1

FACTORS AFFECTING THE SCHEDULING OF PATIENT APPOINTMENTS AT

MATHARI NATIONAL HOSPITAL, NAIROBI, KENYA

Ong'era Vivian Ongera

BHRIM/2021/95784

(Bachelor of Science in Health Records and Information Management)

School of Clinical Medicine

Department of Health Records and Information Management

A research proposal submitted in partial fulfillment of the requirements for the award of the

degree of science in Health Records and Information Management in the School of Public Health

of Mt. Kenya University.

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DECLARATION
This proposal is my original work and has not been presented for a degree in any other

University.

Signature: ……….

Date: ……….

CERTIFICATION
This proposal has been submitted for review with our approval as university supervisors.

Signature: ………. Date: ……… Name: ………… Department: ……….

Signature: ……… Date: ………. Name: ………… Department: ………

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ABBREVIATIONS AND ACRONYMS

IT - Information Technology

HIS - Health Information System

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DEFINITION OF TERMS
Appointment Scheduling - The process of booking and managing patient appointments in a
healthcare facility.

Missed Appointments - Booked appointments that patients fail to attend without notice.

Overbooking - Scheduling more appointment slots than available capacity to account for no-
shows.
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ACKNOWLEDGMENT
First and foremost, I would like to express my sincere gratitude to the Almighty God for the gift
of life, strength, knowledge, and ability to undertake this research study. I wish to acknowledge
my supervisor, Hillary Mutugi Muthii, for his immense support, guidance, and feedback
throughout the research process. His wisdom, patience, and commitment were invaluable in
developing the proposal. I could not have wished for a better mentor.

I am greatly indebted to the management of Mathari National Teaching and Referral Hospital for
permitting me to conduct the study at their facility. Special thanks go to the outpatient
department staff and administrators who provided important insights during the proposal
research.

I am also deeply grateful to the School of Public Health fraternity including lecturers, librarians,
and my classmates for contributing to my academic and professional growth. The progressive
learning environment nurtured my research skills and prepared me for this proposal
development. Thanks to my family and friends for their incredible support, prayers, and
encouraging words throughout the demanding research process. You kept me focused on the
goal.

Finally, I acknowledge the financial assistance from my family towards my tuition fees, this
enabled me to undertake the degree study and work on this proposal. I am truly honored by your
investment in my academic journey.

God bless you all.

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Table of Contents

DECLARATION.......................................................................................................................................2
CERTIFICATION.....................................................................................................................................2
ABBREVIATIONS AND ACRONYMS...................................................................................................3
DEFINITION OF TERMS........................................................................................................................4
ACKNOWLEDGMENT...........................................................................................................................5
Table of Contents.........................................................................................................................................6
LIST OF TABLES AND FIGURES.........................................................................................................8
ABSTRACT...............................................................................................................................................9
CHAPTER 1: INTRODUCTION...........................................................................................................10
1.1 Background to the Study...............................................................................................................10
1.2 Statement of the Problem..............................................................................................................11
1.3 Justification....................................................................................................................................12
1.4 Objectives.......................................................................................................................................12
1.5 Research Questions........................................................................................................................13
1.6 Significance....................................................................................................................................13
1.7 Delimitations..................................................................................................................................13
1.8 Limitations.....................................................................................................................................14
1.9 Assumptions...................................................................................................................................14
1.10 Conceptual Framework...............................................................................................................14
CHAPTER 2: LITERATURE REVIEW...............................................................................................15
2.1 Introduction...................................................................................................................................15
2.2 Appointment Scheduling Procedures...........................................................................................15
2.3 Causes of Failed Appointments.....................................................................................................16
2.4 Challenges in Appointment Scheduling.......................................................................................16
2.5 Strategies for Improving Appointment Scheduling.....................................................................17
2.6 Summary........................................................................................................................................17
CHAPTER 3: METHODOLOGY..........................................................................................................18
3.1 Research Design.............................................................................................................................18
3.2 Study Location...............................................................................................................................18
3.3 Study Population............................................................................................................................18
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3.4 Sampling Technique......................................................................................................................19

