Can Nationwide Central Appointment Systems Reduce Waiting Times in Turkish Public Hospitals?

Öz

Health service delivery is an important component of a well-functioning health system. To achieve a competitive healthcare system, healthcare should be provided on time to avoid delays that could harm the patient. In this respect, patient wait time is an important indicator of health services delivery performance. Countries develop national or regional booking systems to manage patient wait times and healthcare delivery resources more efficiently. In this study; the effect of a national booking system on outpatient wait times in Turkish public healthcare settings was investigated. This study was conducted using anonymized national outpatient data sets for the year 2016 with permission from the Republic of Turkey Ministry of Health. The data was analyzed after pre-processing and transformation. As a result of the study, patient wait times were calculated, analyzed and evaluated according to province and facility care levels (secondary or tertiary). Results showed that in 2016, only 30.69% of outpatient visits had appointments and that the average waiting time for patients with appointments was 11.18% shorter than for patients without appointments. The results of this study fill a gap in the literature as almost no studies have investigated this issue due to a lack of administrative and clinical data and will provide important evidence for the improvement of health service delivery systems.

Anahtar Kelimeler

• Patient Wait Times
• Health Services Planning
• Health Systems
• Healthcare Management
• Health Policy

Kaynakça

1. Adamu, H., & Oche, M. O. (2014). Patient satisfaction with services at a general outpatient clinic of a tertiary hospital in Nigeria. British Journal of Medicine and Medical Research, 4(11), 2181–2202. https://doi.org/10.9734/BJMMR/2014/5918
2. Bleustein, C., Rothschild, D. B., Valen, A., Valatis, E., Schweitzer, L., & Jones, R. (2014). Wait times, patient satisfaction scores, and the perception of care. The American Journal of Managed Care, 20(5), 393–400.
3. Borboudaki, L., Linardakis, M., Markaki, A. M., Papadaki, A., Trichopoulou, A., & Philalithis, A. (2021). Health service utilization among adults aged 50+ across eleven European countries (the SHARE study 2004/5). Journal of Public Health, 29, 671–681. https://doi.org/10.1007/s10389-019-01173-2
4. Brandenburg, L., Gabow, P., Steele, G., Toussaint, J., & Tyson, B. J. (2015). Innovation and best practices in health care scheduling. NAM Perspectives. http://nam.edu/wpcontent/uploads/2015/06/ SchedulingBestPractices.pdf
5. British Columbia Medical Association. (2006). Waiting too long: Reducing and better managing wait times in BC: A policy paper by the BCMA’s council on health economics & policy. British Columbia Medical Association. https://www.bcma.org/files/waiting_too_long.pdf
6. Bucak, I. H., Almis, H., Dogan, F., & Turgut, M. (2018). A retrospective analysis of central physician appointment system data in a tertiary health center in Turkey. Telemedicine and e-Health, 24(3), 216–221. https://doi.org/10.1089/tmj.2017.0109
7. Buckle, R., & Stuart Jr, T. J. (1996). Systematic approach reduced patient waiting times. Physician Executive, 22(4), 12–16.
8. Budinoski, K., & Trajkovik, V. (2012). Incorporate Social Network Services in e-Government Solutions. The Case of Macedonia. International Journal of eBusiness and eGovernment Studies, 4(1), 23–35.

