long patient waiting time at princess marina...

LONG PATIENT WAITING TIME AT PRINCESS MARINA HOSPITAL OUT-PATIENT DISPENSARY

BYPMH TQM TEAM

INTRODUCTION

Total Quality Management (TQM) is a systematic; data based method for improving the quality of specific work processes. TQM follows the Plan-Do-Study-Act cycle as illustrated

6. Standardization7. Future Plans 1. Reason for improvement

2. Current situation3. Problem Analysis

4. Countermeasures

5.Results

ACT PLAN

STUDY DO

ORGANISATIONAL BACKGROUND

Princess Marina (PMH) is a referral hospital. Provides services to patients from all over the country.Bed capacity of 507 patients (normal).Can go up to 700 or 800 including floor beds.The hospital has 45 departments/units.

ORGANISATIONAL BACKGROUND (Continued)

The project was carried out at the Pharmacy outpatient dispensary.The Pharmacy department is divided into 6 units.


Dispensary staff consists of 2- 3 Pharmacists and 2-3 Pharmacy Technicians .The dispensary receives an average of 350 Patients a day.


Like Ministry of Health (MOH), PMH has a strategic objective of providing Timely and Efficient services.

PMH

REDUCE PATIENT WAITING TIME AT DISPENSARY

MOH

PROVIDE TIMELY & EFFICIENT SERVICES

NDP9

EFFICIENCY AND EFFECTIVENESS

VISION 2016

PROSPEROUS, PRODUCTIVE & INNOVATIVE NATION

TEAM MEMBERSMRS M.THAGA, PRINCIPAL PHARMACY TECHNICIAN

(TEAM LEADER)

MR M.F.CHOHAN, PRINCIPAL PHARMACIST II

MR D.SIMBANEGAVI, PRINCIPAL PHARMACIST II(DEPUTY SECRETARY) , LEFT PMH END OF DECEMBER 2006.

MR P.MOROKA, PRINCIPAL PHARMACY TECHNICIAN

MRS. O. MOSALAKATANE,PRINCIPAL PHARMACY TECHNICIAN

TEAM MEMBERSMISS G. GOFHAMODIMO ,SENIOR PHARMACY TECHNICIAN

MISS N. KEETSALETSE,HEALTH CARE AUXILLARY

MRS S. NHIRAPHARMACY TECHNICIAN (SECRETARY)

LIST OF PROBLEMS BRAINSTORMED

1. Expiries2. Inadequate computer skills3. Poor documentation4. Wards not abiding to their ordering

days 5. Misplacement of patient prescriptions6. Inadequate stock availability7. Long patient waiting time at the

dispensaries


8) IDCC patients not honoring refill dates9) Lack of sops (non documentation)10) Time management11) Lack of continuity12) Lack of job description13) Security14) Unauthorized entry of personnel into

the pharmacy


15) Prescribers not signing their prescriptions

16) Poor inventory use17) Too frequent ordering by OPD

dispensary18) Use of trade names19) No custody of files20) Too many people going on offs at the

same time

CLARIFICATION STAGE (Elimination of problems not meeting the brainstorming criteria)

Inappropriate signing of prescriptions by PMH prescribers

F

Long waiting time at the dispensaries at PMH E

Drugs out stock affects our stock availability D

Poor ordering habits by the wards/units at PMH C

Improper documentation and filing at PMH Pharmacy B

Too many Pharmaceuticals expiring in PMH A

PROCESS PROBLEMITEM

MULTIVOTING Problems of top priority

1Inappropriate signing of prescriptions by PMH prescribers F

78Long waiting time at the dispensaries at PMH E

25Drugs out stock affects our stock availability D

2Poor ordering habits by the wards/units at PMH C

26Improper documentation and filing at PMH Pharmacy B

55Too many Pharmaceuticals expiring in PMH A

2ND VOTE 1ST VOTE PROCESS PROBLEM ITEM

THEME SELECTION MATRIX

The Theme Matrix selection was done to select the theme process problem. The following results were obtained :

THEME SELECTION MATRIX

24.4039/8 = 4.88

40/8 = 5.00

•Staff•Patients

Long waiting time at the dispensaries

at PMH

14.0936/8 = 4.50

25/8 = 3.13

PatientStaffMinistry of

Health

Too many Pharmaceuticals expiring in PMH

OVERALLNEED TO IMPROVE

IMPACT ON EXTERNAL

CUSTOMERS

CUSTOMERSPROCESS PROBLEM

FLOW CHARTPATIENT

COLLECTS DRUG

NEXT DAY

CARD SENT TO PRODUCT

ION

OFFICER COLLECTS

CARD

DRUG NEED PREPARATIO

N?

PATIENT ARRIVES

OFFICER GOES OUT

TO COLLECT CARD

IS PRESCP VALID

?

IS TREATME

NT READILY AVAILAB

LE?

IS DRUG

SPECIAL

ORDER?

IS IT NON

DRUG?

IS PATIENT REGISTERED?

IS IT NEW OR REFILL

?

