It was probably around hour five of sitting in an urban Chicago emergency department that I really started to lose my composure.
Saddled with an ailment strong enough to keep me in discomfort, but insignificant enough that every patient being carted in from an ambulance pushed ahead of me, I felt desperate. Tired babies screamed. A homeless man buried his head between his legs. A peeved mother with a sick daughter pleaded for some help at the front desk. With five and a half hours behind me, I figured I should either cut my losses and go get a couple of hours of sleep before work, or pretend to keel over so I could finally receive some care.
Covering some of the hospital industry's best performers the past three years, I was convinced that most in the field had at least started to figure out this whole wait-time conundrum. And yet, even in this new world of consumer-focused, value-based health care, patients are still waiting for hours on end to receive treatment. A new study from the Institute of Medicine, released last week, found that wait times vary dramatically across the health care sector, with patients experiencing a gap of anywhere betweem a few hours to a few months to get an appointment with a doctor.
Such prolonged delays in care can cause myriad negative effects, the report states, such as adverse heath outcomes, poor patient satisfaction and lost organizational reputation. Gary Kaplan, chairman of the committee that produced the report and CEO of Virginia Mason Health System in Washington state, says it's high time that health care looked to other industries that have mastered systems approaches — such as manufacturing and hospitality — to deliver care when and where patients want it.
"We really are not doing all of the things we need to be doing to truly have a patient-centered health care system that is providing the kind of timely access necessary for patients," Kaplan says.
"This isn't rocket science, but it does require us to be willing to use these systems-engineering principles to understand supply and demand, and then design our systems to have adequate capacity for true demand of services," he adds.
The causes for such delays at hospitals are numerous, according to the report. They range from outmatched supply and demand, to a provider-focused approach to scheduling, outmoded workforce and care supply models, priority-based queuing, and the general complexity of both care and reimbursement, just to name a few. In my own case, the hospital's urgent care options are in the works, but not yet open. They offered an app allowing patients to check in and wait at home for an emergency provider and, yet, the hospital couldn't do so late at night because they were short on docs, the woman behind the desk told me. Plus, their priority-based queuing system kept pushing those darned ambulances up ahead of me.
Authors of the report offer six principles that hospitals should embrace to create a culture of "immediate responsiveness." They hope national leaders will help spread these core values, and facility leaders will build them into front-line scheduling practices, according to the report:
- Supply-demand matching through formal ongoing evaluation;
- Immediate engagement and exploration of patient concerns at the time of inquiry;
- Patient preference on timing and nature of care invited at the time of inquiry;
- Need-tailored care with reliable, acceptable alternatives to doctor visits (i.e., telehealth and electronic consultations);
- Surge contingencies in place to ensure timely accommodation of needs;
- Continuous assessment of changing circumstances in each care setting.
Kaplan is a "big believer" in striving for zero wait times in health care and, posits that, by embracing these principles, the industry can get close to that ideal state.
"I think it requires a change in mindset and a willingness to actually say to our patients, ‘When would you like to be seen?' " he says. "We've just got to open our eyes and listen to our patients, and then take full advantage of what we know is possible in health care today."
For more on eliminating wait times, be sure to check out my November 2013 cover story about how hospital leaders are placing downtimes squarely in their crosshairs by eliminating waiting rooms in clinics, reorganizing EDs and bolstering data to target bottlenecks. Contributing writer Lola Butcher also touched on some of these issues in her February installment of our consumerism series, on health care's new impatient, sophisticated and cost-conscious customer.