Wait Time Reality Check
Applied insights from industrial engineering, psychology, and uncertainty management to improve patient satisfaction in an ambulatory surgery setting
Background
Background
Despite continuous focus on patient satisfaction scores and implementation of improvement initiatives within ambulatory surgery, one particular area persisted with low scores across the system: wait time prior to surgery and information about delays.
​
On the surface, these patient satisfaction scores should be the most straight forward to improve - just get surgeries started on time. What we found was surprising. Even when the child is taken to surgery on time, the parents still think the wait was too long, and that they were delayed.
​
A more holistic approach to the problem was needed, one incorporating statistical analysis, psychology, business philosophy, and uncertainty management.
Analysis Framework
Initial analysis indicated that many entrenched assumptions on surgical delays were inaccurate.
​
Further correlation analysis and literature review identified that these two patient satisfaction measures are driven by a business service framework in which perception and expectations must be equally measured with process actual results only indirectly impacting the outcome.
Satisfaction = Perception - Expectation
A new framework for analyzing ambulatory surgery data was developed to incorporate perception and expectations information through patient/family surveys. This data was paired with process cycle time data and analyzed for correlations. ​
​
Insights from this analysis illustrate why this patient satisfaction area was so hard to improve.
-
Patient/family definitions of a delay were not consistent. A family may say they expected to spend 30minutes in reception, but later indicated that they considered it a delay after 45 minutes.
-
Patient/family definitions of a delay were not aligned to what the surgical team had informed them to expect.
-
Perceived time waiting for surgery did not correlate to actual time spent waiting for surgery. The graph below illustrates this phenomenon:
Each patient surveyed appears as a single dot on the graph. If families perceive time exactly as the objective reality of the process occurred, all dots would fall along the diagonal line.
Most families perceived less time than actually occurred, indicating a favorable bias. In order to quantify this bias, the actual time was subtracted from the perceived time to generate a "Perceived-to-Actual" metric per family. We found that depending on the hospital, families perceived anywhere from 13 to 33 minutes less time waiting than actually occurred!
​
​Further, process capability analysis showed hospitals varied in their ability to meet family expectations for time spent waiting before surgery from 36 to 80%.
Appling Insights for Impact
Through this lens, analysis informed improvement recommendations within 3 categories:
Process
Goal: reduce pre-op time to indirectly impact perceptions
Recommendations: Traditional lean six sigma principles for waste reduction and value added activities. ​
-
Give families a realistic arrival time to reduce unnecessary waiting
-
Evaluate and align surgery length scheduled to actual times
-
Conduct a MUDA (waste) walk to find areas to streamline
Perception​
Goal: foster the favorable bias in perceived to actual time
Recommendations: Research indicates occupied time feels shorter than unoccupied time and anxiety increases the experienced length of a wait. ​
-
Reduce anxiety through engaging Child Life Specialists
-
Get families started on the pre-op process
-
Make toys available to occupy the child's time
Expectation
Goal: create realistic expectations for the day of surgery
Recommendations: When patients/families lose a sense of control in their experience, feelings of anxiety are magnified. Explained waits and explicit apologies preserve customers' sense of value. ​
-
Simplify and reiterate information on what to expect on the day of surgery
-
Provide wait time estimates that are above median (overestimate)
-
Explain delays directly
Using these recommendations, one hospital focused on improving patient and family perception, resulting in a statistically significant increase in favorable perception (perceiving less time than actual) and 8% improvement in meeting patient/family expectations for pre-surgical wait times.
This was achieved through:
-
Integrating Child Life Specialists into the pre-op process
-
Increasing volunteers in the reception area to act as readers and host activity cart experiences
-
Conducting empathy training with all staff to support more direct communication about delays
The Bottom Line
Since the institute of Medicine's 2001 report "Crossing the Quality Chasm," reducing patient exposure to process deficiencies that create additional suffering through unnecessary waits has been a major area of focus operationally.
​
In order to truly minimize patient suffering associated with waiting in healthcare settings, more than just process improvements need to be considered. Incorporating knowledge across industries will help providers and patients see eye-to-eye when it comes to patient expectations and satisfaction.
​
​