The healthcare solution concept

Situation

The healthcare sector is plagued by major capacity problems. This translates, primarily, into unsatisfactory wait-times for all parties.

In the absence of sufficient funding to increase capacity, healthcare professionals, driven by an extraordinary empathy for people in pain, work harder and harder and longer and longer hours.

Conventional productivity improvement projects focus, largely, on finding ways of processing patients faster. Although this does improve things, the improvement is far from enough to deal with the demand overflow.

The simple secret to maximising productivity in healthcare

The secret to productivity improvement in healthcare is to
give priority access to scarce resources to those who really need it.

In this simple secret lies massive opportunity for improvement in all aspects of healthcare.

Sadly, most people think that it's so simple and obvious that they must be doing it already. They very seldom are.

The difficulty is in determining who really needs the scarce resource and who doesn't. Because it's so hard to tell before the event, a very high percentage of the patients that make use of scarce resources, turn out not having needed to do so.

For example, in orthopaedic follow-up clinics, patients are followed up a week and then two weeks after surgery, to ensure that should further intervention be necessary, it can be made in a timely manner.

A high percentage of these patients end up not needing intervention at all - but, because "you can't know until you know", these patients end up using orthopaedic specialist time that could be better used by patients on the national waiting list.

The difficulty lies in working out, in advance, who is going to need specialist attention and who isn't - without increasing the risk unacceptably for those who don't seem to need that attention, but who actually do.

The systemic productivity solution

The systemic productivity solution is

To sub-stream patients based on their profiles
and the symptoms they are exhibiting.

A critical element in this solution is to re-stream patients by exception. In other words, it must be easy to escalate a patient to a higher level of care should key symptoms surface.

Doing it already? Probably, to some extent. Room for doing it better? Oh yes!

In the orthopaedic clinic example above, the idea is to identify key indicators (nature of the operation, clinical condition, symptoms experienced etc) and direct the patient for follow-up to an appropriately skilled clinician.

This clinician would only be an orthopaedic surgeon if needed.

In many instances the expertise of an Orthopaedic Nurse, Orthopaedic Registrar or GP would be more than adequate, with the aid of some clear symptoms to look out for.

This reduces unnecessary demand on orthopaedic surgeons and enables them to spend that time more profitably - seeing, operating on and treating patients that really need their level of expertise.

The challenge

The challenge for healthcare professionals is to recognise the safety factor built into current streaming practices.

This safety factor is typically of the order of 80:20 - i.e. 80% of the patients that pass through any limited resource could have been equally well treated by a lower order resource.

This safety factor is commendable and reflects the professional's commitment to each individual patient's interests. Unfortunately there is a (not so) hidden cost to this commitment - delayed intervention for many others that really do need access to the limited resource. This is evident in the length of the national waiting list and full waiting rooms.

In order to reduce those wait-times, healthcare professionals need to have enough confidence in the re-streaming system to sub-stream patients in the first place.

It's relying on this system that most healthcare professionals find challenging - and it's only when they see the cost (in terms of delayed intervention for those to whom their expertise is critical) that they are able to bring themselves to do so.

Application

The patient sub-streaming solution can be applied to a whole host of areas within healthcare:

Multi-process patient visit durations can be reduced dramatically, by processing patients at each resource in visit time order, rather than in local queue arrival time order.
Theatre utilisation can be optimised by prepping patients outside of the theatre and wheeling them through for surgery at the last minute.
National waiting lists can be decimated by driving general principles in specialist fields out into the fringes of the health system, thereby filtering and preparing patients before they reach the specialist.
Capacity can be created in GP and emergency facilities by providing general guidelines for selecting between self-treatment and professional treatment.
Diagnostic streaming policies can be trained into front-line ambulance staff in large cities, to enable them to treat or filter out patients that don't need to make use of scarce resources.
Telephone support services and national media (television, radio and leaflet) awareness campaigns can be used to provide basic streaming advice, based on key symptoms.

Sub-streaming, properly done, doesn't increase the risk of delaying intervention, it reduces it, by giving those that need it urgently priority access to it - and those that don't, access to the level of care they need.