Running head: County Hospital Process Improvement

County Hospital Process Improvement

In The Partial Fulfillment of Requirements For
MGT 620
Sullivan University
Dr. Adam Evans
March 16, 2015
Submitted by:
Deepak Valavala SVALAV0021@my.sullivan.edu
Karthik Kotha KKOTHA6657@my.sullivan.edu
Keshava Reddy Depa KDEPA1492@my.sullivan.edu
Venkata R Keerthi VKEERT2248@my.sullivan.edu

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Executive Summary
Healthcare organizations have unique issues to be addressed. One of them is the
waiting time of the patients. The County Hospital is also facing the patient
waiting time issue as most of the patients are waiting for more time than they
expect. Apart from patient waiting time, resource optimization has also been an
issue for the County Hospital. To overcome the problem strategies for enhancing
the resource optimization and efficiency have been proposed. These strategies
include increasing the number of dark rooms and hiring radiologists for enhancing
the operational efficiency.

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Introduction: Waiting time is the common issue in healthcare organizations
Queuing has always been one of the most common issues in the health
Waiting time has
been a significant
issue for the
healthcare
organizations

maintenance organizations. Research works have been in motion in the developed

world for enhancing the queuing systems. Queuing theory involves statistical and
mathematical approaches for decreasing the time in waiting lines. Queuing
analysis and simulation tools are commonly used by the healthcare organizations
for enhancing the performance (Afrane & Appah, 2014). County Hospital is one
of the many hospitals that have been facing the issue of long waiting times due to
which the efficiency of the hospital has been declined significantly.
Background: Limited number of resources
County hospital with its existing resource levels intends to increase its service

County Hospital
had limited
resources with
limited
technicians

efficiency for its X-ray operations. In the present context, County Hospital has
five people to handle the entire X-ray operations. There are two X-ray labs and
one dark room, and an inspection room for X-ray. X-ray labs and X-ray inspection
room is generally managed by the X-ray technicians whereas the dark room staff
manages the dark room related activities. The operational process at the County
Hospital is identical for all the patients.
Problem Background: Extremely high waiting time

Resource utilization
and efficiency were
two significant
problems that led to
increase in waiting
time

According to Soni (2011), improper handling of queuing causes unnecessary

delays and creates situations where it reduces service effectiveness of
establishments. In our case there are two problems impacting on the performance

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of the organization. From the perspective of the patients the total required time
has been the primary concern. From the perspective of the management resource
utilization has been the main concern. It is quite clear from the operational model
that patients have to wait in three queues for a successful X-ray activity. This is in
the regards assuming that the X-rays are not rejected. Each patient has to wait for
the call from the desk assistant after taking the instruction from the physician.
Next the patient needs to wait at the X-ray labs after desk assistant fills the
standard form. If everything goes well then the patient needs to wait for frontdesk assistant to finish the out patient process. The rejection rate has been
estimated at 25%. From the given information the waiting time is high because of
the slowness in the X-ray. Due to longer waiting times it has become difficult for
the organization to complete the X-ray process of all the customers in a single
Each patient had to
wait for four hours
for getting the Xray done in a
successful manner.

day. It can be said that each patient has to wait for nearly 4 hours which is
certainly lengthy and is more than the expected waiting time among the patients.
Employee efficiency is nearly 80% for the departments except the x-ray
technician. This technician is certainly underperforming and is one of the reasons
for lengthy waiting times. It is clearly evident that the hospital is having an issue
of lengthy waiting time. In case this issue continues then it impacts on the
customer satisfaction and hence the business.
Opportunities: Increasing the dark rooms
Waiting time between the existing working stations has been the significant issue
for the county hospital specifically in the X-ray department. There is a need for
increasing the resources as well as the manpower for increasing the efficiency of

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the organization. The inter-arrival time has been calculated considering the arrival
data for the X-ray Lab. It has been identified that arrival happens to be an
exponential format from the histogram of Bin Frequency data having an interval
of 4 for the Bin range. Mean has also been calculated using the descriptive
statistics. Mean time happens to be 6 minutes between two patients considering
the inter-arrival time. The flow of activities can be understood by observing the
following flowchart.

Figure 1 shows the flow chart

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The analysis has been run through Simquick and from the below results it is quite
clear that number of customers served is 37 even though the number of patients
remains same or all the patients have been attended. It can be observed that 54
customers are still remaining which is certainly a very big number.

