title: Quality management: reduction of waiting time and efficiency enhancement in an ENT-university outpatients' department.
abstract: BACKGROUND
  Public health systems are confronted with constantly rising costs. Furthermore, diagnostic as well as treatment services become more and more specialized. These are the reasons for an interdisciplinary project on the one hand aiming at simplification of planning and scheduling patient appointments, on the other hand at fulfilling all requirements of efficiency and treatment quality.
  
  
  METHODS
  As to understanding procedure and problem solving activities, the responsible project group strictly proceeded with four methodical steps: actual state analysis, analysis of causes, correcting measures, and examination of effectiveness. Various methods of quality management, as for instance opinion polls, data collections, and several procedures of problem identification as well as of solution proposals were applied. All activities were realized according to the requirements of the clinic's ISO 9001:2000 certified quality management system. The development of this project is described step by step from planning phase to inauguration into the daily routine of the clinic and subsequent control of effectiveness.
  
  
  RESULTS
  Five significant problem fields could be identified. After an analysis of causes the major remedial measures were: installation of a patient telephone hotline, standardization of appointment arrangements for all patients, modification of the appointments book considering the reason for coming in planning defined working periods for certain symptoms and treatments, improvement of telephonic counselling, and transition to flexible time planning by daily updates of the appointments book. After implementation of these changes into the clinic's routine success could be demonstrated by significantly reduced waiting times and resulting increased patient satisfaction.
  
  
  CONCLUSIONS
  Systematic scrutiny of the existing organizational structures of the outpatients' department of our clinic by means of actual state analysis and analysis of causes revealed the necessity of improvement. According to rules of quality management correcting measures and subsequent examination of effectiveness were performed. These changes resulted in higher satisfaction of patients, referring colleagues and clinic staff the like. Additionally the clinic is able to cope with an increasing demand for appointments in outpatients' departments, and the clinic's human resources are employed more effectively.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, University Hospital of Frankfurt/Main, Theodor Stern Kai 7, 60590 Frankfurt/Main, Germany. Matthias.Helbig@kgu.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Helbig
authors.forename: Silke
authors.initials: S
authors.lastname: Helbig
authors.forename: Heike A
authors.initials: HA
authors.lastname: Kahla-Witzsch
authors.forename: Angelika
authors.initials: A
authors.lastname: May
mesh_terms: D000553:Ambulatory Care; D001071:Appointments and Schedules; D017598:Efficiency, Organizational; D005858:Germany; D006297:Health Services Accessibility / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D007407:Interviews as Topic; D010038:Otorhinolaryngologic Diseases / Q000628:therapy; D017060:Patient Satisfaction; D011786:Quality Control; D011795:Surveys and Questionnaires; D013997:Time Factors; D014495:Universities; D014850:Waiting Lists