Metropolitan General Hospital (MGH), a 500-bed teaching hospital in downtown Chicago, had been grappling with significant patient wait times in their outpatient clinics. Patient satisfaction scores had dropped from 85% to 65% over the past year,

Case Study

Healthcare Wait Time Optimisation: Metropolitan General Hospital Case Study

Metropolitan General Hospital (MGH), a 500-bed teaching hospital in downtown Chicago, had been grappling with significant patient wait times in their outpatient clinics. Patient satisfaction scores had dropped from 85% to 65% over the past year, primarily due to extended waiting periods to see care providers. The hospital's CEO, Dr. Sarah Chen, recognized that this issue needed immediate attention as it was affecting both patient care quality and the hospital's reputation.

The outpatient department handled approximately 800 patients daily across various specialties. Recent data showed that patients waited an average of 45 minutes beyond their scheduled appointment times, with some waiting up to two hours. This resulted in increased patient complaints, staff stress, and a 15% increase in appointment cancellations.

Dr. Chen appointed Marina Rodriguez, the newly hired Operations Director, to lead a process improvement initiative. Marina had extensive experience in healthcare operations and decided to approach this challenge systematically. She began by gathering data through patient surveys, staff interviews, and direct observation of clinic operations.

Initial analysis revealed several contributing factors to the extended wait times. These included overbooking of appointments, inconsistent registration processes, inadequate preparation of patient records, and variable provider arrival times. Marina noticed that while some days ran smoothly, others were chaotic, suggesting that the process wasn't standardized.

To better understand the current state, Marina mapped out the entire patient journey using the SIPOC (Suppliers, Inputs, Process, Outputs, Customers) methodology:

Suppliers:

The primary suppliers included referring physicians, laboratory services, radiology department, medical records department, and the hospital's IT system. These entities provided essential information and services necessary for patient visits.

Inputs:

Key inputs encompassed patient demographic information, medical histories, insurance details, appointment schedules, test results, and provider availability. The quality and timeliness of these inputs significantly impacted the overall process flow.

Process:

The current process flow started with appointment scheduling, followed by check-in, registration verification, vital signs measurement, and finally, the provider consultation. Each step had its own set of variables and potential bottlenecks.

Outputs:

The process outputs included completed consultations, treatment plans, prescriptions, follow-up appointments, and referrals to other specialists or services. The quality of these outputs depended heavily on the efficiency of the preceding steps.

Customers:

The primary customers were the patients themselves, but the process also served referring physicians, insurance companies, and other healthcare providers who relied on the consultation outcomes.

Marina implemented a systematic improvement approach. In the first phase, she established baseline metrics and set clear targets. The team collected data on arrival patterns, service times, and bottlenecks. They discovered that morning appointments generally ran more smoothly than afternoon ones, suggesting a cumulative delay effect.

The team then developed and tested several interventions. They implemented a new scheduling template that better accounted for appointment complexity. They introduced a pre-visit planning process where staff reviewed patient records and necessary documentation 24 hours in advance. They also established a fast-track lane for simple follow-up visits.

After three months of implementing these changes, the average wait time decreased to 25 minutes. Patient satisfaction scores improved to 78%, and appointment cancellations decreased by 8%. However, some challenges persisted, particularly during peak hours and with certain specialties.

The team continued to monitor and adjust their interventions. They introduced a real-time tracking system that allowed patients to monitor their queue status through a mobile app. They also implemented a text message system that notified patients of any potential delays before they left home.

By the six-month mark, MGH had achieved significant improvements. Average wait times stabilized at 20 minutes, patient satisfaction reached 82%, and staff reported feeling less stressed. The success of this initiative led to its implementation across other hospital departments.

Case Study Questions

Answer all the questions:
(2500 words for all questions below)

1. What were the root causes of the extended wait times at MGH?
2. How did the SIPOC analysis help in understanding the complex nature of the problem?
3. What metrics would you recommend tracking to measure the success of the improvement initiative?
4. Evaluate the effectiveness of the improvement approach used at MGH.
5. Analyze the relationship between wait times and patient satisfaction scores.
6. How could MGH better use data analytics to predict and prevent future wait time issues? Suggest a forecasting method.
7. What additional metrics should MGH track to ensure sustained improvement?
8. How could technology be better leveraged to further optimize wait times?
9. What is the role of lean methodology in improving healthcare operations? What types of operational wastes can lean methodology address? Is there any literature in research that support the applications of lean in healthcare industry?
   (1000 Words)

Summary of Assessment Requirements

The assessment requires students to analyse the Healthcare Wait Time Optimisation Case Study of Metropolitan General Hospital (MGH), focusing on identifying root causes of extended wait times, evaluating improvement strategies, and demonstrating the use of healthcare operations management tools such as SIPOC, data analytics, and lean methodology.

