Anteneh and Temesgen G

HAWASSA UNIVERSITY
INSTITUTE OF TECHNOLOGY
FACULTY OF MANUFACTURING
DEPARTMENT OF INDUSTRIAL ENGINEERING
Title: Enhancing Quality of Service Through Development of
Queuing Model in Hawassa Referral Hospital
Prepared By:
ANTENEH WONDMU………….……...……0153/11
TEMESGEN GETA…… …..……………... 0972//11
Advisor: Mr. Bahredin A.

Jan 23 -2024
Enhancing quality of service through development of queueing model
DECLARATION
We declare that the work which is being presented in this thesis entitled ―enhance quality of service
through the development of queuing model‖ is our original work, so the work is done under the
guidance of Mr.Bahredin A. (MSc.) The project is submitted to Hawassa University Institute of
Technology at the faculty of manufacturing for the partial fulfillment of the degree program in
Industrial Engineering Department. The Thesis work uses all of the data and material required that
are collected from the case company
Name Id .......................................... Signature
1.Anteneh Wondimu ...................... 0153/11
2. Temsgen Geta ............................. 0972/11
The following Faculty members certify that these students have successfully presented the
necessary written thesis document and oral presentation of this thesis work for the degree of
Bachelor of Industrial Engineering.
Approved by: -
Advisor Name Signature Date
Chair Holder:
Name Signature Date
Faculty Dean:
Name Signature Date
By: Anteneh w. and Temesgen G. Page II

ACKNOWLEDGMENT
First and for most, we would like to thank almighty GOD with his mother saint Merry, who has
power over all things and there is in reality no power and influence except him as well as who
always with us and helping in all case throughout our lives starting from the root level of
fertilization in mother embryo until the day today. Besides, we would like to express preeminently
our deepest gratitude and heartfelt thanks to our advisor Mr. BahredinA. (MSc.) for his
comments and suggestion starting from title selection up to this critical follow up of this work
without any complain. Finally, we would like to thank Hawassa referral hospital management
structure who contributed us voluntary response to join their hospital and in their openness in our
work. Specially we great gratitude to the workers that work in each medical OPD rooms give us
best explanation about overview of the whole works and also give us the best guidance how to go
on the data gathering.
By: Anteneh w. and Temesgen G. Page III

ABSTRACT
Now a days, healthcare is a rapidly developing industry. It faces many challenges like unexpected
number of patients, unexpected demand of patients, emerging of different competitors. Due to this
factor many patients suffer a lot from pain when waiting a line to be served. Sometimes, waiting
for service will make angry and unsatisfied patients which will result unwanted outcome may even
cause death of a patient.
This study aims to enhance the quality of service and reduce the waiting time of patients to get the
service in Hawassa Referral Hospital specifically in medical outpatient department. From our
research we get the amount of time that the patient spent for being serviced and waiting, based on
our analysis of result we found where the patients spent high amount of time to get the service .as
a result most of the time patients experience high waiting time in card and examination room
compared to the other medical OPD rooms.
To conducted this research, we used different methods of collecting data such as primary and
secondary data, after that the distribution of the collected data is identified by using input analyzer
and also the queue model which is appropriate for the system is selected based on their
characteristics and definition in order to develop the queue model. after the collected data is
analyzed and the model developed by using POM-QM software as a result the room which have
high waiting time is identified. Then proposed solution are provided and contains 3 scenarios from
among thus scenarios we select the best one by applying multi criteria decision analysis. finally,
the conclusion and recommendation are drowned. This study has the potential to improve the
efficiency of hospital operations, limit waiting time, and consequently create a better environment
for the patients and the hospital staff.
By: Anteneh w. and Temesgen G. Page IV

Table of Contents
DECLARATION ........................................................................................................................................... I
ACKNOWLEDGMENT .............................................................................................................................. II
ABSTRACT ................................................................................................................................................ III
LIST OF TABLES ...................................................................................................................................... VI
LIST OF FIGURES .................................................................................................................................... VII
ACRONYM ............................................................................................................................................. VIII
CHAPTER ONE............................................................................................................................................ 1
INTRODUCTIONS....................................................................................................................................... 1
1.1 Background and justification of study ................................................................................................. 1
1.2Problem Statement ................................................................................................................................ 3
1.3 Research question................................................................................................................................ 4
1.4 Objectives ............................................................................................................................................ 4
1.4.1 General objective.......................................................................................................................... 4
1.4.2 Specific Objective ........................................................................................................................ 4
1.5 Scope of the study ............................................................................................................................... 4
1.6 Significance of the study ..................................................................................................................... 4
1.7 Limitation of the study ........................................................................................................................ 5
CHAPTER TWO........................................................................................................................................... 6
LITERATURE REVIEW .............................................................................................................................. 6
2.1 Introduction ......................................................................................................................................... 6
2.2. Quality in HealthCare‘s ...................................................................................................................... 7
2.3 Queuing Theory .................................................................................................................................. 7
2.3.1 Classification of Queuing System ................................................................................................ 9
2.3.2 Types of Queuing models with their characteristics ..................................................................... 9
2.4. Operations and application of queuing theory in health care............................................................ 17
2.5 POM-QM software queue analysis application ................................................................................. 19
2.6 Literature review Gap........................................................................................................................ 20
CHAPTER THREE ..................................................................................................................................... 22
RESEARCH METHODOLOGY ................................................................................................................ 22
3.1 Data Collection methods ................................................................................................................... 22
3.1.1 Primary data collection method .................................................................................................. 22
3.1.2 Secondary data collection method .............................................................................................. 23
By: Anteneh w. and Temesgen G. Page V

3.2 Queue System model formulation ..................................................................................................... 23

3.3 Data Analysis Methods ..................................................................................................................... 25
CHAPTER FOUR ....................................................................................................................................... 26
RESULT AND DISCUSSION .................................................................................................................... 26
4.1 Introduction ....................................................................................................................................... 26
4.1.1 Medical out patient‘s department patient flow ........................................................................... 26
4.2 Average recorded data ....................................................................................................................... 26
................................................................................................................................................................ 27
4.3 Pattern of Arrivals at the System ...................................................................................................... 27
4.4 Service Characteristics ...................................................................................................................... 28
4.5 For arrival process and service process ............................................................................................. 28
4.5.1 Poison distribution and exponential distribution ........................................................................ 29
4.6 Introducing cost into the model ......................................................................................................... 39
4.7 proposed solution .............................................................................................................................. 44
4.1 Solution Approaches ......................................................................................................................... 45
CHAPTER FIVE ......................................................................................................................................... 63
5. CONCLUSION AND RECOMMENDATION....................................................................................... 63
5.1 Conclusion......................................................................................................................................... 63
5.2 Recommendation ............................................................................................................................... 64
References ................................................................................................................................................... 66
APPENDIX ................................................................................................................................................. 68
Appendix A Data recorded on OPD ........................................................................................................ 68
Appendix B: Data recorded onOPD ........................................................................................................ 69
Appendix C: Data recorded on OPD ...................................................................................................... 70
Appendix D: Data recorded on OPD ...................................................................................................... 71
Appendix F: Data recorded on OPD........................................................................................................ 73
Appendix G: Data recorded on OPD ....................................................................................................... 74
Appendix H: Data recorded on OPD ....................................................................................................... 75
By: Anteneh w. and Temesgen G. Page VI

LIST OF TABLES
Table 1 values from recorded data .............................................................................................................. 27
Table 2 POM-QM queueing model results on triage ................................................................................... 30
Table 3 POM-QM queueing model result on card room ............................................................................. 31
Table 4 POM-QM queueing model result on examination .......................................................................... 32
Table 5 POM-QM queueing model results on laboratory............................................................................ 33
Table 6 POM-QM queueing model results on pharmacy ............................................................................ 34
Table 7 corrective action of the cause of long waiting time ........................................................................ 36
Table 8 POM-QM queueing model with cost on triage room ..................................................................... 41
Table 9 POM-QM queuing model result with cost on card room ............................................................... 41
Table 10 POM-QM queueing model result with cost on examination room ............................................... 42
Table 11 POM-QM queueing model with costs results on laboratory......................................................... 43
Table 12 POM-QM queueing model with cost result on pharmacy ............................................................ 43
Table 13 sensitivity to number of servers on triage ..................................................................................... 45
Table 14 sensitivity number of servers on card room.................................................................................. 45
Table 15 table of costs based on number of servers .................................................................................... 46
Table 16 sensitivity to number of servers on examination room ................................................................. 47
Table 17 costs based on no of servers ......................................................................................................... 47
Table 18 sensitivity to number of servers on laboratory.............................................................................. 48
Table 19 POM-QM queueing model result on increasing one working hour .............................................. 50
Table 20 POM-QM queueing model results on increasing one working hours........................................... 51
Table 21 POM-QM queueing model results on examination increasing one working hours ...................... 52
Table 22 POM-QM queueing model results on laboratory room increasing one working hour .................. 54
Table 23 POM-QM queueing model result on pharmacy by increasing one working hour ........................ 56
Table 24 table of setting priorities ............................................................................................................... 60
By: Anteneh w. and Temesgen G. Page VII

LIST OF FIGURES
Figure 1 Patient flow ................................................................................................................................... 26
Figure 2 Chart for patient waiting and service time .................................................................................... 27
Figure 3histogram distribution for arrival process ...................................................................................... 29
Figure 4 histogram distribution for service process..................................................................................... 30
Figure 5 fish bone diagram of long waiting time......................................................................................... 36
By: Anteneh w. and Temesgen G. Page VIII

ACRONYM
HRH- Hawassa Referral Hospital
OPD-Out Patient Department
By: Anteneh w. and Temesgen G. Page IX

CHAPTER ONE
INTRODUCTIONS
1.1 Background and justification of study
Health refers to the overall state of a complete social, emotional, mental and physical well-being
that considered as a resource for living a full life, and therefore, the access for the highest
achievable level of health is the basic rights of every human being without the distinction of social
or economic conditions (langlfield, 2001)
Good health of the people is essential in order to develop and improve the economic state of
country. Health care delivery among various service deliveries has been explained as the kind of
delivery in which there is high consumer involvement in the process of consumption process (jody
zall,kusek,ray,c.rist, 2013).
Health is termed as the functional fitness that stress on personal and social resources, as also
physical capabilities. In the race of human beings, the degree of physical, emotional, mental and
social ability of and individual to deal with his/her surrounding environment is known as health
(Turner, Alyssa Crim, 2023)Often however, shortening the patient processing time for various
medical departments at the outpatient clinic of a hospital is needed to meet the requirements for
the medical care system (Park, 2001), it is, then, crucial to measure the performance of the same
To evaluate various health care programs or systems, to help organizations notice consumers that
are likely to deregister, and to recognize which aspects of a service require improvements to
increase patient satisfaction (without patient care has steadily extended. patient waiting time is the
time that patients spend waiting for service in a facility per visit and is calculated from the time
patient enters the facility (taking into consideration the official opening time of the facility) to the
time the patient leaves the facility due to this patient clinic waiting is an important indicator of
quality of service offered by hospital.
Waiting time has been weighed as a significant determinant of patient satisfaction. Increased
waiting time adds to indirect costs of taking part in an emergency department encounter from the
patients ‗perspective.
By: Anteneh w. and Temesgen G. Page 1

In addition, the prolonged waiting time may increase patient disappointment and reduce their sense
of control.
Hawassa Referral health facility is a form of service enterprise that's located in Hawassa. It has
many clients coming from exceptional locations like wondogenet, yrgalem, tikurwuha, bensa, and
others consisting of Hawassa city to be served inside the hospital. Personal hospitals are an
excessive amount of luxurious for hospitality to apply them, mainly for human beings coming
from rural areas. Referral hospitals bills are low value for treatment, card and other associated
matters to get the service. Therefore, due to the fact all people are dependent on hospitals; special
interest ought to accept to the service. All of us should be served with the exceptional way. But
right here in HRH, patients we talked don‘t have a high-quality remark; instead, they were too
much uninterested in the use of the sanatorium. There's constantly lengthy ready line, customers
spend a whole lot time in offerings, sufferers or customers don‘t realize where the departments are
found and These long waiting times for services and or short consultation hours in healthcare
systems can worsen the severity of disease, increase the socio-economic costs and potentially
result in unnecessary suffering, straining the relationship between the physician and the patient,
which leads to patient dissatisfaction
This research will try to enhance the existing trouble via enhancing the present queue version.
Stated that; Queuing theory is the mathematical study of waiting lines or queues. A queuing model
is constructed so that queue lengths and waiting time can be predicted. Queuing theory deals with
the study of queues which abound in practical situations and arise so long as arrival rate of any
system is faster than the system can handle. Simulation is often used in the analysis of queuing
models. Queuing models provide the analyst with a powerful tool for designing and evaluating the
performance of queuing systems
Hawassa Referral Hospital is the only specialized hospital that found in Hawassa Sidamo and starts
in 1998 that provides medical and counseling services for patients that come from in Hawassa and
around Hawassa. The hospital has its own organized mechanism of work with 50 medical and case
team services and also in administration 3 group and 3 services found. The hospital in 2014 in all
types of treatment for 130,000 patients gives the service and in 2015 one fourth year generally for
patients with bed and without bed in sum for 90, 349 patients provide the service.

