Wait Times Secret for Best in Province ED

Healthcare wait timesIf you want to achieve the best wait times in the province, you need to know your hourly wait times, in minutes.  Averages wait times, or wait times at specific times in the day, will not work.  You need to know how your department functions every hour, down to the minute. (We had the best time to physician initial assessment in 2013-2014 at <1.5 hr 90th percentile.)


Clinicians need a thermometer

Managers need an operations report

Board members need a budget

You need hourly wait times reports

Instantaneous Wait Times

To drive change, you need live data, like a thermometer.  Patients benefit when providers change their behaviour based on feedback from data about immediate circumstance.

Sure, yesterday’s information helps, if clinicians can remember what they did yesterday.  Invariably, horrendous cases or surges in volume stick out in our memories from yesterday.  The thousands of banal decisions made that truly impacted performance never get remembered.  They reside in the background of our thinking, safe from examination.

Change happens when data becomes available in the moment.  Hour by hour data can pinpoint who was working at a particular time and what care was being given.

Real time data allows leadership to query performance and address it immediately.

To get the best wait times in Ontario, we had to ask decision support to report hourly waits in minutes.  Hourly reporting supported, or corrected, hunches we had about when wait times lagged.  Once we had the right data, we could start trying creative solutions to improve.

Average Wait Times

‘Average’ causes pain and suffering.  Reporting averages in healthcare is like reporting the average number of parachutes required for passengers jumping out of a plane.

Average wait times, average patient volumes, and average provider work speed mean nothing to a patient standing in line with tearing chest pain.  Leaders should get a bit upset when they hear averages reported, or at the very least, ignore them.

What do you think?  When you ask about wait times, are you getting performance from the last quarter?  Are you asking for the right kind of data?

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(photo credit: carp.ca)

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We Serve Patients Because It Is Hard

moon speechIt’s easy to talk about customer service when patents are nice. Our real motivation surfaces when patients demand narcotics, CT scans, or useless antibiotics.  Patient threats, intimidation, and entitlement wear down the fiercest advocates of patient service.

Unless we commit to great service for our toughest customers, we will start to question whether any patients deserve our attention.

In the 1960’s race to the moon, John F. Kennedy said,

“We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too.”

Why bother?

1. Patients matter.

Nurses and doctors entered training to help patients.  Nearly 100 years ago, Peabody complained that new physicians relied too much on science and had lost “an interest in humanity”.  It’s been said recently that medicine has become “far more interested in diseases than the people who suffer from them” (A. Miles, 2009). Cassell’s classic book on medicine advocates for ‘person centred care’. “The Nature of Suffering and the Goals of Medicine (Oxford University Press, 1991, 2004).

2.  Great service improves outcomes.

Waiting kills patients; over 400 articles demonstrate increased morbidity and mortality from waiting, just in the ED.  Qualitative aspects of service are harder to measure, but things like patients’ trust in their providers improves outcomes, too.  Trust requires great patient service.

3. Medico legal claims drop.

Long waits increase the chance of being sued. Again, waits get reported because they can be measured more easily than qualitative experience.  Virgin media found customers more satisfied with polite service that didn’t fix a problem than rude service that did.


Some of us entered medicine thinking we would be textbooks of physiology, that we would have respect, and have grateful patients.  Instead, we trained in a field with ineradicable uncertainty, a society that leans toward general disrespect for all kinds of title and authority, and patients we often cannot help.

We choose to care for patients, not because it is easy, but because it is hard…

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(photo credit: rice.news.edu)

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Canada’s Hospitals, NOT Canada’s ERs, missing mark on waiting times, new statistics reveal – The Globe and Mail

The Globe and Mail missed the mark.  Hospitals, NOT Emergency Departments (EDs), leave patients in overcrowded EDs for nearly 30 hours before moving them to an inpatient bed.   EDs do not make admitted patients spend too long in the ED.  Hospitals do.  Hospitals could empty EDs of admitted patients at any time, if they wanted to.

Canada’s ERs missing mark on waiting times, new statistics reveal – The Globe and Mail.

Hospitals choose to leave 15 extra patients admitted in the ED; they could spread them out over all the inpatient wards.  Few hospitals enter the political battle of angering unions by placing extra patients on inpatient hallways, despite the nearly 400 articles published showing that mortality and morbidity increase for every hour admitted patients get warehoused in EDs.

Full Capacity Protocols empty EDs, have been used in Canada, and leave no excuse for exposing patients to the proven risks of long waits in the ED.

When will government change incentives so that hospitals start emptying EDs?


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