Yulia Leemanza, and Erna KristinTo cite: Leemanza Y, Kristin E. Effectiveness of wait time targets and patient satisfaction feedback in decreasing wait times for prescription services in an outpatient pharmacy. Can J Hosp Pharm. 2024;77(1):e3438. doi: 10.42112/cjhp.3438
ABSTRACT
Background
Long wait times for prescription services at the Outpatient Pharmacy of the Dr. OEN SOLO BARU Hospital in Indonesia have led to high numbers of complaints. In response, to decrease these wait times, the hospital undertook an intervention to determine wait time targets and provide feedback on patient satisfaction to personnel in the Outpatient Pharmacy.
Objective
To measure the impact of providing wait time targets and patient satisfaction feedback to pharmacists in terms of decreasing wait times for prescription services at the Outpatient Pharmacy.
Methods
This quasi-experimental research study had a single-group interrupted time-series design. Data on wait times and patient satisfaction were collected from “waiting patients”. The study participants were 35 employees (6 pharmacists and 29 technicians), and the intervention entailed provision of wait time targets and patient satisfaction feedback to the participants every week for 5 consecutive weeks.
Results
The wait times for prescription services decreased by 11.13 minutes (17%) for compounded prescriptions and by 12.70 minutes (37%) for noncompounded prescriptions. There was a significant change in average wait time for both compounded and noncompounded prescription services from week 0 to week 4 (p < 0.001). There was also a significant change in patient satisfaction from week 0 to week 4 (p < 0.001). Patient satisfaction increased significantly in conjunction with the decrease in wait times for prescription services.
Conclusions
The intervention of providing wait time targets and feedback on patient satisfaction to pharmacists helped to reduce wait times for prescription services.
KEYWORDS: wait times, targets, patient satisfaction, feedback, PDCA (plan, do, check, act) method
RÉSUMÉ
Contexte
Les longs délais d’attente pour les services de délivrance de médicaments sur ordonnance à la pharmacie ambulatoire de l’Hôpital Dr. OEN SOLO BARU en Indonésie ont donné lieu à un nombre élevé de plaintes. En réponse, afin de réduire ces temps d’attente, l’hôpital a cherché à déterminer des objectifs de temps d’attente et à fournir des commentaires sur la satisfaction des patients au personnel de la pharmacie ambulatoire.
Objectif
Mesurer l’incidence, sur le temps d’attente pour la délivrance de médicaments sur ordonnance à la pharmacie ambulatoire, de la remise aux pharmaciens d’objectifs de temps d’attente et de commentaires sur la satisfaction des patients.
Méthodes
Cette étude de recherche quasi-expérimentale était conçue selon une série temporelle interrompue à groupe unique. Les données sur les temps d’attente et sur la satisfaction des patients ont été recueillies auprès des « patients en attente ». Au total, 35 employés (6 pharmaciens et 29 techniciens) ont participé à l’étude, et l’intervention consistait à remettre aux pharmaciens des objectifs de temps d’attente et des commentaires sur la satisfaction des patients chaque semaine pendant 5 semaines consécutives.
Résultats
Les temps d’attente pour les services de délivrance de médicaments sur ordonnance ont diminué de 11,13 minutes (17 %) pour les ordonnances relatives aux préparations magistrales et de 12,70 minutes (37 %) pour les ordonnances relatives aux préparations non magistrales. Une différence significative a été observée entre les semaines 0 et 4 (p < 0,001) concernant le temps d’attente moyen pour les services de délivrance de médicaments sur ordonnance relatifs aux préparations magistrales et ceux relatifs aux préparations non magistrales. Une différence significative a également été observée dans la satisfaction des patients entre les semaines 0 et 4 (p < 0,001). La satisfaction des patients a augmenté de manière significative parallèlement à la diminution du temps d’attente pour les services de délivrance de médicaments sur ordonnance.
Conclusions
La remise aux pharmaciens d’objectifs en matière de temps d’attente ainsi que de commentaires sur la satisfaction des patients a permis de réduire les temps d’attente des services de délivrance de médicaments sur ordonnance.
Mots-clés: temps d’attente, objectifs, satisfaction des patients, commentaires, méthode PDCA (planifier, faire, vérifier, agir)
The wait time for prescription services is the interval from the time a patient submits a prescription until the patient receives the drug from the pharmacist. The standard wait times for prescription services set by the Indonesian Ministry of Health are 30 minutes for noncompounded drugs and 60 minutes for compounded drugs.1 However, in 2021, the average wait times for prescription services at the Outpatient Pharmacy of the Dr. OEN SOLO BARU Hospital were 37 minutes for noncompounded drugs and 73 minutes for compounded drugs.
