Delays in Issuing Medical Reports

CHAPTER 1

INTRODUCTION

1.1 Background

Health care facilities are frequently requested to provide information about their patients. These requests come from a variety of sources - e.g., patients or their relatives, medical referrals, government agencies and regulatory bodies. Information may need to be provided in the form of a report, a certificate, a statement or a letter. The most important problem observed in our practice is delayed issuance of medical reports. Some other difficulties of issuance of a medical report may include conflicts of interest, unreasonable expectations about the information the doctor may hold and problems about payment to get medical report. Health care systems in the ministry of health (MOH) are variable, some are electronic, some are paper-bases and others are mixing between these systems. Extensive review of literature failed to find any prior work in our area regarding the magnitude of the problem and reason behind delaying of issuance of medical reports. There are many different types of medical reports requested. There are also different systems of medical reports issuance. The processes applied to get different medical reports are also different. The time taken and reasons behind it to get approved medical reports in MOH health care facilities is a matter that needs to be considered. These are some of the things that this current study seeks to look at. Waiting times have been linked to inefficiencies in health care delivery, prolonged patient suffering and dissatisfaction among the public, they have become important issues in many countries. Previous studies have demonstrated some issues in requesting release of medical records, but to date, there has been no comprehensive review of the challenges that exist in all aspects of the request process. (Viberg et al, 2013)

Medical reports required by the patient, and for an emergency cause is delayed issuance, for the completion of the preparation of the medical report it takes two weeks at best, and sometimes it takes more than two weeks, why the delay of granting patients medical reports to two weeks calculated from their health? Why do hospitals not develop their services to satisfy the patients and their families? Why does not the patient get his report at the touch of a button? Especially since the patient's condition is registered in the electronic system of the hospital, and all the data relating to his health and medications are registered, why delay in delivering the application? Is it reasonable for a cancer patient, or whatever illness, to wait two weeks for a medical report or to transfer it to another hospital? (Al-Ali, 2017)

1.2 Statement of the Problem

Long waiting time for MOH health care organizations is an important health policy issue in many countries, despite of availability of human or other resources. Health care systems in the ministry of health (MOH) are variable, some are electronic, some are paper-bases and others are mixing between these systems. Extensive review of literature failed to find any prior work in our area regarding the magnitude of the problem and reason behind delaying of issuance of medical reports. There is different classes of medical reports requested, the different systems of medical reports issuance, the processes applied to get a medical report, the time needed to get approved medical report in MOH health care facilities and the reasons behind the delay of finally getting approved medical report are totally missing and mandatory information that we plan to investigate in the current study.

1.3 Research Objectives

1.3.1 General Objective

The general objective of the study was to determine the factors leading to long waiting periods for medical reports in MOH hospitals in Dammam, KSA.

1.3.2 Specific Objectives

1) To describe different health care systems concerned with medical reporting in MOH, Dammam.

2) To establish classification of requested medical reports in MOH, Dammam.

3) To describe the process of getting a medical report with time intervals in MOH, Dammam

4) To determine the reasons behind delaying of issuance of medical reports in MOH, Dammam.

1.4 Significance of the Study

The main goal of this research project is to reduce the waiting time for patients to receive medical reports in addition to facilitate patients to complete their medical reporting procedures faster, to promote the service provided to patients in the MOH hospitals in Dammam, for the satisfaction feeling of patients in the MOH hospitals in Dammam, Improving the quality of services provided to patients in Dammam MOH hospitals, and to improve the work environment procedures to serve patients properly. Achieving access to services for those who need care is a central challenge for health systems around the world. (Willcox et al, 2007)

1.5 Scope of study

This secondary data analysis was conducted using data collected.

CHAPTER 2

LITERATURE REVIEW

This chapter sought to review the literature that formed the basis of the study and consequently evaluate and analyze the findings from previous researchers.