Currently the hospital has 516 workers that provide the service foe 24 hours and 1350
administration workers medical workers are found. In general, health care systems and hospitals
are very important part of any country. Especially, referral hospitals. Hawassa Referral Hospital
has shown its importance over the years.
1.2 Problem Statement

The existed healthcare system, in Ethiopia, faces the need to re-design the service system for each
clinical department by taking the needs and expectations of both the patients and professionals into
consideration, whether in the private or public sector, for optimized service delivery (Kriegel,
Jehle, Dieck, & Mallory, , 2013).
Long wait times in healthcare facilities contribute to significant costs for both patients and
providers. Prolonged waiting times in hospitals can lead to decreased patient satisfaction, increased
stress levels, and decreased adherence to clinical protocols. In addition, hospital costs associated
with long waiting times include increased staff salaries, loss of revenue due to patients leaving
before they receive care.
Due to the fact too, many people are reliant on hospitals, unique attention should accept to the fine
of the carrier given by using health cares, however maximum of the time this isn't happening in
Hawassa Referral Hospital there are extraordinary issues that exist associated with serve the
clients. In the current system the, patients arrive as early as they can to the healthcare facility, wait
in the queue, even before the facility is open, and have to wait longer for examination and
diagnosis. in OPD (medical) department there's lengthy waiting line in stations, complex flow of
method and it is hard to discover every phase within the medical institution considering that there's
no direction. The sufferers may additionally have one of kind reasons for not being delightful via
the service, There is high waiting times in medical rooms .patients dissatisfied due to the amount
of time that they spent to get the service that means there is high waiting of patients during service
in addition to this to get the information recorded in terms of card takes long waiting time due to
poor arrangement and poor booking system as a result customers wait long time until the card
found and also patients spent at least 2 min time for searching of the rooms due to those reasons
customer exposed for long waiting time in the system and the area become crowded. patients at
least wait 12min in triage,16.8min in card room,25min in examination, and 8 min in laboratory as
an average however patients should not have to wait longer than 10-15 min as a result patients

become un satisfied and they receive much complains in addition to waiting time patients also
incurred waiting cost of 15 birr per hour and the hospital also loss 8192.532-birr per hour due this
long waiting time.
Generally, customer wait in the queue for long time leads to the hospital does not get good profit
and as customer consideration increase illness at least going to the risk of illness condition and
death of patients.
1.3 Research question

1. How can the queuing model in a simulation tool be improved to optimize patient
flow and improve hospital operation?
2. How to identify reasons behind excessive waiting time?
3. How to analyze the existing system ?
4. How to find out optimum service rate and number of servers?
5. What is the key feature of an effective queening model for hospital?
1.4 Objectives
1.4.1General objective
The overall goal of this research is to Enhancing Quality of Service Through Development of
Queuing Model in Hawassa Referral Hospital
1.4.2 Specific Objective

According to the primary goal, the following particular goals have been set:
 To identify the strategies and techniques that can be implemented to improve the queuing model
in simulation tool used for hospital operation
 To identify the reasons behind excessive wait times
 To analyze the system and calculate the performance metrics by using queue model
 To find out optimum service rate and number of servers that average costs are minimized
 To propose and understand the key feature that make a queening model effective in the hospital.
1.5 Scope of the study

It takes a lot of effort to do research on quality service to totally increase client happiness.
Therefore, the emphasis of our research has been the outpatient department specifically medical

OPD An updated queue model created by the researchers will aid to improve service quality.
1.6 Significance of the study

The goal of this project is to shorten patient wait times. Customers will be more satisfied as a
result. Even if cutting down on client wait times won't completely satisfy them, it will increase
their level of pleasure. By lessening the stress brought on by congestion, it can also enhance the
working environment for the staff, increasing their willingness and motivation. This newly
discovered drive for quality improvement may extend throughout the hospital.
1.7 Limitation of the study

This study will have some problems that hinder to accomplish on the desired extent. Some of these
problems are Lack of experience and resources related to problems due to the shortage of time, so,
the study will not be investigated or not focus on all the target areas that absence of organized
document to get relevant information and other limitations are an obstacle of the study. And also,
the research faces a problem of time to collect all necessary data from patients and doctors and
also some respondents are involuntary to give available information. In addition to the patients are
involuntary to tell the real information regarding to the problem that exist.

CHAPTER TWO
LITERATURE REVIEW
2.1 Introduction
This literature review contains brief description about customer dissatisfaction, Quality in health
cares, waiting lines, Queue model, and Simulation in health care‘s. It also describes previous
journals works which are done regarding it. There are a number of researches which are done
considering waiting lines in health care‘s and some of them are pointed out here.
Service quality performance in a healthcare is the patient‘s perspective based on their own
experience and determined by waiting times, staff interactions, perceived medical service quality,
and the overall communication. According to previous studies, waiting time and time spent during
evaluation, and consultation time, (Benevento, Elisabetta and Aloini, Davide and Squicciarini,
Nunzia, 2023) directly affect the patient satisfaction.
In recent years, outpatient medical services are increasingly becoming the main components in the
healthcare system due to the greater attention given to the preventive medical practices and shorter
period of stay at the hospitals. The services at the outpatient clinic include the registration, medical
examinations and the received prescriptions (Ellis, Laura Peyton and Parlier-Ahmad, Anna Beth
and Scheikl, Marjorie and Martin, Caitlin E, 2023) . Time management at the OPD is vital to the
patient, especially to those with bad injuries and to those who seeks diagnosis for the critical
illnesses
There are many Causes of Customer Dissatisfaction such as; Issues with Quality, Issues with
Pricing Failure to Meet Specific Expectations, Failure to Meet Perceived or Implied Expectations,
Issues with Usability, Problems with Customer Service
1. Issues with Quality: Customers might raise concerns and complaints about the make or
durability of your product. This point underscores the principle that underlies customer
dissatisfaction in general — the value you project should never overstep the value you deliver. If
you bill your product or service as the premier option in your space, its quality needs to reflect that
kind of posturing and quality is bad and not worth the price. In this case, the product in question
didn‘t meet the quality standards the consumer anticipated, so the company selling it wound up
with dissatisfied customer on its hands.

2. Issues with Pricing: In a similar vein to the point above, customers might complain about a
product or service being overpriced
3. Failure to Meet Specific Expectations: Through offering product descriptions, showing

product photos, and providing product specifications, you're setting objective expectation.
4. Failure to Meet Perceived or Implied Expectations: Expectations can extend beyond the ones
you set through specifications. Sometimes, customers will assume your offer has certain features
or benefits that it doesn't. This could mean that your product or service description was ambiguous,
or maybe your customers might be holding you to the standards of your industry peers.
5. Issues with Usability: One source of customer dissatisfaction is usability. If your product or
service isn't user-friendly, customers will get frustrated and not shy in expressing it.
2.2. Quality in HealthCare‘s

Health care quality is a level of value provided by any health care resource, as determined by some
measurement. It is the degree to which health care services for individuals and populations increase
the likelihood of desired health outcomes. As with quality in other fields, it is an assessment of
whether something is good enough and whether it is suitable for its purpose. The goal of health
care is to provide medical resources of high quality to all who need them; that is, to ensure
good quality of life, to cure illnesses when possible, to extend life expectancy, and so on.
Researchers use a variety of quality measures to attempt to determine health care quality, including
counts of a therapy's reduction or lessening of diseases identified by medical diagnosis, a decrease
in the number of risk factors which people have following preventive care, or a survey of health
indicators in population who area accessing certain kinds of care. In 1999, the Institute
There are different methods to improve quality in health care‘s. Among them are, Cost Efficiency,
Critical Pathways, Health professional perspective, Patient perspective, and security perspective.
Here in Hawassa referral hospital, there is a long waiting line. Since time is one dimension of
quality, improving or reducing this waiting time and delays will improve quality in health cares.
2.3 Queuing Theory
Queuing theory is a mathematical way of studying the waiting lines, the queues, and was developed
to predict the waiting time and the queue lengths. A queuing system in the healthcare environment
consists of arriving patients and one or more physicians, providing service (Eitel, Dave R and

Rudkin, Scott E and Malvehy, M Albert and Killeen, James P and Pines, Jesse M, 2010) . This
theory was originated in the 23 field of research by the Danish engineer and mathematician Agner
Krarup Erlang, to develop models that could describe the telephone exchange.
Queue theory is generally considered as a branch of operation research as the outputs are mostly
used to make business decisions regarding to the resource allocation. Queueing models are popular
among researchers since they provide reasonably accurate system performance evaluations due to
their analytical nature and provision of quick answers to the ―what-if‖ analyses (Moore, 2003).
In a healthcare system, the patient queuing effect in relation to the time spent for treatment is
gradually becoming a concern to modern society (Cayirli, Tugba and Veral, Emre, 2003). Queues
are formed when the patient's arrivals rate exceeds the rate of service delivery (Bahadori,
Mohammadkarim and Mohammadnejhad, Seyed Mohsen and Ravangard, Ramin and
Teymourzadeh, Ehsan, 2014). Quantitative tools, like queuing models, can help to make decisions
regarding resource planning, resource utilization and scheduling, as these are all affected by the
flow of patients, which the queue performance measures, such as the time spent in the system and
the traffic intensity, which have direct correlations with the patient flow characteristics.
Bailey (1952), documents that queuing theory is valuable to make adjustments between patient
waiting time and the healthcare system idle time and service utilization rate (Fomundam, Samuel
and Herrmann, Jeffrey W, 2007). Over the years, the variety of applications examined can be
summarized into waiting time, utilization analysis, system design and problem solving (Koskela,
Lauri and others, 2000)(Gorry, George Anthony and Scott Morton, Michael S, 1971)
Queuing theory has increasingly become a common decision-making management tool in the
developed world, though it is seldom used in many African countries (Afrane, Sam and Appah,
Alex, 2016), including Ethiopia. Green (2006) showed the application of queuing theory in the
healthcare system, by discussing the relationship amongst delays, number of servers and
utilization‘s using the basic M/M/s model (Lakshmi & Iyer, 2013) .
Founded and Herrmann (2007), in their research, showed waiting time and service utilization can
be used as analytical tool in predicting the healthcare facility configurations effect on the delay of
delivering services and resource utilization (Lakshmi, C and Iyer, Sivakumar Appa, 2013) . Their

research argued that, in queuing systems, minimizing the time that patients have to wait and
maximizing the utilization of physicians are contradicting issues.
2.3.1 Classification of Queuing System

Since customers arrive in a different form and number, there is different classification based on
their arrival. Queue system contains all the process starting from the input to the output or from
arrival of patients or customers, service rate and output. The system is classified as follows:
Single channel single phase system: -this type of queue system has a single line and single server
system. It contains of patients, customers or items forming a single queue. This all queue is served
by a single facility. In most of the time, in this type of queue system, they use the rule FIFO.
Single server multiple phase system: -in this type of classification, there will be a single queue
as same as the single phase but patients, customers or items receive more than one kind of service
before departing.
Multiple server single phase system: -This is another classification of queuing system where
there is only a single queue but there is more than one server providing the same service.
Multi-channel multi-phase: -This is a bit complex than the other models. In this type of system,
there are different queues and multiple of servers to provide services.
Waiting Lines: - Waiting lines are formed whenever the current demand for a service exceeds the
current capacity to provide that service. Because of difficulty in accurately predicting arrival
pattern of customers for service and/or how much time is required to provide service to each
customer, accurate decision regarding the capacity to be provided is made quite difficult.
2.3.2 Types of Queuing models with their characteristics

1. Poisson-Exponential, Single Server-Infinite population model (M/M/1: ∞/FCFS)
The Poisson-Exponential, Single Server-Infinite population model (M/M/1: ∞/FCFS) is a queuing

model that is used to analyze a single-server queuing system with an infinite population, where
arrivals follow a Poisson distribution and service times follow an exponential distribution. FCFS
stands for First-Come-First-Served, which means that the first customer to arrive will be the first
to be served.

