An Internship report on

A STUDY ON WAITING TIME IN THE OUT-PATIENT DEPARTMENT

OF NORVIC INTERNATIONAL HOSPITAL

Submitted by
Aliza Ghimire
Roll No: 15140043

An internship report submitted towards partial fulfillment of the requirement of

Bachelor of Health Care Management (BHCM)
(Awarded by Pokhara University)

Nobel College
Sinamangal Kathmandu
September 2018
 ACKNOWLEDGEMENTS

This report has been prepared as a partial fulfillment of BHCM 8th semester Internship report.
The report deeply indebted to Nobel College and Pokhara University for incorporating project
report in the degree program which provides a wonderful opportunity to carry out the practical
on any topic.

I would like to explicit my gratitude to many of them who provided me very informative and
precious as well as proper information on penmanship this report. I would like to thank Pokhara
University for providing us chance and allowing me for this study. I would like to thank the
lecture for giving orientation class for report writing.

This is my immense delectation to present the report of Bachelor of Health Care Management
(BHCM) 8th semester assigned by Pokhara University. I enjoyed each and every span of time
while creating this report. I would like to take this opportunity to thank Mr. Umesh Dawadi,
for his guidance and constant supervision, ever-abiding encouragement and timely help. His
tactful suggestion and kind help enabled me to complete this project successfully the report.
And also I have the deep regards to Mrs. Punyaswori Shrestha (Human Resource Manager,
Norvic International Hospital ) for her warm support and very thankful to employees and
colleagues of the Norvic International Hospital who provided hand to hand support within 45
days of internship period.

Lastly, I would like to express our sincere to all staff of Norvic International Hospital that
provided me with the required data and also give guideline to fulfill the task in time.

I hope reader’s, teachers and student who read this report will consider my mistake and try to
give their advice, suggestion towards my report. Finally, I again send my warm greetings and
gratitude to all those who have involved in this project directly or indirectly.
 Faculty of Management Studies
Pokhara University

Recommendation
This is certify that the health care practicum report tilted
A study on waiting time in the Out-Patient Department of
Norvic International Hospital

Prepared by
Aliza Ghimire
Submitted towards partial fulfillment of the requirement for the degree
“Bachelor in Health Care Management”
Has been approved by the college and forwarded to Pokhara University.

……………………………………….
Kamal Regmi
Principal
 Approval Sheet
Faculty of Management Studies
Pokhara University
Approval
An internship report titled

A Study on waiting time in the out-patient department of Norvic International Hospital

Submitted by
Aliza Ghimire
Exam Roll no: 15140043
PU Reg No: 2014-2-14-46

Submitted towards partial fulfillment of the requirement for the degree

“Bachelor of Health Care Management”
Has been approved by the following panel of examiners:

S.N Name Designation Signature Date

Preliminary Pages
Title Page
Acknowledgement
Certification by Authority/Organization under Study
Recommendation of Principal
Approval by Panel of Examiners (HOD, Coordinator, Supervisor)
Table of Contents
List of Illustrations
List of Tables
Acronyms/Abbreviations
Executive Summary

Chapter 1
Introduction
1.1 Background of the Study
1.2 Statement of the problem
1.3 Rationale of the study
1.4 Research questions
1.5 Objectives of the Study
1.6 Definition of terms
1.7 Variables
Independent
Dependent
1.8 Conceptual framework

Chapter 2
Review of Literature

Chapter 3
Research Methodologies
3.1 Research Design
3.2 Sampling Method
3.3 Study Area
3.4 Tools used
3.5 Approach/methods
3.6 Validity and reliability
3.7 Exclusion criteria
3.8 Ethical consideration
3.9 Challenges to be overcome
Chapter 4
Descriptive Analysis
4.1 Data Presentation
4.2 Data Analysis
4.3 Main Findings and Discussion

Chapter 5
Summary and Conclusion
5.1 Summary of the Findings
5.2 Conclusion
5.3 Recommendations

