Theoretical Review for Solution Recommendation on Waiting Time Issue at Malaysian Government Hospital

Excessive patient waiting time remains a critical issue in Malaysian government hospitals, leading to reduced healthcare efficiency, overcrowding, and decreased patient satisfaction. This study presents a theoretical review of existing literature and frameworks addressing waiting time reduction through facility planning, service design, Lean principles, and resource optimization. The review highlights that long waiting times stem from systemic inefficiencies including poor spatial layouts, inadequate scheduling systems, outdated administrative procedures, and insufficient staffing. Using a systematic literature review method across Scopus, IEEE Xplore, and Web of Science databases, a total of 45 relevant studies were analyzed. Findings reveal that strategic service redesign, efficient facility layout, and the adoption of Lean methodologies significantly improve patient flow and operational performance. Concepts such as Patient Flow Engineering, Casemix Index (CMI) application, and integrated facilities planning emerged as effective approaches for addressing service bottlenecks without requiring major capital investment. The review also emphasizes the interdependence between facility layout, process design, and scheduling systems, suggesting that improvements in one area must align with the others to achieve sustainable outcomes. Moreover, digital integration—such as electronic health records and data-driven decision-making tools—further enhances coordination and reduces administrative delays. The study concludes that a multidisciplinary approach combining Lean thinking, facilities optimization, and technology adoption is essential to reduce waiting times and improve healthcare delivery efficiency. These findings contribute to a conceptual framework that can guide future empirical studies and policy reforms aimed at enhancing the operational performance of Malaysian government hospitals.

Waiting Time, Government Hospitals, Facility Planning

1. Marshall, E.G., Miller, L., & Moritz, L.R. (2023). Challenges and impacts from wait times for specialist care identified by primary care providers: Results from the MAAP study cross-sectional survey. Healthcare Management Forum, 36(5): 340–346. [Google Scholar] [Crossref]

2. Harrington DW, Wilson K, Rosenberg M, Bell S. (2013). Access granted! Barriers endure: determinants of difficulties accessing specialist care when required in Ontario, Canada. BMC Health Services Research, 13:146. [Google Scholar] [Crossref]

3. Jaakkimainen L, Glazier R, Barnsley J, Salkeld E, Lu H, Tu K. (2014). Waiting to see the specialist: patient and provider characteristics of wait times from primary to specialty care. BMC Fam Pract, 15(1): 16. [Google Scholar] [Crossref]

4. Statistics Canada. (2005) Access to Health Care Services in Canada. Statistics Canada;,25. http://www.pnhp.org/PDF_files/ access_to_care_in_canada.pdf [Google Scholar] [Crossref]

5. Channel News Asia. (2023). Malaysia healthcare capacity stretched with long waiting times, manpower shortage. https://www.channelnewsasia.com/asia/malaysia-public-hospital-overcapacity-3282636. [Google Scholar] [Crossref]

6. The Straits Times. (2023, February 2). A two-day wait for a bed in Malaysian government hospitals. https://www.straitstimes.com/asia/se-asia/a-two-day-wait-for-a-bed-in-malaysian-government-hospitals. [Google Scholar] [Crossref]

7. Prasanthi, K. K. N., Perera, M. K. H., Dharmadasa, A. G. M. M., & Ranathunga, S. (2023). Case study on waiting time and consultation time in OPD patients at three selected district hospitals of Gampaha District from January to March 2023. International Journal of Research Publication and Reviews, 4(11), 1322–1327. [Google Scholar] [Crossref]

8. Jafry, M.A., Jenny, A.M., Lubinga, S.J., Larsen-Cooper, E., Crawford, J., Matemba, C. & Babigumira, J.B. (2016). Examination of patient flow in a rural health center in Malawi. BMC Research Notes, 9, 363. [Google Scholar] [Crossref]

9. Ahmad, B.A., Khairatul, K., & Farnaza, A. (2017). An assessment of patient waiting and consultation time in a primary healthcare clinic. Malaysian Family Physician, 12(1):14–21. [Google Scholar] [Crossref]

10. Abdullah, N., Mohd Yusof, M. M., & Mohamed, M. H. (2020). Workarounds during computerized system use in the clinical environment: A case study in a Malaysian public hospital. International Journal of Medical Informatics, 135, 104041. [Google Scholar] [Crossref]

