FACTORS ASSOCIATED WITH PATIENT WAITING TIME AT A MEDICAL OUTPATIENT CLINIC: A CASE STUDY OF UNIVERSITY OF NAIROBI HEALTH SERVICES By REBECCA BISANJU WAFULA H70/75006/2014 A PROJECT DISSERTATION SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF MASTER OF SCIENCE IN HEALTH SYSTEMS MANAGEMENT IN THE SCHOOL OF PUBLIC HEALTH OF UNIVERSITY OF NAIROBI. 2016 UNIVERSITY OF NAIROBI Declaration of Originality Form This work must be completed and signed for all works submitted to the University for Examination Name of Student REBECCA BISANJU WAFULA Registration Number H70/75006/2014 College COLLEGE OF HEALTH SCIENCES Faculty/School/Institute SCHOOL OF PUBLIC HEALTH Department PUBLIC HEALTH Course Name MSC LEADERSHIP AND HEALTH SYSTEMS MANAGEMENT Title of the work FACTORS ASSOCIATED WITH PATIENT WAITING TIME AT A MEDICAL OUTPATIENT CLINIC: A CASE STUDY OF UNIVERSITY OF NAIROBI HEALTH SERVICES DECLARATION 1. I understand what Plagiarism is and I am aware of the University’s policy in this regard 2. I declare that this project is my original work and has not been submitted elsewhere for examination, award of a degree or publication.
Where other people’s work or my own work has been used, this has properly been acknowledged and referenced in accordance with the University of Nairobi’s requirements. I have not sought or used the services of any professional agencies to produce this work 4. I have not allowed, and shall not allow anyone to copy my work with the intention of passing it off as his/her own work 5. I understand that any false claim in respect of this work shall result in disciplinary action, in accordance with University Plagiarism Policy.
Signature ______________________________ Date __________________________________ ii APPROVAL This dissertation has been submitted for examination with the approval of my supervisors Dr., MBchB Lecturer School of Public Health University of Nairobi Signature Date Dr. Pharm Senior Lecturer School of Pharmacy University of Nairobi Signature Date Approved by the Director, School of Public Health, University of Nairobi Prof.EH, BSc Signature Date iii ACKNOWLEDGEMENT I wish to thank, first, my supervisors Dr Richard Ayah and Dr Peter Karimi for their guidance and expert advice through the whole process of proposal development and dissertation. Second, my lecturers for passing knowledge and skills during the course work. Third, my appreciation goes to my husband Mr.
Cheruiyot for supporting me all through the study period. And finally, to all the UHS staff for cooperation and encouragement during data collection. iv TABLE OF CONTENTS DECLARATION. iv TABLE OF CONTENTS .v LIST OF TABLES.
viii LIST OF FIGURES. ix LIST OF ABBREVIATIONS .x OPERATIONAL DEFINITIONS OF TERMS. xii CHAPTER ONE: INTRODUCTION .2 Purpose of the study.4 Objectives of the study.5 Significance of the study.4 CHAPTER TWO: LITERATURE REVIEW.2 Patient waiting time.3 Type of service sought by patients.4 Availability of healthcare providers at their working station .5 Arrival time of patients .7 Study Justification /Problem statement.8 v CHAPTER THREE: METHODOLOGY .6 Sample size calculation and Sampling procedure.8 Data collection tool .1 Data collection procedure.9 Quality assurance /control procedures .10 Data processing and analysis .12 Dissemination of study results Plan .15 Study closure plan and procedure .17 CHAPTER FOUR: RESULTS .1 Social Demographic Characteristics .2 Patient waiting time .3 Type of service sought by respondents .1 Proportion of patients who received all services.4 Availability of health workers at their stations .5 Patient arrival time.1 Patient rating waiting time at service points .2 Suggestions by respondents on ways to reduce waiting time .6 Acceptability of overall time spent .7 Association between variables .2 Analysis of variance for availability of doctors and patient waiting time. 26 CHAPTER FIVE: DISCUSSION.1 Social Demographic characteristics .2 Mean Patient Waiting Time .3 Type of services sought .4 Availability of Health Workers at their Station .5 Patient Arrival Time .6 Acceptability of Overall Time Spent in the Clinic .31 CHAPTER 6: CONCLUSION AND RECOMMENDATIONS .33 APPENDIX 1: PARTICIPANT INFORMED CONSENT FORM .37 APPENDIX 2: PARTICIPANT EXIT QUESTIONNAIRE .39 APPENDIX 3: LETTER OF APPROVAL – UHS.45 APPENDIX 4: LETTER OF APPROVAL – KNH/UON ERC .46 vii LIST OF TABLES Table 1-Data Collection Tool Summary.14 Table 2- Socio-demographic data .18 Table 3-Average waiting time at different service points.19 Table 4-Proportion of patients who received all services at the clinic .20 Table 5- Patient arrival time at the clinic.22 Table 6 - Response on strategies to improve patient waiting time .25 Table 7- Availability of doctors and total time spent at the clinic.26 Table 8- Gender and total time spent at the clinic .26 Table 9- Mean waiting time for various arrival time .27 Table 10-Total time spent against patient status.27 Table 11-Post Hoc test - Tukey HSD for patient status and total waiting time.28 Table 12- Univariate analysis of variance: Patient waiting time and Gender, patient status and availability of doctors.28 viii LIST OF FIGURES Figure 1.4 Figure 2- Proportion of patients seeking various services at the clinic .19 Figure 3- Reason for not receiving the Services at the Clinic .21 Figure 4 - Availability of health care workers at their working stations .22 Figure 5- Rating of waiting time at service points.23 Figure 6- Areas that cause delays at the clinic.24 Figure 7- Acceptability of overall time spent at the clinic.25 ix LIST OF ABBREVIATIONS MOH - Ministry of Health PWT - Patient Waiting Time SSC - Senior Staff Clinic UHS - University Health Services UON - University of Nairobi WHO - World Health Organization x OPERATIONAL DEFINITIONS OF TERMS Health service delivery provision of health services to staff and students at senior staff clinic.