3.4.1 Patients....................................................................................................................................19
3.4.2 Departmental Heads...............................................................................................................19
3.5 Sample Size....................................................................................................................................19
3.5.1 Patients....................................................................................................................................19
3.5.2 Departmental Heads and Administrators.................................................................................20
3.6 Data Collection Tools.....................................................................................................................20
3.6.1 Questionnaires.........................................................................................................................20
3.6.2 Key Informant Interview Guide............................................................................................21
3.7 Validity and Reliability..................................................................................................................21
3.7.1 Validity.....................................................................................................................................21
3.7.2 Reliability................................................................................................................................21
3.8 Data Collection Procedure............................................................................................................21
3.9 Data Analysis..................................................................................................................................22
3.10 Ethical Considerations................................................................................................................22
APPENDICES...............................................................................................................................................24
I. Questionnaire.........................................................................................................................................24
II. Interview guide......................................................................................................................................25
III. Budget..................................................................................................................................................25
IV. Work plan Proposal development and submission...............................................................................26
V. Map.......................................................................................................................................................27
REFERENCES..............................................................................................................................................28
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LIST OF TABLES AND FIGURES

Table 3.1 Conceptual framework

Table 3.2 Budget

Figure 1.1 Map

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ABSTRACT
Appointment scheduling is a crucial component of quality service delivery and operations in
healthcare facilities. However, many public hospitals in Kenya continue facing challenges related
to missed appointments, long waiting times, and overall patient dissatisfaction. At Mathari
National Teaching and Referral Hospital, complaints persist about failed appointments, delays,
unclear booking protocols, and poor coordination despite investments in scheduling systems.
This indicates underlying deficiencies in the appointment scheduling procedures and systems at
the hospital that need evaluation. This study aims to assess the factors affecting the scheduling of
patients' appointments at Mathari National Hospital in Nairobi, Kenya. Adopting a mixed
methods approach, the study will utilize a descriptive cross-sectional survey with a sample of
384 outpatients selected through systematic random sampling. Quantitative data will be collected
using questionnaires. Qualitative data will be obtained from key informant interviews with 15
departmental heads and administrators purposively sampled. Quantitative data will be analyzed
using descriptive statistics including frequencies, percentages, means, and standard deviations.
Qualitative data will undergo thematic analysis. The findings will provide insights into
deficiencies within the appointment system at Mathari Hospital. Recommendations will inform
scheduling reforms to reduce failed appointments, waiting times, and backlogs, and improve
coordination across departments and overall service delivery. The study will benefit patients
through enhanced access to specialized care at the premier mental health facility in Kenya.
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CHAPTER 1: INTRODUCTION
This chapter provides background information and an overview of the research study. It
introduces the study's focus on evaluating appointment scheduling at Mathari National Teaching
and Referral Hospital in Kenya. The chapter highlights persistent challenges the hospital faces
including increased failed appointments, long patient waits, and coordination issues between
departments. These deficiencies point to gaps in Mathari Hospital's appointment system that
require further investigation.

The chapter states the research problem, which is to assess the factors affecting patient
appointment scheduling at Mathari Hospital. It justifies the need for the study given the lack of
prior in-depth analyses of Mathari's specific scheduling context. The study's objectives are
outlined, which are to examine the booking procedures, causes of failed appointments,
coordination challenges, and potential improvements. Four corresponding research questions are
presented.

Additionally, it also covers the study's significance, delimitations to outpatients, and limitations
including response bias. Key assumptions are noted. Overall, the chapter effectively introduces
the research focus, rationale, aims, and parameters as a foundation for the ensuing study. It
provides helpful background and context for readers on the research gaps this study seeks to
address regarding appointment scheduling at Mathari Hospital in Kenya.

1.1 Background to the Study

Appointment scheduling is an essential process in healthcare facilities that enables efficient
patient flow and service delivery. Effective scheduling systems allow patients to access medical
services on a planned basis and reduce congestion and long waiting times in hospital. Healthcare
providers rely on appointments to manage their patient loads throughout the day or week.

In Kenya, public hospitals have relatively high patient volumes that require robust appointment
scheduling to streamline operations. However, studies indicate that many public facilities still
face significant challenges in their appointment scheduling processes, leading to failed bookings,
long queues, overbooking of slots, and patient dissatisfaction.

Mathari National Teaching and Referral Hospital provides specialized mental health services and
training for patients across Kenya (Kumar et al., 2022). The hospital serves over 700 outpatients
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daily across specialized clinics including psychiatry, psychology, occupational therapy, and
pediatric neurology.

Despite efforts to optimize scheduling through hospital information systems, the hospital
continues facing appointment challenges like increased failed appointments, long patient waiting
times exceeding 4 hours in some cases, miscommunication between departments, and overall
patient dissatisfaction. This indicates gaps in the appointment scheduling system that need
evaluation.

This study aims to assess the factors affecting appointment scheduling at Mathari Hospital
including booking procedures, causes of failed appointments, scheduling challenges, and
potential improvement strategies (Stern et al., 2021). The findings will help formulate
recommendations to enhance the hospital's appointment scheduling system and service delivery.

1.2 Statement of the Problem

Ineffective appointment scheduling systems are a major challenge for healthcare facilities
worldwide. Studies show missed appointments and long wait times are prevalent issues in
hospitals globally, ranging from 10-30% no-show rates and average waits of over 1 hour in many
countries. In Africa, outpatient appointment challenges are aggravated by staff shortages,
infrastructure limitations, and patient behavior factors across public hospitals.

In Kenya, congestion and delays due to poor appointment scheduling continue hindering service
delivery and patient satisfaction nationally. A study across 10 county hospitals found average
waiting times of over 3 hours and failed appointment rates up to 22%. Deficiencies in booking
procedures, clinic management, patient communication and IT systems contribute to these
appointment failures.

At Mathari National Teaching and Referral Hospital, which provides critical mental healthcare,
the appointment scheduling challenges mirror national trends but require focused study. Mathari
Hospital serves over 700 outpatients daily across psychiatry, psychology and other key clinics.
However, the hospital has experienced increased failed appointments from 15% to 25% monthly
between 2018-2020 alongside longer average waiting times rising from 2 to 4 hours.
Additionally, overbooking, coordination issues between departments, and low patient satisfaction
plague Mathari's appointment system.
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1.3 Justification
Prior studies have examined appointment scheduling systems in Kenyan hospitals broadly.
However, few have focused on the specific factors influencing scheduling at Mathari Hospital.
This study will provide an in-depth investigation into the booking procedures, causes of failed
appointments, coordination challenges, and potential improvement strategies based on the
hospital's unique context.

The findings will help hospital administrators and department heads design targeted interventions
to solve the appointment scheduling inefficiencies. Enhancing the scheduling system will
improve departmental coordination, reduce patient waiting times, decrease failed appointments,
and promote optimal resource utilization and service delivery at Mathari Hospital. Consequently,
the scheduling deficiencies that lower patient satisfaction with the hospital will be addressed.
Therefore, an in-depth assessment of the appointment scheduling factors at Mathari Hospital is
justified to inform reforms that will improve efficiency and health outcomes. The study will also
add to existing literature on managing hospital appointment systems in low-resource settings.

1.4 Objectives
The general Objective is to assess the factors affecting the scheduling of patients' appointments
at Mathari National Hospital.

Specific Objectives

1. To determine the specific booking procedures used to schedule patient appointments at

Mathari Hospital.

2. To assess the effect of resources availability on patient appointments at Mathari Hospital.

3. To examine the effects of patient factors on appointments at Mathari Hospital.

4. To determine the effect of communication on appointment scheduling at Mathari Hospital.

1.5 Research Questions

1. What booking procedures are used when scheduling patient appointments at Mathari

Hospital?

2. What is the effect of resources availability on patient appointments at Mathari Hospital?

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3. what is the effect of patient factors on patient appointments at Mathari Hospital?

4. What is the effect of communication on patient appointments at Mathari Hospital?

1.6 Significance
The findings will reveal deficiencies in the appointment scheduling system at Mathari Hospital
based on procedures, failed bookings, coordination, and proposed solutions. The hospital
management can use these to reform scheduling and coordination mechanisms between the
outpatient department, medical records, laboratories, and pharmacies.

