Introducing Electronic Queue Management at RMH: A System Overview

This report proposes the implementation of an electronic queue management system at the Royal Melbourne Hospital (RMH) to address long patient waiting times and improve efficiency. The report begins by outlining the problem, including long queues, incorrect patient details, and privacy concerns. It then recommends a self-check-in and electronic calling system as a best practice, highlighting its benefits in reducing congestion, automating data capture, and improving staff compliance. The report also discusses enablers and barriers to implementation, the methodology for selecting participants for focus groups, and the ethical considerations involved, such as power imbalances and the inclusion of vulnerable populations. The report concludes by emphasizing the system's potential to reduce wait times and improve the overall patient experience at RMH's outpatient clinics. Relevant references are also provided.

Introducing Electronic Queue Management System: The Royal Melbourne Hospital (RMH) 1
INTRODUCING ELECTRONIC QUEUE MANAGEMENT SYSTEM: THE ROYAL
MELBOURNE HOSPITAL (RMH)
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Introducing Electronic Queue Management System: The Royal Melbourne Hospital (RMH) 2
Introduction
The Royal Melbourne Hospital (RMH) like other facilities across Australia running
outpatient clinics usually find it difficult dealing with long patient queues and the confusion
that comes with it. Patients are also concerned with the long waiting time at the reception and
at the waiting bay. There is thus need for a solution and as a recommendation in this
presentation; the facility should install a digital electronic queue management system at both
its RMH City Campus and RMH Royal Park Campus outpatient clinics. This presentation
thus involves the description of the system, best practices using the technology, related
barriers and enablers of the project, methodology for choosing participants in related focus
groups and further, the ethical considerations in rolling out the project.
Problem Description
According to the management and the workers at the Royal Melbourne Hospital, long
patient waiting time at the outpatient section has become a serious concern. A thorough
research established that there are different factors that contribute to the long waiting menace
at the RMH’s outpatient clinics. These include first, long queues at different reception desks
and waiting rooms that are very crowded. Secondly incorrect details of patients in the
facility’s administration that then needs clarification and challenges in pronouncing patient
name by clinic staff also increase waiting time. A number of patients have continuously also
raised concerns over their privacy in regard to name-calling at the waiting bays within the
outpatient unit. Further, where clinical staff members have been unaware whether a patient
had already checked in or whether they are ready to be served, the confusion has ever been
leading to clarifications that are a waste of time.

Introducing Electronic Queue Management System: The Royal Melbourne Hospital (RMH) 3
Best Practice & Recommendation
Best practice requires that hospitals develop strategies which can accelerate the flow
of clients/patients at crowded units especially in outpatient clinics and improve service
integration. It also provides practical approaches which can be used to reduce the wait times
at the clinic. One of the most effective methods to solve this particular problem is to use a
self-check-in and electronic calling system (Ibanez et al, 2015). Since this system is
specifically for hospitals, it will enable patients to automatically check in without queuing at
the outpatient reception. The patients can also leave the waiting bay and reduce the usual
congestion but called back remotely before their appointments. The system will also be
important in facilitating the capturing and verification of individual patient’s data
automatically. Research indicates that queue management systems allow hospitals to create a
criterion for improving services ((Ibanez et al, 2015). Since calling of patients will be done
automatically, the system captures both call and complete time stamps for reference. The
facility can then evaluate their performance in regard to the maximum time a patient needs to
take at a particular section. This can also inform decision making on the need to improve
service speed among healthcare workers (Xie, 2013). The system will capture the arrival time
of each patient, their call, time taken for consultation and in-clinic wait time.
Hospitals using the electronic queue system which I also recommend for the RMH,
have reported shorter and/or no queues at outpatient reception desks. They have also reported
reduced crowding at the waiting rooms with staff giving a positive feedback. It helps solve
the patient name pronunciation problem and provides a visual display of the flow of patients
within the outpatient unit. Automation of queuing management increases the workers rate of
compliance with maximum time for patient call and completion during consultations (Xie,
2013). Statistically, the system is reported to be able to thus reduce the wait time at clinics to
below 20 minutes for each patient. As a result, I highly recommend the installation of the

Introducing Electronic Queue Management System: The Royal Melbourne Hospital (RMH) 4
electronic queue management system at the ABCD hospital’s outpatient care unit in order to
solve the problem of long waits for patients.
Enablers & Barriers
Among the enablers should first be that the facility will serve patients with posters
indicating how the electronic queue management system works. Secondly, the workers are
likely to be willing to embrace the technology understanding well that it will reduce their
work burden. Further, it is also easy and logical to have assistant to direct those patients who
might not be aware of how the system works and those with disabilities. In terms of barriers,
it will take some time for both patients and workers to get used to using the electronic system.
Secondly, the system is relatively expensive and needs a technician to run maintenance
procedures often for quality functionality. The RMH will thus have to incur costs for training
its staff and clientele on the use of the technology through focus groups.
Focus Groups
There are different factors that must be considered when selecting participants in
focus groups in the clinical setting for low risk projects like putting up an electronic queue
management system. Institutions which intend to embrace the electronic queue management
technology should first use focus groups to train workers and clients visiting the facility on
the technology. Effective focus groups need to have between 6 and 10 participants (Redmond
& Curtis, 2009). While the outpatient clientele should participate on a voluntary basis,
healthcare providers within the facility should all take part in the focus groups. There should
however be separate focus groups; one for the volunteering clients and others involving
healthcare providers within the hospital. Focus groups in hospital setting can include
representatives from different departments that will be directly affected by the operations and
data captured by the electronic queue management system (Zwaanswij & Dulmen, 2014).
The different focus groups should have facilitators and observers to run the discussion and

