Longer waiting time for patients and delay in delivery of consultation services at the JDWNRH, are the main issues pointed out by a performance audit report on delivery of OPD services.
The average waiting time for patients in medical OPD is observed at one hour 38 minutes and general OPD at 45 minutes as against the target of 30 minutes. Some patients had to wait for more than two hours.
Further, RAA observed that majority of the patients visit hospital before 10:30 AM resulting in longer waiting time. For instance, in the General OPD, of the 1,649 patients, 996 of them representing 60 percent of the total, arrived in the Hospital before 10:30AM. Similarly, in the Medical OPD of the 686 patients, 552 patients representing 80 percent of the total arrived before 10:30 AM.
Likewise, Lack of appropriate sequencing and staggered appointment system in the JDWNRH had led to overcrowding in early hours, RAA finds. In absence of proper sequencing system and adequate awareness, patients visit hospital as early as 7.00 am in the morning.
RAA recommended that JDWNRH should develop strategies to reduce waiting time in the OPD and Diagnosis services. Despite having clear targets to reduce waiting time to 30 minutes for the patients availing OPD and 2 weeks in diagnosis services in the 11th FYP, the targets were either not achieved or not evaluated properly.
There were no clear strategies developed against each target. In addition, during the survey carried out by the RAA, majority of the respondents were in favour of having appointment system through Mobile Apps, display of information on doctors availability though TV monitors placed in the OPD Chambers and awareness on the OPD timing, customer care and many more.
RAA recommended that the strategies to reduce waiting time for each OPD service should be set clearly and the performance monitored timely. The turnaround time for each service should be evaluated and causes identified for those services performing poorly. On the basis of service evaluation, the new strategies should be proposed to enhance efficient delivery of OPD services.
The study revealed that people come early with expectations to avail faster services (55%) and due to limited tokens issued in the medical OPD (26%). It also revealed that the fear of not meeting doctors in the afternoon (14%) and lack of awareness on the OPD timing (5%) had led to patients arriving early before the Hospital opening hours, thus resulting in longer waiting time.
The RAA observed weak controls in the token and appointment system. There were cases in the General and Medical OPD that patients were provided consultation services without availing the token. The cases were also observed where diagnosis test were performed for some patients without seeking prior appointment.
Moreover, there is no special arrangements for patients referred from far flung places for health services particularly those involving very long waiting time which range from three days to as long as 46 days. The patients were found visiting the doctors for consultation at the in-patient ward, diagnosis services centers and other medical facilities.
Despite instituting the token and appointment system, proper and systematic procedures were not followed and proper controls not instituted resulting in unsystematic practices in the patient consultation process. Therefore, RAA recommended that the JDWNRH should institute proper control system to provide transparent, effective and faster delivery of health services. For patients referred from other Dzongkhags and far flung places, the possibility of making special arrangements may be considered.
The RAA reviewed the service delivery system at the JDWNRH by ascertaining the patients’ waiting time. The waiting time were ascertained by recording patients’ arrival time and the time recorded on entry in Doctor’s chambers for consultations using time sheet. The audit observed the actual waiting time for General OPD and Medical OPD in the month of March 2017 for six days each.
The patients’ arrival time is noted on each token at the reception and on the same token when patients enter the Doctor’s chamber. The RAA collected the data of 1,649 patients in General OPD and 686 patients in Medical OPD who availed health services during the period.
The RAA also found doctors coming late and leaving early as another reason for the longer waits.