Effective scheduling will help reduce patient waiting times, missed appointments, and
departmental backlogs. Consequently, the quality and efficiency of services offered at Mathari
Hospital will improve. Patients also benefit from enhanced access to specialized care at the
facility.

The recommendations can be adapted by other public hospitals in Kenya experiencing similar
appointment scheduling challenges. The study also contributes empirical knowledge on
optimizing hospital appointment systems in limited-resource settings.

1.7 Delimitations
The study will focus on the outpatient department at Mathari National Hospital. It will involve
patients attending outpatient clinics only. The inpatient wards and other units like radiology and
physiotherapy will be excluded.

1.8 Limitations
The collection of data using questionnaires and interviews may introduce response bias from
participants. The tools will be validated through piloting and expert review to minimize this.
Recall bias is another potential limitation where respondents may not accurately remember past
experiences.

1.9 Assumptions
The respondents are assumed to provide honest and accurate responses regarding their
experiences and perceptions of the appointment scheduling system. It is also assumed that the
sample will adequately represent the target population.
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1.10 Conceptual Framework

Independent Variables Dependent Variable

Availability of resources
 Healthcare professional
 Technological infrastructure

Appointment system
effectiveness
Patient factors  Waiting time
 Appointments adherence
 Patients’ preferences  Patient satisfaction
 Transport challenges
 Socio-economic factors

Communication 
 Breakdown
 Lack of coordination between
department
 Limited patient access to
information
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CHAPTER 2: LITERATURE REVIEW

2.1 Introduction
This chapter provides an in-depth review of existing literature on various aspects of appointment

scheduling in healthcare settings. The section critically analyzes previous studies on booking

procedures, causes of failed appointments, scheduling challenges, and potential improvement

strategies. The review provides context and background on the appointment scheduling factors

being investigated at Mathari Hospital.

2.2 Appointment Scheduling Procedures

Appointment scheduling procedures refer to the booking systems and protocols used to allocate
time slots to patients in a healthcare facility. According to research, the scheduling process
involves determining appointment intervals, managing patient demand and provider capacity,
and coordinating appointments between patients and medical personnel.

Several appointment scheduling methods and models have been developed and implemented in
various healthcare contexts. Some common methods include fixed interval scheduling models
where patients are booked at standardized hourly or half-hourly slots due to the approach's
simplicity (Gupta, & Denton, 2008). For instance, a clinic may schedule all patients at every 1
hour from 8 AM to 5 PM daily. However, fixed scheduling is associated with limitations like idle
provider time and patient backlogs when appointments take less time than allotted.

Other more advanced scheduling models include the Bailey-Welch rule which aims to reduce
provider idle time by scheduling successive appointments based on expected service duration.
The rule matches projected service times to booking intervals to optimize schedules. Additional
models like open access and advanced access scheduling have also emerged to improve
flexibility and access by adjusting availability based on fluctuating patient demand.

In the Kenyan context, studies have found that public hospitals still rely heavily on fixed interval
scheduling models due to their straightforwardness. However, efforts are being made to enhance
flexibility and responsiveness using hospital information systems for certain facilities. More
research is still needed on utilizing optimized scheduling models in Kenya's public hospitals.
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2.3 Causes of Failed Appointments

Failed appointments refer to booked appointment slots in which a patient fails to show up or
cancels with inadequate notice. High volumes of failed or missed appointments disrupt schedules
and lower health facility efficiency and revenue.

Existing studies have cited forgetting appointments as one of the primary causes of failures,
resulting from inadequate reminders to patients. Patients get distracted from honoring scheduled
bookings when they do not receive effective reminders prior (Etikan et al., 2016). Appointment
times clashing or conflicting with other personal commitments also frequently lead to last-minute
cancellations or no-shows.

Lack of adequate transport or high transport costs may also hinder patients from showing up,
particularly in low-income regions. Additionally, patients' perceived improvement in health
status and feeling better often reduces their motivation to follow up, causing missed bookings.
Negative experiences during prior visits further lower intentions to return, contributing to
failures.

2.4 Challenges in Appointment Scheduling

Ineffective scheduling systems and processes often create bottlenecks and inefficiencies that
lower service delivery quality in health facilities. Some common challenges cited in the literature
include long patient waiting times, congestion, and high provider idle times from suboptimal
planning.

