The healthcare industry has occasionally been described as “the most complex endeavor on the planet.” Although it is difficult to state that categorically, there is at least a ring of truth to it. Whether as professionals working in healthcare or as a patient, most of us have experienced the confusing processes (or lack of them) that often define the healthcare experience. As leaders in the industry, one of the most important things that we can do is to work together to simplify those processes – for the wellbeing of staff and caregivers, the experience and clinical outcomes for patients and their families, and ultimately for the growth and financial stability of the healthcare enterprise you lead.
The path to simplifying healthcare must begin by addressing the root causes, rather than continuing to treat symptoms. Central to this approach is recognizing the powerful role that time plays in the delivery of care. I still remember as a young healthcare leader being educated by a group of cardiologists who explained the adage that “time equals tissue.” While the context for this applies to a specific emergent clinical condition, in that case heart attacks, its meaning suggested a larger truth. In the immortal words of Henry David Thoreau, “The price of anything is the amount of time you exchange for it.” Time is the universal value, and it demands our attention as healthcare leaders. Our attention is most productively focused in two places in a systemic and disciplines if you want to drive both growth and efficiency, and greatly improve the experience of your consumers and patients. The first is the time spent waiting, and the second is time spent with the patient.
Time Spent Waiting
A decade or so ago, working as the chief operating officer for a large health system, our team took on what felt like an unsolvable problem. We decided to transform our emergency departments (ED), all seven of them, after a long history of failed attempts to improve their performance. After a rough start, we were forced to step back and ask the fundamental question, “Why do patients come to the emergency department?”
The initial responses were complicated, divergent, and strongly clinical in nature. Finally, the answer was distilled to its essence by one of the front-line managers who shared her straightforward perspective, “Patients come to see a doctor.” It seemed too obvious, but entirely correct. Using this as our single objective we restructured everything about our approach and decision-making to align. In essence we adopted ‘time spent waiting’ as our sole focus and single performance metric to drive transformation. For the next eighteen months, the only question I asked the staff was, “What is our patients ‘Door to Doctor’ time today?” It wasn’t long before we were able to map out the processes and subprocesses with a clarity of thought that we hadn’t been able to successfully do in the past. This allowed us to manage the processes to a consistent performance.
This shift in our thinking led to additional changes in our priorities. For example, housekeeping schedules were adjusted based on the flow of patients from the ED by hour and day instead of the traditional 9a – 5p static approach. Each aspect of the process was held under the magnifying glass to understand its effect on “door to doctor.”” Patients’ time spent waiting for care was dramatically and sustainably reduced, which led to growth almost immediately. In a recent conversation with my friend and Chief Medical Officer of Novant Health, Eric Eskioglu, M.D., he made the statement, “No one pays to wait.” He made the point that most other industries understand the negative business implications of making customers wait.
If this improvement in the customer's experience by reducing frustrated waiting time weren't enough, analysis showed all the original performance metrics, including staffing efficiency and team engagement, showed dramatic improvement as well. By focusing on time as the single important patient experience measure, we were able to set a clear goal for staff – that aligned with the patient and produced performance results.
Time Spent with The Patient
This isn’t where the story ends. Reducing time waiting is essential, but it is not the full picture. Time waiting is like the opening act at a concert, setting up the main show – or in this case, time with patients. Healthcare is a relational business, and relationships require intentional and focused time. It is incredibly easy to lose sight of this in the press of a busy and stressed ED. As leaders, the next important step is to improve processes that support caregivers and the time they can effectively spend with patients. There needs to be space to develop an understanding of the person, learning about them – to allow for love and human understanding to develop, rather than focusing solely on the medical issue at hand. It allows us to move beyond “what's the matter with you?” to “what matters to you?” This is a two-way value – benefiting both the caregiver and patient.
I am convinced that a critical answer to simplifying our healthcare system and improving your business lies in focusing on the amount of time that patients spend waiting to see a care team, as well as the time spent with caregivers. The new normal coming out of the pandemic, the crisis of physician and caregiver stress and burnout, increasing competition from insurance companies to the Amazon’s and Apples, and financial stress resulting from both growth challenges and rising costs demand more creative responses than our traditional tools. Only through this dual perspective will we be able to simplify our organizations’ processes, build the morale of our staff, and better serve our customers (and our communities) in a strategically coherent, meaningful, and sustainable methodology.