Waiting Line Models
Waiting Line Models
Waiting Line Models
IJARIIE-ISSN(O)-2395-4396
AN EMPIRICAL STUDY ON
APPLICABILITY OF WAITING LINE
MODEL IN SELECTED HOSPITALS
1
ABSTRACT
The objective of the present study is to examine the applicability of waiting line model in various hospitals of
southern Rajasthan. It also investigates the implementation level of waiting line model as innovation tool for patient
satisfaction because this model helps to reduce waiting time and it turns it makes a good image of the hospital.
Furthermore an attempt has been made to study that delay in services is the biggest issue in the healthcare industry
and patients are not ready for wait to acquire the services, due to impatience or may be emergency case. The
findings suggest that the implementation of waiting line model in health care or in hospital will give positive aspect
of the patient as well as for hospital image.
This study is intended to examine the applicability of waiting line model in various hospitals of southern Rajasthan.
This part of Research describes about the composition of the process, tools, methodology adapted to carrying out
the objectives of the study undertaken.
Key Words: - Waiting Line Mode, Healthcare, Accident and Emergency, Hospitals, Queuing Theory, Healthcare
Industry etc
Healthcare System in India and around the world has witnessed a phenomenal growth during last three decades. The
basic reason behind raising this industry is the increasing rate of population and their demand for the healthcare
service. So, health care systems have been challenged in recent years to deliver services to all the patient and high
quality services with limited resources without delay. This issue for healthcare industry is a bottleneck issue because
delay in service may result in death of a patient and congestion results into mismanagement of resource distribution
and allocation to patient or staff members of the hospital as well. Health care resources are becoming increasingly
limited and expensive, thereby placing greater emphasis on the efficient utilization of the resources and the
corresponding level of service provided to patients.
To resolve the service delays and patient congestion like issues the restructuring and renovation was performed, but
in some region the restructuring and renovation have produced a serious overcrowding effect such that patients wait
for hours to see doctors or before attention particularly in emergency departments (ED) and intensive care units
(ICU). Management of waiting, delays and unclogging bottlenecks requires the assessment and improvement of
flow between and among various departments in the entire hospital system.
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Therefore, Researchers around the world have become more focused on service industries in general and healthcare
in particular. Government regulations, public-private participation, competition amongst hospitals and patient
satisfaction urge hospital administrators to find ways to manage congestion and decrease waiting times (both waiting
time in the hospital as well as the waiting lists that exist outside the hospital). Current health care literature and
practice indicate that waiting lists and congested patient flows are indeed made up of one of the most important
problems in healthcare industries.
In order to improve performance in an environment as complex as a hospital system, the dynamics at work need to
be understood, of which queuing theory provides an ideal set of instruments for such understandings. Queuing
theory was developed to study the queuing phenomena and for analysis and modeling of processes that involve
waiting lines. This study presents the applicability of these techniques more widely across the healthcare system.
Results show that the application of operations research (queuing model in particular) brings greater versatility,
variety and control to the management of healthcare organization.
According to recent studies conducted, the customer's (patient) aspirations are fast changing. Customers are growing
more aware of their health needs, demand quick response, less waiting times, and above all - demand nearness of the
healthcare unit to them.
However, since waiting line is part of our daily life, all we should hope to achieve is to minimize its inconvenience
to some acceptable levels. The customers arrival and service times don't know in advance otherwise the operation
of the facility could be scheduled in a manner that would eliminate waiting completely. For this purpose, to reduce
the time delay trained personnel and specialized equipments are required, study in this research paper with the help
of queuing system.
OBJECTIVES OF THE STUDY
Waiting line model or applicability of queuing theory is a relatively new concept in the Indian hospital industry with
special reference to Rajasthan hospitals. As of the studied literature of queuing theory few researches are there
related to its applicability in the hospital sector. So main purpose of this research study is to examine the
applicability of waiting line or queuing theory is to analyze the congestion of patients in private and public sector
hospitals.