The key properties and characteristics of the M/M/1: ∞/FCFS model are:
1. Arrival process: The arrival process is modeled as a Poisson process, which means that the
arrival rate is constant over time, and the inter-arrival times are exponentially distributed.
2. Service process: The service process is modeled as an exponential distribution. This means
that the time taken for the server to complete a service is exponentially distributed and the
service rate is constant over time.
3. Single server: The system consists of a single server, which serves the customers in the order
in which they can
4. Infinite population: The queuing system assumes that customers are drawn from an infinite
pool of potential customers, and the arrivals are independent.
5. First-Come-First-Served (FCFS): Customers are served on a first-come-first-served basis, The
customer who arrives first will be served first by the server
6. Steady state: In steady-state conditions, the arrival rate is equal to the service rate, and the
queuing system is stable.
7. Waiting time and queue length: The waiting time of a customer in the queue and the length of
the queue can be calculated using Little‘s law, which states that the average queue length is
equal to the average arrival rate multiplied by the average waiting time.
The M/M/1: ∞/FCFS model is widely used in the analysis of single-server queuing systems with
an infinite population, such as customer service centers, call centers, and banks. It provides an
efficient way to study the system performance and helps managers to make informed decisions
regarding the staffing levels, service times, and customer wait times.
2 Poisson-Exponential, Single Server-Finite population Model (M/M/1: N/FCFS)
The Poisson-Exponential, Single Server-Finite population model (M/M/1: N/FCFS) is a queuing

model that is used to analyze a single-server queuing system with a finite population, where
arrivals follow a Poisson distribution and service times follow an exponential distribution. FCFS
stands for First-Come-First-Served, which means that the first customer to arrive will be the first
to be served. The role of the M/M/1: N/FCFS model is to analyze the performance of a queuing
system with a finite number of customers who join the queue and leave the system after receiving
the service. The N parameter indicates the size of the population, and once all N customers have
been served, the queuing system terminates.

The key properties and characteristics of the M/M/1: N/FCFS model are:
1. Arrival process: The arrival process is modeled as a Poisson process, which means that the
arrival rate is constant over time, and the inter-arrival times are exponentially distributed
2. Service process: The service process is modeled as an exponential distribution. This means
that the time taken for the server to complete a service is exponentially distributed, and the
service rate is constant over time.
3. Single server: The system consists of a single server, which serves the customers in the order
in which they arrive.
4. Finite population: The queuing system assumes that the customers are finite, and once all N
customers have been served, the queuing system terminates.
5. First-Come-First-Served (FCFS): Customers are served on a first-come-first-served basis.
The customer who arrives first will be served first by the server.
6. Waiting time and queue length: The waiting time of a customer in the queue and the length
of the queue can be calculated using Little‘s law, which states that the average queue length
is equal to the average arrival rate multiplied by the average waiting time.
The M/M/1: N/FCFS model is used to analyze the performance of finite population systems such
as airports, amusement parks, and hospitals. By analyzing customer wait times, service times, and
system utilization, managers can adjust their staffing levels, service times, and system design to
optimize performance and enhance customer satisfaction.
3 Poisson-Exponential, Multiple Server-Infinite population models (M/M/S: ∞/FCFS)
Poisson-Exponential Multiple Server-Infinite population models (M/M/S: ∞/FCFS) is a queuing

model used to analyze queuing system with multiple servers and an infinite population, where the
arrival process follows a Poisson distribution and the Service time follows an exponential
distribution. FCFS stands for First-Come-First-Served, which means the customer who arrives first
is served first.
The M/M/S: ∞/FCFS model's primary role is to investigate the performance of a queuing system
based on its characteristics and requirements, such as examining the waiting time of a customer,
queue length, system utilization, and service rate.

The main properties and characteristics of the M/M/S: ∞/FCFS model are:
1. Arrival process: In this model, the arrival process refers to the arrival of customers to the
queuing system, and it follows a Poisson distribution. Customers arrive randomly and
independently of the time between them, the inter-arrival time is exponentially distributed, and
the arrival rate is constant.
2. Service process: In this model, service time follows an exponential distribution, and the service
rate is constant. The service time is the time it takes for a server to serve a customer and
complete their transaction.
3. Multiple servers: The queuing system has multiple servers to serve the customers
simultaneously. These servers work independently, and each customer can choose any idle
server or be directed to the least occupied server.
4. Infinite population: This translates that the number of clients that can use the system is not
limited. It means that potentially infinite customers can enter the system.
5. First-Come-First-Served (FCFS): Customers are served according to the order in which they
arrive, and customers who arrive will be served earlier.
6. Queue length: Since the number of servers is limited, it means that the queuing system may
create a queue. Therefore, the length of the queue will change based on the number of
customers in the system.
7. Waiting time: Waiting time in this model refers to the time that a customer spends in the queue
before receiving service.
Suppose we take an example of a hospital where patients are coming with various illnesses and
are waiting in the emergency department. The hospital has multiple doctors and nurses working in
the department simultaneously. The patients entering the emergency department follow a Poisson
distribution, and the doctors and nurses are continually serving the waiting patients. In that
scenario, the M/M/S: ∞/FCFS queuing model can be used to measure system performance by
examining the length of the queue, waiting time for the patients, service time, and the utilization
of the practitioners. By using the model, we can modify the system settings to optimize the
performance of the emergency department and enhance the patient experience.

4. Poisson-Exponential, Multiple Server-Finite population model (M/M/S: N/FCFS)

Poisson-Exponential Multiple Server-Finite population model (M/M/S: N/FCFS) is a queuing
model used to analyze a queuing system with multiple servers, a limited number of customers,
where the arrival process follows a Poisson distribution and the Service time follows an
exponential distribution. FCFS stands for First-Come-First-Served that means the customer who
arrives first will be served first.
The M/M/S: N/FCFS model's primary role is to investigate the queuing system's performance
based on its properties and requirements, such as examining the waiting time of a customer, queue
length, system utilization, and service rate.
The main properties and characteristics of the M/M/S: N/FCFS model are:
1. Arrival process: In this model, the arrival process refers to the customer's arrival to the
queuing system, and it follows a Poisson distribution. The arrival process is independent and
random
2. Service process: In this model, service time follows an exponential distribution, and the
service rate is constant. The service time is the time it takes for a server to serve a customer
and complete their transaction
3. Multiple servers: The queuing system has multiple servers to serve the customers
simultaneously. These servers work independently, and each customer can choose any idle
server or be directed to the least occupied server.
4. Finite population: In this model, the number of customers that can use the system is limited.
It means that the number of customers that can enter the system is finite.
5. First Come First Serve (FCFS): This property signifies that the customer who arrives first will
be served first.
6. Queue length: Since the number of servers is limited, it means that the queuing system may
create a queue. Therefore, the length of the queue will change based on the number of
customers in the system.
7. Waiting time: Waiting time refers to the time a customer spends in the queue before receiving
service.

5 The Poisson Exponential Single Server Infinite Population Model of (M/G/1)
It is a queuing model used to analyze the performance of a single server system with an infinite
population of customers and a general service time distribution. Here are the definitions and
characteristics of this model:
1. Poisson Arrival Process: The arrival of customers to the system follows a Poisson process,
which means that the inter-arrival times between customers are exponentially distributed.
2. General Service Time Distribution: The service time required for each customer follows a
general distribution, which can be any distribution that is not necessarily exponential or
Erlang.
3. Single Server: There is only one server available to serve the customers.
4. Infinite Population: The population of customers is assumed to be infinite, which means that
the arrival rate of customers is not affected by the number of customers in the system.
5. First-Come-First-Serve (FCFS) Queue Discipline: Customers are served in the order in which
they arrive, which means that the first customer to arrive is the first customer to be served.
6. Characteristics: The M/G/1 queuing model is characterized by parameters:
The M/G/1 queuing model is a more general model than the D/D/1 and M/Ek/1 models, as it allows
for a wider range of service time distributions. It is commonly used in various applications, such
as banking, healthcare, and transportation systems, to analyze the performance of single server
systems with an infinite population of customers and a general service time distribution.
6 The Poisson Exponential Single Server Infinite Population Model of (M/D/1)
It is a queuing model used to analyze the performance of a single server system with an infinite
population of customers and a deterministic service time distribution. Here are the definitions and
characteristics of this model:
2. Deterministic Service Time Distribution: The service time required for each customer is
constant and known.

6. Characteristics: The M/D/1 queuing model is characterized by the following parameters:
The M/D/1 queuing model is a special case of the M/G/1 model, where the service time distribution
is deterministic. It is commonly used in various applications, such as manufacturing systems,
where the service time is constant and known.
7 The Poisson Exponential Single Server Infinite Population Model (D/D/1)
Itis a queuing model used to analyze the performance of a single server system with an infinite
population of customers. Here are the definitions and characteristics of this model:
2. Exponential Service Time Distribution: The service time required for each customer is
exponentially distributed.
6. Characteristics: The D/D/1 queuing model is characterized by the following parameters:
The D/D/1 queuing model is commonly used in various applications, such as call centers,
healthcare facilities, and transportation systems, to analyze the performance of single server
systems with an infinite population of customers.
8The M/Ek/1 queuing model
It is a variation of the Poisson Exponential Single Server Infinite Population Model (D/D/1) that
assumes that the service time distribution follows an Erlang-k distribution instead of an
exponential distribution. Here are the definitions and characteristics of the M/Ek/1 queuing model:

2. Erlang-k Service Time Distribution: The service time required for each customer follows an
Erlang-k distribution, which is a generalization of the exponential distribution.
6. Characteristics: The M/Ek/1 queuing model is characterized by the following parameters:
In outpatient department to reducing patients waiting time Single-server queuing models are
commonly used in outpatient departments to reduce patient waiting time. The most frequently used
single-server queuing model is the M/M/1 (Markovian Arrival Process/Markovian Service
Process/Single Server) queuing model.
The M/M/1 queuing model is a simple and widely used queuing model that assumes a Poisson
arrival process, an Exponential service time distribution, and a single server. The model assumes
that patients arrive randomly and independently over time, and the time between arrivals follows
a Poisson distribution. The service time required to treat each patient follows an exponential
distribution, and there is only one server to serve all patients.
By using the M/M/1 queuing model, the outpatient department can predict the expected number
of patients in the queue, the expected waiting time, and the expected utilization of the server. This
information can be used to optimize staffing levels, improve patient flow, and reduce patient
waiting time.
Other queuing models, such as the M/M/S (Markovian Arrival Process/Markovian Service
Process/Multiple Servers) or the M/G/1 (Markovian Arrival Process/General Service
Process/Single Server) models, can also be used to analyze the performance of the outpatient
department and reduce patient waiting time. However, these models may be more complex and
require more data to estimate the parameters, making them less frequently used than the M/M/1
model in outpatient departments.

In most cases, queuing models can be characterized by the following factors: Arrival time
distribution: Inter-arrival times most commonly fall into one of the following distribution patterns:
a Poisson distribution, deterministic distribution, or a general distribution. However, inter-arrival
times are most often assumed to be independent and memory less, which is the attributes of a
Poisson distribution. Service time distribution: The service time distribution can be constant,
exponential, hyper exponential, hypo-exponential or general. Queuing systems in Kendall‘s
notation are described as follows: parameter1/parameter2/parameter3 where: Parameter 1 M =
Poisson arrival time D =Deterministic arrival time Parameter 2 M = Poisson service time G =
General service time D =Deterministic service time, this means that the service time must be set
from above, e.g., at the production line or automatic car wash (Kotowski, 2009). Parameter 3
Number of service points Parameter 4 (does not always occur, in the infinite system this parameter
is omitted) Number of places in the system (including those at customer service points and in the
queues. Commonly used distributions – M = Markovian (exponential) - Memory less – D =
Deterministic distribution – G = General distribution
M/M/1-Poission arrivals, exponential service time, arrival population is un limited, all arrivals wait
to be served, constant, λ <µ.
M/D/1-Poisson arrivals, constant service time (not random), has shorter queues, Lq and Wq are
one half as large
M/G/1-Poisson arrivals, general service time distribution with known mean and standard
deviation, λ >µ
2.4. Operations and application of queuing theory in health care
Works on the hypothesis and applications of lining frameworks have developed exponentially
since the early 1950s (Holl, Augustin FC, 2009). Lining Hypothesis (QT) is the scientific consider
of holding up lines, or lines. QT can be connected in different areas, however most of past thinks
about are well recorded within the writing of Likelihood, Operations Investigate, and
Administration Science. A few of the applications are machine repair, device booths, stock control,
the stacking and emptying of ships, planning patients in healing center clinics and in computer
areas. Lining hypothesis has been connected to computer recreation models to assist with choice
making of numbers of healing center server, asset utilization and to decrease holding up time. QT
has been broadly utilized in mechanical settings to analyze how resource-constrained systems

