Should Hospital Emergency Rooms Adopt the Managerial Techniques Found at Starbucks?

According to researchers at the Cambridge Health Alliance and Harvard Medical School, the median wait time in hospital emergency rooms increased 36% from 1997 to 2004, to an average of 30 minutes.

Particularly troubling, wait times more than doubled for heart attack patients. In 1997, 50% saw a doctor within eight minutes; in 2004 it took an average of 20 minutes. For 25% of heart attack patients, the wait time surpassed 50 minutes.

The study examined more than 90,000 emergency room visits. The authors believe overcrowding and patient bottlenecks are to blame. 12% of the 24-hour emergency departments closed during the seven-year study even as patient visits increased from 93 to 110 million.

A recent New York Times’ editorial was quick to point the finger at the nation’s uninsured, “Uninsured patients — and those who have no primary care doctor — flock to emergency rooms for routine coverage, clogging the system. Meanwhile, hospitals lose so much money dispensing charity care through emergency rooms that many collapse into bankruptcy or give up emergency care.”

Professor Linda Green
, Faculty Director at the Columbia Business School’s Healthcare and Pharmaceutical Management Program, believes journalists tend to oversimplify the problem.

In a recent interview with Jill Stoddard of Public Offering, a new blog from the Columbia Business School, Green notes that emergency room visits for both insured and uninsured are increasing as is the incidence of diabetes, heart disease and other chronic diseases.

In some cases, hospitals could cut wait times if they adopted the management techniques found in other industries. Says Green,

“Hospitals do try to adjust the number of physicians that are on call to accommodate patient flow — for example, they realize more patients show up at noon than at two in the morning. They just don’t do it very well because they don’t know how to do it very well. Most hospitals are not run by MBAs…Banks, supermarkets, airlines and call centers all use mathematical models. Hospitals don’t use these mathematical models so it’s not surprising that they don’t operate efficiently.”

For years now, Starbucks has been introducing strategies to reduce customer wait time. Silvia Peterson, the director of Starbucks operations engineering, heads up a team of 10 engineers who focus exclusively on the customer experience. Thanks to her innovations (bigger ice scoops, for example) it takes 30 seconds less to complete an order at Starbucks today versus five years ago.

According to Jim Alling, President of Starbucks in the U.S., “The customer doesn’t feel like he’s waiting in line. It’s like a ballet, a well-choreographed play.”

Studer Group is one of several health care consulting firms that offer ‘evidence-based’ tools to help organizations streamline operations. They offer their services to primary care practices that seek to improve patient access. Studer examines:

  • Demand (the volume of services sought by patients in the practice)
  • Backlog (requests for services waiting to be provided)
  • Lead-time (the length of time a patient has to wait for an appointment)
  • Cycle time (the number of minutes from check-in to checkout)
  • and Supply (the time available for providing patient care)

These measures form the core data around which an organization can develop improvement initiatives.

Similar data-based strategies could be adopted by emergency rooms if hospitals were to prioritize improvement. But, notes Green, this may not be likely, “It does take up a lot of time and energy from the hospital managers to keep the hospital afloat. Most hospitals are in financial straits — one third of them operate in the red, and they don’t focus on emergency rooms because it’s not where they make money.”

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