Introduction
Patient satisfaction is dependent on factors related to: 1) level of care acquired; 2) empathy; 3) reliability; and 4) responsiveness (Naidu, 2009). Other related factors that will affect feedback are: 1) physician conduct; 2) efficiency; and 3) service availability (Naidu, 2009). This particular study focuses on the importance of service availability. Therefore, it is important to highlight the fact that service availability is linked to waiting times, convenience, and availability associated with health care experiences (Naidu, 2009). Wait time is an important consideration not only in the health sector, but also in organisations that are labeled as service companies. It is widely accepted within the corporate world that organizations worry about the length of their queues because customer waiting time can negatively affect customer feedback regarding the performance of the company. Business leaders also fear the possibility of losing clients if waiting time is too long (Bielen & Demoulin, 2007).
Bottlenecks, long que lines and unnecessary waiting time are always associated with low productivity (Naidu, 2009). These issues are also associated with unnecessary expenses (Barrick, 2009). In the context of the health care industry, patients, and various stakeholders are sensitive to the impact of delays in the delivery of related services (Gijo, Scaria, & Antony, 2013). From the point of view of patients, the unnecessary delays negatively affects productivity (Taner, Sezen, & Atwat, 2012). For example, employees have very limited time when it comes to securing a doctor’s appointment (Keilar, El-Maraghi, & Schweitzer, 2010). Employees are compelled to file a request in advance (Kohn, 2011). In some cases, they need to request a leave of absence. Therefore, patients cannot afford delays in the delivery of health care services (Bielen & Demoulin, 2007).
In most cases, employees try to squeeze in the time to visit health clinics and hospitals during lunch breaks (Atinga, Abekah, & Domfeh, 2011). Prolonged stay in a primary health care facility requires more time, and in this case, patients may have to spend a whole day away from work (Atinga, Abekah, & Domfeh, 2011). In any case, the patient seeking to avail the services of the radiology department expects to receive quality service during a specific time period (Atinga et al., 2011). Patients in a primary health care facility expect a particular standard when it comes to treatments and diagnostics protocols (Willoughby, Chan, & Strenger, 2010). Without a doubt, it is disadvantageous to the patients if they are unable to avail of the services required during the time that they requested the same (Miller & Chalapati, 2015).
Inconvenienced clients are not going to be pleased with the delays (Gunderman & Sawlani, 2012). Nevertheless, this is the best case scenario in the aftermath of long que lines and unnecessary delays. In the worst case scenario, unnecessary delays lead to health risks and other vulnerabilities (Greaves, Gilmore, & Bernhardt, 2013). Managers of primary health care facilities that are not equipped with appropriate technologies to deal with delay problems are compelled to manage the backlogs through the use of a wait list (Cunningham, Reid, & MacSwain, 2013). However, in areas wherein the wait list is no longer a viable solution, a phenomenon called “que jumping” occurs (Cunningham et al., 2013). According to observations made regarding the ill-effects of que jumping, administrators lament the fact that in hospitals the scarcity of resources created severe consequences. As a result, people were compelled to save themselves, and those who are close to them (Cunningham et al., 2013). They were compelled to intervene in behalf of patients, friends, or family, and they ignore those who not known to them (Cunningham et al., 2013). This is not an unacceptable practice because it will lead to unnecessary conflicts that will further reduce the quality of health care services in the said hospital.
In order to solve management issues related to unnecessary “wait time” in a Dubai primary health care facility, the proponent of this study attempts to analyse related literature regarding the reduction of wait time through the use of Information Technology.
Search Strategy
The aforementioned objectives dictate the framework for the search strategy. The focus is on related literature that discussed the significance of wait time in the context of the health care industry. The search strategy narrows down the search for literature that discussed the impact of wait time in the radiology department and other related needs (Gunderman & Sawlani, 2012). However, the search for related literature expands to include the use of Information Technology in reducing wait time (Cunningham et al., 2013). Inclusion of research materials was based on how IT was utilised in a health care setting. It also includes the search for literature that illuminated recent inventions, and innovations linked to the improvement in the delivery of health care services, particularly in the context of reducing wait time (Westbrook, 2007).
