Focus

Streamlining OPD

Scores of patients, a maze of windows, chaos and confusion used to be the typical scenario of a hospital OPD. However, automation, trained staff and new time management tools and techniques are changing the picture, Sonal Shukla discovers

OPDs act as a window to hospital services and a patient's impression of the hospital begins at the OPD. This impression often influences the patient's sensitivity to the hospital and therefore it is essential to ensure that OPD services provide an excellent experience for customers. It is also well-established that 8-10 per cent of OPD patients need hospitalisation. When well organised and professionally run, not only can such OPDs help avoid confusion, frustration and overspending by fearful patients but can also regulate the flow of inpatients to the hospitals. Having observed this, hospitals today are making changes on various fronts to streamline this area.

Kochi-based AIMS Hospital, for example, recently revamped its OPD centre with all related OPD and IPD services at one central location. The 8,000-square-foot division is in the shape of a flower with a central atrium-which can be approached from all segments of the hospital-and petals around. This centralised design of its OPD has the Hospital reaping benefits in terms of eased outpatient flow, less confused patients and optimum utilisation of time. Experts suggest many other key changes in the areas of resource, processes, manpower and design management to reorganise this area like never before.

Mumbai- based Hinduja Hospital conducted a six-sigma study and included more counters for scheduling of clinic timings	Separate information centres help in addressing patient queries at Moolchand Medcity, New Delhi
Mumbai's Dr LH Hiranandani has utilised electronic display plasma screens to dynamically update patient information	Pune's Ruby Hall Clinic has 'Patient Relations Executive' to facilitate patient convenience and resolve any issues
In its OPD, Coimbatore-based KG Hospital has separate cabins for specialists and seating arrangements for patients	Fortis Healthcare, Mohali has a call monitoring system whereby if the call goes unattended it is taken on voice mail

Managing Time

It is crucial to manage time well and optimise its use for both consultants as well as patients. The situation is challenging with more visiting consultants serving hospitals. "Since today many doctors are fee-for-service consultants and operate in more than one hospital it is not easy for the patient to find out whether the particular consultant he is looking for is indeed available in the OPD, especially surgeons who are often in the theatre. The patient might have to wait a while before the consultant is free," explains Joe Curian, President, Global Hospitals Group.

According to Dr Daljit Singh, President, Fortis Healthcare, "Hospitals must set up systems in consultation with doctors to ensure that doctors and everybody else understands why they have to be on time, and how much time is allotted for each consultant so that largely patients are not kept unnecessarily waiting." Dedicated full time doctors can make a huge difference.

Better Scheduling

As most patients, whether new or old, prefer to come to the hospital in the morning, there is always a crowding of outpatients. Moreover, the doctors would like to see the patients in the mornings. Most patients also come without appointments.

Consequently, an important area to improve upon is the appointment and scheduling system. The heavy rush of patients in peak hours leads to long queues to meet the concerned doctors. "Keeping an appointment is becoming difficult for the doctors as well as patients due to inaccurate estimation of time. At times, doctors do not use time slots appointed to them effectively, which affects the productivity of the hospital," complains Shravan Talwar, CEO, Moolchand Medcity.

An effective centralised appointment system for doctors can help in retaining patients. It is integral to provide a single point of contact for making and cancelling appointments. The patient should not after coming to the hospital discover that the doctor hasn't come or is not available on that particular day. Singh suggests, "The appointment should be scheduled with adequate time for each patient to be examined properly and less waiting time for those following. A facility should be provided for either online or telephonic booking of consultations." Good dispersal of information regarding availability, timings and charges of doctors is therefore necessary and can be done via the hospital website to inform the patient in advance. Alternate methods of appointments like email appointments, online appointments and SMS should be utilised thoroughly. "Separate information centres for addressing patient queries will make them more satisfied with our services," suggests Talwar.

"There should be a staggered system of appointments. This will ensure that patients come to see the doctors evenly and there will be orderliness. Thus there will be less crowding of new and old patients," adds Dr G Bakthavathsalam, Chairman, KG Hospital, Coimbatore. In its OPD, KG Hospital has provided separate cabins for specialists and seating arrangements for patients. The doctors complete their rounds early in the morning, i.e. from 7.30 a.m. to 9 a.m. They start their practice in their clinics from 9 a.m. and send patients for investigations and ask them to come the next morning for review. "In this way, we are able to see all patients, both old and new, and satisfy them," says Dr Bakthavathsalam.

