Cradle Care is a growing chain of maternity facilities, which is tapping into the latent need of well-to-do young couples who would like their childbirth experience to be happy and joyous instead of the one tinted with a conventional hospital environment. This case pertains to the patient flow in the outpatient department at Cradle Care, which caters to antenatal visits by pregnant mothers. Historical data show that roughly 20 percent of the visits are new visits, while the remaining are returning visits.

The mother (along with a caregiver, if any) is received at the registration desk by a clerk. During the first visit, the registration clerk notes the basic information, such as name, address, etc., assigns a unique identification number and issues a smart card. The staff members use the card to summon relevant medical record information, and the mother and her family use it to store cash for any transactions that might occur during the visit. During a repeat visit, the registration clerk uses the smartcard to check the patient into the system. The registration step takes 10 minutes for the new visits and 1.25 minutes for the returning visits.

In either case, the mother is assigned a serial number and asked to make herself comfortable in an A/C waiting lounge with interactive screens that provide information about various aspects of pregnancy. In due course, one of the two junior nurses calls for the mother and accompanies her to the nurse station for an initial verification step. The nurse scans the smart card and draws up the medical record and notes from the previous visit. Then, she checks for vital signs and updates the medical history. This step takes 30 minutes for the new visits and 7.5 minutes for the returning visits.

At this point, about 25 percent of the mothers (both new and returning visits) are ordered an ultrasound by the nurse and are directed to the imaging room, which is located in a separate physical space on the same floor. A trained technician conducts the ultrasound, which takes about 30 minutes. After the procedure, the technician asks the mother to sit in a small waiting area outside the imaging room while she prepares the report, which takes 10 more minutes. The mother is then accompanied to the physician, where the main medical exam occurs. The remaining 75 percent of the mothers that do not require a scan are accompanied to the physician directly from the nurse station after the verification step.

The physician, along with a senior nurse, conducts a thorough clinical examination of the mother, which takes about 10 minutes for a repeat visit and 20 minutes for a new visit. After the examination, the senior nurse updates the medical record, which requires another 3 minutes. Finally, the mother is accompanied to the registration counter, where appropriate charges are deducted from the cash balance on the card, and the mother leaves the clinic. This last check-out step takes 2 minutes. What is the theoretical flow time for a new visit and returning visit?

Assignment questions

1. What is the theoretical flow time for a new visit and returning visit?
2. What changes could you make in the process to reduce the theoretical flow time?
3. What is the capacity of the process? Which is the bottleneck resource?
4. Suppose Cradle Care decides to replace the senior nurse with another junior nurse and cross-train all junior nurses to do all the nursing tasks. What would be the impact of this intervention on the theoretical flow time? What would be the impact on the capacity of the process?