West Coast University

Student Health Services Primary Care Clinic

Group members:(Ariel) Jingyi Lai(Iris) Tong Wu

(Janette) Hei Man Leung(Lucy) Qian Ye

(Tina) Yuet Ki Wong

Background Information

Primary Care Clinic (PCC) Central medical facility Appointment / Walk-in System Staffing:

Nurse Practitioners (NP): 5 full-time & 3 part-time Medical Doctors (MD): 5 full-time & 4 part-time Medical Assistants (MA): 6 Support Staff: 1

Brief Summary

From Patient Satisfaction Survey Excessive waiting time Difficulty in scheduling

appointments High return rate Impersonal bureaucracy Non-users: 29.4% Favored (Low

perception of service qualification)

Mission: To provide better and higher quality of services by allowing patients to pick a primary care clinician as their “own doctor”. However, problems start floating up…

Current System – Problem with Scheduling

Clinicians per hour chart: number of clinicians for each time slot Based on the schedule

Total available time of NPs in a week = 11400 min Total available time of MDs in a week = 15600min

Monday Tuesday Wednesday Thursday FridayMD NP MA MD NP MA MD NP MA MD NP MA MD NP MA

8-9am 6 5 1 0 0 1 5 2 1 7 4 1 6 5 19-

10am 6 5 1 6 5 1 7 2 1 7 4 1 6 5 110-

11am 7 7 1 6 1 7 4 1 8 6 1 6 5 111-

12am 7 7 1 6 5 1 7 4 1 8 6 1 6 5 112-1pm 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

1-2pm 8 6 2 6 5 1 5 4 2 7 5 1 8 5 22-3pm 8 6 2 6 5 1 5 4 2 7 5 1 8 5 23-4pm 8 6 2 6 5 1 5 4 2 7 5 1 8 5 24-5pm 8 6 1 6 5 1 5 3 1 7 5 1 8 5 2sum(hr

) 58 48 11 42 35 8 46 27 11 58 40 8 56 40 12

Allocation proble

m exists!!!

I. Analysis of Current System

Actual Capacity

NP capacity for 6 months=11400 minutes*26week=296400 minutes

Demanded Capacity

MD capacity required: 9005 patients*25 minutes per patient=225125 minutes

NP capacity required: 6760 patients*25 minutes per patient=169000 minutes

MD capacity for 6 months=15600 minutes*26week=405600 minutes

Current System – Problem with Scheduling (cont’d)

I. Analysis of Current System

Proper Capacity Calculation Criteria

Utilization for MD = 225125/405600 = 55.55%  Utilization for NP = 169000/296400 = 57.02% Average utilization: (0.5555042+0.57017544)/2 = 56.26% Arrivals per hour (1/a) = (9005+6760)/26 weeks/ 5 days per

week/8 hours per day = 15.158654 customers per hour Inter arrival time (a) = 60 minutes/ 15.158654 patients per hour

= 3.95814 minutes  Process rate (1/p) = 2.4 patient per hour (P=25 minutes per

patient) Processing time (p) = 25 minutes

I. Analysis of Current System

Is there enough capacity?

Yes. Since both utilization rates weigh below the full

capacity, there was indeed enough capacity. Clinicians were not the bottleneck resource.

Long waiting time was mainly caused by patient’s random arrivals.

I. Analysis of Current System

Proposed System

Proposed Strategies: Teams of MDs and NPs Assign pool medical assistants to deal with records

Goals: Total waiting time of 20 minutes or less Less than 5% of patients unable to see their specific team

when they came to the walk-in clinic The maximum delay for seeing a team clinician should be

one day

II. Analysis of Proposed System

Drawbacks of Proposed System

Elevator becomes bottleneck This increases the amount of time needed to

get around the building

Teaming leads to dissatisfaction from employees

Unspecified teams lead to poor perception and insecureness of service

II. Analysis of Proposed System

Critical Measure of Success

Since survey indicates satisfaction of patients are closely related to waiting time, our critical measure of the effectiveness of the system would then be the average waiting time of patients.

III. Measurement of Success

Looking back into Current System

III. Measurement of Success

Looking back into Current System (cont’d)

Average waiting time ≈ 0.5 minute Assumption: Patients arrived evenly throughout the day and

employees are all properly allocated. Patients theoretically should not complain. Truth: patients are more likely to arrive before 3pm At least one server is idle for 90% WASTE!

High return rate of current system Current system failed to accommodate patient’s first

preference for clinicians

Rate of patients getting preferred clinician should also be a measure of success

III. Measurement of Success

Key Takeaway from the Current System

Measure of Success Average waiting time of patients, and Rate of patients getting their preferred clinician

OUR PRIORITY IS TO COME UP WITH BETTER SCHEDULING OF CLINICIANS AND ALLOCATION OF RESOURCES

III. Measurement of Success

Recommendation [1]

Our rationale is: Since employees are not fully utilized, we should allocate resources well so that they are consistent with the needs of patients. And based on previous analysis, our focus would be on MDs and NPs.

We agree on teaming up MDs and NPs, however ways in constructing teams is more essential.

IV. Our Recommendations

Recommendation [1] (cont’d)

The construction of team would be as follow: Before 3pm (high demand): A total of 13 MD and NP per

hour After rush hour: A total of 6 MD and NP per hour

Impact: Improve waiting time of PPC Concerns over overall quality of team work and other

factors have to be taken into account Implication: Plan has to be revised and updated timely

for best results

IV. Our Recommendations

Recommendation [2]

1) Provide drinks, magazines, or even set TV in the waiting facilities

Our rationale is: Unoccupied waits feels longer than occupied waits.

2) Set an ask desk to help explain the process in system and give information about waiting time

Our rationale is: Providing the estimated waiting time and a fair environment can give patients a sense of fairness and security.

In order to change patients’ perception of waiting time better manage the process, and increase the overall customers’ satisfaction, the following measures can be taken:

IV. Our Recommendations

End