October 16, 2012
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This morning on the drive in to work, I saw a billboard for a hospital touting their ER wait time, which was 13 minutes. It got me thinking cynically about how that number is derived and enforced. And I know if I’m thinking about it from a cynical point of view, someone else has thought about it from a serious point of view, and someone else yet has actually done it.
Side-stepping my soapbox about too many people in the world today, I’m going to look at the managerial method to problem-solving: meet the goals. “Meet the goals” is not the same as “fix the problem”. Just yesterday, I came across a poorly-written specification document as part of an issue I was assigned to fix. Following the “Success Criteria” of the document would allow you to skip a major section of the specification, which is what was done. So, now I have to go above and beyond the success criteria to meet the full requirements of the document.
Anyway, back at the hospital, the executives at this hospital see that their ER wait times are too long, or they want to be competitive with other hospitals (because that’s what healthcare has become nowadays), and they figure a wait time metric is a good barometer of their performance. So they task the manager of the ER will lowering the wait time.
It’s probably safe to say that the “wait time” is defined as the time it takes between the time you check in and the time you get called back to see a nurse or doctor. So you would walk in and say “I need to see a doctor.” Your name would be put on a list, then you’d wait for your name to be called. The time between is dependent on how fast the doctors and nurses can turn over cases. The ER Manager could add additional staff to make that turnover quicker, but that increases labor costs, lowering profit, which is bad.
But, if you’ve ever been to an ER, there’s plenty of paperwork and such to process before you get started. The hospital could save some time by giving you the paperwork to fill out while you wait. That will save some time when you get through the door. But if you’re a crafty manager, you can take it a step further and not start the check-in process until the paperwork is completed. So if it takes a patient 20 minutes to fill out the forms and collect the information, that’s not considered “wait time”. That’s pre-check-in time. Ka-ching! Problem solved. No wait, I mean, Goals met!