University of Twente Student Theses


Analysis of the Surgical Outpatient Clinics at Medisch Spectrum Twente

Amersfort, Joy (2013) Analysis of the Surgical Outpatient Clinics at Medisch Spectrum Twente.

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Abstract:The surgical outpatient clinics at MST service a wide variety of patients. There are three different specialties, namely traumatology; vascular surgery and oncology and gastroenterology surgery. All specialists also see patients from the category ‘general surgery’. The specialists hold their consultation hours at three different outpatient clinics. At the outpatient clinics supply and demand are matched, supply being the capacity of the outpatient clinic and demand being the number of appointments needed. A shortcoming in outpatient clinic capacity may cause high access time, overloaded sessions and thus delays in the clinic and overtime. The general experience of the staff is that the access times vary greatly per specialism. The staff finds the frequency of overbooked appointments too high and it causes overloaded consultation hours. They label the waiting time in the clinic as long and sometimes extreme. These problems are affecting patients as well and could lead to dissatisfaction. The dimensions of quality are safety, timeliness, efficiency, effectiveness, patient-centeredness, and equity. These are also aims for improvement as the experienced problems can be categorized into these dimensions. However, there is a lack of objective information concerning the dimensions of quality in daily practice regarding the consultation hours and there is no insight in terms of quantitative data. The main goal of this study is therefore to investigate how the consultation hours can be improved, with recommendations towards improving the efficiency, effectiveness, timeliness and patient-centeredness of the surgical outpatient clinics at MST. Data is collected by the means of, 1) survey research, to gather information on the patient perspective and waiting – and service times, 2) a data set of the patient population during the period of data collection to create insight in overbooked appointments and no shows. In addition, supply and demand are compared, access times are gathered, and utilization is calculated. The results of this study indicate that access times are not consistent in their length which indicates an imbalance between fluctuations in demand and supply. Measuring access times more frequent may provide further insight in the fluctuation and help determine the extent of the shortcoming of supply. Investigation and determination of variations/fluctuations in supply and demand should offer the greatest potential for success according to literature. Fluctuation in supply was seen in the utilization analysis: consultation hours are often not held as scheduled and start an hour later or end earlier than planned. This indicates that specialists carry out other responsibilities in the time that was initially reserved for consults, and secretaries leave a buffer at the end of afternoon sessions where they do not plan any appointments. The efficiency of the consultations hours can therefore be improved. Reducing these fluctuations should also allow to reduce overloaded sessions. There was no balance between overbooked appointments and no shows, and the amount of overbooked appointments was relatively large. It is advised to formulate a policy for overbooking appointments to avoid overloaded sessions which cause delays and overtime. A general lack of capacity was seen and mostly attributed to oncology. Oncology also had the largest proportion of overbooked appointments and delays which support a capacity problem. Apart from generating capacity, demand can also be reduced. For example by revising the policies for follow-up patients. Variability in arrival times of patients did not seem to affect the performance of the appointment system as very little patients were tardy. Variability in service time could not be attributed consistently to gender, age, location or activities that were performed during the consult, which can indicate a natural variability inherent to the process. Investigation of this variability may provide insight into possible patient categorization into different codes and service times. Looking at specific patient processes might also lead to the selection of tasks that can be delegated from specialists to nursing staff, nurse practitioners, residents, or possibly other departments. Waiting times were confirmed, but may be longer and more extreme in practice: 70,15% of the respondents had to wait for their appointment, however only 33,99% of the respondents had to wait as long or longer than their maximum acceptable waiting time. Waiting time can be caused by variability in service time and overbooked appointments. Further research into these causes will allow waiting time to be reduced. The majority of the respondents were satisfied with the service at the outpatient clinics. The respondents found it most important to have sufficient time with the specialist, the comfort of the waiting area was found least important. Respondents find it more important not to wait longer than their maximum acceptable waiting time than being notified on their waiting time exceeding their appointment time. However, the respondents were divided in their level of agreement on the notification of the waiting time. This can be improved by making use of different tools available for this: a scale in minutes at the front desk where the indicator can be moved to current waiting times or applying for a monitor where news and information can be displayed in the waiting area. Respondents were satisfied with the waiting area, but did indicate suggestions for improvements: most mentioned were recent newspapers and literature and a coffee/tea machine.
Item Type:Essay (Master)
Medisch Spectrum Twente
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:83 economics
Programme:Health Sciences MSc (66851)
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