4 ambulances waiting in the hospital carpark
Is measurement about managing the symptom or the cause of delays?

Measuring hospital wait times

Understanding how hospital systems, both in terms of parts and wholes, are performing is an essential component for the better administration of effective operations management.

How we monitor and manage hospital performance can often seem opaque and appear to be generated from a black box that no-one understands.

Within hospitals, we use a multitude of IT systems, direct observation and proxy techniques to examine how a system or process is performing, and many organisations expend significant resources and effort to generate reports.

Measuring hospital wait times

Sometimes we are able to directly measure what we want to understand, such as the time from ambulance arrival to off-load and the way we may use proxy or secondary measures to provide visibility of a system’s performance at a meta-level.

High-performing organisations often break down large cumbersome processes rather than fixing, managing and monitoring at the micro-transactional level. In doing so, they avoid workarounds and addressing inefficiencies by trying to fix a whole system at the outcome level.

An example of this is the ‘four-hour ED wait’. Unlike its sub-measures (eg time to triage or time to treatment), the overall wait tells us more about the system as a whole rather than just the emergency department in isolation.

The ED wait target

The emergency department or ‘ED’ wait target as a performance measure was first introduced in the United Kingdom (UK) in the 1990s.

What became known as the four-hour wait or ED target was intended to manage, monitor and drive improvement to reduce over-grounding in the emergency departments of hospitals.

Although there has been some conjecture with regards to the success, mechanics and particulars of this performance measure over the years, it remains an excellent example of the use of secondary measures to monitor and manage system performance.

Applying ED wait targets

Many other countries have adopted, adapted and adjusted these ED wait targets, but it’s interesting to note how common many of the original measures remain (Australia and New Zealand provide two such examples).

Many hospitals, including private providers, share their performance and aggregate data with regards to how their systems are performing not only to improve their own performance, but also to benchmark and demonstrate to others about what can be achieved by applying these.

Issues to consider

When addressing the problem of achieving a minimum four-hour wait, we first need to understand what it takes to safely and effectively process different types of patients through various hospital departments.

For example, we need to consider how patients are booked in, how they physically move between care environments and how investigations are requested, undertaken and reviewed.

While we can’t measure them all, all of the time, we can look at refining and improving processes to improve our overarching goals.

In this sense, the saying that what we can measure is what matters, is true.

In other words, the team that actually delivers patient care can only focus on a limited number of things at one time. This means that defining and refining what the most important components of a system are is an important function of the hospital manager.

Your task

Consider how acute hospital and other departments interact, are led and come together to facilitate best patient care.

For example, how do labs, orderlies (porters) and other support departments directly or indirectly support achieving the four-hour wait target?

Conduct your own online search of information related to hospital wait targets and use the comments to share, compare and discuss your thoughts and findings with other learners.

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Hospital Operations: Improving Patient Experience

Deakin University

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