Documenting and Improving Outpatient Processes

Documenting and Improving Outpatient Processes

Assignment 2 Description

Following up from the as-is process modelling (in Assignment 1), your Consulting Team has been asked to conduct a targeted process analysis and improvement project for the end-to-end Outpatients processes at Divi-Osu hospital.

One of the key goals set by Divi-Osu’s management team is to exceed customer expectations throughout the Consultation, Prescription Fulfillment, and Laboratory processes. This means that the core end-to-end processes should be efficient, timely, customer focused and have minimal duplication of effort, while at the same time mitigating its risk exposure and maximising profit opportunities. It is expected that your project will contribute towards this goal.

Your team has been asked to produce a short report, which documents the completion of the following tasks:

Task 1: Analysis of the current process. Specifically, the Divi-Osu management team is interested in:

the identification and analysis of all process waste, using a variety of qualitative and quantitative techniques;
the development of a comprehensive register of issues in the current process, including their root causes; and
a discussion on their impact on the overall efficiency of the process.

Your findings should be supported by a detailed analysis through the application of appropriate analytical techniques. Note: given the amount of data available, it would be difficult to conduct meaningful queueing analysis and simulation. Hence, you are NOT required to perform these two analysis techniques.

Task 2: Improvement of the current process. Specifically, your consulting team is expected to identify a set of different process changes which can benefit the process, including:

a variety of improvement ideas that focus on enhancement techniques
at least one improvement idea (for part/all of the process) which has been derived from existing practice.
at least one improvement idea (for part/all of the process) which exploits an existing resource that is currently underutilised.

For each new idea presented, you are expected to:

Classify the idea as being achievable in the short term (next 3-6 months) or in the long term (next 1-3 years).
Explain the qualitative and quantitative benefits of the idea, when implemented.
Assess the feasibility of your improvement recommendation.

Finally, assuming all of your recommended improvement ideas are accepted by the Divi-Osu management team, prepare a multi-level to-be model, derived from your as-is model, that encapsulates all of your improvements. Your model should be consistent with the modelling hierarchy agreed to by the Divi-Osu management team:

You should have multiple levels when modeling [e.g., Level 1 (value chain), Level 2 (high-level activities grouped) and Level 3 (detailed activities)]. Include the control-flow, data and resource perspectives.
You should also include any additional modelling (e.g., Level 4) which you think is necessary to highlight the major improvements made to the process.
Furthermore, the model should make clear where changes have occurred (for instance, link model parts to discussion and explanations of ideas and/or issues using text annotations).
*It is also important that you discuss the key differences (using qualitative and quantitative evidence) on how the overall proposed to-be processes are better than the as-is processes.

IMPORTANT: Every team member must make a fully proportional contribution to all process analysis and improvement activities.

Take note of the Marking guide

Due: 11:59pm Friday 20th Oct 2023

About the process

A process description was provided with the Assignment 1 materials- which has been updated further now. See the updated details provided in Appendix C- which is meant to provide more clarity to the flow and activities, and also presents some of the quantitative data.

We have also provided a set of as-is process models, that the Divi-Osu Management has confirmed as the models they prefer to be used for the next steps. Your team needs to use these given process models for this assignment. They may not capture all the details of the current process, but capture the majority of the scenario that the Divi-Osu Management wants you to focus on. There may also be some errors and/ or missing aspects, which your team will need to identify and list as you proceed with your analysis.

While the management team has tried to cover everything, it is very likely that the information provided will still be inadequate at times. As for Assignment 1, a dedicated Channel is made available via IFN515’s MS teams page. This forum is open to clarify any missing details. You should try to make clarifications through this forum BEFORE you make any assumptions. In the event any assumption is made, all assumptions should be systematically recorded in your report.

Submission Requirements

Submit a single PDF file of your report, including all text and models, via the Assignment 2 link on IFN515 Canvas space.
Each submission must contain a declaration, signed by all group members, stating that they have viewed the final version of the assignment that is to be submitted and that it is entirely their own original work (see Appendix B for the template).
Each team should only submit one report (by only one of the team members).

Appendix A: Sample Report Structure

Note: all page limits given are approximate and meant only as a guide

Cover page (1 page) o Title and team name (if any) o Name and Student ID of each team member o Signed declaration of original work (see Appendix B)
Executive summary (0.5 – 1 page)
Table of contents (1 page)
Introduction (1–2 pages) o Purpose of the report o Project goals o Structure of the report

Process Analysis (10-15 pages) o Discuss the evidence, assumptions, justifications, results, reasoning and interpretations of the results, etc., as required for Task 1.