2.1 Introduction

Studies and literatures on patient waiting time for medical reports have been done prior and are available. However, there is not a research done in the area of Dammam or the larger KSA on the same, unlike where, in most developed and developing countries this research has previously been done. (Whyte & Goodacre, 2015) Examples of such developing countries include Nigeria and Uganda where a number of literary work that can be cited has been completed. (Wanyenze et al, 2010; Musinguzi, 2015; Oche & Adamu, 2013).The study came up with findings indicating that there are a number of factors that affect patient waiting time in hospitals. Amongst the factors cited are, large number of patients, limited number of care providers, and insufficient relevant facilities. (Chen & Li, 2010; Maluwa et al.) Wafula (2016) cited that, in Africa, healthcare providers still grapple with the problem of long waiting time for patients who visit the OPD. Apart from causing delays with receiving their medical reports, this sometimes leads to lack of treatment and missed appointments with physicians.

2.2 Theoretical Review

2.2.1 Decreasing the dispatch time of medical reports sent from hospital to primary care with Lean Six Sigma

Timely communication is important to ensure high quality health care. To facilitate this, the Gastro Intestinal Oncology Center Amsterdam (GIOCA) stipulated to dispatch medical reports on the day of the patient's visit. The aim and objective of this study was to dispatch 90% of medical reports on the day of the patient's visit by improving the logistic process. To assess the main causes for a prolonged dispatch time and to design improvements actions, the roadmap offered by Lean Six Sigma (LSS) was used, consisting of five phases: Define, Measure, Analyze, Improve and Control (DMAIC roadmap). Initially, 12.3% of the reports were dispatched on the day of the patient's visit. Three causes for a prolonged dispatch time were identified: (1) determining which doctors involved with treatment would compose the report; (2) the reports composed by a senior resident had to be reviewed by a medical specialist; and (3) a medical specialist had to authorize the administration to dispatch the reports. To circumvent these causes, a digital form was implemented in the electronic medical record that could be completed during the multidisciplinary team meeting. After implementation, 90.6% of the reports were dispatched on the day of the visit.

2.2.2 Methods for generating patient-specific medical reports

The present invention relates to novel methods and memory storage devices for generating a report that contains medical counseling information which is specific to a patient. The medical information is dependent upon the diagnostic analysis of a biological sample from the patient. A relational database management system is used that stores a plurality of diagnostic codes and archived textual and graphical information specific for each diagnostic code. By inputting a diagnostic code specific for the results of the diagnostic analysis, a report is compiled from retrieved archived textual and graphical information specific for the entered diagnostic code. The archived information provides counseling and descriptive information useful for the patient. (James et al, 1997)

2.2.3 A statistical natural language processor for medical reports

Statistical natural language processors have been the focus of much research during the past decade. The main advantage of such an approach over grammatical rule-based approaches is its scalability to new domains. In this study they present a statistical NLP for the domain of radiology and report on methods of knowledge acquisition, parsing, semantic interpretation, and evaluation. The parser uses no hand-coded rules, but rather gathers word affinity knowledge from training sentences whose dependency diagrams are manually specified. This ability to acquire knowledge is important for adapt ability to new domains and writing styles. In the ten-fold cross validation study, the parser achieved high performance from a surprisingly small amount of training data. Recall and precision reached a percentile in the mid 80's from a little over one hundred training sentences and reached recall 90% at precision 89% by one thousand training sentences. The statistical models of resonance allow the system to generalize well, and behave gracefully in the presence of unseen grammar patterns. Work is underway to improve the following aspects of the system: 1) Co-reference resolution, 2) dynamic modification of word features, 3) integration of existing electronic medical lexicons, 4) improved handling of conjunctive lists and parenthetical phrases, 5) handling of unknown words, 6) mapping system output representation to a controlled reference terminology such as SNOMED-RT. (R. K. Taira & S. G. Soderland. 1999)

2.3 Conceptual Review

CHAPTER 3

RESEARCH METHODOLOGY

3.1 Research design

This research engaged a logical review of similar works of literature to collect data and find conclusions. The procedure involved analytically evaluating research studies and synthesizing findings qualitatively. Qualitative research techniques are useful in ascertaining the significance of a phenomenon and its impact on particular variables (Walker et al, 2009). Qualitative research techniques are appropriate when the researcher is trying to understand the underlying behaviour or attitude present between certain variables. Furthermore, this approach develops frameworks and produces relationships of meaning that build new knowledge in a particular field, such as this (Clark et al., 2008). Besides the systematic review of works of literature, the study also used the grounded theory in deriving conclusions. (Morse et al. 2016) defines grounded theory as a systematic approach in the social science field involving the development of theories using methodical deducing and analysis of information. Therefore, this study also applied inductive reasoning and deductive approach of arriving at conclusions.

