Patient Waiting Time : Gaps And Determinants Of Patients Waiting Time In Hospitals In Our Communities To Receive Quality Services

DOI: http://dx.doi.org/10.24018/ejmed.2020.2.1.136 1 BACKGROUND: Patient waiting time has been recognized as an important indicator for determining the quality of healthcare services offered by health facilities. Waiting time is strongly related to patients’ satisfaction with the care received at the hospital in general. METHODS: This is a descriptive crosssectional study carried out in February 2018 among new patients attending general out-patient department (GOPD) of randomly selected hospitals in South-Western Nigeria. A structured pre-tested questionnaire was used to elicit information from 223 patients who were recruited into the study using a convenience sampling method. RESULTS: The average total clinic waiting time (TCWT) from entry to seeing a medical doctor was 137.02 ± 53.64 minutes. Only 6 (2.7%) met the Institute of Medicine (IOM) recommendation of having at least 90% of patients seen within 30 minutes of their scheduled appointment in contrast to 193 (86.5%) of respondents desiring to wait not more than 30 minutes for whatever reason before been attended to by the doctor. Although, the level of satisfaction was high (81.2%) in this study, patients who waited longer (>180 min) are more likely to be dissatisfied with services rendered in the OPDs (χ2 = 20.104, df = 1, P = 0.001). Factors such as few health personnel (81/120) and having an insurance cover contributed significantly to the waiting time (χ2 = 19.54, df = 1, P = 0.001). CONCLUSION: In a competitively managed health care environment, patient waiting time play an increasingly important role in a clinic’s ability to attract new business. Efforts therefore, should be made not only to reduce the patient waiting time, but health managers should invest in resources and activities that ensure a productive use of the time patients spend in the process of seeking healthcare services.


I. INTRODUCTION
Patient waiting time is defined as the length of time patients wait before being seen by a clinic medical staff [1]. It has been recognized as an important indicator for determining the quality of healthcare services offered by health facilities. Several studies have established a strong link between waiting time with patients' satisfaction [2, 3, 4 & 5]. Generally, the patient waiting time varies across settings. In a Nigerian study published in 2013, 61% of the respondents waited for 90 -180 minutes in the clinic, whereas 36.1% of the patients spent less than 5 minutes with the doctor in the consulting room. The commonest reason for the long waiting Published  time in the GOPD was the large number of patients with few healthcare workers [6]. Also, 31% of the patients waited for less than an hour in the waiting room in a 2011 research work, which revealed as well that 96.6% spent less than 30 minutes with the doctor while more than half (55%) were satisfied with the service delivery in the hospital and 16% of the respondents admitted to being given health talks while waiting to be seen by the doctor [7]. In Vietnam, the average waiting time from registration to preliminary diagnosis in 2014 was 50.41 minutes and in 2015 was 42.05 minutes. A longer waiting time was recorded in the morning and in those having health insurance. In Northern Ethiopia, the overall patient satisfaction in health care services rendered at Deherebirhan referral hospital was 57.7%. Majority of the patients were satisfied with the quality of medical instruments (88.9%). Older age, provision of prescribed drugs, higher educational status and those who were not charged for service, were significantly associated with patient satisfaction [3]. In North West Ethiopia, the mean waiting time was 149.2 minutes in a particular referral hospital while it was 94.2 minutes in another. The major causes of long patient waiting time was large numbers of patients with a few doctors (40.5% and 28.9% in both hospitals respectively) and long registration time (25.4% and 32.5% respectively) [2].This study aimed at assessing the patient waiting time and factors responsible for the waiting time at the general outpatient department (GOPD) of two high-volume patient hospitals in Southwestern Nigeria.

II. AIM & OBJECTIVES OF THE STUDY
The aim of the study is to determine the patient waiting time and its determinants in the General Based on the sampling interval, the systematic sampling technique was carried out as follows; 1. Simple random sampling was done for the first two patients to get the starting point. 2. Thereafter, every other new patient that came to the clinic was enrolled in the study over a two day period until the required sample size was obtained.

Sample Size Estimation
The minimum sample size determined using the formula for estimating required sample size in a population less than 10,000 [9]. Nf = n/1 + (n/N) n = Z2pq/d2 where n = sample size, Z = standard normal deviation at 95% CI = 1.96 p = prevalence of the factor under consideration; 84% (0.84) from a previous study [10]. q = Complementary factor (1-p) = 0.16 N = Average number of targeted population (i.e. average number of patients attending GOPD daily) = 300 (50 for the private and 250 for the public hospital) Nf = Minimum required sample size for population less than 10,000. n = 1.962 x 0.84 x 0. 16 = 206.52 0.052 Nf = (206.52/1 + 206.52/300) ~ 210 Also, adding a 5% non-response rate, the minimum sample size (n) = 5/100 X 210 = 11 Thus, 11 + 210 = 221 = n The sample size was then distributed between the two hospitals in ratio 1:5 Private = 1/6*210 = 35 and public = 5/6 *210 = 175 STATISTICAL ANALYSIS Data was statistically analyzed using Statistical Package for the Social Sciences (SPSS) for windows version 23.0 software (SPSS Inc., Chicago, IL, USA). Data were expressed as Mean ± Standard Deviation (SD). Frequency counts were generated for all variables and statistical test of significance was performed with Chi-Square test. Significance was fixed P <0.05 and highly significance when P < 0.01.