"To reduce patients' apprehension, there should always be a friendly person to give information and attend to any needs that they may have" - Dr Alok Roy, MD Medica Synergie Kolkata

"The OPD should be on the ground floor near diagnostic departments like laboratory, CTs, MRI, X-rays and USG" - Dr Ashish Banerji Medical Director & CEO Woodlands Medical Centre Kolkata

Trained to Soothe

Well-groomed and efficient billing and front office staff is key to the efficient functioning of OPDs. Therefore imparting soft skills, customer focused and process centric training to the OPD personnel and creating a culture of empathy and compassion for patients in the OPD is high on the agenda of today's hospitals. "To reduce patients' apprehension, there should always be a friendly and efficient person available to greet them, to give them information and attend to any needs they may have," says Dr Alok Roy, MD, Medica Synergie. The front office executives should also have a good knowledge of the various common procedures. Besides dedicated chambers for doctors, experts also emphasise having special co-ordinators and nursing staff available at the OPD desk. Smart secretaries can be appointed for the consultants, who would feel the pulse of the patients and make suitable small adjustments, so that those in a hurry may be allowed to see the doctors on priority without offending those who are waiting for long.

"Adequate nursing staff can help doctors by assisting the patients at the entry point and catering for female patients," says Dr Singh. To give proper attention to patients, it is advisable to have a separate help desk and registration counter. Pune's Ruby Hall Clinic has a 'Patient Relations Executive' available in the OPD area for the patient's convenience and to resolve any issues on the spot. According to experts, multi-tasking by staff in this area is also relevant for keeping manpower within limits. "However, it may not work always as you require exceptionally talented staff for this, which may come at a price," warns Dr Akash Rajpal, Senior Manager, Medical Services, Dr LH Hiranandani Hospital, Mumbai.

Divide to Rule

Poor facility planning and space allocation for specialities, and dispersed functionally related departments are major hindrances for efficient functioning of an OPD. OPD and IPD activities carried out from common facilities i.e. reception, enquiry, cash collection and diagnostics leads to overcrowding and confusion. "Some hospitals have central-OPD-registration, causing huge crowds, queues, confusion, lack of adequate seating, lack of guidance to go to the respective doctors' consulting rooms. If this central-OPD-registration is in the main hall of the hospital, you can imagine the chaos," elaborates Col RL Sharma, Hospital Administrator, Ruby Hall Clinic, Pune.

According to Joy Chakraborty, Deputy Director, Administration, PD Hinduja Hospital, Mumbai, the reason could be the exponential growth in patient load for the hospital OPD either due to error in forecasting or because of lack of opportunity for a hospital to expand in the existing location over time. This not only affects the patient satisfaction due to unpleasant experience in hospital but also restricts the growth of the hospital and creates obstacles to bring in new specialities and facilities. Indirectly it hits the revenue generation of the hospital and its penetration into new markets. Col Sharma suggests having a separate OPD while the main hospital focuses only on IPD. "Let the state-of-the-art equipped hospital treat the vast majority of seriously sick people in the society. A separate OPD can be in the same compound as a hospital," he opines. Distribution of OPDs in groups according to function for least movement of patients and crowding, de-centralised billing and optimised number of assisting counters and waiting areas are critical.

"The OPD should be on the ground floor near diagnostic departments like laboratory, CTs, MRI, X-rays and USG," advises Dr Ashish Banerji, Medical Director & CEO, Woodlands Medical Centre, Kolkata. In Ruby Hall, the OPDs are concentrated on the ground floor, though in different areas. Diagnostic and lab facilities are also located on the same floor. Max Healthcare has streamlined the OPD area by segregating OPD and IPD billing counters and by further segregating OPD patients into corporate, appointments and walk-ins. Dr LH Hiranandani Hospital has divided the OPDs into two groups (surgical and non surgical) at different levels, which has led to optimised crowd dispersal. "Now the OPDs do not look crowded and there is better crowd management," Dr Rajpal claims.

Programme the Flow

Developing a service blueprint and making it more relevant by keeping the target customer base in mind can help to streamline the functioning of OPD. "Any issue related to planning and designing of the facility takes time and resources to streamline. So one should be careful before taking any decision and ensure that it is acceptable," Chakraborty warns.

Curian concurs, "A flowchart can be applied either at the time of planning the hospital or later, to pick the service counters and service points." It is necessary to study the service delivery system of OPD step-by-step. The hospital needs to study carefully the value addition of each step and how it is making a patient's journey in the hospital smoother. "We also must remember that more interactive phases with the patients in a hospital may make patients unhappy. So it is advisable to bring down the unnecessary interaction with the patients during the care process," explains Chakraborty.