NOTE: ***It is vital that the workings of the analysis are clearly documented- outlining each step, and presented within the report (refer to workings you see in the tutorial model answers as examples). You can add these as part of the main report and/or as details in an Appendix.

Process Improvement (10-15 pages) o Discuss the improvement recommendations, impact analysis, feasibility analysis, etc., as required for Task 2.
- To-Be Process Models (Changes made to the as-is process models to reflect the improvement recommendations should be highlighted, annotated and explained).

NOTE: ***It is vital that the new process is described in sufficient details (to complement the models), highlighting the key changes recommended and demonstrating the benefits the new process brings to the case organisation.

Short proposal of Implementation Plan (2-3 pages)
- A consolidated plan of systematic implementation of improvement recommendations considering long-term vs. short-term and prioritisation based on impact & feasibility analysis.
Conclusion (0.5 pages)
References (if any, 0-1 page)
Appendices (Reflection statements and any other Appendices your team chooses to have here)

Appendix B: Declaration Template

By submitting this assignment, I am/We are aware of the University rule that a student must not act in a manner which constitutes academic dishonesty as stated and explained in the QUT Manual of Policies and Procedures. I/We confirm that this work represents my individual/our team’s effort, I/we have viewed the final version and does not contain plagiarised material.

Full Name	Student No.	Signature

Appendix C: UPDATED Process Descriptions (with process metrices)

This case study is of a mid-sized private hospital in Sri Lanka, ‘Divi-Osu’[1]. Divi-Osu provides inpatient and outpatient services and operates a few branches in the Colombo district and Western province of Sri Lanka.

Divi-Osu is a leading private-sector healthcare provider in Sri Lanka—among the top ten private hospitals in Sri Lanka. Divi-Osu’s service network offers inpatient and outpatient care facilities, pharmacy outlets, a wide range of sample collecting centers and ISO-certified laboratory services. Divi-Osu has three private hospitals for inpatient care and eight other branches for outpatient care, with a total of ten ISO 9001- 2015 certified laboratories and over 250 sample collection centers spread over three districts. Also, ten pharmacies offer pharmaceutical and medical needs. They strive to be customer-focused on all their service offerings and highlight this in their branding and marketing campaigns.

The hospital’s senior executives decided to systematically analyze its customer-facing processes to improve the overall customer experience while identifying mechanisms to create self-service opportunities for the customers and reducing costs with little or no impact on service quality. By ‘customers,’ they refer to the patients who directly receive the service and their families who accompany them while in the hospital.

The hospital management has selected several key focus areas and invited your team (IFN515 project team) to work with the Outpatient department of the main branch in the town of ‘Malabe’. The data presented here is about this single branch, and the scope of the analysis is limited to the information provided. The management wants you to focus on three main areas: the consultation unit, pharmacy, and laboratory.

Outpatient services are one of the first environments in the hospital that patients are introduced to when they arrive, delivering diagnostic, curative, preventative, and rehabilitative services. The outpatient service is most important as it influences the overall perception of a hospital’s services to the patients. Outpatient care is globally rapidly growing, and it has been predicted that outpatient centers’ revenue will be greater than inpatient services revenue in future.

The information shared below was gathered from semi-structured interviews and questionnaires. There will also be a provision to clarify any queries you may have. A separate channel has been set up within the IFN515 MS team’s page to facilitate this.

The Business Processes in Focus

The Consultation Process

The typical patient journey starts when a patient organizes a booking in the consultation wing of the hospital.

Customers can arrange an appointment with a doctor in two ways: (a) by booking an appointment via the hospital reception by phone (~30) or (b) with an in-person visit to the reception (~ 70%). The booking fees vary (e.g., different doctors charge different amounts), but on average is ~ RS 3000.00 per consultation. All bookings are recorded in a central booking system- that the entire hospital chain uses for managing bookings.

Both types (phone and in-person) bookings are handled by the outpatient receptionists, where all activities, such as entering patient details, booking an appointment, and getting and processing the payments, are handled by these receptionists. Patients need to pay the full appointment fee when making a booking.

