Patients’ Patience for Care Is Shrinking

ENCINO —  In today’s rapid-fire economy, you can get new glasses in about an hour, get your oil changed in 15 minutes or get a meal on the run faster than you can say “Pass the McNuggets.”

But for many people, a trip to the doctor or the emergency room means long, frustrating waits and “down time” that can stretch on for hours.

I consider myself a fairly patient person--after all, I have a toddler.

Yet when gnawing abdominal pains sent me scurrying to the doctor last week--first to my HMO’s urgent care clinic in North Hollywood and from there to the emergency room at Encino Hospital--I found my endurance in the waiting room diminishing as the spasms in my tummy increased.

Months ago, the pain was a minor annoyance, and not worth missing a day of work, I felt. It turns out I’m not the only one who thinks that way.

Leery of taking too much time off the job, a growing segment of the American work force is putting off medical care until their problems become severe, medical researchers said.

“That happens every day,” said Maureen Bisognano, executive vice president of the Boston-based Institute for Healthcare Improvement. “And it is increasing as people’s tolerance for waiting diminishes.”

Recognizing that lengthy physician wait times mean not only inferior patient care but also wasted time from a business standpoint, a number of organizations--from General Motors to the Institute for Healthcare Improvement--are tackling the issue with an eye toward speeding up the process.

“Waits are really a key issue for us,” said Neil Romanoff, vice president of medical affairs for Cedars-Sinai Medical Center in Los Angeles, which is one of about three dozen health care facilities nationwide working with GM to improve patient wait times. “It’s a waste from the point of view of the employer and us.”

Nationwide, health care officials said, the issue of patient delays is slowly moving higher on the health care radar screen.

Through a combination of staffing improvements and incorporating some of the same principles that have boosted production on the assembly line, some physicians groups have made dramatic strides in cutting wait times and improving patient flow, said Bisognano, whose 8-year-old organization aims to “help to improve the quality and value of the health care system.”

“We have a number of physician practices that are working to re-engineer their whole practice,” said Bisognano, whose organization began focusing on the issue three years ago. “And waiting time is the first issue they’re tackling.”

Neither Bisognano nor spokespersons for two other national organizations that track health care issues could site statistics on how wait times, both in the doctor’s office and the ER, have changed over time.

“But I do know they’re still way too long,” Bisognano said.

In 1997, the most recent data available, the nationwide average time spent in an emergency room was just over two hours, according to patient satisfaction surveys done by Press, Ganey Associates Inc., a South Bend, Ind., firm that studies patient attitudes for its 1,200 clients. That included time spent waiting for the physician and treatment.

The average wait time in a physician’s office is under half an hour, said Dennis Kaldenberg, director of research and development for Press, Ganey. That includes about 17 minutes in the waiting room and an additional 12 minutes waiting in the examining room.

The waits I encountered last week were somewhat longer than the national norms (nearly five hours to make it through both facilities), but far less than the horror stories one often hears when discussing health care.

And even though the times were not outrageous, as 11:15 a.m. slowly became 3:50 p.m., I could not help but feel that the health care system was chewing up my day as gastric acids were chewing up my stomach.

Officials at Encino Hospital said patients with non-life-threatening emergencies routinely wait up to 25 minutes in the lobby and another 15 minutes inside the examining room before seeing a doctor.

During my visit, two preceding emergencies commanded the attention of the lone physician on duty, pushing my wait-to-see-the-doctor time closer to an hour.

Mark Bell, associate director of emergency services at Encino Hospital, which is owned by Tenet California HealthSystem, said he feels the emergency room’s wait times are not a problem, noting that care is immediate for life-threatening ailments.

He also said that the hospital’s wait times are short compared to local competitors.

“That’s one of our big pitches . . . it’s something that we’re very much marketing.”

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Today, the focus on wait times is moving beyond the medical community.

Romanoff said Cedars-Sinai is one of 40 health care facilities around the nation, and the only one in Southern California, selected by General Motors to focus on all issues of medical waste, including wasted time.

“The reason they got into this was because of the incredible amount of money that GM spends on health care across the country,” said Romanoff, noting that a number of GM retirees who are Cedars’ patients were once employed at the massive former GM plant in Panorama City.

Employing some of the same engineering techniques used to improve efficiency in manufacturing plants, Romanoff said his hospital and others are working with GM to “improve the process” in a number of areas.

For example, he said that within the past few months the hospital has improved the flow for surgical admissions and cardiology patients moving from the ER to intensive care.

“Excess time is a waste,” Romanoff said. “It’s a waste in starting treatment, it’s a waste in somebody going back to work.”

Frustration over wait times, either actual or anticipated, routinely causes would-be patients to alter their plans, health care insiders said.

Back in 1993, before it tightened up procedures, the Olive View-UCLA Medical Center in Sylmar was averaging 400 ER patient walkouts a month. That’s right--ill patients who were sick of hours-long waits simply were walking away in frustration, according to Vena Ricketts, associate chief of Olive View’s emergency medical department.

Today, she said, the number has dropped to about 100, a “significant decrease,” due at least in part to a big drop in patient waiting times.

Ricketts said that as of July, the average time patients spent in the ER was five hours, down from ER stays of up to eight hours in 1993, she said.

She, too, said it was an issue the hospital is working to improve.

With health care margins shrinking, and competition for customers / clients / patients increasing, observers within and outside the health care industry predict that the issue of patient waiting times will take on increasing importance.

“The average patient is becoming more consumer-oriented,” said Irwin Press, president of Press, Ganey Associates. “And they’re viewing health care as a commodity, where service is key. Patients are consumers and they’re starting to act more like consumers.

“With increasing consumer orientation, I would expect you’d find increasing dissatisfaction with waiting times.”