9. Canadian Institute for Health Information. Health care in Canada, 2012: A focus on wait times. (Ottawa, ON: CIHI; 2012.) https://publications.gc.ca/collections/collection_2013/icis-cihi/H115-15-2012-eng.pdf
10. Cayirli, T., & Veral, E. (2003). Outpatient scheduling in health care: A review of literature. Production and Operations Management, 12(4), 519–549. https://doi.org/10.1111/j.1937-5956.2003.tb00218.x
11. Cheshire, J., Mateos, P., & Longley, P. A. (2011). Delineating Europe’s cultural regions: Population structure and surname clustering. Human Biology, 83(5), 573–598. https://doi. org/10.3378/027.083.0501
12. Cook, L., Landry, M., Cott, C. A., Sheridan, K. & MacKay, C. (2006). Wait lists and wait times for community-based adult rehabilitation in Ontario. Toronto: Arthritis Community Research & Evaluation Unit, University Health Network. http://www.acreu.ca/pdf/pub5/06-02.pdf
13. Corrigan, J. (2005). Institute of medicine, national academy of engineering building a better delivery system: A new engineering/health care partnership. In Reid, PP, Compton WD, Grossman JH, Fanjiang G.(Eds.), Crossing the Quality Chasm (pp. 95–99). National Academies Press.
14. Devaraj, S., Ow, T. T., & Kohli, R. (2013). Examining the impact of information technology and patient flow on healthcare performance: A Theory of Swift and Even Flow (TSEF) perspective. Journal of Operations Management, 31, 181–192. https://doi.org/10.1016/j.jom.2013.03.001
15. Eurostat. (2020). History of NUTS. https://ec.europa.eu/eurostat/web/nuts/background.
16. García, M., & Harmsen, B. (2012). Qlikview 11 for developers. Packt Publishing Ltd.
17. Gröne, O., & Garcia-Barbero, M. (2001). Integrated care: A position paper of the WHO European Office for Integrated Health Care Services. International Journal of Integrated Care, 1(June), e21.
18. Gunal, M. M., & Pidd, M. (2008). Interconnected DES models of emergency, outpatient, and inpatient departments of a hospital. S. G. Henderson, B. Biller, M.-H. Hsieh, J. Shortle, J. D. Tew, and R. R. Barton (Ed.). Proceedings of the 2007 Winter Simulation Conference (pp. 1461–1466). IEEE.
19. Hong, T. S., Shang, P. P., Arumugam, M., & Yusuff, R. M. (2013). Use of simulation to solve outpatientclinic problems: a review of the literature. South African Journal of Industrial Engineering, 24(3), 27–42.
20. Institute of Medicine (2015). Transforming health care scheduling and access: Getting to now. Washington, DC: The National Academies Press.
21. Johnson, W. L., & Rosenfeld, L. S. (1968). Factors affecting waiting time in ambulatory care services. Health Services Research, 3(4), 286–295.
22. Kielar, A. Z., El-Maraghi, R. H., & Schweitzer, M. E. (2010). Improving equitable access to imaging under universal-access medicine: the Ontario wait time information program and its impact on hospital policy and process. Journal of the American College of Radiology, 7(8), 573–581. https://doi.org/10.1016/j.jacr.2010.03.017
23. Kreindler, S. A. (2008). Watching your wait: Evidence-informed strategies for reducing health care wait times. Quality Management in Healthcare, 17(2), 128–135. https://doi.org/10.1097/01.QMH.0000316990.48673.9f
24. Kreindler, S. A. (2010). Policy strategies to reduce waits for elective care: A synthesis of international evidence. British Medical Bulletin, 95(1), 7–32. https://doi.org/10.1093/bmb/ldq014
25. Kurşun, A., & Kaygısız, E. G. (2018). Merkezi Hekim Randevu Sistemi (MHRS) uygulamalarına yönelik memnuniyet ve erişilebilirlik düzeyinin belirlenmesi. Acıbadem Üniversitesi Sağlık Bilimleri Dergisi, 9(4), 401–409. https://doi.org/10.31067/0.2018.63
26. Küçük, A., Demirci, M., Kerman, G., & Özsoy, V. S. (2021). Evaluating of hospital appointment systems in Turkey: Challenges and opportunities. Health Policy and Technology, 10(1), 69–74. https://doi.org/10.1016/j.hlpt.2020.11.008
27. Leddy, K. M., Kaldenberg, D. O., & Becker, B. W. (2003). Timeliness in ambulatory care treatment: An examination of patient satisfaction and wait times in medical practices and outpatient test and treatment facilities. The Journal of Ambulatory Care Management, 26(2), 138–149.
28. Lewis, S. (2009). Patient-centered care: An introduction to what it is and how to achieve it. A Discussion Paper for the Saskatchewan Ministry of Health. https://www.researchgate.net/publication/281610313_PatientCentered_Care_An_Introduction_to_What_It_Is_and_How_to_Achieve_It
29. Litvak, E., & Fineberg, H. V. (2013). Smoothing the way to high quality, safety, and economy. The New England Journal of Medicine, 369(17), 1581–1583.
30. Mardiah, F. P., & Basri, M. H. (2013). The analysis of appointment system to reduce outpatient waiting time at Indonesia’s public hospital. Human Resource Management Research, 3(1), 27–33.
31. Michael, M., Schaffer, S. D., Egan, P. L., Little, B. B., & Pritchard, P. S. (2013). Improving wait times and patient satisfaction in primary care. The Journal for Healthcare Quality (JHQ), 35(2), 50–60. https://doi.org/10.1111/jhq.12004
32. Mondal, B., & Dubey, J. D. (2020). Gender discrimination in health-care expenditure: An analysis across the age-groups with special focus on the elderly. Social Science & Medicine, 258, 113089. https://doi.org/10.1016/j.socscimed.2020.113089