If the booking is made in person, the appointment fee can be paid via cash or card, after which they will receive a printed booking confirmation. If the booking is made via phone, the appointment fee can only be paid by card, after which they will receive a booking confirmation via SMS or email. A request for an appointment made by a direct visit will take ~ 5 mins of serving time. But the waiting time will vary if there is a queue (~up to 30 mins). An appointment by phone will take ~ 8 mins of serving time and, at times, can involve long waiting times (up to 1 hour).

There are 2-3 receptionists on duty- 24/7, 365, to look after any calls or visitors at the reception desk. Sometimes the reception desk gets very busy, especially in the mornings from 7.00 a.m.-9.30 a.m. and 4.00 pm to 7.00 p.m., in which case the responses to phone calls get delayed (~20 mins). Sometimes phone calls go unanswered. Anyone waiting to be served must queue up; there is only one queue at the reception desk.

Any time before the appointment booking, a patient may reschedule the appointment. Any changes to an existing appointment must be dealt with by a phone call or a drop-in at the reception. An admin fee (of Rs 300.00) is charged for each rescheduling triggered by the patients. This additional rescheduling admin fee is only handled directly at the cashier (regardless of if paid by cash or card). This fee is paid when a patient comes for the appointment and not at the time of rescheduling (unless both occur on the same day). This can take ~ 5 mins of serving time, but the patient may have to be in a queue before being attended to (~30 mins).

~ 20% of the outpatient appointments already made – get rescheduled. ~ 5% of the rescheduled appointments get rescheduled again. While rescheduling may take only 3-5 mins, the customer must wait to reach the reception to arrange this (~30 mins).

Any time before the appointment booking, a patient may cancel the appointment, which incurs a penalty. An admin fee of Rs 300.00 is charged for cancellations (which is taken from the original booking fee). A cancellation can be made either in person or over the phone. Someone from the patient’s side must physically go to the cashier for all cancellations to collect the refund. While the actual servicing time may only be ~ 5 mins, the queues at the cashier are often long (~45-90 mins waiting time). Several customers have complained about the inconvenience caused by this (both having to come physically and the waiting times).

~5% of appointments made get cancelled, and 90% of appointment cancellations occur within the same date of the appointment—this makes it harder for the hospital to back-fill any vacant places. There is no system in place to manage any waitlisted patients.

The process continues once a patient presents themselves at the reception for their appointment. Note that when a patient arrives at the reception for appointment, they have the option to book an in-person appointment on the same day, be registered for a pre-booked appointment, or be asked to pay a rescheduling fee, if it applies.

Patients must register at the reception and show their booking confirmation (~ 10 mins) when they arrive. The receptionists will then issue (~ 3 mins) the patients a printed ‘ticket’ (a number confirming the order with which the Doctor will see the patient that day and an estimated appointment start time). The patients are expected to be in the waiting rooms, ready to be called in to see the doctor – per the estimated start time of the appointment. The waiting times vary, depending on the doctor’s arrival time (they get delayed with ward rounds and traffic if they travel from elsewhere) and the time it takes the doctor to see other patients on the day. 95% of the time, there are delays between this ‘estimated time’ and the time the patient sees the doctor (approximately 60-90 mins delay).

Given the doctors’ busy and somewhat unpredictable schedules, the exact consultation times vary. The appointments are based on an estimated time frame (e.g., ‘First patient seen at 4.00 pm’…). Different doctors have different capped bookings per day. Booking over typical capacity limits for each consultation session is standard practice. For example, if the doctor has capped six patients per hour, the receptionist may book 8 patients. This is to cater to potential reschedules and patient cancellations. But sometimes (~ 50% of the time), all patients do come, creating a bottleneck.

Each doctor works with a practice nurse to prepare their consultation room and handle patients orderly. The practice nurse picks the list of patients from the receptionist as soon as the doctor arrives. The doctors see the patients in chronological order of the issued ticket numbers. When the doctor is ready to see a patient, they inform the practice nurse. Then, the practice nurse calls the patient into the doctor’s examination room by announcing the ticket numbers. While each consultation varies, on average, a patient spends ~ 15 mins with the doctor.

If a patient is not present or does not respond to the call of the number- when it is made, they may have to wait till the end of the issued numbers to see the doctor. These patients are put at the end of the list of patients and are recalled once after all other patients have seen the doctor. Furthermore, if the patient does not present themselves the second time their ticket is called, this appointment is treated as a ‘no-show’ and ends there. The patient will not be able to get any refunds in these cases.