Studies also indicate that miscommunication and lack of coordination between different hospital
departments undermines integrated scheduling across facilities. For instance, poor coordination
between laboratories and clinics leads to delays in testing that disrupt appointment workflows.

Moreover, scheduling systems that rely on inaccurate demand forecasting and suboptimal
booking rules often result in overbooking or underutilization of capacity. Understaffing and
improper scheduling protocols exacerbated by a lack of staff training further hampers scheduling
efficiency.

In the Kenyan context, several studies have attributed appointment scheduling deficiencies in
public hospitals to continued reliance on paper-based systems, understaffing, and lack of
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integrated health information systems. Technological barriers including resistance to adopting

new electronic booking systems have also slowed scheduling improvements.

2.5 Strategies for Improving Appointment Scheduling

Existing literature proposes several potentially useful strategies to enhance appointment
scheduling in health facilities. A key recommendation involves developing and implementing
optimized booking rules and protocols to align patient demand with provider capacity. Using
scheduling models like Bailey-Welch rules can minimize idle times.

Automating the scheduling process using electronic health information systems has also been
cited as crucial for promoting efficiency. Integrated health IT systems reduce paperwork, manual
errors, and delays associated with paper records and provide real-time data to optimize booking
(Anand et al., 2019). Investing in scheduling module upgrades and infrastructure is vital.
Providing pre-appointment reminders through SMS, calls and letters has been found effective in
decreasing failed appointment rates. Staff training on scheduling protocols and technologies
similarly bolsters booking success. Audits help assess gaps.

Furthermore, integrating scheduling across hospital departments through shared health IT

systems enables coordination and continuity of care. Patient-centered approaches like self-
scheduling models where clients book their own appointments grant convenience and
engagement (Anand et al., 2019).

Continually monitoring scheduling performance data enables the identification of bottlenecks

while user feedback fosters improvement. Evidence-based scheduling protocols and policies also
optimize bookings.

2.6 Summary
This chapter has provided an extensive review of existing literature on appointment scheduling
factors including procedures, failures, challenges, and solutions. Key gaps identified include
limited context-specific studies on drivers of scheduling effectiveness in Kenya's public
hospitals. This study aims to address this gap by investigating the predictors of successful
booking at Mathari Hospital. The next chapter outlines the methodology adopted for the study.
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CHAPTER 3: METHODOLOGY
3.1 Research Design
This study will adopt a descriptive cross-sectional study design that allows the researcher to
describe the phenomena in its nature but does not draw inferences. According to Kothari (2004),
research design refers to the out-line that enables the researcher to smoothly carry out the
difference research operations. It therefore lead to effective production of maximum data with
minimum expenses in terms of time and finances. Bryman and Bell (2017) affirmed that
descriptive study design strive to gather data that describe the existing phenomenon through
questions relating to attitudes and perceptions of the individuals concerned.

It involves collecting data that describes the happenings and later on categorization, tabulation,
presentation and then description of the information. Since the study is to determine the
influence of health records on the quality of health services delivery in Embu County, descriptive
study design was the most appropriate for this study.

3.2 Study Location

The study will be carried out at the outpatient department clinics in Mathari National Teaching
and Referral Hospital in Nairobi, Kenya. Mathari Hospital is the premier public mental health
facility in Kenya and faces ongoing appointment scheduling challenges that need investigation.
The hospital's outpatient department provides diverse specialized care in psychiatry, psychology,
occupational therapy, neurology, and other mental health disciplines.

3.3 Study Population

The study population will comprise two main categories:

1. Outpatients attending mental health clinics at the Mathari Hospital outpatient department. An
estimated 400 patients visit the outpatient facility daily (Mathari Hospital, 2018). This group
experiences the appointment scheduling procedures firsthand.
2. The health records and information department personnel responsible for coordinating
appointment scheduling across departments at the hospital. The departmental heads will also
be included in the study. There are 8 key departmental heads and hospital administrators
directly engaged in scheduling as per the hospital's organization chart.
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3.4 Sampling Technique

3.4.1 Patients
A systematic random sampling technique will be utilized to select patient respondents from the
daily appointment registers and attendance sheets at the outpatient department clinics. Systematic
random sampling allows the selection of subjects at regular predetermined intervals to ensure an
equal probability of inclusion for all population units (Kihuba et al., 2004). Based on the sample
size determined, every 3rd patient will be picked from the registers.

