Improving waiting time and operational clinic flow in a tertiary diabetes center.

The Singapore General Hospital Diabetes Centre (DBC) is a multidisciplinary specialist outpatient clinic which aims to provide an integrated one-stop service for diabetes. As with many tertiary academic centre clinics, DBC encounters an expanding patient load, greater patient expectations and increasingly complicated patients who require services from a multitude of health providers. Such rising demands amidst limited resources cause inefficiencies and long waiting times to consultation. This result in low patient satisfaction and an unpleasant clinic experience. A multidisciplinary team was formed to reduce the waiting time at DBC and improve communication and work processes of staff. Addressing wait-times is complicated as multiple stakeholders and operational processes are involved and interlinked. By systematically breaking down processes and identifying problem areas, targeted changes were implemented. This included a revised model of appointment scheduling, a patient reminder system, more effective communication sheets and work reassignments. The primary aim of this project was to improve the patient turn-around time (duration a patient spends at the centre for a visit). There was no documented improvement in turn-around time after project implementation (108.23 minutes versus 106.6 minutes) but other secondary aims were achieved. These included an increase in the percentage of patients seen by the doctor within 60 minutes from 80% to 84%, a reduction in wait-time for payment and reappointment at the cashier by 36.6% and a reduction in non-attendances of new cases to the clinic from 30.2% to 21.3%. Staff satisfaction and communication were greatly improved. To aid sustainability, personalized reports of individual doctor's waiting times and workload were produced quarterly and tracked. As this is a first step quality improvement project, efforts to track, examine and further improve turn-around times are on-going. Future initiatives are directed at time-efficient appointment scheduling between care providers for same day appointments, a reactive SMS system for reminders and reappointments and optimization of processes and manpower allocation for clinics.