Comparison of patient flow and provider efficiency of two delivery strategies for HPV-based cervical cancer screening in Western Kenya: a time and motion study

Abstract

Background: Improving patient flow and reducing over-crowding can improve quality, promptness of care, and patient satisfaction. Given low utilization of preventive care in low-resource countries, improved patient flows are especially important in these settings. Objective: Compare patient flow and provider efficiency between two cervical cancer screening strategies via self-collected human papillomavirus (HPV). Methods: We collected time and motion data for patients screened for cervical cancer in 12 communities in rural Migori County, Kenya as part of a larger cluster randomized trial. Six communities were randomized to screening in community health campaigns (CHCs) and six to screening at government clinics. We quantified patient flow: duration spent on each active stage of screening and wait times, and the number of patients arriving at CHCs and clinics each hour of the day. In addition, for four CHCs, we collected time and motion data for providers, and measured provider efficiency as a ratio of active (service delivery) time to total time spent at the clinic. Results: Total duration of screening visits, at CHCs and clinics was 42 and 87 minutes, respectively (p < 0.001 for difference). Total active time lasted longer at CHCs, with a mean of 28 minutes per patient versus 15 minutes at clinics, largely due to differences in duration for group education (p < 0.001). Wait time for registration at clinics was 36 minutes, explaining most of the difference between settings, but sometimes incorporated other health services. Conclusions: There is a substantial difference in patient flow at clinics compared to CHCs. Shorter duration at CHCs suggests that the model is favorable for patients in limiting time spent on screening. Future cervical cancer screening programs designed for scale-up should consider how this advantage may enhance satisfaction and uptake. For clinic-based screening programs, efforts could be made towards reducing registration wait times.

HPV‐based cervical cancer screening in low‐resource settings: Maximizing the efficiency of community‐based strategies in rural Kenya

“…[13][14][15] The cost per woman screened across the six CHCs ranged from US $22.06 to $30.21 (Table 1). Detailed results comparing CHC screening and treatment costs and uptake are presented elsewhere, and showed the main driver of the difference in efficiency was personnel time in the health facilities.…”

“…Detailed results comparing CHC screening and treatment costs and uptake are presented elsewhere, and showed the main driver of the difference in efficiency was personnel time in the health facilities. [13][14][15] The cost per woman screened across the six CHCs ranged from US $22.06 to $30.21 (Table 1). Most costs were fixed across CHCs, including tents, vehicles, data collection tools, and careHPV machine, so variations in costs and efficiency were mostly attributable to differences in personnel numbers.…”

“…13,14 In brief, all resources used were enumerated, whether fully paid, donated, or subsidized, and then multiplied by the unit price paid or from market quotes, adding up to estimate total unit costs per woman screened. Micro-costing techniques were used, as described in previous reports.…”

Patient Flow Analysis in General Hospitals: How Clinical Disciplines Affect Outpatient Wait Times

“…The main uses of patient flow are for estimating wait time and visit time, 2,9,10 identifying bottlenecks in service providing processes, 11,12 optimizing schedules, 13,14 and planning for future reorganization and resource allocation. 8,[15][16][17] Studies have focused on a large variety of hospital departments, such as outpatient departments and clinics, emergency departments, inpatient wards, surgical units, and also diagnostic and paraclinic departments. 18 Results of studies have indicated that PFA was useful in controlling patient wait times and throughput in the system.…”

An intern’s case study analysis of the patient transport function

“…[2] Recent studies address patient flow efficiencies within emergency departments. [3][4][5] It is difficult to find research on patient flow embedded in a large acute care hospital or integrated delivery system (IDS). In addition, the intra-hospital patient transport literature is focused primarily on ensuring the ergonomic safety of transport staff and wellbeing of transported patients.…”