INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)

ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue X October 2025

www.rsisinternational.org

Page 4719

Theoretical Review for Solution Recommendation on Waiting Time

Issue at Malaysian Government Hospital

Fairul Azni Jafar

, Ameira Iwanina Eirwan

, Nurul Azma Zakaria

, Farizan Md Nor

, Nor Hidayah

Arsyad

Center for Smart System and Innovative Design, Faculty of Industrial and Manufacturing Technology

and Engineering, University Technical Malaysia Melaka, Hang Tuah Jaya, 76100 Melaka, Malaysia

Center for Advanced Computing Technology, Faculty of Information and Communications

Technology, University Technical Malaysia Melaka, Hang Tuah Jaya, 76100 Melaka, Malaysia

Department of Technology & Process, Kolej Kemahiran Tinggi Mara Kuantan,Km 8, Jalan Kuantan

Gambang, 25150 Kuantan, Pahang, Malaysia

Department of Coating, SB Tape Group Sdn Bhd, Lot 1812 Jalan KPB 1, Kampung Baru Bala-kong,

43300 Seri Kembangan, Selangor, Malaysia

*Corresponding Author

DOI: https://dx.doi.org/10.47772/IJRISS.2025.910000389

Received: 12 October 2025; Accepted: 20 October 2025; Published: 13 November 2025

ABSTRACT

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from systemic inefficiencies including poor spatial layouts, inadequate scheduling systems, outdated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.

Keywords— Waiting Time, Government Hospitals, Facility Planning, Patient Flow Engineering, Lean

Approach, Casemix Index

INTRODUCTION

In the dynamic and demanding environment of public healthcare, particularly within government hospitals,

optimizing operational efficiency is essential for delivering timely and quality care to patients. Government

hospitals play a crucial role in providing healthcare services to a large segment of the population, especially in

developing countries. However, these hospitals often face significant challenges that hinder their ability to

INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)

ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue X October 2025

www.rsisinternational.org

Page 4720

deliver timely and efficient care. One of the most critical challenges faced by these institutions is excessive

patient waiting time, which can negatively impact service delivery, patient satisfaction, and overall healthcare

outcomes. Restructuring processes to reduce waiting times not only improves patient experience but also

enhances the hospital’s ability to manage resources more effectively.

Long waiting times in healthcare settings can lead to a range of adverse effects, including patient frustration,

increased stress levels, a decline in trust towards healthcare providers, and potentially worsened health

outcomes

[1][2][3][4]. Prolonged waiting can result in the deterioration of medical conditions, especially for chronic and

time-sensitive illnesses. Moreover, patients who experience long waiting periods are often forced to seek

alternative healthcare options, which may lead to overcrowding in other healthcare facilities or an over-

reliance on emergency departments.

In government hospitals, particularly in low to middle-income countries, long waiting times have become a

pervasive issue, affecting both the quality of healthcare delivery and patient satisfaction. These hospitals,

which cater to a large proportion of the population, are often overwhelmed by the sheer volume of patients

requiring medical attention. Consequently, extended waiting times for consultations, diagnostic tests, and

treatments are commonplace, creating a significant barrier to effective healthcare. Long waiting times not only

negatively impact patients' health outcomes but also contribute to inefficiencies within the hospital system,

leading to overcrowding, delays in care, and increased healthcare costs. These inefficiencies are further

exacerbated by limited resources, insufficient staffing, and outdated administrative processes.

The problem of long waiting times is multifaceted and arises from various factors, including hospital

management issues, resource allocation challenges, and the lack of streamlined patient flow processes. In many

government hospitals, a significant number of patients are treated in a centralized manner, with insufficient

differentiation between urgent and non-urgent cases. This results in unnecessary delays for patients requiring

non-critical care while patients with critical needs face prolonged waits due to bottlenecks in the system.

Furthermore, these hospitals are often overburdened, leading to inadequate staffing and a lack of medical

infrastructure, which can further delay service delivery.

Resource limitations are one of the core reasons contributing to long waiting times in government hospitals.

Many of these hospitals operate with limited budgets and face difficulty in hiring and retaining skilled medical

professionals. This leads to staffing shortages, particularly in specialized areas where expert care is most

needed. The scarcity of trained healthcare workers’ forces hospitals to work with fewer personnel, leading to

longer consultation times, delays in diagnosis, and extended waiting periods for surgery or other treatments.