Customer dissatisfaction can result in long-term losses; for example, there may be a decrease in repeat visits from existing customers, and customers may mention their dissatisfaction with the organization’s services to others. Therefore, reducing wait times can be an important concern for organizations that aim to provide superior services.2 In terms of the provision of services, motivation has a significant effect on employee performance.3 The application of rewards typically has a positive effect and can improve employee performance. The presence of goals can also benefit performance, although setting easy goals results in the worst performance, whereas setting difficult yet realistic goals can lead to the best performance.4 The literature shows that interventions like performance feedback and goal setting have improved customer service behaviour.3,4 Accordingly, hospital managers try to reduce wait times as a way to provide better customer service.2
In a study conducted by Slowiak and others in 2008, an intervention involving a targeted reduction in wait time and provision to pharmacy employees of feedback on patient satisfaction and average wait times resulted in a 20% reduction in wait time for prescription services at a hospital outpatient pharmacy in Michigan (USA).5 Several years later, the same author team conducted a follow-up study at the same location2 and observed shorter wait times for prescription services, higher patient satisfaction, and greater consistency of pharmacy employee performance than in the earlier study.
In the current study, we attempted to replicate the research conducted by Slowiak and others2,5 by targeting a reduction in wait time while providing feedback on patient satisfaction and average wait times for prescription services to employees of the Outpatient Pharmacy at our hospital. The study objective was to find solutions to support reductions in wait time for prescription services and increases in patient satisfaction with Outpatient Pharmacy services.
The study protocol was approved by the Medical and Health Research Ethics Committee of the Faculty of Medicine, Public Health, and Nursing, Gadjah Mada University (reference number KE/FK/0483/EC/2022).
This quasi-experimental study had a single-group interrupted time-series design.6 The intervention consisted of a combination of setting wait time targets and providing patient satisfaction feedback to employees of the Outpatient Pharmacy. Data were observed and collected for 5 consecutive weeks after consent was obtained from the employees.
The study participants were all of the employees in the Outpatient Pharmacy (6 pharmacists and 29 technicians). For measuring patient satisfaction and wait times for outpatient prescription services, a sample of 100 prescriptions was obtained each week using the Slovin formula, consisting of 46 prescriptions for compounded products and 54 prescriptions for noncompounded products. Patients whose prescriptions were selected for analysis of wait times were asked to provide satisfaction ratings. A stratified random sampling method was used to obtain prescription and patient satisfaction samples.
The dependent variables were wait times and patient satisfaction, the independent variable was the target for reducing wait time, and the PDCA (plan, do, check, act) method was applied. Prescription and wait time data were obtained from the hospital information system used in the Outpatient Pharmacy, patient satisfaction data were collected with a survey form, and a PDCA sheet was used to record steps in the process.
A bivariable analysis was conducted to examine the effect on wait times for outpatient prescription services of setting a target for reduced wait times and providing patient satisfaction feedback to employees. The Kolmogorov–Smirnov and Shapiro–Wilk tests were used to analyze the normality of wait times for prescription services and patient satisfaction data. If the data were not normally distributed, then the Mann-Whitney U test was used for statistical analysis. Linear regression was used to determine whether there was a relationship between patient satisfaction and wait time for prescription services. The 95% confidence interval was used, with a significance level of 5% (p < 0.05), and the analyses were conducted with SPSS version 17.0 software (IBM).
Statistical tests were conducted to compare the wait time data as follows: week 0 versus week 1, week 1 versus week 2, week 2 versus week 3, week 3 versus week 4, and week 0 versus week 4.
This study used the PDCA method to determine the target wait times for compounded and noncompounded prescription services at the Outpatient Pharmacy. During week 0 (April 25–30, 2022), the average wait times for compounded and noncompounded prescription services were collected. For each subsequent week of the study, a target was set for improvement in wait times, based on simulations and joint meetings involving the head of the Pharmacy Installation and Outpatient Pharmacy personnel. Details of the PDCA method as applied in this study are shown in Table 1.
TABLE 1 Activities Planned and Completed over the 4-Week Intervention Period, According to the PDCA Method
The Shapiro–Wilk test showed that wait time data for compounded prescriptions were not normally distributed (p < 0.05). Similarly, the Kolmogorov–Smirnov test showed that wait time data for noncompounded prescriptions were not normally distributed (p < 0.05). On this basis, it was determined that comparisons of average wait times, both week by week and for week 0 versus week 4, should be tested with the Mann–Whitney U statistic.
