ULTRASOUND GAP

ANALYSIS

To do Gap Analysis and reduce the waiting

time of patients.
 The sample data collected for Analysis

686 Patients
which includes:
• OPD
• IPD
• PHC
• Emergency
 Type of
Patients

OPD IPD Emergency

Walk IN Appointment
 Flow of OPD patients for USG.
Walk In Appointment
Patients patients
(already (already
registered) registered) Registration
of Patient is
done if he/she
• The Front • FOE prepares
Office bill and inform is visiting for
Patient the patient the first time.
arrives at the executive
informs the regarding the It takes about
Radiology patient about charges. 5 mins to
Reception. the waiting time generate the
and after their
consent
registration
prepares bill. number.
 Acknowledgement When token
Billing is done as is done followed number displays
per prescription by giving the patient goes
via Cash or Card. token number to inside the
the patient. procedure room.
 Flow of IPD patients for USG.

Patients are
Appointments shifted to
are generated radiology for
The physician USG prior the
Nurses on HIS
generates appointed time
prepares the accordingly
request for along with the
bill on HIS. from the
USG. requisition/
radiology
department. data sheet.
On reaching the
site GDA informs Patient is then
Acknowledgement
FO about the taken inside
is done.
arrival of the IP procedure room.
patient.
 Frequently asked questions at Front
Office
120 115

100
88
80

60

40
30

20
10

0
Waiting time for the When will I get report Why ID proofs are Do I need to do
procedure(before required? fasting?
billing) OPD patients
Observations made at Front Office
• Patients enquire about the amount as well as the waiting
time.
• HIS functions slowly and results into long queue.
• Patients gets confused from where billing and
acknowledgement is done. Lack of proper segregation.
• Credit bills takes a lot of time. (112 patients
)..\Excel for presentation\Credit pts..xlsx

• Most of the OPD patients don’t carry the required

documents.
• Some of the appointment patients don’t show up.
• Error in updating of token numbers allotted to the patients.
• Patients are informed prior the procedure if they need to
do fasting or not by FOE.
• Sometimes there were error in the display of token
number.
• Telephonic queries are also tackled at FO.
• Sometimes laboratory bills are also generated along with
radiology bills for the comfort of patient.
• Less use of feedback forms, they are only used when
senior executives ask to get them filled.
• Lack of professionalism in front of the patients.

• ..\Excel for presentation\observations.xlsx

Root Cause Analysis for finding
the GAPS.

Define
Use of DMAIC Measure
for finding the
Analyse
loopholes and
discrepancies. Improve
Control
All patients coming for Ultrasound at Radiology should
not wait more than 30 minutes from their time of
arrival.
AVERAGE TIMINGS
Arrival to
Billing, 0:07

TAT , 0:42 Appointment to

arrival , 0:25

Billing to
Acknowledgem
ent , 0:20

Acknowledgem
ent to Scan In ,
0:40
Problems at Front Office

Patients do not carry

HIS is very slow and documents which are Because patients are
takes a lot of time to required at the time of not being informed
generate bills. registration. Specially
Followed by poor flow the cases of PNDT prior about such
of patients. and Empanelled requirements.
patients.

Telephonic There is a lack in the

appointments and Patient Query
queries takes a lot of Management. FOE
time of the FOE while escalate the queries
other patients wait to Senior Executives
and queue extends. if they fail to do so.
 The departmental structure is
congested and pts. arriving
Potential Errors in wheel chairs, etc.
blocks the isle.

Protocols are being

followed on an average
basis.

Protocols,
Management,
Organizational
Culture of Safety,
Training.
System Errors
Construction, Design,
Facilities, HIS.
Technical
(Also related to
Equipment)
 Cooperation and
Compliance

Patient

Extent of illness or
Vulnerability.

Human Errors
Practitioners/
Executives.
KSAs

Interpretation,
Communication error from the FOE side.
Lack of coordination leads to mismanagement at Communication,
FO. Coordination among
themselves.
Root Cause 1
Factors affecting patient
flow.
Patient Flow • Volume of patients on daily basis.
from Arrival • Types of patients seen in terms of
to Billing. stage care.

Slow HIS Reasons for Delay

• Billing and
acknowledgement takes
more than the estimated
time and results into more
crowd.
• Waiting for the Doctor specially in the
morning.
• Formalities takes a quite lot of time and
extended queue results in delay.
 Waiting Time from arrival to billing.
0:43

0:36

0:28

0:21
Waiting Time
0:14

0:07

0:00
A B C D E
Why did the patients wait?
Pt. A Pt. B Pt. C Pt. D Pt. E

• Crowd at • Patient arrived • There was a • Vulnerable • There was

billing counter at 9:53 am long queue for patient, still problem in
at 11:30 am was waiting in billing as the was waiting in documentation
and patient queue for HIS was queue for her as the patient
arrived at billing. FOE running slow turn for billing. was carrying
11:33 am. HIS was taking a as well as the Patient was the required
speed was lot of time documentation unaware but documents. As
slow and while was taking a the FOE did HIS was slow
billing was preparing the lot of time. not paid it took time to
done at 11:54 bills. attention to it. receive the
am. mail from
patient’s end.
Also there was
certain
discount to be
made but HIS
was not
picking the
discount.
 From the data collected

