hellow

1. Can we start?
Good morning everybody, and thank you for your coming today.
I'd like to start by introducing myself, my name is wadha al breaiki , and I
am working at Tawam hospital as a team leader for user support in IT
department.
Today I am going to talk about polyclinic waiting time problems and its
solutions.
I have chosen to speak about this topics because I am one of the patients
who suffering from this problem and need immediately solution to
resolve this problem from the roots.
I will speak for 20 minutes.
The presentation divided into 4 parts:
In the first part I will give you overview about the topic
In the next section I will show you the results of the study
In part three I am going to explain the current process and proposed
process
And in the last part I will give you the recommendation and conclusion.
Now let us turn to the point one.
Tawam Hospital is one of the leading hospitals in the UAE. It was
formally opened on 17th December 1979. Johns Hopkins Medicine
International (JHMI) took over the management of Tawam hospital
In March 2006. The hospital in affiliation with Johns Hopkins Medicine
International, and is offering a high-quality healthcare; in a sociable and
sympathetic environment.

2. One of the most critical challenging of Tawam Hospital is patient waiting
time which defined as the length of time from entering the patient into the
outpatient clinic till the time when the patient actually received his or her
prescription.
Waiting time is One of the vital measurements for clinic’s efficiency.
Waiting time is defined as the time period that would take for a patient to
enter the clinic until leaving the clinic. In Tawam Hospital, Outpatient
Polyclinics are clinics that patients get treatments, follow-ups, and get a
diagnosis. Those clinics contain different clinics spread over a 3-floor-
bulding that contains 11 wings which can serve up to 200,000 patients’
visits per year
Inefficient staffing or poor organization may cause an extremely
waiting time. To reduce this problem we need real tools and organized
procedures addition to a strong budgeting.
For the real tools Tawam hospital implement one of the important system
over the world, Health Information System or (HIS) which is a system
focus on developing effective electronic patient health care through
qualified physicians, Nursing, laborites, pharmacist & administrative
services (Registers). See figure (1) However, this system does not serve

3. the patients only, it also helps the staff by linked them all together and
keep them updated 24 hours a day /7 days a week as shown
There are several benefits from using the HIS which can be
summarized in the following table (1).
Table 1. The benefit of using HIS
No. Benefits Details
1. Access The HIS Electronic Health Record is a
patient-centric record of care which will be
easily accessible to clinicians, 24 hours a
day, seven days a week.
Health records will be shared efficiently,
securely and confidentially between linked
Hospitals and PHCs.
Patient information will be stored and

4. updated electronically with important
safeguards to protect patient confidentiality.
2. Clinical Diagnostic results will be accessible to
clinicians faster than with paper-based
methods – via Inbox alerts and HIS Results
viewers.
No more handwriting headaches! All
orders, notes and prescriptions will be on-
line and legible.
Reduced duplicate clinical testing as
Physicians will be alerted of duplicate test
entries in real-time.
More accurate clinical data will improve
reporting capabilities
3. Safety The care provided will be safer because vital
clinical information (current and historic)
regarding the patient’s diagnosis and

5. treatment (such as current medication,
details of previous operations, test results
and allergies) will be available to all
authorized clinicians.
Reduction of multiple (possibly conflicting)
records due to a single source of accurate
up-to-date patient information.
4. Patients Reduced “repeated” patient questioning
because of access to updated, current data.
3. Aims of research:
The main objectives of this Studying are to identify the factors and
reasons that affect waiting time and recommend solutions to reduce the
delay.
4. Methodology:
To achieve our goal, two questionnaires have been designed, one for the
patients to measure how much time they spent on it since they arrived to
the clinic till they leave it. The other questionnaire is for specialist

6. (physician, Nursing and register) to measure how the HIS helps them to
provide patients with high quality service as well as measure how
efficient their work, accurate and reliable. For the specialists I used two
ways to distribute the Survey, one way is by email them and the other
way is going to the concern clinic and distributes the survey. For the
patients I have selected 5 clinics in the polyclinic with the highest peak
which are Ob/Gyn, Pediatric, Medicine, Surgery and Orthopedic, and I
asked the help from their staff to record the time that each patient has
spent at each process since he/ she arrives to the clinic till he/ she leaves.
Moreover, to analysis these questionnaires I used excel to enter the data
and an SPSS program to make the analysis.
The result of the first questionnaire about the HIS program showed
that different medical and paramedical are satisfied with the program,
80% of the different specialist agreed that the health information
system provides them with the strong support to do their work in a
professional way. After reviewing the data collected from the sample,
we found that HIS is not the main reason of delaying patient waiting
in the clinics.
I have divided the results of the first questionnaire to the 3 groups,
each group contain 4 questions.

