Part 1:

Case study:

Healthcare Wait Time Optimization: Metropolitan General Hospital Case Study

Metropolitan General Hospital (MGH), a 500-bed teaching hospital in downtown Chicago, had been grappling with significant patient wait times in their outpatient clinics. Patient satisfaction scores had dropped from 85% to 65% over the past year, primarily due to extended waiting periods to see care providers. The hospital's CEO, Dr. Sarah Chen, recognized that this issue needed immediate attention as it was affecting both patient care quality and the hospital's reputation.

The outpatient department handled approximately 800 patients daily across various specialties. Recent data showed that patients waited an average of 45 minutes beyond their scheduled appointment times, with some waiting up to two hours. This resulted in increased patient complaints, staff stress, and a 15% increase in appointment cancellations.

Dr. Chen appointed Marina Rodriguez, the newly hired Operations Director, to lead a process improvement initiative. Marina had extensive experience in healthcare operations and decided to approach this challenge systematically. She began by gathering data through patient surveys, staff interviews, and direct observation of clinic operations.

Initial analysis revealed several contributing factors to the extended wait times. These included overbooking of appointments, inconsistent registration processes, inadequate preparation of patient records, and variable provider arrival times. Marina noticed that while some days ran smoothly, others were chaotic, suggesting that the process wasn't standardized.

To better understand the current state, Marina mapped out the entire patient journey using the SIPOC (Suppliers, Inputs, Process, Outputs, Customers) methodology:

Suppliers: The primary suppliers included referring physicians, laboratory services, radiology department, medical records department, and the hospital's IT system. These entities provided essential information and services necessary for patient visits.

Inputs: Key inputs encompassed patient demographic information, medical histories, insurance details, appointment schedules, test results, and provider availability. The quality and timeliness of these inputs significantly impacted the overall process flow.

Process: The current process flow started with appointment scheduling, followed by check-in, registration verification, vital signs measurement, and finally, the provider consultation. Each step had its own set of variables and potential bottlenecks.4

1. What were the root causes of the extended wait times at MGH?
2. How did the SIPOC analysis help in understanding the complex nature of the problem?
3. What metrics would you recommend tracking to measure the success of the improvement initiative?

Outputs: The process outputs included completed consultations, treatment plans, prescriptions, follow-up appointments, and referrals to other specialists or services. The quality of these outputs depended heavily on the efficiency of the preceding steps.

Customers: The primary customers were the patients themselves, but the process also served referring physicians, insurance companies, and other healthcare providers who relied on the consultation outcomes.

Marina implemented a systematic improvement approach. In the first phase, she established baseline metrics and set clear targets. The team collected data on arrival patterns, service times, and bottlenecks. They discovered that morning appointments generally ran more smoothly than afternoon ones, suggesting a cumulative delay effect.

The team then developed and tested several interventions. They implemented a new scheduling template that better accounted for appointment complexity. They introduced a pre-visit planning process where staff reviewed patient records and necessary documentation 24 hours in advance. They also established a fast-track lane for simple follow-up visits.

After three months of implementing these changes, the average wait time decreased to 25 minutes. Patient satisfaction scores improved to 78%, and appointment cancellations decreased by 8%. However, some challenges persisted, particularly during peak hours and with certain specialties.

The team continued to monitor and adjust their interventions. They introduced a real-time tracking system that allowed patients to monitor their queue status through a mobile app. They also implemented a text message system that notified patients of any potential delays before they left home.

By the six-month mark, MGH had achieved significant improvements. Average wait times stabilized at 20 minutes, patient satisfaction reached 82%, and staff reported feeling less stressed. The success of this initiative led to its implementation across other hospital departments.

Case Study Questions

Answer all the questions:

1. Evaluate the effectiveness of the improvement approach used at MGH.
2. Analyze the relationship between wait times and patient satisfaction scores.
3. How could MGH better use data analytics to predict and prevent future wait time issues? Suggest a forecasting method.
4. What additional metrics should MGH track to ensure sustained improvement?
5. How could technology be better leveraged to further optimize wait times?

Part 2

1. What is the role of lean methodology in improving healthcare operations? What types of operational wastes can lean methodology address? Is there any literature in research that support the applications of lean in healthcare industry?