Academic Dental Hospital: Patient Flow Improvement

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Table of Contents

Elements of Search Strategy
Waiting Times in Dental Clinics
Improving Patient Flow
Digital Devices to Reduce Waiting Times
Implications for the Project
References

Nowadays, medical organizations aim at improving their services and thinking about the best methods of cooperating with patients. It is not enough for the medical staff to be confident in the quality of their work and the experience they get. It is necessary to succeed in management and improve patient flow in all hospital departments. In this paper, certain attention will be paid to the promotion of a Queue management system with the help of which it is expected to improve patient flow in the urgent care clinic at the academic dental hospital. The elements of a search strategy will be properly described to prove the correctness of the chosen approach. In the end, the main implications for the project will be identified to share the general attitude about the work done.

Elements of Search Strategy

Search Terms

It is necessary to clarify the main search terms and details of a searching process. “Google Scholar” is used. In addition, with the help of a Google search engine, several databases and research criteria should be identified.

Keywords

The main keywords include “patient flow”, “dental hospital”, and “queue management”. Several additional keywords should be given. They are “urgent care”, “lean management”, and “waiting time”.

Databases

Researchers can use online databases and choose the material for their studies. In this project, several powerful databases can be used to meet the initial goals. These databases are Cochrane, PubMed, and Medscape. Multiple articles with original research can be easily found.

Data Parameters

The main parameters are the publication date and contextual relevance. It is necessary to use only English articles so that no translation is required. Finally, all full-text articles have to be available online or downloaded from the databases. Abstracts of articles are not enough for this research.

Types of Literature Reviewed

All articles are taken from journals. These journals may be about medicine, healthcare, and management. All sources have to be peer-reviewed with a reference list being properly given at the end of the study.

Inclusion and Exclusion Criteria

Inclusion criteria of this project are publication date 2013 – present, studies may be from any geographical location, English language, and correspondence with the keywords identified above (patient flow in hospitals as the main topic).

Exclusion criteria: non-English language, published before 2013, not peer-reviewed article, published abstracts.

Review of Themes

The goal of this project is to evaluate the work of the medical staff in an urgent care unit at an academic dental hospital and clarify if it is possible to reduce waiting times and improve patient flow using the latest queue management systems. The review of literature will be divided into three logical parts. First, the analysis of waiting times in dental clinics and their urgent care units will be introduced. Then, the ideas of how to improve patient flow relying on the lean and other management systems will be developed. Finally, the evaluation of digital devices that can be applied to reduce waiting times in dental hospitals will be given.

Waiting Times in Dental Clinics

Dental services for the population

Nowadays, dental problems turn out to be a serious burden for millions of people worldwide. Dental infections vary and contribute to the development of various emergency departments where patients may ask for urgent services and receive primary care (Verma & Chambers, 2014). McCornick, Abubaker, Laskin, Gonzales, and Garland (2013) admit that many patients find it normal to seek care in hospital emergency departments, which can lead to overburdened and overcrowded situations. Dental clinics should have qualified employees in order to provide patients with high-quality and appropriate care in a short period of time. In addition to solid knowledge and experience, doctors and nurses have to promote patient safety. Safety is one of the main fundamental aspects of any healthcare setting (Bailey, Tickle, & Campbell, 2014). The promotion of safe services and primary dental help is the task that has to be performed by all hospital workers. A successful tandem of individuals, environments, and systems has to be developed for hospitals to strive for in a competitive world and patients to be confident in the services offered and use the same clinics again.

Dental care differs from other health care services due to fewer cases of hospitalization and the necessity to offer urgent care for many patients in a short period of time. Proper training of medical staff is an important aspect of hospital work that may contribute to effective management and improvements in clinics (Lee et al., 2013). Only when medical workers understand how crucial their work for every patient is in terms of management, they can be ready to make improvements and consider waiting times as an integral aspect.

Waiting times in dental clinics

In dental clinics, much attention is paid to the analysis of waiting time and the evaluation of patient turnaround. Turnaround is defined as a period of time from when a patient enters a clinic to the time when a patient leaves the department (Khatoon, Reddy, & Guvva, 2016). Waiting time is currently defined as one of the main challenges, frustrating parts in the healthcare system, or barriers for patients to obtain services (Khatoon et al., 2016). It is a tangible aspect of dental practice. Therefore, it is possible to analyze all factors that may influence waiting time and develop some initiatives in order to achieve positive changes.

