The Out-Patient Departments (OPD) is often the first point of contact for patients seeking healthcare services and involves the coordination of both administrative and clinical processes. High patient volume and inefficient patient flow can result in prolonged waiting time, contributing to patient dissatisfaction. We performed a root cause analysis (RCA) through group interviews with OPD patients visiting Geta Eye Hospital, Nepal to understand the factors contributing to dissatisfaction towards OPD waiting time. In addition, patient flow through OPD service points was mapped, time-in, time-out and waiting time across OPD rooms was recorded to identify operational bottlenecks for intervention.

The Vision Refraction room (VRR) emerged as key contributor to prolonged waiting time. This operational research study aims to determine the reasons for delay in the VRR and develop strategies to reduce the mean waiting time and improve patient satisfaction with waiting time. This study will be conducted over a 6-8 month period using a two-phase before and after intervention design. Phase 1 will establish baseline waiting time and patient satisfaction, and identify operational challenges. Based on these findings, context-specific interventions will be developed and implemented in Phase 2, and waiting time and patient satisfaction will be reassessed.

The demand for quality medical services is growing globally, particularly in developing nations such as Nepal, (Kruk ME, 2018; Sharma J,2024). Patient satisfaction has emerged as a key indicator of service quality, reflecting how effectively health institutions meet patients' expectations and experiences (Khamis & Njau, 2014). A cross-sectional study conducted to assess patient satisfaction with care services, examined the impact of different dimensions on overall satisfaction and found that accessibility and technical quality were most strongly associated with the overall satisfaction (Ziaei H, 2011). New patients often arrive with heightened anxiety, limited health literacy, and logistical challenges and need proper care in the waiting area including lower waiting time. For new patients, these factors take on greater weight because they lack familiarity with the hospital layout, staff routines, and treatment pathways.

Geta eye Hospital provides comprehensive eye care services to the catchment area and also to patients who visit from across the border in India. It was unanimously agreed by the Institutional Operational Research Capacity Building (I-ORCB) team that prolonged OPD waiting time for patients was a concern that needed to be addressed. A group discussion was conducted separately between Nepalese patients and Indian patients to identify the most problematic areas in the OPD. Approximately 8-10 patients participated in each group discussion. In addition, a patient flow chart recorded the time in and time out from each unit of the OPD over a period of 2 weeks. Both the patient flow analysis and groups discussions identified prolonged waiting time in the Vision Refraction Room (VRR) of the OPD as the primary source of dissatisfaction in the OPD.

This operational research project will be conducted in two phases over a period of 8 months:

Phase 1: Baseline assessment The first phase will determine the mean waiting time for vision refraction services, assess patient satisfaction, and explore the reasons for dissatisfaction related to waiting time.

Measurement of waiting time: a structured time tracking chart will be used to record the time of arrival at the VRR waiting area (W1) to the time at which vision refraction services begin (W2). Waiting time will be calculated in minutes as the difference between W1 and W2.

Assessment of patient satisfaction: A patient satisfaction questionnaire will be administered to patients awaiting VR services.

The mean waiting time and patient satisfaction scores obtained during Phase 1 will serve as baseline measures for comparison in Phase 2.

Identification of causes of delay: Patient feedback from the satisfaction questionnaire along with observational findings will identify operational, staffing, workflow or system-related factors contributing to prolonged waiting time in the VRR.

Phase 2: Intervention and Evaluation Development of Intervention: Based on the causes for delay identified in Phase 1, context-specific, evidence-informed interventions will be developed in consultation with OPD staff and hospital management. These may include: workflow reorganization within the VRR, redistribution of staff or staff duties, schedule or queue management and task shifting. The agreed upon interventions will be implemented over a 2-month period. The VRR staff will be oriented to the changes to ensure consistent implementation.

Evaluation: Following implementation of intervention, the waiting time and patient satisfaction will be reassessed and compared with baseline.

Inclusion Criteria: All patients awaiting vision refraction services. -

Exclusion Criteria: Patients aged less than 19 years.

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