Review of Themes
The search framework elucidated the thematic type of inquiry into literature that are relevant to the topic. These are listed as follows:
- The significance of wait time reduction;
- Innovations in the field of Information Technology with regards to improving health care delivery systems;
- The problems inherent to the application of Information Technology to reduce wait time in a health care facility setting.
The Significance of Wait Time Reduction
According to an educational perspective with regards to wait time in the radiology department, the patients that went through the scanning equipment spent considerable time in the waiting room. Yet this phenomenon and the waiting experience are matters that health experts did not give much thought, because these issues were not addressed in the curricula of most medical schools (Gunderman & Sawlani, 2012).
The end result of reducing wait time in terms of health care delivery systems is enhanced client satisfaction (Naidu, 2009). Enhanced satisfaction is a guaranteed byproduct from the point of view of patients and other stakeholders (Cunningham et al., 2013). Wait time reduction also eliminates or mitigates the impact of health risks in connection to the failure in the delivery of certain health care services (Willoughby et al., 2010). According to the study of early diagnosis, and early prevention strategies, there are certain steps in the health diagnostic protocol that are very critical to proper diagnosis and management of patients health care needs (Gijo et al., 2013).Therefore, it is very essential that pertinent data must be collected as fast as possible, thereby decreasing the report generation time, and improve the overall process (Gijo et al., 2013). Radiology departments under Dubai hospitals will experience tremendous improvement in client satisfaction if the managers of the said facilities are able to reduce wait time for patients requiring radiology procedures.
Innovations in the field of Information Technology in Health Care Delivery
Health care facility managers must consider the feedback from patients and other stakeholders (Blackley, Burley, & Duffy, 2012). Clients of the hospital directly affect the financial health of the said institution. It is for the best interest of hospital management to improve customer satisfaction, particularly in the area of health care delivery systems (Greaves et al., 2013). Succeeding revelations regarding the issue of wait time reduction will reveal the link between the financial capability of a specific health care facility and its capacity to invest in IT-related technologies (Miller & Chalapati, 2015). Therefore, there is a certain degree of symbiosis between improving health care services, and the ability to further improve the same (Lodge & Bamford, 2007).
Before going any further, it is important to point out that the need to reduce wait time using technology is not a novel contribution to the study of health care management (Zabada, Singh, & Munchus, 2001). As early as two decades earlier, health care facility administrators voiced out their concerns regarding delays in health care delivery (Hart, 1995). They also commented on the possible impact of using IT to address the problem of delays and long que lines (Kovner & Knickman, 2011). However, the application of technology was not made in such a way that an IT solution was created to directly solve the problem. The application of technology was not done in such a way to efficiently gather information regarding the said issue (Hart, 1995). The end goal was the integration of detailed statistical data create strategies for improved health care delivery (Hart, 1995). In the 21st century, the end goal must go beyond the analysis of data. It must end up in the creation of a viable IT solution based on the current population’s access to computers and their ability to use the same. As early as a decade ago, technology was used to address the problem of service availability. But nothing concrete was created to specifically design an IT-based solution that will speed up the process of registration and scheduling health care delivery.
More often than not, the staff who enter data that are used to determine wait times, the said data they create as they interact with triage, the patient registration process and medical record systems, the same trickle down into the federal and accountability domain, and the said information play a role in significant policy debates (Westbrook, 2007). The focus of conventional strategies to use IT-based solutions was to assist administrators manage data related to health care delivery, but these were not specifically designed to reduce wait time (Kohn, 2011). Hospital administrators in Dubai must move beyond the conventional use of Information Technology, and develop an online booking system to lower backlogs with regards to the number of patients requiring imaging services as a requirement for their respective medical diagnostic needs.