3.4.2 Departmental Heads

Purposive sampling will be applied to recruit health records and information officers and the
departmental heads in the study. Purposive techniques enable the deliberate selection of
participants with desired characteristics and roles pertinent to the study subject (Etikan et al.,
2016).

3.5 Sample Size

3.5.1 Patients
The sample size for patients will be determined using the Yamane (1967) formula:

n = N/(1+N(e)2)

Where:

n = Sample size

N = Study population

e = Precision level

With a population of approximately 400 daily outpatients and a precision of , the sample size is:

n = 400/ (1+400(0.03)2)

n = 294

Therefore, the patient sample will comprise 294 individuals selected through systematic random

sampling from the daily appointment registers.

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3.5.2 Departmental Heads and Administrators

Purposive sampling will be used to recruit 8 departmental managers and hospital administrators
involved in appointment scheduling at Mathari Hospital. This is an appropriate saturation point
for qualitative data.

3.6 Data Collection Tools

3.6.1 Questionnaires
The use of a structured questionnaire with closed-ended and open-ended questions aligns well
with the objectives of the study. Here's how the questionnaire approach addresses each specific
objective:

1. To determine the specific booking procedures used to schedule patient appointments at

Mathari Hospital:

- The questionnaire can include questions about the booking procedures patients experience
when scheduling appointments, allowing for the identification of the specific processes used.

2. To identify the factors leading to failed patient appointments at Mathari Hospital:

- Open-ended questions can gather patients' perspectives on the causes of failed appointments
from their point of view, providing insights into the contributing factors.

3. To examine the coordination challenges between different departments involved in

appointment scheduling at Mathari Hospital:

- While the questionnaire may not directly address interdepartmental coordination challenges,
patients' experiences and perceptions of the appointment scheduling process could reveal
potential coordination issues.

4. To establish the causes of long patient waiting times when scheduling appointments at Mathari
Hospital:

- Questions about perceived challenges and open-ended feedback from patients can shed light
on factors contributing to long waiting times during the appointment scheduling process.

5. To identify strategies to reduce failed appointments when scheduling patients at Mathari

Hospital:
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- Open-ended questions can gather patients' recommendations and suggestions for improving
the appointment scheduling process, potentially providing insights into strategies to reduce failed
appointments (Jensen & Laurie, 2016).

3.6.2 Key Informant Interview Guide

A semi-structured key informant interview guide will be used for qualitative data collection from
the departmental heads and hospital administrators. The guide will include broad questions to
facilitate an in-depth exploration of the appointment scheduling process, coordination between
departments, causes of failed bookings, and potential strategies for improvement at the hospital
from the departmental perspective.

3.7 Validity and Reliability

3.7.1 Validity
Content validity will be established by having the data collection tools reviewed by three experts
in health systems research to evaluate their ability to measure the variables under study.
Construct validity will be assessed through pilot testing of the tools on 10% of the sample
population to identify ambiguities in the questions before data collection. This will establish face
validity showing that the tools measure the intended constructs.

3.7.2 Reliability
Test-retest methods will evaluate the reliability of the tools where they will be administered

twice to the pilot sample. Pearson correlation values above 0.7 will indicate acceptable

reliability. For the qualitative tool, two researchers will independently code the pilot data and

compare their coding for consistency to ascertain inter-rater reliability.

3.8 Data Collection Procedure

There are several ways in which the questionnaire can be distributed to the selected participants:

 In-person administration: The research team can approach patients at the hospital
premises, such as in waiting areas or after their appointments, and request them to
complete the questionnaire on the spot. This method allows for immediate data collection
and ensures a higher response rate, as the researchers can explain the purpose of the study
and address any queries from the participants.
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 Self-administered paper-based questionnaires: Printed copies of the questionnaire can be

distributed to patients during their visits or appointments. Patients can then complete the
questionnaire at their convenience and return it to designated collection points or to the
research team during their next visit.
 Online or electronic questionnaires: The questionnaire can be converted into an electronic
format and distributed through email or a web-based platform. Patients can access the
questionnaire online using a provided link or QR code and submit their responses
electronically.
 Telephone or virtual interviews: For patients who may have difficulty completing the
questionnaire in person or online, the research team can conduct telephone or virtual
interviews, where they can read out the questions and record the responses directly.

