Open Access Open Badges Research article

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

Gayle A Shinder1*, Pierre Emmanuel Paradis23, Marianne Posman4, Natalia Mishagina25, Marie-Pascale Guay4, Dina Linardos4 and Gerald Batist14

Author Affiliations

1 Department of Oncology, McGill University, Gerald Bronfman Centre, 546 Avenue des Pins Ouest, Montreal, Quebec, H2W 1S6, Canada

2 Groupe d'analyse ltée, 1000 de la Gauchetière West, Suite 1200, Montreal, Quebec, H3B 4W5, Canada

3 Current address: AppEco Analytics, 222 Louis-Ducharme, Mont-Saint-Hilaire, Quebec, J3H 6J6, Canada

4 Segal Cancer Centre of the Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Côte Ste-Catherine Road, Montreal, Quebec, H3T 1E2, Canada

5 Current address: CIRANO, 2020 University Street, Room 2520-B, Montreal, Quebec, H3A 2A5, Canada

For all author emails, please log on.

BMC Health Services Research 2012, 12:370  doi:10.1186/1472-6963-12-370

Published: 29 October 2012



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.

Patient flow; Work flow; Time and motion; Cost analysis; Metastatic colorectal cancer; FOLFOX/bevacizumab; XELOX/bevacizumab