7. Questions 1 to 4 measure how the system is easy to use. As you see in
the figures, most of the participants (purple color) agreed that HIS
system is comfortable to use. In Q (1) about 75% said that the way in
which data come is suited with task they want to perform comparing
to 6% who disagreed. In Q (2) 86% agree with statement that said the
messages displayed by the software are easy to understand comparing
to 2% disagreed. In Q (3) 58% agree that It is easy to retrieve the
information about a certain entry field comparing to 10% who can't. in
Q(4) 52% agree with statement that said "It’s easy for me to move
back and front between different screens comparing to 12% disagreed.
Questions 5 to 8 measures the designed of the system, It can be
demonstrated from figure (8) that 50% of participants either agree or
strongly agree on the statement that clarify the HIS software is
designed in way that help employees to do their work in easy way,
while 2% are disagreed with them. According to the results shown in
figure (9), about 70% of participants either agree or strongly agree
with statement that describes that the employee can expect which
screen will come next comparing to 2% who can't. The results in
figure (10) shown that most of participants (66%) were neutral while
the rest agreed with this statement that “I can easily restore everything
to its previous state, if a mistake was made in completing a form.

8. Figure (11) showed that about 56% of the participants agreed that HIS
is easy to be adopted only 4% are disagreed with them.
Questions from 9 to 12 measures how the end users deal with system,
According to the results shown in figure (12), only 48% of
participants agree with statement that said “I am able to adjust the
amount of information (data, text, graphics, etc.) displayed on-screen
to my needs comparing to 8% disagreed.figure (13) shows that 80%
of participants either agree or strongly agree on the statement that the
software is easily to remember even if they stopped using it for long
times unlike 4% who disagree with them. The results in figure (14)
revealed that 72% respondents either agree or strongly agree on the
statement that describe the general opinion about the HIS program.
Furthermore, 30% of them were neutral and only 8% of the
participants was disagree.
In this slide I will show you the results of the second questionnaire
that designed for the patients to measure the time spend it since they
arrives the clinic till they leave it.
Distribution of patients by time interval from registration to be assessed
by Nurse was also recorded. Table (16) showed that 64% of patients

9. waited to be assessed for less than 30 minutes, 26% between 31to 60
minutes and 10% more than 60 minutes.
The waiting time from Nurse Assessment to physician consultation
ranged from 3minute (minimum) to 82 minutes (maximum). According to
the results shown in Table 17, about 56% of patients waited less than 30
minutes, 34% between 31 to 60 minutes, and 10 % more than 60 minutes.
The results in Fig. (15) show that only 2 % of the patient waited less than
30 minutes to get the required service. 18% waited between 31 to 60
minutes and 80% waited more than 60 minutes.
All the clinics in the polyclinic follow the same processes when the
patients arrive till they leave. To understand this whole process we took a
pediatric clinic as an example to help us to find how the process works,
where is the problem and what should we do to solve this problem from
its roots.
The Following chart shows in details the workflow for the patient visit in
the Pediatric clinic (Fig.17).
As you see in the flowchart the patient start the process by attending the
clinic, if he/ she uninsured he go direct to the registration if not he should
to go to the insurance office and cashier office then to the registration,
after that he do the assessment then see the doctor, if there is no

10. procedure the doctor provide the patients with follow up appointment in
some-case there are some procedures need to be done for the patients like
x-ray, the porter take him to the required place and the nurse or the
technician do the procedure then the results checked by the doctor.
This is a general procedures should every patients pass it when he visit
any clinics in the polyclinic.
One of the simple tools used to understand the problems is a process
mapping which refers to activities involved in defining exactly what a
business entity does, who is responsible, for what standard a process
should be completed and how the success of a business process can be
determined. In our case, we have sited this process map in order to
identify how many steps the patient is going through, where are the
Hands-off , what is the total time for the process, and the areas delays
where we can identify our bottleneck and try to manage it.
Our process mapping showed that the whole process for insured patients
takes around 138 minutes while uninsured patients take around 116
minutes, so the difference between them is 22 minutes.
Therefore we can divide the whole process into two categories, (task time
and wait time). Task time is the time that the patients get the service

11. during his/ her visit to the clinic. In our case the total of the task time for
uninsured patient is 57 minutes and for an insured patient is 79
Waiting time is the time that the patient spends before takes the required
services, it starts when the patient arrives at the clinic regardless of the
appointment time.
Table (19) showed the approximately time that the patient is waiting in
the queue before taking the required service.
From above we can notice that the waiting time is approximately equal to
the task time, by going back to the mapping process it is obvious that the
waiting time for consultation was the longer than the waiting time by 34
minutes, to know the reasons, we have asked some of our samples
elements why the patient s have to wait for a long time to be consulted,
then we can summarize the answers in the following points:
The consultant did not arrive on time.
The physician is busy with inpatient rounds and consultation at the
hospital
Staff shortage (he/ she the only one available in his/ her specialty).