3.2 Literature search

A literature search is a systematic process of searching pieces of evidence related to the subject under study (Christmals et al., 2017). To actualize this study, a literature search through several databases, including the Cochrane Library, Encore, the web of knowledge, and Google scholar was done. These databases provided an extensive array of works of literature that were used to shape the research by assessing the existing literature. Therefore, through this process, the study was able to come up with conclusions in line with the study objective. Literature validity is particularly dependent on the research intensity in a certain area of research (Bettany- Saltikov, 2012). Focus was given on intense and extensive researches which provided much valuable information on the reasons behind long waiting periods for medical reports.

3.3 Search Strategy

It is vital to develop a search strategy to identify relevant and valid works of literature when conducting a systematic review (Creswell, 2011). Therefore, this study employed the University of Warwick to locate and select relevant works of literature from the Encore database. It also used Google Scholar as a complementary source of evidence to assist in the research process. These two sources were selected because they are part of the primary research; the resources were ranked based on their originality and efficiency. These sources were given prominence because they contain up-to-date pieces of evidence, which means that the study used the latest published information. Secondly, they have meticulous review procedures ensuring the journals are of the highest quality. And lastly, they are always accessible whenever reference is needed. Various subject headings linked to the subject under investigation were identified and selected during the search procedure. The search process involved typing the keywords in the search box of every database; several works of pieces of literature were identified using the inclusion and exclusion criteria (see table 1). The keywords used in the search process include waiting time, Medical reports, outpatient department. The Boolean operators such as 'and, or' were employed to link the keywords to identify the most relevant and valid pieces of literature (Coughlan et al., 2013). Lastly, before selecting a study, its weakness and strength were evaluated to determine its significance; for instance, the research questions were assessed to decide whether or not they are linked with the subject under study. Secondly, the study's aims and goals were assessed to determine whether they were clearly defined. Lastly, the research design was assessed to see whether it was appropriate (Holland & Rees, 2010). The search strategy used was well founded and the databases selected, as already stated, reflected the most appropriate of results, thus providing the foundation of this secondary review.

3.4 Inclusion and exclusion criteria

The inclusion strategy employed in this study included all peer-reviewed articles (qualitative, quantitative, and mixed methods) relevant to the subject topic under investigation. The second approach included sourcing for relevant evidence published in English; no limit was applied to the year of publication. However, the conclusion part of the discussion incorporated evidence published from the year 2009 to 2020. The latest pieces of evidence made sure that the findings were relevant to the current times. Conversely, the exclusion criteria involved abstracts and other works that were not related to the research topic. This approach ensured that the study has logical precision, and only crucial evidence was used (Burns, 2005).

3.5 Limitations of the search

The study could have omitted valid information from the various kinds of literature because it wasn't possible to consider all works of literature found in the user databases. Also, research in KSA on this topic was limited, which necessitated the use of other resources and those done in other countries.

3.6 Critiquing tool

The study employed both an inductive and deductive reasoning model when reviewing the works of literature. Besides, it used a structured critical approach in identifying the strengths and weaknesses of every research reviewed. In addition, the research included the use of the Critical Appraisals Skills Programme Tool (CASP). For its specificity and versatility in clinical research, this tool is most appropriate in critiquing the articles chosen for review.