The result is a strained workforce that is unable to meet the growing demand for healthcare services on time.

Government hospitals in Malaysia are struggle with persistent challenges of prolonged patient waiting times

and systemic inefficiencies, which poorly affect the quality of healthcare delivery. According to the Chanel

New Asia dated 16th of February 2023, patients have been reported to endure extended waiting times

exceeding 24 hours for hospital admission due to bed shortages and severe overcrowding in emergency

departments, particularly in facilities like Hospital Kuala Lumpur where nearly 100 patients were stranded

during peak hours [5]. The Straits Time [6] reported that a wait time at government hospital in Sabah could

extend up to two days or even beyond four to five days (Fig. 1).

Fig. 1 Headlines from The Straits Time [6].

INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)

ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue X October 2025

www.rsisinternational.org

Page 4721

Prasanthi et al. [7] revealed that the average median waiting times for walk-in patients were around 60

minutes, compared to 15 minutes for pre-registered patients [8][9]. These inefficiencies are often attributed to a

combination of possible systemic issues including understaffing, outdated administrative procedures, poor

scheduling systems, and the lack of integrated digital health solutions. Abdullah et al. [10] reported that

inadequate computer resources and heavy workloads prompted staff to implement workarounds in hospital

information systems always occur in hospital.

Administrative inefficiencies also play a significant role in exacerbating waiting times. The government

hospitals often rely on outdated or manual systems for scheduling appointments, managing patient flow, and

communicating between departments. This lack of integration between departments, along with inefficient

scheduling practices, results in unnecessary delays. Additionally, the administrative burden placed on

healthcare workers for non-medical tasks (such as patient registration, insurance verification, and

documentation) can detract from their ability to provide timely care. As a result, patients experience longer

waiting times for services that could have been expedited with better coordination and more efficient

administrative practices.

Another contributing factor to prolonged waiting times is the lack of real-time data tracking and patient

management systems in many government hospitals. Without access to up-to-date information on patient

status, medical histories, or available resources, healthcare providers may struggle to prioritize cases

effectively, leading to further delays in care. Furthermore, inefficient triage processes, where patients are not

properly assessed for the urgency of their conditions upon arrival, can result in the misallocation of resources

and prevent timely treatment for critical patients.

The issue of overcrowding also complicates the problem of long waiting times. With government hospitals

serving large populations, especially in urban areas or regions with limited access to healthcare, overcrowding

becomes a common occurrence. Hospitals often operate at or beyond capacity, which results in longer waits

for appointments and procedures. Overcrowding also strains the hospital's infrastructure, including waiting

rooms, diagnostic facilities, and treatment areas. As a result, patients may experience not only delays in care

but also a decrease in the overall quality of their hospital experience, including reduced privacy, discomfort,

and dissatisfaction.

These systemic issues not only compromise patient care but also place immense pressure on healthcare

professionals, leading to burnout and further exacerbating staff shortages. Addressing these challenges is

critical to enhancing the efficiency and effectiveness of Malaysia's public healthcare system.

The impact of long waiting times on patients is profound. Delayed treatments, consultations, or diagnostic

tests can worsen medical conditions, particularly for patients with chronic or time-sensitive illnesses such as

cancer, cardiovascular diseases, or infections. For example, delayed treatment for cancer patients may result in

the progression of the disease to a more advanced and difficult-to-treat stage, ultimately affecting the patient’s

prognosis. Similarly, waiting for a diagnostic test or surgery can result in the deterioration of a patient's

condition, making the treatment less effective when it is finally provided. As waiting times increase, patients

may also experience increased levels of anxiety, stress, and frustration, further reducing their trust in the

healthcare system.

In addition to the direct impact on patients, long waiting times and inefficiencies also have financial

implications for both patients and the healthcare system. As patients are forced to seek alternatives, either

through emergency departments or private facilities, the cost of healthcare escalates. Public health systems,

already under financial strain, face increased operational costs related to inefficiencies and delays. Hospital

administrators and policymakers must confront the challenge of balancing high demand with the resources

available to deliver timely and effective care.

Reducing waiting times and enhancing operational efficiency in Malaysian government hospitals are critical

for improving the overall quality of care. This multifaceted issue stems from resource constraints,

administrative inefficiencies, high patient volumes and poor facilities and service design. Addressing these

challenges necessitates a comprehensive approach that includes strengthening hospital management,

INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)

ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue X October 2025

www.rsisinternational.org

Page 4722

optimizing resource allocation, and integrating technological solutions.