One of the primary issues related to long que lines is the inability of hospital administrators to anticipate the influx of patients demanding access for a specific type of health care service within a specific time period. The apparent solution is a two-fold process. First, hospital management must anticipate the number of patients coming in at a particular time of the day, and the specific needs that require a particular type of service. Second, hospital management must develop a system of scheduling to effectively manage the influx of patients on a given time schedule. According to one report that studied efficiency issues, as well as the link between human resource scarcity, the following observations were made: 1) The management of human resources was a critical waste in terms of resource management in the said health care facility; 2) However, it was a secondary issue with regards to the patient waiting time; 3) The main issue was the inability of the health care facility to control patient arrivals. With the existence of a mechanism to see patient appointments, the said facility was able to identify patients that required specific care and call the attention of junior doctors so that they could better manage the flow (Miller & Chalapati, 2015).
In a study that was designed to determine the impact of IT solutions to the radiology department of a primary health care facility, the researchers made the following conclusion, the Computerised Radiology Information System (“CRIS”) allowed health workers to use computers for encoding patient details and relevant information such as the request card (Greaves et al, 2013). This is visible to the staff at all sites, enabling health workers to track patients. Related procedures with regards to the need for review and authorisation can be finalised and recorded. As a result, printed information no longer need to move from one area to the next. There is no need to move hard copies of files from the reception desk to the radiologist’s tray. This reduces delays. In addition, the Picture Archiving and Communication System “(PACS”) allow scanned images to be accessed in different sites. This is a time saving mechanism (Greaves et al, 2013).
The innovative solution called CRIS is good news for Dubai hospital administrators interested in creating an online booking system to manage patient flow. This means that the hospital does not have to start from scratch. The IT-based solutions generated from studying the implementation of the CRIS system will provide a wealth of information that also serves as a template for developing systems specifically designed for Dubai hospitals.
Even the most sophisticated IT infrastructure and IT software cannot resolve the human resource aspect of the problem. It has to be made clear that the success of a particular management initiative is affected by several factors, such as, the numerous challenges in terms of resource management (Willoughby et al., 2010). In many hospitals, health care workers are very busy and operating at a relentless pace with not enough breaks (Willoughby et al., 2010). Thus, hospital administrators must realise the importance of commitment to the task at hand (Willoughby et al., 2010).
An online booking system is an example of an IT-based solution that reduces waiting time due to the efficiency of transmitting pertinent information regarding patient’s needs. Nevertheless, an IT-based solution must be complimented with other management strategies that effectively reduce wait time due to the removal of blockades to efficient patient flow. The following strategies were documented as effective improvements to a radiology department’s management program: 1) Improve the efficiency of the scanners, such as, the acquisition of scanners that utilises faster and less redundant sequences; 2) improve the efficiency and quality of machines so that old machines must be replaced with new ones; 3) improving patient flow and throughput, such as insertion of intravenous access sites in advance, and outpatients are made to change into gowns in a timely manner; 4) at the other end of the booking process are clerks responsible for informing patients regarding the specific time of scheduled scans, it is imperative to hire clerks working in night shifts to improve the communication process between the health care facility and its respective patients; and 5) the need for efficient signing off of final reports by radiologists (Keilar et al., 2010). In addition, hospital management must consider other components of the work flow process that significantly affects the length of time needed to complete a particular task. In a study that combined manufacturing management theories with health care management principles in the context of radiology examinations, the proponents of the said study remarked on the typical inefficiencies in a normal work flow process. More often than not, the radiology department suffers from examination repeats (Taner et al., 2012). These are byproducts of inefficiencies. Even after investing in the latest equipment, many radiology units are still struggling with the impact of human errors. Precious resources are wasted due to the misinterpretation of the images by radiologists. Hospital administrators must combine management techniques with information technology to optimize patient flow for greater efficiency and better clinical outcomes (Taner et al., 2012).