Bibliography
Annexure
 Chapter 1
Introduction
1.1 Background of the Study

Many health care systems globally continue to grapple with lengthy waiting time for patients.
For instance in developing countries like the United States (US), the Institute of Medicine
called the long waits in emergency outpatient department a national epidemic.
In addition studies in the United States have found the average waiting times to be twice the
recommended time for acute patients (Horwitz et al. 2010). In addition, a report in 2014, from
the Centre for Disease Control found that the average patient treatment time was 90 minutes.
Another international survey conducted by the Canadian Institute of Health information in
2012, showed that at least half of the patients take four hours to be given treatment.
Consequences of long stays in the health facilities have been linked to poor outcome (Yeboah
& Thomas 2009). Some of these established outcomes at individual level are unhappy patients,
with low satisfaction levels towards the services received. Studies have shown that these
patients will not return to these facilities while others will leave the facility without being
attended to thus risking their health (Nabbuye-Sekandi et al. 2011). In a tertiary hospital in
Nigeria, a study carried out in a busy outpatient unit showed that the longer a patient waited
the lower the satisfaction levels reported. Most patients found a waiting time of less than 30
minutes acceptable while more than 60 minutes was reported as not acceptable (Umar, I., Oche,
M. O., & Umar 2011). The Institute of Medicine recommends that patients should be attended
to within 30 minutes of their arrival to the facility or their appointment (Musinguzi 2015).
A study done in Indonesia found that managing the flow of patients in a health facility can
improve the time a patient spends on the queue (Mardiah & Basri 2013). Long waiting time in
outpatient clinic negatively affect the perception of service provision and clinic experience by
patients (Oche & Adamu 2013). The length of time a patient spends at each service delivery
point as they wait to receive the required care from the health service provider and the overall
total time the patient spends in a health facility from the time of arrival at the facility to the
time of exiting the facility is one major factor that affects the patient’s perception of the quality
of care delivered (Bleustein et al. 2014).
These factors and the subsequent long waiting time are prevalent in developing nations such as
Malawi, in which factors such as insufficient equipment, long registration procedures, patient
overload, and insufficient human resources are the main causes of long patient waiting
time(Maluwa et al. 2012; Musinguzi 2015).
According to Oche & Adamu, a patient who waits for long to get a service perceives this as a
hindrance to care. Yeboah & Thomas observed that the result of long waiting times is
dissatisfaction and poor compliance to drug regimens leading to poor clinical outcomes.
Waiting time can be defined as an objective evaluation of the quality of service received against
the individual’s expectations. Patients spend a considerable amount of time in hospitals waiting
for services to be delivered by physicians and other allied health professionals. Delayed access
to health care is assumed to negatively affect health outcomes due to delays in diagnosis and
treatment plus unforeseen cost implications on the patients and public health system.
2-4 h in the out-patient departments before seeing the doctor. A recent study carried out at the
outpatient departments in Mulago hospital found out that the overall satisfaction of patients
with outpatient services is closely related to their satisfaction with. Reducing outpatient waiting
times has been the focus of a large number of studies because waiting and treatment times are
usually regarded as indicators of service quality (MOH 2004, Nabbuye-Sekandi et al., 2011).
However, despite the declared importance of ensuring timely access to care, little research has
actually measured how long patients wait and also examined any empirical associations with
patient waiting time for outpatient care.
Norvic International Hospital is a compassionate provider of patient-centered health services
with an emphasis on affordable specialty medical care, for its patients. The Hospital plays an
active role in promoting and improving health within the community. It collaborates with a
wide range of partners to address the needs of the community and to build a strong, integrated
system for regional health care delivery. Vision of the Norvic International Hospital is “To
provide World Class Quality Health Care to the citizens of Nepal at an affordable cost without
compromising on quality". Norvic is a multi-specialty hospital and specialize in life saving by
specialist expert in critical care and who have access and support of standard state of art
equipment and pathology services.
1.2 Statement of the Problem
Long waiting time has been found to be a major source of patient dissatisfaction and
adversely affect patient compliance with treatment regimes and clinical outcomes
Outpatients in major hospital in Uganda often reported early, but many did not leave until
very late, and then frequently without treatment (Omaswa, 1997). A study of client
satisfaction with health services among public facilities Uganda found that most patients
waited for long than 3 hours before they are attended- up to (Jessica et al., 2008b). A recent
satisfaction survey among out-patient departments in Mulago also found long waiting times
among patients with over about 39.5% of patients waiting for at least 4 hours (Nabbuye et
al., 2011).
The implication of long waiting times is that it increases the proportion of patients who
leave without being seen by a physician (Stock et al., 1994, Fernandes et al., 1997). A
similar study found out that among patients who left without being seen, 46% needed
urgent medical attention, and 11% were hospitalized within a week (Baker et al., 1991) and
60% of them sought other medical care within a week (Rowe et al., 2006). Patients who
left without being seen were twice as likely to report worsened health problems (Bindman
et al., 1991).
 Lack of coordination while scheduling an appointment for patients with multiple
providers. For example, if a patient needs multiple tests, book the test with the longest
wait for results first
 Lack of enough manpower
 Lack of communication between various sources while scheduling appointment for
example between patient care coordinator and doctors, including surgeon, call centre
staff in case to change schedule or any new doctor’s appointment.
 Patients are not informed about change in appointment
 When patient come without appointment than waiting time is increased
 Wastage of time in searching correct doctor if patient does not know whom to consult
 Billing is done at different places
 Lack of functional computers where registration can be done.
1.3 Rational of the study
Being the first point of contact with a patient the general OPD serves as the window to any
health care service provided to the community. The care in the OPD is indicative of the general
quality of services of the hospital and is reflected by the patient satisfaction with time spent.
This study can be an effective means of evaluating the quality of OPD service of one of the
major national referral hospital from the patient point of view.
This study may be able to generate time sensitive and clinic specific operational data that can
be used by management to improve patient flow and quality of health service delivery
especially where the patients show concerns on the services. A clear understanding of the
factors associated with waiting time could help in deciding which interventions will have the
greatest impact in improving patient flow and patients clinic experience therefore, reducing the
waiting times could help to decrease congestion in the clinic and potentially increase patient
satisfaction (Were et al., 2008).

1.4 Research Question

 How does the type of service sought affect patient waiting time in Out-patient
Department of the Norvic International Hospital?
 How does the availability of healthcare providers at their work stations
influence patient waiting time at Norvic International Hospital?
 How long do patients wait to receive care in Out-patient department?
 What are the possible factors that may lead to excessive patient waiting times.