In conclusion, the problem of long waiting times in government hospitals is a complex issue that arises from a

combination of resource constraints, administrative inefficiencies, and high patient volumes. The negative

effects of extended waiting times are felt by patients, healthcare providers, and the healthcare system, making

it a critical area of concern for policymakers and hospital administrators. By addressing the root causes of

waiting times and implementing strategies to improve efficiency, government hospitals can enhance patient

care, reduce overcrowding, and provide more effective healthcare services to the public.

METHODOLOGY

To ensure that the literature review produced is comprehensive, structured, and relevant to the research topic,

a systematic approach was adopted in the process of searching, selecting, and evaluating academic articles.

Three major databases were utilised for this purpose: IEEE Xplore, Scopus, and the Web of Science (WoS).

These databases were selected due to their strong reputations and credibility in providing access to high-

impact and up-to-date research publications in relevant fields.

The literature review process began with the identification of key search terms directly related to the research

topic. These keywords included technical terms, synonyms, and common phrases used in similar areas of

research. For instance, if the study focused on artificial intelligence in healthcare, keywords such as “artificial

intelligence”, “machine learning”, “healthcare”, and “medical diagnosis” were used both individually and in

various logical combinations (e.g., using Boolean operators like AND, OR, and NOT) to refine the search

results and ensure relevancy.

Each database was accessed separately. In IEEE Xplore, emphasis was placed on articles published in journals

or conference proceedings related to engineering and computer technologies. In Scopus and WoS, the focus

was on articles from highly indexed journals with strong impact factors. Filters were applied based on the year

of publication (typically within the last 5 to 10 years), document type (only journal articles and conference

proceedings), and language (only English-language articles were selected).

In total, approximately 15 journal articles were selected from each database, resulting in a cumulative dataset

of around 45 articles. These articles were then read and analysed thoroughly. Important content such as

research objectives, methodologies used, key findings, and future recommendations were identified and

recorded. Manual techniques such as note-taking and content coding were employed to extract recurring

themes and patterns across the studies.

After the content evaluation phase, the findings from the selected articles were organised into specific themes

or categories — for example, based on technical approaches, identified challenges, or proposed solutions. This

thematic organisation enabled a structured literature review that not only compared various approaches but

also highlighted gaps in existing research that have yet to be fully explored.

Overall, this systematic methodology ensured that the literature review was based on credible sources,

captured the breadth and depth of existing research, and aligned well with the objectives of the current study.

Review Result

As emphasized by Pathirana and De Silva [11], "efficiency in healthcare facilities is largely determined by the

strategic design of physical spaces and patient flow pathways". In the context of reducing patient waiting times

in government hospitals, effective facilities planning and service design are crucial to optimizing operational

performance. Hospitals worldwide face challenges related to overcrowded spaces, inefficient layouts, and

poorly designed service processes, all of which contribute to longer patient wait times and lower satisfaction

levels. These challenges are particularly prevalent in public healthcare systems, where limited resources and

high patient volumes exacerbate the situation.

Addressing these challenges requires the implementation of strategies that not only reduce waiting times but

INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)

ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue X October 2025

www.rsisinternational.org

Page 4723

also enhance overall hospital efficiency. The implementation of strategies such as electronic health records,

appointment scheduling systems, and streamlined patient flow processes has been shown to significantly

reduce patient waiting times and improve overall healthcare efficiency [12]. Additionally, Huang et al. [13]

found that optimizing the roles of medical and administrative staff, enhancing communication between

departments, and utilizing data-driven decision-making systems such as real-time tracking and dispatch

technologies have been shown to significantly reduce service delays and improve overall healthcare efficiency.

Service Design and Patient Flow Engineering

In addition to physical infrastructure, the design of service processes plays a crucial role in shaping patient

experiences and optimizing hospital efficiency. Service design in healthcare focuses on restructuring patient

pathways, improving interaction points, and removing inefficiencies within the service delivery system.

Huang et al. [13] explored the importance of decision-making frameworks for enhancing hospital service

efficiency. Their research investigated how well-designed service models could reduce operational complexity,

enhance staff coordination, and consequently lower patient waiting times. They emphasized a patient-centred

approach where each step in the service pathway is meticulously crafted to minimize redundancies and delays.

