Across the Chasm Aim #4: Health Care Should Be Timely

Information for this feature story was obtained from the IHI Calls to Action series, Implementing the Quality Chasm Report.
Health care should happen promptly, for the sake of both patients and the health care providers. "We think waiting is defect," says Donald M. Berwick, MD, MPP, former President and Chief Executive Officer of the Institute for Healthcare Improvement and one of architects of the Institute of Medicine’s 2001 report, Crossing the Quality Chasm: A New Health System for the 21st Century. "At least non-instrumental waiting, waiting that no one intends or that doesn’t carry any information with it. So we’re asking for less waiting in our system — for both patients and those who give care — as a centralized characteristic of the system." Timeliness is one of the six "Aims for Improvement" in the groundbreaking Chasm report, which describes the immense divide between what we know to be good health care and the health care that people actually receive.
Nowadays most patients have to wait on the telephone, for appointments, in the doctor’s office, for test results. Waiting can take an emotional toll. At worst, it can be medically harmful. (A recent survey showed the average wait at crowded emergency departments in the United States was a full hour, and a third of all US emergency departments periodically have to divert ambulances to other facilities.) But patients are not the only ones burdened by long waits. For care providers, waits and delays often mean wasted time, lost continuity, and frustration.
In an ideal world, every patient would visit his doctor the same day he calls for an appointment. Care providers would be available via email to answer questions within a couple of hours. He would see the specialist to whom his doctor refers him within a few days. He would be transferred from one hospital unit to the next precisely when he is supposed to be. Fortunately, that ideal world is growing closer. Many organizations have shown it’s possible to change the system functions that have kept waits and delays a chronic part of the health care system.
For instance, open access scheduling has eliminated burdensome backlogs of appointments in many organizations, and each day’s schedule fills like a glass from the bottom up as patients begin to call. In settings ranging from office practices to emergency departments, smoother patient flow is relieving bottlenecks and promoting better care and greater continuity. "We need to free ourselves from the assumption that waiting is a necessary part of health care — it is not," says Roger Resar, MD, a Senior Fellow at the Institute for Healthcare Improvement. After all, when care happens is often just as important as the care itself.
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