Key Pointers to Be Covered in the Assessment:

Part 1: Case Study Analysis (2500 words)

Students must address the following:

1. Identify root causes of extended wait times.
2. Explain how SIPOC analysis supports understanding of complex processes.
3. Recommend key performance metrics for improvement tracking.
4. Evaluate the effectiveness of the improvement initiatives implemented at MGH.
5. Analyse the relationship between wait times and patient satisfaction.
6. Suggest how data analytics and forecasting could prevent future delays.
7. Recommend additional long-term metrics for sustained improvement.
8. Propose ways technology can further optimise wait times.

Part 2: Lean Methodology (1000 words)

Students must:

• Explain the role of lean methodology in healthcare operations.
• Identify operational wastes addressed by lean.
• Support arguments using relevant academic literature on lean implementation in healthcare.

How the Academic Mentor Guided the Student 

The Academic Mentor approached the assessment in a structured and systematic manner, ensuring the student understood each stage of analysis and how to develop a comprehensive, evidence-based response.

Step 1: Understanding the Case Study Requirements

The mentor began by breaking down the assessment into two major components—case analysis and lean methodology—clarifying what each question was asking. The student was guided to:

• Read the case line-by-line
• Highlight operational challenges
• Identify all stakeholders involved
• Understand the timeline of improvement initiatives

This provided the foundation needed to answer the analytical questions accurately.

Step 2: Diagnosing the Problem (Root Causes)

The mentor guided the student to extract root causes directly from the case using operational management lenses such as:

• Overbooking
• Registration inconsistencies
• Poor record preparation
• Provider delays
• Lack of standardisation

The student learned the importance of differentiating symptoms (long waits) from causes (process inefficiencies).

Step 3: Applying SIPOC Analysis

The mentor explained how SIPOC supports system-wide understanding and helped the student:

• Map Suppliers, Inputs, Processes, Outputs, and Customers
• Recognize interdependencies across the patient flow
• Identify breakdowns at each SIPOC stage

This taught the student how SIPOC reveals hidden inefficiencies in healthcare processes.

Step 4: Identifying Metrics for Improvement

The mentor highlighted the key metrics relevant to healthcare operations such as:

• Average waiting time
• Queue length
• Patient satisfaction
• No-show and cancellation rates
• Staff utilisation rates

The student learned to justify why each metric matters for continuous improvement.

Step 5: Evaluating Improvement Strategies

The mentor guided the student to critically examine the interventions implemented:

• Scheduling redesign
• Pre-visit planning
• Fast-track lane
• Real-time tracking app
• Notification system

The student evaluated their effectiveness by linking them to improvement results found in the case (e.g., wait time reduction to 20 minutes).

Step 6: Using Data Analytics and Forecasting

The mentor demonstrated how MGH could adopt predictive analytics by:

• Analysing arrival patterns
• Using queueing models
• Implementing time-series forecasting (e.g., ARIMA)

This helped the student understand how forecasting can prevent cumulative delays.

Step 7: Recommending Additional Metrics

The student was guided to recommend long-term metrics such as:

• Provider punctuality
• Throughput rates
• Variability in service time
• Peak-hour bottlenecks

This supported the understanding of sustainable operations management.

Step 8: Leveraging Technology

The mentor helped the student explore modern technologies such as:

• AI-based scheduling
• Automated check-in kiosks
• Digital triage tools

This allowed the student to propose realistic technology-driven solutions.

Step 9: Part 2 – Lean Methodology Guidance

The mentor structured the lean methodology section by helping the student:

1. Define lean thinking in healthcare.
2. Identify the eight wastes:
   • Overproduction, waiting, defects, overprocessing, unnecessary movement, inventory, transportation, underutilised talent.
3. Support claims with academic sources showing how lean reduces wait times, errors, and inefficiencies in hospitals.

This ensured the student connected theory with real-world operations.

Final Outcome and Learning Objectives Achieved

Through the guided process, the student successfully produced:

• A clear diagnosis of root causes of wait time issues.
• A complete SIPOC analysis illustrating process complexity.
• A justified set of healthcare performance metrics.
• A critical evaluation of improvement interventions.
• Insightful analysis on the link between patient satisfaction and wait times.
• Practical suggestions for using data analytics and forecasting.
• Evidence-based recommendations on lean methodology in healthcare.

Learning Objectives Covered:

• Application of healthcare operations management tools (SIPOC, metrics, analytics).
• Critical evaluation of process improvement initiatives.
• Understanding of lean methodology and its relevance in healthcare.
• Ability to apply forecasting and technology solutions to real-world healthcare problems.
• Development of problem-solving and diagnostic reasoning skills.
• Integration of theory with practice using case-based evidence.