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According to Biggs (2008) Elective surgery waiting lists are used to manage access to public hospital
elective surgery services and give priority to those in most urgent need of care. They have become an
integral feature of our health system, and allow limited health resources to be allocated or rationed on the
basis of need. Waiting lists also provide health consumers with an indication of how long they can expect
to wait for their surgery.
Queuing theory is a very volatile situation which causes unnecessary delay and reduce the service
effectiveness of establishments. Apart from the time wasted, it is also leads breakdown of law and order.
Many lives and property had been lost in queues at filling stations in the past. (Adeleke, Ogunwala, Halid
2009),
Schoenmeyr et al. (2009) analyzed that healthcare organizations function with very small net margins, so
decisions about committing resources must be made with a high degree of confidence that the investment
will lead to the desired result. The queuing approach is useful because it enables the investigation of future
scenarios for which historical data are not directly applicable.
Waiting times assist in measuring the rate of turnover on hospital waiting lists and are considered a more
reliable indicator of hospital performance than the size of the waiting list. In some cases the patient may be
removed from a waiting list. Reasons may include that they no longer require the procedure, are instead
admitted as an emergency patient, receive their treatment at a different hospital or are transferred to the
waiting list of a different hospital, are untraceable or die.
Agrawal & Saxena (2010) analyzed the use of queuing theory in the healthcare Centre of IIT-K and the
benefits accrued for the same and they conceptualize an appointment system in which customers who are
about to enter service may have a probability of not being served and may rejoin the queue. In their
investigation, they found that the capacity utilization is 76%, average number of people waiting in the
queue is 2.57calculated by the Poisson distribution method.
As Examined by Mehandiratta (2011) with rapid change and alignment of the health care system, new
lines of services and facilities to render the same, severe financial pressure on the health care organizations
and extensive use of expanded managerial skills in healthcare setting, use of queuing models has become
quite prevalent in it. Queuing models are used to achieve a balance or tradeoff between capacity and
service delays.
Waiting times assist in measuring the rate of turnover on hospital waiting lists and are considered a more
reliable indicator of hospital performance than the size of the waiting list. In some cases the patient may be
removed from a waiting list. Reasons may include that they no longer require the procedure, are instead
admitted as an emergency patient, receive their treatment at a different hospital or are transferred to the
waiting list of a different hospital, are uncountable or die.
RESEARCH METHDOLOGY
The nature of the research design is such that the hospitals were identified through judgmental and random
sampling procedure. The researcher has used his judgment at two levels: One at the level of selection of
hospitals among various hospitals located in districts and second at the level of selecting the department
and units to examine the applicability of waiting line model.
The judgment for selection of hospitals has been pertained to: the size and scale of hospital, locality of the
hospital, and availability of all types of treatment with modern technology, public awareness, and cost
applied in treatment. As far as the units and department of hospitals is concerned, the judgment pertained to
the size and scale of unit, nature of responsibility, patient turnover, services offered.
A list of participating hospitals is given in Table 1 This list is district wise hospital's name of both private
and public / government sector.
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District
Name of Hospital
Private
Public
Private
Public
Private
Public
Private
Public
Private
Public
Udaipur
Banswara
Chittor
Type
Bhilwara
Rajasmand
Source: - Survey
RELIABILITY FOR DATA COLLECTED
The reliability coefficient tested by using Cronbachs alpha () analysis. In order to measure the reliability
for a set of two or more constructs, Cronbachs alpha is a commonly used method where alpha coefficient
values range between 0 and 1 with higher values indicating higher reliability among the indicators
RELIABILITY ANALYSIS - SCALE (ALPHA)
For Indoor Patients
Number of Cases =
Cronbach Alpha =
142.0
.8176
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132.0
.7433
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Facilities and
Services
Variable
Measured Used
Variable 1
Parking
Variable 2
Variable 3
Variable 4
Variable 5
Variable 6
Drinking Water
Electricity
24 hrs service
Free treatment
Building
Variable 7
Variable 8
Capacity
Research Lab
Variable 9
Variable 10
Variable 11
Specialist Doctors
Hi-tech OT
Clean and Hygienic
Variable 12
Variable 13
Variable 14
Variable 15
Record maintenance
Infrastructure
Specialty
Operational
Services
Functional
Activities
Source: - Questionnaire, Primary data
Degree of relationship was studied by Pearsons correlation between mediating variables, facilities and
services, infrastructure, specialty, operational service and functional activities for indoor and outdoor
patients.