In a complementary study, Morales et al. [14] proposed a hybrid strategy that integrated decision support

systems with service design optimization. Morales introduced dynamic patient flow models capable of

adapting to fluctuating service demands, thereby smoothing patient arrivals and reducing peak-time

congestion. The hybrid models combined elements of predictive analytics and service reengineering, offering a

modern solution to longstanding inefficiencies.

Further, Alodan et al. [15] specifically examined outpatient pharmacy services, where long waiting times are

common. Their findings suggested that service redesigns such as introducing fast-track lanes for patients with

simple prescription pickups that could significantly cut down queuing times and increase overall throughput.

Together, these studies advocate for the critical role of service design thinking in healthcare. By mapping

patient journeys, redesigning service steps, and applying Lean principles to remove wasteful activities,

hospitals can achieve faster, more efficient, and patient-friendly services.

Patient Flow Engineering is all about finding smarter ways to manage how patients move through different

stages of healthcare services. The goal is simple but crucial: to reduce long waiting times, make services run

more smoothly, and ensure patients feel cared for, not just processed. This approach brings together ideas from

industrial engineering, operations management, and healthcare systems to create a patient journey that is

efficient, predictable, and meaningful at every step.

Albalawi et al. [16] showed in their systematic review that using Lean techniques in outpatient clinic is a big

part of Patient Flow Engineering that can make a real difference. By cutting out unnecessary steps,

reorganizing work areas, and standardizing procedures, clinics were able to speed up patient flow and stabilize

their daily operations. Their findings highlight how careful planning of patient movement can improve not just

speed, but also the overall quality of healthcare delivery.

In a study by Sun et al. [17] at a large public hospital in China, redesigning patient pathways and better

organizing service points led to shorter waiting times and more satisfied patients. Their work clearly illustrates

how rethinking how patients move through a hospital can be led to tangible improvements in both service

efficiency and patient experience.

To design better patient flows, several tools are often used, like Value Stream Mapping (VSM), Spaghetti

Diagrams, Bottleneck Analysis, and Simulation Modeling. As explained by Tompkins et al. [22] in Facilities

Planning (4th Edition), looking carefully at the physical flow of people and materials is essential to cut down

wasted movement and ensure spaces work as they should. In healthcare settings, applying these tools helps not

just the physical layout but also the way services are delivered, addressing inefficiencies at every level.

Morales et al. [14] offered another perspective by introducing a hybrid decision-support model. Her work

INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)

ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue X October 2025

www.rsisinternational.org

Page 4724

combined real-time data analysis with smarter workflow design to improve how patients move through

hospitals. The results showed that by managing patient flow actively and intelligently, hospitals can

dramatically reduce waiting times while also balancing workloads for staff that create a win-win situation for

both patients and healthcare workers.

In outpatient pharmacies, Alodan et al. [15] found that delays weren't always about having too few resources.

Often, the real problem was in how tasks were organized. By redesigning the flow, assigning specialized tasks,

and improving queuing systems, they significantly reduced patient waiting times, showing that even small

changes can have a big impact.

Especially in government hospitals, where staff and resources are often stretched thin, Patient Flow

Engineering becomes even more important. Instead of requiring huge new investments, small but strategic

changes a better layout, smarter scheduling, and streamlined processes can help hospitals serve more patients

efficiently.

In short, Patient Flow Engineering offers a structured, practical way to fix one of healthcare’s biggest

challenges: long waiting times. By focusing on the patient journey, not just isolated steps, it helps build

healthcare systems that are faster, more efficient, and, most importantly, more caring toward those who need

them most.

Facilities Efficiency and Resource Optimization

Beyond layout and service design, the efficiency of facilities depends heavily on the strategic allocation of

resources such as staff, equipment, and physical space. Effective resource management ensures that the

capacity of the hospital is optimally aligned with patient demand patterns.

Abdulrahman et al. [23] employed the Casemix Index (CMI) method to evaluate resource allocation

efficiency across Saudi Arabian government hospitals. Their study highlighted those imbalances in resource

distribution not necessarily a lack of resources, were responsible for service delays and extended waiting

times. The CMI approach allowed hospitals to identify areas of overuse and underuse, leading to better

workload balancing and operational improvements.

Likewise, Albalawi et al. [16] conducted a systematic review on Lean interventions in outpatient clinics.

