The Doctor Will See You Eventually: Long Wait Times Scrutinized

Megan Brooks

June 29, 2015

Across the United States there is large variability in how long Americans wait to see a healthcare professional, ranging from same-day service to several months, according to new report from the Institute of Medicine (IOM) released today.

Reducing wait times will take "systems-based approaches" akin to those applied successfully in other industries, the report says.

"Everyone would like to hear the words, 'How can we help you today?' when reaching out for health care assistance," Gary Kaplan, MD, chair of the Committee on Optimizing Scheduling in Health Care, which wrote the report, said in a news release.

"Health care that embraces this philosophy is patient- and family-centered and implements the knowledge of systems strategies for matching supply and demand. Care with this commitment is feasible and found in practice today, but it is not common. Our report lays out a road map to improve that," said Dr Kaplan, chairman and chief executive officer of Virginia Mason Health System in Washington state.

Fast-Track Report

The 2001 IOM report, Crossing the Quality Chasm: A New Health System for the 21st Century, identified six fundamental aims for healthcare — that it be safe, effective, patient-centered, efficient, equitable, and timely. Of these, "timeliness is in some ways the least well studied and understood," the IOM says.

The new report, Transforming Health Care Scheduling and Access: Getting to Now, aims to answer two questions: How can timely care be ensured in various healthcare settings, and what are some of the reasons that care is sometimes not timely?

While the "fast- track" report was prompted by months-long wait times uncovered recently at Veterans Affairs (VA) hospitals and commissioned by the VA, it focuses more broadly on the experiences and opportunities for improvement in the wider healthcare system.

The 137-page report finds wide variation across the country in provision of timely care and notes that long wait times to see a health provider have "multiple consequences" including negative effects on health outcomes, patient satisfaction, healthcare utilization, and the reputation of a healthcare organization.

Factors responsible for long wait times included mismatched supply and demand, the current provider-focused approach to scheduling, outmoded workforce and care supply models, priority-based queues, care complexity, reimbursement complexity, and financial and geographic barriers, the report notes.

The report outlines several "basic access principles" to curb wait times including supply and demand matching; immediate attention to the patient's needs and timing preference at the time of inquiry; need-tailored care with reliable, acceptable alternatives to clinician visit; surge contingencies to ensure timely care; and continuous assessment of changing needs.

"These systems-based approaches will require careful consideration of the full range of components and resources available in the interconnected health system," the IOM news release says.

National Leadership Essential

The report acknowledges that available evidence is "very limited on which to provide setting-specific guidance on care timeliness." It notes that "emerging best practices" have improved timely delivery of healthcare in some locations and "serve as promising bases for research, validation and implementation.

"Contrary to the notion that same-day service is not achievable in most sites, same-day options have been successfully employed through a variety of strategies," the IOM notes in its news release.

The report calls on national leadership to help spread and implement these basic access principles; launch coordinated federal initiatives; promote systems strategies in healthcare; and propose, test, and apply standards development. It asks professional societies and leaders of healthcare facilities to take a leadership role in applying systems approaches, and public and private payers to provide financial and other tools.

"There is a need for leadership at both the national level and at each health care facility for progress to be made in improving health care access, scheduling, and wait times," IOM President Victor Dzau, MD, said in the release.

"Although a lack of available scientific evidence hinders establishing specific standards for scheduling and wait times, systems strategies and case studies can help guide successful practices until more research is completed," he notes.

The report was sponsored by the US Department of Veteran Affairs.

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