From week 0 to week 4, the average wait time for compounded prescription services decreased by 17% (from 63.93 to 52.80 minutes [Table 2]; p < 0.001 [Table 3]).
TABLE 2 Wait Times for Prescription Services
TABLE 3 Comparison of Wait Times for Prescription Services for Compounded and Noncompounded Products
Over the same period, the average wait time for noncompounded prescription services decreased by 37% (from 33.90 to 21.20 minutes [Table 2]; p < 0.001 [Table 3]).
The results of the patient satisfaction survey (Figure 1) involved nonparametric data, so the Mann–Whitney U test was again used for statistical comparisons, both week by week and for week 0 versus week 4.
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FIGURE 1 Results of patient satisfaction survey, based on a total of 100 prescriptions randomly selected during each week of the study. C = compounded products (n = 46 prescriptions each week), NC = noncompounded products (n = 54 prescriptions each week). | ||
For compounded prescription services, there was a significant change in patient satisfaction from week 0 to week 4 (p < 0.001), but patient satisfaction did not differ significantly in the week-by-week analysis (Table 4).
TABLE 4 Comparison of Patient Satisfaction with Prescription Services for Compounded and Noncompounded Productsa
For noncompounded prescription services, there was a significant change in patient satisfaction from week 1 to week 2 (p = 0.009), as well as a significant change from week 0 to week 4 (p < 0.001), but all other differences were nonsignificant (Table 4).
From baseline (week 0) to week 1, the interventions of adding a computer at the prescription reception counter, setting a schedule for outpatient technicians, and expanding the Outpatient Pharmacy room contributed to decreasing wait times by 6.43 minutes (10%) for compounded prescriptions and 9.12 minutes (27%) for noncompounded prescriptions, both of which were statistically significant. The reductions in wait time from week 0 to week 4 were also statistically significant, because the accumulation of improvements from week 1 to week 4 resulted in overall decreases in wait time of 11.13 minutes (17%) for compounded prescriptions and 12.70 minutes (37%) for noncompounded prescriptions.
At the study hospital, the PDCA cycle will be continued as long as the target wait times have not been achieved. In this regard, the better the feedback on the effectiveness of a given intervention, the more ideas for better solutions that are expected to emerge. In this situation, greater benefits are likely to occur with an implementation process that is repeated many times.7
For compounded prescription services, patient satisfaction increased significantly from baseline (week 0) to week 4 because of a decrease, by 8 patients (17%), in the number of patients who were dissatisfied or very dissatisfied with these services. At the same time, there was a corresponding increase, by 8 people (17%) in the number of patients who were quite satisfied, satisfied, or very satisfied with compounded prescription services.
For noncompounded prescription services, patient satisfaction increased significantly from week 1 to week 2 because of a decrease, by 1 person (2%), in the number of patients who were dissatisfied or very dissatisfied with these services. At the same time, there was an increase, by 11 people (20%), in the number of patients who were very satisfied with noncompounded prescription services. From baseline (week 0) to week 4, patient satisfaction with noncompounded prescription services increased significantly because of an increase, by 9 people (17%), in the number of patients who were very satisfied with these services.
There was a negative correlation between wait times for prescription services and patient satisfaction. In other words, the shorter the wait time for prescription services, the higher the level of patient satisfaction. The results of linear regression analysis between wait times for prescription services and level of patient satisfaction were statistically significant, implying a causal relationship between these 2 variables. This finding is in accordance with the results of a previous study in which patient satisfaction increased with short wait times for drug preparation.8
This study was based on an analysis of electronic prescriptions only; it did not include handwritten prescriptions in the Outpatient Pharmacy. In addition, the demographic and clinical characteristics of patients who completed the satisfaction survey were not analyzed.
The interventions of setting wait time targets and providing patient satisfaction feedback to pharmacists were supporting solutions for reducing wait times for prescription services at the Outpatient Pharmacy.
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Competing interests: None declared.
Address correspondence to: Dr. Yulia Leemanza, Dr. OEN SOLO BARU Hospital, Perum Solo Baru - Grogol, Sukoharjo, 57552, Indonesia, email: yleemanza@mail.ugm.ac.id
Funding: This study was funded by the Panti Kosala Health Foundation.
Acknowledgements: The authors would like to thank the director and staff of Dr. OEN SOLO BARU Hospital for their help and cooperation in obtaining the data.
Submitted: December 26, 2022
Accepted: June 20, 2023
Published: January 10, 2024
© 2024 Canadian Society of Hospital Pharmacists | Société canadienne des pharmaciens d’hôpitaux
Canadian Journal of Hospital Pharmacy, VOLUME 77, NUMBER 1, 2024
