Why is it that every time I go to a doctor, I am given an appointment for a precise time and then every time, every single time, the doctor shows up at least 20 minutes late? Does the healthcare system hate me? Do they not want to fix the problem? Or are they just simply incompetent?
To dig deeper into the question, I spent the summer working with a startup focused on healthcare operations analytics. We interviewed 50 healthcare providers and dove deep into the operations at three different types of clinics — cancer infusion treatment, oncology, and hematology — to understand the problem and how best to solve it.
The truth is that most healthcare providers have the patient’s interest at heart and are trying their level best. However, “optimal patient slotting” is a lot more complex than might appear on the surface — in fact, “Googol sized” in complexity. The good news is it’s a problem solvable with advanced data science; the sobering news is it MUST be solved if we are to handle the incoming onslaught of an increasing, aging patient population all carrying affordable insurance over the next 20 years.
The Doctor Will Be Right With You. NOT.
There are few things I take for granted in life, and waiting to see a doctor is one of them. The average wait time for a routine visit to a physician is 24 minutes. I am sure I am not the only one who has sat in a doctor’s waiting room thinking, “You said you would see me at 3:00 p.m. — why am I being called at 3:24? This happens every time; I bet you could have predicted it. So, why didn’t you just ask me to come at 3:24 instead?”
A Press Ganey study of 2.3 million patients at 10,000 sites nationwide found that a 5 minute wait can drop patient satisfaction by 5 percent, a 10 minute wait by 10 percent, and more than 10 minutes by 20 percent.
That 24-minute stat is, in fact, not so bad compared to anyone who has had to get an infusion (chemo) treatment, visit a diabetes clinic, prepare for surgery, or see just about any specialist. That wait time can be hours.
Just visit any hospital or infusion center waiting room, and you will see the line of patients who have brought books, games and loved ones along to pass that agonizing wait time before the doctor sees them.
Healthcare Providers Feel the Pain of Schedules that Don’t Stay on Schedule
I spent this summer researching this problem on behalf of LeanTaaS, a Silicon Valley healthcare operations startup, and saw for myself just how overworked and harried nurses and doctors operating across the healthcare system are. I spoke to several nurses who have had days they were not able to take a single bathroom break. Clinics routinely keep a “missed meal metric” — how often nurses miss lunch breaks — and most of the ones I spoke to ring that bell loudly every day.
I even heard of stories of nurses suing hospitals for having to go a whole day without breaks or meals.
The fact is that long patient wait times are terrible for hospitals too. Patients waiting for a long time is symptomatic of chronically inefficient “patient flow” through the system and that has serious negative impact on the hospital’s economic bottom line and social responsibility:
Lower Access and Revenue: A natural corollary to long patient wait times is that the hospital sees fewer patients than it possibly could each day. In financial terms, low asset utilization and patient throughput — fewer surgeries than could have been done, fewer infusion treatments than could have been performed, and so on. The Medical Group Management Association found that the average utilization of operating rooms at large hospitals in 2013 was only 53 percent. Less patients served directly implies reduced access to care, lower revenues, and higher unit costs.
Rising Labor Costs and Declining Nurse Satisfaction: Nurses are an expensive and scarce skill set. Because of the “peaks and valleys” caused by inefficient scheduling during the day, hospitals have to staff for the “peak” and simultaneously experience periods of low activity while still needing significant overtime hours from nurses.
Hospital leaders know this well. Every administrator I spoke to in my research — CEO / CAO / CNO — has some kind of transformation effort going on internally to improve patient flow — “lean” teams, 6-sigma teams, rules for how to schedule patients when they call into various clinics, and so on. They know that if patients could be scheduled perfectly in a way that doctors could see them on time, the resulting “smoothing of patient flow” throughout the system would making their facilities, staff, and the bottom line much better off.
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