Challenger Highlights for Academic Programs No. 4: Waiting Times
A source of constant debate in systems-based practice has to do with what constitutes a reasonable patient waiting time.
"Any waiting-time measure can be thwarted or misrepresented," according to Michael Davies, MD, FACP, Acting Director, High Reliability Systems and Consultation, U.S. Department of Veterans Affairs. A more comprehensive discussion of the topic can be found at this link: http://online.wsj.com/article/SB10001424052702304840904577424512625333928.html
The primary findings are:
- Waiting time estimates based on internal practice focused measures vary greatly from estimates based on patient feedback. Most practices use internally driven criteria, rather than patient satisfaction, as the controlling factor.
- If the measure is how long patients coming off a waiting list have spent on that list, a hospital or practice under evaluation has little incentive to clear the patients with the longest waiting times, since that will make their overall assessment look worse!
- If the measure is the percentage of patients seen within a specified number of hours, those who can't be seen in that time might find themselves waiting much longer, as earlier slots are saved for patients who call up later and can be slotted in, thus boosting the practice numbers.
- If the measure is the number of people on a waiting list for an appointment or non-elective surgery, the practice may change the definition of how long patients have to wait to be included on the waiting list.
- If patients wait a few days to schedule an approved appointment with a specialist, does that "delay" count as part of the waiting time?
- Some practices count initial and follow-up visit delays in different categories. Surgeons and emergency medicine practices separate emergent or urgent appointments or arrivals from non-urgent.
Challenger supports evidence based medicine. This article is part of a series of brief synopses of information across our served specialties.