Timesheets as a Measure of Efficiency

We all know the annoyance of having an appointment with a doctor at 10, getting to the office at 9:50, sitting in the waiting room till 10:15, sitting in the patient room till 10:45, meeting a nurse till 11, and then finally seeing a doctor at 11:15 and not being able to leave until 12. However, this minor annoyance is compounded when you don’t have a car, and have to walk 15 minutes to a bus stop and take a circular route to get to a clinic where you have to use your last few dollars to pay for treatment because you don’t have insurance and you may get fired from work because you have to keep missing half a day to see a doctor.

This scenario is what drew me to time sheets, which show what time a patient arrives, what time he checks in, how long he is in the waiting room, how long he is with the nurse, how long he is waiting in the patient room, how long he is with the doctor, and how long it takes him to check out. This data was meant to see how long the typical patient is in each stage of the visit and how Olde Towne can make this process more efficient.

I went on to follow patients as they went through the process. Patients who came when two receptionists were working rather than one were able to check in in a fraction of the time. Variability in type of patient visit was also a major factor. While patients are always scheduled 15 minutes apart, some minor problems can be handled with 5 minutes of the doctor’s time, while other complaints are complex and multifaceted and could take more than half an hour.

One of the things OTMDC patients are happy about is that the center is right on the bus line. Other clinics, such as the Lackey Clinic, are not on a bus line and can be difficult to get to for their target population: low income and disabled patients.

It was clear after finishing the timesheets that patients were spending sometimes more than 2 hours at the clinic and only seeing doctors for a fraction of that time. While I did not follow patients before they reached the clinic or after they left, the mass of patients always surrounding the bus stop in the parking lot shows that many had a long way to go before reaching work or home.

Solutions to this problem are clear but expensive. More receptionists, more nurses, more doctors. Money is something most clinics serving low income areas do not have an abundance of. However, having a bus stop nearby and trying to maintain two receptionists (training a volunteer receptionist could help) would speed the patient visit tremendously. Another solution is having a schedule that takes into account the reason for a patient visit. A patient in pain who has not been diagnosed could be budgeted for 30 minutes while the student who needs a sick note could get budgeted 5 minutes. This requires prior planning but could be helpful going forward.