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
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
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.
- At the entrance
of the OPD displaying the map of hospital is essential, with the proper
marking of departments.
- The details of doctors
with their consultation timings should be properly displayed in OPD.
- Each site should be clearly signposted
from the main entrance and on all relevant corridors and parts of the
- Signages should be in English and in the
- Related diagnostic departments must be
closely located to OPD, preferably on the same floor.
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
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.
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,
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
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,
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.
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) centreThe 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 wont 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
timelower 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,"
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.