Waiting time is usually evaluated by patients to make their final decisions and evaluate the work of health personnel. Sometimes, patients are not interested in skills or knowledge of nurses and doctors. What they want to know is how long they should wait for their services being offered and how soon they can leave a hospital. In teaching hospitals, the level of patient satisfaction may be considerably decreased. Patients want to observe convenience and accessibility when they come to dental clinics and choose a dentist. According to the investigations of Lee et al. (2013), the reputation of clinics and the length of waiting time bother many patients in almost the same way as dentists’ competence and attitudes to their patients. Patients ask for guarantees, and hospitals are not ready to give any because of the inability to understand what factors can actually influence waiting time.

At this moment, Mardiah and Basri (2013) admit that many public hospitals work according to the system in which average length of waiting time is about 0,3 hour, meaning 18 minutes. In their intentions to evaluate the possibility of waiting time reduction, Mohebbifar et al. (2014) come to the conclusion that per admission waiting time may take about 10 minutes. In teaching hospitals, it is hard to predict the length of waiting time because some interns are ready to work fast and hard in order to achieve positive results, and some interns need more time to understand what kind of work is expected. Due to the latest budget improvements and policies, hospital waiting time may be increased because people are not ready for numerous tasks or try to focus on other work in order not to be confused or distracted (Schut & Varkecisser, 2013). In other words, because of low salaries and high expectations, not many doctors and nurses want to work as hard as it is expected. As a result, waiting time becomes a problem that has to be solved. Still, its solution is hard to achieve without the solution of other managerial problems and concerns. Therefore, the only rational decision that can be offered at the moment is the evaluation of the steps that can be taken to improve patient flow and reduce waiting times without serious loading of the personnel of an urgent care clinic at any academic dental hospital.

Improving Patient Flow

Modern hospitals introduce complex systems with a number of benefits and costs. The presence of these healthcare systems promotes a high quality of life that many people are eager to reach. Patient flow is one of the main characteristics of hospital work that influences patient satisfaction, hospital reputation, practice efficiency, and clinical safety. Many researchers agree that improving patient flow has a considerable impact on care quality that cannot be neglected in all hospitals, including dental clinics and emergency departments (Armony et al., 2015; Peck, Benneyan, Nightingale, & Gaehde, 2014). The reasons, methods, and outcomes of flow improvement may vary, and this project aims at discussing some of them in a brief but informative way.

Reasons for patient flow improvements

Medical workers have to be ready to introduce high-quality services in emergency departments of hospitals and dental clinics due to the expectations patients have. Effective leadership may not be enough to understand how to reduce costs and what tools are appropriate (Chiarini, 2013). Patient flow is a chance to help patients and demonstrate medical care and support. Improvement of patient flow promotes a possibility to clarify patient destinations fast and not to waste the time of doctors and families. In addition, patient flow is the reason for overcrowding. In hospitals, such condition is not acceptable because some information can be lost, and important facts may be neglected (Kriegel, Jehle, Dieck, & Tuttle-Weidinger, 2015). Finally, flow improvements may show potential steps and plans that can support effective traffic of patients with fewer complaints about management and overall organization of the work in hospitals. Dental services are usually required by people who experience severe pain that causes irritation, panic, and other emotional challenges people are not ready for, and in-time patient flow is an opportunity to avoid behavioral complications in clinics. Management of fear and anxiety is the task for dental care providers (Armfield & Heaton, 2013). Training and practice of the medical staff is a crucial aspect of the work of urgent care units.

Lean management

Many hospitals prefer to work according to one particular system that has to be chosen and approved by a leader. Systems are usually developed in regards to the needs of employees and patients. In emergency departments and urgent care units, overcrowding, cost containment, and increasing patients’ demands are the main problems that have to be resolved in a short period of time to raise patient satisfaction (Chan et al., 2014). Lean healthcare is a successful management system that many hospitals and emergency departments want to follow since it was introduced in the early 2000s and led to a 44% gain of productivity in two years (McIntosh, Sheppy, & Cohen, 2014). Lean management helps to maximize value and eliminate waste (D’Andrematteo, Ianni, Lega, & Sargiacomo, 2015). The term “lean” process came from Toyota Motor Company whose main goal was the promotion of continuous improvement and small changes in a working process (Robinson et al., 2016). It means that perfection can hardly be measured or limited to something, and organizations always have a goal to develop and grow. Within a short period, that technique was recognized by different organizations, and healthcare facilities were not the exception. The necessity to improve safety and quality of health care cannot be neglected. Many hospital leaders try to postpone the interruption of outside sources in the work of their organizations. Lean management helps to involve local workers in different activities and choose a solution that creates less harm to the company.

Triage management

Some hospitals continue using a triage management system when the priority of patient treatment is established regarding the severity of conditions. Triage is the first step a registered nurse has to take when a patient enters the emergency department, performing the assessment and defining the priorities (Hitchcock, Gillespie, Crilly, & Chaboyer, 2013). Each country has its own system and scale of a triage process. However, the majority of them include the classification with 10-30-60 minutes as recommended treatment time.

