Healthcare Organizational Development Project: Reduction of Outpatient Waiting Times and Improvement of Patient Satisfaction

This project aims to reduce waiting times and improve patient satisfaction in a renowned hospital in the United Arab Emirates. The proposed change process uses the Six Sigma and PDSA cycles of healthcare change to implement waiting list data collection, patient feedback surveys, delegation of staff services, implementation of telemedicine and electronic health records and performance of regular quality audits.

Running head: Healthcare Organizational Development Project
Healthcare Organizational Development Project: Reduction of Outpatient
Waiting Times and Improvement of Patient Satisfaction
Name of the Student:
Name of the University:
Author note:

1Healthcare Organizational Development Project
Executive Summary
Long queueing times in hospitals results in lack of patient reception of adequate
healthcare services and negative customer feedback. Considering the problem of
long waiting times in a renowned hospital in the United Arab Emirates, an
organizational change process has been proposed using the six sigma and Plan-Do-
Study-Act (PDSA) cycles of healthcare change. The objective of the proposed
project lies in improvement of service quality and ensuring patient satisfaction by
reducing waiting times. Using the six sigma and PDSA cycles, the change project
proposes conductance of waiting list data collection, patient feedback surveys,
delegation of staff services, implementation of telemedicine and electronic health
records and performance of regular quality audits to ensure compliance to change
process and achievement of positive patient health outcomes.

2Healthcare Organizational Development Project
Table of Contents
Title....................................................................................................................3
Introduction........................................................................................................3
Available Evidence............................................................................................3
The Proposed Project........................................................................................4
The Six Sigma Project Proposal of Reducing Waiting Times and Ensuring
Patient Satisfaction...................................................................................................4
The PDSA Cycle of Directing Change towards Reducing Waiting Times and
Ensuring Customer Satisfaction................................................................................4
Aim and Objective..............................................................................................4
Aim.................................................................................................................4
Objective........................................................................................................4
Evaluation and Assessment...........................................................................5
Concluding Statements: Ensuring Internal and External Validity......................5
References.........................................................................................................6
Appendices........................................................................................................8
Appendix 1: Existing process flow of services (As designed by the Author). 8
Appendix 1: Process flow after implementation of Six Sigma (As designed
by the Author)............................................................................................................8
Appendix 2: Process flow after implementation of PDSA (As designed by
the Author)................................................................................................................9

3Healthcare Organizational Development Project
Title
Improving patient satisfaction by reducing inpatient and outpatient waiting
times and implementing healthcare organizational change process using the Six
Sigma PDSA Cycle.
Introduction
The chosen organization is a renowned multispecialty hospital located in
Dubai, United Arab Emirates. Recent evidence across the last seven months of the
year 2018, reported a total of 4, 599 children in the waiting list. 13, 128 patients have
been in the waiting list for more than year while 43, 538 of them have encountered
the same for less than 6 months ("IPDC Waiting List By Group Hospital - IPDC
Waiting List By Group Hospital 2018 (to date) - HSE Open Data", 2018).Hence, the
proposed project proposal aims to implement an organizational change process of
reducing the number of patients who are waiting by half in the next six months and to
almost zero by the year 2020.
Available Evidence
According to Rosman et al., (2018), a lack of available beds results and
triaging have been documented as a key reason behind long waiting times (Alam et
al., 2018). Manual consultations using traditional pen and paper methods is a major
contributor. Health professionals may not be available during certain days of the
week or working hours (Dong, Yom-Tov & Yom-Tov, 2018). Being totally customer
oriented, the six sigma process will be undertaken to ensure customer satisfaction
through regulation of processes associated with long waiting times (Bhat,
Gijo&Jnanesh, 2016). However, as researched by Deblois and Lepanto (2016), its
major disadvantage lies in excessive consideration of customer needs. Similarly, as
researched by Kampstra et al., (2018), the Plan-Do-Study-Act (PDSA) cycle is
advantageous for initiating change process in healthcare due to the ease with which
it can be understood. However, as examined by Kryzanowski et al., (2018), its
continuous nature may be time consuming.

