RAA found that doctors on-duty arrived late and left as early as two hours before the closing time

The average waiting time for patients at the Jigme Dorji Wangchuck National Referral Hospital’s (JDWNRH) medical out – patient department (OPD) was observed at 1 hour 38 minutes and general OPD at 45 minutes against the target of 30 minutes.

“Some patients had to wait for more than two hours,” the Royal Audit Authority’s performance audit of the hospital’s OPD services report on December 5 revealed.

To reduce waiting time and improve service delivery, the hospital increased the general OPD consultation chambers from four to five, and assistant clinical officers were replaced with doctors. The waiting area in front of the general OPD was extended with adequate infrastructure to accommodate increasing number of patients.

However, doctors on – duty at the medical OPD chambers arrived late and left as early as two hours before the closing time.

The auditors found that erratic arrival and exit time from the chambers were attributed to multiple tasks assigned to the doctors on-duty, including administrative and academic purpose.

“The doctors’ services were also called for other services when they were engaged in OPD chambers, affecting smooth delivery of consultation services and increasing the waiting time for OPD patients,” the report for 2014-2016 stated.

Sometimes, the OPD chambers, particularly medical OPD were found without doctors, causing inconveniences to patients who come to see the doctors and resulting in longer waiting time.

Auditors also observed weak controls in the appointment and token system, which resulted in unsystematic practices in patient consultation process. There was no proper patient registration system to capture the patients’ information of earlier diagnosis, frequency of visits, addresses and drugs prescribed to monitor patients’ progresses.

While there is an information and service desk at the hospital, it does not have clear terms of reference and services to be provided from the desk.

The audit report stated that the hospital lacked strategic focus on enhancing efficient delivery of services. The review on efficiency in delivery of OPD services showed various lapses and deficiencies such as, poor registration, no health information system, lack of monitoring and evaluation and a comprehensive equipment management and maintenance plan.

The study was carried out to ascertain the turnaround time, the adequacy and optimal utilisation of human resource and equipment and to assess the existence and effectiveness of supervision and monitoring mechanism in delivery of OPD services.

The hospital also lacked standard operating procedures (SOPs), which could impede efficient delivery of health services.

“The detailed SOPs are required to describe and address various important areas like admission procedures, consultations and other areas to clearly define the works or mandates.”

The RAA sent nine recommendations to the hospital to enhance greater accountability, improved decision-making and efficiency in the delivery of healthcare services.

On monitoring and evaluation, the audit report identified opportunities for the hospital to institute appropriate quality assurance unit, which could facilitate improved coordination and information management system.

The RAA said that the hospital has to institute a system to provide transparent, effective and faster delivery of services, and conduct monitoring and evaluation of effective working hours of doctors and number of consultations provided by them.

The quality assurance unit should include clinical audits to capture information about daily work of clinical practice, identifying problems and monitor progress towards improved patient outcome. The hospital should also provide public education on prevention and first-aid care and awareness on the timing and healthcare services.

Tshering Palden