3.7 Search outcome

From the search conducted, a number of articles were returned; the first search conducted over all databases selected returned over 100 articles on or related to the topic chosen. This necessitated a basic refinement on the second search, which consequently resulted into around 40 full text articles. Using the inclusion and exclusion criteria formulated, further refinement was done, which resulted into around 20 full text articles. In order to further enhance validity, conceptuality and evidence based practice; only 7 articles were selected for this review. Evidence based practice research is the kind of research that integrates important clinical values in research and recognizes all these values with the relevant parties involved in clinical practice (Sackett et al, 2000). For the applicability and significant purposes of the topic selected, therefore, these kinds of researches form valid foundations of the study. The results obtained from the search have been shown in the PRISMA diagram below.

CHAPTER 4

FINDINGS

4.1 Data analysis

In a bid to assert relevance to the research problem, data was systematically analyzed from the 7 literature selected and thereafter thematic concerns were generated. These were founded upon the analysis of the recurrent themes across most of the studies. This enabled the provision of coherence and organization to this study, thereby strengthening the validity of the research.

4.2 Waiting and service time

According to Xie and Or (2017), actual waiting time in this context refers to the cumulative amount of time that the patient spent waiting for all of the services expected, as measured from the time when the patient was logged on to the system to the time they receive the service, or from the time when the patient was done with one care service to the time when he or she moved on to the next service. It is unique with the waiting times in healthcare in that the patient can opt for a different service provider, unlike to other businesses, only under a defined expense. The patient has in very limited information on the amount of waiting times at other hospitals when he or she goes to the hospital. Especially in hospitals and clinics, it can be psychologically difficult to change the physician, once a patient is in treatment or alternatives to change the service provider (which means to go to the next hospital) are not available. Even the change of the family doctor is associated with effort as, for instance, the new doctor doesn’t have access to necessary historical health care data.

4.3 Patient Satisfaction

Low patient satisfactions can numerously be associated with prolonged waiting times. According to Al- Harajin et al (2019), the overall satisfaction levels of the patient is significantly influenced by long waiting times in service; particularly in regards to receiving medical records and receiving health care. In this study, the writers showed that the waiting time differed depending on the type of care setting they attended. There was a significant difference in patient satisfaction level scores depending on the waiting time experienced. According to the results of Sun et al (2017), there was a significant negative correlation recorded between waiting times and patient satisfaction. There is a global consensus that well designed health care systems which deliver services in a convenient and timely manner generally improve patient satisfaction. Ma et al (2019) foundationally state that long waiting times in public hospitals result into low patient satisfaction levels. The study aimed to look at some of the ways in which patient satisfaction may be improved through shortening of the actual waiting time (AWT) and extending the expected waiting time (EWT). Bleustein et al (2014) agreed with this issue by finding that it is foundationally established that poor scores of patient satisfactions are directly associated with longer wait times for medical reports. The aim of the study was to analyze the effects of waiting time on patient satisfaction scores. In regards to the waiting time and patient satisfaction, Al- Harajin et al (2019) further assert that there is great room for improvement in the quality of health care service delivered. Xie and Or (2017) examined the associations that exist between AWT, the perceived acceptability and the level of patient satisfaction dragged from it. AWT, in this case, negatively associated with the levels of satisfaction of the patients; this also concerned the satisfaction levels on how patients received medical reports and how these medical reports were shared with other medical staff.

4.4 Care quality perceptions

Bleustein et al (2014), in their study, aimed at analyzing the impact waiting time had on the specific perception of the quality of care and the abilities of the physicians, as well as on the patient satisfaction scores. The study involved the use of surveys from sample 11, 352 responses returned over a chosen course of time. The results of the study were that there is a negative correlation present whenever long wait times is associated with perceived quality of care the patient confidence in the care provider. Xie and Or (2017) also looked at the concept of AWT and the direct associated it had on the levels of patient satisfaction with the care quality. The results of this study suggested that negative perceptions on the level of care could be directly associated with longer waiting times on the service deliveries. Quinton et al (2018) conducted a clear study examining the impact waiting time had on patient’s perceptions of care quality. Patient satisfaction, in this context, resulted from the measurement of the overall care quality, the likelihood recommendation of practice and the likelihood recommendation of the care provider. The study yielded results upon 45 mins or longer waiting time recordings, where there was a noticeable effect on the overall patient satisfaction difference. The study further denotes that understanding the aspects behind patient’s experience drive care quality is an important aspect in the operation of a health care setting. According to a study conducted in Northern Nigeria, an urgent need arises in public a hospital that involves the increase in the number of health works so that the general patient satisfaction and quality of health care service delivery may be improved (Oche and Adamu, 2013).