respond to different request levels, and in this way may be a characteristic fit for modeling quiet
stream in a wellbeing care setting (Snieder, Roel and Larner, Ken, 2009) . The theory empowers
numerical examination of a few related prepare, counting arriving at the line, holding up within
the line, and being served at the front of the queue.
The hypothesis grants the determination and calculation of a few execution measures counting the
normal holding up time within the line or the framework, the anticipated number holding up or
accepting benefit, and the likelihood of experiencing the framework in certain states, such as purge,
full, having an accessible server or having to hold up a certain time to watched (Van Alstyne,
Marshall, 1997) Healing centers are known as complex frameworks which are included with a few
societal benefits and cost.
Those costs are made to be caused more since of inefficacies of forms which happen due to
blockage and delays within the patients care frameworks. Writing demonstrates that forecast of
level of clog and required capacity is incomprehensible to be figured out without the assistance of
lining.
Models (Green, 2006). Subsequently, in arrange to ponder and move forward patients stream, it is
appropriate to look at the office with the focal point lining organize (Moore Jr, Donald E and
Green, Joseph S and Gallis, Harry A, 2009). Lining models are required to be put in a little
information and comes about can be calculated by the assistance of basic formulae in terms of
execution measures; this can be an simpler way to figure out the ideal arrangements rather than
assessing the execution of the framework within the provided context (Green, 2006). The foremost
viable approach to solve these sorts of issues is lining hypothesis or holding up line hypothesis
(Olorunsola et. al., 2014). It was created by eminent Danish phone design.
The major components in holding up line hypothesis include individuals getting administrations,
entrance handle, line arrangement, teach of the lines and the benefit instruments within the benefit
businesses like as healing centers, holding up times of the customers/patients must be anticipated
at the diverse levels of the benefit (Henderson, Kathryn, 1998) .
Line or holding up line at healing centers are related with holding up taken a toll of patients, when
they are made to hold up within the clinics (Van Esch, Ann and Clermont, Christian and Devillers,
Magali and Iori, Mauro and Huyskens, Dominique P, 2007). These issues are unraveled and

rearranged by utilizing the lining hypothesis. In which holding up time and service times are
calculated conjointly the ideal benefit level and holding up time of the understanding can be
calculated (Varma, 2016). The think about of line bargains with evaluating the wonder of holding
up in lines utilizing agent measures of execution, such as normal line length, normal holding up
time in line and framework individually and normal office utilization (Moore, Mark H, 2003).
Lining models are utilized to think about line efficiently (Duan, Qingyun and Sorooshian, Soroosh
and Gupta, Vijai, 1992) Due to dealing with the packed scenarios, lining hypothesis is moreover
known as the hypothesis of overcrowding (Liu, Chiung-Lin and Shang, Kuo-Chung and Lirn,
Taih-Cherng and Lai, Kee-Hung and Lun, YH Venus, 2018).in expansion to this numerous analyst
is checked on this line hypothesis as take after (Sechelski, Amber N and Onwuegbuzie, Anthony,
2019), utilized applications of lining hypothesis in healthcare were mainly centered. Diverse
divisions i.e., patient‘s enlistment office, outpatients‘ office (OPD) and drug store were beneath
thought: on the same time, diverse forms in within the queuing framework were moreover kept on
the perception. Exponential and harm dispersion were utilized for the benefit and entry of patients
individually. Single server M/M/1 and different server lining model‘s M/M/2 were utilized for the
calculation of execution measures and for examination reenactment was utilized. McManus et al.,
2004 created a numerical show for the understanding stream. Information of the patients i.e.,
Affirmation and release of the patients in ICUs. By utilizing lining hypothesis application, a
mathematical model of persistent stream was created. The actual/real situation was compared with
the comes about of the show. After the approval the demonstrate was proved to be accurate
(McManus et. al., 2004).
2.5 POM-QM software queue analysis application

POM-QM software is widely used in analyzing queuing models in the context of production and
operations management. With the software's queuing analysis tools, users can simulate and
evaluate the performance of different queuing models and identify areas where improvements can
be model
One typical application of POM-QM in queuing analysis is to evaluate the impact of changes in
queue parameters, such as service time, arrival rate, and number of servers, on queue performance
measures such as average waiting time, service time, and queue length. By adjusting these

parameters, users can identify optimal conditions that maximize productivity, minimize wait times,
and improve overall system efficiency.
Another application is to evaluate the performance of different queuing models in varying

contexts. For example, POM-QM can be used to compare the performance of single-server and
multi-server queuing models, or to evaluate the performance of different queue disciplines, such
as first-come-first-served, priority, or shortest job first. Singh, M., & Garg, D. (2014). Queuing
Analysis of a Mobile Service Center Using POM-QM Software (Prasetyo, Hanung Nindito and
Sarno, Riyanarto and Wijaya, Dedy Rahman and Budiraharjo, Raden and Waspada, Indra and
Sungkono, Kelly Rossa and Septiyanto, Abdullah Faqih and others, 2023).
POM-QM also allows users to perform sensitivity analysis, which involves systematically varying
input parameters to evaluate their impact on queue performance measures. This helps users
identify areas in the queuing system that are most sensitive to changes and focus their improvement
efforts accordingly.
Overall, POM-QM is a powerful tool that can help users model and analyze different queuing
models and make data-driven decisions to optimize queue performance and improve system
efficiency.
2.6 Literature review Gap

Seeing and reading deeply previous works regarding queue, POM-QM software, outpatient
department will lead for gap for what we are currently doing. In most previous works, different
things were done to reduce waiting line in Hospitals, especially in outpatient and emergency
rooms. Among them were, adding different human resources (adding doctors or nurses or may be
other employees who will take care of patients with a new room so that more patients would be
served), adding beds (so that more patients would be served with the right care on beds), (so that
there will be a reduced overcrowding in the room which will lead for better or less crowding which
will be helpful for doctors and nurses to do their job efficiently and effectively). Other than this,
different researches included adding new technologies which could be helpful in reducing service
time.
Most researches had solutions based on the above suggestions. Waiting lines could be reduced
using below listed methods. in this research, other alternatives are used. Among them are:

 Adding working hour

 Merging resource addition and increasing working hour together.
Based on the above gaps, this research is to be done in Hawassa Referral Hospital, specifically in
medical outpatient department.

CHAPTER THREE
RESEARCH METHODOLOGY
3.1 Data Collection methods
Data has an important role to play in doing any research. Especially in health care‘s. When doing
a queuing model, a real and accurate data needs to be recorded. Otherwise, it will create a model
which will not improve anything or it will bring a wrong model which will take to external costs
and may be more waiting line. It is not easy to gather data in health care‘s, and this could become
a real problem. This is the problem in healthcare, where parts of the information system are not
recorded. A solution for the problem is to collect real-time data manually by observing patients
flow for a certain period of time. If a recorded data is not found, this is the only choice to make.
In this OPD department, for four weeks data was collected about patient arrival, time of service
for patients, time of service ends, departure time, time for services in labs, time of service in card
rooms, treatment time for each process, number of beds, doctors and nurses. This data has helped
to prepare queuing model using POM- QM software.
3.1.1 Primary data collection method

In this type of method data is observed or collected directly from the patient, nurse, doctors, and
other workers. The information must be in its original form or collected from first hand testimony.
In primary data collection, the information is taken by using the following data collection
techniques:
Interview: is a kind of data collection in which the researchers will directly talk to the employees,
patients or other persons over there. This interview may be formal or informal.
In this research, workers and patients that found during our visit in the hospital has been
interviewed. Patients have been selected randomly and interviewed. Different employees who
work in the card room, OPD department, laboratory department, examination room has been
interviewed on their willing. And lastly, the head or the leader of the OPD Department has been
interviewed. All the interviewees were done in Amharic to clearly understand from both sides.
Direct observation: in this kind, data is recorded through direct observation.
Formal observation instrument has been used. Different data‘s including waiting times in each
place has been recorded through direct observation since a real data is needed. This has not been

done with only the researchers, because it will be impossible to record one patient‘s time. One
patient will have its own arrival time, service time for each section and waiting time for each
section. Therefore: with the help of other researchers, the data has been directly observed. Other
things that have been observed in the research are: -What the patient flow looks like and Number
of queues. To perform all the above-mentioned things, 2 things have been used and they are: -Stop
watch on phones and Direct observation and recording on papers
Pictures: In this kind of method, pictures have been taken using phones.
Generally, the questions that has been asked for the open-ended questions start using; What, How,
how many, When and Where.
3.1.2 Secondary data collection method

Written documents which include recorded data‘s: there are documents in the hospital which are
recorded and which are standards. The recorded data include the number of patients who has
visited OPD department in each year.
The data‘s recorded has been represented using
 Pictures
 Flow charts
 Tables
3.2 Queue System model formulation

It represents the system in a mathematical way. When performing this, we will use different
notations. Among them are:
 λ = Mean rate of arrival.
 µ: Mean service rate. It is equal to 1/E[Service-Time].
 ρ = λ/µ for single server queues: utilization of the server; also, the probability that the server
is busy or the probability that someone is being served
 c or s: Number of servers
 Pn: Probability that there are n customers in the system
 L: Mean number of customers in the system
 Lq: Mean number of customers in the queue
 W: Mean wait in the system

 Wq: Mean wait in the queue

 C2: Coefficient of variation of a random variable; C2 = V variance (Mean)
 C2s: Coefficient of variation of service time
 C2a: Coefficient of variation of inter-arrival time
 σ2s: Variance of service time
 K: Capacity of queue
Using the above notations, little‘s rule has provided the following results:
For single server
Lq = p2/ 1-p
Wq = Lq / λ
ρ = λ/µ
V=1-p
L = λW; Lq = λWq.
W = Wq + 1/µ
For Multi-Server Model M/M/S

3.3 Data Analysis Methods

First of all, a questioner is given to the patients in order to clearly understand the patient‘s
feedback. Then existing service quality will be analyzed. After that the Data is collected. The data
is first collected from the OPD department. Patients arrive, wait, be served and are disposed with
different rate of time. This collected data is the existing one. Before analyzing and developing a
model the models that are used in this process are identified among 7 queue models depending on
their property and characteristics after the collected data distribution type is identified and checked
depend on data property and by providing statically evidence using input analyzer. Then this data
will be analyzed by using queuing theory mathematical analysis with different disciplines and
models by using POM or QM software analysis tool being used.
There is different reason which cause long waiting time in HRH however most frequently
happened but generally the causes that gained from respondents and others are listed.

CHAPTER FOUR
RESULT AND DISCUSSION

4.1 Introduction
To have real result Data collection is the most important thing on doing any projects or researches.
It is also a very big challenge to collect data especially in health care centers because most of the
patients focus only on getting their treatment. Developing a queuing model needs an accurate data.
There the collected data must be real otherwise the intended result will not define the system.
The OPD department contains different services. They are: Card room, central Triage, central
laboratory, examination room, pharmacy.
In Hawassa Referral Hospital, different data were recorded including: patient arrival, time of
service for patients, time of service ends, departure time, time for services in labs, time of service
in card rooms, treatment time for each process, number of beds, doctors and nurses. All this data
is recorded in the OPD department. The data was collected in a way which will not be a problem
for both the patients and staffs of the hospital. This data is collected by direct observation,
interviewing and documentation but mostly by directing observation using stop watches on a
phone. For the selected medical OPD the analysis result is tabulated as follows from tables.
4.1.1 Medical outpatient’s department patient flow
Figure 1Patient flow
The researchers have used stop watches with their phones to record all the data below. The below
table shows the record of a random day. The recorded time are the average from the different days
except the arrival time.
4.2 Average recorded data

In this research we have used stop watches with our phones to record all the data that referred in
the appendix part. It was recorded by 2 persons. The recorded data table shows the record of the

same day which is Monday and Tuesday for four weeks. The recorded time is the average from
these days.
Table 1 values from recorded data
Parameters Value
Arrival time 3.21
Service time for central triage 5.9
Service time for card room 10.3
Service time for examination room 25.7
Service time for central laboratory 8.4
Service time for pharmacy 2
30
20
10
0 service time waiting time

waiting time service time
Figure 2 Chart for patient waiting and service time
4.3 Pattern of Arrivals at the System

In general, patients arrive at a service facility either according to some known schedule (for
example, one patient every ten minutes) or else they arrive randomly. According to this study the

arrivals are random (Arrivals are considered random when they are independent of one another
and their occurrence cannot be predicted exactly). The number of arrivals per unit time can be
estimated by a probability distribution known as the Poisson distribution.
4.4 Service Characteristics

Two basic properties are important on providing service to the patients, namely, design of the
service system and the distribution of service times Service systems are usually classified in terms
of their number of channels (number of servers) and number of phases (number of service stops).
They are single-channel queuing system, multi-channel queuing system. The current queuing
situation at the OPD can be identified as a multi-channel queuing system(M/M/C) and single-
channel queuing(M/M/1) system because system is with one waiting line but with one server and
several servers. The distribution of service time is assumed to be an exponential distribution
because service times occurs randomly meaning occurrence of an event is not influenced by the
length of the time that has elapsed since the occurrence of the last event. In addition, statistically
evidences are providing to prove our data follows the assumptions that we provide above this is
done using arena input analyzer to check our assumptions by making histogram distribution chart
and computing the p-value of 0.05or 5% commonly used for statistical significance so based on
this we compute our p-value.
4.5 For arrival process and service process

P-value is a statistical measure that helps determine level of significance. If p-value <0.05 meaning
there is low probability that your result occurred by chance and there is likely a real effect or
relationship in your data and for p-value >is the opposite one depends on this our value is presented
below.