Table 3: Evaluation of Relationship between variables persuades indoor and outdoor patients
Type of
Patient
Indoor
Patient
Outdoor
Patient
Table 3 describes that correlation between constructs and depicts highly significant, significant and
insignificant correlation for both indoor and outdoor patients separately.
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To analyze the consequences for different constructs between hospitals and Indoor and Outdoor
patients various hypotheses were established and analyzed through Two-Way ANOVA. The hypotheses
were formulated on the basis of:
1.
2.
3.
Constructs shares common attributes for all the ten hospitals in study area.
Constructs shares common attributes for both Indoor and Outdoor patients.
There is no relation for constructs in hospitals and Indoor and Outdoor patients.
The consequences of Two- Way ANOVA test for all the constructs for indoor and outdoor patients of
selected hospitals of the study area is shown below. This representation will show that variation in
construct is whether significant for outdoor and indoor patients or not.
Table 4: Two-Way ANOVA analysis of constructs and their significance for Indoor and Outdoor
patients
Constructs
Facilities & Services
Infrastructure
Specialty
Operational Services
Functional Activities
Measures of Significance
Significant
Insignificant
Yes
Yes
Yes
Yes
Yes
-
Above table 4 depicts that variation in any of the construct is significant for both indoor and outdoor
patients in the selected hospitals in the study area.
All the related dimensions of constructs for indoor and outdoor patients of selected hospitals have
been analyzed further using T-test. This test helped to identify that is there a significant difference in
dimension of constructs between indoor and outdoor patients.
1.
2.
3.
4.
5.
There is no significant difference for facilities and services and its measures between indoor and
outdoor patients. But these variables are more important for indoor patients.
There is no significant difference in infrastructure and its measures between indoor and outdoor
patients. However, infrastructure and capacity variables are more important for indoor patients.
There is a significant difference for specialty and its measures between indoor and outdoor
patients. However, these differences for specialty, research lab were not found to be nonsignificant. In case of differentiation, factors specialist doctors and Hi-Tech OT are more
important for the indoor and outdoor patients. In these factors specialist doctors is an important
variable for outdoor patients and for indoor patients Hi-Tech OT is more considerable variable.
There is a significant difference for operational services and its measures between indoor and
outdoor patients. This difference in technology for treatment was not found to be non-significant.
In case of differentiation, factors, operational services clean & hygienic, directional guidelines
were more important for the indoor and outdoor patients. These factors are important variables for
indoor patients in comparison to outdoor patients.
There is a significant difference for functional activities and its measures between indoor and
outdoor patients. In case of differentiation, factors, functional activities, availability of resources
and record maintenance system were more important for the indoor and outdoor patients. These
factors are important variables for indoor patients in comparison to outdoor patients.
The analysis on the effectiveness of factors responsible for choosing a hospital by patients shows
that good will and reputation, specialty and due to emergencies are highly significant factors
responsible for choosing a hospital by patients. The result of corporate tie ups has been found nonsignificant, which means still less patients are aware about the corporate tie ups of hospitals and even
did not check this issue.