Taking into consideration all discussion and peculiar features of patient flow and the aspects of its improvement, it is possible to say that patient flow remains to be a general topic. To achieve positive results and identify the scope of future interventions, it is expected to focus on one particular issue and develop it (Armony et al., 2015). In this paper, certain attention will be paid to the promotion of digital devices, such as queue-management system.

Digital Devices to Reduce Waiting Times

Healthcare improvements may have different forms. Still, the only two goals that matter are to provide high-quality care and support and not to lose patients (Rich & Piercy, 2013). With time, people set high expectations, and it is not an easy task to meet all of them. However, numerous attempts are taken, and new approaches are offered. For example, planning digital hospitals is the solution that has been already made in several countries. Clinics and hospitals where digital information is used promise high efficiency and quality of services that can be offered to patients (Lacanna, 2013). Some hospitals are ready for digital innovations, and some organizations just need more time to understand what they can actually do with such opportunities.

Despite various attitudes to digital progress in health care, queue culture has been already adopted, and it has to be properly managed to avoid complications and negative experiences in dental hospitals. Waiting lines and patients flow introduce a unique queue culture where multiple occasions for conversations, re-thinking of personal opportunities, and generation of the already achieved results can be developed (Wexler, 2015). If some people are ready to cope with that flows and diversity, some people want to learn more about queue management and digital systems that can be offered to reduce waiting times.

Another important aspect of queue management is the necessity to deal with big amounts of information and structure the data in a proper way. Hospitals’ data continues increasing making the staff think about new approaches and improvements in terms of which waiting time can be reduced. For example, Chen, Li, Tang, Bilal, and Li (2016) introduce a Patient Treatment Time Prediction (PTTP) algorithm with the help of which it is possible to predict the waiting time for each patient and choose an appropriate treatment model for each task. Automatic search and the identification of the main symptoms with the options for treatment can help hospitals and promote effective care for all patients despite their status, current condition, and other factors that may influence the decision of the personnel to start an assessment (Youseef & Liu, 2013). Technologies do not divide people according to their social factors or past medical histories. A queue management system is focused on needs and chief complaints at the moment.

Queue management included a successful combination of physical, psychological, and emotional factors that may influence patients’ perceptions of their waiting experiences in hospitals (Brahma, 2013). Current technological progress and the needs of patients create certain obligations for patients, especially when they are put in a certain microcosm, known as a waiting line, and have to spend some time there thinking about different things and choosing various behavioral models. Queue management that is based on digital technologies that are offered to patients in urgent care units may include cell phones to promote communication, free Wi-Fi to entertain and support patients, and tablets to keep patients informed about the latest changes in queues and their treatment options (“Time as a commodity waits for no-one”, 2015). Patients may sign-in to the chosen health care system and clarify the details of their arrivals online. Patients should be ready to tell about their needs and concerns. Though it is hard for the personnel to pay attention to every patient in the urgent care unit, it is possible to gather enough information via technologies offered as a part of a queue management system.

Implications for the Project

The information gathered from different databases and the studies developed in the chosen articles help to develop this project in several ways. The sources can be used as effective guidelines and outlines for any future independent project. The authors structure their works in a proper way, improve their thoughts by illustrative examples and pictures, and combine their personal opinions and suggestions with the thoughts taken from past studies. After reading the articles, it is possible to create one definite opinion about patient flow and waiting time and the necessity to think about the improvements for dental clinics. Today, academic dental hospitals hire people to investigate the organizational culture, missions, and values to understand how to increase patient satisfaction not at the expense of care quality. Lean and triage management are effective steps for consideration. Still, this research helps to clarify the benefits of digital devices and possible pros and cons of a queue management system in particular. Finally, the authors use different research methods to support their hypotheses and answer research questions. Their examples introduce a solid background.

In general, this project is a serious step in the researcher’s attempts to promote the use of a queue management system in dental clinics and emergency departments. Selected readings help to understand that the reduction of waiting time in urgent care unit is a step that has to be taken. More knowledge is gathered on this topic, more effective solutions can be offered to hospital workers with time.

References

Armfield, J.M., & Heaton, L.J. (2013). Management of fear and anxiety in the dental clinic: A review. Australian Dental Journal, 58(4), 390-407.

Armony, M., Israelit, S., Mandelbaum, A., Marmor, Y.N., Tseytlin, Y., & Yom-Tov, G.B. (2015). On patient flow in hospitals: A data-based queueing-science perspective. Stochastic Systems, 5(1), 146-194. Web.

Bailey, E., Tickle, M., & Campbell, S. (2014). Patient safety in primary care dentistry: Where are we now? British Dental Journal, 217(7), 339-344. Web.