CHAPTER 5

DISCUSSSION

The study, under this chapter, portrays the synthesis of the findings. After data was analyzed, the findings and main thematic concerns were derived and further synthesis was necessary. From the previous chapters, it is clear that the main themes were generated taking into account the element of evidence based practice, which portrays effective relationships between the patient values and professional practice (Sacket et al, 2000). This factor is particularly important for this topic and also forms a basis for discussion under this chapter. Studies conducted in various institutions, such as military clinics, outpatient veteran’s clinics, outpatient primary care units, ambulatory services, outpatient ophthalmology clinics, outpatient orthopedic clinics, or university health service clinics show that dissatisfaction of patients is primarily as a result of long waiting periods for medical reports in hospitals. For example, (Bar-dayan et al) found that long waiting time for medical reports at the military clinic led to dissatisfaction by soldiers seeking to be attended to. (Probst et al) found that satisfaction was high among patients who did not wait for long. (Camacho et al) found that the higher the waiting time for medical reports, the higher the dissatisfaction and the less the willingness to come back. (Dansky and Miles) found that patient satisfaction kept diminishing with an increase in the wait time for medical reports at the OPD (Huang et al) focusing on a Chinese population found that emergency room patients who were dissatisfied with the amount of time they spent waiting to be attended to were generally dissatisfied with the whole care system of the hospital they sought medical care. The waiting period by patients for medical reports was also directly linked to how the patients perceived other aspects of the hospital that were not necessarily medical related. For instance, (Spaite et al) found out that patients who spent a shorter time waiting perceived the staff at the hospital as being kind and compassionate. (Bleustein et al, 2014) on the other hand found that the longer the wait time for medical reports by the patient the more the patient had diminished confidence in the capability of the doctor and generally, the health services provided at the facility and had a great effect on the patients’ perceptions on the ability of their caregivers to provide health services reliably and accurately. A lot of efforts have been made in a bid to understand the factors leading to long waits for medical reports and to determine viable efforts that can be pursued to avert the problem. The most common of factors were pointed out to be, inadequate staffing, limited resources, high demand due to seasonal illnesses, and unnecessary visits to medical facilities. Strategies employed in a bid to reduce wait time whilst ensuring satisfaction have included the revamping of scheduling systems and better workforce management. However, due to shortages of staff and increases in patient volume, prolonged waits are often inevitable. Actual waiting time refers to the total amount of time that a patient spends waiting to be attended to. (Miceli and Wolosin) found out, that longer waiting times draw a parallel negatively with how patients felt about the general health care service system. Oche and Adamu (2013) define waiting time as the time the patient waits in a clinical setting before being attended to by any clinical or medical staff. This, in most instances, is an important indicator of the quality of services being delivered at a setting. In regards to the delivery of medical reports, keeping patients waiting can cause stress to both patients and the doctors. Most patients actually perceive long waiting times to be barriers to receiving healthcare services. Actual service time refers to the total amount that a patient spent by a patient at the hospital in a particular visit during which he/she receives services. This number is the time that the patient spent receiving every health care service, with each service measured from the time when the patient started that service until the time when that service concluded.

