According to the principles of achieving lean organizations, a thought process to transform waste into value, there are eight process-oriented sources of waste in most healthcare systems:
- Excess Processing
Waiting, the source most closely perceived by the public to be linked with good or bad patient outcomes, exists across the system. It doesn’t matter where the patient flow is within the system – acute care to community, acute care to mental health, community to acute care, GP to specialist or chronic services, or community to home – patients continue to contend with unreasonable wait times.
According to a 2008 study published by the Canadian Medical Association, excess patient wait times cost the Canadian economy $14.8 billion. The wait times led to increased health system costs such as unnecessary doctor appointments, tests, and medications. The Canadian economy also lost both patient and caregiver workers which resulted in increased government costs through disability pensions and welfare benefits, as well as lost tax revenue. Aside from this, the highest cost of waiting was patient deterioration. Patients wait in hospital for downstream community placements to become available and during their wait, their condition decompensates.
Fast forward four years. The Fraser Institute’s 21st Annual Waiting List Survey (2012) shows Canadians are waiting longer than ever to receive medical treatment. In the report, the Institute references a study by Esmail (2011) “that the cost of waiting per patient in Canada was approximately $1,105 in 2010 if only hours during the normal working week were considered “lost,” and as much as $3,384 if all hours of the week (excluding eight hours of sleep per night) were considered “lost.” The Fraser report also says that “economists Stokes and Somerville (2008) also found that in 2007, the cumulative total of lost economic output in Canada (representing the cost of waiting for treatment for joint replacement surgery, cataract surgery, coronary artery bypass graft surgery, and magnetic resonance imaging (MRI) scans collectively) was nearly $15 billion.”
But nowhere is the cost of waiting more evident than in the acute care to community scenario. A key factor in longer wait times is the inappropriate occupation of hospital beds. The public has known for more than 30 years that hospital beds are consistently occupied by patients who no longer need acute care. Through no fault of their own, these patients tax limited, expensive resources of the acute system while they wait to be discharged to more appropriate settings. The time these patients spend in acute settings is captured in hospitalization data as non-acute hospital days – patients waiting for Alternative Level of Care (ALC).
The Wait Time Alliance (2011) estimates that almost one in six hospital beds in Ontario is occupied by someone who could be cared for elsewhere. The Alliance’s 2011 Report card makes a key recommendation: focus on strategies to reduce ALC on discharging patients sooner from acute care to the appropriate setting, and reduce demand for future hospital-based care. The pathway to achieving this efficiency and reduce costs is to ensure that data reporting systems are integrated, and comprehensive enough to match patient needs to available and appropriate services.
The modern eReferral utilizes standardized processes that are client-driven and objective. Patient prioritization for urgent community or compassionate placement is key. Health system prioritization pinpoints organizational/regional stressors for maximum discharge efficiency through custom sorting algorithms and auto client transfer to choice of alternative care. Matching patient clinical needs (based on client preference, geographic, timing, and eligibility profiles) to single/multiple programs/beds, or directly to a central access point, while showing live wait times during the process is a hallmark feature of a robust intelligent eReferral solution.
Analytics that immediately measure data drive performance management and accountability. eReferral solutions that enhance the healthcare process and demonstrate daily gains in client service levels lead to better system productivity and outcomes. In the end that means lower costs, which is what we all strive for. This is why Patients Shouldn’t Wait.