Problem
Case Study: The Carbondale Clinic
The Carbondale Clinic, located in Carbondale, Illinois, is a large group practice of about 30 physicians. The clinic employs about I00 people and serves a regional population of about 100,000. Specialties ranging from pediatrics to psychiatry are offered by the clinic, which also operates its own laboratory, basic imaging services, and outpatient surgical center.
For some years, the clinic has been receiving complaints from its patients that appointment times are not being met. For instance, a patient with an appointment for two o'clock might not get in to see the physician until four o'clock. However, the clinic has felt that such delays are unavoidable due to the uncertainty involved in the time it takes to adequately examine each patient and the possibility of emergency cases that must be inserted into the schedule.
Several criteria are used for scheduling. For instance, many patients are scheduled for annual physical exams. These are usually scheduled at least several weeks in advance because they require coordination of laboratory services and physicians' time. However, some physicians will begin examining a patient and decide that the patient needs a physical immediately. The physicians feel this does not really cause problems because they can send the patient down to the laboratory while they continue to see other patients.
Some patients also phone the clinic for an appointment when they have nonemergency, routine problems such as a mild fever or sore throat. Such patients are scheduled into available time slots as soon as possible-usually a day or two from the time they call. The objective here is to fit such patients in as quickly as possible without overloading the schedule with more patients than can reasonably be examined in a time period. Usually the plan is to schedule four patients per hour.
However, each day, various emergencies occur. These can range from a splinter in the eye to a heart attack, and these cases cannot wait. For an emergency that is not life threatening, the approach is to try to squeeze the person into a time slot that is not too heavily scheduled. However, a case of life or death-such as a heart attack-means that the schedule must be disrupted and the patient treated immediately.
Currently, all scheduling of appointments is done centrally. However, this frequently causes problems because the people making appointments often do not know how long it should take to examine a patient with a particular complaint. On the other hand, the nurses in each department are usually too busy to do the scheduling themselves. Generally, if there is a doubt about whether a patient can be fitted into a time slot, the preference is to go ahead and schedule the patient. This is because the physicians prefer not to have any empty times in their schedules. At times, if it looks as if there might be an available opening, the clinic even calls patients who were originally scheduled for a later time and asks them to come in early.
Task
1. "For some years, the clinic has received complaints from its patients that appointment times are not being met." 'Why has no action been taken to correct the situation?
2. You are a member of a QIT that was asked to evaluate the appointment/scheduling process. Are there some "assumptions" in the narrative that you question? If data were sufficient for a Pareto diagram of problems with the appointment/scheduling process, what do you think the items would be? List them.
3. Draw a cause-and-effect (Ishikawa) diagram of causes for patient complaints.
4. What recommendations would you make to decrease patient waiting time?