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Principal component factor analysis was used for analyzing the opinions of patients as well about
hospital and related issues like service and facilities offered by it. For indoor patients there were 34 issues
and for outdoor patients there were 26 different statements and four doctors there were 33 statements /
parameters taken and put into component analysis test. The consequences are as follows:
Outdoor Patients: After analyzing outdoor patients' opinions four factors were extracted. In which factor 1
is associated with infrastructure, factor 2 is associated with services and facilities offered by hospitals,
factor 3 is associated with the availability of resources and services and factor 4 represents behavioral
measures of hospital staff.
Indoor Patients: After analyzing indoor patients' opinions four factors were extracted. In which factor 1 is
associated with infrastructure, factor 2 is associated with services and facilities offered by hospitals, factor
3 is associated with the availability of resources and services and factor 4 represents specialty and
approached of hospital for indoor patients.
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. 696*
.333
-.635
.542
. 992*
-.034
-.013
.286
. 828*
-.122
.129
-.145
.342
. 958*
.238
.493
. 790*
-.501
-.288
-.381
. 833*
.658
-.127
.461
-.638
-.003
. 712*
.326
.658
-.127
. 738*
-.232
.634
.267
-.628
. 691*
.084
-.526
. 821*
-.123
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IJARIIE-ISSN(O)-2395-4396
.256
.356
-.712
. 598*
-.210
. 827*
.292
.223
.333
.512
. 905*
-.326
Adequate number of
hospital
.575
.191
.053
. 976*
.162
041
. 785*
-.216
-.318
-.098
. 817*
-.496
.290
.496
. 905*
-.098
.117
.404
. 889*
.292
-.526
-.292
.516
. 876*
-.301
.664
. 691*
.463
.348
.791*
-.260
.314
-.415
. 586*
.361
.014
-.398
.756*
-.226
-.113
. 928*
.669
-.096
-.057
. 876*
.839
.454
.621
-.098
Extra charges taken by staff members from
patient
Source: Primary Data [Analysis made by IBM SPSS 19.0]
-.041
.587
.723*
Oxygen cylinders in
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.868*
.147
.599
.195
.691*
.664
-.301
.019
.972*
-.183
.007
.413
.398
.839*
-.260
-.248
.822*
.504
-.236
-.159
.095
-.396
.882*
-.225
.297
-.411
.972*
.365
.036
.742*
-.502
.411
-.142
-.335
.095
.664*
.126
-.719
-.016
.280*
.297
.925*
-.689
.456
-.198
.972*
.095
.362
.742*
.598
.452
-.042
.280*
-.719
-.411
-.196
.321
.095
.856*
-.198
.331
.972*
.425
-.212
-.394
-.411
.662*
.565
.167
.141
.472*
-.365
-.497
-.423
.556*
-.225
.239
.111
.632*
.418
.114
-.074
.456*
.327
-.019
-.522
.666*
-.228
.414
.489
.724*
.561
.387
-.623
.698*
.222
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.141
.326
.745*
.624
. 806*
.761
-.496
-.389
.365
. 586*
-.612
.014
-.523
. 741*
-.171
-.564
-.415
. 366*
.238
.014
. 741*
.127
-.514
.363
. 992*
-.034
-.513
.446
.542
.426
-.635
.696*
.266
Timely discharge by the Hospital after complete
treatment, without delay
Source: Primary Data [Analysis made by IBM SPSS 19.0]
-.334
-.616
. 492*
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Indoor /
Outdoor
Mean
Std.
Deviation
Indoor
140
3.85
1.05
Outdoor
129
3.21
1.12
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T-value
P-value
0.926
0.946
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IJARIIE-ISSN(O)-2395-4396
Indoor
132
4.18
0.95
Outdoor
118
4.08
0.84
Indoor
142
3.07
1.26
Outdoor
132
3.21
1.12
Indoor
140
4.03
0.92
Outdoor
130
4.08
0.9
Indoor
114
4.36
0.76
Outdoor
120
4.31
0.73
Indoor
127
4.12
0.98
Outdoor
123
4.36
0.82
Indoor
141
3.96
0.83
Outdoor
132
4.26
0.78
Indoor
110
3.98
0.76
Outdoor
107
3.93
1.08
Number of Doctors
Number of paramedical
staff
Parking and
Transportation
Reception Counter
Doctors availability
Behavior of Paramedical
staff
Others
0.058
0.494
1.09
0.277
0.921
0.218
0.02
0.011*
1.912
0.641
2.138
0.897
1.05
0.042*
Indoor /
Outdoor
Mean
Std.
