Paediatric Orthopaedic Clinic at the Children’s Hospital of Western Ontario – Case Solution

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Paediatric Orthopaedic Clinic at the Children's Hospital of Western Ontario Case Answers

Introduction – The Paediatric Orthopaedic Clinic at the Children’s Hospital of Western Ontario

Children’s Hospital of Western Ontario (CHWO) is a large, regional health-care center providing specialized pediatric services to children. The Paediatric Orthopaedic Clinic (“the Clinic”) is one treatment center at the Children’s Hospital of Western Ontario that is jointly managed with the Division of Surgery.

As patients come to the Clinic, their visit includes four steps. Upon arrival, all patients go through the front desk from where they move to the Radiology department, where their X-ray is taken and developed. Once their film is analyzed by a radiologist, the patient may leave the Radiology department and hand off their X-ray film at the front desk. Finally, patients go to a medical examination performed by either a surgeon or one of the two residents. This final step may also involve a visit from a cast technician, if necessary.

The complete patient flow at the Paediatric Orthopaedic Clinic can be seen in Figure 1 and the complete staff roster in Figure 8.

The Chief of Paediatric Orthopaedic Surgery at the CHWO, Dr. Kellie Leitch, was concerned by the long times that the young patients spent at the Clinic as well as staff being over-extended. Dr. Leitch volunteered her clinic to hospital management as a test case to demonstrate that patient care could be done in a more timely fashion, without increasing costs.

Problem (Issue) Statement

The problem Dr. Leitch addresses is the patients spending roughly two hours on their visits at the Paediatric Orthopaedic Clinic. She has set an objective to reduce patient wait times by 20% to both alleviate over-burdened staff and appease frustrated parents, all without increasing costs.

Data Analysis

Figure 1 illustrates CHWO’s current process for serving its patient base. Further, Figure 2 shows key statistics related to this current process. In evaluating the system’s wait times, a crucial variable to consider is the utilization. The Paediatric Orthopaedic Clinic’s two customer segments, new and follow-up patients, have vastly different needs in the way they are serviced. Therefore, in addition to examining the overall process, we analyzed the customer segments separately to find their respective utilization rates. Figure 3 outlines the findings related to both customer segments.

Both customer segments have a utilization exceeding 100%, showing that the system is overloading with more patients than it can service. Overly high utilization rates lead to increased wait times for patients. Although the follow-up patient segment has a shorter service time and a higher service rate, its utilization is stretched beyond capacity due to its high input of patients. Finally, when attempting to find the system’s wait times using the Kingman equation, the calculated wait time was negative because the system had far exceeded its capacity.

Another critical component when evaluating wait times at the Paediatric Orthopaedic Clinic is…