Emendo Clinical Advisor, Alan Spinks, has been featured on eHealthSpace.org talking about how systems are the cause of waiting lists, not patients.
By Alan Spinks
As hospitals implement the four hour target for emergency admissions a question worth asking is why do queues form?
Is it excess demand, a mismatch between financial and operational plans, or poor resource utilisation?
It’s not patients that cause waiting lists, but organisational systems and processes. The path to eliminating waiting lists lies in changing how we think about patient flow and the type of data we employ to help us understand and plan demand.
The starting point is to view healthcare as one system and a hospital as a single integrated organisation, not as one building housing 1000 micro organisations.
By basing healthcare provision on referral-based activity and not true underlying demand, we (unwittingly) design the system to achieve queues. Queues ultimately result from a failure to understand the combined impact of variations in demand and variations in capacity.
Yet patient demand is very predictable and variations to the mean can also be forecast using accepted statistical models.
The key is to keep variations in demand to within an anticipated range at each step of the patient journey by improving the quality of processes. For example, treating discharge as an ongoing process and not an event, means take home medication demand is managed, avoiding last minute pharmacy delays which result in an extra night in hospital.
Such changes can only be introduced if hospital management and operational staff see the whole system from the patient’s perspective. Obtaining this information is illuminating on many levels. Mapping out the real patient journey for one stroke victim required input from people representing 54 different patient-facing roles.
Once patient flow is understood across each unit, overall demand can be planned so that, for example, the theatre activity at any given point of time we have corresponding bed capacity.
The key principle is that if we know demand, we can plan for it. By concentrating on improving quality to reduce variation in demand, we can reduce waiting times from existing resources.
Alan Spinks was a keynote speaker at the ‘Optimising Patient Flow’ conference in Sydney, 19-22 October. He has over 20 years of experience in health service transformation in the UK and New Zealand and is currently a clinical advisor to Emendo.
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