4.5.1 Poison distribution and exponential distribution
Figure 3histogram distribution for arrival process

Figure 4 histogram distribution for service process
As shown in the above our assumption is true for both processes our p-value is greater than 0.05
that means the test statistics is not significantly deviates from the expected distribution.
After checking modeling, the arrival and service process is done using POM-QM software as
shown below.
Models for central triage room
Table 2 POM-QM queuing model results on triage

Models for card room
Table 3 POM-QM queueing model result on card room
Models for examination room
Table 4 POM-QM queuing model result on examination

Models for laboratory room
Table 5 POM-QM queueing model results on laboratory
Models for pharmacy
Table 6 POM-QM queuing model results on pharmacy

The POM-QM software can help in analyzing the different scenarios and identify the bottlenecks
causing delays. Higher utilization and waiting time in the examination and card room among the
5 different rooms indicate that these rooms are experiencing a higher volume of patients or requests
compared to the other rooms. It means that patients have to wait longer for their turn in the
examination and card room, leading to delays and longer waiting times.
The higher utilization also suggests that these rooms are operating at or near their capacity,
indicating that additional resources or improvements may be required to manage the workload
effectively. It may be necessary to consider strategies such as increasing the number of staff,
optimizing processes or even setting up a separate queue for these rooms to reduce the waiting
time and improve the patient experience.
Based on the results of the queue analysis using POM-QM software, higher utilization and waiting
time in the examination and card room among the 5 different rooms indicates that there is a higher
demand or workload in these rooms compared to the others. This suggests that further investigation
should be done to identify the underlying causes of the bottleneck and delays to improve the patient
experience, enhance quality of care and increase operational efficiency.

Due to his different reason which cause long waiting time in HRH however most frequently
happened but generally the causes that gained from respondents and others are listed. Actions and
suggestions are taken
Figure 5 fishbone diagram of long waiting times
Table 7 corrective action of the cause of long waiting time
Cause Corrective actions
Method When addressing issues such as too much paperwork and long processes in a hospital,
a corrective action plan is necessary to ensure that these issues are eliminated or
minimized. Here are some potential actions to consider:
 Simplify documentation
 Implement Electronic Health Records (HER
 Establish Standard Work Procedures.
 Cross-Functional Training
 Continuous Improvement (Kaizen) Process

These corrective actions help to reduce the burden of paperwork in the hospital
environment and shorten processes through efficient and streamlined practices..
People When patients jump the queue, staff are not available, or unexpected patients show up,
it can create several operational issues in healthcare settings, including reduced quality
of care and decreased patient satisfaction. Here are some corrective actions that can be
implemented to address these issues:
 Improved Scheduling
 Educate Patients on Appointment Protocol
 Increased Staff Availability
 Optimized Resource Allocation
 Patient Queue Management Systems
Corrective action plans can eradicate suboptimal patient experience and ensure quality
care is provided to all patients. Implementing these actions can help hospital staff and
administrators alleviate the negative consequences of long wait times, queue jumping,
and staffing shortage.
Environment Not having enough treatment rooms can significantly impact hospital operations and
lead to decreased patient flow, which can reduce overall hospital revenue. Here are some
corrective actions that can be taken to address the issue:
 Increase Capacity.
 Implement a Queue Management System.
 Use Telemedicine

 Flexible Treatment Rooms

 Measure Wait Times
 Enhance Patient Education
In summary, the above corrective actions aim to increase treatment room capacity,
reduce wait times, optimize room utilization, and improve the patient experience. With
these corrective actions implemented, hospital administrators should see a positive
impact on overall hospital revenues and workflows.
Equipment Equipment breakdowns like a broken lift or the unavailability of wheelchairs in a

hospital can cause significant inconvenience to patients, impact hospital operations, and
increase the risk of potential accidents. Here are some corrective actions that can be
taken to address these issues:
 Preventive Maintenance
 Backup Equipment
 Streamline Patient Transport
 Prioritize Scheduling
 Communication Channels.
 Training & Education
In summary, the above corrective actions aim to improve the availability and reliability
of equipment within the hospital, to reduce downtime, optimize patient flow and
improve the patient experience. With these corrective actions implemented, hospital
administrators should see a positive impact on operations and improve patient
satisfaction levels.
Efficiency of the corresponding performance metrics for the rooms high waiting time and
bottlenecks exists is calculated as shown below
service time∗utilization
Efficiency =
service time∗utilization+average waiting times
For card room = 10.3∗0.75

*100%
10.3∗0.75+6.43

= 54.2%
For examination room= 25.7∗0.95

*100%
25.7∗0.95+53.14
=31.4%
After we calculate performance metrics with introducing costs
4.6 Introducing cost into the model

In order to evaluate and determine the optimum number of servers in the system, two opposing
costs must be considered in making this decision;
• Service costs
• Waiting time cost of customers
Economic analysis of these costs helps the management to make a trade-off between the increase
costs of providing better service and the decreased waiting time costs of customers derived from
providing that service.
Expected service cost (𝑆𝐶) = 𝑆𝐶𝑠 (Where 𝑆 = 𝑛𝑢𝑚𝑏𝑒𝑟𝑜𝑓𝑠𝑒𝑟𝑣𝑒𝑟𝑠𝐶𝑠 = 𝑠𝑒𝑟𝑣𝑖𝑐𝑒𝑐𝑜𝑠𝑡𝑜𝑓𝑒𝑎𝑐h

𝑠𝑒𝑟𝑣𝑒𝑟
Expected waiting costs in the system (𝑊𝑐) = (𝜆𝑊𝑠)
Where 𝜆 = 𝑛𝑢𝑚𝑏𝑒𝑟𝑜𝑓𝑎𝑟𝑟𝑖𝑣𝑎𝑙𝑠
𝑊𝑠 = 𝑎𝑣𝑒𝑟𝑎𝑔𝑒𝑡𝑖𝑚𝑒𝑎𝑛𝑎𝑟𝑟𝑖𝑣𝑎𝑙𝑠𝑝𝑒𝑛𝑑𝑠𝑖𝑛 𝑡h𝑒 𝑠𝑦𝑠𝑡𝑒𝑚
𝐶𝑤 = 𝑜𝑝𝑝𝑜𝑟𝑡𝑢𝑛𝑖𝑡𝑦𝑐𝑜𝑠𝑡𝑜𝑓𝑤𝑎𝑖𝑡𝑖𝑛𝑔𝑏𝑦𝑐𝑢𝑠𝑡𝑜𝑚𝑒𝑟𝑠)
We have, Expected total cost: (𝑇𝐶) = (𝑆𝐶) + (𝑊𝐶)
Expected Total cost :(𝑇𝐶) = 𝑆𝐶𝑠 + (𝜆𝑊𝑠)𝐶𝑤

To calculate lambda in recorded data, use two methods:
A. Use the Poisson distribution formula to calculate lambda
1. Determine the time period for which you want to calculate lambda. For example, if you have
recorded data for 10 seconds, you may want to calculate lambda for each second.
2. Count the number of occurrences of the event you are interested in during the time period. For
example, if you are interested in the number of cars passing through a traffic intersection, count
the number of cars that passed during each second of the recorded data.

3. Calculate the average number of occurrences per unit time by dividing the total number of
occurrences by the length of the time period. For example, if there were 50 cars that passed
through the intersection during 10 seconds of recorded data, the average number of cars passing
per second would be 5.
4. Use the Poisson distribution formula to calculate lambda, which is the expected number of
occurrences per unit time. The formula is:
lambda = (total number of occurrences) / (total time)
In our example, lambda would be: lambda = 50 / 10 = 5
Therefore, the expected number of cars passing through the intersection per second is 5.
B. Use the Little's Law to calculate lambda

1. Determine the time period for which you want to calculate lambda. For example, if you have
recorded data for 1 hour, you may want to calculate lambda for each minute.
2. Count the number of patients who arrived at the hospital during the time period. For example, if
you are interested in the number of patients who arrived at the emergency department, count the
number of patients who arrived during each minute of the recorded data.
3. Calculate the average number of arrivals per unit time by dividing the total number of arrivals by
the length of the time period. For example, if there were 60 patients who arrived at the emergency
department during 1 hour of recorded data, the average number of arrivals per minute would be 1.
4. Use the Little's Law to calculate lambda which is the expected number of patients who enter the
waiting line per unit time. The formula is:
lambda = (average number of patients in the waiting line) / (average waiting time)
To use this formula, you need to collect data on the average number of patients in the waiting line
and the average waiting time. You can do this by observing the waiting line and timing how long
each patient waits before being seen by a healthcare provider.
For example, if you observe that there are on average 10 patients waiting in line and the average
waiting time is 30 minutes, then lambda would be: lambda = 10 / 30 = 0.33
Therefore, the expected number of patients who enter the waiting line per minute is 0.33
.
So in this case our research to calculate (number of arrivals) using Poisson distribution method
lambda = (total number of occurrences) / (total time)
total number of occurrences =160 (check on appendix our recorder data)
total time = 8 , we take 8 day to record 160 patient in OPD
lambda= 160/8=20

In order to do costs first we must know the wages of workers that work in medical OPD and other
costs corresponding to this service facility as a result thus information‘s provided as follow
We take average of doctor‘s wage 12000ETB/month=50ETB/hour and Wage for nurses,

pharmacists, and laboratories‘ we take average of 8017ETB/Month=38.50ETB/hours and for card
workers average of 6741ETB/month=32.5ETB/hour

Triage room queueing modeling with cost
Table 8 POM-QM queueing model with cost on triage room
a) Waiting line with cost result
b) Table of costs based on no of server
For card room queueing modeling with cost
Table 9 POM-QM queuing model result with cost on card room
a) waiting line result with cost on card room

b) table of costs based on no of server on card
For examination
Table 10 POM-QM queueing model result with cost on examination room
a) waiting line with cost result
b) table of costs based on no of servers

For laboratory
Table 11 POM-QM queueing model with costs results on laboratory
b) table of costs based on no of server
Pharmacy queue model with cost
Table 12 POM-QM queueing model with cost result on pharmacy
a) waiting line with costs results

b) table of costs based on no of server
As shown in the above POM-QM software result including costs are calculated the amount of cost
that customers spend based on waiting and based on system.
4.7 proposed solution

The result from the data collection and data analysis shows that patient‘s expectations and demands
is not matched with the hospitals service. Patients are waiting a long time to get services. This is
creating dissatisfaction for the patients. This should be fixed. In order to fix this, different
techniques used. Thus, techniques which are used to bring solutions are discussed below:
 By adding staff members in the rooms which high waiting time exists In this case, in a
scenario waiting time will be tried to be reduced by adding human resources in different
sections especially high waiting time appeared. Some rooms may require more human
resources than it has been allocated. In this case also, the result will be evaluated with
scenarios.
 Increasing the working hour of workers by one hour in this case in order to improve the
performances and decrease waiting time of patients we add one hour in addition to their
previous working hours.
 Merging adding server and one working hour together in this case we merge the first and
the second solutions together for better improvement or in order to enhance the service quality
in a better way

4.1 Solution Approaches

1 Adding number of servers in the rooms which high waiting time exists
In this case we add number of servers and compute the performance metrics and compare each
performance from the existing ones to take optimum number of servers that make a system with
less waiting time and more efficient.
I. Waiting line solution result in central triage
Table 13 sensitivity to number of servers on triage
In this room the server that have before is enough as shown in the above table. when we see by
adding server numbers their utilization becomes low or servers become idle so in this room adding
extra server is not appropriate.
II. Waiting line solution result in card room
Table 14 sensitivity number of servers on card room
As shown in the above table by adding different number of servers the performance metrics are

compared and we select the number of servers that results low waiting time or having good
performance metrics. We select 3 and 4 servers and compare their performance with cost and take
the server number that result low cost.
Table 15 table of costs based on number of servers
First existing cost for server 2 =total cost of based on waiting +total cost based on system
=403.52 + 563.12 = 966.12 ETB/hours
We add one number of servers the cost is = total cost of based on waiting +total cost based on
system
=322.68 +482.28 = 804.96 ETB/hours
Revenue =the cost of server 2-the cost of server 3
=966.12ETB/hours – 804.96 ETB/hours = 161.16ETB/hours
We add two number of servers the cost is = total cost of based on waiting +total cost based on
system
=401.4 +561 = 962.4 ETB/hours
=966.12ETB/hours – 962.4 ETB/hours = 3.72ETB/hour

As shown in the above the server number that results with good cost and performance is a server
number of three so we take it that means adding one server is enough and the efficiency regarding
to this server is calculated below
𝑠𝑒𝑟𝑣𝑖𝑐𝑒 𝑡𝑖𝑚𝑒∗𝑢𝑡𝑖𝑙𝑖𝑧𝑎𝑡𝑖𝑜𝑛 10.3∗0.5

Efficiency = = =0.86=86%
𝑠𝑒𝑟𝑣𝑖𝑐𝑒 𝑡𝑖𝑚𝑒∗𝑢𝑡𝑖𝑙𝑖𝑧𝑎𝑡𝑖𝑜𝑛+𝑎𝑣𝑒𝑟𝑎𝑔𝑒 𝑤𝑎𝑖𝑡𝑖𝑛𝑔 𝑡𝑖𝑚𝑒𝑠 10∗0.5+0.79
There is increment of efficiency from 54.2% to 86%
III. Waiting line solution for examination room
Table 16 sensitivity to number of servers on examination room
When we come to this room as shown in the above table the same procedure is taken as in card
room.
Table 17 costs based on no of servers
First existing cost for server 3 =total cost of based on waiting +total cost based on system
=4432.79+ 5247.24 = 9680 ETB/hours
We add one number of servers the cost is = total cost of based on waiting +total cost based on
system

=908.93+1723.38 = 2632.31ETB/hours
=9680ETB/hours – 2632.31 ETB/hours = 7047.7ETB/hours
We add two number of servers the cost is = total cost of based on waiting +total cost based on
system
=833.04+1647.49 = 2480.53 ETB/hours
=9680ETB/hours – 2480.53 ETB/hours = 7199.47ETB/hours
Based on the above result the server number which has good cost and good performance is server
5 that means we add 2 extra server and the efficiency corresponding to this service is calculated
below.