Introducing Electronic Queue Management System: The Royal Melbourne Hospital (RMH) 5
training on the use of the technology. Effective focus groups should usually not take more
than an hour’s time.
Separating the two groups including healthcare workers and outpatient clients is
crucial in preventing unexpected conflicts and/or power struggles. The facilitators should
however make the ground neutral in that shy participants are not intimidated by those that are
more assertive. The moderators should be experts in the technology and skilled in handling
groups. The venues chosen according to the Nonprofit Business Advisor Journal (2016)
should also be appropriate as the environment influences responses and reactions to the
conversation especially for the groups that involves outpatient clients. It is paramount to
ensure that participants who form the outpatient clientele must have an informed consent
before being included in the focus group (Anderson, 2011). While the focus group for health
workers at the facility may be held a few times , there is need for repeated focus group
sessions with other volunteers who would like to give their views on the technology even
after implementation is on-going. This will be crucial in informing decision on making
necessary improvements at the outpatient section of the hospital.
Ethical Considerations in Participating in Focus Groups & Using the Technology
First, tension is likely to emerge if health workers at the outpatient section are put in
the same focus groups due to the obvious imbalance of power and potential power struggle
(Item 12 of Part C). The facilitators should thus separate focus for healthcare providers from
those involving volunteer patients. Secondly considering that majority of Australians speak
English, any patient who does not understand English including the deaf and blind will
always be assisted by an assistant who will be regular at the reception (item 14 of Part C).
Their bookings on the digital electronic queue management system will be done by the
assistant who can show them when to get into any room once the system calls out their
numbers.

Introducing Electronic Queue Management System: The Royal Melbourne Hospital (RMH) 6
Thirdly in line with item 13 of Part C, the focus groups should only involve adult
volunteers mainly above 18 years (Anderson, 2011). However, parents who are willing to
bring their children who are not below 16 years to take part in the focus group under their
watch will be free to do so. Considering section 3 part B of the ethics form, this project can
involve children but not those aged 16 years and below. They can however, only be included
in focus group discussion with parental consent (Moore & Richardson, 2013). As indicated
earlier, the focus group will not include the deaf and the blind since it is basically includes
audio sounds and a visual display. Further in line with item 3 Part B Section 3 on participant
vulnerability, those with impaired ability to consent will be assisted to book their place on the
queue by an assistant. Even so, parents and or people with the responsibility to give consent
on their behalf can be asked to take part in the focus group and/or use the electronic queue
management system.
Conclusion
The presentation above involves the description an electronic queue management
system recommended for the RMH hospital’s RMH City Campus and RMH Royal Park
Campus outpatient clinics. The presentation cites best practice aspects of the technology in
reducing waiting time in health facilities. It also includes related barriers and enablers of the
project implementation and the methodology for choosing participants in focus groups to
discuss its use and importance. Further, the ethical considerations in rolling out the project
have also been outlined to ensure that it meets the threshold of a low-risk project.

Introducing Electronic Queue Management System: The Royal Melbourne Hospital (RMH) 7
References
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Anderson, W. (2011). 2007 National Statement on Ethical Conduct in Human
Research. Internal Medicine Journal, 41(7), 581-582.
Coule, T. (2013). Theories of knowledge and focus groups in organization and management
research. Qualitative Research in Organizations and Management: An International Journal,
8(2), pp.148-162.
Focus groups offer cost-effective way to get inside the minds of your supporters.
(2016). Nonprofit Business Advisor, 2016(322), pp.1-3.
Ibanez, M., Clark, J., Huckman, R., & Staats, B. (2015). Discretionary Task Ordering: Queue
Management in Radiological Services. SSRN Electronic Journal.
Moore, T., & Richardson, K. (2013). The Low Risk Research Ethics Application Process at
CQUniversity Australia. Journal of Academic Ethics, 11(3), 211-230.
National Statement on Ethical Conduct in Human Research (2007)
Ryu, S., Rump, C. and Qiao, C. (2004). Advances in Active Queue Management (AQM)
Based TCP Congestion Control. Telecommunication Systems, 25(3/4), pp.317-351.
Waller, R. (2009). The Royal Melbourne Hospital Emergency Department twenty years
on. Emergency Medicine, 6(2), pp.109-118.
XIE, L. (2013). Passive queue management algorithm based on synchronized queue. Journal
of Computer Applications, 32(10), pp.2716-2718.
Zwaanswijk, M. and van Dulmen, S. (2014). Advantages of asynchronous online focus
groups and face-to-face focus groups as perceived by child, adolescent and adult participants:
a survey study. BMC Research Notes, 7(1), p.756.