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This is the author's final published version in BMC Health Services Research, Volume 22, Issue 1, December 2022, Article number 1388.

The published version is available at Copyright © The Author(s) 2022.


Purpose: To use a mixed methods approach to investigate the patient waiting experience for a medically underserved population at an outpatient surgical clinic.

Methods: We used lean methodology to perform 96 time-tracked observations of the patient journey in clinic, documenting the duration of activities from arrival to departure. We also used human-centered design (HCD) to perform and analyze 43 semi-structured interviews to understand patients’ unmet needs.

Results: Patients spent an average of 68.5% of their total clinic visit waiting to be seen. While the average visit was 95.8minutes, over a quarter of visits (27%) were over 2hours. Patients waited an average of 24.4minutes in the waiting room and 41.2minutes in the exam room; and only spent 19.7% of their visit with an attending provider and 11.8% with a medical assistant. Interviews revealed that patients arrive to their visit already frustrated due to difculties related to scheduling and attending their appointment. This is exacerbated during the visit due to long wait times, perceived information opacity, and an uncomfortable waiting room, resulting in frustration and anxiety.

Conclusions: While time tracking demonstrated that patients spend a majority of their visit waiting to be seen, HCD revealed that patient frustrations span the waiting experience from accessing the appointment to visit completion. These combined fndings are crucial for intervention design and implementation for medically underserved populations to improve the quality and experience with healthcare and also address system inefciencies such as long wait times.

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.