ChikitsaOne: fixing a multi-specialty hospital's OPD, one queue at a time

Our first meeting with ChikitsaOne's medical director was not in a boardroom. She asked us to sit in the orthopaedic OPD waiting area for a morning. Patients arrived at nine for appointments that did not happen until noon. Nobody knew their position in the queue; relatives hovered at the doctor's door asking "how many more?"; staff answered the same question hundreds of times.

Inside the consultation rooms, doctors were writing prescriptions by hand, reading old paper files that patients had to carry, and ordering tests on slips that the lab sometimes could not decipher. The hospital's clinical quality was excellent. Its outpatient experience did not reflect it.

We mapped the patient's path through the OPD: registration, billing, vitals, waiting, consultation, tests, pharmacy and follow-up booking. The biggest discovery was that queues were not really about doctor speed. They were about unpredictable arrivals, walk-ins mixed with appointments with no rules, and patients returning with test reports and joining the back of the line.

We also timed consultations. Doctors spent a surprising share of each consultation searching for previous information — earlier prescriptions, test values, allergies — that was either on paper or in a system that took too many clicks to reach.

We designed the doctor console with one metric in mind: seconds of doctor attention spent on software. The patient summary loads before the patient walks in — allergies, chronic conditions, last prescription, recent results. Prescriptions are built from favourites and recent medicines with dose defaults; a common prescription takes a few taps. Doctors who prefer speaking can dictate notes, which are transcribed into the record for them to review.

We tested the console with doctors from four departments using real (anonymised) cases and a stopwatch. If a change added time, it did not ship.

We included a clinical informatics consultant — a doctor with software experience — to review every clinical workflow alongside the hospital's own department heads.

In healthcare, every design decision is also a safety decision. Each of these was reviewed with the medical director and department heads.

Everything that shipped across patients, reception, doctors and the wider hospital.

We launched in orthopaedics, the busiest OPD and the one where we had started, with our team on the floor for the first two weeks. Reception staff kept a paper fallback for the first days. Time-slotted appointments changed arrivals immediately: patients with a slot came near their slot instead of at nine.

Other departments followed in waves. Each department head chose their own prescription favourites and templates before going live, which did more for doctor adoption than any training session.

Queues are a scheduling problem before they are a software problem. Time-slotted arrivals and clear walk-in rules did more than any display screen.

Measure the doctor's time, not the software's features. Every second saved in the console was a second returned to the patient.