OPERATIONAL ASPECTS OF POLYCLINICS IN SINGAPORE : A JURONG POLYCLINIC STUDY

Abstract

Polyclinics in Singapore are well equipped to provide basic ambulatory care services to all Singaporeans at an affordable cost Over the years these polyclinics have grown in importance· and serve to complement the primary medical care provided by general practitioners. These polyclinics provide general and curative treatment to all outpatients who are either walk-in patients or referrals from the government hospitals, preventive health care for women of child bearing age and pre-school children, and implement immunisation programmes for pre-school children. A comprehensive study was conducted on Jurong Polyclinic to understand the policies guiding the operations of polyclinics in Singapore and generate some feasible solutions to enhance operational effectiveness and efficiency. The study revolved around the operational aspects pertaining to the clinic attendances, patient arrival patterns, consultation and treatment policy, capacity utilization and waiting time at the various service stations. The focus of the study is on the group of Community Health (CHS) walk-in patients as they are of lowest priority and account for about two-third of the total clinic attendances. The study revealed the very high concentration of CHS walk-in patient arrivals during opening hours in the morning and afternoon. These high arrival rates usually exceed the serving capabilities of the staff which leads to long waits for some of the patients. The capacity requirements analysis has shown that the consultation room is a bottleneck station in the CHS walk-in patient flow and the current ten CHS doctors are insufficient to support the high arrival of patients seeking consultation. In addition, CHS walk-in patients perceive unfair service treatment when allocated to consultation rooms seeing both walk-in and chronic patients as a consequence of the consultation policy adopted. The arrival patterns can be managed to a certain extent by scheduling appointments to off-peak hours to accomodatc the high arrival of walk-in patients at peak hours, verbal advice and use of signboards indicating the expected waiting time at peak and off-peak hours. Educating walk-in patients on the incentive of a shorter wait at off-peak hours is crucial to the success of regulating patient arrivals. By evening out the distribution of arrivals throughout the day, optimal utilization levels can then be attained for all service stations. It is further recommended that Jurong Polyclinic requests for at least one additional doctor to ease the workload of the current staff at peak hours. Also, the perceived unfair service treatment can be resolved by assigning room(s) exclusively for chronic patients.