A Case Study: Negative Effects of Unscheduled Appointment System to Physiotherapists and Paediatric Patients
Abstract
Community-Based Rehabilitation (CBR) units are growing in developing countries, including Indonesia. However, patient safety measures in CBR units have not yet been conducted, especially regarding flexible, unscheduled appointment system. This study aims to evaluate the unscheduled appointment system as a cause of errors in the care delivery of a CBR unit for children with disabilities in Makassar city. This case study conducted 278-hours observations and three structured interviews. The observation findings, encoded interview findings, field notes, and self-reflective notes were triangulated and link thematically. Four key findings were illustrated in an explorative model. The CBR unit implements a day-based scheduling system without time slots. Working in this system, the therapists experienced random visits, long waiting times, and excessive workload as a result of this flexible scheduling system. Significant risks of human errors and patient safety were revealed due to these consequences. As flexible scheduling systems produce more negative effects to the therapists and children, it is suggested that a CBR unit or a health care unit implement a scheduled appointment system with timeslots to achieve prudent healthcare.
References
1. Disabled World. Disability Statistics: Information, Charts, Graphs and Tables. [Report]. Disabled World; 2020.
2. Kemenkes RI. Buletin Jendela Data & Informasi Kesehatan: Situasi Penyandang Disabilitas.. Jakarta: Pusat Data dan Informasi Kementerian Kesehatan RI; 2014.
3. COMCEC. The Role of Community-Based Rehabilitation in Poverty Reduction : A Comparative Study among Iran, Malaysia, and Indonesia. Ankara-Turkey: COMCEC Coordination Office; 2016.
4. Dinkes Kota Makassar. Profil Kesehatan Provinsi Sulawesi Selatan Tahun 2016. Makassar: Dinas Kesehatan Kota Makassar; 2017.
5. WHO. Health Component CBR Guidelines. Geneva: World Health Organization; 2010.
6. Bradley P, Wilson A, BuBradley P, Wilson A, Buss P, Harrhy S, et al. Achieving Prudent Healthcare in NHS Wales. Public Health Wales. 2014:1–52.
7. Ellis DA, McQueenie R, McConnachie A, Wilson P, Williamson AE. Demographic and Practice Factors Predicting Repeated Non-Attendance in Primary Care: A National Retrospective Cohort Analysis. Lancet Public Health. 2017;2(12):551–559.
8. Cashman SB, Savageau JA, Lemay CA, Ferguson W. Patient Health Status and Appointment Keeping in an Urban Community Health Center. Journal of Health Care for the Poor and Underserved. 2004;15(3):474–488.
9. Yin RK. Case Study Research : Design And Methods. [Fourth Edition]. California: SAGE Publications; 2014.
10. Cleland G, Habli I, Medhurst J. Evidence: Using Safety Cases in Industry and Healthcare. London: Health Foundation; 2012.
11. Streubert HJ, Carpenter DR. Qualitative Research in Nursing: Advancing the Humanistic Imperative. [Fifth Edition). Philadelphia: Wolters Kluwer Health; 2011.
12. LaGanga LR, Lawrence SR. Appointment Overbooking in Health Care Clinics to Improve Patient Service and Clinic Performance. Production and Operations Management. 2012;21(5):874–888.
13. Noon CE, Hankins CT, Côté MJ, Lieb M. Understanding the Impact of Variation in the Delivery of Healthcare Services. Journal of Healthcare Management. 2003;48(2):82–97.
14. Gupta D, Denton B. Appointment Scheduling in Health Care: Challenges and Opportunities. Journal IIE Transactions. 2008;40(9):800–819.
15. Murray M, Berwick DM. Advanced Access: Reducing Waiting and Delays in Primary Care. Journal of the American Medical Association. 2003;289(8):1035–1040.
16. Corsano P, Majorano M, Vignola V, Guidotti L, Izzi G. The Waiting Room as a Relational Space: Young Patients and Their Families’ Experience in a Day Hospital. Child: Care, Health and Development. 2015;41(6):1066–1073.
17. Temple M, Monaghan S, Watkins J, Atenstaedt R. What Drives Demand for Unscheduled Care Services in Wales?. Public Health Wales. 2015;1(1):1–33.
18. Kosnik L. Breakthrough demand-capacity management strategies to improve hospital flow, safety, and satisfaction. International Series in Operations Research & Mana-gement Science. 2006;91:101–122.
