Client Flow Analysis

What is it?

Who uses it?

Why use it?

When to use it?

• measure the time clients spend at each station

• identify bottlenecks in client flow, that is, places where clients wait longer to be served than elsewhere in the clinic

• locate gaps in clients' contact with staff

• measure total waiting time of clients

How to use it:

1. Ensure that all staff understand the technique and how it will be used and analyzed, and get their commitment to participating.

2. Assign a number to each client as they register, and attach a Client Flow Form to the client's medical record to collect information about the client's entry and exit time, the amount of time the client spends with each staff member, and the reason for the visit.

   Example of a completed Client Flow Form:
   

   Client Flow Form
   Client Number: Time of Client's Arrival in Clinic: Type of Visit:	01 8:00 City Health Center First	Date:

   
   

   Client's Contact	Type of Staff	Service Started	Service Completed	Total Service Time
   First Contact	Registration Clerk	8:00	8:03	3 mins
   Second Contact	Nurse	8:22	8:29	7 mins
   Third Contact	Doctor	8:30	8:35	5 mins

   
   

3. Indicate whether the visit is a first visit or a follow-up visit.

4. Ask your staff members at each station to enter on the Client Flow Form the time they start and complete their service with the client.

5. Summarize the data from all the Client Flow Forms in a Client Flow Summary Table.

   Client Flow Summary Table
   

   Client No.	Time In	Time Out	Total Minutes	Contact Minutes	Waiting Time	Percent Waiting Time	Visit Code
   01	8:00	8:35	35 min.	15 min.	20 min.	57 %	First
   02	8:00	9:08	68	37	31	46 %	First
   03	8:00	9:32	92	29	63	68 %	Revisit
   04	8:05	10:00	115	33	82	71 %	First
   05	8:07	10:34	147	26	121	82 %	Revisit
   06	8:10	10:55	165	27	138	84 %	First

   
   
   Sample Summary Analysis of Client Flow
   
   Average Time in Clinic: 138 min.
   Average Waiting Time: 115 min.
   Average Contact Time: 22 min.
   % Time in Contact with Staff: 16%
   % Time Waiting: 83%

6. Involve your staff in creating a client flow graph:
   
   • If "type of visit" will be considered, a different color should be assigned for each type of visit, for example, green for initial visit, red for return visit, blue for prenatal visit, etc.
     
   • Using graph paper, enter the time in 5- or 10-minute intervals on the X axis.
     
   • Enter the client numbers on the Y axis. Begin with client number 01.
     
   • Use different codes to indicate when the client arrives or departs, contact time with staff, waiting time, and codes to indicate the different staff members with which the client has contact. In the example below, "*" is used to indicate client arrival/departure, a bold line indicates contact time, hatch lines indicate waiting time, R indicates registration clerk, N indicates nurse, and D indicates doctor.
   • For client number 01, place a "*" on the graph, starting at the time the client arrived and ending at the time he or she left. Then place a bold line (indicating contact time with staff) with the code for the type of staff above the line. Draw hatch lines for waiting time.
     
   • Repeat this process for each client in the session.
   
   

   

7. After completing your graph, you will be able to see how clients moved through your clinic and locate the bottlenecks in client flow. For example, you can see that the first few clients are seen relatively quickly, but the latter clients have to wait longer and longer to see the doctor or nurse.

8. Use the results of the client flow analysis to set attainable goals, streamline client routes through the clinic, and develop other solutions to reduce your clients' waiting time.

Example: