Wait Times & Inefficiences -Need an ER? Make an Appointment...

A hospital here in Holland wants to hire me as an advisor. I very much want to be a part of their team. It's a great match, and we're both anxious to take the relationship to the next level - i.e. my first day of work.

Unfortunately, I wasn't born in this amazing land of tulips, common sense, and thriftiness (nor am I an EU citizen with high workforce mobility granted under the free mover arrangement).

Therefore trying to get a Temporary Work Visa (TWV) and gain legal access to work in Holland seems like an exercise in learning forebearance.

Luckily, I don't give up easily, but it's frustrating nonetheless to fantasize that if I could just schedule ONE visit with an actual representative at IND to go over all the paperwork, submit it, and have an interview, the decision could be made to grant me work permission (or not) in about 4 hours.

Here is an ugly, rough-and-tumble estimate of resources used thus far in pursuit of ONE temporary work permit (for a contract of 1-3 years - and I don't have the thing in hand yet):

1. One Dutch hospital HR specialist working, let's say 20 hours over a 3 month stretch since the position was offered (minimum) to research the process, contact the office in charge of my NATO residence permit, and contact the Dutch immigration department (IND)

2. One Health Management Rx blogger working, let's say 30 hours over a 3 month period to contact offices, make copies, ask questions, and do research online.

3. One hospital executive following efforts of both HR specialist - let's say he's spent 5 hours total responding to inquiries, asking for updates, and himself researching our options

That's a minimum of 55 hours spent trying to obtain one work permit. On Friday I found out I'd need to fill out and submit more forms to Dutch immigration (IND), and then wait for the agency's response. Add another 3 hours to read the 26 pages and fill out the forms. So we're up to 58 hours.

That's a lot of hours, a lot of follow-up time, and thousands of 'touches' to chase down one permit.

Unfortunately, I'm getting just a small personal taste of the professional frustration many ER providers feel every shift.

Similar bureacratic inefficiencies about in medicine.

Ian Furst, a Canadian oral/maxillofacial surgeon blogging over at Wait Time & Delayed Care, proposes an interesting theory for reducing wait times and improving patient satisfaction in the ER - consumers should call ahead and schedule a time to come in.

Ian writes a great blog, and is also one of the most prolific healthcare bloggers reading/commenting on other blogs.

So he's one of the few bloggers I take seriously when he recommends call ahead service to the ER that looks a bit like ordering a pizza from Papa John's on a frantic Friday evening.

And he's absolutely right that "unless we try something new" the ED snarl will continue to sap strength from the system.

Time is money, and it's also the most valuable thing we can give to another person. Why not pencil in visits to be sure such a precious resource is spent wisely?