Excessive Wait Times in Healthcare Literature Review

Excessive wait times in healthcare are a problem for both patients and care providers as they affect patient satisfaction, which in turn impacts the job satisfaction of nurses and other care providers (Chan, 2014). Fatigue and overwork can set in for providers if wait time excesses are not adequately addressed, which can lead to higher turnover rates for professionals and higher costs as a result of recruiting and training new talent (Zbori-Benson, 2016; Dall’Ora, Griffiths & Ball, 2016; Walker, 2017). Wait times can also lead to complications for patients, especially if their conditions worsen, and in cases where patient wait times are especially long, such as in busy urban ERs, patient conditions can quickly become critical unbeknownst to nurses and physicians. This paper will discuss excessive wait times in healthcare and identify how management can address the issue for health care organizations to mitigate the risks associated with it and better organization operations so that wait times are reduced.

Queuing theory has been identified as an appropriate perspective to utilize when approaching this issue as it addresses the manner in which patients are scheduled to be seen. However, the IOM (2015) notes: “Queuing theory holds that the effect of variability on wait times will be more pronounced in a system with an increased number of queues,” so it is important for an organization to determine the way it will introduce queues based on the staff available at any one given time. Another issue is that in provider-centered care models, multiple queues can lead to exasperating wait times for patients. In patient-centered care models, the patient’s time and satisfaction is the focus of all care and Connole (2012) shows that nurses have a duty to provide patient-centered care at all times.

One way to more effectively achieve patient-centered care and reduce wait times is to utilize telehealth and telemedicine—technological means of engaging with patients. The study by Hofstetter, Kokesh, Ferguson and Hood (2010) showed that “prior to use of telemedicine by audiology and ENT, 47% of new patient referrals would wait 5 months or longer to obtain an in-person ENT appointment” (p. 551). Once the healthcare facility implemented the use of telemedicine, the wait times of scheduling patients dropped substantially, with only 8% of new patient referrals having to wait 5 or more months to receive in-person care. After three years of usage of telemedicine, fewer than 3% of all patients were waiting that long: “The average wait time during the first 3 years using telemedicine was 2.9 months, a 31% drop compared with the average wait time of 4.2 months for the preceding years without telemedicine. The wait time then dropped to an average of 2.1 months during the next 3 years of telemedicine, a further drop of 28% compared with the first 3 years of telemedicine usage” (Hofstetter et al., 2010, p. 551). This shows that using technological advancements like e-Health can help managers to better address the important issues that patients face. This would allow a patient-centered approach to medicine to be conducted and managers to more efficiently manage the time of their staff so that supply and demand are always effectively balanced and wait times are reduced.

Kvedar, Coye and Everett (2014) have also shown that telehealth can reduce wait times, improved quality care, reduced costs and increased patient satisfaction. Therefore, because queuing theory is a useful way to approach this issue, it can be joined with the application of telemedicine to...

The provider-centered model that underlies queuing theory can be combined with the patient-centered model that underlies telemedicine so that there is a balance achieved between patient and provider—supply and demand.
Goals

The goals of a health care organization should be to see patients as quickly and efficiently as possible so as to ensure that optimal quality care is provided to patients and that patient satisfaction is the top priority. The Institute for Healthcare Improvement (IHI) (2018) states that there are “six principles for improving access: understanding the balance between supply and demand, recalibrating the system, applying queuing theory, creating contingency plans, influencing the demand, and managing the constraints.” These principles can be applied by managers who are tasked with organizing the health care facility and its patient scheduling processes while applying a patient-centered approach with the use of telemedicine. Queuing theory can be applied to direct the channels and queues used via telemedicine. The Committee on Optimizing Scheduling in Health Care at the Institute of Medicine (IOM, 2015) has found that while scheduling practices vary according to the type of health care organization, the basic principles identified by the IHI are effective in reducing wait times.

Overcoming the obstacles to reducing wait times is critical to achieving the goals and the IOM (2015) has identified these obstacles as: “inefficiencies in operation, in care coordination, and in health care organizational culture that result in flow disruption, the underuse of resources, and an imbalance between the demand of patients to be seen and the supply of providers, facilities, and alternative strategies to care for them at any given time.” Each of these obstacles is one that managers of healthcare organizations must address in order to achieve the goal of reducing wait times. Operations must become more efficient, care better coordinated, resources used appropriately, communication achieved effectively, and the balance between supply and demand moderated.

The impact of this issue on management of healthcare organizations is significant and many articles have been written on it. Epstein (2016) writes that managers will see clinical as well as financial impacts from wait times: “For example, a health plan’s value-based payment program may tie patient satisfaction scores to reimbursement — and few frustrations impact satisfaction more than waiting. From a fee-for-service perspective, speeding wait times by increasing physician capacity results in increased volume, which drives up practice revenue.” Additionally, the issue of wait times will impact organizations with regard to government regulations under the Affordable Care Act, as there are strict rules that health care organizations must abide by in terms of providing patient services in order to be eligible for reimbursements.

Additionally, the Joint Commission (JCAHO, 2018) notes that telemedicine can be used to reduce wait times: “Use of e-communications and telemedicine to provide alternatives for face-to-face visits and allow for after hours care” is a suitable method for managers to more effectively help balance supply and demand in their healthcare facility.

Personal Learning Statement

Wait times are an important and critical factor in the successfulness of a healthcare organization. Patient satisfaction is the main objective of a healthcare facility and if patients are kept waiting, they may…