Quantitative data will be gathered through self-administered questionnaires distributed to

patient participants at the outpatient department clinic reception and waiting areas after their
appointments. Qualitative data will be collected through face-to-face key informant
interviews with departmental heads and administrators guided by the interview tool.
Interviews will be conducted in their offices at suitable pre-scheduled times.

3.9 Data Analysis

Quantitative data will be coded and analyzed using Statistical Package for Social Sciences
(SPSS) version 26.0. Descriptive statistics such as frequencies, percentages, means, and standard
deviations will be generated.

Qualitative data will undergo thematic analysis where responses are grouped into major themes.
Relevant quotes will also be identified. Data will be triangulated to reconcile the quantitative and
qualitative findings.

3.10 Ethical Considerations

Approvals will be obtained from the Mathari Hospital administration and Kenyatta University
ethics review committee before study commencement. Informed written consent will be obtained
from all participants after explaining the study's aims, risks, and benefits (Drewek, Mirea, &
Adelson, 2017). They will also be informed of their voluntary participation and freedom to
withdraw from the study at will without consequences. Confidentiality will be ensured by
 23

excluding personal identifiers during data collection, storage, and publication. The collected data
will also be safely stored in password-protected devices and encrypted platforms.
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APPENDICES
I. Questionnaire
Section 1: Demographic Information

Gender:

a) Male

b) Female

Age (years): a) 18-25 b) 26-35 c) 36-45 d) 46-55 e) 56+

Section 2: Appointment Scheduling Experiences

How do you book appointments at this facility?

a) Phone b) Walk-in c) Online system d) Other (specify)

How often do you miss scheduled appointments?

a) Never b) Rarely c) Sometimes d) Often e) Always

What are the main reasons you miss appointments?

a) Forgot scheduled date b) Transport challenges c) Time clash with other commitments d) Felt

better e) Other (specify)

In your opinion, what are the main challenges with appointment scheduling at this facility?

a) Long waiting times b) Failed appointments c) Few slots d) Unclear booking process e) Other

(specify)
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What do you recommend to improve appointment scheduling at this facility?

a) More booking options e.g. online b) Reminders for appointments c) More booking staff

d)Clearer scheduling protocols e) Other (specify)

II. Interview guide

i. Briefly describe the appointment scheduling process used at this facility.

ii. What booking procedures are used for outpatient department appointments?

iii. What is the average lead time between booking an appointment and the appointment

date?

iv. How many appointment slots are available per clinic per day on average?

v. What is the approximate failed appointment rate for your department? What factors do

you think contribute to this?

vi. What challenges have you experienced with coordination of appointment scheduling

between departments like labs and clinics?

vii. In your opinion, what are the main bottlenecks or issues with the current appointment

scheduling system?

viii. What strategies would you recommend the hospital adopt to improve appointment

scheduling?

ix. Any other comments or thoughts on enhancing appointment scheduling at the facility?

III. Budget
Item Cost (Ksh)

Stationery (papers, pens) 10,000

Printing and photocopying the questionnaire 30,000

Transport for data collection 20,000

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Data analysis software 10,000

Internet data bundles 30,000

Contingency 10,000

Total 110,000

Table 3.2

IV. Work plan Proposal development and submission.

i. Review by supervisors.

ii. Ethical review approval.

iii. Piloting data collection tools.

iv. Revisions from piloting.

v. Data collection.

vi. Data analysis.

vii. Report writing.

viii. Submission of final report/thesis.

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V. Map

Figure 1.1
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Bosch, R., & Rendon, A. (2012). Managing appointment scheduling. Patient flow: Reducing

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Drewek, R., Mirea, L., & Adelson, P. (2017). Lead time reduction utilizing lean tools applied to

healthcare: The inpatient phlebotomy process. The Quality Management Journal, 24(1),

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(2014). Assessing the ability of health information systems in hospitals to support

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