Patients' Patience - Virtue or Untapped Value?

Anyone who's spent time in a hospital or doctor's office in the last five years knows the wait is likely to be:

A. 77x longer than expected, especially if you have an urgent car repair/child care/real estate/or circuit court appointment;

B. Interrupted by noise pollution from a CD, radio station or TV set at a volume that makes its squawking audible to all within a 55.876 mile radius;

C. Punctuated by complaints from the hyper-caffeinated, business-monkey-suit-wearing, Blackberry-toting crowd (guilty as charged) who were silly enough to take only half the day off for this visit and are pissed because they neglected to bring their laptops;


D. All of the above.

On June 22nd, BusinessWeek published this article, by Catherine Arnst, titled "The Doc's In, but It'll Be Awhile."

It's a good piece that pulls together research, quotes, and a bunch of 'pop' H/HC news, including the obligatory SiCK0 mention. Based on my sister's experience, I perked up reading a UCSF nugget that a patient with a possibly cancerous mole waits an average of 38.2 days to see a dermatologist.

Even more frightening than the 2-year old selection of motorhead periodicals left via natural selection in waiting areas across the country is the fact that we aren't even keeping track of how much productivity is lost as a result of increased wait times.

Who is getting paid for all this time? And why aren't people generating capital by providing patients with things to do while they wait?

So who's getting paid? Not the doctors. Not the hospitals. Patients? Perhaps, if they are using PTO.

Granted, this is an extremely tricky thing to measure, as it's certainly not ethical to ask employees which doctor they're visiting, or whether it's for a new vs. preexisting condition (even if you're really trixsy and colloquial about it).

You could have your HR/Benefits dept. try to approximate calculations on lost productivity based on average PTO taken for docs visits (if you record this and employees volunteer the information), but this enterprise may be more painful than trying to remove your fingernails with kitchen tongs.

Where we're examining wait times analytically at all, we're examining delays in the medical system from the aspect of the hospitals, and doctors, who are certainly not getting paid for the 3 hours of time a patient waits for a 30 minute appointment.

We're only examining what these wait times do to the continuum of care, or how much our D&T, throughput, and output percentages change. The strain on EDs is particularly severe, as people use ER visits as an alternative to a primary care/family practice appointment.

Almost no one denies wait times are an issue.

They impact care. They impact throughput. They impact patient satisfaction. They may increase exposure to viruses during flu season and spread infectious diseases if waiting areas are not cleaned regularly.

And to be honest, who here has seen waiting rooms cleaned with the same frequency and intensity as patient/exam rooms?

Patients certainly want to be in and out. Medical staff want patients to be in and out (let's be optimistic).

Administrators want patients and families to be happy and healthy upon discharge, and throw open the exit doors spouting the gospel of good, fast treatment, which means - that's right, say it with me - in and out.

But what to do? What if we're going at reducing wait times the wrong way?

We're looking at reducing wait times from the supply side, while demand continues to grow. Yet we're not harnessing demand to create additional market share, and many are not even looking closely at what drives demand at our individual facilities.

As an industry, we're not being overwhelmingly successful in recruiting new staff to drive the patient/staff ratio down, as shortages illustrates (yes, there are some bright points - shop around for a magnet hospital).

We're not expanding facilities fast enough because we're operating on shrinking margins (when merely 'being in the black' is part of your 10 year strategic plan, it's difficult to free up multi-million dollar chunks of capital for an expansion project).

So let's take a stab at reducing wait times from an oppositional hypothetical angle.

What if we opened up wait times to a free market, capitalistic system?

It could look a bit like an airport gate area just prior to boarding, with the "Premium Plus" members cycled through quickly while the A, B, and C acuity levels wait their turn to be herded through the 'coach' continuum. Think concierge/executive care on speed.

Oh, but I'm forgetting one pesky little thing - acuity. You can't triage and then cycle patients with potentially life-threatening health problems through the system by whether or not they'll PAY more Jen!!!

But wait, aren't we sort of doing this now? Don't we ALREADY treat patients differently based on whether or not they can pay? Make decisions about treatment based partially on what type of insurance they have?

We're also not calculating the drain on energy (including electricity, waste removal/recycling, water use, etc) nor the cost of resources used by all those waiting in pre-appointment purgatory.

If we threw all the resources used, all the hours patients spend waiting instead of working or pursuing other personally meaningful activities into the kit, the opportunity cost of all these lost hours looms writ large.

So, today's recommendations:

1. Businesses: Hire a 'housecall' PCP to come offer exams at your place of business. Assure employees visit records are protected and that management, your coworkers, the janitor, etc. never see them. Pay everyone's copays. Follow up the exam day with a nice massage and/or office lunch and you'll also be more attractive to millenials looking for unique benefits packages.

2. Hospitals & Docs Offices: Put in things for patients and their families to do during long waits. At the bare minimum, have coloring packets for kids, a bookshelf for adults, a television. Consider having fixed computer workstations with internet access (with privacy controls if you wish) and printers for use (with a time restriction). Consider innovative ways to make a buck and keep people occupied, including a pay-for-use video game system complete with earphones (hospital waiting room DDR anyone?)...vending machines with board games, etc. The Japanese sell just about everything in vending machines, why can't we?

But wait, you say - wouldn't this be counterproductive? Wouldn't some people come and hang around just to use the facilities?

Of course some would - when I worked in an ED we had some patients come for a meal and/or complimentary bus pass. But don't let those who work the system keep you from improving the system.

Now, wouldn't this be something? People actually choosing your hospital/office over another based on what you offer.

Next step, hire a Chief Experience Officer like M. Bridget Duffy a la the Cleveland Clinic...then let her loose on your waiting areas.

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