The Average waiting time from Arrival to Billing was found

to be

7 minutes 51 seconds.
Billing within 15 mins= 226 patients
Billing b/w 15- 30 mins= 15 patients Out of 253 OPD
patients.
Billing beyond 30 mins= 12 patients
Corrective Actions
• Upgradation of HIS to reduce the extra waiting time.
• Emphasis should be on taking documents in hard copy
from patient end.
• Extend the number of counters for registration and
queries during rush hour.
• Minimize the billing errors.
• More display of information boards for the patients.
• FOE to remain seated and not leave the counter during
rush hours.
• One of the FOE to can be appointed to entertain the
queries of the patients during peak time.
Root Cause 2

Patient waiting
Time clash
time from
between OPD
Acknowledgment
and IPD patients
to Scan In
 Timings

OPD IPD

Starts from
8-9am 13-14pm 7-8pm
9:30am

Patients arrive early

so that they don’t
have to wait for long.
PEAK HOUR ANALYSIS
Count of time slot
Slot Wise OPD/IPD
120 2-3 PM 8-9 AM
13% 12%

100 97 12-1 PM
92 13%
9-10 AM
82 25%
79
80 11AM-12
PM
25% 10-11 AM
12%
60
47 46
39
40
24
2019 19 19 20
20 12
15 13
7
2 1 2 2 2 1 2 4 4 3 2
1 1 1 1
0
Before 8 8-9 AM 9-10 AM 10-11 11-12 12-1 PM 1-2 PM 2-3 PM 3-4 PM 7-8 PM
AM PM

OPD IPD PHC ER

Why there is a Clash?
• OPD starts from 9:30am onwards.
• Rush hour 9 am to 1 pm for OPD
• 12-1pm more IPD patients.(OPD slot)
• 8-9am and 7-8pm slots, less IPD patients.

Mostly waiting time for OPD increases between 9am-12pm.

Also, IPD patients are taken before the allotted time.
9-10 slot= 19 pts.
10-11 slot=7 pts.
11-12 slot=12 pts.
12-1 slot= 19 pts.
From Acknowledgement to Scan In
1:55

1:40 1:37
1:25
1:26

1:12 1:04
0:56
0:57 0:50
0:46 0:47
0:43 0:37
0:31 0:33
0:28 0:21 0:20
0:15
0:14

0:00
A B C D E F G H I J K L M
Waiting time
Reasons for Waiting:
• Pt. F waited for 10 am for the female doctor to arrive and
getting USG done.
• Pt. K was not on fasting as he was not aware about the
precautions required for the procedure.
• Pt. J – Long queue for token number and extended
waiting for the procedure.
• ..\Excel for presentation\PAtient waiting time Ack- SI.xlsx
 From the Data collected

The Average waiting time from

Acknowledgement to Scan In was

40 minutes 29 seconds.

Within 30 mins= 338 patients

B/w 30 mins – 1hr= 190 patients Out of 668 patients.
Beyond 1 hr= 140 patients
Delays for the Procedure. ..\Excel for presentation\Delays.xlsx

Delays
80

70

60

50

40

30

20

10

0
BEFORE 8 AM 8-9 AM 9-10 AM 10-11 AM 11AM-12 PM 12-1 PM 1-2 PM 2-3 PM 3-4 PM 7-8 PM

Delay b/w 30 mins to 1 hour Delay beyond 1 hour Scan within 30 Mins
What can be done to reduce the waiting
time?
• Use of Machine C when rush increases.
• Categorize the patients according to their Vulnerability
and condition.
• Give trainings to FOE in such a way so that they can give
approx. waiting time to the patients.
• Patient should be informed about the fasting prior billing.
How to reduce the Time Clash?

Restrict OPD
patients from
1-2pm.
Few IPD pts. • Confirm if IPD
7-8pm slot patient will
come from 8-
Change the can be come at the
9am. This allotted time or
OPD timings. utilized for
time can be not.
IPD patients.
utilized.
Patients coming for USG
Total no of WALK IN patients= 584
• OPD- 422
• PHC-109
• IPD-38

Total no of APPOINTMENT patients= 100

• OPD- 42
• IPD-58

Patients tend to choose Walk In over appointment.

 APPOINTMENT ADHERENCE
OPD IPD
Early 9 12
On Time 18 26
Late 9 19

Total waiting time of OPD pts.

1:55
1:40
1:26
1:12
0:57
Total waiting time.
0:43
0:28
0:14
0:00
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
STRENGTHS WEAKNESS

• Skilled and • HIS

Experienced FOE. • Less Manpower
• Good Infrastructure during rush hour.
and ambience. • Communication error
with patients.

OPPORTUNITIES
• Prioritize patients
according to their
condition as well as THREATS- Excess
appointments. waiting time may lead
• Technological to dissatisfaction.
advances.
Changes observed at FO
Proper segregation of the counters.
Less communication error with the patients.
There are more than 2 FOE during rush hours.
More Information boards in the department.
Information sheet for patients regarding the precautions
before procedure.
Less errors in billing.
Improved flow of patients in the department.
Summary
According to my observations there were a lot of problems
at the front office but they were tackled and resolved at the
same time.
There were two major gaps found which increased the
waiting time of the patients.
Root causes of the problems were found and with help of
data collected corrective solutions are given.
 Presented by

PRAKRITI SINGH