BOOKS OF RtfiDIfGS - PAHO/WHO

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2. ldentify problemn areas in a -, and all patient flow related
operations;
3. Collect and analyze meaningful hard data to test various
hypotheses regarding the status of the patient flow systems
and procedures and the reasons for the evolution of these
systems to their current state;
4. Delineate the most meaningful and reasonable goals and
objectives for the patient flow system;
5. Recommend both long-range and short-range improvements
to the patient flow related operations.
Historical background
The "old appointment system" was romprised of a central appointment
desk (CAD) and several parrially decentralized nonuniform
procedures. Within the Medical Division, the CAD
scheduled physical examinations only. All types of appointments
of the surgical division as well as "forme'r" appointments for all
departments were made either by the desk receptionists or by the
medical secretaries. Routing Section personnel were responsible
for consults, X-rays, laboratory tests, special exams, and reports.
Each doctor kept an appointment sheet specifying the time of day
during which different types of patients should be scheduled.
Because of the rapid growth of the outpatient clinic and a lack
of adequate support, the CAD became less effective in performing
its job. As matters worsened, complaints abcut patient flow
were expressed by physicians throughout the clinic. The major
criticisms were incompetence in the scheduling function and
favoritism (more patients were directed to certain physicians or
departments than to others.) Consequently, some departments
transferred control of their appointments (except reports and
consults which were kept by the Routing Section) to appointment
secretaries stationed on the department floors. Further movement
toward decentralization followed. As each department devised
its own rules for scheduling patients, a gradual degeneration
of the clinic's overall systems and procedures for making
appointments resulted. This degeneration was further aggravated
by the rapid turnover of clerical personnel which was
HOSPITAL & iHEALTH SERVICES ArtMINISTRA1ION 1 WINTER 1978