Waiting Time and Patient Satisfaction in a Subspecialty Eye Hospital in Cameroon Using a Mobile Data Collection Kit: Pre and Post Quality Improvement Intervention (Preprint)

BACKGROUND Waiting time could considerably increase the cost to both the clinic and the patient, as well as be a major predictor of the satisfaction of eye care users. Efficiently managing waiting time remains a challenge in hospitals. Waiting time management will become even more crucial in the post-pandemic era. A key consideration when improving waiting time is the involvement of eye care users. This study aimed at improving patient waiting time and satisfaction through the use of Plan-Do-Study-Act quality improvement cycles. OBJECTIVE The study’s objectives were to (1) determine the waiting time and patient satisfaction, (2) measure the association between waiting time and patient satisfaction, and (3) determine the effectiveness of the Plan-Do-Study-Act model in improving waiting time and satisfaction. METHODS This was a pre and post-quality improvement study among patients consulting with the Magrabi ICO Cameroon Eye Institute, aged 19-80 years. We made use of Plan-Do-Study-Act (PDSA) cycles to carry out improvement audits of waiting time and satisfaction over 6 weeks. A mobile data collection kit (ODK) was used for real-time tracking of waiting, service, and idling times at each service point. Subjects were also asked whether or not they were satisfied with waiting time at the point of exit. Data from 25 pre-intervention and 24 post-intervention subjects were analyzed in Stata14. An unpaired t-test was used to assess the statistical significance of observed differences in times pre and post-intervention. Logistic regression was used to examine the association between satisfaction and waiting time. RESULTS Forty-nine subjects were recruited with mean(SD) age 49(15.7) years. The pre-intervention mean(SD) waiting, service, and idling times were 449.6(96.6) minutes, 111.9(47.0) minutes, and 337.7(98.1) minutes respectively. There was no significant association between patient wait time and satisfaction (Odds Ratio=1.0; 95% CI: 0.99 to 1.0, P=.26; Chi2=.25). The use of Plan-Do-Study-Act led to a 14.5% (65.4/449.6) improvement in waiting time (t=2.0, df=47, P=.05) and a non-significant increase in patient satisfaction from 32% (8/25) to 33.3% (8/24) (z=0.1, P=.9). CONCLUSIONS The use of PDSA led to a borderline statistically significant reduction of 65.4 minutes in waiting time over 6 weeks and an insignificant improvement in satisfaction, suggesting that quality improvement efforts have to be done over a considerable period to be able to produce significant changes. The study provides a good basis for quality improvement in limited-resource settings making use of block appointment systems, with comprehensive subspecialty eye care services. We recommend shortening the patient pathway and other measures including a phasic appointment system, automated patient time monitor, robust ticketing, patient pathway supervision, standard triaging, task shifting, doctor consultation planning, patient education, and additional registration staff.