Patients who present themselves will see the doctor in the doctor’s consultation room. After examining the patient, the doctor will instruct them on the next steps:

~ 5% of the patients are asked to get admitted to the hospital for further treatment (as in-house patients). 40% get admitted on the same day, and the rest return later within 1-2 days. Occasionally (1% of the time), the patient may decline the request for hospital admission (note that ‘Admissions’ (as in-patient customers) are out of scope for this project).

For this investigation, the process ends once the patient has been scheduled to be admitted to the hospital (as they will then enter a new process as an ‘in-patient’).

Of the rest:

15% are asked to do some further tests and to come back with the test results. Patients can take these tests within the laboratory facilities within the hospital. See the Section outlining the laboratory process below for the details of testing.

Once the tests are done, the patients must make a new booking to come back and see the doctor and obtain the relevant medical advice.

Some patients (~ 11% from this) may decide not to come back to see the doctor.

80% of the patients get prescriptions written up for ongoing medication. The doctor will also instruct the patients on using the medication and advise on additional care (if needed).

The Prescription Fulfillment Process

The pharmacy is open to the public and is one of the few big pharmacies in ‘Malabe’- where this branch of Divi-Osu resides. They have a reputation for always having medicines in stock with different brand options and are open 24/7; hence, many people come there to purchase their pharmaceutical needs.

The prescription fulfilment process starts when a customer requests the fulfilment of a script. Customers can present themselves in person or call to order products. In either case, customers can pick up orders from the pharmacy – or get them delivered. Call-based orders are just for non-prescription items – the pharmacist needs to see the prescriptions before any prescription medications can be issued.

The Pharmacy-assistant handles any call orders. They will confirm the products and costs while on the call, and once the customer confirms that they will buy the agreed products, the collection mode is discussed and confirmed (~2 mins of serving time). With 30% of the call orders, customers pick up the goods from the hospital counter and ask for an estimated time for when the goods will be ready—the rest request delivery. The estimated delivery date and time are communicated, and the delivery address is confirmed.

After this, the Pharmacy-assistant packs the order (takes ~ 8 mins) and bills those (~ 2 mins). Orders to be picked up are handed to the Cashier. The patients who arrive to collect the orders will make the relevant payments (~ 3 mins serving time) and collect the order at the cashier. If the customer has requested the medication/ products to be delivered, the goods are handed over to the delivery person. The actual handing-over of the goods to the delivery persons only takes ~ 2 mins; however, the exact timings may vary depending on the availability of delivery persons. A delivery fee is included with the bill and is automatically calculated based on the distance.

Customers who walk into the pharmacy must wait there for a while in a queue. The waiting time varies- based on how big a queue already exists (approx. 30 mins). The queue is influenced by the complexity of each prescription- like how many medications are listed and the effort required to prepare the medicines and appliances. Some customers ‘drop off’ the prescription (and their order) and return later to collect it – as it can take a while (especially at peak times) to be served with the products. Patients who present their scripts can also alter them, e.g., request brand names or cheaper products and/or add additional items from the pharmacy.

A pharmacy assistant will take the prescription from the customer next in line and use the digital stock reports to check the availability, prices, and substitutes for what is recommended in the prescriptions (~ 4 mins). The Pharmacy-assistant will read the prescriptions and collate the medicine as per the prescriptions (~ 5 mins).

If a pharmacy assistant cannot identify the handwriting in the prescription or has any other doubt – they seek advice from the Pharmacist (~ 3 mins of serving time). There are times (~ .005%) when the Pharmacist needs to call the referring doctor to seek clarification (when the prescription is also unclear to the pharmacist). Seeking clarification this way is problematic, as it is often difficult to reach the doctors, and the pharmacist may need to call the doctor multiple times. Customers are encouraged to return later or arrange a delivery when such delays occur.

Some customers want the exact medicine from the actual brand, and some are ready to buy from another brand that offers the same medicine for a lower price. In the prescription-checking stage, the Pharmacy-assistant lets the customer know these facts (~ 3 mins). Then, after the customer states what they want, the Pharmacy-assistant collects the medicines and appliances from relevant racks and packs them (~ 5 mins).

The customers, at times, add non-prescription items (e.g., paracetamol, vitamins & supplements, sanitary towels etc.) to the order. The Pharmacy-assistant collates these products and bundles them with the customer’s orders (~ 5 mins).