33. Oğuzlar, A. (2003). Veri̇ ön i̇şleme. Erciyes Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, 21, 67-76.
34. Özdemir, D. (2013). Hastane süreçlerinin yalın yöntemler ile iyileştirilmesi(Publication No. 329375). [PhD thesis, Bursa Uludag University] Ulusal Tez Merkezi.
35. Pierce II, R. A., Rogers, E. M., Sharp, M. H., & Musulin, M. (1990). Outpatient pharmacy redesign to improve work flow, waiting time, and patient satisfaction. American Journal of Hospital Pharmacy, 47(2), 351–356. https://doi.org/10.1093/ajhp/47.2.351
36. Pyle, D. (1999). Data preparation for data mining. Morgan Kaufmann Publishers.
37. Rohleder, T., Bailey, B., Crum, B., Faber, T., Johnson, B., Montgomery, L., & Pringnitz, R. (2013). Improving a patient appointment call center at Mayo Clinic. International Journal of Health Care Quality Assurance, 26(8), 714–728. https://doi.org/10.1108/IJHCQA-11-2011-0068
38. Santibáñez, P., Chow, V. S., French, J., Puterman, M. L., & Tyldesley, S. (2009). Reducing patient wait times and improving resource utilization at British Columbia Cancer Agency’s ambulatory care unit through simulation. Health Care Management Science, 12, 392–407. https://doi.org/10.1007/s10729-009-9103-1
39. Schoen, C., & Doty, M. M. (2004). Inequities in access to medical care in five countries: Findings from the 2001 Commonwealth Fund International Health Policy Survey. Health Policy, 67, 309–322. https://doi.org/10.1016/j.healthpol.2003.09.006
40. Schwartz, F., Evans, W., Sullivan, T., & Angus, H. (2004). Gaining access to appropriate cancer services: A four-point strategy to reduce waiting times in Ontario. Cancer Quality Council of Ontario (CQCO). https://citeseerx.ist.psu.edu/document?repid=rep1&type=pdf&doi=ce91afa1dae07ebb1fe5edc1f1f22902080bb0c3
41. Shafeek Amin, N., & Driver, N. (2020). Health care utilization among Middle Eastern, Hispanic/ Latino, and Asian immigrants in the United States: An application of Andersen’s behavioral model. Ethnicity & Health, 27(4), 858–876. https://doi.org/10.1080/13557858.2020.1830034
42. Siciliani, L., & Hurst, J. (2005). Tackling excessive waiting times for elective surgery: A comparative analysis of policies in 12 OECD countries. Health Policy, 72(2), 201–215.
43. Siciliani, L., Moran, V., & Borowitz, M. (2014). Measuring and comparing health care waiting times in OECD countries. Health Policy, 118(3), 292–303.
44. Statistics Canada (2005). Access to health care services in Canada, January to December 2005. (Statistics Canada – Catalogue no. 82-575-XIE) The Minister responsible for Statistics Canada. http://www.statcan.gc.ca/pub/82-575-x/82-575-x2006002-eng.pdf
45. Speed, D., Bornstein, S., Kean, R., Bornstein, S., & Brien, S. O. (2016). Reducing wait times for outpatient services in Newfoundland and Labrador. The Newfoundland and Labrador Centre for Applied Health Research. https://www.mun.ca/nlcahr/media/production/memorial/administrative/nl-centre-for-applied-health-research/media-library/chrsp/Reducing_Wait_Times_RER.pdf
46. Sun, J., Lin, Q., Zhao, P., Zhang, Q., Xu, K., Chen, H., Hu, C., Stuntz, M., Li, H., & Liu, Y. (2017). Reducing waiting time and raising outpatient satisfaction in a Chinese public tertiary general hospital-an interrupted time series study. BMC Public Health, 17(668), 1–11. https://doi.org/10.1186/s12889-017-4667-z
47. Şahin, Ş. (2013). Merkezi hastane randevu sistemi uygulamasının etkinlik, farkındalığının, hasta bekleme süresine ve memnuniyetine etkisinin ağız ve diş sağlığı merkezinde değerlendirilmesi (Publication No. 351362). [Master’s thesis, Okan University] Ulusal Tez Merkezi.
48. TC Ministry of Health. (2019). General directorate of health information systems “Sağlık.NET.” https://sbsgm.saglik.gov.tr/
49. TR Ministry of Health. (2020). Central Physician Appointment System. https://www.hastanerandevu. gov.tr/Vatandas/hakkimizda.xhtml.
50. Turkish Statistical Institute. (2018a). Distribution of the number of health personnel by provinces. [Data set]. https://data.tuik.gov.tr/Kategori/GetKategori?p=saglik-ve-sosyal-koruma-101&dil= 1
51. Turkish Statistical Institute. (2018b). Number of people per healthcare professional. [Data set]. https://data.tuik.gov.tr/Kategori/GetKategori?p=saglik-ve-sosyal-koruma-101&dil=1
52. Watts, B. V., Shiner, B., Ceyhan, M. E., Musdal, H., Sinangil, S., & Benneyan, J. (2013). Health systems engineering as an improvement strategy: A case example using location-allocation modeling. The Journal for Healthcare Quality (JHQ), 35(3), 35–40.
53. White, D. L., Froehle, C. M., & Klassen, K. J. (2011). The effect of integrated scheduling and capacity policies on clinical efficiency. Production and Operations Management, 20(3), 442–455.
54. World Health Organization. (2010). Key components of a well functioning health system. https:// www.paho.org/derechoalaSSR/wp-content/uploads/Documentos/Bloques-Basicos-de-un-Sistema-de-Salud-OMS.pdf
55. Yıldızbaşı, E., Öztaş, D., Sanisoğlu, Y., Fırat, H., Yalçın, N., Dağ Şeker, E., Doğusan, A.R, & Akçay, M. (2016). The measurement of the satisfaction levels of patients using the central physician appointment system in a training and research hospital. Ankara Medical Journal, 16(3), 293–302. https://doi.org/10.17098/amj.63878