Stage-wise analysis of outpatient department patient flow and waiting time at a government tertiary teaching hospital in North India: a mixed-method study

Background: Outpatient department (OPD) waiting time is a recognised indicator of hospital service quality. There are few studies from large Indian government tertiary hospitals combine direct time-motion observation with patient reported timing within a single design. This study measured stage-wise OPD patient flow at a large tertiary teaching hospital in North India to identify the primary contributor(s) to patient delay. Methods: A descriptive, cross-sectional, mixed-method study was conducted from May 2026 to June 2026 among 255 OPD patients selected by convenience sampling. Patient reported timing was used for the arrival to consultation stages, and direct time-motion observation for the pharmacy stage. Data were analysed descriptively, and examined using Pareto analysis and fishbone (Ishikawa) root cause analysis. Results: Mean total patient journey time was 260.4 minutes (arrival to consultation) and 318.6 minutes (arrival to pharmacy completion), of which consultation itself accounted for only 12.8 minutes (under 5% of total time). Waiting time from arrival to being called by the doctor was the primary bottleneck (242.8 minutes; 76.2% relative contribution), followed by pharmacy dispensing time (119.4 minutes; 37.5%). Root cause analysis identified registration-counter misallocation, absence of patient-guidance infrastructure and centralised, multi-stop pharmacy layout as the primary structural causes, rather than clinical staffing or patient volume. Conclusions: OPD delay at this tertiary hospital is driven predominantly by process and layout design rather than from insufficient service points, although staffing and patient volume were not measured here. Target interventions are registration reallocation, patient-guidance infrastructure, digital queue systems, and decentralised dispensing of generic medicines offer a practical, low-resource pathway to measurable improvement.