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The Proposed Project
The following change process methodologies will be followed, the diagrams of
which have been outlined as Appendices at the end of the project report.
The Six Sigma Project Proposal of Reducing Waiting Times and Ensuring
Patient Satisfaction
The change will be implemented using the following Six Sigma DMAIC
Methodology (Antony et al., 2018):
 Define: The project of reducing waiting times will be defined by obtaining
patient waiting time and feedback information by the quality control and
information technology department.
 Measure: Data of the will be collected, measured and analysed by the
information technology department.
 Analyse: Collection of data and analysis will be performed by the
maintenance, information technology and quality control department.
 Improve: Change process for improvement will be implemented by execution
of telemedicine, telephone triage and delegation of new staff members.
Electronic health software will be used for quicker documentation.
 Control: Control and adherence to change process to maintain quality will be
conducted by regular auditing by the quality control department.
The PDSA Cycle of Directing Change towards Reducing Waiting Times and
Ensuring Customer Satisfaction
The change will be implemented using the following PDSA cycle methodology
(Raschke et al., 2017):
 Plan: After data collection of patients in queue and feedback surveys,
objectives of the proposed change process will be defined.
 Do: The collected data will be analysed by the quality control department
followed by implementation of electronic health records by the information
technology department.
 Study: Pilot studies on the usage of the above will be conducted followed by
evaluation.
 Act: The change processes will be implemented followed by continuous
auditing, data collection and obtaining feedback by the maintenance, quality
control and information technology department.
Aim and Objective
Aim
To improve customer satisfaction in a selected healthcare organization by
reducing waiting times.
Objective
1. To reduce waiting times and hasten patient admissions by delegating a
separate healthcare staff team.
2. To reduce waiting times and hasten patient admissions by implementing
electronic health records and telemedicine.
3. To ensure positive customer feedback and quality care deliverance by
conductance of regular auditing.

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Evaluation and Assessment
1. Objective 1 will be assessed by conducting customer as well as staff feedback
surveys and collecting data on number of patients in queue (Liang et al.,
2015).
2. Objective 2 will be assessed by conducting the above, followed by evaluation
of efficiency of usage of the newly implemented software (Xu & Chan, 2018).
3. Objective 3 will be assessed by conducting regular auditing to evaluate staff
performance and customer satisfaction (van Harten et al., 2015).
Concluding Statements: Ensuring Internal and External Validity
The external validity of the proposed change process will be evaluated by
conducting customer interviews, feedbacks and monthly data collection of waiting
times. Internal validity will be evaluated by quality control auditing checks along with
conductance of evidence based research resulting in evidence based practice by the
quality control department as well as associated clinicians. Implementation of this
change process is useful since it will pave the way for improved healthcare services
and positive patient health outcomes (Jarvis, 2016).

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References
Alam, S., Osama, M., Iqbal, F., &Sawar, I. (2018). Reducing pharmacy patient
waiting time. International Journal of Health Care Quality Assurance, 31(7),
834-844.
Antony, J., Palsuk, P., Gupta, S., Mishra, D., &Barach, P. (2018). Six Sigma in
healthcare: a systematic review of the literature. International Journal of
Quality & Reliability Management, 35(5), 1075-1092.
Bhat, S., Gijo, E. V., &Jnanesh, N. A. (2016). Productivity and performance
improvement in the medical records department of a hospital: An application
of Lean Six Sigma. International Journal of Productivity and Performance
Management, 65(1), 98-125.
Deblois, S., & Lepanto, L. (2016). Lean and Six Sigma in acute care: a systematic
review of reviews. International journal of health care quality assurance, 29(2),
192-208.
Dong, J., Yom-Tov, E., & Yom-Tov, G. B. (2018). The impact of delay
announcements on hospital network coordination and waiting times.
Management Science.
IPDC Waiting List By Group Hospital - IPDC Waiting List By Group Hospital 2018 (to
date) - HSE Open Data. (2018). Retrieved from
https://data.ehealthireland.ie/dataset/ipdc-waiting-list-by-group-hospital/
resource/bc5bdcda-f102-4dcd-acab-ebb4d21c3760.
Jarvis, P. R. E. (2016). Improving emergency department patient flow. Clinical and
experimental emergency medicine, 3(2), 63.
Kampstra, N. A., Zipfel, N., van der Nat, P. B., Westert, G. P., van der Wees, P. J.,
&Groenewoud, A. S. (2018). Health outcomes measurement and
organizational readiness support quality improvement: a systematic review.
BMC health services research, 18(1), 1005.
Kryzanowski, J., Bloomquist, C. D., Dunn-Pierce, T., Murphy, L., Clarke, S., &
Neudorf, C. (2018). Quality improvement as a population health promotion
opportunity to reorient the healthcare system. Canadian Journal of Public
Health, 1-4.
Liang, B., Turkcan, A., Ceyhan, M. E., & Stuart, K. (2015). Improvement of
chemotherapy patient flow and scheduling in an outpatient oncology clinic.
International Journal of Production Research, 53(24), 7177-7190.
Raschke, R. A., Groves, R. H., Khurana, H. S., Nikhanj, N., Utter, E., Hartling, D., ...
&Calleja, M. (2017). A quality improvement project to improve the Medicare
and Medicaid Services (CMS) sepsis bundle compliance rate in a large
healthcare system. BMJ Open Qual, 6(2), e000080.
Rosman, M., Rachminov, O., Segal, O., & Segal, G. (2015). Prolonged patients’ In-
Hospital Waiting Period after discharge eligibility is associated with increased
risk of infection, morbidity and mortality: a retrospective cohort analysis. BMC
health services research, 15(1), 246.

7Healthcare Organizational Development Project
vanHarten, M. C., Hoebers, F. J., Kross, K. W., van Werkhoven, E. D., van den
Brekel, M. W., & van Dijk, B. A. (2015). Determinants of treatment waiting
times for head and neck cancer in the Netherlands and their relation to
survival. Oral oncology, 51(3), 272-278.
Xu, K., & Chan, C. W. (2016). Using future information to reduce waiting times in the
emergency department via diversion. Manufacturing & Service Operations
Management, 18(3), 314-331.

8Healthcare Organizational Development Project
Appendices
Appendix 1: Existing process flow of services (As designed by the Author)
1. Priority Patient Admissions based on Triage and Medical Emergencies
2. Usage of Manual Pen and Paper methods for documentation
3. Prolonged conductance of Patient Screening and Assessment
4. Unavailability of required Health Professionals during specific hours/days
5. Existing Process Outcome: Delayed Admission and Long Patient Waiting
Times
Appendix 1: Process flow after implementation of Six Sigma (As designed by
the Author)
1. Defining project objectives by collecting data and obtaining feedback on waiting
times and patient satisfaction.
2. Measuring the collected data by segregation and filtering.
3. Analysing collected data to identify waiting time bands and departments or
clinicians associated with longer waiting times.
4. Improving existing process flow by implementation of electronic health records,
telemedicine, rescheduling specific hospital or clinician services and allocating
separate staff for patient admission management.

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5. Controlling by conductance of regular auditing, monthly waiting time data
collection and obtaining customer feedback.
6. Proposed Process Outcome: Reduced waiting time and customer
satisfaction.
Appendix 2: Process flow after implementation of PDSA (As designed by the
Author)
1. Planning the objectives of the change project based on reports of patient
feedback and number of patients in long waiting lists across various time bands
and hospital services or departments.
2. After data analysis and objective formulation, ‘doing’ the change by
implementation of electronic health records, telemedicine, rescheduling specific
hospital or clinician services and allocating separate staff for patient admission
management.
3. Prior to final implementation of the above proposed changes, performing pilot
studies to execute the same over a small scale to assess the organizational effects
of change.
4. Final implementation of change process followed by continuous auditing, data
collection and obtaining feedback to ensure quality and immediate to
shortcomings and negative customer feedback
5. Proposed Process outcome: Proposed Outcome: Reduced waiting time
and customer satisfaction.