Actual service time was not significantly correlated with perceived acceptability of service time. This lack of correlation may have occurred for 2 reasons. First, the patients might not have had a strong sense of time as they were being treated. Their attention might have been focused on their treatments or on their interactions with the doctors and nurses. In contrast, the patients might have had a stronger sense of time while they were waiting, especially if they were not occupied or if their attention was not diverted from waiting. These factors may also explain why the correlation between the perceived acceptability of waiting time and the actual waiting time was much greater than the correlation between the perceived acceptability of service time and the actual service time. Second, we notice that the actual service time of our patients ranged from 1.7 to 62.4 minutes, with an average of 17.8 minutes. Therefore, the service time might have been generally too short for patients to experience much difference between the actual time they spent receiving care services and their perception of that time period. In contrast, the actual waiting time of our patients ranged from 39.2 to 272.3 minutes, with a mean of 150.5 minutes. These waiting times were long enough that the patients tended to form strong perceptions of how long they had waited. The negative correlation between the actual service time and the PSQ-information after procedures was also contrary to our intuition. This finding suggested that patients who spent more time with their health professionals tended to be less satisfied with the information provided about self-care, or with the results of the tests or treatments they received. At least one of the indicators regarding perceived acceptability of service time was positively correlated with medical-technical competence, physical-technical conditions, identity-oriented approach, and sociocultural atmosphere, as indicated in the QPP measure. This set of findings might suggest that the contents and effectiveness of the health care provided have a greater influence on the patients’ perceived acceptability of service time than the actual amount of time that the health care professionals spent with them. To investigate the long waiting times and the causes of these undesirable long waiting times within the hospitals and the general healthcare sector, it is necessary to have a theoretical fundament. Therefore, (Becker and Douglass) categorized the waiting process in a hospitals waiting room into three steps:

1. Pre-process: When the patient arrives to the time he/she is taken into the examination room.

2. In-process: The time between entering and leaving the exam room.

3. Post-process: The remaining time from leaving the examination room to actually leaving the hospital.

Within the study those categories were modified to reach the objectives as follows:

1. Administrative waiting: waiting time at the administrative desk

2. Waiting time: waiting time at the waiting area (the sum of the “administrative waiting” and the “waiting time” is equal to the “Pre-process” category)

3. Duration of treatment: This period sums up the entirety of the time between getting into the exam room and getting out of the exam room; It is similar to “In-process”, a main point of interest when in relation to the waiting time is how the patients observe the stipulated schedules. The Hartmannbund, an association of physicians in Germany, issued the outcome a study that was done with the aim of seeking to find out how well patients adhered to their schedules. More than 7,000 questionnaires were issued to doctors and healthcare providers through various means such as E-mail. They intuitively submitted an estimate of the number of patients that did not attend to their appointments as expected. When the hospital is using an appointment system those patients who do not show up for their appointments end up creating idle time, which in the end causes disruption in the normal operation of the hospital. This eventuality leads to pile-ups that then lead to long waiting time for patient seeking to get their medical records from the facility.

There are a number of studies which show that long waiting times directly lead to low patient satisfaction (Anderson et al, 2007). In 2015, Med et al (2015) in their study in Saudi Arabia depict that waiting time is the only factor in MOH care settings that has a significant influence on the overall satisfaction of patients; those who waited for over 30 mins reported dissatisfaction with the provision of service. In another study, 65.3% of patients reported that one thing that could influence the level of satisfaction of patients was long waiting time (Service et al, 2006). In regards to the perceptions of health care, another Saudi study shows that at 1% significant levels, compared to the neutral perception level, there is a significant reduction in the levels of perceptions regarding the waiting time for service (Alahmari et al, 2015). The concept behind waiting time in care settings is considered to be an important factor in the determination of quality of care. This factor also represents a valuable tool for patient satisfaction evaluation (Al- Harajin et al, 2019).