For all prescription medicines, once the products are allocated, the Pharmacy-assistant passes (~ 2 mins) these to the Pharmacist, who checks them against the prescriptions and derives the instructions on how to take the medication (~ 10 mins). The instructions are always in English on a printed label affixed to the products. Since not all customers are fluent in English, the customers sometimes (~ 30% of the time) ask for a verbal explanation from the Pharmacists.

Once the orders are checked, the Pharmacist passes the goods (~ 2 mins) to be billed to the cashier. The Cashier handles all bills paid at the pharmacy.

If the customer has opted to pick up the medicine in person, the Cashier handles the payment from the customer, where they can pay with cash and credit or debit cards (~ 3 mins). The goods are issued after payment is confirmed, together with a receipt issued to the customer. When a customer is billed- the stock reports are adjusted simultaneously via the stock management system- this is done automatically through the central billing system.

If the customer has opted for delivery, the delivery team handles the payment and delivers the medicine to the patient at their home. The delivery person (via phone) contacts the customer to inform them of the estimated delivery time and to reconfirm the address/ location (~ 3 mins). The customer is told that they must be ready to collect and pay for the goods.

When the delivery person reaches the destination, they deliver the order and provide the customer with the bill (~ 3 mins). At this point, the customer must make the payments – before receiving the goods (~ 3 mins). They can pay with cash or cards. The delivery person collects the payment, and the customer is issued a receipt (~ 2 mins). Sometimes (~ 5% of the time), the delivery person may not have the correct change to give back to the customer- in which case the customer must pay by card. When the delivery person reaches the pharmacy, the funds of the delivered goods are handed over to the Cashier and noted in a separate ledger (~ 5 mins).

Deliveries are only on weekdays (9.00 am-5.00 pm) and Saturdays (9.00 am-12.00 pm). Two delivery persons (casual employees) work for the pharmacy during these times, and they will each take the deliveries on a first-come, first-serve basis. At this stage, there are no priority delivery options available, and prioritizing the orders is something the pharmacy is considering for an additional fee- hopefully, to be implemented by 2024.

However, if the delivery person cannot locate the customer’s address and/or there is no one available to receive the goods (this is rare, about .005% of the time), the delivery person returns the goods to the pharmacy. The Chief-pharmacist has asked to maintain a record of any incidents of this sort. There is a manual ledger in the pharmacy to keep such details (which takes ~ 5 mins to fill – and is filled by the delivery person and confirmed by the cashier). These customers are called back again at the end of each day (after the last scheduled delivery) to see if they still want the goods. If they say ‘yes,’ a second delivery is arranged with an additional fee (again calculated based on distance). The process ends for those still unreachable or say ‘no’ at that stage. Upon receipt of any returned goods, the pharmacy-assistant updates the stock records (~3 mins) and returns the goods to the shelves (~ 5 mins).

When the delivery person reaches the pharmacy, the funds of the delivered goods are handed over to the Cashier and noted in a separate ledger (~ 5 mins). This ledger is checked by the Chief-pharmacist (against funds received and delivered orders and delivery persons) periodically 2-3 times daily. Delivery travel times vary drastically from 10 mins to 1.5 hrs.- depending on distance and traffic conditions.

At the Pharmacy, there are 2 Pharmacy-assistants on weekdays from 7.00 am-7.00 pm and only one at night and at weekends. There is always one Pharmacist and one Cashier present. A Chief-pharmacist is present each weekday from 8.00 am-6.00 pm. The Chief-pharmacist oversees the business operations of the pharmacy and is mainly engaged with the overall management of the pharmacy, including supervising all staff, reviewing, and managing the HR (e.g., staff rostering), financial aspects (e.g., procurement) and marketing. But the Chief-pharmacist steps in when needed to assist with any bottlenecks -especially in the roles of the Pharmacist and Cashier.

The Laboratory Process (for outpatients)

Like the Pharmacy, Divi-Osu’s Laboratory services are open to anyone seeking them. For the public and Divi-Osu’s out-patients, their opening hours are Mon-Fri, 7.00 am to 6.00 pm and Sat from 8.00 am-1.00 pm. For Divi-Osu’s in-patient needs, the Laboratory is functioning on an on-call basis, and there is a separate process[2] for this. Below we narrate the current scenario of how out-patients and the public access Divi-Osu’s laboratory services. While this is in-scope for your assessment, handling in-patients’ laboratory needs are out-of-scope and not described here.

