Redistribution of Doctors and Decentralization of Clinics Improved Utilization of Services, Demand, and Capacity of Hamad Medical Corporation's Staff Clinic

Abstract

Background: The Staff Medical Clinic (SMC) of the Hamad Medical Corporation (HMC) serves the staff members who require healthcare services, but in a crowded environment, the SMC can only meet 75% of that demand. Overcrowding reduces productivity and service quality and increases waiting time. Furthermore, overcrowding in healthcare facilities decreases the experience and satisfaction of patients and healthcare providers.

Aim: The main objective of this study was to use simulation modeling to evaluate interventions that could improve SMC waiting time and efficiency.

Method: Eighteen months of data on SMC patient flow, staffing, and clinical sessions were collected (January 2018 to June 2019). The patient's journey through the SMC was modeled as a series of processes with assigned durations defined mathematically using the appropriate probability distribution. A simulation flow model was developed considering the locations of the staff and nearby main hospital facilities. An intervention was proposed and evaluated through a simulation. The intervention involved redistributing 25% of the SMC staff into three main satellite clinics located at the facilities where most of the SMC patients came. Results: The proposed intervention decreased crowding by 37%, reduced staffing requirements by 28%, and increased the number of patient slots by 22%, resulting in a net increase in the number of patients served by an average of 1250 monthly, without the need for hiring new additional staffing.

Conclusion: Redistribution of the available medical staff to three new satellite clinics reduces workload pressure at all sites and increases clinic capacity without additional costs.

Keywords: patient flow; physician redistribution; simulation; staff clinic; waiting time.

Figure 1. Resource definition of the Staff Medical Clinic (SMC) and patient journey within SMC

Figure 2. Staff clinic volumes and access by visits during the study period

(A) shows that Staff Medical Clinic (SMC) served 75% of the demand during the observation period; the remaining served at the emergency department (ED), the Primary Healthcare Corporation Center (PHCC), or did not show up for their appointment. (B) shows that most patients served at the SMC were walk-ins, and only 28% were prescheduled.

Figure 3. Principal causes of visits to the staff clinic

Figure 4. Sources of patients

HGH: Hamad General Hospital; WWRC: Women Wellness and Research Center; RH: Rumaillah Hospital; HH: Heart Hospital; EMS: Emergency Medical Services; NCCCR: National Center for Center Care and Research; ACC: Ambulatory Care Center.

Figure 5. Monthly capacity and demand over the 18-month observation period

Figure 6. Context diagram of the patient flow in the simulation model

The graph shows the system or process that was designed for walk-in patients (i.e., without appointment) and patients booking (i.e., with appointment). OPD: Outpatient department.

Figure 7. Scenario: graphical results of the experiment

The graph shows average monthly staff visits in the "Actual scenarios" (a) and the "Scenario experiments" (b). The boxes show the interquartile ranges, while the horizontal lines represent medians. The vertical lines depict the maximum and minimum values. They were then compared to an average monthly measure. The figure shows that there is an increase in the number of patients served per month by 1250 ± 241.