“The wait”: Healthcare’s big miss

If you’ve ever sought medical attention, there’s nearly a 100% chance you also had to wait. There’s also nearly 100% chance you felt that wait was too long, unsatisfying and you had a poor experience. The waiting experience might be one of the most dreaded parts of healthcare. Granted it depends on the context, the region and other nuances but in general, it’s easy to argue that healthcare has broadly neglected the waiting experience. Some institutions have done better than others undoubtedly but overall, this represents a massive opportunity yet a rare focus especially in the design of new clinical spaces and processes.

In this post, we’ll discuss the following:

  1. The challenges related to waiting in healthcare
  2. How we can think approach solutions to improve the waiting experience

What’s challenging about waiting in healthcare?

It’s true that waiting in healthcare isn’t quite the same as waiting in line to speak with a customer service representative. Prioritization for most businesses is simply first come first serve which really eliminates any issues of fairness (more on that in a bit). No one is acutely ill and the complexity of the situation is certainly less than it is in healthcare. Let’s consider a few reasons why waiting in healthcare is so challenging, with a focus on the emergency department (ED). The ED is the quintessential wait in healthcare where people spend long periods clouded by uncertainty. Here’s a list of several evidence-based themes for why the waits in healthcare (especially the ED) feel so long:

  1. Wait times are uncertain – arriving in the ED, in most places, its completely unknown to the patient how long they’ll wait
  2. Patients are in pain – not only do patients wait, they often do so in some degree of discomfort. The pain and potential anxiety compounds the distress we experience when waiting and makes time feel even longer.
  3. Perceived inequity – After waiting a few hours in the ED, its possible others will go before you and it seems completely arbitrary. This seems VERY unfair. It’s not, I promise, as someone who works in the ED, but the inherent lack of transparency makes the wait feel longer
  4. A lack of understanding regarding waits – unexplained wait times feel longer than waits where you know and understand exactly what you’re waiting for. It’s difficult to explain to everyone exactly what’s happening (often linked patient confidentiality reasons) but it doesn’t diminish the fact the wait can feel long
  5. Diagnostic uncertainty – uncertainty about your condition makes any wait feel longer than a wait where you know exactly what’s going on.
  6. Perceived value – for those who have “simple” problems (e.g. ankle sprain, prescription renewal), its less tolerable to have longer waits than those with more complex issues. Unfortunately it doesn’t work that way in healthcare. In fact, often patients with higher complexity (mostly higher acuity) are seen first.

While much can be said about actually reducing the wait times, separate efforts should be dedicated on improving the experience. Intuitively, longer waits should result in lower satisfaction scores, but this simplistic view neglects the emotion tied to waiting. In fact, actual wait times are not linked with how patients rate their visit (1). Rather, it’s all about perception.

Does waiting matter to the clinical teams? Yes. It should.

Violence towards clinicians is increasing and wait times are a key factor identified in multiple studies. (2) While there is controversy about how much the waiting experience is linked to violence, the waiting experience and violence towards clinical teams seem to be inextricably tied. Interestingly, most interventions to deal with emergency department violence don’t focus on waits but rather try to manage the behaviors and characteristics of individual patients. (2)

“surprisingly there is little attention paid in the literature

to environmental prevention or queue management” (2)

This people-focused approach is fraught with problems. This is akin to trying to improve automobile safety by asking people to drive more carefully rather than installing seatbelts in all cars. The design of the environment (and the wait therein) is closely linked to the patient experience and the likelihood for violence. Expecting improvement without a systems- and environmental-based focus is completely unreasonable.

Rather multi-pronged interventions that include environmental alterations (enhanced information, signage etc) along with patient-oriented components (e.g. team members exclusively dedicated to help guide the patient through the experience) substantially reduced violence rates by >50%! (3, 4)

Optimizing the healthcare waiting experience

It’s clear there isn’t a single solution that will suddenly eliminate all issues related to the waiting experience in healthcare. There are however several components that, when applied, increase the probability of success. Importantly, there requires customization to ensure the solutions work for the proposed environment. What works in a clinic may not work in the ED (and vice versa).

  1. Co-design the waiting experience with clinical teams, patients and families

There are several issues that exist in the design of the healthcare waiting experience but first and foremost, the person who is doing the waiting (aka the patient) is virtually NEVER involved in providing input on the waiting experience. Now, admittedly we don’t need to involve all patients, all the time to co-design a waiting experience especially given the breadth of understanding we have on the psychology of waiting. We know very well from other industries what makes waits feel longer and what makes waits feel shorter. But to neglect the human experience in the design of this process is mindboggling at best.

  1. Integrate evidence-based waiting principles

The design of waiting environments should incorporate well established principles linked to the psychology of waiting.

  • Be transparent – let patients know the approximate wait time. We worry far too often about being wrong and as a result, we elect not to provide any time frame at all. This results in frustration among patients and risks verbal (and sometimes physical abuse) towards staff. Use conservative estimates, but provide an estimated wait time. Think of the last time you were on the phone waiting to speak with a customer service representative, its fare more palatable when provided with a time estimate.
  • Explain the process – We must acknowledge that we won’t always be able to deliver “fair” waits when some people are sicker than others. But it’s critical to ensure that patients understand this. It might mean signage or perhaps waiting room attendants who can help answer questions and provide meaningful updates
  • Keep people occupied – Unoccupied time feels longer than occupied time. Develop solutions that mitigate this. (e.g. TVs, smartphone updates, moving through a space)
  • Provide updates about the waiting process – let people know that there are suddenly 3 critically ill patients who just arrived, or that 5 people are in front of them for the CT scan. This promotes understanding and respect for the patient
  • Provide comfort – waiting when you’re comfortable is far easier than if you’re uncomfortable. This might mean staff attending to those in pain/discomfort or even small provisions like food/drink.

Source: https://wlmedia.co.uk/design-reducing-violence-nhs/

  1. Prototype ideas

While it’s a subtle distinction but we should move away from “pilot” testing since this implies an end-state solution. Rather, we should prototype solutions in both simulated and real-time environments. By labelling solutions as prototypes it conveys an iterative process.

  1. Develop multi-pronged solutions

It’s extremely unlikely that a single solution will suddenly bring the waiting experience from a 0/10 to 10/10. This is a complex issue that requires multiple strategies from various angles to improve. Begin the process of re-designing the waiting experience with the knowledge that several strategies will be required.

Summary

Waiting in healthcare is inevitable but it doesn’t need to be painful. Looking forward, the waiting experience requires a massive overhaul led by end-users (both patients and clinicians). A co-design process, using evidence-based strategies, iteratively prototyped will translate to better and safer care for everyone involved.

It’s time we built healthcare waiting environments that promote calm and healing instead of frustration.

References:

  1. https://www.annemergmed.com/article/S0196-0644(13)00723-3/fulltext
  2. https://pubmed.ncbi.nlm.nih.gov/34032010/
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6731840/
  4. https://www.designcouncil.org.uk/what-we-do/social-innovation/reducing-violence-and-aggression-ae
Share on facebook
Share on twitter
Share on linkedin
Share on email