The laboratory testing process starts when a customer presents with a doctoral referral (which outlines the necessary tests). Patients must visit the laboratory counter to access any services or book appointments. Some tests can be done without a prior booking (at Divi-Osu, these are called ‘walk-ins’), while others require a booking.

The lab tests are of two kinds:

sample collections (e.g., for blood, urine tests etc.) – these are done by ‘sample collectors’ and are simpler and non-invasive, and
other tests (e.g., ‘fine needle’ aspirations, ultrasound-supported pathology tests etc.) are done by specialized ‘technicians’- these often require technical equipment and can be invasive).

For booked tests, the technicians(s) often need to prepare in advance; hence there can be a wait for these booked services (approx. 30 mins).

When a patient comes to the laboratory counter, they must hand over the doctor’s referral to a clerk servicing the counter (there are usually 2-3 clerks on duty at any time – ~ 5 mins serving time). The clerk checks: the referral, availability of the tests and technician conducting the tests, costs of the tests etc. (~ 5 mins) and informs the patient of these details. There are several outcomes from this point.

Ideally, the clerk checks if the patient is happy to proceed (~ 2 mins), and if they are, the process continues.
However, a patient may decide not to continue with testing, which occurs 2% of the time. This may be for several reasons; for example, after checking the costs for the tests, they may want to go to another lab, or they may not wish to proceed with the test if they feel/ fear it is invasive.
Finally, a doctor may sometimes request a test unavailable through Divi-Osu’s labs. In these cases (5% of the time), the patients are informed of this and advised where else to get the tests done. The process, from the hospital’s perspective, ends with such scenarios.

If the patient is happy to proceed, then they need to register. The clerk opens a physical folder for each registered patient, held temporarily at the counter till the test reports are issued (~ 5 mins). This physical patient file will have the patient’s details, referring doctors’ details, and the test’s name and prices at the front. This file (and its information) is only used to issue the test results and discarded afterwards. For some pre-booked tests, the technicians will require the patient’s medical history to integrate with the test reports. Thus, when booking these pre-booked tests, the clerk will ask the patient to fill out additional information detailing their medical history.

Once the patient has registered and confirmed they want to proceed with the tests, the patient is issued a bill by the clerk at the counter, using a digital billing system- where the clerk enters the details from the manual form the patient filled out earlier (~ 8 mins). The patient must make the payments at the cashier (~ 5 mins) – where they get issued a bill receipt.

For tests requiring a booking (determined by the test type and occasionally by the demand for tests), the patient can visit the lab counter, make a booking (~ 3 mins), get the bill, and then come for the tests later. Pre-booked appointments can make the payments at the time of booking or when they come to do the tests. If a customer misses a pre-booked appointment, they can reschedule it after paying an additional fee. Tests are done only after all due payments are made.

For the testing, the patient must take the bill receipt to the relevant collection/ testing area and show it to the nurse in charge there (~ 2 mins). The nurse formulates and issues a printed tests-schedule to the patient, which outlines, in brief, the order of tests to be taken (most relevant when there are multiple tests). The nurse may also offer further verbal guidance to the patient on what to do and where to go next.

How long it takes a nurse to service a customer varies; on average, the service time is about 5 mins. There are often queues of patients waiting to speak to the nurse in charge at the collection center(s). Following the guidance of the nurse, the patient meets the sample collector and/or test technicians with the test schedule and bill receipt (~ 3 mins).

For test referrals that involve sample collections – the sample collector confirms patient demographic details (~ 3 mins) and prepares the labels for the samples (~ 5 mins). The patient is advised on how the collection occurs and the actual collection occurs (~ 5 mins). The labels are fixed to the samples, then placed in an ‘out-box’ tray (~ 2 mins), ready to be picked up by the back-end lab staff. These back-end lab staff periodically visit and take the samples of the ‘out-box’ trays, the tests are performed, and the results are delivered (manually) to the clerk at the counter. The time frames for test results depend on different tests but are usually within 24 hrs.

For more advanced test referrals that involve a technician– the test technicians will first confirm patient demographic details. Sometimes, the test technicians must also establish the patient’s medical history over a short conversation (~ 10 mins). Any equipment needed for the tests is prepared (the times here vary, on average 10 mins between patients), after which the test is conducted (again, the testing time depends on the type of test, on average, it’s ~ 10 mins per test per patient). The technician does a preliminary assessment post each test (~ 5 mins) to check that the test was done correctly (i.e., with all data points/ information needed to be covered). If things are not satisfactory at this point, the test is redone. The test reports are written up (~ 30 mins per test) later by the technicians, in-between patient appointments or after-hours (which they get paid overtime for).