Efficiency == = =0.94=94%
𝑠𝑒𝑟𝑣𝑖𝑐𝑒 𝑡𝑖𝑚𝑒∗𝑢𝑡𝑖𝑙𝑖𝑧𝑎𝑡𝑖𝑜𝑛+𝑎𝑣𝑒𝑟𝑎𝑔𝑒 𝑤𝑎𝑖𝑡𝑖𝑛𝑔 𝑡𝑖𝑚𝑒𝑠 25.7∗0.5+0.85
As the server increase from 3 to 5 the efficiency also increases from 31.4% to 94%
IV. Waiting line solution for laboratory room
Table 18 sensitivity to number of servers on laboratory
As shown before the waiting times compared to the other room in this room waiting times are
lower than the other so we do not add servers we let up as before because as we have seen the
results it results idle than the previous.

2 increasing working hours of doctors and workers results in with less waiting times this can
be done by adding these hours in to the system and perform the POM-QM software and see how
this can affect in performance measures and corresponding costs as shown below.
As the working hour increase information regarding wages or costs to this hour becomes changed
because as the time increase their wage also increase so we must change the data before in order
to calculate the costs due to this this information listed below.
Wage of doctor 12000 ETB/Month and wage after adding 1 hour is 1500 that mean 13500
Wage for workers in card room 6741 ETB /Month
Facility cost = 47500ETB this facility cost of table &chair, desktop and others but this facility
used for at least for 5year so we change this cost in hours in order to get cost incurred per hours so
this facility cost per hour results 2.16ETB/Hours
Opportunity cost is the value of the time they spend waiting in the queue, for our research we take
the average monthly income in Ethiopia that is 5055.00 ETB/month that means 14 ETB/hour.
After one hour added We take average of doctor‘s wage 12000ETB/month=56.25ETB/hour
For nurses, pharmacists, and laboratories‘ we take average of 8017ETB/Month=42.7 ETB/hours

and for card workers average of 6741ETB/month=35.6ETB/hour
Then we calculate the service cost and waiting cost using the above data as follow
For card room Service cost (𝑆𝐶) = 𝑆𝐶𝑠=3*35.6+2.16=108.9ETB/hours
Waiting costs in the system (𝑊𝑐) = (𝜆𝑊𝑠)C𝑤=20*0.074*14=20.72ETB/hours
For examination room Service cost (𝑆𝐶) = 𝑆𝐶𝑠=3*56.25+2.16=170.91 ETB/hours
For laboratory room Service cost (𝑆𝐶) = 𝑆𝐶𝑠=2*42.7+2.16=87.56 ETB/hours
Waiting costs in the system (𝑊𝑐) = (𝜆𝑊𝑠)C𝑤=20*0.05*14=14ETB/hours
For pharmacy Service cost (𝑆𝐶) = 𝑆𝐶𝑠=1*42.7+2.16=44.86ETB/hours

First, we take the number of customers that serve in the rooms per hour in order to get the new
service time.
A. For card room the service time is25.7 that means they serve 3patients/ hour when we add one
working hours, we need to substitute this time in to the system by combining with the first
service time, this can be done for other rooms in the same way.
New service time = 𝑎𝑑𝑑𝑒𝑑 𝑤𝑜𝑟𝑘 𝑕𝑜𝑢𝑟 =1=0.33hour/customer =0.33 *60=20min after we
𝑐𝑢𝑠𝑡𝑜𝑚𝑒𝑟𝑠 𝑠𝑒𝑟𝑣𝑒 𝑝𝑒𝑟 𝑕𝑜𝑢𝑟 3
substitute the result into the software results as follows
Table 19 POM-QM queueing model result on increasing one working hour
a) waiting line with cost
b) table of probabilities

c) table of costs based on number of servers
Evaluation of cost after adding one working hours=total cost of based on waiting +total cost of
based on system
=225.6+247.01 =472.61ETB/hours
And the existing total cost = 966.12 ETB/hours
Revenue cost = existing total cost -cost of adding one working hours
=966.12-472.61 =493.51 ETB/hours

𝑠𝑒𝑟𝑣𝑖𝑐𝑒 𝑡𝑖𝑚𝑒∗𝑢𝑡𝑖𝑙𝑖𝑧𝑎𝑡𝑖𝑜𝑛+𝑎𝑣𝑒𝑟𝑎𝑔𝑒 𝑤𝑎𝑖𝑡𝑖𝑛𝑔 𝑡𝑖𝑚𝑒𝑠 10.3∗0.52+1,21
Table 20 POM-QM queueing model results on increasing one working hours
a) sensitivity to number of servers

b) graph of probabilities
B. For examination room new service time = 𝑎𝑑𝑑𝑒𝑑 𝑤𝑜𝑟𝑘 𝑕𝑜𝑢𝑟 =1=0.33hour/customer =0.33
*60=20min after we substitute the result into the software results as follows
Table 21 POM-QM queueing model results on examination increasing one working hours
a) waiting line with cost

c) table of cost based on no of servers
based on system
=533.03+598.5 = 1131.53ETB/hours
And the existing total cost = 9680 ETB/hours
=9680-1131.53 =8548.47 ETB/hours

d) table of sensitivity to number of servers

e) graph of probabilities
C. For laboratory room new service time= 𝑎𝑑𝑑𝑒𝑑 𝑤𝑜𝑟𝑘 𝑕𝑜𝑢𝑟 =1

Table 22POM-QM queueing model results on laboratory room increasing one working hour
a) waiting line result

c) table of costs based on no of servers
For laboratory total cost Evaluation of cost after adding one working hours=total cost of based on
waiting +total cost of based on system
=178.47+191.23 = 369.53ETB/hours
And the existing total cost = 189.38+232.78=422.16ETB/hours
=422.16-369 =53 ETB/hours not that much but there is still little revenue than the
existing system but compared to other rooms its revenue not that much great change.

D. For pharmacy room new service time= 𝑎𝑑𝑑𝑒𝑑 𝑤𝑜𝑟𝑘 𝑕𝑜𝑢𝑟 =1=20min
Table 23 POM-QM queueing model result on pharmacy by increasing one working hour
b) tables of probabilities

c) table of costs based on no of servers
For pharmacy total cost Evaluation of cost after adding one working hours=total cost of based on
waiting +total cost of based on system
=51.13+57.61= 107.74ETB/hours
And the existing total cost = 50.91+59.89=110.8ETB/hours
= 110.8 -107.7=3.06 ETB/hours its revenue is not that much compared to the other but there is a
little difference.

3 Merging scenario 1 and scenario 2 having increased server number and working hours together
Card room when adding one server and one working hour
Evaluation of cost after adding one working hour and add resource=total cost of based on waiting
+total cost of based on system
=327.77+349.18 =676.88ETB/hours
And the existing total cost = 966.12 ETB/hours
=966.12- 676.88 =289.24 ETB/hours

Examination room result when adding two server and one working hour

based on system
=855.43+920.89 =1776.32ETB/hours
And the existing total cost = 9680 ETB/hours
=9680-1776.32 =7903.68 ETB/hours

For Laboratory and Pharmacy room result when adding two server and one working hour
As said before for these two rooms we do not add server resource so we do not use merging we
only apply adding hours because it does dot increase their idleness and for better flow of work
adding room must be
Among the above proposed solutions scenario 2 which have good in terms of generating revenue
than the other and scenario 3 which have good performance and efficiency than the other but less

revenue than the other due to this reason in order to select the best one form thus alternative we
need a decision-making method that is multi-criteria decision making.
Simple Multi-Criteria Decision Making (MCDM) is a technique used to make decisions among
several alternatives based on different criteria, using a straightforward and intuitive approach to
present and handle complex information. It involves analyzing different alternatives based on
multiple criteria or factors such as cost, benefit, risk, feasibility, and so on.
To use the simplest MCDM, follow these steps:
Here are the steps you can follow to make a decision using the Simple MCDM framework:
1. Identify the Criteria: List out all the critical criteria that will influence your decision.
* Criteria: Revenue, Efficiency and Performance.
2. Assign Weights to Criteria: Assign a weight to each criterion based on its importance. The total
weights should sum up to 1.
Table 24 table of setting priorities
Intensity of Definition Explanation

importance
1 Equal importance Two elements contribute equally to

the element
3 Moderate importance one over the Experience and judgment slightly

other favor one element over another
5 Essential or strong important Experience and judgment strongly

fever one element
7 Very strong important An element is strongly favored and its

dominance is demonstrated in practice

9 Extreme important The evidence favoring one element

over the other is of the highest
possible order affirmation
2,4,6,8 Intimidate value between the two- Compromise is needed between two
adjustment basement judgments
 Criteria: Revenue 5, Efficiency 3, Performance 9, total 17
Revenue= 5 =0.29
17
Efficiency= 3 =0.17
17
Performance = 9 =0.53
17
3. Identify Alternatives: List down the two solutions.
* Alternatives: Scenario 2 and scenario 3
4. Evaluate Alternatives: Score each alternative for each criterion on a scale of 1 to 10, where 10
is the best and 1 is the worst.
Scenario 2 Revenue (5), Efficiency (2), Performance (3)
scenario 3 Revenue (8), Efficiency (3), Performance (6)
5. Compute the Overall Score: Calculate the overall score of each alternative by multiplying the
score of each criterion by its weight and adding them.
Scenario 2: Overall Score = (0.29*5) + (0.17*2) + (0.53*3) =3.38
scenario 3: Overall Score = (0.29*8) + (0.17*3) + (0.53*6) = 6.01
6. Select the Best Alternative: Compare the overall scores of both solutions and select the one with
the highest score.

In this case, scenario 3seems to be the better choice as it has a comparatively higher overall score
than Scenario 2.
Generally, the data that are collected are computed for each room for existing system and for the
new system using POM-QM software and different solutions are also developed based on the result
of the analysis. Among the solutions the cost that incur also calculated and compared each other
to select the one solution that have good performance with low cost or higher revenue based on
this merging scenario 1 and scenario 2 is better for card and examination because the result that
compared to each scenario is better and for the laboratory and card room we take scenario 2 for
better flow that means we decide adding one hour in card and examination room this also needs to
add this hour to the next rooms because patients must go for laboratory and pharmacy room to
finish their service unless the patient flow stop at examination room is the hour adding end at this
room so we select scenario3 for card and examination room and we select scenario 2 for laboratory
and pharmacy.

