| Outpatient service is "the window" of a hospital which directly provides service. Some factors rightly affected the medical order, quality, and even the prestige of a hospital, Such as, whether the time of lining up and waiting for examination is too long; whether doctors have enough time to treat patient; whether pricing and charge is fast and accurate; and whether medicine payment and fetching is convenient.Outpatient service process is the core process of a hospital. As process property of a hospital outpatient service may realize the result connection to different division of labor, reflection of the relationship of activity, as well as defining the function of related personnel. Optimization and restoration of outpatient service process could promote hospital medical service and management quality, make resources cost to be the smallest, improvement effectiveness and enhance benefit. The restoration may cultivate and promote hospital core competitive power increasingly, form own unique competitive advantage; provide excellent, moderately-priced, convenient and rapid healthcare service. The optimization also plays a vital role in hospital management and operation, construction of process organization and informationization. ObjectiveFirstly, surveying the efficiency of hospital outpatient service process by using queuing theory model, which could provide quantitative basis for the process restoration; Then, based on the union service process reorganizes (BPR) principle, method and technology, we analyzed the problem and influence factors in the hospital outpatient service process. In order to use the existing resources of outpatient service, change the pattern of service, reduce the non-essential standby period of patient, enhance the effectiveness and reduce the phenomenon "three long and one short" during outpatient service, further improve medical service quality and solve the problem "to see a doctor difficultly", we definite the outpatient service process optimized goal and solution by establishing structure equation model and quantitative analysis.Contents and MethodsIn order to consummate the goal and to perfect the strategy, outpatient service process of case hospitals was carried out and analyzed in this study. System analysis was performed, which includes overall analysis, structure analysis, correlation analysis and arrangement analysis.Survey on the efficiency of outpatient service process Outpatient service registration, charge, service times in such service nodes as Department of Digestion Internal Medicine and Department of Gynecology, and patients' arrival time, were randomly investigated by using the queuing theory. Service intensity, average queue length and line time, average staying time, probability of information desk idleness and patient needing to wait for, were calculated by using Queuing ToolPak4.0 analysis software in various nodes., Reasonable numbers of service desks were calculated, The optimum sum value of the costs of patient waiting and hospital service was simulated.Survey on the present situation of outpatient service process Utilizing model case analysis, intention investigation and expert consultation, etc, qualitative appraisal was carried out and current problems existed in the outpatient service process were illuminated. Medium and long-term questions also were predicted. Based on the frame of "macroscopic model of health system", the questions above described were classified. Systems analysis method was used to analyze the relationship between the issues, research problems in the development and evolution of the root causes; various issues concerning the impact of the size were sorted and advised by experts.Outpatient process reengineering study Combination of the above-mentioned research results, the use of expert interviews, and analysis of the situation and so on, out-patient process management was followed by analysis of its internal and external environment, to define its borders and the internal structure of the system; clearing the status quo, analysis of deficiencies and weaknesses, and research to improve the goals and strategies to conduct a feasibility assessment; eventually out-patient process optimization was recommended and developed.Evaluation of the effects of out-patient process optimization we Designed a "patient satisfaction survey scale in outpatient process," satisfaction surveys from clients of outpatient process (before and after the optimization) was carried out to evaluate the level of it's optimize results.ResultsApplicator queuing theory model to measure the efficiency of outpatient process, By simulating the indexes of lining up model at a different desk, conclusion was drawn out ,that is ,process efficiency of registration room is better by setting 6 registration desk in the morning so one more service window should be increased ,and its better to set 3 service desk in the afternoon , process efficiency of charge room is better by setting 11 registration desk in the morning, so one more service window should be increased .Process efficiency is better in electro-cardiograph room by setting 3 registration desk, setting 9 physicians in department of gynecology in the morning( one more physician should be added ) , and 2. Physicians in the afternoon (one physician can be retracted) .Process efficiency of digestive system department is better by setting 6 physicians in the morning (one more physician should be added), and setting 2. Physicians in the afternoon (one physician can be retracted).Based on Six Sigma theory and the establishment of "efforts - effective" matrix, shortening the waiting time and integration of human resources were achieved by step-by-step integration of on-site registration fee and the way of the counter.To restructure and optimize outpatient process by Business Process Re-engineering ideas and methods To improve the registration process, the outpatient service registration was directed to doctor or consulting room, cancelled original registration to arrive in examine registration twice again, simplified the outpatient service link. Simultaneously implementing floor registration, dividing floor charge, and in the outpatient service establishment independent registration for such great quantity administrative offices, charge window, reducing grievances which patient goes and returns. Through automatic account transfer service was cooperated with bank net, hospital should provide functions such as self-service registration, carried appointment registration, self-service charge, and so on. There is cooperation with The Agriculture Bank to promote "the Gold Wheat card-hospital". Register in every floor registrations, diagnose room or each medical technology section room and pharmacy, all are directly deducted by doctors. Patients did not need to return and reduce queue time. The implement lines up theories, establishment separate examines the line call system, pharmacy sends the medicine line ringing system, supersonic inspection line call system LIS system, the CR system. Design function to diagnose a system completely, realization examines paperless, notification system and each kind of statistical analysis, makes an appointment in examines, each kind of medicine management proof and so on, raised diagnosis and treatment level and efficiency. After taking a variety of measures to optimize patient process, outpatients of the case hospital have been an increase of 64.41 percent during the following 4 years, outpatient services and patient satisfaction of this hospital was listed in the city's top three general hospitals for 3 years.Conclusions and Discussions1. The application of queuing theory for out-patient process measurement of efficiency is feasible. Queuing theory experienced nearly 100 years of development and improvement, its method and model has been repeatedly proven to be reliable. This study selected queuing theory model in the standard M/M/1 and M/M/C type, and used Queuing ToolParK 4.0 queuing theory analysis software to measure the efficiency of the out-patient services process by user-friendly approach.2. Six Sigma method can be applied to achieve several comprehensive functions of the out-patients windows, such as patient-centered, simplify processes and improve efficiency, cost-effective management.3. BPR for optimization application process should be followed the following main principles: paying attention to the changes from management functions to business process management; focusing on the overall process of the best based on the system; the organization based on the process, rather than the process in accordance with organization; giving everyone to full play role in the overall process; using of information technology to coordinate the conflicts between scatter and focus.4. BPR for optimization application process should address the following key issues, for example, organizational structure, information technology issues, human resource issues, out-patients cultural issues and waiting cost, etc. Summary1. Innovation spot:(1) This study will be the first time to address the current weaknesses in the management of outpatient service process and provides new methods and ideas to solve the outpatient service process optimization by using the classic queuing theory, theory of business process reengineering and information technology research.(2) To restructure and optimize the outpatient service process, we can not simply use the existing analog information technology and business process management, which can be used for practical guide in the hospital information.2. Suggestion for the further research:(1) From the system operational research (scientific management) point of view, hospital outpatient service is a queuing system, but its complexity is very high. The existing queuing theory and six Sigma research also have difficulty in the solution to the comprehensive questions. While continuing to study the system dynamics can be done to support the theory. Anti-real computer language modeling tools, such as PowerSim, ITHINK, GPSS / H, Matlab, and other software tools could be used.(2) Fatherly, scientifically designing the outpatient satisfaction measurement scale, the satisfaction of patients before and after process reengineering should be compared, in particular the processes of satisfaction, in order to optimize the quantitative analysis of out-patient process.(3) A large general hospital for study, it is difficult to reveal all types of hospital cases. After the formation of the proposed method, multi-system and multi-level hospitals should be selected to promote the research.
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