The forgotten premise of healthcare delivery-waiting time

• ABSTRACT:• This is a national study to determine the

average waiting time in Malaysian public hospitals and to gauge the level of patient satisfaction with the waiting time.

• It also aims to identify the factors perceived by health care providers which contribute to the waiting time problem.

DESIGN AND METHODOLOGY

• Self administered questionairres which were administered in 21 public hospitals.A total of 13000responses were analysed for the patient survey and 3000 were analysed for employee survey.

PATIENT SURVEY ANALYSIS

• Average waiting time to get treatment from the appointment time for different type of clinics ranges from 18minutes(Emergency dep) to 85 minutes(medical department)

• When analysed hospital wise,the average waiting time was longest at kuala lumpur hospital(75min) and shortest at district hospital without specialists(30min).

• Of the respondents in the kualalumpur hospital,which had the longest waiting time,only 21% indicated that the waiting time experience was unreasonable.

• Possible causes:patients at public hospitals have low expectations as they are low income earners who are aware that they are paying nominal amounts for the serviceor not paying anything.

• Provision of reading material-90.8%• Provision of television-90.8%• Provision of newspapers-87.3%• Provision of appealing waiting environment-

80.5%

ANALYSIS ON EMPLOYEE SURVEY

• The findings indicate that the employees perceive inefficient work process (mean-3.89)followed by lack of cooperation among staff (mean -3.35) for long waiting times.

• Lack of commitment among employees was also perceived to be a contributing factor.

• Heavy workload:• Lack of staff contributes to lengthy waiting

followed by patients not adhering to appointment time.

• Supervision problem:• Doctors commencing the clinic late(mean

value-3.86)• Slow response from the management(3.47)

• Lack of supervision(mean-3.19)• However administration matters such as staff

having breaks at the same time were not seen as a major factor.

• Inadequate facilities:• Lack of consultation rooms was perceived to

contribute to waiting time problem(mean-3.81)

• SOCIAL IMPLICATIONS:• Public health care in malaysia is in a state of

excess demand,where demand outstrips supply,due to large fee differences between the public and the private sector.

• There is a need to reduce the boredom fa ced by patients while waiting and to address the problem in a scientific manner.

WAITING FOR SERVICES:THE EFFECTIVENESS OF RECOVERY

STRATEGIES• Preprocess waits can be classified into 3 types:• Preschedule(customer arrives early for the

appointment)• Post schedule(customer waits after the

appointment time to receive the service)• Queue waits(where service is on a first come

first serve basis)

• Hypothesis 1• When a preprocess post schedule wait

occurs ,offering an apology only is least effective recovery strategy with respect to improving customer intention towards the service provider

• Assistance is a more effective recovery strategy than compensation

• Hypothesis3:• Assistance and compensation is the most

effective recovery strategy.

• METHODOLOGY• Experimental design,interviews with the

service managers and questionaires were administered to the hotyel guests

• SERVICE EXPECTATION:• Internal standards against which the

customers judge the quality of services.• The two expectations for a hotel scenario

were operationalized as a destination hotel for a 4 day stay(high expectations) and a motel chain on the way to a vacation(low expectaion)

• For the restaurant scenario,the levels were operationalised as a family celebration at a restaurant known for excellent food(high expectation)

• Casual family meal in a restaurant known for good food in a relaxed setting(low)

• Intention is based on the likelihood of switching service provider ,complaint to the service provider,and negative word of mouth communication.

• Results:• The responses to the restaurant scenario with

regard to recovery strategies was more negative than that of the hotel scenario.

• The shorter wait scenarios led to more negative intentions which indicate that the wait time relative to the total time of customer service needs to be considered while evaluating the relationship between waiting and service evaluation

• The main effect of expectation was significant for the restaurant scenario but not for the hotel scenario

• The relative effectiveness of assistance versus compensation was equivalent

• Offering both assistance and compensation was most effective,but it still left respondents with negative intentions.