CHAPTER FIVE
5. CONCLUSION AND RECOMMENDATION

5.1 Conclusion
Hawassa referral hospital is one of the biggest hospitals that found in Hawassa city which gives
health service for patients depending on their case of illness. In this research focus on studying of
long waiting line or queue of patients that experiences due to different reasons in medical OPD
rooms. After all this have been done, one can conclude that HRH has a high waiting line and
customers are not fully satisfied with the service.
In conclusion the pre-determined objectives of the research have been achieved, the finding of the
research identifies the most common problems that exist in medical OPD department regarding to
waiting time due to different reasons like shortage of resource, method of service and others as a
result data used for the research is collected ,analyzed and model developed by using POM-QM
software in order to determine their operating performance of each rooms and to determine in
which rooms customers experience more waiting time to get the service in medical OPD as a result
a room which have high waiting time are determined .
In the result and discussion part those data‘s result is provided in terms of queue performance and
their associating cost based on these different scenarios identified to solve the problem according
to the rooms which have high waiting time with high cost and low performance. From among the
3 scenarios based on multi criteria decision making and the best one is selected in terms of their
performance and cost which is merging adding server number and adding working one hour
(scenario 3)for examination waiting time reduced from 44.38to 1.28 (wq)and for card room 6.43
to 1.21(wq) and their associated saved cost around to 7903 birr and 289 birr r and also the
efficiency increased by 65.6% and 40.8% respectively. for laboratory and pharmacy only adding
the working time is selected for better flow of work. the selected scenario also increases the
revenue of the company also decrease waiting time of patients and increase efficiency of the
system that means the system becomes improved in terms of performance and efficiency.

5.2 Recommendation
To make the healthcare system more accessible and effective, there is an urgent need towards
addressing the existing significant gaps in the human resources, equipment and logistics so as to
efficiently minimize the existing long waiting, to ensure effective, efficient and operational
healthcare delivery system. As the current operating philosophy in the healthcare system is ―First
Comes First Served‖ and unless the healthcare places an appointment system to implement a
patient scheduling scheme, patients believe that a physician can see them earlier if they come
earlier. Implementing and enforcing a staggered appointment system for patients and improving
the clinics patient scheduling system, will ensure a smooth clinic process and will reduce the
waiting times. This scheduling shall also consider implementing specific time-based appointments
for the follow-up patients, in place of the existing day-based appointment. This intervention is
expected to be cost effective and for its long-term efficiency there needs to be a close follow-up in
its implementations.
Regarding to the existing system the following recommendations were made to reform the number
of servers that available, beds and equipment, the service mechanism, to cope with the tasks.
Monitor patient flow: Implement a system to monitor patient flow and wait times across all
departments. This would help to quickly identify bottlenecks in the system, adjust staffing levels
in real-time, and reduce wait times. In addition (Utilize technology) Implement digital appointment
scheduling systems so that patients can book appointments ahead of time and reduce waiting time.
Automated check-ins and real-time status notifications can also be leveraged to inform patients of
non-clinical wait times and manage their expectations.
Increase staffing levels: Evaluate staffing levels across all departments and add more staff where
necessary to reduce wait times and improve patient satisfaction levels and Waiting room
experience also Renovate and redesign waiting rooms to create a more comfortable and welcoming
atmosphere for patients. Provide amenities such as water, magazines, and a TV to make the wait
time more bearable.
Implementing a digital queue management system. A digital system would not only provide
customers with greater clarity and comfort during their wait but would also offer several benefits
to the business. A digital queue management system allows customers to check in virtually, either

through a mobile application, online portal or kiosk, and then receive updates via text message or
push notification about their wait time and estimated service time. Customers could also be able
to see how many customers are ahead of them, how many counters or service stations are open
and, in some cases, which employee will be serving them. Many businesses and organizations rely
on manual methods for managing queues, such as having customers take a number or standing in
a physical line. However, these methods have several limitations, including the potential for
confusion, long wait times, and a lack of staff visibility into customer needs.so implementing
digitalized system is better. Finally, it is better arranging their booking system or making their
booking system using paperless that means digitalized computer access should be added,
arranging their retrieve system in card rooms and arrange rooms, practicing kaizen principle,
guiders should be applied so that everyone could hear it easily and for better communication
between patients and hospital workers, making simpler and well-developed layout. Generally, all
the recommendations can help the hospital in order to provide quality service.

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APPENDIX
Data recorded for four weeks or one month
Appendix A Data recorded on OPD

N Arriva Triage(min) Card room Examination room Laboratory Pharmacy
o l of
patient Waitin Servic Waitin Service Waiting Service Waiting Servi Waiting Service
‘s time g time e time g time time time time time ce time time
time
1 2:01 12:05 6:02 11:25 6:23 8:52 22:05 14:02 7:01 1:17 1:17
2 2:21 10:43 3:15 19:01 6:19 12:19 30:15 15:52 9:52 2:18 2:11
3 3:20 8:02 4:20 8:52 4:13 11:05 21:06 13:49 10:17 2:22 4:04
4 3:36 6:56 2:35 6:49 3:43 16:15 22:08 17:50 6:35 3:13 1:49
5 3:45 11:30 3:01 8:52 5:12 18:20 16:59 14:59 8:30 2:55 2:01
6 4:12 12:00 7:53 10:23 6:26 5:59 28:39 10:05 9:49 2:43 4:52
7 4:30 14:35 5:20 9:29 3:45 13:08 21:43 16:08 11:29 1:32 1:19
8 4:58 13:49 8:12 12:05 6:32 12:19 22:05 9:17 5:52 2:30 5:22
9 5:10 9:30 6:14 7:15 6:02 15:32 26:07 12:52 9:01 3:00 3:45
10 5:29 13:10 4:59 13:42 4:34 14:43 29:56 13:69 6:08 2:17 1:51
11 5:26 10:59 3:05 13:42 14:34 24:43 19:09 16:08 3:19 4:17 2:51
12 5:34 11:05 4:53 14:25 28:10 18:52 28:05 14:03 12:36 3:05 1:11
13 5:39 19:43 7:59 18:17 15:30 20:39 22:16 16:51 10:40 4:11 1:52
14 5:43 17:30 7:36 16:32 25:12 21:25 39:08 15:11 12:56 5:59 0:59
15 5:50 12:28 6:50 19:41 23:08 19:53 28:02 18:18 4:33 3:09 2:49
16 5:58 7:29 4:15 15:19 16:50 16:49 20:06 15:20 5:35 4:17 2:40
17 6:02 8:05 4:15 10:20 16:50 19:20 26:23 16:10 6:21 4:54 2:00
18 6:20 20:04 7:01 22:04 17:34 23:09 20:34 14:32 9:08 6:05 3:09
19 6:31 15:01 3:40 17:08 08:35 17:29 32:54 16:11 8:28 3:27 3:04
20 6:39 08:07 4:02 7:03 14:43 22:16 19:56 14:01 7:01 2:09 2:48
21 6:48 17:20 5:23 13:50 16:22 24:44 24:35 15:47 5:03 3:01 2:51
22 6:58 3:02 35:18 7:52 9:43 9:56 48:45 20:19 3:11 4:04 0:14

23 7:16 4:08 23:50 4:14 4:34 18:37 39:17 19:17 4:10 3:17 0:17
Appendix B:Data recorded on OPD

o l of
time
1 2:01 33:05 16:05 10:05 4:23 6:52 22:05 14:52 7:35 1:52 1:00
2 2:24 22:15 15:19 12:25 4:56 9:33 27:13 14:33 6:38 2:11 2:17
3 3:24 14:10 7:56 8:56 7:12 12:35 24:29 13:39 3:36 2:10 3:02
4 3:48 24:15 9:06 10:19 5:43 11:43 35:25 15:45 8:37 3:07 2:11
5 4:00 11:12 7:10 23:52 13:53 19:27 28:11 12:30 4:58 4:50 2:12
6 4:17 11:53 6:08 20:23 28:26 25:59 18:07 15:04 4:05 3:43 3:01
7 4:46 18:12 3:49 12:05 26:32 14:49 27:05 10:52 11:17 5:30 1:28
8 5:05 15:20 9:35 19:29 13:45 14:30 26:04 12:29 10:08 3:32 1:26
9 5:19 19:43 7:59 18:17 15:30 20:39 22:16 16:51 10:40 4:11 2:47
10 5:29 11:05 4:53 14:25 28:10 18:52 28:05 14:03 12:36 3:05 1:26
11 5:40 10:59 3:05 13:42 14:34 24:43 19:09 16:08 3:19 4:17 2:58
12 5:58 6:14 8:30 7:15 18:02 15:32 26:07 19:01 12:52 3:00 3:53
13 6:03 17:30 7:36 16:32 25:12 21:25 39:08 15:11 12:56 5:59 1:59
14 6:28 7:29 4:15 15:19 16:50 16:49 20:06 15:20 5:35 4:17 2:44
15 6:39 20:04 7:01 22:04 17:34 23:09 20:34 14:32 9:08 6:05 3:29
16 6:47 12:28 6:50 19:41 23:08 19:53 28:02 18:18 4:33 3:09 2:43
17 6:59 8:05 4:15 10:20 16:50 19:20 26:23 16:10 6:21 4:54 2:23
18 7:10 17:20 5:23 13:50 16:22 24:44 24:35 15:47 5:03 3:01 3:28
19 7:24 08:07 4:02 7:03 14:43 22:16 19:56 14:01 7:01 2:09 1:57
20 7:35 15:01 3:40 17:08 08:35 17:29 32:54 16:11 8:28 3:27 4:13
21 7:51 1:30 36:10 11:15 9:56 9:41 25:20 28:01 3:13 4:45 0:51
22 8:02 4:50 26:23 14:27 13:34 11:12 44:13 19:39 7:45 2:17 0:53

Appendix C: Data recorded on OPD

o l of
time
1 1:12 8:06 4:12 11:20 6:33 8:25 38:32 16:54 10:02 3:51 0:56
2 1:58 15:00 9:27 20:05 6:45 10:49 27:49 15:25 9:43 2:08 0:59
3 2:20 10:20 5:59 10:59 5:23 13:59 37:53 15:59 11:22 4:10 0:00
4 2:49 16:54 6:43 15:06 4:28 18:06 11:46 17:05 7:40 5:14 0:17
5 3:10 13:19 9:50 7:10 7:34 12:43 35:36 17:50 9:58 2:09 0:32
6 3:30 14:00 7:49 11:23 10:43 11:54 21:59 18:17 13:53 3:17 0:17
7 3:59 9:53 2:35 9:56 12:34 9;08 32:05 13:08 17:14 2:47 0:16
8 4:10 18:12 3:49 12:05 26:32 14:49 27:05 10:52 11:17 5:30 1:22
9 4:43 6:14 8:30 7:15 18:02 15:32 26:07 19:01 12:52 3:00 1:45
10 4:56 10:59 3:05 13:42 14:34 24:43 19:09 16:08 3:19 4:17 2:51
11 5:13 6:02 3:05 11:25 10:23 18:52 26:05 26:01 4:02 3:17 2:17
12 5:30 9:09 4:43 19:01 9:19 22:19 30:15 17:02 5:52 4:18 1:11
13 5:49 9:20 5:02 18:52 15:13 24:05 21:06 15:17 10:49 3:22 1:04
14 5:00 22:35 6:56 16:49 14:43 16:15 29:08 21:35 7:50 3:13 2:49
15 5:20 12:01 5:30 28:52 15:12 18:20 26:09 10:30 14:59 5:55 2:01
16 5:40 11:53 6:08 20:23 28:26 25:59 18:07 15:04 4:05 3:43 3:52
17 6:00 15:20 9:35 19:29 13:45 14:30 26:04 12:29 10:08 3:32 1:19
18 6:14 15:01 3:40 17:08 08:35 17:29 32:54 16:11 8:28 3:27 3:04
19 6:42 08:07 4:02 7:03 14:43 22:16 19:56 14:01 7:01 2:09 2:48
20 7:01 17:20 5:23 13:50 16:22 24:44 24:35 15:47 5:03 3:01 2:51

Appendix D: Data recorded on OPD

o l of
time
1 2:09 6:02 3:05 11:25 10:23 18:52 26:05 26:01 4:02 3:17 2:17
2 2:27 9:09 4:43 19:01 9:19 22:19 30:15 17:02 5:52 4:18 1:11
3 2:44 9:20 5:02 18:52 15:13 24:05 21:06 15:17 10:49 3:22 1:04
4 3:55 22:35 6:56 16:49 14:43 16:15 29:08 21:35 7:50 3:13 2:49
5 4:12 12:01 5:30 28:52 15:12 18:20 26:09 10:30 14:59 5:55 2:01
6 4:30 11:53 6:08 20:23 28:26 25:59 18:07 15:04 4:05 3:43 3:52
7 4:58 15:20 9:35 19:29 13:45 14:30 26:04 12:29 10:08 3:32 1:19
8 5:10 18:12 3:49 12:05 26:32 14:49 27:05 10:52 11:17 5:30 1:22
9 5:19 6:14 8:30 7:15 18:02 15:32 26:07 19:01 12:52 3:00 1:45
10 5:26 10:59 3:05 13:42 14:34 24:43 19:09 16:08 3:19 4:17 2:51
11 5:34 11:05 4:53 14:25 28:10 18:52 28:05 14:03 12:36 3:05 1:11
12 5:49 19:43 7:59 18:17 15:30 20:39 22:16 16:51 10:40 4:11 1:52
13 5:43 17:30 7:36 16:32 25:12 21:25 39:08 15:11 12:56 5:59 0:59
14 5:50 12:28 6:50 19:41 23:08 19:53 28:02 18:18 4:33 3:09 2:49
15 5:15 7:29 4:15 15:19 16:50 16:49 20:06 15:20 5:35 4:17 2:40
16 5:28 20:04 7:01 22:04 17:34 23:09 20:34 14:32 9:08 6:05 3:09
17 5:42 15:01 3:40 17:08 08:35 17:29 32:54 16:11 8:28 3:27 3:04