Figure 2 shows the results from the Base Line Model

In this context the customer satisfaction is entirely down. To identify the potential
scenarios there is a need for overcoming the potential flaws in the existing
operating model of the hospital. As the X-ray lab is the heart of the process ways
for enhancing the x-ray activities have to be identified. In this context value-

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added and non-value added times need to be calculated. This helps in
understanding the issues being faced by the hospital. For calculating the nonvalue added time there is a need for adding the Mean cycle time for each lobby. In
this context the value added time is certainly constant. There is a sequence of
steps have to be followed by each patient.
Time
Process

Time Pattern

Taken

Description
In uniform(a,b), time taken =

1. FRONT DESK
2. XRAY LAB
3. DARK ROOM
4. INSPECTION

Unit(2,5)
Nor(15,5)
Nor(10,5)
Nor(3,1.5)

3.5
15
10
3

5. EXIT DESK

Unit(2,5)
Total Time Taken

3.5 (a+b)/a

(a+b)/a
In Normal(m,d), time taken = m
In Normal(m,d), time taken = m
In Normal(m,d), time taken = m
In uniform(a,b), time taken =

35 mins

One of the ways to increase the efficiency at the hospital is to decrease the wait
times and one such area where time can be decreased is the lobbies. In this
context the non-value added time for the above process can be evaluated by
adding the mean cycle times from every lobby.
Improved Model
The data from the hospital is run through Simquick as it helps in allowing more
number of simulations to be performed within a reasonable amount of time and
also helps in achieving accurate results (Hill, 2002). County Hospital to improve
its efficiency needs to add resources to its existing ones. In this context adding an

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X-ray lab and an extra technician would help the hospital to achieve its objective
of increasing the efficiency. There are 54 patients waiting in the queues therefore
it is essential that hospital should set up another X-ray lab and an extra technician.
At present there are two X-ray labs and three X-ray technicians for handling them.

It can be observed that even after adding a new X-ray lab the efficiency level is
Increase in the dark
rooms rather than Xray labs has led to the
increase in efficiency

not increased to a great extent. It implies that of the 90 clients arriving at the front
desk only 37 are being served. This means that remaining 53 patients have to wait
for their turn patiently. It is quite clear that it may take more than a day for
performing X-ray on all these patients as the average number of patients in a day
seems to be 38.

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In this context an enhanced approach will be effective. This may include adding
more number of technicians and dark rooms to deal with the existing issues.
When the dark rooms are increased the efficiency has been increased to serving
64 patients out of 89 members. This is certainly an encouraging perspective for
the County Hospital. Simultaneously the work efficiency of the front desk
assistant increased to 92%.
Recommendations: Hiring radiologists
In the present situation County Hospital needs to improve its efficiency at the
Training and
development
programs and hiring
radiologists would
help in increasing the
efficiency.

same time increase the resource utilization. Efficiency will be improved when the
resource utilization increases and vice versa. As per Walter (1973), there is always
increase in efficiency when the proportion of the appointments with the number of
patients get increased. There is a need for improving the employee efficiency
before investing in the new equipment. This is because even if new equipment
and new technicians are added there is no guarantee that the efficiency will be
increased. This is observed when an additional x-ray lab was added the efficiency
hardly increased. There is a need for effective training and development
programs.
In this process it is necessary to hire professional radiographers rather than
dealing with X-ray technicians. Radiographers are medical imaging technologists
performing medical imaging by offering higher quality X-ray pictures or images.
This will help in addressing two issues first it helps in efficiency rate of the
County Hospital at the same time it decrease the 25% failure rate. Radiographers

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generally deal with sophisticated equipment like the Computed Tomography (CT)
and Magnetic Resonance Imaging (MRI) and mobile X-ray machines. The role
played by these radiographers is diverse and also challenging. Most of the
radiographers are trained to deal with various image testing and equipment
handling issues. Most of the radiographers work in areas where there is large
number of patients. They also work in hospitals that have couple of rooms and
small staff (Sullivan, 2010)
Conclusion
Most of the hospitals have facing the issue of waiting times at different levels.
One such case is evident in the County Hospital wherein the management is
determined to improve the efficiency and resource utilization at the hospital. In
this case adding the resources in the right areas will help the hospital improve the
efficiency. It implies that adding more number of X-ray labs has not increased the
efficiency but adding an extra dark room and technicians has significantly
increased the efficiency of the hospital.

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References
Afrane, S., Appah, A., (2014). Queuing theory and the management of waitingtime in hospitals: the case of Anglo Gold Ashanti Hospital in Ghana,
International Journal of Academic Research in Business and Social
Sciences, 4(2), 34-44.
Hill, R. R. (2002). Process simulation in Excel for a quantitative management
course, INFORMS Transactions on Education, 2(3), 75-84.
Soni, K. (2011). A study of applicability of waiting line model in health care: a
systematic review, Operation Research, 5(20), 6.
Sullivan, B., (2010). The radiographer (medical imaging technologies), Retrieved
on

10th

March

2015

from

http://www.insideradiology.com.au/pages/view.php?
T_id=9#.VQE5UnyUflE
Walter, S. D. (1973). A comparison of appointment schedules in a hospital
radiology

department, British

medicine, 27(3), 160-167.

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social