A year back, Hinduja Hospital conducted a six-sigma study to assess the level of patient satisfaction and identify other operational issues. It identified quite a few areas to improve the efficiency from the operational aspect. It included more counters/reception for the patients, efficient scheduling of clinic timings, developing a proportionate load from appointment and non-appointment patients for a clinic and outsourcing outpatient services. "Over time, it has improved our sigma value significantly," Chakraborty believes.

Informed Technology

Incorporating the latest IT processes forms an essential part of streamlining the services of a hospital. The Hospital Management System (HMS) helps in storing patient data efficiently and improves the sensitivity of surveillance information. A computerised appointment system to minimise the waiting time for patients is very useful for increasing customer satisfaction levels as well. Token/ticketing of patient turn to avoid frequent enquiry, Electronic Display System (EDS) to display turn, smart cards for quick patient records retrieval, ‘Express registration’ interactive kiosks for patients to feed in their personal details, are the other hot new technology trends which have captured the industry's imagination. "Interactive kiosks are actually great because the hospital will save on the reception or inquiry counter staff as many frequently asked questions will be answered by the machine. In Global Hospital, we have put up kiosks in some of the specialities," says Curian.

Dr Balabhai Nanavati Hospital, Mumbai recently inaugurated a new state-of-the-art outpatient department (OPD) centre—The Durgadevi Saraf Outpatient Department. Spread over 7,500 square feet, the new OPD has 27 dedicated departments for consultation, diagnosis and treatment of all specialities. “The management is planning to implement a token system in this OPD centre. With this system in place, patients number will be flashed on a TV screen which will automate and simplify the process further,”said Micah Joseph, Director-Administration, Nanavati Hospital. The Hospital is also contemplating on making the OPD centre paperless Departments likes blood test rooms are a part of the OPD area in the Hospital. "By having the bloom test on the groud floor OPD, even the lab technician can take the tests for the patients and patients won’t have to visit the lab especially for that," says Joseph.

Dr LH Hiranandani has utilised electronic display plasma screens to dynamically update patient information like availability of doctors, hospital services and other useful information. This has resulted in fewer enquiries from patients and less overcrowding of help desks. Experts, however, warn against being over zealous on having a "fully enabled" IT HMS system. "Consider the core functions of the software, and focus on the speed of completing a transaction. Every second of wait counts as it will have a multiplying effect on the delay which may be eventually caused. Try and mix and match a software HMS and a manual system to optimise the OPD services if IT systems fail you. It's absolutely 'ok' to have a fully manual non-HMS system if the patients' waiting time is reduced considerably," Dr Rajpal assures.

Make it an Experience

Patient friendly environment and other tangible facilities also play a major role in improvement of OPD services. Providing magazines, newspapers and installing a television in the waiting room and supplying coffee, tea or water would delight the patients. These may not cost much, but the patients will put up with the waiting time. "Keep the patient occupied i.e., make the wait a part of the customer experience. The patient should be engaged in something constructive like an interesting health talk or Audio Visual Aids," opines Dr Sanjiv Malik, Regional Director, Max Healthcare.

The Cheaper Route

Hospitals today are applying various cost-effective routes to make the OPD services more profitable. Hiranandani Hospital has applied different charging based on time—lower charges during off peak hours and higher during peak hours. This has resulted in optimised use of human resources and OPD rooms. Earlier where the patient flow was less in off peak hours (8-10 am and late afternoons), it has now improved. The OPDs are also now planned as per the convenience of patients, like early morning OPDs are kept for busy executives whereas afternoon OPDs are scheduled for housewives to get the optimum results.

Fortis Healthcare has applied a call monitoring system to take care of the call drop rate whereby if a person is not available to attend the call, it is taken on voice mail and the patient is contacted subsequently. "Earlier almost 40 per cent of calls coming to OPD were dropped. Now all calls are tracked diligently," Singh asserts.

In Woodland Hospital, getting feedback from patients is a crucial element to address the loopholes in the process. "We are taking feedback from our OPD patients through a questionnaire and modify our services accordingly. We have set fees to be paid by OPD patients such that first visit and follow up visits are charged at different rates," says Dr Banerjee. Also important are the other stakeholders involved in the process. Doctors and concerned staff must be well informed of the upcoming change. Taking their feedback may change the thought process completely.

Optimal segregation of OPDs to reduce movement of equipment and staff, and use of elevators, conserve energy and make good use of daylight, focused meetings with all stakeholders on fixing the concept plan, and including architects from Day One are some other crucial aspects, which if taken seriously can reap rich dividends for the hospital. In addition, visiting outside facilities can provide inspiration. "You do not need to be original if it someone else's strategy works for you. But you may always strive to create something workable for others to follow," believes Dr Rajpal.

sonal.shukla@expressindia.com