For patients at public outpatient clinics, a five-minute consultation with a doctor can mean a half-day expedition, including travelling time, lining up to register, waiting to be called, paying and picking up medication. But some public hospitals are using their own innovative measures to cut waiting time, which can add up to three to four hours. Some have streamlined their procedures, while others have increased staff levels to clear the backlog. At Castle Peak Hospital in Tuen Mun, for example, management has cut the waiting time at its outpatient mental clinic by 45 per cent in the past year using a scheme modelled on one devised by carmaker Toyota. Patients' Rights Association spokesman Tim Pang Hung-cheong says long waiting times remain a widespread problem despite improvements at individual hospitals. 'It is still very common for patients to wait two to three hours to see a doctor for just a few minutes, while the wait at the pharmacy sometimes takes more than an hour,' Pang said. Some clinics allocated too many appointment slots in every hour. 'The system is designed for the sake of convenience to doctors; it makes sure doctors do not need to wait for patients, so many patients are booked in the same time slot,' he said. 'The Hospital Authority should consider making the system more patient-oriented.' The Castle Peak solution, according to the hospital's senior executives, does not come from any advanced technology or extra money but a change of mindset and a detailed review of procedures. Modelled on Toyota's kaizen improvement system - meaning improvement or change for the better - it looks at every detail of a patient's movement through the hospital system, seeking to raise efficiency. 'Reviewing the whole patient journey and reforming the appointment system has successfully solved the old problem that had been with us for a long time,' consultant psychiatrist Dr Lam Ming said. 'The reform is not complicated; mainly it is about a change of mindset. Our experience tells us that hospital managers have to visit the site to see the real situation themselves, and to talk to staff and patients directly to get their views.' For decades, Castle Peak's mental outpatient clinic had been known for congestion, long waits and red tape. As there were only two medical appointment times, 9am or 2pm, more than 60 per cent of patients would flood the clinic early in each session to queue up. At any one time, more than 10 patients would be waiting outside each consultation room. A snapshot of one patient showed that he had spent 21/2 hours on the whole process - from registration to paying the fees, receiving a nursing check-up, seeing a doctor and collecting his drugs. This did not include the time he had spent queueing to register before the clinic opened. Consultation with the doctors and nurses, however, took only 11 minutes, a tiny 7 per cent of the total time he had spent at the hospital. Lam said the crux of the reform, introduced in November 2009, was to even out the appointments into different time slots. Each 30-minute slot has a fixed number of patients. The clinic also cut its red tape by trimming the number of steps in the patient journey from 11 to five. The number of employees involved, including nurses, general office workers and accounting staff, was cut from four to two. Before the reform, a patient spent an average of 127 minutes from registration to consultation, counselling and drug dispensing. This was cut to 70 minutes after the reform. Lam said the clinic had felt pressure to streamline its process because of increasing patient loads. The number of consultations each year has doubled in the past decade, from 60,000 in 2000 to 120,000 last year. He said the past practice of setting only two appointment times was designed to encourage mental patients to come forward. 'We welcomed mental patients to come to see us any time at each session because some were reluctant to seek help. We tried the new system and patients quite like it because they wait less time than before.' Staff morale has also improved. 'In the past, doctors had to bear with the dozens of patients' files piled on their desks. From the time they stepped into the consultation room at 9am they felt stressed. The new system means they have a rather fixed number of patients in each session, and they feel more relaxed.' This month, big electronic display boards will go up at different sites at the hospital showing the queuing situation. 'The system will be like that used at the airport. Patients at different locations at the hospital can check when they have to go back to the clinic,' Lam said. 'Before that, they can relax and walk around the hospital and have a coffee.'