Effective management strategies coupled with practical steps to improve the health care delivery systems are needed to reduce wait time. Administrators of radiology departments in Dubai hospitals must go beyond the conventional use of technology for the sake of recording data. It is imperative to develop IT-based solutions like an online booking system for patients requiring the use of the facilities under the control of the radiology department.
Inherent Problems in the Application of IT in order to Reduce Wait Time
It is not enough to simply acquire new technology in order to solve a particular problem. According to a report of a study that examined the value of improving patient flow, the significant findings from the Flow Cost Quality Programme were the technical insights into service design alone (Blackley et al., 2012). These are not sufficient to achieve meaningful change. If hospital administrators aim to acquire more radical benefits by giving first priority to optimising flow, it is on how they approach change and the organisational context where they are assured of a satisfactory outcome (Blackley et al., 2012).
A project management team must be created to collect pertinent information regarding wait time in the context of the radiology department in a particular health care facility in Dubai. After collecting critical information needed to design an appropriate solution to the given problem, the project team manager must begin mapping out the implementation phase of the project.
An unexpected outcome of an IT solution is to create a dehumanising effect on health care delivery. According to the study on patients’ perspective regarding wait time, one must consider the size, complexity, and technological sophistication of health care facilities, because it has the power to dehumanise both patients and health workers (Gunderman & Sawlani, 2012). It must be made clear that every patient wants to be seen and treated as a human being, and not just a mere statistic (Gunderman & Sawlani, 2012). Thus, it is not enough to simply develop powerful IT-based solutions. Hospital administrators must enhance the delivery process taking into consideration the need for empathy and demonstration of genuine care for the patient’s quick recovery.
A major problem encountered by administrators during the implementation phase of a management initiative to establish IT-based solutions for a given problem is the lack of support from stakeholders or the flawed design of the system because of the failure to consult stakeholders. After the challenges confronting the patients were identified, the first stage of the implementation process was the identification of the primary stakeholders in the health care process. The first stage of the analysis revealed interrelated factors comprising a complex health care system. Researchers discovered the presence of internal stakeholders, such as, doctors, health care staff, and patients. They also discovered that the opinions of internal stakeholders were often times in conflict with external stakeholders, such as, regulators, politicians, and investors. In addition, the two groups of stakeholders had different perspectives when it comes to the definition of value and waste (Miller & Chalapati, 2015).
The failure to consult stakeholders leads to the unexpected creation of roadblocks. In a study made on the importance of collaboration in the implementation of organisational change, researchers discovered that in many cases, the need to change the system was perceived negatively (Lodge & Bamford, 2007). They also said that changes were only possible when the carefully developed change programmes has the approval of internal stakeholders (Lodge & Bamford, 2007). Administrators of health care facilities in Dubai must study the expected conflicts in the context of implementing change or changing the culture of a particular workplace.
Another unexpected consequence of developing IT-based solutions is the discovery that the use of cutting-edge technology is a costly endeavour that does not guarantee an acceptable return on investment. According to one report, there is proof that IT-based solutions do lower costs. However, those savings are not always delivered to the organisation that made the investment (Kovner & Knickman, 2011). This is a challenge for hospital administrators that are answerable to the hospital’s board of directors or the investors that established the said health care facility.
Implications for the Project
The review of literature revealed the significance of reducing wait time. It has been made clear that unnecessary delays and service unavailability is a cause for client dissatisfaction. If the health care facility in Dubai is viewed as a profit center, then, it is imperative to ensure cash flow. Profitability based on positive earnings is only possible if the administrators are able to sustain reliable and efficient health care delivery systems. One of the problematic areas is the utilisation of the equipment under the radiology department.
Aside from the prospect of a failed business operation, the incentive to solve long que lines, and unnecessary delays in service delivery is also rooted in the need to mitigate the impact of unethical behavior of health workers due to the pressure created by an unmanageable wait list system.