11. Pathirana, D. P. I. M., & De Silva, N. (2021). Efficient workplace planning and designing strategies to reduce waiting time in the outpatient departments (OPD) of government hospitals in Sri Lanka. Built Environment Project and Asset Management, 11(1), 1–20. [Google Scholar] [Crossref]

12. Putra, R. E., Djatna, T., & Hasibuan, M. S. (2022). Digital-based outpatient lean system for patient flow improvement in public healthcare. International Journal on Advanced Science, Engineering and Information Technology, 12(5), 1819–1827. [Google Scholar] [Crossref]

13. Huang, S. W., Weng, S. J., Chiou, S. Y., Nguyen, T. D., Chen, C. H., Liu, S. C., & Tsai, Y. T. (2022). A study on decision-making for improving service efficiency in hospitals. Sustainability, 14(13), 7785. [Google Scholar] [Crossref]

14. Morales, J., Silva Aravena, F., & Sáez, P. (2024). Reducing waiting times to improve patient satisfaction: A hybrid strategy for decision support management. Mathematics, 12(23), 3743. [Google Scholar] [Crossref]

15. Alodan, A., Alalshaikh, G., Alqasabi, H., Alomran, S., Abdelhadi, A., & Alkhayyal, B. (2022). Studying the efficiency of waiting time in outpatient pharmacy. Journal of Pharmaceutical Policy and Practice, 15, 18. [Google Scholar] [Crossref]

16. Albalawi, M., Mahmud, A., Abdul Manaf, R., Mohd Nazan, A. I. N., Aljohani, A., & Mohamad, A. (2024). Improving the waiting time in outpatient clinics using Lean approach in hospital: A systematic review. Malaysian Journal of Medicine and Health Sciences, 20(1), 263-270. [Google Scholar] [Crossref]

17. Waiman,E., Achadi, A., & Agustina, R. (2023). Reducing hospital outpatient waiting time using Lean Six Sigma: A systematic review. Indonesian Journal of Health Administration, 11(1), 154-166. [Google Scholar] [Crossref]

18. Rathi R, Vakharia A, Shadab M. (2022). Lean Six Sigma in the healthcare sector: A systematic literature review. Mater Today Proc., 50, 773-781. [Google Scholar] [Crossref]

19. Al-Zain, Y., Al-Fandi, L., Arafeh, M., Salim, S., Al-Quraini, S., Al-Yaseen, A., & Abu Taleb, D. (2019). Implementing Lean Six Sigma in a Kuwaiti private hospital. International Journal of Health Care Quality Assurance, 32(2), 431–446. [Google Scholar] [Crossref]

20. Tlapa D, Tortorella G, Fogliatto F, Kumar M, Mac Cawley A, Vassolo R, Enberg L, Baez-Lopez Y. (2022). Effects of Lean interventions supported by digital technologies on healthcare services: A systematic review. International Journal on Environmental Research and Public Health, 19(15), 9018. [Google Scholar] [Crossref]

21. Sun, J., Lin, Q., & Zhao, P. (2020). Reducing waiting time and raising outpatient satisfaction in a Chinese public tertiary general hospital—An interrupted time series study. BMC Public Health, 20, 1815. [Google Scholar] [Crossref]

22. Tompkins, J. A., White, J. A., Bozer, Y. A., & Tanchoco, J. M. A. (2010). Facilities planning (4th ed.). John Wiley & Sons. [Google Scholar] [Crossref]

23. Abdulrahman, A., Balkhi, B., Gleeson, G., & Atassi, E. (2021). Efficiency and resource allocation in government hospitals in Saudi Arabia: A casemix index approach. Healthcare, 9(6), 700. [Google Scholar] [Crossref]

24. Ahmad, A. N. A., Ahmad, M. F., Abdul Hamid, N., Abdul Hamid, N. A., Chuan, L. T., Nawanir, G., Bakri, A., & Abdul Rahim, M. (2021). Implementation of Lean technique towards reducing waiting time in a public healthcare using Arena simulation. International Journal of Advanced Computer Science and Applications, 12(5), 100–108. [Google Scholar] [Crossref]

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