Guangzhou Women and Children’s Medical Center has implemented the comprehensive reservation service of non-emergency registration since October 2015. With the exception of emergency and isolated patients in the clinic, the remaining patients are encouraged to make an appointment using any of the following methods: a mobile phone (WeChat public platform, Alipay of Guangzhou Women and Children’s Medical Center), the Yichengtong application (mobile application), the hospital website, interclinic appointment registration or appointment registration for subsequent visits after discharge, phone calls and an on-site self-service terminal.
Patients are mainly encouraged to use the mobile payment systems for online registration, as there is no need to queue for payment and obtaining a paper registration certificate in our hospital. The large number of patients who make appointments but do not pay in advance results in a large number of patients who visit the hospital to pay for a paper registration certificate after making the appointments. Among three districts with more than 12,000 outpatients per day, there was a longer queue. The comparison of outpatient medical service processes before and after the implementation of the comprehensive reservation service are shown in Fig. 1.
Combining reservation rules and information technology avoids wasting registration number resources and restricts speculative behavior. Our hospital has unified the appointment registration methods and has re-amended the appointment registration rules to strengthen the management of nonattendance at the clinic.
The Guangzhou Women and Children’s Medical Center consists of Zhujiang New Town Hospital District, Child Hospital District and Maternal and Infant Hospital District. It is the largest specialist hospital for women and children in South China, and patients from all over the country are seen.
The appointment registration rate and outpatient volume data were obtained from the Business Intelligence System of our hospital. Data on patient satisfaction and the proportion of patients who believed that the waiting time needed improvement were extracted from quarterly survey results of the outpatient satisfaction survey conducted by the Guangdong Situation Research Center. Data collection took place from October 2014 to September 2016. The satisfaction survey was conducted on-site in the women and children’s medical center. The method of application was paper-based. The survey was conducted by 60 trained investigators. During the first quarter of 2015, 2194 valid questionnaires were collected from the outpatient clinics; 982 questionnaires were collected from the outpatient clinic of Zhujiang New Town hospital District, 884 questionnaires were collected from the outpatient clinic of the Children’s Hospital District, and 328 questionnaires were collected from the outpatient clinic of the Maternal and Infant Hospital District.
General satisfaction was the first-level indicator; there were six second-level indicators: general impression, service attitude, service quality, hospital environment, price perception and medical ethics. There were 31 third-level indicators. The responses to the third-level index were categorized by a 5-point Likert scale. The answers were coded from 1 to 5: 1-very satisfied, 2-satisfied, 3-neutral, 4-unsatisfied, and 5-very unsatisfied [9, 10]. All of the questionnaire data were statistically analyzed by SPSS software. The current internationally recognized method for calculating the satisfaction degree on the basis of public opinion was adopted for calculating each of the third-level indexes [9, 10]:100 points: “very satisfied”, 80 points: “relatively satisfied”, 60 points: “neutral”, 40 points: “unsatisfied”, 20 points: “very unsatisfied”; “unclear” was assigned for missing values, which were excluded from the data analysis.The minimum and maximum possible values of the third-level indexes were 20 and 100, respectively (Additional file 1).
General satisfaction was calculated by summing the scores of all the second-level indicators after multiplying them by their assigned weights: general impression (5%), service attitude (15%), service quality (20%), hospital environment (10%), price perception (20%), and medical ethics (30%) [9, 10].
Statistical analyses
IBM SPSS Statistics 23.0 software was used for the statistical analyses. The W test was used to evaluate whether the data were normally distributed. Independent samples t test were used to compare the sample means of registration waiting time, consultation waiting time and outpatient satisfaction. Paired t-tests were used to compare the sample means of monthly outpatient volume, and a chi-square test was used to compare the rates. The multiple test procedure was performed to evaluate the differences in the reservation rates during a 12-month period. To correct for multiple comparisons, the p value of each variable was adjusted to a family-wise corrected α of 0.05 using bootstrap permutation testing in SAS 9.4 for Windows software (SAS Institute, Inc., Cary, NC, USA 2015). P < 0.05 was considered statistically significant.