12. According to the results of this study, we suggest 4- step solutions to
resolve this problem from the roots,
8.1. Stakeholders:
First of all we have to define the stakeholders who are involved in this
operation and affect the whole process and activities, table (20) describes
the main stakeholders in the polyclinic and we set them according to their
importance.
Table 20. Stakeholders of the Polyclinic
No Stakeholders Description
.
1. Patient Is the target of the hospital; Tawam hospital mission,
vision and value focus on the patient's satisfaction.
Mission:
To provide a continuum of quality health care which
meets the needs and expectations of the UAE
population and the surrounding GCC countries."
"Vision:
Tawam Hospital believes in treating all Patients,
Visitors and Employees with Respect, Dignity and
Equality, guided by UAE laws and respect for

13. patients' rights."
"Values:
Tawam Hospital will provide high quality, affordable
medical services delivered in a friendly, safe and
caring environment which meet JCIA Standards of
Care."
From above we conclude that patient satisfaction is
very important and necessary in measuring the
efficiency of health care delivery.
2. Nursing and We can call them the unknown soldiers; polyclinic is
registration run and managed by them. They are the first line
staff soldiers who receive patients, implement policies and
ensure that process runs as planned.
3. Physicians Is the health care provider, without their support, the
hospital will not succeed in solving the problem of
waiting time.
4. Nurse Urges and coordinates staff to make sure that efficient

14. Manager nursing services are provided, and quality standards
are met.
5. Patient He deals mainly with patient services and complaints.
Affairs All patients concerns are conveyed to him through a
Manager built up system.
6. Hospital Provide full support to any idea comply with the
CEO: mission, vision and value and serve to solve the
problem of the delay as the hospital mission is patient
focused.
7. Porter Porters are needed when the patient need to move
from one place to another especially if there is a
procedure required such as X-ray, and so on.

15. 8.2. Re-Design of the current process:
To achieve our target and solve this problem we have to redesign the
process in a way that matches our capacity with demand and eliminate the
wasteful steps.
The Following flow-chart is the proposal workflow for the new design of
the pediatric clinic (Fig.19).
The international standard of patient said that the patient should be seen
within 30 minutes upon their arrival, by implement this standard in our
case we can achieve the following:
Reducing the time form insurance verification to cashier from 13
minutes to 5 minutes,
Reducing the waiting time of registration to nurse assessment from
14 minutes to 5 minutes.
Reducing the waiting time from nurse assessment to physician's
consultation from 34.5 minutes to 15 minutes.
Cutting of unnecessary steps by joining the cashier and the claim
officer this will decrease the number of steps for the uninsured
patients by 1.

16. The following 4 groups in Table (21) are defined as the main reasons for
the problem and each group contains underlying factors lead to the
problem.
No. Groups Factors
1. Patients a. The patients not show up on time,
they attending late or early for their
appointments.
b. Increased number of overbooked.
c. Increased number of patients who
come as a walk in, either to refill their
medication prescription, or they
missed their appointment.
2. Staff d. Shortage of staff

17. e. The late arrival of the doctors to the
clinic due to some important issue
such as calling them for emergency
cases.
3. Administration
f. Interruption of clinics by the VIP
patients’ visits that necessitate the use
of the examination room.
4. Resources g. Shortage of staff: we have two
registers records around 100 patients
in one day.
h. Lack of specialized clinics
. Recommendation:
Our recommendation is based on the results of the research and we can
summarize them in the following points.

18. Decrease the waiting time between claim and cashier by joining
them into one office, and make them as one step rather than of 2
steps.
Decrease the waiting time between nursing assessment and
physician by making sure that the doctor arrives on time and force
them by setting policy, monitor their attendance and report it to the
top management.
Decrease the numbers of overbooks by expanding the clinic and
increases the numbers of physicians.
Decrease the numbers of walk-in by adhering to the written policy;
develop a system for refill of prescriptions and by educating
patients.
Reduce the interruption of physicians by not transferring telephone
inquiries.
Control patient’s arrival by adhering to the written policy related to
the registration and scheduling.
Make the patients busy during the waiting time by providing them
some activities.

19. Maintain a good customer services practice such as notify patients
about the accurate estimate of waiting time and apologize for any
delay.
10. Conclusion:In conclusion I would like to say that
We can conclude from all above that process mapping is exciting and a
simple toll to solve the problem based on the perceptions of patients and
staff. This tool helped us to identify the major bottleneck and find out
which areas that need improvement. It focuses directly on providing high
quality service to the patients in a short time.
Thank you very much for your attention and If there are any questions
please feel free to ask.