Reducing Wait Times In Congested Healthcare Facilities /Canada press
By Germain Tanoh, PhD : In an article published in Healthcareparpers, Ida Goudreau, former CEO of Vancouver Coastal Health Authority, outlined her experience leading a huge and complex healthcare organization. She described how challenging it is to match healthcare capacity with demand. Having tried all available solutions from system redesign to “lean” thinking, she noticed that: “In a system in which demand exceeds supply, rationing becomes a time-honoured and sometimes desperate solution.” Healthcare organizations around the country are experiencing excessive wait time in their facilities due to high demand for healthcare services. It is frequent patients wait over several hours in Emergency Room. The following situations are symptomatic of demand not being fully met: overcrowded Emergency Rooms, excessive lengths of stay in hospital and long wait times for diagnostic imaging. A problem that will get worst, as the aging population increases.
Wait times have a negative perceive value by patients. For instance, excessive wait times are associated with poor service quality. Patients, hospital staff members, and healthcare leaders might think, the solution to speed up services is to add more staff, beds or equipments. However, by increasing healthcare service capacity, employee’s idle time would increase dramatically, or more beds will be empty. And having employees be paid for doing nothing or having a lot of empty beds is a waste of taxpayers’ money and hospital resources. The challenge for the healthcare service provider is to find a trade-off between the cost of maintaining the ability to provide healthcare service and the cost to the healthcare organization of keeping patients waiting.
Why Do Patients Have To Wait?
Waiting lines appear wherever patients arrive randomly for services. Also, patient’s service time are not predictable, for example some operations take longer time to complete than others, length of stay in bed at hospital are not the same for all patients. Both arrival time and service time show a high degree of variability. As a consequence, the healthcare system at times becomes temporary congested, giving rise to wait lines; at other times there are no patients and the healthcare service is Idle. Thus, wait line is a natural phenomenon, and waiting are inherent to the business of healthcare service delivery. However, excessive wait time is the result of bad management decisions. It is the lack of anticipation of demand for healthcare services that creates chaos in the healthcare system. Long waiting lines form because patients are seeking service faster than they can be served. Healthcare service providers are not able to meet the demand for healthcare service because of limited capacity or resources. A situation more seen in high volume department, such as emergency department or operating rooms.
Strategies for Reducing Wait Time
Wait lines in healthcare organization are intimately related to their capacity and resources. To reduce wait times healthcare managers must match their capacity with demand for healthcare services. An effective alignment of capacity with demand can be performed by following these tips:
1. Forecasting patient demand and volume. Use forecasting as an iterative process to predict the demand of healthcare services over a specific time period. It can be qualitative by using expert opinion and judgment or doing a market research. It can also be quantitative, by using advanced mathematical model and historical data on healthcare service usage collected over time. Forecasting in healthcare, should mainly be based on quantitative methods.
2. De-bottleneck to free capacity. Bottleneck can be identified and remove by redesigning the system and implementing a process improvement method to reduce wait time.
3. Decrease demand. This might include decreasing the services provided, or procedures performed or re-directing patient to other partner’s facilities.
4. Increase speed, by eliminating unnecessary tasks or procedures. Investigate the time it takes to achieve a deliverable, to perform a specific procedure. A thorough analysis of each healthcare process must be done to measure its total duration and reduce the number of motions or tasks performed. For example, reduce nurse’s travail time in hospital by optimizing facility layout and design.
5. Transfer capacity from other areas. Some departments may have capacity that is not needed. These free spaces can be used to fund capacity expansions in other departments. For example, if facilities or space is the issue, square footage can be reduced in one department and provided to another.
6. Increase capacity, if more money are available. This can be done by buying more equipment, hiring more labour, adding more beds, or increasing rooms’ size. Another option to increase capacity is to outsource certain service lines or subcontract with other facilities to provide additional capacity. Before spending money to increase capacity, be certain the benefits are higher than the marginal cost of the capacity expansion.
7. Perform simulation to validate process redesign, or to support service capacity upgrade or downgrade decision. Build a simulation model of wait lines to align staffing with projected demands, improve service, and control the time spent in a queue. By creating what-if scenario, simulation will help in identifying the level of service capacity that will minimize total cost and patients wait time.
8. Monitor healthcare services utilization. A sample of healthcare services utilization indicators that need to be measured are: Hospital admissions rate, patient days, average length of stay. Utilization rate may be calculated for diagnostic imaging services, nursing homes, emergency rooms, outpatient clinic, surgery centre, and urgent care centre among other. Use utilization as an initial estimate for demand, but be careful not to confuse utilization and demand. The level of demand may exceed actual utilization or, conversely, utilization levels may be above demand. For instance, some services may experience less utilization than projected because of restricted access to healthcare services (service too expensive).
Bad management of waiting time causes waste and poor service performance. A proper understanding of patient wait times in healthcare facilities is a required step to design process and staffing change in order to improve healthcare service delivery. By implementing these tips healthcare organizations with limited capacity will start to see a decrease in wait times without over spending on capacity expansion.
About the Author: Germain Tanoh is the founder and President of Quantimal Consulting. He is a dedicated consultant with expertise in healthcare analytics, project management, and business process improvement. He can be reached at gtanoh@quantimal.ca or visit Germain www.germaintanoh.com
