Medical Report Refund Process

Year Submitted: 2026
Published Date:

Tags: Productivity,  Care Process ＆ Redesign,  Quality Improvement,  Workflow Redesign,  Cost Saving,  Turnaround Time,  Access To Care

About this Content

Aims

To streamline and improve the refund process by reducing refund requests, shortening turnaround time (TAT) and simplifying workflows for staff.

Background

The project addresses the long turnaround time (TAT) for medical report refunds, currently averaging 61 days (online) and 88 days (over-the-counter). Delays arise when patients request refunds due to reasons such as reports no longer being needed, incomplete reports, or incorrect payments. The prolonged TAT is mainly caused by delayed responses from requestors and slow approval and processing of refund requests. This issue impacts multiple stakeholders, including patients, third parties, finance teams, Medical Records Office staff, and outpatient clinics. Delays occur across various stages, particularly in email communications and system processes (e.g., ePAS, eBAR) for approval and request submission.

Methods

The project applied Lean / Kaizen improvement methods to reduce refund turnaround time. It started with process mapping (current state analysis) to understand both online and OTC workflows, followed by data analysis (TAT, percentiles, case distribution) to identify delays. A gap analysis using Fishbone (Ishikawa) and 5 Whys was conducted to uncover root causes across system, process, people, and information. Based on this, solutions were prioritised using an Impact vs Effort matrix, then tested through rapid experiments (PDSA cycles) such as FormSG implementation, email routing rules, and staff training. Finally, improvements were standardised and sustained through SOP development, system enhancements, and workflow redesign, achieving a significantly reduced TAT.

Results

The project significantly reduced refund turnaround time from 61-88 days to around 15-16 days, achieving the target of 21 days. Monthly refund cases decreased from 9 to 3 cases, with improved efficiency and reduced workload (0.032 FTE saved). Cost savings of approximately $722 per year were achieved, while process improvements (e.g., FormSG) reduced back-and-forth communication and prevented delays. Overall, patients benefited from faster refunds and a smoother experience.

Conclusion

The project successfully reduced refund turnaround time through process standardisation and simple digital solutions, improving efficiency and patient experience.

Lessons Learnt

Standardising processes and having clear SOPs are critical for efficiency. Early stakeholder engagement (e.g., Finance/1FSS) and continuous communication help drive smoother implementation. Simple digital solutions like FormSG can be effective and easy to adopt. However, challenges include limited stakeholder availability and existing constraints (e.g., cash payment processes). Strong ownership, clear guidance, and change management are key to sustaining improvements.

Keywords

Medical Report, Refund, Process

Innovators' Details

Connect with this contributor!

Ng Kah Lai - ng.kah.lai@nhghealth.com.sg

Project Attachment

Leading Kaizen Course (Nov 2024) - Medical Records Office.pdf