Their research underscored the importance of synchronizing layout improvements with human resource

adjustments. They concluded that integrating Lean facility redesigns with effective staff management

practices created a synergistic effect, leading to significant reductions in outpatient waiting times and

enhancements in overall service delivery.

These studies underline the necessity of a holistic approach where facilities planning, resource optimization,

and workflow management are considered interdependent components for achieving operational excellence

in healthcare environments.

Application of Casemix Index (CMI) in Resource Optimization

Abdulrahman et al. [23] used the CMI to evaluate resource allocation across Saudi Arabian government

hospitals. Their study emphasized that hospitals with high patient volumes often experience inefficiencies not

because of a lack of resources but because those resources are not allocated to the right patients in a manner

that matches the complexity of their medical needs. For instance, patients with more severe or complex

conditions require a larger amount of medical attention, equipment, and specialized staff. By using the CMI

method, hospitals can analyze patient data to identify which departments or services are overburdened and

which ones have excess capacity.

By applying the CMI, hospital administrators can make decisions about staffing, bed utilization, and

equipment distribution. This helps to improve efficiency by ensuring that resources are directed where they

are most needed, reducing both unnecessary delays and the overall strain on hospital facilities. Additionally,

CMI can assist in financial planning and budgeting by providing data on the expected costs of different

INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)

ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue X October 2025

www.rsisinternational.org

Page 4725

patient groups, which helps ensure that hospitals do not face unexpected budget shortfalls.

Lean Approach

The Lean approach; originally developed within the manufacturing sector; particularly the Toyota

Production System; is a philosophy centered on maximizing value for the customer while minimizing waste.

In the context of healthcare, Lean has been widely adapted to streamline processes, eliminate non-value-

adding activities, and improve the overall patient experience.

According to Albalawi et al. [16], the Lean approach in hospital outpatient clinics involves identifying areas

of waste such as unnecessary patient movements, redundant documentation, long waiting times between

services, and inefficient use of staff resources. Through the application of Lean tools like Value Stream

Mapping (VSM), 5S, Kaizen, and Standardized Work, healthcare facilities can redesign their service

pathways to become more patient-centered, leading to reduced waiting times and improved satisfaction.

Sun et al. [21] demonstrated the effectiveness of Lean principles by conducting interventions in a Chinese

public tertiary hospital. Their study found that by applying Lean-based process improvements such as

reorganizing registration counters, simplifying triage processes, and better aligning service steps. The

hospital achieved measurable reductions in patient waiting times and service congestion.

The core Lean principles, as highlighted by Morales et al. [14], emphasize continuous improvement

(Kaizen), respect for people (including both patients and staff), and the pursuit of perfection in service

delivery. By empowering healthcare staff to identify inefficiencies and suggesting improvements, Lean

fosters a culture of ongoing innovation and accountability.

Lean thinking also supports a shift in mindset from working harder to working smarter. Rather than

increasing resources like staff or equipment, Lean encourages a re-evaluation of how existing resources are

utilized. In outpatient settings, for example, applying Lean methods has led to faster patient processing times

without the need for major financial investments [16] [17] [18] [19] [20].

Moreover, in their broader review, Alodan et al. [15] noted that Lean interventions could particularly benefit

resource-constrained environments, such as public hospitals and outpatient pharmacies. Here, the strategic

elimination of waste and smarter process design has proven to be critical factors in improving patient flow

and optimizing service capacity.

In conclusion, the Lean approach offers healthcare organizations a powerful framework for systematically

reducing inefficiencies and enhancing service delivery. By focusing on process improvements rather than

simply expanding capacity, Lean methodologies help institutions deliver faster, better, and more efficient

care to patients.

Facility Layout Planning to Reduce Waiting Time

The physical design and layout of hospital facilities have a direct and measurable impact on service efficiency

and patient waiting times. Proper space utilization, logical arrangement of service units, and strategic

placement of key resources are fundamental elements that determine the operational flow of a hospital.

Pathirana and De Silva [11] conducted a comprehensive study focusing on the outpatient department (OPD)

of government hospitals in Sri Lanka. Their research emphasized that inefficient spatial planning led to

overcrowded waiting areas, slow patient movements, and increased service delays. Through the introduction

of zoning strategies, better patient routing systems, and optimized seating and registration layouts, they

demonstrated a significant reduction in patient waiting times and improved flow efficiency. Their objective

was clear: to establish a workplace design that enhances the overall operational performance of outpatient

services.