Deviation
Indoor
140
3.85
1.05
Outdoor
129
3.21
1.12
Indoor
132
4.18
0.95
Outdoor
118
4.08
0.84
Indoor
142
3.07
1.26
Outdoor
132
3.21
1.12
Number of Doctors
Number of paramedical
staff
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T-value
P-value
0.926
0.946
0.058
0.494
1.09
0.277
278
Parking and
Transportation
IJARIIE-ISSN(O)-2395-4396
Indoor
140
4.03
0.92
Outdoor
130
4.08
0.9
Indoor
114
4.36
0.76
Outdoor
120
4.31
0.73
Indoor
127
4.12
0.98
Outdoor
123
4.36
0.82
Indoor
141
3.96
0.83
Outdoor
132
4.26
0.78
Indoor
110
3.98
0.76
Outdoor
107
3.93
1.08
Reception Counter
Doctors availability
Behavior of Paramedical
staff
Others
0.921
0.218
0.02
0.011*
1.912
0.641
2.138
0.897
1.05
0.042*
CONCLUSIONS
In present scenario, rapid growth of technologies is increasing expectation of patients in the health care
environment, which is recognized as customer satisfaction a measure of quality. In the delivery of medical
service, individual patient needs, expectations and experiences will undoubtedly vary for several of
reasons. Knowledge of the use of waiting line model / queuing model to determine system parameters is of
value to health providers who seek to attract, keep and provide quality health care to patient in the evercompetitive marketplace.
Queuing theory is one of the most prevailing and tested mathematical approach which can be used for
analyzing waiting line performance parameters for health care centers. Effective application of the model
can help to improve access to quality at any unit of hospital system which is viewed as key to increase
quality with special reference to resource utilization, availability of facilities & services, waiting time
reduction and queue management methodologies. It is worth mentioning that queuing models are not the
end in itself in decision making, they are just the beginning of the structuring of decision making
framework.
There are various reasons like rate and nature of patients arrivals and patient severity, etc. are the cause of
fluctuation and variation in the healthcare system which directly or indirectly affects the service quality and
are outside the control of the hospital management. Providing patients with timely access to appropriate
medical care is an important element of high quality care which invariably increases patient satisfaction,
when care is provided is often as important as what care is provided. Dont we think providing medical
services to expectant mothers, in a setting where the worry and burden of waiting time management was
reduced or even eradicated, keeps patients happy and decreases the anxiety of the doctors.
SUGGESTIONS
This study attempts to study the applicability of waiting line model in the health care system to measure its
effectiveness and to identify the relationship between the servers and waiting lime delays. So the overall
composition of the thesis focuses on mathematical analysis of queuing model and other important analysis,
which works on identified constructs that persuades patients and their opinions.
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The recommendations for improving the service quality, reducing the patient waiting time and increasing
the satisfaction of patients could be classified under administrators, patients and doctors head.
SUGGESTIONS FOR PATIENTS
Generally, improvement in the patient flow, systematic service available to patients and reduction in
service delay time for patients can be achieved by following ways:
1. Patients should follow the guidelines published by hospitals and doctors on the information board.
2. Should follow proper appointment time frame assigned to you to visit a doctor or to avail a service like
report collection.
3. Should be very careful for the uses of resources like electricity, water, etc., should not waste the
resources.
4. Should be aware about the camps organized for awareness related to specific diseases.
5. Relatives and others should follow the visiting hours for patients and doctors as well.
6. Should be sensitive towards the uses of free facility provided by hospital administration or government
as well.
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Scree plots
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