Modellierung und Prozessoptimierung der Organisationsstruktur in der orthopädischen Poliklinik

Outpatient´s long waiting times before treatment have been one of the main organizational problems in the outpatient clinic at the Department of Orthopaedics and Rheumatology, University Hospital Giessen and Marburg. Objective of this work is to analyze and to optimize interdisciplinary clinical processes in this outpatient clinic. Three different formal methods are used and contribute to the successful reorganization of the clinical processes in order to reduce waiting times. Ínitially, business process modelling methodology is applied in order to obtain an adequate process view of medical practice in the outpatient clinic. Necessary information is collected via discussion with employees and long-term observation in the clinic. A clear and comprehensible view of the core processes, co-ordination of activities, and a clear description of causal and conditional relations between activities can be yielded. MaPDok, developed at the Institute of Medical Informatics, Philipps-University Marburg, shows to be a feasible and effective documentation tool in this context. To characterise work routine and duration of all relevant activities exactly, time recordings are performed on site over several months. Furthermore available data origins, e.g. appointment books, are analysed. This data is used in a queueing theory-based approach. Because of the distribution of Patient`s arrival times before intervention, this work fails to create a valid queueing model for the current state. Nevertheless many scenarios with different appointment times can be tested and an effective appointment system can be devised. With the knowledge of the duration of all relevant operations, the flow of individual patients can be simulated using a discrete-event simulation model. This model turns out to be valid, so six scenarios with different staffing and appointment systems can be analysed. With the aid of these approaches, four bottlenecks in the organisation of operations in the orthopaedic outpatient clinic can be identified and quantified: the appointment system, the ineffective co-operation with the Medical Center for Radiology, the enormous workload of the doctors, and in some cases the absence of patient´s records and radiographs. For these four problems solutions are devised. After approval of the staff, many recommendations can be implemented. Since two years the changed clinical processes prove their value.