BOTTOM LINE

TEAM MEMBERS:
1. Mandava Poojitha
2. Harsh Raj
3. Manish Kumar Mishra

NITIE
NATIONAL INSTITUTE OF INDUSTRIAL ENGINEERING
BOTTOM LINE
Process Flow Diagrams for Regular and New Patients Process Flow Diagrams for Pharmacy Customers

Symbol Symbol
S.No Description Time(min) S.No Description Time(min)

1 Wait Time at Security 10 1 Wait Time at Security 10

Processing time at Check-in. Red/Yellow Processing time at Check-in. Red/Yellow
2 2 2 2
Colour card issuance Colour card issuance
3 Wait Time for Registration 24 3 Wait Time for Registration 24

Registration & Enrollments 4 Registration 7

4 8
(For Returning/New Patients)
6 Wait Time at Pharmacy 13
5 Waiting for Vital Signs Checking 15
7 Filling Prescription 11
6 Checking Vital Signs 6

7 Waiting after Vital Signs Checking 8

8 Waiting For Consultation from Provider 17 Total Time (min): 67

9 Consulting Provider 20

10 Waiting for Follow-up appointments 25

11 Receiving Follow up appointments 7

12 Wait Time at Pharmacy 13 - Operation Assumptions: 1.Travelling between

different facilities is considered
13 Filling Prescription 11 - Transport negligible. So the Distance column is
- Delay also removed to avoid redundancy
Total Time (min): 166 2.The customers who are seeking
- Inspection refills are assumed to take same time
for registration as Regular Patients
- Storage
Multiple Activity Chart for Regular and New Patients
Multiple activity is used to Determine the amount of time spent by the resources for a single Regular/New patient
Man
S.No Description Time(min) Security Registration Medical
Physicians Co-ordinators Pharmacists
Guard Clerk Assistant
1 Wait Time at Security 10
Processing time at Check-in. Red/Yellow
2 2
Colour card issuance
3 Wait Time for Registration 24
Registration & Enrollments
5 8
(For Returning/New Patients respectively)
6 Waiting for Vital Signs Checking 15

7 Checking Vital Signs 6

8 Waiting after Vital Signs Checking 8

9 Waiting For Consultation from Provider 17

10 Consulting Provider 20

11 Waiting for Follow-up appointments 25

12 Receiving Follow up appointments 7

13 Wait Time at Pharmacy 13

14 Filling Prescription 11

Average Number of Regular and New Patients that visit clinic facility =112+8(120)

Time Utilized for Regular/ New patients(min)

Security Guard : 240(120*2)

Registration Clerk: 960 (120*8)
Medical Assistant : 720(120*6)
Physicians : 2400(120*20)
Co-ordinators : 840
Pharmacists : 660(60*11(As only 50% on an average proceed to Pharma after consultation))
Multiple Activity Chart for Pharmacy Customers
Multiple activity is used to Determine the amount of time spent by the resources for a single Pharmacy Customer
Man
S.No Description Time(min) Security Registration Medical Co-
Physicians Pharmacists
Guard Clerk Assistant ordinators
1 Wait Time at Security 10
Processing time at Check-in. Red/Yellow
2 2
Colour card issuance
3 Wait Time for Registration 24

4 Registration 7

5 Wait Time at Pharmacy 13

6 Filling Prescription 11

Average Number of Pharmacy Customers=30

Time Utilized per patient(min)
Total Time utilized by all resources for Regular/New Patients & Pharma
Customers (min)
Security Guard : 2
Registration Clerk: 7
Security Guard : 300(60+240)
Pharmacists : 11
Registration Clerk: 1260(210+960+90)(Assumption: Clerks work for 30
Time Utilized for Pharmacy Customers (min) mins during 11 to 12.30 break and 1 hour after 4 to set records)
Medical Assistant : 720
Security Guard : 60 Physicians : 2400
Registration Clerk:210 Co-ordinators : 840
Pharmacists : 330 Pharmacists : 990(330+660)
UTILIZATION OF RESOURCES(MAN)
Time available of various resources(in min)
Role Timing Break Time No. of ppl Total Time
Assumptions:
Physicians 9 A.M to 5 P.M 1 hour 9 3780(9*7*60)
1.Medical assistants work from 9
Medical Assistants 9 A.M to 5 P.M 1 hour 7 2940(7*7*60) to 5 with 1hour break
Registration Clerks 8.30 A.M to 5 P.M 1 hour 4 1800(4*7.5*60) 2.Registration clerks work for 30
mins and take a break of 60 mins
Coordinators 9 A.M to 5.30 P.M 1 hour 3 1350(3*7.5*60) and work for an hour after 4 on
Security Guard 7A.M to 6P.M 1 hour 1 600(1*10*60) paperwork
3.Security Guard takes a break of
Pharmacist 9A.M to 5.30 P.M 1 hour 3 1350(3*7.5*60) one hour
&PharmaTechnnicians
Percentage Utilization
Role Utilized time Available time Percentage Utilization Assumption:
Physicians 2400 3780 63.49% 1.Besides, issuing cards Guard
Medical Assistants 720 2940 24.49% Guards the door all the
available time
Registration Clerks 1260 1800 70.00%