It is interesting to note that IT-based solutions in the past were geared towards the administrative functions of managers. In other words, computers and other computer-related paraphernalia were acquired and utilised to help managers control the recording and accessibility of data. The main purpose of the data collection was not to speed up the work flow process, but to use the information to develop hospital policies. The policies that were developed were not always related to the reduction of wait time. Most of the policies were created to help reduce expenses and increase profitability. It is important to point out the insight regarding the lack of information regarding the nature of wait time in the radiology department. It is interesting to highlight the fact that colleges and universities are focused on other aspects of the health care process. But the plight of the patients that were forced to endure unnecessary delays are not always in the forefront of discussions and management decisions.
It is also important to highlight the fact that the mere creation of an online booking system is not enough to solve the problem. One of the critical components of the project design and implementation is the need to consult stakeholders, and the need to secure the support of influential leaders within the workplace. If an influential leader was not persuaded to support the need to implement specific change, such as the use of a new management system, it would be difficult to encourage other health workers and key personnel to seriously consider learning the intricacies of the new system.
The failure of implementing change programmes is usually due to the failure in the design. It is imperative to consider the feedback of patients, physicians, and other stakeholders to develop an appropriate IT-based solution that is both practical and functional. It is impractical to spend resources in developing a solution that is difficult to implement and difficult to manage.
Another critical aspect in the creation of an online booking system is the inherent challenges when it comes to Information Technology. IT infrastructures are expensive to upgrade or overhaul. The most problematic aspect of the cost of establishing IT-based solutions to reduce wait time is the fact that IT-related software and tools are made obsolete in a matter of months or a few years. There is also the problem of spending additional resources for regular upgrades. The prohibitive costs pile up when administrators consider the need to train users regarding the intricacies of new technology
It is not enough to develop a system that is easy to use in a hospital setting. The online booking system must be accessible to outpatients. In addition, the designer must consider the need for creating a system that is accessible through mobile gadgets.
Finally, the hospital administrator in Dubai must consider the return on investment. It is prudent to develop a business model that will enable the hospital to enhance its revenue stream in order to sustain the new online booking scheme. Furthermore, the said hospital administrator must consider other aspects of the work flow process in order to reduce wait time. The patient’s ability to communicate their needs is just part of the solution. The other aspect to the solution strategy is the availability of resources. Therefore, it is also important to reduce the work load of health workers by eliminating unnecessary repeats.
Summary and Conclusions
It is not enough to simply develop a solution to reduce wait time. It is also important to consider the requirements and consequences of developing an online booking system to improve patient flow. A project manager must be empowered to gather the necessary information and develop an implementation strategy that considers all the different aspects needed to ensure success.
The critical aspect to the implementation strategy is not only the capability to develop practical and functional IT-based solution to reducing wait time. It must also consider the capability to pool resources in order to finance the implementation process. It is therefore prudent to use available information with regards to the successful use of similar technologies. Dubai’s hospital administrators are not required to build from scratch. The successful implementation of online booking systems in the Western world are useful in developing an IT-based solution that will solve the challenges of wait time reduction in the context of Dubai’s health care sector.
Aside from developing the online booking system, hospital administrators must look into the implementation of other strategies that will help reduce wait time. Thus, management strategies adopted from the manufacturing sector such lean management strategies and Six Sigma management strategies must be utilised to look into the inefficiencies within the patient flow process. Hospital administrators must examine the other aspects of the health care delivery system, specifically with regards to the needs of the radiology department. For example, an efficient inventory program must take control of some aspects of the management system of the radiology department in order to reduce breakdowns and unnecessary delays due to equipment failure. It is also important to reduce the need to repeat certain processes. Aside from changes applied to the technical aspect of the health care delivery system, the project manager must also look into the human resource aspect of the project as well. Cutting-edge technology is only as effective as the person tasked to use the said technology.
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