Assessment of patient flow, areas of inefficiency for improvement in Tikur Anbessa Specialized Hospital: A mixed explanatory study
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Date
2024-03
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Addis Ababa University
Abstract
Introduction: In Ethiopia, hospitals face many challenges like high waiting times, inefficiency,
and negative patient experiences. Tikur Anbessa Specialized Hospital (TASH) is a tertiary level
hospital located in Addis Ababa. There is little study done on patient flow, areas of inefficiency,
and patient experiences. Understanding these areas will help in making improvement in the
health service provision that are given in Tikur Anbessa Specialized Hospital in an efficient
manner.
Objective: This study aims to assess the patient flow and identify bottleneck areas of
inefficiency for improvement in Tikur Anbessa Specialized Hospital.
Methods: A facility based cross sectional design, employing time motion survey and Data
Envelopment Analysis (DEA) to assess the patient flow and measure technical efficiency
respectively. And a qualitative phenomenological design is used to explore the patient
experience identify the bottleneck area at TASH. For the time motion study, descriptive
analysis is performed using mean and standard deviation to characterize health worker contacts
time at services areas at the hospital by using STATA version 12. For the patient experience
interview, the transcript is read repeatedly to have an overview and coded. The codes with
similar meaning were categorized which were then further classified into themes that reflects
the central idea. The data are analyzed using Atlas.ti version 9 software. A DEA was used to
calculate the efficiency of each department taking them as decision making units (DMUs). As
an input, the number of health workers are taken; and as an output the number patients
treated/visited at that department were included. The data were analyzed using MaxDEA
software.
Result: The identified bottlenecks in operating the routine activities include communication
barrier between the health care providers themselves, and between the health care providers
and patients and caretakers. In addition to these issues, lack of fulltime doctors at outpatient
departments (OPDs) and poor appointment system were found to be challenges resulting in
long patient queues at different services areas. In addition, issues of inconsistent availability of
drugs and supplies, services like MRI and CT scan have resulted in the clogging the patient
flow in the routine operations of the Hospital. Out of the ten OPDs with the highest patient
visits, only two were technically efficient.
Conclusion: Therefore, these bottlenecks contributed for the OPDs not functioning efficiently.
Furthermore, the results from the DEA indicated that the technical efficiency of OPDs needs
better operational improvement.
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Keywords
Patient Flow, Bottleneck Areas