Reducing waiting time in a medical clinic of a secondary care hospital in Sri Lanka: An audit and quality improvement project
1 Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.
2 Regional Directorate of Health Services, Galle, Sri Lanka.
3 Regional Directorate of Health Services, Puttalam, Sri Lanka.
Research Article
International Journal of Science and Technology Research Archive, 2026, 11(01), 030–038.
Article DOI: 10.53771/ijstra.2026.11.1.0030
Publication history:
Received on 24 June 2026; revised on 05 August 2026; accepted on 07 August 2026
Abstract:
Background: Long outpatient waiting times are a persistent feature of Sri Lanka's government hospitals, contributing to patient dissatisfaction and pushing better-off patients toward costlier private care. Published, completed audit cycles from secondary care (base hospital) clinics remain scarce despite a national guideline for measuring waiting time.
Objective: To measure and reduce patient waiting time in the general medical clinic of a secondary care hospital in Sri Lanka through a complete clinical audit cycle.
Methods: A baseline audit of 180 patients over 10 clinic days (January 2025) measured stage-wise and total waiting time using the national DHQS methodology. Twelve key informants scored candidate causes of delay for impact and feasibility; causes meeting pre-set thresholds were addressed through three sequential PDSA cycles — staggered arrival slots, an additional peak-hour registration counter, and a pharmacy token/pre-packing system — run between February and June 2025. A re-audit of 172 patients over 10 clinic days (June 2025) compared outcomes with baseline.
Results: Mean total visit time fell from 118 minutes (SD 31) at baseline to 74 minutes (SD 19) at re-audit, a 37.3% relative reduction (p < 0.001). Every stage improved, with registration showing the largest proportional gain (−54.2%). The proportion of patients waiting over 90 minutes fell from 62% to 21%, while mean consultation time was essentially unchanged (3.4 vs 3.5 minutes).
Conclusion: A structured baseline audit, staff-informed prioritisation, and three low-cost PDSA cycles cut mean waiting time by more than a third without additional staff or capital expenditure, offering a transferable model for other Sri Lankan secondary care clinics.
Keywords:
Waiting time; Quality improvement; PDSA cycles; Clinical audit
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