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WAITING FOR DOCTOR ZHIVAGO

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HBSP No.: NTU187
Ref No.: ABCC-2018-016
Wang Jianfu and Opher Baron Date: 09 July 2018

It was 2 o’clock in the afternoon. Dr. Zhivago felt exhausted. Her stomach was growling loudly. She just
apologised to another unhappy patient who had lamented about the long waiting time. “I had the

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appointment at 1 o’clock, and I have been waiting here since after lunch. I have to cancel my afternoon
meeting due to this,” Dr. Zhivago heard Mrs. Kim complaining. Laying back in the chair, she wondered why
she was wasting so much time dealing with patients’ complaints about the long waiting time. Why could her
time not be better spent on diagnosis and treatment?

Dr. Zhivago glanced at the waiting room. Three more patients were waiting, but she really needed a short
break. Standing in front of the coffee machine, she saw her regular patient, Mr. Chen, limping into the clinic.
Ms. Celine, the newly hired nurse-receptionist, quickly found Mr. Chen a place to rest and then skilfully
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pulled out his record from a pile of documents on the shelf. Dr. Zhivago felt a bit relieved as she knew she
had found a good replacement for Mr. Tao who had just retired.

The nurse’s job involved helping to fill up a form to describe the patient’s current condition, pulling out the
patient’s medical record from the shelf, and putting these records in sequence so that when Dr. Zhivago
finished seeing a patient, she could pick up the next patient’s record and call the patient in.
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Ms. Celine was a fresh graduate from college and this was her first job. As with many new employees, she
had been performing her tasks with passion and diligence. She always pulled out the medical records for
scheduled patients the evening before their visits. Moreover, her desk was always in perfect order. She
promptly served incoming patients upon their arrival. Her compassion for people also made her a good fit
for the job. “She’s the most efficient nurse I’ve ever seen,” Dr. Zhivago thought.

Before Ms. Celine, Mr. Tao never seemed to be in a rush. “Haste will lead to failure,” he once told Dr.
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Zhivago. He only retrieved the medical records when patients arrived and chatted with them while they
were filling out the registration forms. Sometimes, Dr. Zhivago would wish he could be a bit faster as she
was afraid the patients might lose patience with him. It did not, however, really matter as the time she took
to check patients was longer than the time it took Mr. Tao to register them. Moreover, she did not receive
any complaints about Mr. Tao’s inefficiency. Thus, she did not bother to bring up the issue.

Assistant Professor Wang Jianfu and Professor Opher Baron, Rotman School of Management, University of Toronto
prepared this case based on generalised experience. This case is intended for class discussion and learning, and not
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intended as source research material, or as illustration of effective or ineffective management. The authors may have
disguised certain names and other identifying information to protect confidentiality.
COPYRIGHT © 2018 Nanyang Technological University, Singapore. All rights reserved. No part of this publication may
be copied, stored, transmitted, altered, reproduced or distributed in any form or medium whatsoever without the written
consent of Nanyang Technological University.
The Asian Business Case Centre, Nanyang Business School, Nanyang Technological University, Nanyang Avenue,
Singapore 639798. Phone: +65-6790-4864/6552, E-mail: asiacasecentre@ntu.edu.sg

This document is authorized for educator review use only by Rev. Dr. P. Paulraj SJ, Bharathidasan University until Jul 2022. Copying or posting is an infringement of copyright.
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Overall, Dr. Zhivago was happy with her achievements at the clinic. Since she opened it 10 years ago, she
had built a good reputation as a nice, effective, and proficient doctor. This helped her grow her patient
population significantly. This growth, however, halted a few years ago when she decided not to accept any
new patients due to time constraints. Recently, she noticed that although she still saw about 20 patients
per day, there were more and more complaints about long waiting times.

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Most of the time, patients would make appointments before their visits. Each appointment was scheduled
for 20 minutes. While the majority of patients arrived before or on time, there were still cases of late arrivals.
Latecomers, however, could not be blamed as traffic in the area was pretty unpredictable. This was
compounded by frequent subway delays.

As Ms. Celine had been so efficient, Dr. Zhivago could only attribute the fault to herself and tried her best
to be faster. Yesterday, Ms. Celine showed her a table with the arrival and service times of each patient for
that day. (See Table 1 and in the accompanied Excel file for more details.) Most patients seemed to

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complete their visit to the clinic in less than an hour, as was always the case. Mr. Tao, who recently retired,
had prepared similar data (summarised in Table 2). This data showed a similar duration per visit.

