The dynamics of arrival and service delivery in a Nigerian public ophthalmic outpatient clinic

Aim: To investigate the dynamics of patients' arrival and service uptake in order to propose a way of achieving the time target of the 'Service Delivery Charter' of the Federal Government of Nigeria.

Materials and Methods: One hundred and seventy one presenting sample of patients between the 8 and 25 February, 2005 were monitored at the outpatient ophthalmic clinic of the Federal Medical Center, Bida-Nigeria. A trained principal confidential secretary using a digital watch timer and timed closed-circuit television (CCT) camera conducted a timed motion record - as developed by Frederick Taylor in 1911- of patients and service provider for the entire clinic period. These records included patients' order of arrival as well as the time for waiting, service call up, service times at different service stations as well as the time of exit from service for each patient. Data were entered and analyzed using the Statistical Package for Social Science computer software.

Results: Only 3.6% of patients arrived before the commencement of clinic operations, but as much as 75% arrived before 9.00 am, a time that is 30 minutes before the attainment of peak clinical service operation. Only 6.4% will arrive spontaneously at an interval of time that is big enough to discharge the patient who arrived before them. With respect to the time for service uptake, 700% of time was spent in waiting for services, while clinic layout and logistic redesign offers a maximum time saving of 57% of service uptake time.

Conclusion: A timed appointment system is therefore hypothesized to be a very important option to add to the booking systems for the attainment of time targets in public hospitals in Nigeria.