united health services: walk-in clinic

operations strategy

Case Analysis Report

Submitted To

                                Prof. l.s. murthy

On

JUNE 29, 2007

                                                       By

                                        PGP, group - 01

                    aravind vasudevan               (0611011)

deepak raghu                             (0611081)

raman kartikeyan                  (0611111)

praveen krishnan                    (0611108)

seshadri r.                                    (0611120)

         

                  Indian institute of management, bangalore


INTRODUCTION

United Health Services is a comprehensive health care and medical services provider run by the Harvard University for its students, staff, faculty and other insurers. UHS is built on the philosophy of providing best care to all patients within the Harvard community through its facilities like Walk-in clinics, inpatient infirmary, mental health services and other specialized services. Walk-in Clinics of UHS comprises four clinics located across the campus providing ambulatory health care. Out patients can walk in to any of these four clinics where they will be treated by either Nurse practitioners or general physicians. By virtue of its nature and the kind of service provided, the key success factors like service time, consistency and quality of service are extremely important for the continued success and sustainability of Walk-in clinics.

The administration of Walk-in clinics recently introduced a patient care system called Triage system, where incoming patients were classified into patients to be treated by Nurse practitioners and patients to be treated by Doctors. This classification is done by experienced registered nurses, who match the needs of the patient and the hospital’s health resource capabilities. The new system was implemented to improve the efficiency of service provided along with other objectives like bringing down waiting time and improving consistency of service.

ISSUES OF CONCERN

  • Long waiting time – The time spent by a patient in waiting for a doctor has shown a significant increase from 10 to 25.2 mins in the triage system (Exhibit 5 of the case). In the case of patients treated by nurse practitioners the total service time has also shown an increase from around 61 mins to approximately 63 mins. This situation continues to be a cause of customer dissatisfaction 
  • Scheduling of doctors and nurses – The scheduling of doctors and nurses is not optimal considering the hourly variations in patient arrivals (Exhibits 2 and 4 of the case).
  • Increased patient load on doctors - The patient load on doctors has increased from 60% to 72% after triaging (Exhibit 6). This has also contributed to the increased waiting time for seeing a doctor.
  • Specific provider requests – Such requests from patients disrupts the triaging process by loading specific doctors more than others and leading to increased waiting time. Some of the doctors also promote this behavior by asking their patients to visit them in the walk-in clinic. From exhibit 10, we observe that for almost one third of the physicians, more than 40% of the patients request them, skewing the scheduling and disrupting the system.
  • Nurse productivity – Patient handling rate of nurses is low (1.8 patients per hour) even though they deal with relatively common  cases as compared to doctors (3.1 patients per hour)
  • Under utilization of physician hours: Currently 22 physicians work in Walk-in clinics in a week working for a total of 150 physician hours.  This means a physician works for just 7 hours on average in a week. This is due to part timers and administrative work performed by these doctors.
  • Time spent on patient record retrieval and checking – The patient waits for 13.5 mins after signing the AVF form for the records before he/she is ready for triaging.
  • Patient awareness – There is low awareness among the students and other patients about the approach of ambulatory medical care. Lack of awareness about the triaging model has also led to a mismatch in patient expectations about the service quality in the clinic.

ANALYSIS:

The methodology used was to minimize the Mean Square Sum of the differences between the capacity and the demand for each hour. The sum of the squared differences for all the hours for all the days what the target to be minimized.

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        The arrivals per hour are assumed to be present at the beginning of the hour. The optimization was carried out using Excel Solver, to try and reduce the waiting time of those patients arriving in the first few hours, so that the waiting time of those arriving later would not be high.

        The optimized solution shows that higher number of doctors and NPs are needed in the morning hours when the number of patients are higher, to prevent the buildup of the queue. For example, for Monday morning 8am to 9am, the number of MDs currently assigned is 2, ...

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