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01.12.2012 | Research article | Ausgabe 1/2012 Open Access

BMC Health Services Research 1/2012

Patient and work flow and costs associated with staff time and facility usage at a comprehensive cancer centre in Quebec, Canada – a time and motion study

BMC Health Services Research > Ausgabe 1/2012
Gayle A Shinder, Pierre Emmanuel Paradis, Marianne Posman, Natalia Mishagina, Marie-Pascale Guay, Dina Linardos, Gerald Batist
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1472-6963-12-370) contains supplementary material, which is available to authorized users.

Competing interests

During this study, Pierre Emmanuel Paradis and Natalia Mishagina were full time employees of Groupe d’analyse ltée, which had a consulting agreement with Gerald Batist to design the study and perform the data analysis.

Authors’ contributions

GS designed the study protocol, supervised the data collection, contributed to the analysis of the data and wrote the manuscript. PEP designed the study protocol, analyzed the data and edited the manuscript. MP collected the data, participated in revisions to the study protocol and reviewed the manuscript. NM analyzed the data and reviewed the manuscript. M-PG and DL participated in the design of the study protocol and data collection and reviewed the manuscript. GB participated in the design of the study protocol, provided patients for the study and wrote the manuscript. All authors read and approved the final manuscript.



Mapping patient and work flow and cost analysis studies can help determine the most efficient and cost effective way of providing health services while still maintaining the best standards of care. This study used both time and motion methodology and hospital data to assess the contribution of staff time and facility usage to the overall cost of cancer care during patient visits to a comprehensive cancer centre in Quebec, using metastatic colorectal cancer as a model.


A workflow diagram was created mapping direct and indirect steps involved during a patient’s physician or treatment (FOLFOX/bevacizumab or XELOX/bevacizumab) visit. Staff were timed as they performed each task and this data together with compensation amounts were used to calculate personnel costs. Mean work times and 95% confidence intervals (CI) were calculated. Operation and maintenance (O&M) costs for the Centre were calculated using information from hospital databases. All costs were presented in constant Canadian dollars for the 2010–2011 fiscal year period.


For physician visits, direct and indirect personnel costs were $9.25 (95%CI:$7.00-$11.51) and O&M costs were $60.21, for a total of $69.46 (95%CI:$67.21-$71.72). For treatment visits, personnel and O&M costs were $71.91 (95%CI:$45.53-$98.29) and $62.00 respectively for a total of $133.91 (95%CI:$107.53-$160.29). When calculated for treatment alone, the total cost was $136.06 (95%CI:$109.16-$162.95) for FOLFOX/bevacizumab and $119.94 (95%CI:$96.89-$142.99) for XELOX/bevacizumab. The highest cumulative personnel costs were for the pharmacists and nurses ($38.87 and $34.82 respectively). Regarding patient flow, total time in between steps was 77.6 and 49.5 minutes for a physician or treatment visit respectively.


This study from a health care provider’s perspective, demonstrated that in the context of increasingly expensive therapies, costs associated with staff time and facility usage do not contribute greatly to the overall cost of treating cancer at this cancer centre. It also illustrated the need for improvements in patient and work flow to reduce wait times in the clinic.
Authors’ original file for figure 1
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