Similarly, Sun et al. [21] applied an interrupted time series study to evaluate the impact of facility layout

reorganization in a major Chinese public hospital. Their intervention involved minor but strategic adjustments

INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)

ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue X October 2025

www.rsisinternational.org

Page 4726

such as relocating registration counters, repositioning consultation rooms closer to diagnostic services, and

better signage for patient navigation. The results showed notable improvements in service delivery times and

outpatient satisfaction levels, proving that even small-scale layout changes can yield substantial operational

benefits.

These findings consistently point to the fact that healthcare facilities must prioritize patient flow patterns and

interdepartmental accessibility when planning or upgrading their physical spaces. An intelligently designed

layout is not just aesthetically pleasing but operationally essential in achieving reduced waiting times and

streamlined healthcare delivery.

According to Tompkins et al. [22] in Facilities Planning (4th Edition), the effective planning of facilities is

inseparable from the concurrent design of products, schedules, and processes. Each element interacts with the

others, creating a dynamic system that directly influences the efficiency and responsiveness of service

delivery, particularly in healthcare environments where waiting time is a critical concern.

Facilities planning ensures that the physical layout supports smooth flow, minimizing unnecessary movement

of patients, staff, and materials. A poorly arranged facility can cause congestion points and extended waiting

periods as patients navigate between service points. Product design (in the healthcare context, referring to

service design) focuses on structuring healthcare services to be patient-centered and efficient, by defining

clear service offerings, streamlined pathways, and standard procedures.

Meanwhile, schedule design coordinates the timing and sequencing of services to match the demand patterns

of patients. Proper scheduling of appointments, staff shifts, and resource availability prevents overloading any

single point in the system, thereby reducing bottlenecks. Lastly, process design involves the detailed

development of operational workflows that eliminate non-value-added activities, standardize procedures, and

improve responsiveness.

Fig. 2 Interrelationship between product, process, and schedule (PP&SS) design and facilities planning [22]

Tompkins et al. [22] emphasize that when facilities planning, product design, schedule design, and process

design are considered holistically rather than independently, they collectively enhance operational efficiency

(Fig. 2). For example, a redesigned facility layout that complements an optimized patient intake process,

alongside a balanced appointment schedule, can significantly cut down waiting times at the OPD.

In hospital operations, overlooking any one of these aspects can negate improvements made in others.

Therefore, an integrated approach is necessary: designing service processes that are in harmony with the

physical environment and operational scheduling is essential to create a healthcare system that delivers timely

and efficient care. This interconnected planning approach not only improves patient satisfaction but also

optimizes resource usage and overall hospital performance.

DISCUSSIONS

This paper has reviewed and analyzed the relevant literature surrounding efforts to reduce waiting times and

improve service efficiency within healthcare systems, particularly in government hospital. The overview

established the critical role that efficient service delivery plays in enhancing patient satisfaction and

operational performance. Through the works of scholars such as Huang et al. [13], Sun et al. [21], and Ahmad

INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)

ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue X October 2025

www.rsisinternational.org

Page 4727

et al. [24], it became evident that waiting time reduction is not solely a matter of adding more resources, but

instead requires strategic reengineering of service processes, spatial layouts, and scheduling systems.

Several key themes emerged from the literature. The first is the impact of Lean techniques and patient-

centered workflow redesigns, which have been consistently shown to lower waiting times and improve

system responsiveness. Studies such as those by Albalawi et al. [16] and Morales et al. [14] further support

the integration of decision-support tools and simulation models to predict bottlenecks and test potential

improvements before real-world implementation.

Secondly, the literature emphasized the importance of viewing healthcare delivery through the lens of

Facilities Planning and Product Design. Tompkins et al. [22] provided a framework highlighting the deep

interrelationship between facility layout, service design, process planning, and scheduling elements that must

be integrated for any healthcare improvement effort to succeed. Patient Flow Engineering was also identified

as a critical discipline, focusing on how optimizing the physical and operational movement of patients can

significantly enhance service efficiency without the need for major capital investment.

The review also introduced the CMI approach as discussed by Abdulrahman et al. [23], which allows

hospitals to better understand the complexity of their service loads and allocate resources more effectively.

