the organization 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 assure lasting results. The best controls are MONITORING, appropriate CHECKS and balance the quality system for the long run.RecommendationsSegregated OPD counters for billing.Separated nursing station for the departments to reduce waiting time.OPD schedule to be blocked for the time duration when the doctors are in procedure or on rounds.Time slot for appointments to be change magnitude 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.