1.5 Objectives of the study

The following were the objectives of the study:
 To establish the type of services sought affect patient waiting time.
 To assess the patient arrival time affects waiting time at Norvic International Hospital.
 To examine the availability of healthcare providers at their work stations affect patient
waiting time at Hospital.
  To measure the overall patient waiting time at Out-patient Department of Norvic
International Hospital.
 To examine the factors associated with patient waiting time.
1.6 Definition of the terms
Health Care
Healthcare provision and maintenance of physical and mental health status of outpatients
through provision of health intervention. Health care or healthcare is the maintenance or
improvement of health via the prevention, diagnosis, and treatment of disease, illness, injury,
and other physical and mental impairments in human beings. Healthcare is delivered by health
professionals in allied health fields.

Out-patient
Outpatient a patient who visits a medical facility for treatment or care but is not hospitalized
overnight at the facility. A patient who is not hospitalized overnight but who visits a hospital,
clinic, or associated facility for diagnosis or treatment is considered as Out-patient.

Out-Patient Department
An outpatient department or outpatient clinic is the part of a hospital designed for the treatment
of outpatients, people with health problems who visit the hospital for diagnosis or treatment,
but do not at this time require a bed or to be admitted for overnight care. The outpatient
department is an important part of the overall running of the hospital.
It is normally integrated with the in-patient services and manned by consultant physicians and
surgeons who also attend inpatients in the wards. Many patients are examined and given
treatment as outpatients before being admitted to the hospital at a later date as inpatients. When
discharged, they may attend the outpatient clinic for follow-up treatment.

Patient waiting Time

Waiting time refers to the time a patient waits in the patients before being seen by one of the
medical staff. Waiting time is an important indicator of quality of services offered by hospitals.
The amount of time a patient waits to be seen is one factor which affects utilization of
healthcare services. Patients perceive long waiting times as a barrier to actually obtaining
services. Keeping patients waiting unnecessarily can be a cause of stress for both patient and
doctor. Waiting time in a tangible aspect of practice that patients will use to judge health
personnel, even more than their knowledge and skill.

Arrival time
Arrival time is the time a patient reports at the registration or records office seeking healthcare.

Departure time
Departure time is the time a patient exits the clinic after reaching the last service points.

1.7 Variables
 Dependent Variables
 Patients Satisfaction
 Overall waiting Time

 Independent Variables
 Demographic factors
Age
Sex
Residence
Employment

 Behavior of staffs
Attitude
Expressions
Conversations
Friendly

 Clinical factors
Type of referral
Severity of illness
 Type of diagnoses
Previous health facility visited

1.8 Conceptual framework

The Conceptual framework is based on the Donebedian input-process-output model. The
patient factors (input), the operational or process factors (process) in conjunction with hospital
factors and waiting time (output) whose impact is on the quality of care.
At the input level are the patient related factors. These are divided into demographic and
clinical factors. From a socio-demographic point of view, elderly patients usually find it hard
to navigate through the labyrinth of the OPD while men may not be patient enough to wait.
Those who are highly educated could easily communicate with staff and read instructions
compared to less educate thus allowing them navigate better. From clinical point of view,
patient visiting the facility for the first time have less experience than those who have had
previous visits. Research has shown that patients with physician referral particularly from a
public hospital have lesser waiting time compared to those with self-referral.
At the process level is the operations of the assessment process. Each section is unique to it
and requires different requirements to operate efficiently. The biggest challenge is the
efficiency of each of these sections in delivering services. In order to have smooth flow,
patients should have uninterrupted movement through each service point. Staff should be able
to have access to all the necessary resources for example patient records, equipment, etc. in
order to serve the patients in a timely manner. From the patient’s side, it’s mainly the numbers
of patient at any point in time that would affect the work load therefore causing most queues.
Hospital related factors closely related to the process/operational factors and therefore called
external factors. All hospital are unique in the way they handle patients based on policies that
govern them. In this case, the design of the facility is related to the movements (direct or
indirect) patients will make, the distance between sections and the accessibility to service
points. The facility also has shared facilities with other departments. This would increase the
demand and number of patients receiving care, thus the longer length of queues. The facility
should also provide information (charts) for educational/communication purposes. Presence of
amenities (toilets) would lessen time patients have to leave the queue in search of them.
Inter-relatedness between patient factors and process factors is prominent since in some cases
place of residence will affect the arrival times of patients and therefore, the size of the queue.
More so, if a high number of patients who are severely ill report to the reception, this may delay
patient who are in line waiting since the triage system will have preference for the very ill.
Inter-relatedness between Hospital related and process factors is eminent since shared facilities
may have an effect on the size of the queue and the rate of patient flow.