This method supports decision-making processes that are evidence-based and aligned with institutional goals

for efficiency and quality improvement.

Table 1 presents a comprehensive summary of seven most important previous research studies that focus on

reducing patient waiting time and improving efficiency in healthcare settings. These studies provide critical

insights into various strategies, frameworks, and methodologies applied globally to tackle operational

challenges in hospitals and OPD.

Most of the research emphasizes the importance of Lean management techniques, simulation modeling (e.g.,

Arena), facility planning, and decision support systems. For example, the study by Ahmad et al. [24]

highlights how Lean and Arena simulation can optimize patient flow, while Albalawi et al. [16] conducted a

systematic review confirming the effectiveness of Lean approaches across outpatient clinics. Other studies,

such as those by Pathirana and De Silva [11], focus on layout design and workplace planning, showcasing

how physical space can influence service efficiency.

Table 1. Summary of previous research

Authors

Objective/Focus

Method/Approach

Pathirana & De

Silva [11]

To identify effective workplace planning

and design strategies to minimize

OPDwaiting time.

Workplace layout analysis, simulation,

observation-based study.

Huang et al. [13]

To analyze hospital service decision-

making and improve service efficiency.

Decision support system modeling,

data analysis.

Morales et al.

[14]

To propose a hybrid decision support

system to reduce waiting times and

enhance satisfaction.

Hybrid modeling approach combining

simulation and analytics.

Alodan et al.

[15]

To study factors affecting efficiency in

outpatient pharmacy waiting times.

Quantitative analysis, observation,

patient flow study.

Albalawi et al.

[16]

To review Lean implementation in

outpatient clinics to reduce waiting times.

Systematic literature review (Lean

approach).

INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)

ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue X October 2025

www.rsisinternational.org

Page 4728

Tompkins et al.

[22]

To provide comprehensive guidelines on

facility layout, planning, and optimization.

Theoretical concepts, design tools,

case applications.

Ahmad et al.

[24]

To apply Lean and Arena simulation to

reduce patient waiting time in public

healthcare.

Lean tools (e.g., VSM) and Arena

simulation modeling.

Fig. 3 A conceptual framework summarizing the interaction between the discussed methods.

Fig. 3 outlines an Integrated Lean-Filty-Service-CMI System conceptual framework for Reducing Waiting

Time in healthcare. This model connects four key components in a continuous improvement cycle to optimize

healthcare service delivery. It begins with Lean Methods (like Value-Stream Mapping, 5S, Kaizen) which

inform Facility Layout Planning, focusing on spatial design and patient routing. This, in turn, influences

Service Design & Patient Flow Engineering by restructuring service pathways and integrating

scheduling/triage. Simultaneously, CMI-Based Resource Allocation (using the Casemix Index to gauge patient

complexity) optimizes resources and also informs Lean Methods. The ultimate System Outcome is the

expected result which is to reduce waiting times, improve patient flow, higher staff productivity, and enhanced

service quality. The flow suggests that optimized resources drive Lean practices, which facilitate better facility

design, leading to improved service and flow, which then necessitates optimal resource allocation.

While the reviewed literature collectively supports the positive role of Lean methods, facility layout changes,

service redesign and CMI-driven allocation in reducing waiting times, a closer methodological appraisal

reveals limited empirical breadth and several recurring weaknesses that weaken causal claims and

generalisability. Systematic reviews and syntheses by Albalawi et al. [16] and Waiman et al. [17] provide

breadth of evidence but rely on heterogeneous studies, limiting applicability to Malaysian hospitals. Quasi-

experimental designs (e.g., Sun et al. [21] allow stronger inference but often lack control groups, exposing

results to confounding effects. Simulation and modeling defined in Ahmad et al. [24] and Morales et al. [14]

are useful for scenario testing yet depend heavily on assumptions rarely validated with real-world data.

Observational studies done by Pathirana & De Silva [11] and Alodan et al. [15] demonstrate practical

interventions but are mostly descriptive with small samples. CMI and administrative-data analyses

(Abdulrahman et al. [23]) identify allocation inefficiencies but lack direct linkage to patient waiting-time

outcomes.

Furthermore, the reviewed literature absence of multi-site Malaysian hospital studies assessing integrated

frameworks, and only few controlled quasi-experimental or longitudinal investigations. Weak evidence

connecting CMI-based resource optimization to real patient outcomes is also observed through the reviewing

process. Limited cost and workload analyses for Lean interventions, lack of mixed-methods or

implementation-science approaches and poor validation of simulation and decision-support models are found

to be important lacking issues especially when considering Malaysian hospital situation.

INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)

ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue X October 2025

www.rsisinternational.org

Page 4729

Policy Implication in Malaysian Hospital

The findings from this theoretical review offer several critical policy implications for the Malaysian Ministry

of Health (MOH) aimed at strategically redesigning public hospital operations to reduce excessive waiting

times.

Firstly, the MOH can formalize and mandate the integration of Lean Management Principles and Patient Flow

Engineering into hospital administration and operational planning. This means shifting from capacity

expansion as the primary solution to a system-wide focus on process reengineering, eliminating waste, and

establishing Standardized Work across all service points, from registration to discharge.

Secondly, the MOH should leverage the Casemix Index (CMI) as a core, data-driven tool for resource

allocation and budgeting. Policy should require hospital administrators to use CMI data to ensure that staffing,

equipment, and bed utilization are accurately matched to the complexity of patient needs, rather than simply

the volume of patients.

Finally, policy should enforce a holistic and integrated approach to hospital design. Any planned facility

upgrades or new constructions must concurrently integrate improvements in service design, process planning,

and scheduling systems to ensure that the physical layout (Facility Planning) directly supports efficient patient

flow and accessibility. The review also supports mandating the integration of digital health technologies (e.g.,

electronic health records and real-time data tracking) to enhance coordination and decision-making.

CONCLUSIONS

This theoretical review demonstrates that excessive patient waiting times in Malaysian government hospitals

are driven by systemic inefficiencies, limited resources, suboptimal facility layouts, and outdated

administrative practices. A comprehensive, multidisciplinary strategy; integrating Lean management

principles, Patient Flow Engineering, Facility Planning, and the Casemix Index (CMI); is vital to address these

persistent challenges. Collectively, these approaches emphasize the need for process reengineering, data-

driven scheduling, and optimized spatial configurations to enhance patient flow and operational performance.

The synthesis of literature reveals that Lean-based interventions and patient-centered service design

significantly improve efficiency and satisfaction without requiring major financial investment. Furthermore,

the integration of digital health technologies, such as electronic health records and predictive analytics,

enhances coordination, resource utilization, and real-time decision-making. Aligning these technological and

operational improvements within a cohesive system ensures sustainable reductions in waiting times.

This review contributes a conceptual framework to guide future empirical studies and policy reforms focused

on operational excellence in Malaysian public healthcare. It highlights the necessity for strategic collaboration

between hospital administrators, policymakers, and technology stakeholders to create data-informed, efficient,

and patient-focused healthcare environments that deliver timely, equitable, and high-quality services to the

Malaysian population.

As for the recommendations for future research, we plan to conduct cluster stepped-wedge or controlled ITS

studies in Malaysian hospitals to evaluate integrated Lean–layout–service–CMI frameworks. We also plan to

use mixed-methods designs combining quantitative performance data with qualitative feedback from staff and

patients. Integrating cost-effectiveness analysis into intervention evaluation and Include long-term

sustainability assessments are also recommended to be done. This research work also looking into validating a

decision-support models prospectively using real hospital data. Perhaps, developing CMI linkage studies

connecting case complexity, resource use, and patient flow could also be considered to find a solution.

In conclusion, although existing literature presents encouraging trends, its methodological limitations restrict

causal interpretation. Rigorous, multi-site, and mixed-methods research is essential to confirm the

sustainability and transferability of integrated Lean–Facility–Service–CMI frameworks in Malaysian

government hospitals.

INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)

ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue X October 2025

www.rsisinternational.org

Page 4730

ACKNOWLEDGMENT

Authors would like to thank University Technical Malaysia Melaka (UTeM) for the technical and financial

support to carry out this research work.

REFERENCES

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

18. Rathi R, Vakharia A, Shadab M. (2022). Lean Six Sigma in the healthcare sector: A systematic

INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)

ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue X October 2025

www.rsisinternational.org

Page 4731

literature review. Mater Today Proc., 50, 773-781.

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.

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.

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.

22. Tompkins, J. A., White, J. A., Bozer, Y. A., & Tanchoco, J. M. A. (2010). Facilities planning (4th ed.).

John Wiley & Sons.

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.

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.