MAKERERE UNIVERSITY SCHOOL OF PUBLIC HEALTH (MakSPH-CDC FELLOWSHIP PROGRAM) REDUCING PATIENT WAITING TIME AT OUT PATIENTS’ DEPARTMENT AT KAWOLO GENERAL HOSPITAL. BY SILVIO ABIRIA,MSC-HM, BA (SS) Dip SCN and Dip MN SALIMA KABISE, Certificate Medical Records, CCA,CCNA HARRIET NANGOBI, Dip. Comp. Nursing. MEDIUM-TERM FELLOWS (HEALTH SERVICE IMPROVEMENT) MENTORS HARUNA WAMALA DR MAYANJA ROBERT FEBRUARY2015 1 TABLE OF CONTENTS TABLE OF CONTENTS..............................................................................................................................2 DECLARATION ..........................................................................................................................................3 FELLOWS’ ROLE IN PROJECT IMPLEMENTATION............................................................................ ii ACKNOWLEDGEMENT. .......................................................................................................................... iii ACRONYMS............................................................................................................................................... iv OPERATIONAL DEFINITIONS................................................................................................................. v EXECUTIVE SUMMARY ......................................................................................................................... vi INTRODUCTION AND BACKGROUND..................................................................................................1 About Kawolo Hospital ............................................................................................................................2 STATEMENT OF THE PROBLEM ............................................................................................................3 Problem Identification .............................................................................................................................3 Problem Prioritization..............................................................................................................................4 PROJECT OBJECTIVES .............................................................................................................................6 General Objective.....................................................................................................................................6 Specific Objectives....................................................................................................................................6 COUNTER MEASURES .............................................................................................................................7 PROJECT OUTCOMES.............................................................................................................................10 LESSONS LEARNT AND CHALLENGES EXPERIENCED .................................................................11 RECOMMENDATION AND NEXT STEPS ............................................................................................12 REFERENCES ...........................................................................................................................................14 2 DECLARATION I, Silvio Abiria, Salima Kabise and Harriet Nangobi, do hereby declare that this end of project report entitled; Reducing Patient Waiting Time at Out Patients’ Department At Kawolo General Hospital, has been prepared and submitted in fulfillment of the requirements of the Medium-term Fellowship Program at Makerere University School of Public Health and has not been submitted for any academic or non-academic qualifications. Signed ………………………………………………. Date ……………………………………… Silvio Abiria, Medium-term Fellow Signed ……………………………………………….. Date ………………..…………………… Salima Kabise, Medium-term Fellow Signed ……………………………………………… Date ……………………………………… Harriet Nangobi, Medium-term Fellow Signed ………………………………………………. Date ……………………………………… Haruna Wamala, Institutional Supervisor Signed ………………………………………………… Date ……………………………………. Dr Mayanja Robert, Academic Mentor 3 FELLOWS’ ROLE IN PROJECT IMPLEMENTATION The team from Kawolo Hospital consisted of three members and each played a very important role in the implementation of the project as indicated below; 1. Silvio Abiria- Team leader: Oversaw the entire implementation exercise and was also the contact person responsible for liaising with the MakSPH-CDC Fellowship program, as well as the institutional and academic mentors. 2. Salima Kabise -Secretary and records manager: Ensured proper documentation of the activities, progress and outcome related with implementation of the project activities. 3. Harriet Nangobi - Coordinator: Was responsible for the overall coordination of the activities implemented in the project, ensuring that all the other health workers within the Hospitals work harmoniously with the trained team members to implement project activities. She also led the dissemination of project results to stakeholders. ii ACKNOWLEDGEMENT. We would like to thank the staff of Makerere University College of Health sciences, School of Public Health, especially Dr.Violet Gwokyalya, Mr.J.B Matovu, Ms. Rose Baryamutuma and Ms. Farida Mbambu for their valuable technical support and guidance throughout the entire training period. We also acknowledge all stakeholders who participated in the different activities during project implementation. Lastly, we are indebted to our families for the support they rendered to us during the busy period of project implementation. iii ACRONYMS OPD Out Patient Department MOH Ministry of Health SUSTAIN Strengthening Uganda’s Systems by Treating AIDS Nationally DHT District Health team IP Implementing Partner TB Tuberculosis ANC Antennal Clinic ART Anti Retroviral Therapy MakSPH Makerere University School of Public Health CDC Centers for Disease Control and Prevention HCQI Hospital Continuous Quality Improvement. iv OPERATIONAL DEFINITIONS Waiting time in this report is defined as the total time spent from when the patient enters OPD to the time he/she leaves OPD after receiving the required services. v EXECUTIVE SUMMARY Patient waiting time is one of the measures of the quality of health services from a client’s perspective. Kawolo Hospital had a persistent problem of long waiting time at the outpatient department. An assessment to determine the amount of time patients took to exist the facility revealed that patients were waiting for an average of 4 hours. This was way above the 2 hours recommended by the Ministry of health. Following meetings with the relevant stakeholders at the hospital, it was agreed that the support from Makerere University School of Public Health CDC fellowship program towards implementation of a QI project be focused on this service problem. The project was designed with the overall objective of reducing patient waiting time at OPD at Kawolo General Hospital from 4 to 2 ½ hours within 5 months. In order to achieve this set objective, relevant counter measures were adopted which included; strengthening support supervision, reducing staff absenteeism and streamlining patient flow among others. After six months of project implementation, both direct and indirect outcomes were registered. Overall, patient waiting time reduced from 4 to 3 hours, staff absenteeism reduced significantly because of the involvement of administration and transferring some of the basic laboratory tests for HIV and malaria from the congested laboratory to a separate testing area which greatly reduced turnaround time for test results. In addition, patient comfort was improved by the creation of another waiting place for those awaiting test results. Through this project we learnt; the importance of team work, innovation to improve health service provision and involvement of administration in QI interventions to ensure successful implementation. We recommend that hospital administrators be trained in quality improvement to enable them provide more support to the staff. The Ministry of health should also strengthen vi supervision in the public health facilities and maintain adequate staffing levels to enable timely service delivery to clients. vii INTRODUCTION AND BACKGROUND The time patients spend at health facilities is a key performance indicator for health facilities especially for outpatient clinics. The effect of long waiting time on utilization of health services is well documented (Fernandes et al., 1994; dos Santos et al., 1994) and has been associated with poor utilization of available health care services (Kurata et al., 1992). Out Patients Departments (OPD) act as windows to hospital services and they reflect the quality of services in the other departments. A patient’s impression of the hospital begins at the OPD. This impression often influences the patient’s sensitivity to the hospital and it is therefore essential to ensure that OPD services provide an excellent experience for patients. When well organized and professionally run, OPD can help avoid confusion, frustration and regulate the flow of patients in the hospital. Additionally, waiting time becomes a factor in retaining current users of the service as well as attracting new users. Throughout the world, patient waiting time has increased most especially in the developing countries where it is compounded by poor health systems (Willcox et al., 2007; Siciilian and Hurst 2004). Studies have revealed that patient satisfaction is highly correlated with waiting time (Maitra and Chikhani, 1992). A study done