Independent Variables

Demographic factors

Dependent Variables

 Patient Satisfaction
Behavior of staffs  Overall waiting time

Clinical factors

Fig: Conceptual Framework

 CHAPTER 2
Review of Literature

Much of the published work about patient waiting time in health facilities covers large hospitals
and outpatient departments within these large hospitals. Majority of these studies have been
done in developed countries .A good number of literary work has also been done in developing
countries like Nigeria and Uganda Several factors have been established from the findings of
these studies that they affect patient waiting time. Some of these factors are few health
personnel, high patient load and inadequate infrastructure and medical equipment. Most of the
research conducted in these area has established that patients experience long waiting time
before receiving the services they have sought in health facilities. The process of reviewing
and writing the literature review could be found complicated so it is useful to work in organised
way and follow specific plan which makes tracking articles, reading materials and notes much
easier.
Long waiting time is considered as one of the most common matters in different departments
in the majority of healthcare organizations (British Columbia Medical Association, 2006). It
forms serious problem for bulk of patients and is recognized as the central element for their
satisfaction. Nowadays, Patients' experience is documented as one of the major factors of
healthcare quality in the NHS together with safety and effectiveness (Sizmur & Redding,
2009). The objective of this review is to inspect and assess the literatures relating to reduce
patients’ waiting times and increase patients’ satisfaction by improving patient's flow pathway
and service capacity in healthcare. A detailed study of similar topics was done to show the
impact of patients’ delays on their satisfaction degree, to understand the connection of long
waiting with patient's journey and to collect some solutions for similar cases.
The key themes and words for the literature review were: Improving patient’s flow pathway,
mapping process, impact of waiting time on patients’ satisfaction, reducing waiting time ,
questionnaire, organizational change, improve quality of care, clinical governance,
organizational culture and resistance to change. Those key elements were passed in the search
strategy which helped in identifying the main themes and underlining its correlation with the
project as it will be outlined in this chapter.

Theoretical background of waiting time in healthcare

Over the years, healthcare organization and processes have been viewed within the context of
queuing systems in which patients arrive, wait for service, obtain service, and then depart
(Fomundam and Hermann, 2007).
Queuing theory was originally developed by French mathematician S.D. Poisson which usually
used to define a set of analytical techniques in the form of closed mathematical formulas to
describe properties of the processes dealing with scenarios of congestions and blockages.
Therefore, it seems very logical to view the services or operations of Outpatient department as
a queuing system: patients needing the services of the units wait in a queue to be served and
leave the system after service.

Basics of Queuing Theory

The basic structure of the queuing model can be separated into input and output queuing
system. The simplest queuing model is called single–server single queue model. It is a situation
in which patients from a single line are to be served by a single service facility or server, one
after the other.

Description of the OPD patient queuing model (Input and output process)
Input process is known as the arrival process. These Patients enter the queuing system and join
a queue to be served. A patient in the queue is selected for service by some rules known as the
queue discipline. The required service is then delivered to the patient by the service mechanism,
after which the patient leaves the queuing system. The provision of services using certain rule
and discharge of patients is referred to as output process.
Arrival
Although most analytical queuing models assume a constant patient arrival rate, many
healthcare systems have a variable arrival rate. In some cases, the arrival rate may depend upon
time but be independent of the system state. For instance, arrival rates change due to the time
of day, the day of the week, or the season of the year. In other cases, the arrival rate depends
upon the state of the system (Samuel and Jeffrey, 2007).

Waiting Line or Queue

A waiting line or queue occurs when patients wait before being served because the service
facility is temporarily engaged. A queue is characterized by the maximum permissible number
of patients that it can contain. Queues are called infinite or finite, according to whether this
number is infinite or finite. An infinite queue is one in which for all practical purposes, an
unlimited number of patient can be held there. Unless specified otherwise, the adopted queuing
network model in this study assumes that the queue is an infinite queue.
Queue Discipline
The queue discipline refers to the order in which members of the queue are selected for service.
In most healthcare settings, unless an appointment system is in place, the queue discipline is
either first-in-first-out or a set of patient classes that have different priorities (as in an
emergency department, which treats patients with life-threatening injuries before others).
Studies propose a priority discipline for different categories of patients and then a first-in-first-
out discipline for each category. They find that the priority discipline reduces the average
waiting time for all patients: however, while the waiting time for higher priority patients
reduces, lower priority patients endure a longer average waiting time.
Service Mechanism
According to Mosek and Wilson, service mechanism describes how the patient is served. In a
single server system each patient is served by exactly one server, even though there may be
multiple servers. In most cases, service times are random and they may vary greatly. The
service mechanism also describes the number of servers. The first patient from the common
queue goes to the server who becomes free first (Medhi, 2003).
Departure
Once patients are served, they depart through a number of routes. Once an OPD patient is
served, a number of exit fates are possible
i. The patient may be admitted to hospital specialized units
ii. The patient may receive the service to their expectation and return to source population.
iii. The patient may experience delays and opt for a similar service elsewhere.
iv. A patient may be advised by the health worker at any point to seek services elsewhere due
to capacity to handle the case.

Factors associated with waiting time a health facility

Patient flow
Patient flow represents the ability of the healthcare system to serve patients quickly and
efficiently as they move through stages of care. Blockage in the flow can increase waiting and
through put time creating a negative effect on the quality of service delivery. When patient
flow is handled well, it is represented by short wait at registration, examination, diagnostic
testing, pharmacy and discharge. Thus, improving patient flow is one way of improving
healthcare services.
Operational efficiency
Once a health care facility has an understanding of its patient flow, these flows can be used to
improve the facility’s operation. Therefore, efficient patient flow may be a key to achieve
operational efficiency in the outpatient department. According to (Wanyenze et al., 2010) a
number of factors can influence efficiency and the emergence of bottleneck in health care
operation during examining operational efficiency with regard to patient flow. These factors
include the volume of patients seen on the daily basis, the types of patient seen in terms of stage
of care, clinic policies on frequency of patient visits, the type of provider who they should see,
the size and composition of the providers and the staffing model.
Physical design
The physical environment greatly affects the quality, efficiency, and efficacy of healthcare
delivery in outpatient settings. To appreciate this concept, it is important to understand the
journeys that patients make through the department. Patient environment can best be studied
from the ordinary experience. Physical experience can be affected by the way in which spaces
are connected, the changes of direction imposed by the circulation system, the creation of room
sequences, the distribution of branching points, the availability of alternative routes, and the
relations of visibility between and across spaces.
Studies show that hospital design coupled with walking distances and common journeys affects
access to every department, with a direct impact on the movement of patients, staff, and
supplies.Therefore controlling movement in terms of; the number of changes in direction
needed to access different service points from the main entrance, the distance and number pit
stops (treatment rooms), would ensure less use of time on walking to locate service points.

