Reducing Waiting time in the Emergency Room and Improving Patient Turnaround in Public Hospitals


This report is based on finding solutions to improving patient turnaround time by reducing the current time spent on waiting by half.

 For the past years, public hospitals have been congested as the patient take a long time to be served. The patients spent a long time in the queue before seen the doctor causing collapsing and even deaths of those in bad condition. Some patients reported in the emergency department the problem of long waiting time and the staff choose a team to research ways of improving patient turnaround and reducing waiting time. Questionnaire and observation methods were used to collect data from hospital management and patients. From the data collected we found that the public hospital had few doctors while the number of patients was very many (Graban. 2018).

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We developed several forms of solutions to curb the problem, such as the hospital should implement scheduling software to allocate the hospital staff duties in time to reduce confusion thus being on work at the exact time. Also, the software will help to give timely patient appointments to reduce waiting time in the queue thus improving patient turnaround time. The hospital should assess current patient flow into the facility to know where patients are few and why to make effective adjustments. (Graban. 2018), The emergency room should review patient turnaround frequently to make important changes to reduce the time taken in there. In addition, the hospital should have prepared pre-exam rooms ahead of time with nurses and medics to perform scheduled operations in time; this will reduce congestion as the patient will be served on arrival. The hospital should familiarize itself with electronic health records as it will help to store patient details making it easy to refer in the future. This will help reduce the time taken to feed the patient data again in the system enabling faster and effective service to the patient. Generally, it’s important to improve the patient turnaround time in the hospital as well as reducing current waiting time thus giving them quality services.

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Identification and Analysis of the System Archetypes that may Impede Performance

Indeed, several system archetypes are considered to form patterns of system behavior (Guo at el,.2015) . The system archetypes that may impede performance which was identified and analyzed included the tragedy of the commons which dictates that every person has incentives of consuming available resources at the expense of another person, which results to overconsumption of resources, so in public hospitals, all patients are entitled to cheap services which attract everyone causing congestion. Another system archetype identified was shifting the burden in which people took actions when the problem is at the acute stage (Guo at el,.2015)  .

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I found that most public hospitals acted on problems at adverse stages causing more problems in the future instead of finding a solution. Other system archetype was fixing and fail, which dictated that several public hospitals did not understand the congesting problem; hence, it was difficult to find a solution to improving patient turnaround time. Attractiveness principle was another system archetype in which most hospitals believed that they could not do all things to customers. Growth and underinvestment was also identified in which the organization valued some departments that the other. Eroding goals were also identified where historical instances of long working hours were perceived to cause poor performance hence congestion.  Escalation was also identified and analyzed in which patients who needed surgery were to wait for higher level doctors to attend to them, therefore, spending an extremely long time waiting. Limits to growth and accidental adversaries’ system archetypes were also identified and analyzed. Also, success to the successful type of system archetype was identified in which one department gained more resources than the other making it more successful in the organization (Guo at el,.2015).

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Analysis of the Current State Stream Map of the Emergency Department based on System Archetypes

In addition, this report includes the analysis of the current state value stream map of the emergency department based on the system archetypes. The current state value map of the emergency room was examined to describe the process from waiting time between the steps, investigating the effects of care models on patients. From the current state value stream map, the patients moved from registration to the waiting area, where all waited to go to the emergency room. From the emergency room, the patient waited to see the nurse for examination. Also, the patients waited to see the doctor for further examination. The patient waited further for the nurse to bring the medicine and also waited for the doctor to treat them as well as waiting to be given instructions to depart from the hospital facility (Cudney, 2018).  .

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The process was too long but systematic for the patients to follow, although they waited from one step to the other. All the patients had a chance of meeting the doctor or the nurse for examination according to the situation of the patients. Despite the long process of waiting to be treated and going back home, there is a need to improve the current state value map of the emergency department. I found that the public hospital should focus on improving patient flow through the process in that continuous flow moves the patients through the whole process without the need to wait long. Although continuous-flow is hard in most cases, the staff ought to put in place rules like come first be first to be served to avoid overlapping of the queue. Also, the staff should be keen to take note of the time spent for a doctor to serve one patient. The doctors should spend approximately 5 minutes to serve one patient to reduce waiting time allowing all patients to be served. Also, according to the current value map, the hospital staff should develop all the departments in the organization to ensure the success of the whole hospital (Cudney, 2018).

In addition, improving the current state value map, the management should implement electronic software to feed and store patient details to reduce waiting time in retrieving documents in files.

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      Since the current state value stream map appears confusing and has to wait in every step I recommend that the hospital should make adjustments on the value stream map (Nash et el,.2011). I recommended that they should use a proper value stream map with generally accepted standard symbols to easy reading and understanding. I also recommended using product families by grouping departments and their tasks to achieve better performance in the hospital. Also recommended, the management should consider reducing the number of process boxes to allow faster reading by the patients; therefore, if the value stream map has many steps, they should consider combining and renaming the process. (Nash et el,.2011) Also, i recommended that the value stream map be followed by allowing a good implementation to prevent confusion of the patients. I recommended the government to employ more qualified doctors and nurses in the public hospitals to balance the workforce and demand in the hospital thus quality services.

        This report also contains discussions on the intended and unintended consequences of modifying the system. The intended impacts are it will help to understand the flow of information and materials as services make way through the value stream map. Also, to help simplify the process taken by patients in the hospital and eliminating wastes through recycling of materials in the hospital as well as speeding the patient turnaround time reducing waiting time.  Facilitate all the steps in the hospital thus improved performance as it helps to evaluate all the activities done in each department. Also, the value stream map makes it easy to identify the shared resources in the organization as the symbols show the departments doing similar activities. Another intended impact was to improve service delivery to the patients by streaming operations in the hospital (damian et el ,.2019). On the other hand, unintended consequences include that the value stream map that does not always capture all the activities in the organization, so some minor activities may not be recorded. Also, symbols in most cases affect thinking; hence, people end up following them blindly, making the wrong choices. In addition, symbols have a different meaning hence, understanding the exact meaning is difficult and needs training. However, it’s essential to consider challenges facing the implementation of the value stream map such as lack of funds to employ professional personnel to develop and create a standard map (Damien et el ,.2019).  . Also, public hospitals have strict policies and different structures that make it difficult to draw and set the map.


          According to the research done, this report concludes that there was a lot of congestion in public hospitals. The congestion was due to a high turnover of patients in the public hospital. Also in public hospitals, there were few doctors and nurses to meet a large number of patients; however, if the doctors managed themselves well, they would have reduced congestion. It concludes that it’s important to identify and analyze system archetypes as they can help in impeding the performance of the whole organization. In addition, system archetypes are important in any organization as they help in making effective decisions on operations performed by the organization. The report also concludes that analysis of the current state value stream map is important as it provides steps followed by the patients in the hospital. Also, the map helps to eliminate waste in the process. Along with this, the report also shows the intended and unintended consequences of the value stream map. In conclusion, we were able to recommend ways of improving patient turnaround and reducing wasting time to half.


I recommend that public hospitals develop and implement standard value steamed map with simple symbols to direct patients to move from one department to another with ease. Also, the government should increase the supply of resources such as drugs, doctors in public hospitals to meet the increased demand for medication. The management should embrace electronic software to feed and store patient details for easy retrieval to avoiding recording at every stage in the process of seeing the doctor. I also recommend the staff should give priority to those who come first as it will help to avoid overlapping in the queue.  Also, the public hospitals to ensure the employees have the needed set of the skills required in completing responsibilities. When the hospitals have the right workforce, they have a significant impact on improving how services are delivered to the employees reducing the time taken in the hospital.

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