The healthcare industry has been described as “the most complex endeavor on the planet.”
It is hard to say this definitively, but there is certainly an element of truth to the sentiment. As professionals who work in the industry – and as patients who consume its services – we have all come to understand the complexities of healthcare. One of our most important roles as leaders is to simplify it, both for our staff and caregivers, as well as for the benefit and understanding of our customers, patients and their families.
We can begin to simplify healthcare by treating it as we do most problems that need solving – instead of treating the symptoms, go deeper with a root cause analysis. At the center of that analysis, you will find that much of our industry’s decision-making revolves around the concept of time. Henry David Thoreau said, “The price of anything is the amount of time you exchange for it.” Time is the universal value, so it demands our attention. It demands it in two perspectives within our operational healthcare processes; time spent waiting and time spent with.
A decade ago, while serving as chief operating officer for a health system, I inherited a deeply dysfunctional emergency department (ED). After several failed attempts to fix it, we began internally asking the question, “why do patients come to the ED?” The initial responses were complicated and very clinical in their articulation. Finally, one of the front-line managers hesitantly offered, “to see a doctor.” A simple, but ultimately correct assessment. We then organized everything – from our approach to our ultimate decision-making – around that one objective. Gone were the multiple priorities and performance metrics. Gone were the ambiguous and anecdotal quality goals. I asked no question for almost eighteen months except, “what is our ‘door to doctor’ time today?” Soon after, the entire process, both inside and outside of the ED, had been mapped out with previously unparalleled clarity.
This change in our collective thought process led to changes in the staffing schedules of housekeeping, (previously it was unrelated to the actual flow of patients needing beds, but a typical 9-5 approach), to how x-rays were tracked and sequenced to be read by the radiologists (previously time tracking didn’t even begin in the ED). Every aspect of our process was scrutinized for its effect on “time to doctor,” and eventually “time to departure” (either resulting in an admission or in discharge to home) as well.
The result on time spent waiting was dramatic and sustained, and when we analyzed all previous measures, from staffing efficiency to patient experience; they also improved significantly. This singular focus acted as a forcing function, assuring a clear goal for staff that made intuitive sense, a process orientation with the patient at the center, and efficiency that was a natural outcome.
However, I don’t think we achieved the complete result. Time spent waiting is a necessary but insufficient condition for success in healthcare. Ours is a relational business, and relationships require time. As process designers, our next goal must be to increase and optimize time spent with patients. Quality time, where we can better understand the whole person, listen for the said and unsaid, and perhaps allow for love and compassion to color the experience (for both the caregiver and patient). This is blending of art and science – of the tangible and intangible. There can be no question that the person-to-person interaction is art, where the magic of medicine becomes, at least, possible. This must be supported by good science, and strong, efficient processes.
It is with a relentless focus on time patients spend waiting to see a care team in relation to time spent with said care team that we can and must simplify our organizations, sustain the morale of our care givers, and serve our customers – and in turn, our communities – most meaningfully.
Brian Paradis is a senior partner at CSuite Solutions, a strategic advisory firm serving health system leaders across the U.S. Most recently, Paradis served as President of Florida Hospital’s Central Region and as the Chief Financial Officer for the Florida Division of Adventist Health Systems.