Rwema Ivan Steve2025-09-112025-09-112025-07-10https://dspace.ughe.org/handle/123456789/956Background Long waiting times in outpatient departments (OPDs) are a persistent challenge in low and middle-income countries, especially in rural settings where staff shortages, poor coordination, and high patient volumes affect care quality. Waiting time refers to the period a patient spends between arriving at a service point and receiving care. Long waits contribute to overcrowding, patient frustration, and delayed treatment. In Rwanda, little is known about the status of waiting time in rural facilities like Butaro Level II Teaching Hospital and the factors associated with long patient waiting time. Objective This study aimed to measure waiting and process times for outpatients at Butaro’s OPD, identify the main causes of delay, and propose simple, practical solutions to improve patient flow. Methods A cross-sectional observation study (time-motion) was conducted over four weeks, tracking 131 patients from arrival to exit from 6:30 AM to 5:00 PM. Observers recorded the time spent at each service station, along with notes on congestion, staffing levels, and operational challenges such as unclear signage or patient confusion. Results Patients spent a median of 264 minutes at the OPD, of which 94% was waiting time. The longest waits were at radiography (118 minutes) and consultation (93 minutes), and the shortest waiting times were observed at the laboratory (17 minutes). Nearly half (48.9%) of patients dropped out after registration, mostly because they were non-OPD patients using the same intake points, which created unnecessary congestion. Afternoon patients spent significantly less time compared to morning patients in the OPD (p = 0.0031), largely because even though services started at 8:00 AM, on average, 29 patients were there before 6:30, and this large crowd before services opened contributed to early morning crowding and naturally longer waiting times. Patient volumes also regularly exceeded the OPD’s consultation capacity of 80 per day. As a result, some patients had to return the next day, creating a daily backlog that built up over the week. Staff-related issues were also common: observers recorded 16 instances of staff stepping away, especially during lunch hours, and several departments started services later than the official opening time. In addition, we observed limited patient navigation support: there was no clear signage, no help desk, and no structured queue system. This led to confusion, patients going to the wrong stations, being overtaken in line, or waiting unnecessarily. Conclusion This study highlights the urgent need to streamline outpatient care in rural hospitals. Key solutions include separating intake at registration for different patient types, numbering chairs to manage queues, scheduling return visits properly, adjusting staff levels to match demand, and improving signage and patient guidance. These low-cost changes can reduce waiting times and improve the care experience in rural health systems.enTeaching HospitalOutpatient departmentsHealthcareRwandatext::thesis