Redesigning Clinical Workflows to Return Joy to Patient Care
Improving Patient Flow to Improve Wait Times

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Improving Patient Flow to Improve Wait Times

Wait times are a major challenge for most health systems. I’d like to tell you about some great work addressing this challenge.

This past week I had the honor of delivering the keynote address on Clinician Engagement in Lean Quality Improvement at the Clinicians Leading Change and Improvement Masterclass Event at the Mater Misericordiae University Hospital in Dublin, Ireland. Other presenters included Dr. Colm Henry, who presented an excellent overview of key issues in clinical leadership, and Dr. Ken Mealy, the incoming president of the Royal College of Surgeons for Ireland (RCSI).

Dr. Mealy’s talk on using data to drive decision making was inspiring.  He demonstrated a number of challenges:

  • the variation in coding for certain procedures,
  • the wide variation in the frequency of specific surgical procedures, and
  • the variation in location where procedures are performed.

Reducing Patient Wait Times

What impressed me the most was his approach to wait times for elective surgeries and appointments to see a surgeon.  About 30% of patients referred for an outpatient appointment have been waiting more than 9 months, and about 20% scheduled for surgery have been waiting for that long. And the number of patients on the waiting list is growing as the population grows and ages.

Dr. Mealy juxtaposed these numbers against the utilization rate of the operating rooms (ORs). He made the point that by improving the utilization rate of the ORs, the wait times could be stabilized and even reduced. The baseline OR utilization rate was 56%, meaning that about 44% of the time during regular working hours the ORs were not being used for surgical cases.

There are a variety of reasons:

  • First cases of the day not starting on time,
  • Delays in turnaround time between one case finishing and the next starting, and
  • Early finishes for the day, with the OR unoccupied for hours at the end of the day.

His team’s initial work on this is addressing these issues as shown in this slide .

This utilization rate, and these reasons for low utilization, are common in many hospitals across the world. What is striking is that by improving the utilization rate by 10%, from 56 to 66%, the wait times for appointments and surgeries would stop growing, despite the growing number of patients. Even more impressive, an improvement of 15% would reverse that growth, leading to decreases in wait times trending over time to zero.

This would be a dramatic reversal of a problem that seems insurmountable considering the constraints of the health care budget in Ireland. Most of us would say the only way to reverse the wait times would be to add more:

  • more people
  • more ORs
  • more time the ORs are open for cases each day.

Dr. Mealy has shown us the link between a problem of access to a physician’s office, and a solution that comes from improving throughput in another location – the operating room. We don’t often make those connections without the help of systems thinking.

Improving Care without Adding Resources

In fact, we can provide better care without adding more resources, if we use what resources we have more intelligently and carefully across the full spectrum of care, as in this case from physician office to the operating room and hospital.

This is an important lesson, because this is only one example of access issues common in all health care systems. Limited access to primary care, specialists, imaging studies, and surgery are common in most health systems worldwide. In order to improve access, most of us think we need to add more resources. In fact, we have much more capacity than we acknowledge. This capacity is hidden in the waste in our systems and workflows. Doctors, nurses, and others on the front lines of care experience that waste as barriers and frustrations to providing care to their patients. These drive physician and nurse burnout.

We need Lean Done Right, with the Respect for People that empowers those doing the work to identify and remove waste, and to identify and remove those barriers and frustrations.

Dr. Mealy has used data to show us the extent of the access problems and the potential to reverse these by improving utilization, by improving workflows, by removing waste, barriers, and frustrations, for one specific problem. We can use Lean to address many such problems and have great impact.

What problems do you have for which the only solution seems to be to add more?

Have you been able to look at the entire work flow, across silos, to seek potentially unseen connections?

Have you worked on a workflow issue in one area and seen improvement in another?

It happens all the time in healthcare. If you have one to share, leave a comment and tell us about it.