Enhancing the Patient Journey and Reducing Waiting Times in the Referral Process from General Dentist to Speciaist Dental Clinics in the Riyadh Second Health Cluster

Abstract

Abstract Intermittent delays concerning dental referrals remain an ever-present problem in global health systems. These delays can negatively impact patient safety by worsening dental conditions, potentially leading to more complex and costly treatments and increasing the risk of complications. They also affect patients' experiences and the overall systems' performances. Although several strategies have been carried out to solve this problem such as growing the stock of specialists and efficient use of available resources, the problem could not be solved fully. Therefore, it becomes necessary to discuss integrated strategies that can address the demand and supply side as well as system imbalances producing these delays. This systematic literature review aims to obtain patterns of effective evidence-based treatments for streamlining the referral from general dentists to specialized dental units, especially concerning Riyadh Second Health Cluster. The review aims to bring together available evidence about the causes of referral delays, assessment of current interventions, and set up a framework to improve the referral process to minimize waiting time and patient outcomes in Riyadh. Aims The purpose of this report is to explore processes to streamline the patient referral pathway from GP dental clinics to specialist dental clinics. Specifically, it focuses on reducing waiting times and minimizing risks for patients by optimizing the referral process in Riyadh Second Health Cluster.

Research Question: This research seeks to answer the following question: What strategies can streamline the dental referral process, reducing waiting times and minimizing patient risks in Riyadh's Second Health Cluster? Methodology This research adopts a case study method (Yin, 2018) to assess the dental referral process in Riyadh Second Health Cluster, establish the causes of delay, and recommend possible interventions. The research methodology of a systematic literature review based on operations management (Meredith & Shafer, 2019) principles are used to analyze the elements influencing demand, supply, and system factors of referral efficiency. The review also involved the use of sources in databases including PubMed, Web of Science, Scopus, and JSTOR, using keywords and terms including, “dental referral, waiting times, patient journey, healthcare efficiency, and digital pathways.” From this review, the generated conceptual framework shows the relationships between these aspects and their impact on the duration of time that waits for the patients, outcomes, and perceptions. It helps decide on the specific actions aimed at improving the referral process in Riyadh Second Health Cluster based on the specific characteristics of the area. Key Themes Key themes in an analysis of 40 articles revealed the importance of the multifactorial nature of referral delays (demand, supply, systems); the impact of waiting times on patient outcomes, experience, and system efficiency; the effectiveness of demand management, supply optimization,

and system-level improvement strategies; as well as the potential for digital health technologies to enhance efficiency and communication. Theoretical Focus This report follows the structure of patient journey mapping, in conjunction with principles of service design (Stickdorn et al., 2018), where concepts of flowcharting business processes are in line with operations management (Slack, Brandon-Jones & Johnston, 2016). Demographically outlining the patient's journey towards the referred dentist helps in the following aspects: (1) Points to areas of delay and opportunities for improvement from the patient’s perspective; (2) Reveals non-value-added activities or stages; and (3) Provides a guide for the suggested solutions in redesigning the referral process. The present framework draws on insights from MBA Health by considering the patient as a consumer while also considering the processes of operation management. Implications for Practice Prolonging dental referrals disintegrates continuity of the care, complicates the treatment, makes it costly, and most importantly, leads to dissatisfied patients. Healthcare decision-makers and practitioners can use the findings of this review to enhance healthcare referrals, decrease the time clients spend waiting for dental compartments, and increase the quality of timely and appropriate dental care. These include an electronic referral system; referral of patients to specialists; enhancing communication & collaboration among PCPs by establishing clear referral guidelines and protocols, facilitating regular communication channels (e.g., secure messaging, EHRs, case conferences, direct consultations), implementing feedback mechanisms from specialists to general dentists, and promoting continuing education on collaborative care and referral management; purchasing of Health IT; and improving patient self-management regarding oral health. Findings: The literature review indicates that dental referral delays stem from the complex patient journey and healthcare system inefficiencies. These include poor communication between primary care providers and specialists, underutilization of health IT systems, and unnecessary referrals. Recommendation: The integration of digital health technologies, improved resource allocation, and enhanced communication strategies are essential to address these challenges. Additionally, increasing the number of dentists, particularly specialists, and streamlining the referral process through electronic systems and web-based platforms are crucial. Collaboration and integration among healthcare providers and strengthening the health IT framework are also important for an effective referral system. Limitations: This study has several limitations that should be considered when interpreting the findings. First, this study focused specifically on the Riyadh Second Health Cluster, and the findings may need to be more generalizable to other regions or healthcare systems with different organizational structures, resources, and cultural contexts. This limitation potentially restricts the broader applicability of the identified strategies to streamline the dental referral process, as proposed by the research question: "What strategies can be implemented to streamline the dental referral process from GP dental clinics to specialist dental clinics in Riyadh's Second Health Cluster, thereby reducing waiting times and minimizing risks for patients?" Second, since the number of quantifiable records concerning patient satisfaction and definite waiting time within the Riyadh Second Health Cluster is scarce, this work chiefly depends on the literature review and general tendencies as operating qualitative data. It has been an advantage, but it might have influenced the quantitative measurement of the effects of referral delays on the overall patients' satisfaction and safety. The precise measurement of the proposed strategies to the goal achieved according to the research question. Third, there was a broad literature search; therefore, it must be considered that other relevant studies needed to be identified. This may limit the number of strategies and best practices highlighted in improving the dental referral processes highlighted in the research question. Keywords: Dental referrals, waiting times, patient journey, healthcare efficiency, digital health, e-referral, teledentistry, demand management, supply optimization, integrated care, Saudi Arabia, Riyadh Second Health Cluster. Article classification: Research paper: A systematic review of strategies to improve dental referral efficiency.