Brahma, P.K. (2013). Queuing theory and customer satisfaction: A review of terminology, trends, and applications to hospital practice.Asia Pacific Journal of Marketing & Management Review, 2(6), 83-89. Web.

Chan, H.Y., Lo, S.M., Lee, L.L.Y., Lo, W.Y.L., Yu, W.C., Wu, Y.F., … Chan, J.T.S. (2014). Lean techniques for the improvement of patients’ flow in emergency department. World Journal of Emergency Medicine, 5(1), 24-28. Web.

Chen, J., Li, K., Tang, Z., Bilal, K., & Li, K. (2016). A parallel patient treatment time prediction algorithm and its applications in hospital queuing – Recommendation in a big data environment. IEEE Access, 4, 1767-1783. Web.

Chiarini, A. (2013). Waste savings in patient transportation inside large hospitals using lean thinking tools and logistic solutions. Leadership in Health Services, 26(4), 356-367. Web.

D’Andrematteo, A., Ianni, L., Lega, F., & Sargiacomo, M. (2015). Lean in healthcare: A comprehensive review. Health Policy, 119(2015), 1197-1209. Web.

Hitchcock, M., Gillespie, B., Crilly, J., & Chaboyer, W. (2013). Triage: An investigation of the process and potential vulnerabilities. Journal of Advanced Nursing, 70(7), 1532-1541. Web.

Khatoon, K.F., Reddy, B.K., & Guvva, S. (2016). Reducing patient waiting time in dental clinic according to treatment type. International Journal of Community Health and Medical Research, 2(4), 3-8. Web.

Kriegel, J., Jehle, F., Dieck, M., Tuttle-Weidinger, L. (2015). Optimizing patient flow in Australian hospitals – Improvement of patient-centered care by coordinating hospital-wide patient trails. International Journal of Healthcare Management, 8(2), 89-99. Web.

Lacanna, G. (2013). The role of information and communication technology in planning the digital hospital. World Hospitals and Health Services, 49(3), 4-6. Web.

Lee, K.T., Chen, C.M., Huang, S.T., Wu, Y.M., Lee, H.E., Hsu, K.J., … Wu, J.H. (2013). Patient satisfaction with the quality of dental treatment provided by interns. Journal of Dental Services, 8(2), 177-183. Web.

Mardiah, F.P., & Basri, M.H. (2013). The analysis of appointment system to reduce outpatient waiting time at Indonesia’s public hospital. Human Resource Management Research, 3(1), 27-33. Web.

McCornick, A.P., Abubaker, A.O., Laskin, D.M., Gonzales, M.S., & Garland, S. (2013). Reducing the burden of dental patients on the busy hospital emergency department. Journal of Oral and Maxillofacial Surgery, 71(3), 475-478. Web.

McIntosh, B., Sheppy, B., & Cohen, I. (2014). Illusion or delusion – Lean management in the health care sector. International Journal of Health Care Quality Assurance, 27(6), 482-492. Web.

Mohebbifar, R., Hasanpoor, E., Mohseni, M., Sokhanvar, M., Khosravizadeh, O., & Isfahani, H.M. (2014). Outpatient waiting time in health services and teaching hospitals: A case study in Iran. Global Journal of Health Science, 6(1), 172-180.

Peck, J.S., Benneyan, J.C., Nightingale, D.J., & Gaehde, S.A. (2014). Characterizing the value of predictive analytics in facilitating hospital patient flow. IIE Transactions on Healthcare Systems Engineering, 4(3), 135-143. Web.

Rich, N., & Piercy, N. (2013). Losing patients: A systems view on healthcare improvement. Production Planning and Control, 24(10-11), 962-975. Web.

Robinson, F.G., Cunningham, L.L., Turner, S.P., Lindroth, J., Ray, D., Khan, T., & Yates, A. (2016). Improving a dental school’s clinic operations using lean process improvement. Journal of Dental Education, 80(10), 1170-1179.

Schut, F.T., & Varkecisser, M. (2013). Tackling hospital waiting times: The impact of past and current policies in the Netherlands. Health Policy, 113(2013), 127-133. Web.

Time as a commodity waits for no-one: Queue culture slows time, technology speeds things up. (2015). Strategic Direction, 31(9), 15-17. Web.

Verma, S., & Chambers, I. (2014). Dental emergencies presenting to a general hospital emergency department in Hobart, Australia. Australia Dental Journal, 59(3), 329-333. Web.

Wexler, M.N. (2015). Re-thinking queue culture: The commodification of thick time. International Journal of Sociology and Social Policy, 35(3-4), 165-181. Web.

Youseef, A., & Liu, F. (2013). Average waiting time of customers in a new queue system with different classes. Business Process Management Journal, 19(1), 146-168. Web.

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