Paediatric Orthopaedic Clinic at the Children's Hospital of Western Ontario

The chief of pediatric orthopedic surgery was very concerned by long times that young patients (and their parents) were experiencing in the orthopedic clinic. Long wait times tended to aggravate the already pent-up distress and concern that patients were facing.

1. Develop the process flow diagram.
2. Calculate the activity utilization (the book calls it capacity utilization) of the following process steps:
   1. Front Desk (Registration and Verification)
   2. Radiology Department (X-ray imaging, Development of x-ray, and Diagnostic reading and comments)
   3. Hand-off of X-ray to clinic (Collection of x-rays and Filing/exam room prep)
   4. Examination Room (Surgeon, Resident, and Cast technician)
3. How is variability affecting capacity at the clinic and how can it be controlled?
4. Where is the bottleneck and what suggestions would you make to eliminate it?

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Richard Ivey School of Business The University of Western Ontario IvEy 908D01 PAEDIATRIC ORTHOPAEDIC CLINIC AT THE CHILDREN'S HOSPITAL OF WESTERN ONTARIO Manpreet Hora wrote this case under the supervision of Professor Robert D. Klassen and Dr. Kellie Leitch solely to provide material for class discussion. The authors do not intend to illustrate either effective or ineffective handling of a managerial situation. The authors may have disguised certain names and other identifying information to protect confidentiality. Ivey Management Services prohibits any form of reproduction, storage or transmittal without its written permission. Reproduction of this material is not covered under authorization by any reproduction rights organization. To order copies or request permission to reproduce materials, contact Ivey Publishing, Ivey Management Services, c/o Richard Ivey School of Business, The University of Western Ontario, London, Ontario, Canada, N6A 3K7; phone (519) 661-3208; fax (519) 661-3882; e-mail cases@ivey.uwo.ca. Copyright 2008, Ivey Management Services Version: (A) 2010-01-13 Dr. Kellie Leitch glanced at the data on wait times collected from the patients in one of her clinics. As Chief of Paediatric Orthopaedic surgery at the Children's Hospital of Western Ontario (CHWO), she was very concerned by the long times that the young patients (and their parents) were experiencing in the daily clinic. Long wait times tended to aggravate the already pent-up distress and concern that they were feeling, and parents were understandably irritated at missing significant time at work. Currently, on an average, patients were spending roughly two hours in the clinic. Patient health was not Dr. Leitch's only concern. Clinical staff had increasingly complained about being over-extended, yet budgetary pressures to reduce the cost of service continued to mount. She was not convinced that all staff was being effectively utilized, and there was an unresolved request from the Radiology department for more advanced equipment. Dr. Leitch also served on several government task forces. From these, she knew that federal and provincial policy-makers were increasingly concerned with the economic impact that health-care wait times had on national economic productivity. In a moment of weakness, Dr. Leitch recently had volunteered her clinic to hospital management as a test case" to demonstrate that patient care could be done in a more timely fashion, without increasing costs. An objective of reducing wait times by 20 per cent was established to show meaningful improvement that would be clearly evident to patients, staff and management. A monthly executive meeting was fast approaching, and expectations were starting to run high that Dr. Leitch would present preliminary recommendations that would offer significant reductions. PAEDIATRIC ORTHOPAEDIC CLINIC As part of London Health Sciences Centre, located in the city of London, Ontario, Canada, CHWO was a large, regional health-care centre that provided specialized paediatric services to children. The population 1 Paediatric orthopaedics is the branch of medicine that deals with the treatment of injuries to or conditions involving the musculoskeletal system in children. Richard Ivey School of Business The University of Western Ontario IvEy 908D01 PAEDIATRIC ORTHOPAEDIC CLINIC AT THE CHILDREN'S HOSPITAL OF WESTERN ONTARIO Manpreet Hora wrote this case under the supervision of Professor Robert D. Klassen and Dr. Kellie Leitch solely to provide material for class discussion. The authors do not intend to illustrate either effective or ineffective handling of a managerial situation. The authors may have disguised certain names and other identifying information to protect confidentiality. Ivey Management Services prohibits any form of reproduction, storage or transmittal without its written permission. Reproduction of this material is not covered under authorization by any reproduction rights organization. To order copies or request permission to reproduce materials, contact Ivey Publishing, Ivey Management Services, c/o Richard Ivey School of Business, The University of Western Ontario, London, Ontario, Canada, N6A 3K7; phone (519) 661-3208; fax (519) 661-3882; e-mail cases@ivey.uwo.ca. Copyright 2008, Ivey Management Services Version: (A) 2010-01-13 Dr. Kellie Leitch glanced at the data on wait times collected from the patients in one of her clinics. As Chief of Paediatric Orthopaedic surgery at the Children's Hospital of Western Ontario (CHWO), she was very concerned by the long times that the young patients (and their parents) were experiencing in the daily clinic. Long wait times tended to aggravate the already pent-up distress and concern that they were feeling, and parents were understandably irritated at missing significant time at work. Currently, on an average, patients were spending roughly two hours in the clinic. Patient health was not Dr. Leitch's only concern. Clinical staff had increasingly complained about being over-extended, yet budgetary pressures to reduce the cost of service continued to mount. She was not convinced that all staff was being effectively utilized, and there was an unresolved request from the Radiology department for more advanced equipment. Dr. Leitch also served on several government task forces. From these, she knew that federal and provincial policy-makers were increasingly concerned with the economic impact that health-care wait times had on national economic productivity. In a moment of weakness, Dr. Leitch recently had volunteered her clinic to hospital management as a test case" to demonstrate that patient care could be done in a more timely fashion, without increasing costs. An objective of reducing wait times by 20 per cent was established to show meaningful improvement that would be clearly evident to patients, staff and management. A monthly executive meeting was fast approaching, and expectations were starting to run high that Dr. Leitch would present preliminary recommendations that would offer significant reductions. PAEDIATRIC ORTHOPAEDIC CLINIC As part of London Health Sciences Centre, located in the city of London, Ontario, Canada, CHWO was a large, regional health-care centre that provided specialized paediatric services to children. The population 1 Paediatric orthopaedics is the branch of medicine that deals with the treatment of injuries to or conditions involving the musculoskeletal system in children.