IHI Touts Three Strategies for Reducing Delays
IHI Touts Three Strategies for Reducing Delays
To reduce delays and waiting times, the Institute for Healthcare Improvement recommends the following strategies for reducing delays in health care delivery systems:
1. Redesign the system.
This involves changing the processes that make up the system, making it more efficient and less prone to delay, without adding resources. Tasks traditionally done in sequence can be done concurrently, handoffs can be eliminated, tasks can be synchronized around a common reference point, and/or steps can be removed or rearranged. For example, patients in an emergency department (ED), instead of having to go through a triage/registration/rooming/nurse assessment/physician evaluation process for ordering X-rays, could see a triage nurse upon arrival if the ED redesigns its system. The nurse orders X-rays as needed, with results made available at the time of physician evaluation.
2. Shape the demand.
Rather than adding capacity, shaping demand can often reduce delays. Examples include:
• Extinguishing demand for ineffective care. Instead of automatically scheduling recheck appointments following an office visit for an acute problem, give the patient a reminder to phone after a predetermined time level to reevaluate need for the recheck.
• Substitute services. Provide the service in another location or in another way. For example, instead of scheduling individual appointments, offer group appointments for patients with hypertension.
• Reframe the need. Redefine needs so the customer no longer perceives a need for the service. For example, reduce the frequency of required camp physicals from every year to once every two years.
3. Match capacity to demand.
Sometimes, fairly simple changes can bring system capacity into alignment with demand. For example, a clinic with long waiting room waits assigns more of its physicians to those times when patient demand for urgent care is highest. Or a nursing unit with delays because admissions from the ED coincide with the time patients are being discharged from the unit redesigns the process so that discharge takes place before the busy admission time.
Source: Reducing Delays and Waiting Times Throughout the Healthcare System, a Breakthrough Series Guide from the Institute for Healthcare Improvement, 135 Francis St., Boston, MA 02215.
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