CHAPTER 3
Research Methodologies

3.1 Research Design

The study was a cross-sectional survey to measure the actual patient waiting time and identify
out some of the factors that contribute to the time patients spend in the out-patient department
in order to provide information on the quality of services delivery.

3.2 Sampling Method

Sampling Technique used for this study will be Simple random sampling where waiting
patients will be select as samples who are present while data collection.

3.3 Study Area

This study was carried out in Norvic International Hospital at the out-patient department.
Norvic Hospital is located on Thapathali, Kathmandu. It operates 200 beds and remains a full-
service community health-care facility, designated as an International Hospital. They have a
highly skilled staff of affiliated physicians, full-time and part-time professional health care
staff, and active volunteers.

3.4 Tools used

There are three major data collection methods that were be used in this study. The first tool is
the time and motion that measures times using a stop watch for each section of service delivery.
This tool was used to track patient flow from the time they enter, through various sections until
the time they depart from the assessment center.
The second tool is the interviewer administered structured questionnaire. This tool captures
demographic variation among patient, their previous encounters with others health services and
of quality services they received in the assessment center. This information was linked using
the patient study number as a unique identifier to identify and assess the factors associated with
patient waiting time.
The third tool is staff key informant. This tool is used to capture staff opinion on the reasons
as to why patients experience delays and any solutions or recommendation that could improve
the quality of services delivered at out-patient department.

3.5 Validity and Reliability

Validity: Validity means the ability of the questionnaire to measure variables that are
designed to be measured where generality and non-duplication are relatively considered in the
questionnaire’s form. Therefore, it will offered to some arbitrators specialized in management
and within those involved in health.

Reliability: Reliability refers to the ability to repeat the study with the same parameters and
get the same result. To guard against threats to reliability, the Principal Investigator will
develop a detailed case study protocol and a case study database. Periodic data audits will be
performed to review the data documentation process and ensure protocol will be followed and
data will field consistently. The final study analysis and summary reports were written to
address reliability, including enough information to follow the logical steps towards a
conclusion.

3.6 Exclusion Criteria

 Patients who is seeking emergency Medical Services.
 People who refuse to participate in study.
 Those who will not be available at the time of study.
3.7 Ethical Consideration
Permission and ethical clearance was obtained from Nobel College. Participate have to take
permission from Hospital Administrative Department. Participation in study was
voluntary, no coercion was used and participants were assured that no repercussions will
follow clients that are unwilling to participate. Willing participants signed an informed
consent form expressing their willingness to participate in the study. Anonymity of
participants was assured by coding all questionnaires uniquely using numbers and by not
recording names of participants. Confidentiality of information given by clients was
upheld. The research findings will be presented to the administrative member of the
hospital and teacher of the Nobel College after completion of the study.

3.8 Challenges to be overcome

 Interns may be unable to do all the duties or tasks or sometimes they may not receive
support. In this case, Interns should inform the internship coordinator about the
problems.
 If the environment of the working area is not peace and homely or if their expectation
doesn’t match, they must inform the internship coordinator.
 Every company has its own method for communicating with its employees. In the
beginning, getting used to the different communication platforms was a little difficult.
In this case, we can take help from the IT department of the hospitals or internship
coordinator may help.
  If the intern may absent due to illness, he/she should cover-up those days within the
agreed internship period up to a maximum of 15work days.
 If the students lack the knowledge or skills of specific filed, internship mentor and
students can bring the problems to the internship coordinator. This helps to solved the
problem arise during the internship.

CHAPTER 4
Descriptive Analysis
Descriptive analysis is brief descriptive coefficient that summarizes a given data set, which can
be either a representation of the entire survey population or sample of it. Descriptive analysis
are statistics that quantitatively describe or summarize features of collective of information.res

4.1 Descriptive Presentation and Analysis

Gender

Gender
25

20
Frequency

15

10

0
male female
Gender

Figure 1: Gender of respondents

 Gender

Frequency Percent Valid Percent Cumulative Percent

Valid male 18 45.0 45.0 45.0

female 22 55.0 55.0 100.0

Total 40 100.0 100.0

Table 1: Gender of respondents

In above figure, there more respondents are female than male. Among 40 respondents 22 and
female and 18 are male. That is, 55% respondents are female and 45% of respondents are
female. That means female patients are more than male.

