Most of us know the frustration of rushing to the hospital for urgent care, only to wait hours to see a doctor. It’s a big problem for hospital administrators and medical teams too: how can they handle huge patient loads efficiently, without compromising care?
At the heart of it, this might be an operations management problem, say Rotman professors Opher Baron and Dmitry Krass.
“The questions that most hospitals are asking, like ‘Why are there such long wait times?’ and ‘How can we relieve bottlenecks?’ are essentially about operations management,” explains Krass.
When one of his former students approached him about an opportunity to work with and study the emergency department at Southlake Regional Health Centre — a 45-minute drive from Toronto — Krass, Baron and PhD student Tianshu Lu jumped at the opportunity.
At Southlake, the emergency care team, led by Dr. Marco Duic, had implemented a series of patient flow and design improvements aimed at reducing the time patients spent waiting to see a doctor — also known as the time to physician initial assessment or TPIA.
The clinical team had observed what appeared to be significant reductions in TPIA.
They were curious to see whether in-depth data analysis could verify whether these recent process improvements, rather than other external factors, were responsible for reductions in wait times. They also wanted to learn more about how these reduced wait times might impact other performance measures for the hospital, including the length of a patient’s stay.
“The questions that most hospitals are asking are essentially about operations management.”
—Dmitry Krass, Professor, Operations Management and Statistics
Krass, who is interested in predictive analysis and operational effectiveness, and Baron, who built much of his academic career exploring queueing theory, were the ideal researchers to examine and analyze the inner workings of the hospital’s emergency department.
For this project, the researchers examined changes in response to specific adjustments that Southlake had made in its emergency department, which included removing the department’s pre-waiting area, adjusting physician scheduling to account for differing work speeds, hiring patient navigators to handle administrative work and assigning patients to physicians in an ordered way. More specifically, they looked at whether these changes impacted TPIA, the volume of patients seen and length of stay, among other performance indicators.
Interestingly, the researchers found that these improvements — some of which might not have been obvious to patients — made a big difference in reducing initial patient wait times.
“When we accounted for all the factors and examined all the changes the department had instituted, the improvements in reducing initial wait times were real,” explains Krass.
Additionally, the researchers found a significant reduction in the number of patients that left the facility without being seen — an important healthcare performance indicator. Importantly, these improvements were achieved in spite of significant growth in patient volumes at Southlake.
“The next big challenge in healthcare operations management: how do we reduce wait times?”
—Opher Baron, Professor, Operations Management and Statistics
However, other indicators — such as the total length of stay for patients who required extensive care — remained unchanged or were not significantly impacted.
“It could be that these factors are beyond an emergency department’s control,” explains Baron. “But the confirmed improvements in wait times should make us think about other changes we could make across healthcare operations.”
Now, the researchers intend to further explore the impact of Southlake’s emergency care redesign — and publish academic papers about their findings.
“We’re really interested in finding out exactly what is driving the improvements at Southlake,” says PhD student Tianshu Lu, who completed much of the statistical modeling work for this project. Next, Lu plans on developing a theoretical model that examines the payment structure for physicians and how this system might influence the pacing and volume of patients they see during shifts.
“It could give us clues as to how to structure physician payments and scheduling,” he adds.
This work has also caught the attention of other Toronto-area hospitals and Baron, Krass and Lu have been invited to visit and potentially study other emergency care units. They are looking forward to the work ahead.
“Now it’s a matter of changing the culture and getting hospitals to think differently about their processes and how they provide care,” he says. “This might be the most meaningful work that I’ve ever done.”
Written by Rebecca Cheung | More Rotman Insights »