V. DISCUSSION
In this study, the average total clinic waiting time (TCWT) from entry to seeing a medical doctor was 137.02 ± 53.64 minutes. Overall, 185 (83.0%) waited for less than 180 minutes while 38 (17.0%) waited for more than 180 minutes before seeing a medical doctor. Only 6 (2.7%) met the Institute of Medicine (IOM) recommendation of having at least 90% of patients seen within 30 minutes of their scheduled appointment [11]. 76 (34.1%) waited between 4 to 89 minutes before being registered while 147 (65.9%) waited for 90 minutes and above to be registered. Regarding consultation, 77 (34.5%) spent a maximum of 10 minutes in the consultation room with the doctor. In contrast, 193 (86.5%) of the respondents desire to wait not more than 30 minutes for whatever reason before been attended to by the doctor. This finding is slightly lower than that of some studies in the Northern Nigeria which reported a TCWT of 168 ± 35 minutes [6] and median patient clinic encounter time of 162 minutes [12]. It was also remarkably lower than the average 181 ± 34.8 minutes reported in Abeokuta South West Nigeria [5] whereas, it is almost similar to that reported in a referral hospital in North West Ethiopia [2]. This further speaks to the variability of TWCT in different settings. Similarly, majority (78%) of the subjects in a study were of the opinion that, the ideal waiting time should not be longer than 30 min from the time of arrival in the hospital to the time the patient is attended to by the doctor [7]. There were 2 record officers, 3 nurses, 3 Doctors, 3 Laboratory staff and 3 pharmacy staff respectively available in the hospital during this study period. 7 (3.1%) of the respondents felt that the time spent was short, 96 (43.1%) felt that it was just right while 120 (53.8%) opined that the waiting time was too long. Factors linked with long waiting time were few health personnel (81/120), staff taking too long with a patient (25/120), poor attitude of staff such as lateness (12/120) as well as staff member or patients jumping the queue (2/120). This is in line with those findings of Oche and Adamu where availability of few doctors in the clinic to attend the numerous patients, few fling and record clerks as well as jumping of queue by patients or staff members accounted for the reported long waiting time [6]. In this study, only 7 (3.1%) of the patients admitted to being given health education while 37.2% watched television and the majority 96 (43.0%) simply sat or watched happenings in the OPDs. Most of the respondents, 186 (83.4%) visited the clinic in the morning, followed by 34 (15.2%) in the afternoon and 3 (1.3%) in the evening. The attending boredom by simply sitting in the clinic especially in the morning which is assumed to be the most productive time of the day before seeing the clinical staff can always be minimized if patients are engaged in interesting activities. This finding is in consonance with that in Ibadan, where it was observed that, the three common activities patients engaged in during waiting time were watching happenings in the clinics, reading and chatting [13]. Some study participants however preferred health education specific health issues as a constructive way of utilizing their time while waiting in the OPDs as reported in Ibadan [13] and Saudi Arabia [14]. We also reported the time it took patient to be seen by the laboratory and pharmacy unit. In addition to the preconsultation and consultation time, the average TCWT increased to 176.81 ± 77.55 minutes. However, majority of the respondents, 181 (81.2%) were satisfied with the services provided while 42 (18.8%) were not. Also, 208 (93.3%) are willing to recommend the hospital to others. Recent studies also showed an increase in patient satisfaction with healthcare services [4,5]. This is not surprising because health managers are increasingly recognizing the patients as a major drive in shaping the competitions in the health sector. Another reason could be the preference of patients to utilize tertiary hospitals in this setting because they anticipate better services. Long waiting time was the most common reason (6/15) why patients were not willing to recommend healthcare services while poor staff attitude to work and few health personnel accounted for 5/15 and 4/15 respectively. Long waiting time before registration has been adjudged as a major contributory factor to the total waiting time in various setting as observed in this study [4, 6, 7 & 15]. This could be as a result of shortage of manpower evidenced by two record clerks attending to an average of 100 new patients daily in addition to a far greater number of follow up attendants.

VI. CONCLUSION
In a competitively managed health care environment, patient waiting time play an increasingly important role in a clinic's ability to attract new business. Efforts therefore, should be made not only to reduce the patient waiting time while seeking healthcare services.

VII. ACKNOWLEDGEMENTS
Our sincere appreciation goes to all participants that took part in this study.