Paediatric Orthopaedic Clinic at the Children’s Hospital of Western ontario

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The radiologist department is open for the patients from 8.30-12.30 h and dedicated 2/3 of the time to the Paediatric Clinic, so the availability time is:

4 hours x 60 minutes/hour x 2/3 time = 160 minutes/day

And the workload for the staff is:

- Radiologists:

73 patients/day x 5 minutes/patient= 365 minutes/day

%Utilisation = 365 / (3 radiologist x 160 minutes/day)=76%

- X-Ray Technicians:

73 patients/day x 11 minutes/patient = 803 minutes

% Utilisation = 803 / (6 technicians x 160 minutes) = 84%

We see that the %utilisation is less than 100% and then reasonable, so when the six X-ray machines are dedicated to the Paediatric patients, waiting times should not be long. Let’s calculate again the rate of utilisation in the situations when the machines are shared with the ER department:

1 X-Ray dedicated to ER:

% Utilisation = 803 / (5 x160) = 100%

2 X-Ray dedicated to ER:

% Utilisation = 803 / (4x160) = 125%

Those results show us that with only 5 machines, the X-ray system reaches the maximum of its utilisation and with only 4 the system is overload with patients waiting for the X-ray analysis. Consequently, the sharing of the X-ray machines with the ER department leads to increase the waiting times. This is a potential bottleneck.

There is a proposal of improvement from the Radiology Department of purchasing a new X-Ray machine. The cost (investment + maintenance + labour cost) would be $110 000 and the expected waiting time reduction is 25%. We can make an approximate calculation to check if this option could be profitable:

Full-time workers in the region earn an average of 44 000 $/year. That is approximately 50 $/hour (44 000 / (8 hours/day x 20 days/month x 11 months/year). A reduction of 25% would be 12.5 $/h. If we consider that the clinic works 3 days per week and 54 weeks per year with an average of 80 patients per day, we have:

12.5 $/h patient x 80 patients/day x 3 days/week x 54 weeks/year = $ 162 000 /year.

So at first, it would make sense to go forward with this proposal.

Other recommendations are related to some processes that could be eliminated or reduced. In this way, the explanation of the x-Ray procedure and parents consent could be eliminated if we give this information when the patient get to the reception in the radiology area. They can read the explanation and sign the consent while they wait in the waiting area. That will reduce time in the X-Ray room.

Another improvement to consider would be to reduce the time necessary for the X-Ray machines adjustment. These ones depend on the body part that has to be x-rayed. There two option: superior or inferior. If we can segregate the patients and group them in function of the part of the body to be radiographed, we might be able to reduce a lot of time in adjusting the machines. That segregation could be made during the appointment phase.

Finally, if a patient information system would be implemented, it would not be necessary for the patients to wait again in the radiology waiting area to get the images and the radiologist comments. Those documents could be added to the patient file and they would be available to be review by the surgeon or the senior resident. All the ‘hand-off of X-ray” could be eliminated, saving the 2 minutes activity time for nurses in the Front Desk. In fact, we could reduce 1 of the nurses in the Front Desk because the workload would be reduced by 25%, to 480 minutes from 640 minutes, so:

% Utilisation with 2 nurses= 480 / (2 x 4.25 h x 60) = 94%

- Examination Room.

The process flow is as follows:

[pic 5]

The staff working in the patient’s examination room are:

1 surgeon

2 senior residents

1 cast technician

As we did for the rest of processes, we calculate the % of utilisation to see if they are constraints in the process flow:

Surgeon: He works from 8.45 to 13.00 h (4.25 h = 255 minutes) and treats all new patients (40% x 80 patients = 32 patients) and 30% of the follow-up ones (30% x 60% x 80 = 14,4 ). He spends in average 7 minutes with the new patients and 4 with the follow-up ones.

% Utilisation = (32 x 7 + 14,4 x 4) / 255 = 110%

We can see how the surgeon is overloaded and consequently it is a bottleneck in the process.

Senior Residents: Only 1 senior resident treats patients. He treats 70% of the follow-up patients.

% Utilisation = (70% x 60% x 80 x 7 minutes) / 255 = 92%

Cast Technician: He treats 25% of new and 15% of follow-up patients.

% Utilisation = (25% x 40% x 80 x 17 minutes + 15% x 60% x80 x13) / 255 = 90%

So both, senior resident and cast technician’s utilisation rates are under 100% and, therefore, we do not consider them constraints to the process.

As the results obtained, we recommended reducing the surgeon’s workload. Because the utilisation rate in case of the senior resident is close to 100%, we would study the possibility of assigning to the other senior resident, part of the surgeon’s follow-up patient, in order to speed up the process. If we consider a maximum of 95% utilisation rate for the surgeon, we obtain a maximum of 10% of follow-up patients that he could treat without being overloaded, leaving the other 20% to the second senior resident.

- Conclusions.

In other to reduce parents’ work time lost, the first recommendation that I would give to the clinic management would be to change the opening hours. One option would be to open the clinic in the evenings and increasing from three to four days a week. Then,

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