For all cases, the test reports (when they are ready) are handed to the clerk at the counter (~ 2 mins), who then locates the patient registration file and attaches the report to the file (~ 10 mins). When all patient test results arrive and are ready, the clerk at the counter calls and informs the patient (~ 5 mins) that the reports are ready for collection. The patient must bring the bill receipt (as proof) when collecting the reports. Once the reports are collected, the clerk at the counter discards any remaining information about the patient.

From this point onwards, the process is deemed complete. However, the reality is that the patient could ‘restart’ the process by making a new booking for a consultation.

Additional Information

Further information about the process to assist your analysis has been provided by Divi-Osu’s management:

Patient numbers:
Divi-Osu currently serves ~ 54,000 patients with doctor Consultations a month.
Divi-Osu’s laboratory conducts, on average, 55,000 tests per month – with an average of 31,000 patients per month. Peak times for the laboratory are:
- Mon-Fridays 7.30 am till 10.00 am, and 12.30 pm-2.00 pm.
- Saturdays 8.00am-10.00am
Divi-Osu’s pharmacy serves ~ 80,000 patients a month (on average, each having ~ 3 prescription items and ~ 2 non-prescription items). Peak times for the pharmacy are:
- Mon-Fridays 7.30 am till 9.00 am and 4.30 pm-6.30 pm.
- Saturdays 10.00-1.00 pm

The average salary for hospital staff is as follows:
- Receptionist: RS 60,000 per month
- Cashier: RS 65,000 per month
- Practice Nurse: RS 87,000 per month
- Doctor: Gets a base salary of ~ RS 15,000 per hour and a commission of 60% of the revenue from each patient they see at the Outpatient department.
- Pharmacy Assistance: RS 50,000 per month
- Pharmacists: RS 87,000 per month
- Chief Pharmacists: RS 120,000 per month
- Clerk: RS 40,000 per month
- Nurse (in-charge in the laboratory): RS 90,000 per month
- Delivery Person: RS 300 per hour
- Sample collector: RS 75,000 per month
- Lab technician: RS 87,000 per month
- Back-end lab staff: RS 80,000 per month

Appendix D: IFN515 Assignment 2 Criteria Marking Sheet

Report marked out of 100 and will consist of 25% of the marks- this is for the whole group. You will get 5% of individual marks from a Peer Review, which is set up separately within Canvass.