19. Addis S, Holland-Hart D, Edwards A, Neal RD, Wood F. Implementing Prudent Healthcare in the NHS in Wales; What are the Barriers and Enablers for Clinicians?. Journal of Evaluation in Clinical Practice. 2019;25(1):104–110.
20. Cristian A, Tran A, Patel K. Patient Safety in Cancer Rehabilitation. Physical Medicine and Rehabilitation Clinics of North America. 2012;23(2):441–456.
21. Vincent C. Is Health Care Getting Safer?. BMJ. 2008;337(11):1205–1207.
2. Kemenkes RI. Buletin Jendela Data & Informasi Kesehatan: Situasi Penyandang Disabilitas.. Jakarta: Pusat Data dan Informasi Kementerian Kesehatan RI; 2014.
3. COMCEC. The Role of Community-Based Rehabilitation in Poverty Reduction : A Comparative Study among Iran, Malaysia, and Indonesia. Ankara-Turkey: COMCEC Coordination Office; 2016.
4. Dinkes Kota Makassar. Profil Kesehatan Provinsi Sulawesi Selatan Tahun 2016. Makassar: Dinas Kesehatan Kota Makassar; 2017.
5. WHO. Health Component CBR Guidelines. Geneva: World Health Organization; 2010.
6. Bradley P, Wilson A, BuBradley P, Wilson A, Buss P, Harrhy S, et al. Achieving Prudent Healthcare in NHS Wales. Public Health Wales. 2014:1–52.
7. Ellis DA, McQueenie R, McConnachie A, Wilson P, Williamson AE. Demographic and Practice Factors Predicting Repeated Non-Attendance in Primary Care: A National Retrospective Cohort Analysis. Lancet Public Health. 2017;2(12):551–559.
8. Cashman SB, Savageau JA, Lemay CA, Ferguson W. Patient Health Status and Appointment Keeping in an Urban Community Health Center. Journal of Health Care for the Poor and Underserved. 2004;15(3):474–488.
9. Yin RK. Case Study Research : Design And Methods. [Fourth Edition]. California: SAGE Publications; 2014.
10. Cleland G, Habli I, Medhurst J. Evidence: Using Safety Cases in Industry and Healthcare. London: Health Foundation; 2012.
11. Streubert HJ, Carpenter DR. Qualitative Research in Nursing: Advancing the Humanistic Imperative. [Fifth Edition). Philadelphia: Wolters Kluwer Health; 2011.
12. LaGanga LR, Lawrence SR. Appointment Overbooking in Health Care Clinics to Improve Patient Service and Clinic Performance. Production and Operations Management. 2012;21(5):874–888.
13. Noon CE, Hankins CT, Côté MJ, Lieb M. Understanding the Impact of Variation in the Delivery of Healthcare Services. Journal of Healthcare Management. 2003;48(2):82–97.
14. Gupta D, Denton B. Appointment Scheduling in Health Care: Challenges and Opportunities. Journal IIE Transactions. 2008;40(9):800–819.
15. Murray M, Berwick DM. Advanced Access: Reducing Waiting and Delays in Primary Care. Journal of the American Medical Association. 2003;289(8):1035–1040.
16. Corsano P, Majorano M, Vignola V, Guidotti L, Izzi G. The Waiting Room as a Relational Space: Young Patients and Their Families’ Experience in a Day Hospital. Child: Care, Health and Development. 2015;41(6):1066–1073.
17. Temple M, Monaghan S, Watkins J, Atenstaedt R. What Drives Demand for Unscheduled Care Services in Wales?. Public Health Wales. 2015;1(1):1–33.
18. Kosnik L. Breakthrough demand-capacity management strategies to improve hospital flow, safety, and satisfaction. International Series in Operations Research & Mana-gement Science. 2006;91:101–122.
19. Addis S, Holland-Hart D, Edwards A, Neal RD, Wood F. Implementing Prudent Healthcare in the NHS in Wales; What are the Barriers and Enablers for Clinicians?. Journal of Evaluation in Clinical Practice. 2019;25(1):104–110.
20. Cristian A, Tran A, Patel K. Patient Safety in Cancer Rehabilitation. Physical Medicine and Rehabilitation Clinics of North America. 2012;23(2):441–456.
21. Vincent C. Is Health Care Getting Safer?. BMJ. 2008;337(11):1205–1207.
Authors
Karnadipa, T. (2020). A Case Study: Negative Effects of Unscheduled Appointment System to Physiotherapists and Paediatric Patients. Media Kesehatan Masyarakat Indonesia, 16(3), 336-345. https://doi.org/10.30597/mkmi.v16i3.9864
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.