CHAPTER 6

CONCLUSION AND RECOMMENDATIONS

6.1 CONCLUSION

Patients who experienced longer waits tended to consider their health care services as less accessible and their waiting times as less acceptable. Also, spending a longer time in receiving care services did not always correlate with a more positive perception of the services. Our study shows that patients who actually spent longer periods of time receiving care services did not perceive that they had spent more time in those activities, and they were no more satisfied with the service they received than those who spent less time receiving such services. Accordingly, we suggest that the effectiveness of the health care service and the attitudes of the caregivers actually matter more than the length of the treatment. Although the problem of long waiting periods is difficult to solve through actually reducing the waiting times, it may be possible to better manage how patients feel about the amount of time they have to wait and the amount of time they spend receiving care services. The patients’ feelings about waiting may be mitigated through several patient-centered strategies, such as providing patients with useful information about the care services they are going to receive and the health professionals who will provide those services. Doctors and nurses can also be encouraged to offer respect and empathy to patients, to provide the patients with private spaces to talk to doctors when needed, and to treat the patients’ accompanying family members or friends in a friendly way. Moreover, objective was to determine the various causes of increased waiting time in the OPD and do a root cause analysis of the same, thus reducing the bottlenecks in the entire process. The two major bottlenecks were found to be waiting time for consultation and waiting time for billing. In addition, good communication and a robust rapport between the hospital or the care givers and the patient are guaranteed to greatly impact and reduce undesirable effects in relation to long waiting times. Two categories of patients were observed- those with appointment and those without (walk in). An unusual observation regarding the waiting time of these 2 categories of patients was made – the patients who took an appointment had a longer waiting time than those who didn't. This was due to improper handling of appointments and disuse of HIS based appointment system. Rescheduling of the various OPDs would help in reducing the waiting time and thus reduce peak workload for the staff. The patient experience feedback was done to assess the satisfaction level among the OPD patients and look for improvements that can be made. This will bring about efficiency in healthcare delivery and increased patient satisfaction. There is always the need to better understand the factors influencing patient satisfaction and find ways to find mechanisms for future improvement (Al- Harajin et al, 2019)

6.2 RECOMMENDATIONS

In regards to recommendations for future studies, as highlighted earlier, there is a limited number of studies that explores this particular concept in KSA, the takeoff point for the improvement of the overall outcomes and quality of healthcare services should therefore be clear from this study. Particular considerations should also be given to methodological aspects of selection bias and unreliable measures; Al- Harajin et al (2019) also highlight the fact that most studies available under this topic have limitations as to their methodology; in some instances this may relate to limited study areas or participant selections. Further studies on the topic are crucial so that helpful information may be passed to clinicians and policy makes in a bid to ensure better patient satisfaction and quality improvement. For practice, there are some recommendations generated from the study to reduce waiting time for medical reports in hospitals in Dammam, KSA. To this effect, ensuring proper display of consultant’s timing’s in the OPD is an important consideration. This should also be done on online platforms, hence reducing the number of patients making enquiries at one given moment. Appointments should be made online and staff to be given proper and adequate training on the same. The study also recommended the use of a HMIS based system in hospitals as this will greatly improve efficiency thereby greatly reducing the amount of wait time by patients for medical reports in hospitals. This is because, the use HMIS in managing medical care has over time proven to be beneficial to both the hospitals and the patients as well. Computer software systems have been technologically advanced that enable hospitals and medical practitioners to provide better quality service to patients in short periods of time. Databases can archive large amounts of patient data, and hence, increase the capabilities of physicians and hospital staff in making decisions. Relational databases have added physicians getting access to medical information. A use for relational databases in managing medical care is disclosed in (Christopher A. Tacklind et alia). A system for monitoring and reporting medical measurements includes a stand-alone monitor that can store data records such as measured values and time stamps. The monitor transmits the records to a remote reporting unit over a communication system. When the reports are received by the remote reporting unit, they are entered into a relational database. Chronological graphs are generated for that patient of the measured values and transmitted to the health care provider. On the other hand, it was recommended that the MOH should increase the number of doctors in hospitals with a high number of patients in the Dammam area hence increasing the standards of operation and thereby reducing the amount of waiting time. The MOH should also conduct training for health workers and other administrative staff that are not directly involved with generation of medical reports. By doing so, the quality of support given by the support staff increases and this helps improve efficiency in the hospitals and thus reduces patient waiting time.

The study also recommended that the MOH should ensure to deploy sufficient and competent staff to all the hospitals in Dammam. The staff should also be trained on smart care computer applications that are to be used in managing the ground activities of the hospital. Having been given the relevant training, the hospitals should then insist on punctuality of the staff and take care of absenteeism of staff. This will exponentially increase the level of efficiency in the hospitals and this directly reduces the amount of time spent by patients waiting for their medical reports.

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