Healthcare provision and maintenance of physical and mental health status of outpatients through provision of health intervention Outpatient a patient who visits a medical facility for treatment or care but is not hospitalized overnight at the facility Outpatient clinic a stand-alone health centre that provides treatment services without an overnight stay for staff and students. Working station the area or room a health provider works from in clinic Service point the area in the clinic designated for service provision. Arrival time the time a patient reports at the registration or records office seeking healthcare. Departure time the time a patient exits the clinic after reaching the last service point.
Patient waiting time the whole waiting time which is the service points waiting time added together. Service point waiting time the time spent awaiting for a service at respective service points namely records office, triage nursing, pharmacy and consultation rooms. xi ABSTRACT Background: Excessive long waiting time in outpatient clinics in Africa is a constant challenge for patients and the health providers of these facilities. Prolonged waiting times are associated with poor adherence to treatment, missed appointment and failure or delay in initiation of necessary treatment.
The time a patient spends at each service point before being attended to by a health provider and the overall total time a patient spends in a health facility from the arrival time to the departure time is a major factor towards the perception of the patient towards the care received. Objective: To determine wait time and associated factors among outpatients attending senior staff clinic at University of Nairobi health services.Methodology: In this cross-sectional study, data collection was conducted on 384 outpatient over a period of four weeks using an interviewer administered pretested structured exit questionnaire with a time-tracking section. Simple random sampling was used to select respondents in a walk- in outpatient clinic set up. To analyse all data was cleaned then entered in the Statistical Package for Social Sciences (SPSS) 20.
Analysis of variance (ANOVA), and cross tabulation was used to establish associations between the independent variable and dependent variables. Results: In total 384 patients were tracked and interviewed. The average patient waiting time was 55.3mins during the four week study period. Majority of the respondents waited in the clinic for 60 minutes to receive the services they had sought.
The longest average patient waiting was 13.1 minutes at the doctor’s office. Most services sought for at the UHS are new consultations and specialised consultations. Whilst most respondents at 69% felt the time they had spent at the clinic was acceptable, many at 52% suggested that improving availability of staff at their stations will help in reducing Patient waiting time at UHS. In this study, gender (P=0.005) and availability of doctors (p=0.000) were found to affect patient waiting time.
Conclusion: Identifying the area of delay and the actual mean waiting time at the clinic is the first step for UHS in implementing the needed changes in internal processes and practices at the clinic. Majority of the patients are spending an hour at the facility to be served. Most patients felt the overall time spent in the facility is acceptable but suggested that improving availability of health workers at their stations will reduce the patient waiting time and thus enhance service delivery to the university community. xii CHAPTER ONE: INTRODUCTION 1.1 Background 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.In addition, a report in 2014, from the Centre for Disease Control found that the average patient treatment time was 90minutes.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 outcomes (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.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. 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) In many developing countries in sub Saharan Africa, mean waiting time in facilities of more than four hours has been reported. A study of patient flow efficiency in three HIV clinics in Uganda reported a mean waiting time of up to 4.6 hours (Wanyenze et al.Several determinants have been identified to be leading to the long waiting hours in many outpatients units within and without hospitals in developing countries.
Some are few health personnel, and a high patient load (Maluwa et al. Out of these causes, lack of adequate staff has emerged the main reason for long stay in clinics (Dimakou et al. In a busy hospital in Malawi, a study on moral distress in nursing practice 1 established that nurses developed low morale for work and strain due to attending to many patients daily (Maluwa et al. 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.