Massachusetts General Hospital’s Operative Inefficiency


The Massachusetts General Hospital’s case study is an example of operative inefficiencies, which are caused by a multitude of factors. Although the improvements can be made through the usage of additional resources, there are plausible solutions that might not require them. One should note that PATA plays a critical role in pre-surgical assessment, and thus, any approach should not compromise the quality of the analysis. Therefore, the problem can be resolved through the optimization of patient flow and the proper allocation of PATA employees.

Critical Analysis

It is important to note that the case evidently has issues with scheduling and capacity utilization. Although some improvements can be made within the layout design and people-related challenges, they are insignificant or not as significant as the previously mentioned problems. One of the clearest issues can be observed from the case data on patient arrival and leave times. It is stated that the average waiting time is around 2-4 hours, whereas face-to-face interaction takes only 90 minutes at most (McCarty, Gallien, & Levi, 2012). In the case of add-ons and no-shows, they do not have a major impact on patient flow. The main reason is that they take up only a small fraction of total patients and cancel each other out due to similarity in numbers. The case also claims each patient has to see a laboratory technician, a nurse, and an anesthesiologist (McCarty et al., 2012). In addition, there are five lab technicians, five nurses, and eight anesthesiologists available during the working hours (McCarty et al., 2012). Therefore, one can observe that anesthesiologists require more time for assessing the patients due to the sheer complexity of the procedures.

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In addition, one more inefficiency can be spotted within the role of an RN and MD. It is stated that their assessments are mostly similar in terms of questions and points, but they ask a patient to visit them separately (McCarty et al., 2012). One should be aware that both nurse and an anesthesiologist can complete their consent and assessment forms jointly. However, the fact that they conduct their documentation in such way creates more time waste. In other words, both face-to-face time and waiting time can be reduced greatly without any demand for additional resources. Moreover, it should be noted that PATA can only see 65% of all out-patients, which is a major indicator of flawed operations management (McCarty et al., 2012). Thus, there are evident problems within the workflow stages and their coordination. Charge nurse inefficiencies are also present because she has to leave the station to find an available provider for the patient, which means that the specialist can assist only one patient on time.

Proposed Solutions

It is critical to note that, although some members of the task force suggested solutions without the usage of additional resources, the minimum amount might be necessary for complete improvement. First, PATA needs to put RNs and MDs together, which will allow both specialists to complete their forms in one session. This will shorten the face-to-face time by 30-50 minutes, which will reduce the overall value by half (McCarty et al., 2012). In addition, PATA lacks ordered patient streamline, because they are assigned an available provider. There needs to be a step-by-step flow of patients, where they visit lab technicians first, and then, they go to the room with RN and MD. The transfer of documents from one room to another is also problematic due to the fact that a specialist needs to leave and take the results from a holding bin. Since a charge nurse will no longer accompany each patient and search for an available provider, she will be responsible for relocating the results from the bin to the rooms. This will eliminate the need for MDs, RNs, and lab techs to leave their places.

The scheduling process’s 30-minute gap should not be changed, because the combination of RN and MD assessments will make their process needing a similar amount of time. PATA patients almost always arrive on time to their appointments, and thus, there are no issues with lateness. As soon as a patient arrives, they need to be directed towards the lab techs’ rooms, after which they proceed to the room occupied by RNs and MDs. The latter will assess people jointly, and, since there are eight anesthesiologists and five nurses, RNs will have to coordinate with MDs assessments. In other words, registered nurses’ assessment forms are not as complex as anesthesiologists’, which means that they require less time and can leave the room to join another MD.


In conclusion, PATA’s case shows a great deal of inefficiencies within the operations management and workflow. The major issue lies in the fact that RNs and MDs conduct their assessments separately despite their equivalence of their procedures. This makes face-to-face time twice as long, or 90 minutes, and, by taking into account the scheduling time of 30 minutes, there are prolonged waiting times. Therefore, it is important to combine the assessments of RNs and MDs to make face-to-face time around 40 minutes. In addition, the patient flow should be ordered, where they will visit lab techs before going to RNs’ and MD’s room.

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McCarty, K., Gallien, J., & Levi, R. (2012). Massachusetts General Hospital’s Pre-Admission Testing Area (PATA) [PDF document]. Web.

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