TASK 1 & 2 Criteria	High Distinction	Distinction/Credit	Credit/Pass	Pass/Borderline	Fail	Mark
Executive Summary (5%)	The executive summary provides a stimulating and complete summary of the report. It includes the insightful identification of key findings (e.g. ‘This report will deliver x key findings, which are…’).	The executive summary provides a complete summary of the report. It includes the effective identification of key findings (e.g. ‘This report will deliver x key findings, which are…’).	The executive summary provides an incomplete summary of the report. It includes key findings (e.g. ‘This report will deliver x key findings, which are…’).	The executive summary provides a limited summary at a meta level (e.g. ‘This report will discuss…’).	The executive summary makes little to no attempt to summarise the report.
Introduction (5%)	Insightful and articulate introduction that illustrates the purpose of the report and states the project goals. It concludes by presenting the structure of the report (e.g. ‘The report is organised as follows …’) in a thorough and successfully organised manner.	Effective introduction that clearly illustrates the purpose of the report and states the project goals. It concludes by presenting the structure of the report (e.g. ‘The report is organised as follows …’) in an effective manner.	Sound introduction that appropriately illustrates the purpose of the report and states the project goals. It concludes by presenting the structure of the report (e.g. ‘The report is organised as follows …’) in a clear manner.	Limited introduction that partially illustrates the purpose of the report and states the project goals and report structure of the report. May be unclear or poorly organised.	The introduction fails to illustrate the purpose of the report or state the project goals and report structure of the report, and is very poorly organised.
Conclusion (5%)	Insightful conclusions that summarise the main findings, contextualise the report and cover any potential limitations.	Thoughtful conclusions that summarise the main findings, contextualise the report, and cover any potential limitations.	Satisfactory conclusions that summarise the main findings, contextualise the report, and cover any potential limitations.	Limited conclusions that summarise the main findings, contextualise the report, and cover any potential limitations.	Conclusion failes to summarise the main findings, contextualise the report, and/or cover any potential limitations.
Format (10%)	The report is presented in a highly professional manner (i.e. clearly formatted, paginated and with no spelling or grammar errors).	The report is presented in a very professional manner (i.e. clearly formatted, paginated and with very few minor spelling or grammar errors).	The report is presented in a generally professional manner (i.e. mostly clearly formatted, paginated and with a few minor spelling or grammar errors).	The report is presented in a unclear manner (i.e. unclearly formatted, incorrectly paginated and/or with a many spelling or grammar errors).	The report is presented in a largely unformatted manner.
Process Analysis (40%)	Highly insightful analysis of process waste, root-causes of issues, issues priority, and process efficiency, conducted using a variety of appropriate qualitative and quantitative analytical techniques. Process performance astutely measured and justified in a variety of clearly defined performance dimensions. All identified issues are consolidated in a well-structured issue register, which includes both qualitative and quantitative impact assessments. Perceptive interpretation and integration of results into discussions.	Complete analysis of process waste, root-causes of issues, issues priority, and process efficiency, conducted using appropriate qualitative and quantitative analytical techniques. Process performance measured and justified in a variety of clearly defined performance dimensions. Identified issues are consolidated in a well-structured issue register, which includes both qualitative and quantitative impact assessments. Clear interpretation and integration of results into discussions.	Mostly complete analysis of process waste, root-causes of issues, issues priority, and process efficiency, conducted using different qualitative and quantitative analytical techniques. Process performance measured in several defined performance dimensions. Most identified issues are consolidated in a structured issue register, which includes qualitative and quantitative impact assessments. Interpretation and integration of results into discussions.	Partly complete analysis of process waste, root-causes of issues, issues priority, and/or process efficiency, conducted using qualitative and quantitative analytical techniques. Process performance measured in one or two defined performance dimensions. Some issues are consolidated in an issue register, which may include limited qualitative or quantitative impact assessments. Some integration of results into discussions.	Little to no process analysis performed. Few to no issues identified. Issue Register poorly formed or largely incorrect.
Process Improvement (35%)	All process improvement recommendations are clearly articulated, closely linked to the analysis findings, and astutely integrated into discussions. Insightful analyses of the impacts of the proposed process improvements are clearly presented, including a feasibility analysis for each. A thoughtful, consolidated implementation plan around short-term and long-term recommendations is persuasively argued. A set of to-be process models, meeting all correctness requirements, fully reflect the proposed improvements, and include highly cogent annotations or explanations to link the updated parts of the process model and the relevant improvement recommendations.	All process improvement recommendations are soundly articulated, linked to the analysis findings, and integrated into discussions in a reasoned way. Sound analyses of the impacts of the proposed process improvements are well presented, including a feasibility analysis for each. A consolidated implementation plan around short-term and long-term recommendations is argued. A set of to-be process models, meeting all correctness requirements, mostly reflect the proposed improvements, and include thoughtful annotations or explanations to link the updated parts of the process model and the relevant improvement recommendations.	Most process improvement recommendations are reasonably articulated, linked to the analysis findings, and integrated into discussions. Analyses of the impacts of the proposed process improvements are presented. A consolidated implementation plan around short-term and long-term recommendations is provided. A set of to-be process models, meeting most/all correctness requirements, somewhat reflect the proposed improvements, and include annotations or explanations to link the updated parts of the process model and the relevant improvement recommendations.	Some process improvement recommendations are articulated, loosely linked to the analysis findings. Some analyses of the impacts of the proposed process improvements are presented. A implementation plan around short-term and long-term recommendations is provided to a degree. A set of to-be process models, meeting some correctness requirements, loosely reflect the proposed improvements, and include a few annotations or explanations to link the updated parts of the process model and the relevant improvement recommendations.	Few to no process improvement recommendations are provided, and/or are left unanalysed. Poorly formed implementation plan. To-be models are missing or of poor quality.

[1] The original names have been replaced with aliases to protect anonymity, as per agreements with the case organizations and the authors.

[2] The hospital decided to investigate this process when the in-patient processes will be modelled and analyzed, which is planned for another phase/ project due to trigger in another 3 months’ time.

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