Outpatient waiting time bottlenecks in a secondary hospital: A mixed-methods study

Prolonged outpatient waiting times remain a critical challenge in hospital service delivery and are closely linked to perceived service quality. This study analyzed outpatient waiting-time bottlenecks at a secondary hospital in South Sumatra, Indonesia. An explanatory sequential mixed-methods design was employed. The quantitative phase consisted of a time-and-motion study of 242 outpatient visits across six clinics, measuring waiting time from the completion of registration to the start of medical consultation. The qualitative phase included focus group discussions with managers and health workers, semi-structured interviews with patients, observation and document review. Quantitative data were analyzed descriptively, while qualitative data were analyzed thematically. The mean outpatient waiting time was 34.33 min, and 95.45% of visits complied with the national standard ≤60-minute. However, waiting for physicians after registration constituted the principal bottleneck, accounting for approximately two-thirds of total visit time. Lean activity analysis indicated that only 14% of the total visit time was value added. The bottleneck was driven by interrelated structural, process, and outcome factors. Meeting waiting-time standards does not necessarily indicate efficient service flow. System-level interventions targeting physician availability and non-value-added activities are required to improve outpatient efficiency and patient experience in secondary hospitals.