Age
 Age
18
16
14
12
frequency

10
8
6
4
2
0
Less than 20 21-30 years 31-40 years 41-50 years 51-60 years 60 and above
years
Age of Respondents

Figure 2: Age of Respondents

Age
Cumulative
Frequency Percent Valid Percent Percent
Valid Less than 20 years 4 10.0 10.0 10.0
21-30 years 17 42.5 42.5 52.5
31-40 years 8 20.0 20.0 72.5
41-50 years 8 20.0 20.0 92.5
51-60 years 2 5.0 5.0 97.5
60 and above 1 2.5 2.5 100.0
Total 40 100.0 100.0

Table 2: Age status of respondents

Here in above table2 and figure2, more respondents are of age 21 to 30 years. That means
42.5% of the respondent are 21 to 30 years. In the age of less than 20 years, there are 10%
respondents. In age of 31 to 40 years, there are 20% respondents. In the age of above 41 to 50,
there are 5% respondents and in the age of 60 and above there are 2.5% respondents. That
means most of the people who visit hospital are young age people.

Religion
 Figure 3: Religion of Respondents

Religion
Cumulative
Frequency Percent Valid Percent Percent
Valid Hindu 30 75.0 75.0 75.0
Buddhist 5 12.5 12.5 87.5
Christian 5 12.5 12.5 100.0
Total 40 100.0 100.0

Table 3: Religion of respondents

In above figure3 and table3, more respondents are Hindu. There are 75% of Hindu, 12.5% are
Buddhist and 12.5% of Christian. Most of the patients are Hindu. Most of the people in Nepal
are Hindu. So, most of the people who visit Hospital are hindu.

Services provided by staffs of OPD is good

 12

10

8
Frequency

0
Strongly Agree Agree Neutral Disagree Strongly Disagree
Services provided by staffs of OPD is good

Figure 4: Graph showing service provided by staffs of OPD

Services provided by staffs of OPD is good

Cumulative
Frequency Percent Valid Percent Percent
Valid Strongly Agree 9 22.5 22.5 22.5
Agree 11 27.5 27.5 50.0
Neutral 8 20.0 20.0 70.0
Disagree 7 17.5 17.5 87.5
Strongly Disagree 5 12.5 12.5 100.0
Total 40 100.0 100.0
Table 4: Table showing services provided by OPD

In above figure4 and Table4 it shows that among 40 patients, 9(22.5%) of them strongly
disagreed, 11(27.5%) agreed, 8(20%) neutral, 7(17.5%) disagreed, 5(12.5%) strongly
disagreed that the services provided by staffs of OPD is good.

Cost charge to the patient in OPD is appropriate

 12

10

8
Frequency

0
Strongly Agree Agree Neutral Disagree Strongly Disagree
Cost charge to the patient in OPD is appropriate

Figure 5: Graph showing the cost charge of patient in OPD

Cost charge to the patient in OPD is appropriate

Cumulative
Frequency Percent Valid Percent Percent
Valid Strongly Agree 11 27.5 27.5 27.5
Agree 8 20.0 20.0 47.5
Neutral 10 25.0 25.0 72.5
Disagree 7 17.5 17.5 90.0
Strongly Disagree 4 10.0 10.0 100.0
Total 40 100.0 100.0

Table 5: Table showing that the cost charge of patient in OPD is appropriate

In above table5 and figure5 it shows that 11(27.5%) strongly agreed, 8(20%) agreed,
10(25%) neutral, 7(17.5%) disagreed and 4(10%) strongly disagreed that the cost charge of
patients in OPD is appropriate.

Physical facilities provided in OPD is good

 12

10

8
Frequency

0
Strongly Agree Agree Neutral Disagree Strongly Disagree
Physical facilities provided in OPD is good

Figure 6: Graph showing physical facilities provided in OPD is good

Physical facilities provided in OPD is good

Cumulative
Frequency Percent Valid Percent Percent
Valid Strongly Agree 9 22.5 22.5 22.5
Agree 11 27.5 27.5 50.0
Neutral 8 20.0 20.0 70.0
Disagree 7 17.5 17.5 87.5
Strongly Disagree 5 12.5 12.5 100.0
Total 40 100.0 100.0

Table 6: Table showing physical facilities provided in OPD is good

In above figure6 and table6, it shows that 9(22.5%) strongly agreed, 11(27.5%) agreed,
8(20%) neutral, 7(17.5%) disagreed and 5(12.5%) strongly disagreed that the physical
facilities provided in OPD is good.

Participation of management and health care providers can improve the

performance of OPD
 16
14
12
10
Frequency

8
6
4
2
0
Strongly Agree Agree Neutral Disagree Strongly Disagree
Participation of management and healthcare providers can improve the
performance of OPD

Figure7: Participation of management and healthcare providers can improve the performance of OPD

Participation of management and healthcare providers can improve

the performance of OPD
Cumulative
Frequency Percent Valid Percent Percent
Valid Strongly Agree 11 27.5 27.5 27.5
Agree 15 37.5 37.5 65.0
Neutral 9 22.5 22.5 87.5
Disagree 3 7.5 7.5 95.0
Strongly Disagree 2 5.0 5.0 100.0
Total 40 100.0 100.0

Table7: Participation of management and healthcare providers can improve the performance of OPD

In above figure7 and table7, it shows that 11(27.5%) strongly agreed, 15(37.5%) agreed,
9(22.5%) neutral, 3(7.5%) disagreed and 2(5%) strongly disagreed that the participation of
management and healthcare providers can improve the performance of OPD.

