1. Title of the Change Project
Student ID.
MSc in Healthcare Management,
Institute of Leadership, Royal College of Surgeons in Ireland
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Make Patients Happy
Improving Waiting Time and Patients’ Experience in a Medical Retina Clinic
Raghda AlKhani
MSc Healthcare Management
Abstract
The aim of this project was to reduce patients’ waiting time and increase level of patients’ satisfaction by improving patient flow pathway and service capacity in the medical retina clinic. The change project was conducted due to the high demand on this clinic as there is expanding need for the intraocular injection across the United Kingdome, resulting in long waiting time affecting patients’ satisfaction.
Thus, a need had been raised to enhance the capacity and utilise the provided services by analysing the best ways to increase the number of patients receiving the intraocular injections per session and to reduce patients’ waiting time with improving their experience. Patient's pathway was redesigned in more efficient way where unnecessary steps and delays were removed. The Health Service Executive change model was selected to structure the project's steps as it is nonlinear model which allows flexible movement with adjustment of the change process at any time. Several evaluation methods were used in this project before and after the change. A total of 100 patients’ questionnaires which included information on waiting times and patient satisfaction were distributed during two times period in the retina clinic. Streamline patient's flow through process mapping along with time measuring and waiting time data were done after observing patient’s journey in addition to Kirkpatrick Evaluation Model for training and informational session. The main result of the implemented change was doubling number of patients receiving the injection at same time so the average waiting time was reduced from 120 minutes to 60 minutes (±10minutes) which led to raise patients’ satisfaction to 90% (n=45) where 50% (n=25) were not satisfied with long delays before the change. In conclusion, the change project was successfully implemented in the retina clinic due to the strong management support and the effective collaboration between the stakeholders.

2. Make Patients Happy Methodology Evaluation Aims & Objectives
Improving Waiting Time and Patients’ Experience in a Medical Retina Clinic
Raghda AlKhani
MSc Healthcare Management
Introduction & Background
Methodology
Evaluation
Treating patients with intraocular injections, which are administrated in the eye to cure certain retina conditions, falls under medical retina clinic responsibilities. Recently, there has been an increase in the demand on these injections nationwide with monthly monitoring for several years. The biggest challenge of medical retina services across the UK is to accommodate all patients and increase capacity1. Many patients were complaining of long waiting times. By mere observation, patients were spending hours each visit to get the usual consultation and treatment.
The project was guided by the “HSE Change Model” chosen for its flexibility and applicability.
Changing Process:
“Box” model for Process and Outcome evaluation before and after the change3.
Observing and process mapping of patients’ flow with measuring the overall average waiting time and time spent in each step.
The average waiting time reduced from120 to 60 minutes ±10minutes.
Patient Satisfaction Questionnaire:
Evaluating Informational Session by Kirkpatrick’s evaluation model4.
Figure 1: HSE Change Model 2
Figure 2: Average Waiting Time Improvement
Mainstreaming:
-Evaluating and maintaining the implemented change.
Implementation:
-Adding new chair for injection.
-Re-designing patient’s pathway.
-Informational session for staff involved.
Initiation:
-Rational for the change.
-Cultural analysis, SWOT and Force field analysis.
-Identifying key stakeholders.
Planning:
- Meeting stakeholders.
-Determining change details by observing and process mapping patient’s journey and measuring overall waiting.
Minutes
Aims & Objectives
Aim: To reduce patients’ waiting times and increase patients’ satisfaction by improving patient’s flow pathway and service capacity in the medical retina clinic.
Objectives:
The number of patients receiving the intraocular injection per session will increase from 1 patient to 2 patients.
The average waiting time in the medical retina clinic will reduce from 2 hours to 1 hour.
100% of patients attending the medical retina clinic will report being satisfied or very satisfied with the improved service.
All multidisciplinary team participating in patients’ flow pathway will have attended the informational session on the implemented change.
Figure 3: Patients’ Satisfaction with Overall Waiting Time (Before and After)
Before Change
After Change
Organisational Impact
1- Opened discussion to search for further improvement.
2- Facilitated the organisation to meet and promote its values.
3- Holding educational sessions for different departments' employees.
Conclusion
Number of patients receiving the injection per session was doubled, waiting time was reduced and patients’ satisfaction was enhanced.
Recommendation: To search for further modification to raise patients’ satisfaction to 100%.
References
1. The College of Optometrists & The Royal College of Ophthalmologists. Commissioning better eye care:
Age-related macular degeneration. London: RCOphth; 2013 Nov 25; Version: 1.
2. Health Service Executive. IMPROVING OUR SERVICES: A Users’ Guide to Managing Change in the
Health Service Executive. Dublin: Health Service Executive; 2008.
3. Øvretveit J. Evaluating Health Interventions. England: Maidenhead;1998.
4. Parry GJ, Carson-Stevens A, Luff DF, McPherson ME, Goldman DA. Recommendations for Evaluation of
Health Care Improvement Initiatives. Academic Paediatrics.2013;13(6S): S23-S30.