Appendix E: Data recorded on OPD

o l of
time
1 3:08 11:05 4:53 14:25 28:10 18:52 28:05 14:03 12:36 3:05 1:11
2 3:10 19:43 7:59 18:17 15:30 20:39 22:16 16:51 10:40 4:11 1:52
3 4:16 17:30 7:36 16:32 25:12 21:25 39:08 15:11 12:56 5:59 0:59
4 4:25 12:28 6:50 19:41 23:08 19:53 28:02 18:18 4:33 3:09 2:49
5 4:32 7:29 4:15 15:19 16:50 16:49 20:06 15:20 5:35 4:17 2:40
6 4:40 8:05 4:15 10:20 16:50 19:20 26:23 16:10 6:21 4:54 2:00
7 4:58 20:04 7:01 22:04 17:34 23:09 20:34 14:32 9:08 6:05 3:09
8 5:10 6:02 3:05 11:25 10:23 18:52 26:05 26:01 4:02 3:17 2:17
9 5:19 9:09 4:43 19:01 9:19 22:19 30:15 17:02 5:52 4:18 1:11
10 5:26 9:20 5:02 18:52 15:13 24:05 21:06 15:17 10:49 3:22 1:04
11 5:34 22:35 6:56 16:49 14:43 16:15 29:08 21:35 7:50 3:13 2:49
12 5:39 12:01 5:30 28:52 15:12 18:20 26:09 10:30 14:59 5:55 2:01
13 5:43 11:53 6:08 20:23 28:26 25:59 18:07 15:04 4:05 3:43 3:52
14 5:50 15:20 9:35 19:29 13:45 14:30 26:04 12:29 10:08 3:32 1:19
15 6:30 7:29 4:15 15:19 16:50 16:49 20:06 15:20 5:35 4:17 2:40
16 6:46 8:05 4:15 10:20 16:50 19:20 26:23 16:10 6:21 4:54 2:00
17 6:59 20:04 7:01 22:04 17:34 23:09 20:34 14:32 9:08 6:05 3:09
18 7:14 15:01 3:40 17:08 08:35 17:29 32:54 16:11 8:28 3:27 3:04

Appendix F: Data recorded on OPD

o l of
time
1 1:00 6:02 3:05 11:25 10:23 18:52 26:05 26:01 4:02 3:17 2:17
2 1:23 9:09 4:43 19:01 9:19 22:19 30:15 17:02 5:52 4:18 1:11
3 1:50 9:20 5:02 18:52 15:13 24:05 21:06 15:17 10:49 3:22 1:04
4 2:20 22:35 6:56 16:49 14:43 16:15 29:08 21:35 7:50 3:13 2:49
5 2:41 12:01 5:30 28:52 15:12 18:20 26:09 10:30 14:59 5:55 2:01
6 2:55 11:53 6:08 20:23 28:26 25:59 18:07 15:04 4:05 3:43 3:52
7 3:18 15:20 9:35 19:29 13:45 14:30 26:04 12:29 10:08 3:32 1:19
8 3:30 18:12 3:49 12:05 26:32 14:49 27:05 10:52 11:17 5:30 1:22
9 3:48 6:14 8:30 7:15 18:02 15:32 26:07 19:01 12:52 3:00 1:45
10 3:59 10:59 3:05 13:42 14:34 24:43 19:09 16:08 3:19 4:17 2:51
11 4:16 11:05 4:53 14:25 28:10 18:52 28:05 14:03 12:36 3:05 1:11
12 4:39 19:43 7:59 18:17 15:30 20:39 22:16 16:51 10:40 4:11 1:52
13 4:53 17:30 7:36 16:32 25:12 21:25 39:08 15:11 12:56 5:59 0:59
14 5:10 12:28 6:50 19:41 23:08 19:53 28:02 18:18 4:33 3:09 2:49
15 5:30 7:29 4:15 15:19 16:50 16:49 20:06 15:20 5:35 4:17 2:40
16 5:49 12:05 6:02 11:25 6:23 8:52 22:05 14:02 7:01 1:17 1:17
17 5:56 10:43 3:15 19:01 6:19 12:19 30:15 15:52 9:52 2:18 2:11
18 6:09 8:02 4:20 8:52 4:13 11:05 21:06 13:49 10:17 2:22 4:04
19 6:18 6:56 2:35 6:49 3:43 16:15 22:08 17:50 6:35 3:13 1:49
20 6:31 11:30 3:01 8:52 5:12 18:20 16:59 14:59 8:30 2:55 2:01
21 6:52 12:00 7:53 10:23 6:26 5:59 28:39 10:05 9:49 2:43 4:52
22 7:14 14:35 5:20 9:29 3:45 13:08 21:43 16:08 11:29 1:32 1:19
23 7:31 13:49 8:12 12:05 6:32 12:19 22:05 9:17 5:52 2:30 5:22
24 7:40 9:30 6:14 7:15 6:02 15:32 26:07 12:52 9:01 3:00 3:45

25 8:02 13:10 4:59 13:42 4:34 14:43 29:56 13:69 6:08 2:17 1:51
Appendix G: Data recorded on OPD

o l of
time
1 3:08 6:02 3:05 11:25 10:23 18:52 26:05 26:01 4:02 3:17 2:17
2 3:10 9:09 4:43 19:01 9:19 22:19 30:15 17:02 5:52 4:18 1:11
3 4:16 9:20 5:02 18:52 15:13 24:05 21:06 15:17 10:49 3:22 1:04
4 4:25 22:35 6:56 16:49 14:43 16:15 29:08 21:35 7:50 3:13 2:49
5 4:32 12:01 5:30 28:52 15:12 18:20 26:09 10:30 14:59 5:55 2:01
6 4:40 11:53 6:08 20:23 28:26 25:59 18:07 15:04 4:05 3:43 3:52
7 4:58 15:20 9:35 19:29 13:45 14:30 26:04 12:29 10:08 3:32 1:19
8 5:10 18:12 3:49 12:05 26:32 14:49 27:05 10:52 11:17 5:30 1:22
9 5:19 6:14 8:30 7:15 18:02 15:32 26:07 19:01 12:52 3:00 1:45
10 5:26 10:59 3:05 13:42 14:34 24:43 19:09 16:08 3:19 4:17 2:51
11 5:34 11:05 4:53 14:25 28:10 18:52 28:05 14:03 12:36 3:05 1:11
12 5:39 19:43 7:59 18:17 15:30 20:39 22:16 16:51 10:40 4:11 1:52
13 5:43 17:30 7:36 16:32 25:12 21:25 39:08 15:11 12:56 5:59 0:59
14 5:50 12:28 6:50 19:41 23:08 19:53 28:02 18:18 4:33 3:09 2:49
15 6:13 7:29 4:15 15:19 16:50 16:49 20:06 15:20 5:35 4:17 2:40
16 6:33 8:05 4:15 10:20 16:50 19:20 26:23 16:10 6:21 4:54 2:00
17 6:51 20:04 7:01 22:04 17:34 23:09 20:34 14:32 9:08 6:05 3:09
18 7:18 15:01 3:40 17:08 08:35 17:29 32:54 16:11 8:28 3:27 3:04
19 7:37 08:07 4:02 7:03 14:43 22:16 19:56 14:01 7:01 2:09 2:48
20 7:51 17:20 5:23 13:50 16:22 24:44 24:35 15:47 5:03 3:01 2:51

Appendix H: Data recorded on OPD

No Arrival Triage(min) Card room Examination Laboratory Pharmacy
of room
patients Waitin Servic Waitin Servic Waiting Servic Waiting Service Waiting Service
time g time e time g time e time time e time time time time time
1 3:05 7:02 3:05 11:25 8:20 20:52 19:15 16:10 5:20 4:07 3:17
2 3:20 10:09 3:40 19:01 9:19 19:49 27:51 22:20 6:52 3:10 2:10
3 3:45 9:03 6:12 18:52 17:18 28:38 31:46 12:18 08:49 5:12 2:08
4 3:50 12:35 7:05 16:49 15:13 17:34 19:18 29:05 08:20 4:13 3:40
5 4:03 19:01 8:30 28:52 13:12 18:23 26:18 20:30 10:59 6:43 1:10
6 4:20 11:53 10:08 20:23 28:26 25:59 28:27 16:40 8:05 5:34 2:25
7 4:28 17:20 9:30 19:29 13:05 13:08 16:14 12:19 20:08 4:23 4:29
8 4:40 8:12 5:14 12:05 16:15 12:19 37:45 20:22 10:17 5:03 2:22
9 4:55 16:14 13:10 7:15 17:52 15:32 16:39 09:01 06:52 3:00 1:45
10 5:06 13:59 3:07 13:42 14:45 24:43 29:58 06:08 9:19 2:07 2:51
11 5:02 14:05 4:53 14:25 18:18 18:52 28:35 15:30 11:06 3:50 3:11
12 5:15 13:43 7:50 18:17 25:30 20:39 32:06 12:51 12:04 5:58 1:52
13 5:25 17:30 7:36 16:32 28:42 21:25 29:29 14:18 13:56 6:19 1:09
14 5:37 22:28 6:50 29:41 23:16 19:53 18:22 19:28 5:33 4:09 2:49
15 5:46 17:29 4:15 15:19 16:50 16:49 30:19 13:30 5:35 5:50 1:08

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HAWASSA UNIVERSITY

TEMESGEN GETA…… …..……………... 0972//11

Advisor: Mr. Bahredin A.

Name Id .......................................... Signature

1.Anteneh Wondimu ...................... 0153/11

2. Temsgen Geta ............................. 0972/11

Advisor Name Signature Date

Name Signature Date

Name Signature Date

By: Anteneh w. and Temesgen G. Page II

By: Anteneh w. and Temesgen G. Page III

By: Anteneh w. and Temesgen G. Page IV

By: Anteneh w. and Temesgen G. Page V

3.2 Queue System model formulation ..................................................................................................... 23

By: Anteneh w. and Temesgen G. Page VI

By: Anteneh w. and Temesgen G. Page VII

By: Anteneh w. and Temesgen G. Page VIII

HRH- Hawassa Referral Hospital

OPD-Out Patient Department

By: Anteneh w. and Temesgen G. Page IX

By: Anteneh w. and Temesgen G. Page 1

By: Anteneh w. and Temesgen G. Page 2

1.2 Problem Statement

By: Anteneh w. and Temesgen G. Page 3

1.3 Research question

1.4.2 Specific Objective

1.5 Scope of the study

By: Anteneh w. and Temesgen G. Page 4

1.6 Significance of the study

1.7 Limitation of the study

By: Anteneh w. and Temesgen G. Page 5

By: Anteneh w. and Temesgen G. Page 6

3. Failure to Meet Specific Expectations: Through offering product descriptions, showing

2.2. Quality in HealthCare‘s

By: Anteneh w. and Temesgen G. Page 7

By: Anteneh w. and Temesgen G. Page 8

2.3.1 Classification of Queuing System

2.3.2 Types of Queuing models with their characteristics

The Poisson-Exponential, Single Server-Infinite population model (M/M/1: ∞/FCFS) is a queuing

By: Anteneh w. and Temesgen G. Page 9

2 Poisson-Exponential, Single Server-Finite population Model (M/M/1: N/FCFS)

The Poisson-Exponential, Single Server-Finite population model (M/M/1: N/FCFS) is a queuing

By: Anteneh w. and Temesgen G. Page 10

3 Poisson-Exponential, Multiple Server-Infinite population models (M/M/S: ∞/FCFS)

Poisson-Exponential Multiple Server-Infinite population models (M/M/S: ∞/FCFS) is a queuing

By: Anteneh w. and Temesgen G. Page 11

By: Anteneh w. and Temesgen G. Page 12

4. Poisson-Exponential, Multiple Server-Finite population model (M/M/S: N/FCFS)

By: Anteneh w. and Temesgen G. Page 13

5 The Poisson Exponential Single Server Infinite Population Model of (M/G/1)

6 The Poisson Exponential Single Server Infinite Population Model of (M/D/1)

By: Anteneh w. and Temesgen G. Page 14

7 The Poisson Exponential Single Server Infinite Population Model (D/D/1)

8The M/Ek/1 queuing model

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2.5 POM-QM software queue analysis application

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