Easy access to Reception, Inquiry and Registration counters of hospital

OPD decrease the waiting time of patients
 16
14
12
10
Frequency

8
6
4
2
0
Strongly Agree Agree Neutral Disagree Strongly Disagree
Easy access to reception,inquiry and registration counters of hospital
OPD decrease the waiting time of patients

Figure 8: Easy access to various counters of hospital OPD decrease the waiting time of patients

Easy access to reception, inquiry and registration counters of hospital

OPD decrease the waiting time of patients
Cumulative
Frequency Percent Valid Percent Percent
Valid Strongly Agree 12 30.0 30.0 30.0
Agree 14 35.0 35.0 65.0
Neutral 10 25.0 25.0 90.0
Disagree 3 7.5 7.5 97.5
Strongly Disagree 1 2.5 2.5 100.0
Total 40 100.0 100.0

Table 8: Easy access to various counters of hospital OPD decrease the waiting time of patients

In above figure8 and table8, it shows that among 40 patients, 12(30%) strongly agreed,
14(35%) agreed, 10(25%) neutral, 3(7.5%) disagreed and 1(2.5%) strongly disagreed that the
easy access to reception, inquiry and registration counters of hospital OPD decrease the waiting
time of patients. Here most of the patients agreed that easy access to reception, inquiry and
registration counters of hospital OPD will decrease the waiting time of patients.

Appointment of Patients
 35

30

25
Frequency

20

15

10

0
Yes No
Have an appointment for today?

Figure 9: Appointment for patients

Have an appointment for today?

Cumulative
Frequency Percent Valid Percent Percent
Valid Yes 33 82.5 82.5 82.5
No 7 17.5 17.5 100.0
Total 40 100.0 100.0

Table 9: Appointment for patients

In above figure9 and table9 it shows that among 40 patients 33(82.5%) of patients have an
appointment for visit in hospital OPD and 7(17.5%) of patients doesn’t have an appointment
for visit in hospital OPD. Nowadays, most of the people have an appointment for visit in
hospital.

Appointment system would help in reducing the waiting time

 30

25

20
Frequency

15

10

0
Yes No
An appointment system would help in reducing the waiting time

Figure 10: An appointment system would help in reducing the waiting time

An appointment system would help in reducing the waiting

time
Cumulative
Frequency Percent Valid Percent Percent
Valid Yes 27 67.5 67.5 67.5
No 13 32.5 32.5 100.0
Total 40 100.0 100.0

Table 10: An appointment system would help in reducing the waiting time

In this above figure and table, among 40 patients 27(67.5%) think that an appointment system
would help in reducing the waiting time and rest 13(32.5%) do not think that an appointment
system would help in reducing the waiting time in hospital.

How long after the stated appointment time did your appointment
start?
 18
16
14
Frequency

12
10
8
6
4
2
0
Less than 30 minutes Between 30 minutes and More than one hour Do not have to wait
1 hour
How long after the stated appointment time did your appointment start?

Figure 11: Appointment start time after the appointment stated

How long after the stated appointment time did your appointment start?
Cumulative
Frequency Percent Valid Percent Percent
Valid Less than 30 minutes 16 40.0 40.0 40.0
Between 30 minutes and 1 15 37.5 37.5 77.5
hour
More than one hour 4 10.0 10.0 87.5
Do not have to wait 5 12.5 12.5 100.0
Total 40 100.0 100.0
Table 11: Appointment start time after the appointment start

In above table11 and figure11 it shows that 16(40%) of patients appointment start in less than
30 minutes. In between 30 minutes and 1 hour 15(37.5%) patients appointment start. 4(10%)
patients wait for more than hour. 5(12.5%) do not have to wait. Old people do not have to wait
for a long time or they do not have to be in queqe

How long did you wait to see the physician and receive the
treatment?
 30

25

20
Frequency

15

10

0
Less than 30 minutes Between 30 minutes and 1 More than one hour Do not have to wait
hour
How long did you wait to see the physician and receive the treatment?

Figure 12: Time to wait to see the physician and receive the treatment

How long did you wait to see the physician and receive the treatment?
Cumulative
Frequency Percent Valid Percent Percent
Valid Less than 30 minutes 25 62.5 62.5 62.5
Between 30 minutes and 1 9 22.5 22.5 85.0
hour
More than one hour 1 2.5 2.5 87.5
Do not have to wait 5 12.5 12.5 100.0
Total 40 100.0 100.0

Table 12: Time to wait to see the physician and receive the treatment

In above figure and table it shows that among 40 patients, 25(62.5%) have to wait for less than
30 minutes, 9(22.5%) have to wait for between 30 minutes and 1 hour, 1(2.5%) have to wait
for more than one hour and 5(12.5%) do not have to wait to see the physician and receive the
treatment.
Are you Satisfied with waiting time?

30

25

20
Frequency

15

10

0
Satisfied Not Satisfied
Satisfied with waiting time

Figure 13: Satisfaction on waiting time

Satisfied with waiting time

Cumulative
Frequency Percent Valid Percent Percent
Valid Satisfied 24 60.0 60.0 60.0
Not Satisfied 16 40.0 40.0 100.0
Total 40 100.0 100.0

Table 13: Satisfaction on waiting time

In above figure and table among 40, 24(60%) are satisfied with waiting time and 16(40%) are
not satisfied with waiting time.

