Telemedicine and Health Care

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 help provide a more sensible, effective and patient-centered approach to care. 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 decide to seek care at a different facility. It is important that managers recognize when surges in patient care can be expected and how to best manage the supply of providers with the demand of patients. In order to achieve this end, queuing theory can be applied to help managers establish maximum control over the process and maintain an effective and efficient use of staff. The use of telemedicine, however, can most effectively although the organization to provide patient-centered care and reduce wait times.
Interpretation of Data
The data indicates that in this particular issue it is necessary to examine the situation from the point of view of both providers and patients. Providers are in limited supply and must be able to balance their time among patient demand. From a provider-centered model of care, care givers must be able to organize themselves in an efficient and effective manner so that they can properly see the patients who are waiting to be seen. From a manager’s perspective, the provider-centered model offers substantial rewards: it lets the manager see what supply is available and how it can be applied in the best way possible. Multiple queues can be set up so that patients are waiting to see the appropriate care provider.
However, without adopting a patient-centered approach as well, a manager will risk upsetting patients, leading to reduced patient satisfaction and possible loss in revenue. Patient-centered care is advisable because ultimately the health care organization’s goal is to obtain patient satisfaction. If patients are happy with the time frame in which they are seen, they will not feel the need to seek health care from another alternative.
One way to balance provider-centered care with patient-centered care, from a management perspective, is to assert that managers should focus on how technology can be used to help address issues such as wait time. Technological advancements in the digital era have allowed nurses and physicians to overcome obstacles such as time and space, which can reduce the inconveniences that many patients suffer in attempting to schedule face-time with providers.
The research shows that telemedicine can be used to help reduce wait times, increase patient satisfaction, and better manage queues. Over a long period of time, telemedicine allows providers to speak with patients without the latter having to travel to the facility and overcome obstacles of time and space in the process. There is less inconvenience for all stakeholders and wait times can be reduced substantially as Hofstetter et al. (2010) have shown.
Thus, a two-fold approach that combines a provider-centered model of care with a patient-centered model of care can allow queuing theory to work with telemedicine so that patient wait times are reduced.
Proposal to Reduce Wait Times
Management should incorporate telemedicine into the organization’s approach to providing patient care. Telemedicine can be utilized to help reduce wait times by allowing care providers, nurses, physicians and staff to discuss issues with patients via telecommunications and telemedicine means so that there is no need to schedule as many in-person visits. The telecommunications conferences can eliminate a lot of time that is lost in scheduling via various queues and stretching thin the operations of the staff and the providers.
Implementing telemedicine can also help providers to feel greater job satisfaction, as their own personal feelings towards providing care can begin to be more patient-centered, which is truly the focus of nursing and care giving. A manager who can help providers to feel more naturally inclined to successfully showing effective care towards patients will be one who helps to boost morale and create a positive and happy workplace culture. This will in turn help to reduce turnover rates and save the organization costs in the long run.
Because of the fact that in a complex environment like an organization variables are closely integrated and connected so that one factor impacts another and has a snowball effect on a number of others, it is critical that a proposal such as the use of telemedicine to reduce wait times be taken seriously. This type of plan can address one issue, which in turn has a positive effect on another issue, which in turn has another positive effect on other issues.
Since the goal of the healthcare organization is to achieve patient satisfaction, identifying ways to help providers do this, such as by reducing wait times through the use of queuing theory and telemedicine, can be a great method for the organization to be more successful in the larger scheme of things. It ultimately shows that wait times are tied to patient satisfaction, which is tied to care provider satisfaction, which is tied to job retention, which is tied to cost-saving strategies for the organization, which is tied to revenue generation. In other words, a happy and satisfied patient translates into a happy and financially successful organization. And the way to bear out that equation is through the application of telemedicine.
Ethical Considerations in Business
Ethical considerations in business are always important to make, as a business is an organization in which there are diverse stakeholders of various cultural backgrounds. Values may align among most stakeholders, but it is crucial to see where there is divergence so that stakeholders in a business are not marginalized or isolated. When such occurs, stakeholders may begin to pull out or find another organization to invest themselves in.
With regard to the practice of ethics, the best approach that an organization can take is to engage in transcultural awareness, appreciating the values of all stakeholders and finding ways to incorporate them into the management strategy that will most effectively help the organization to achieve its aims. Transparency and honesty can be two qualities that management utilize in order to help identify stakeholder values. In some cases, managers and leaders have cut themselves off from stakeholders by not being open and not engaging in communication with them in an honest manner. The case of Enron can be used as an example of what happens when leadership fails because of dishonest reporting tactics and a lack of transparency.
For an organization to be successful it must embrace qualities and characteristics that are associated with ethical practices. Ethics is the foundation upon which all successful organizations are based. They provide the framework and discipline-oriented approaches that managers can use to identify with stakeholders and develop strategies that will be appreciated by the same stakeholders.
In the case of this proposal, the application of telemedicine and queuing theory helps managers to take into consideration the values and needs of the two primary stakeholders in the organization: the care providers and the patients. The effectiveness of this strategy should prove evident after some time, just as it did for researchers who have examined this exact problem of using telemedicine to reduce wait times and increase patient satisfaction.

References
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