Paediatric Orthopaedic Clinic at the Children’s Hospital of Western ontario

Paediatric Orthopaedic Clinic at

The Children’s Hospital of Western Ontario

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1. Introduction.

The aim of this paper is to give some recommendations to solve the problems faced in the Paediatric Orthopaedic Clinic at the Children’s Hospital of Western Ontario.

There are two main issues to study:

• Long waiting times experienced by the patients (more than two hours in average).
• Clinical staff’s complaints regarding overtime hours.

The main objective that the management would like to achieve is to reduce waiting times by 20%.

The clinic works 3 half-day per week, Monday to Wednesday, from 8.30 – 13.00 h or 4.5 hours/day. The average number of patients per day is 80 of which 60% are returning patients (or follow-up patients) and 40% new patients. The average annual earnings for full-time workers in the Hospital region is $44.000 per year.

The staff that works in the Paediatric Orthopaedic Clinic is composed of 1 Surgeon, 2 senior residents, 1 cast technician,         4 nurses, 3 clerks, 6 X-rays technicians and 3 radiologists.

Following it will be analysed each one of the different processes in the Clinic, based on the data obtained from the patient’s survey and the staff activity time’s report. At the end, it will be presented the recommendations to improve the overall process.

1. Processes Analysis.

1. Front Desk Area.

The Front Desk Process Flow is as follows:

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The average time spent by the patients is the 30 minutes in case of new patients and 25 minutes for the follow-up patients. The variability of the data is 4 minutes, not very significant (16%) but that indicates some variation. However, the data obtained regarding the activity times shows that only 5 minutes were needed to accomplish the registration process and 9 and 4 minutes for the verification process in case of new and follow-up patients respectively.

        Comparison Times in Front Desk Process

We observe that the average waiting time in this process is 16±4 minutes. We should check now if this waiting problem could come from a lack of labour resources. For analysing that, we calculate the utilisation rate percentage of the different workers:

Clerks: We have three clerks working in the Front Desk. Each one works from 8.30 h to 11.30 h (3 hours = 180 minutes). So we have an ‘availability time’ of 3 x 180 minutes = 540 minutes.

On the other hand, we can calculate the work load for these clerks as follows:

80 patients x 40% new patients x 5 minutes/patient + 80 patients x 60% follow-up patients x 5 minutes/patient = 480 minutes.

% Utilisation of clerks in Front Desk = 480/540 = 88%.

Nurses: We have three nurses in the Front Desk working from 8.30 h- 12.45 h who perform the verification of the documents for the patients arriving at the clinic and also collect the X-ray films and radiologist comments. Their availability time is:

3 nurses x 4.25 hours/day x 60 minutes/hour = 765 minutes

And the Workload is:

(9 m + 2 m) x 40% x 80 patient + (4 m + 2 m) x 60% x 80 patient =640 minutes

% Utilisation of nurses in Front Desk = 640/765 = 84%.

The rate of labour resources utilisation in the Front Desk Process are less than 100% and, therefore, they seem reasonable. We do not think the main cause of the long waiting times is in this area. However, there are some recommendations that could be made to improve the performance of the unit.

The first recommendation would be to improve the appointment process. If all new patients need to get an X-ray, it should be better to send them directly to the radiology department, instead of making them go to the front desk and then walk 25 metres to the radiology area. It would be necessary to place some of the clerks and nurses in the Radiology front desk to do the registration and verification.

The second recommendation would be the implementation of an electronic information system (like a Customer Relation Management information system) to better handle the patients information and then speed up processes as registration, documents verification, X-ray images filing, …that certainly will reduce the activities times in the Front desks.

1. Radiology Department.

The different tasks in this process area are the followings:

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From the data given, we observe there is also a problem of long waiting times in this department. Waiting times reported are 58 minutes for new and follow-up patients while the activity time reported by the staff is only 23 minutes. The standard deviation for waiting time data is high, 22 minutes, and probably that variability is the result of sharing the X-ray machines with the ER rooms, so we have waiting times that could go for 36 minutes until almost 80 minutes.

        Comparison Times in Radiology Department

The staff in the Radiology area is made up of:

1 clerk, 3 radiologist and 6 X-ray technicians that operate each of the 6 X-Ray machines. We calculate now their availability times and workload as we did in the Front Desk area.

The number of patients from the Paediatric Orthopaedic Clinic that need an X-ray is:

80 patients x 40% new patients + 80 patients x 60% follow-up patients x 85% = 73 patients/day.