Patients waiting time can be reduced

 16
14
12
Frequency

10
8
6
4
2
0
Increase staff per Improve staff Introduce Increase service
shift availability at their appointment system points
status
Patients waiting time can be reduced

Figure 14: Patients waiting time can be reduced

Patients waiting time can be reduced

Cumulative
Frequency Percent Valid Percent Percent
Valid Increase staff per shift 8 20.0 20.0 20.0
Improve staff availability at 10 25.0 25.0 45.0
their status
Introduce appointment 7 17.5 17.5 62.5
system
Increase service points 15 37.5 37.5 100.0
Total 40 100.0 100.0

Table 14: Patients waiting time can be reduced

In above table14 and figure14 among 40 patients, 8(20%) think waiting time can be reduced
by increasing staff per shift, 10(25%) think that waiting time can be reduced by improving
staff availability at their status, 7(17.5%) think that waiting time can be reduced by
introducing appointment system and 15(37.5%) think that waiting time can be reduced by
increasing service points.

4.2 Main Findings and Discussion

This study sought to assess the patient waiting time and identify associated factors using the
queuing theory. Application of this theory is therefore important to help in predicting how long
a patient should take to receive a particular service and this can be used to design facility
specific patient management guidelines. As, Norvic International Hospital is one of the reputed
or private hospital of Nepal which patient’s satisfaction is important to avail the services so
this study was conducted to know the patient satisfaction toward waiting time in this institute.
More respondents were female and this was shown to be significant. Among 40 patients, 55%
respondents are female and 45% respondents are male. These findings are similar to other
studies done in Nigeria, (Oche & Adamu 2013) and other developed countries (Whyte &
Goodacre 2016) but percentage for the female was higher than that found in another study in
Nigeria (Umar, I., Oche, M. O., & Umar 2011).
In our study majority patients attending the OPDs was belong to 21 to 30 years of age group
(42.5%) followed by less than 20 years of age group (10%) and 31 to 40 years of age (20%).
In the age of above 41 to 50 there are 5% respondents and above there are 2.5% respondents.
Here, in this study more Hindu people visit hospital as Nepal is one of the Hindu country.
Among 40 patients, 30 people were Hindu. Others were Buddhist and Christian. Most people
think that physical facilities provided in OPD and services provided by staff of OPD is good.
In this study, more patients were satisfied with waiting time of OPD. Among 40, 24(60%) are
satisfied with waiting time whereas, 16(40%) are not satisfied with waiting time in OPD. For
reducing patients time most of the respondents 15(37.5%) think of increasing service
points,10(25%) think to improve staff availability at their status,8(20%) think of increasing
staff per shift and 7(17.5%) think of introducing of appointment system. These suggestions are
more less the same with some given in another study (Ameh et al. 2013) and different from
those suggested by respondents in Malaysia (Pillay et al. 2011). It was also noted that the few
patients who were given an appointment were not given a specific time for the appointment
similar to another study in Uganda (Wanyenze et al. 2010). Patients should be informed on
time about the delay of OPD services. In this study, we observe that 65% of respondents agreed
that easy access to reception, inquiry and registration counters of hospital OPD decrease the
waiting time of patients.
 CHAPTER 5
CONCLUSION

5.1 Conclusion
Patients attending each hospital are responsible for spreading the good image of the hospital
and therefore satisfaction of patients attending the hospital is equally important for hospital
management. Various studies about outpatient service have elicited problems like
overcrowding, delay in consultation, proper behavior of the staff etc. The study reveals the
average spend by the patients and also expresses their view towards the hospital and hospital’s
services provided by the hospital and the total consumed on each activity. In this study, it was
found patients constitute of all age groups and genders among which most of them were
females. Study depicts that average no. of patients coming to OPD each day as walk-in is more
in comparison to the appointment patients.
In outpatient services there are certain factors which caused delays in providing the services on
time .These delays cause reduction in patient satisfaction. Significant reduction in waiting time
was achieved in the outpatient service by using quality process approach .In addition the service
was improved by effective communication providing enough manpower and educating the
patients the importance of taking appointment before arriving at the hospital. Registration
forms were modified, additional staff were appointed to handle the telephone in OPD and they
were also taught basic telephone etiquette. Further data collection through VOC will help to
monitor and control any variance.
This study found that the mean waiting time in hospital is about an hour to get the services
needed which most patients felt was acceptable. Availability of healthcare workers and
especially the doctors was found to affect the patient waiting time at Norvic International
Hospital with majority of patients suggesting that improving availability of health workers at
their stations will help reduce patient waiting time. This may be the one of the first studies in a
stand-alone outpatient department and therefore further studies are needed in this area that will
involve healthcare workers and other qualitative data collection methods. In addition other
proved ways of improving healthcare workers performance like capacity scenario challenges
can be applied by managers in Norvic International Hospital to improve decision making on
staffing levels that can provide optimal wait time reduction and hence improve service delivery
to the community.

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Khani, R. A., 2015. Improving Waiting Time and Patients' Experience in a Medical Retina Clinic,
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Lowalekar, H. & Ravichandran, N., 2012. Managing the Outpatient Department Waiting Time at
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Patel, Ravikant; Patel, Hinaben R, 2017. A Study on waiting time and out-patient satisfaction at
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