PRODUCT DISPENSED

TO PATIENT

SPECIAL ORDER

COLLECTED & SENT TO DI

PATIENT TO CHECK

APPROVAL LATER ON

CARD COLLECTED

PACKAGING OF DRUGS

DATA ENTRYINTO

SYSTEM

DISPENSING &

COUNSELING

OFFICER GOES TO IV FLUID ROOM

DIALYSIS SOL.ISSUED TO PATIENT

Y

REFER FOR REGISTRATION

REFER TO PRESCRIBER

Y

N

N

NY

NEW

REFILL

Y

Y

YY

Y

NN

DIALYSIS SOLUTION

AVERAGE PATIENT WAITING TIME (Data collected before implementation of countermeasures)

AVER MONTHLY WAITING TIME

105110115120125130135140145

OCT NOV DEC

MONTH

WA

ITIN

G T

IME

IN M

INS

Series1

AVER DAILY WAITING TIME (OCTOBER,2006)

0

50

100

150

200

MON TUE WED THU FRID

DAYS

AVE

R W

AITI

NG T

IMES

Series1

PROBLEM STATEMENT

During the month of October 2006 , 282/297 (95%) of sampled patients at PMH outpatient dispensary waited for 2 hrs 21 mins instead of 1 hr (expected time) ,and thus causing patient dissatisfaction.

PROBLEM STATEMENT (Continued)

When? October, 2006How many? 282/297 (95%)Who? OutpatientsWhere? Princess Marina Outpatient dispensaryWhat ? Waited for more than 1 hourImpact? causing customer dissatisfaction.

IMPROVEMENT TARGETThe average waiting time at PMH outpatient dispensary will be decreased from an average of 2hrs 21 minutes to 60 minutes by February 2007.

FISHBONE DIAGRAM

Too many stages Dispensary understaffed

Available members cannot meet demand

Inadequate and breakdown Of equipment

Lack of service and capacity High patient volume

Budget constraints Self referrals

PROCESS STAFF

EQUIPMENT PATIENTS

Long winding dispensing system and processes in

placeInadequate

allocation and frequent rotation

Patients not informed

Long patientWaiting

Time at PMHOutpatientdispensary

PARETO CHARTA= HIGH PATIENT VOLUME

B= DISPENSARY UNDERSTAFFED

C= TOO MANY STAGES

D= INADEQUATE & FREQUENT BREAKDOWN OF EQUIPMENT

COUNTERMEASURES MATRIX

A tool to identify countermeasures which can be implemented.

NO8.42.2518/83.7530/8Introduce shift work

YES13.33.1325/84.2534/8Re-allocation

YES10.53.3827/83.125/8Reduce frequent rotation

YES143.528/8432/8Introduce relief schedule

ACTIONOVERALL

TeamIndividualTeamIndividual

Review allocation of staff and frequent rotation .

Inadequate allocation of staff and frequent rotation.

FEASIBILITYEFFECTIVENESSCOUNTERMEASURE

OBJECTIVEACTIONABLE ROOT CAUSE

YES

NO

13.5

11

3.6

2.75

29/8

22/7

3.75

4

30/8

32/7

Issue 2 months supply to selected prescriptionIncrease prepacks

YES20.244.637/84.435/8Frequent meetings to be reduced

NO92.520/83.629/8Open a discharge patient dispensary

YES11.964.637/82.621/8To open a card collection window

ACTIONOVERALL

TeamIndividualTeamIndividual

ReviewLong winding dispensing system and processes

Long winding dispensing system and processes in place.


OBJECTIVE

ACTIONABLE ROOT CAUSE

NO10.82.8823/83.7530.8Meeting with GCC Pharmaceutical staff

YES13.583.8831.83.528/8Open an enquiries window

YES10.993.2526/83.3827/8Provide education to get medication from clinics

ACTIONOVERALLTeamIndividualTeamIndividual

Patients are informed about getting their medication from the nearest clinic/health facility

Patients not informed


OBJECTIVEACTIONABLE ROOT CAUSE

AVER MOTHLY WAITING TIME

020406080100120140160

OCT NOV DEC JAN FEB

MONTH

WAI

TING

TIM

E IN

MIN

S

Series1

The graph below illustrates the average waiting time collected before and after implementation of countermeasures .

Countermeasure Implementation Target (60 mins)

BEFORE AFTER

STANDARDIZATION INFORMATION

Plans for standardizing and replicating process improvements:

• Morning relief to continue until staff situation changes i.e. increases.

• Dispensary supervisor to monitor.• Relief to be replicated to stock management

during receipt of bulk orders.• Officers tasked to draw relief schedules.

STANDARDIZATION INFORMATION (Continued)

Scheduled meetings on the notice boards.Enquiries window to be continually attended to.An auxillary to be availed at all times to work with the clerk.

After standardization the dispensary continued collecting waiting time data as

illustrated on the graph below.

AV.MONTHLY WAITING TIME

6987 83

0

50

100

MAR APR MAY

MONTH

AV.W

AITI

NG

TIM

E IN

MIN

Series1

FUTURE PLANSAdditional long term countermeasures e.gThe opening of satellite Pharmacies at the eye and Psychiatric units to decongest dispensaryThe opening of a discharged patient dispensary. Meeting with GCC staff to resolve the issue of reducing volumes of patients coming to PMH dispensary through educating the patients to collect their medication from their nearest health facility.

FUTURE PLANS Request for the update of the clinic list. Pharmaceuticals expiring within PMH organization (wards and Pharmacy) as the next project.

CONCLUSION

The data collected before and after implementation & standardization of countermeasures illustrates the effectiveness of the TQM project.

LONG PATIENT WAITING TIME AT PRINCESS MARINA HOSPITAL DISPENSARY

Do what you can with what you have, where you are!

long patient waiting time at princess marina...

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