Table of Contents
Chapters
- Understanding the Concept
- Evidence-Based Practices
- Adaptability
- Links with Other Services
- Minimizing Paperwork
- Physical Factors
- Service Hours and Scheduling
- Client Flow
- Division of Labor and Job Design
- Social Factors
- Implementing the Concept
- Bibliography
This issue was prepared in collaboration with the Maximizing Access and Quality (MAQ) Initiative of the United States Agency for International Development's Office of Population and Reproductive Health. The MAQ Initiative supports research and evidence-based interventions to promote access and quality of reproductive health and family planning services.
Published by the INFO Project, Center for Communication Programs, The Johns Hopkins University Bloomberg School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202, USA.
Volume XXXII, Number 1,
Winter 2004
Series Q, Number 2
Maximizing Access to Quality
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7 |
Client Flow |
Improving client flow—how clients move through a clinic —can avoid bottlenecks that cause delays and reduce the quality of care. Often, poor client flow causes long waits that discourage clients from seeking services (26, 122). Clinics can improve client flow through better planning and resource allocation.
Principles of Client Flow
Principles in Action Malawi: Meeting Both Clients’ and Providers’ NeedsIn 1996 staff at a district hospital in Malawi performed a client flow analysis to assess waiting time. They found that clients waited an average of over two hours for services but spent only an average of two minutes in direct contact with a provider. The long waits resulted from the practice of giving a group health education talk to clients first. Providers saw clients individually only after the group health talk. Therefore many clients had to wait while others saw providers. Since the clinic waited until a certain number of clients had arrived before giving the talk, providers had a window of open time and then had to rush through counseling sessions to accommodate the backlog. To overcome this problem, the clinic eliminated the group health talk. Providers saw clients individually as soon as they arrived, providing the same information given previously at the group talk. This change enabled providers to spend an average of 10 minutes with each client, taking time to answer questions and address the health issues of greatest interest and relevance to each client. Waiting times decreased by two-thirds for family planning clients and by more than three-quarters for antenatal care clients. The change also helped relieve the pressure on providers (40, 66). |
Balance client load and client flow. Improving client flow can help shorten the time that clients spend waiting, increase the number of clients that a provider sees each day, or allow providers to spend more time with each client (52) (see box right). Clients are more satisfied with services when they spend less time waiting and spend more time with the provider (96).
Client flow analysis can help. Client flow analysis involves recording a sampling of clients’ arrival times and lengths of time spent in contact with staff members (70). By summarizing and graphing these data, managers can calculate how much time clients spend waiting compared with seeing providers, and where the greatest delays occur.
Causes of long waits vary; so do their solutions. If providers face a backlog of clients at some times but see fewer clients during other parts of the day, changing when clients are scheduled can shorten waits (5, 50, 121). If providers need to fit walk-in clients among scheduled clients, the clinic can encourage more scheduled visits in advance or can allow more time between scheduled appointments (52).
Sometimes, check-in procedures have not been established at all. Giving clients numbered cards when they arrive and calling them by number can shorten waits and increase client satisfaction with services, as in a clinic in Cambodia (91). Also, showing videos or providing educational pamphlets in the reception area can keep clients engaged while they wait.
Improve client flow by using signs, posted instructions, and simplified paths. Organizations can improve workflow and direct clients through clinics by putting up signs and graphics. Signs that convey clinic policy can tell clients when they can expect to be seen by a service provider. For example, walk-in clients who are waiting may observe that other clients who came in after them are seen first, leaving them wondering why they must wait. In this case, displaying signs explaining that clients with appointments are seen first, and then walk-ins, can reassure them (12).
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In a Nigerian family planning clinic a health care worker discusses contraceptive methods with clients while they wait their turn for individual counseling. Shortening waiting time and making better use of it can improve clients’ satisfaction. |
Often, organizations can improve workflow by reducing the number of steps required to deliver a particular service, shortening the time clients must wait between steps, and eliminating procedural bottlenecks. For instance, in 1999 in Jordan, hospital staff divided the emergency department into three parts. First, patients were examined in a pre-screening area. Then they were moved to a newly designated triage section to determine who needed care immediately and who could be referred to the outpatient department. These changes helped to streamline service delivery, keep patients moving from one step to the next, and reduce waiting lines (107). Family planning facilities can create express lines for clients obtaining repeat injectable contraception, so that clients returning to the clinic to receive routine injections, if they have no problems, do not have to wait with clients receiving more time-consuming services.