Coordinators 840 1350 62.22

Security Guard 600 600 100.0%

Pharmacist 990 1350 73.33%

&PharmaTechnnicians
Multiple Activity Chart for Pharmacy Customers and New/Regular Customers(Room Facility)

Room Facilities
S.No Description Time(min)
Registration
Waiting Room Provider room Coordinator desk Pharmacy
window
1 Wait Time at Security 10
Processing time at Check-in.
2 2
Red/Yellow Colour card
3 Wait Time for Registration 24
Registration & Enrollments
5 8
(For Returning/New
Waiting for Vital Signs
6 15
Checking
7 Checking Vital Signs 6
Waiting after Vital Signs
8 8
Checking
Waiting For Consultation
9 17
from Provider
10 Consulting Provider 20
Waiting for Follow-up
11 25
appointments
Receiving Follow up
12 7
appointments
13 Wait Time at Pharmacy 13

14 Filling Prescription 11

Room Facilities
S.No Description Time(min)
Registration
Waiting Room Provider room Coordinator desk Pharmacy
window
1 Wait Time at Security 10
Processing time at Check-in.
2 2
Red/Yellow Colour card
3 Wait Time for Registration 24
Registration & Enrollments
5 8
(For Returning/New Patients
6 Wait Time at Pharmacy 13

7 Filling Prescription 11
UTILIZATION OF RESOURCES(ROOM FACILITIES)
Room Percentage Utilization
Waiting Room 83-100%
Registration Window 48.7%
Provider Room 52.85%
Coordinator Desk 46.66%
Pharmacy 100%

Percentage Utilization=Utilized time/Available time

• Waiting Room= Between 83-100% (calculated using averages)
4(𝑐𝑙𝑒𝑟𝑘𝑠)
• Registration window= ∗ utilization of clerks
5(𝑑𝑒𝑠𝑘𝑠)
3∗𝑢𝑡𝑖𝑙𝑖𝑧𝑎𝑡𝑖𝑜𝑛 𝑜𝑓 𝑚𝑒𝑑𝑖𝑐𝑎𝑙 𝑎𝑠𝑠𝑖𝑠𝑡𝑎𝑛𝑡𝑠+8∗𝑢𝑡𝑖𝑙𝑖𝑧𝑎𝑡𝑖𝑜𝑛 𝑜𝑓 𝑝ℎ𝑦𝑠𝑖𝑐𝑖𝑎𝑛𝑠
• Provider room =
11
3(𝑐𝑜𝑜𝑟𝑑𝑖𝑛𝑎𝑡𝑜𝑟𝑠)
• Coordinator desk= *utilization of coordinators
4(𝑑𝑒𝑠𝑘𝑠)

• Pharmacy Utilization=100% Because the average time spent by patients and pharmacy customers is higher than
450(90*11/2=495 is avg for prescription)
INFERENCES
Inspite of having a lot of unused time patients are having a high waiting
time this is due to inefficient process flow.
For Regular/New Patients
Avg.Cycle Time =166
Avg.Wait Time =112 For Regular/New patients time in service is 32.53% and Pharmacy
Avg.Time in Service=54 Customers it is 29.85% which is very low.

The Physicians time utilization though given is highest but based on the
data given the utilization is not even. Because of the Distribution not
being even the wait times are going high

For Pharmacy Customers Inspite of having 7 medical assistants there is improper documentation
Avg.Cycle Time =67 due to which the 840 minutes of Physician time is being
Avg.Wait Time =47 unutilized (70% of 120 cases a delay of 10 minutes occurs because of
Avg.Time in Service=20 incomplete reports). At the same time 1 out of 5 registration desk is
unutilized.

Pharmacist utilization is less compared to Pharmacy Technicians who

contribute a 100% utilization
Bottleneck
Coordinator & Follow Up
SUGGESTIONS
Establish Infrastructure for Synchronization between Registration Desk and Physicians.
This would lead to effective utilization of Physicians as well as reduction in wait times for patients.
Reduce the number of Medical assistant from 7 to 5 to increase their utilization.

Train Medical Assistants in terms of Reports. This would help Medical Assistants understand the
report requirement and if the problem of missing reports continues, they will be needed to be
replaced

Besides providing consulting for technicians the Pharmacist should also be involved in the filling
prescription process for effective process flow. Also, train 1 medical assistant for pharmacy job
and use him.

Number of Registration Windows is 5 when the number of registration clerks is 4. So one

registration window can be closed for effective utilization of resources.
Similarly there are 4 Co-Ordinator desks for 3 Co-Ordinator so one desk can be removed.
THANK YOU