1. OUTPATIENT BLUES Antoine van Gelder Pretoria Academic Hospital TOC Upgrade Workshop August 1991

2. Undesired Effects Staff dissatisfaction: Nurses Doctors Long patient waiting time (12+ weeks) Patient dissatisfaction High level of “no shows” (up to 25%) Overcrowded waiting areas Records often unavailable

3. Undesired Effects Doctors’ complaints: Wasting time (no shows) Too many patients per session Records usually not available Nurse in charge “uncooperative” Nurses’ complaints: Doctors arrive late & leave early Many no shows Records slow in reaching clinic

4. Undesired Effects Patients’ complaints: Doctors often late Impatient doctors and nurses Short consultation time Long wait to see doctor Overcrowding in waiting area

5. Current Reality Tree (CRT)

6. CRT

9. Evaporating Cloud

10. Actions Institute appointments for clinic Inform staff of appointment system Obtain telephone numbers of patients Maintain a waiting list (Buffer) (nurse in charge) 1 week check by telephone fill vacancies by telephone

11. Results Average waiting time decreased from 12 weeks to 4 weeks Clinic time and space utilization increased from 60% to 90% Patient complaints changed to long waiting time for medicines

12. Results Doctors complaints about nurses stopped Nurses complaints about doctors stopped Records still not available in clinic