It has been said that "the healthcare industry is the most complex endeavor on the planet.”
Although it is difficult to state that categorically, there is ring of truth to it. Whether as professionals working in healthcare, or as a patient who has received care, we have all been exposed to the often confusing processes that define healthcare. As leaders in the industry, one of the most important things that we can do is to work together to simplify those processes, both for the wellbeing of staff and caregivers, and our customers, patients, and their families.
The path to simplifying healthcare must start with imaginative, creative, and innovative thinking to identify the root causes, rather than continuing to treat the symptoms. Central to this approach is recognizing the powerful role that time plays in decision-making in the delivery of care. In the immortal words of Henry David Thoreau, “The price of anything is the amount of time you exchange for it.” And with time as the universal value, it demands our attention from two perspectives for healthcare operations; that of time spent waiting, and time spent with a caregiver.
Ten years ago, working as the chief operating officer for an eight-hospital health system, Paradis was tasked with transforming the emergency departments (ED) that were all functioning poorly. After several fruitless attempts, they were forced to step back and ask the fundamental question, “why do patients come to the emergency department?” The initial responses were complicated, divergent, and strongly clinical in nature. But finally, the answer was distilled to its essence by one of the front-line managers who shared her straightforward perspective, “to see a doctor.” It was obviously correct. Using this as their one objective they then re-ordered, re-structured and re-organized everything about their approach and decision-making. All other priorities and performance metrics were removed, as were ambiguous and hard-to-measure quality goals. And for the next eighteen months, the only question we asked the staff was, “what is our ‘door to doctor’ time today?” Soon after changing priorities, they were able to map out the process from end-to-end (both within and outside of the department) with a simplicity and clarity of thought that they hadn’t been able to do successfully in the past.
"This complete shift in our thinking led to a change in priorities where staffing schedules of housekeeping were changed to focus on the flow of patients needing beds rather than the typical 9 – 5 staffing approach, as well as the tracking and sequencing of x-rays to be read by radiologists where previously that time had not been tracked in the ED. Each aspect of the process was held under the magnifying glass to understand its effect on 'time to doctor,' and then later 'time to departure' (which would either result in an admission to the hospital or the decision to discharge to home) as well."
The results on time spent waiting for care were dramatic and lasted long past the first few weeks of implementation. Even an analysis of all the previous measures that looked at staffing efficiency and the patient experience showed significant improvement. By focusing on the single most important aspect, a clear goal for staff was established that made intuitive sense. Reorienting the process by placing the patient at the center meant that efficiency became a natural outcome.
But Paradis doesn't think that this is where the story ends. Reducing the waiting time is necessary, but it is not the full picture. A successful result should include the time spent with patients. Healthcare is a relational business, and relationships require focused time. "As leaders, the next step important step is to increase and improve the time caregivers spend with patients. Here there needs to be space to develop an understanding of the person, learning about them with a view to allowing for love and compassion to develop rather than focusing solely on the medical issue at hand. This is a two-way process, benefiting both the caregiver and patient, blending both what is seen, and unseen to offer the patient undivided quality time. It is a delicate balance between the art of interaction and the need for a robust, efficient process that is supported by good science," says Paradis.
"I am convinced that the answer to simplifying our healthcare system lies in focusing on the amount of time that patients spend waiting to see a care team as well as time spent with caregivers. Only through this dual perspective will we be able to simplify our organizations, build the morale of our staff, and properly serve our customers (and our communities) in a way that is meaningful and sustainable."