Compared with other doctors, 1 hour was the industry standard. Dr. Zhivago asked Dr. Fan, her friend from
medical school, if he had encountered similar issues. Dr. Fan shared that normally his patients waited for
about 1.5 hours. “Do they complain?” Dr. Zhivago asked. “Of course! Because of this, I installed a 60-inch
TV to give them a distraction besides just waiting there, which didn’t help much.” Dr. Zhivago thought,
“Luckily I didn’t waste money on a TV. The magazines in the waiting room serve the same purpose.”
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So, why were so many of patients complaining about their waiting times since Mr. Tao retired? “These days,
people may not be as patient as in the old days. They may not read newspapers anymore and they cannot
wait an hour without complaining,” Dr. Fan said. “But it cannot be that simple,” Dr. Zhivago reckoned.

Questions:
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1. Why were the waiting times and the patients’ perceptions important in service systems in general and in
doctors’ clinics in particular?

2. Derive (a) the average waiting times for the nurse, (b) the average waiting times for the doctor, and (c)
the average total time per visit in Tables 1 and 2, respectively. What were the differences between the
average waiting time for the nurse and the doctor before and after Mr. Tao had retired?
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3. Imagine yourself as a patient, how would you feel about these two different service processes? Which
process would you prefer?

4. What led to these differences? How did Mr. Tao’s longer service time affect the waiting times? Note that
Mr. Tao sometimes idled even when patients were waiting. How did this affect the waiting times?
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Table 1: Patients Arrival Service and Departure Times by Ms. Celine

Patient # Arrival Time Start Check-in Check-in Ends See Doctor Departure time
1 9:09:49 9:09:49 9:12:46 9:12:46 9:41:22
2 9:15:33 9:15:33 9:24:41 9:41:22 10:13:57

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3 9:39:43 9:39:43 9:46:02 10:13:57 10:24:20
4 9:44:37 9:46:02 9:48:57 10:24:20 10:48:36
5 10:28:59 10:28:59 10:36:17 10:48:36 11:00:06
6 10:39:31 10:39:31 10:48:44 11:00:06 11:29:37
7 10:58:12 10:58:12 11:01:35 11:29:37 11:36:39
8 11:00:10 11:01:35 11:09:50 11:36:39 12:16:15
9 11:43:06 11:43:06 11:45:04 12:16:15 12:35:08

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10 11:47:40 11:47:40 11:52:49 12:35:08 12:38:26
11 12:00:51 12:00:51 12:09:56 12:38:26 13:06:23
12 12:21:08 12:21:08 12:27:00 13:06:23 13:29:29
13 12:45:31 12:45:31 12:46:08 13:29:29 13:32:05
14 13:31:28 13:31:28 13:36:57 13:36:57 14:14:06
15 13:37:32 13:37:32 13:38:06 14:14:06 14:38:02
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16 14:05:20 14:05:20 14:13:26 14:38:02 15:09:39
17 14:16:01 14:16:01 14:19:50 15:09:39 15:11:47
18 14:26:20 14:26:20 14:32:41 15:11:47 15:39:26
19 14:49:55 14:49:55 14:59:13 15:39:26 15:41:51

Avg. time with nurse: 5:34

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Avg. time with doctor: 20:13

Avg. waiting time (for nurse and doctor): 28:12

Source: Authors.
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 Page 4
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Table 2: Patients Arrival Service and Departure Times by Mr. Tao

Patient # Arrival Time Start Check-in Check-in Ends See Doctor Departure time
1 9:08:52 9:08:52 9:22:35 9:22:35 9:47:00
2 9:19:10 9:22:35 9:24:39 9:47:00 10:11:29

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3 9:38:50 9:47:30 9:52:22 10:11:29 10:36:46
4 10:05:35 10:12:05 10:19:55 10:36:46 10:51:17
5 10:18:05 10:36:50 10:48:59 10:51:17 11:06:29
6 10:34:55 10:48:59 10:50:51 11:06:29 11:29:53
7 11:04:41 11:07:03 11:09:43 11:29:53 12:01:50
8 11:11:25 11:16:21 11:24:23 12:01:50 12:11:07
9 11:32:05 11:47:05 11:54:34 12:11:07 12:39:37

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10 11:55:55 12:03:52 12:13:38 12:39:37 12:57:07
11 12:26:45 12:26:45 12:38:43 12:57:07 13:25:54
12 12:35:52 12:50:20 13:00:24 13:25:54 13:51:51
13 13:02:32 13:17:35 13:30:40 13:51:51 13:59:34
14 13:19:27 13:30:40 13:35:40 13:59:34 14:11:10
15 13:24:44 13:40:00 13:52:20 14:11:10 14:20:02
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16 13:59:20 14:09:15 14:14:39 14:20:02 14:56:07
17 14:22:57 14:22:57 14:30:33 14:56:07 15:10:03
18 14:29:45 14:30:33 14:35:53 15:10:03 15:43:14
19 15:09:41 15:11:00 15:28:34 15:43:14 15:51:57

Avg. time with nurse: 8:21

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Avg. time with doctor: 20:30

Avg. waiting time (for nurse and doctor): 27:02

Source: Authors.
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Permissions@hbsp.harvard.edu or 617.783.7860