Emergency Department Wait Times are Down, but not Being Measured?


Here is a link to a story that caught my eye: “Wait times shrink in Brockton hospitals' emergency rooms.”

The good: “time spent waiting to see a doctor in emergency rooms at Brockton's hospitals is down, according to officials and patients.” Wait times used to be up to six hours. There was lots of room for improvement.

The head scratcher: “Quite honestly, I'm not measuring wait times right now,” said Dr. Richard Herman, chairman of emergency medicine at Good Samaritan.”

So, hmm, I guess gut feel tells them they are improving… but if you've designed new space and re-engineered processes and workflow, why wouldn't you have performance measures?

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Mark Graban
Mark Graban is an internationally-recognized consultant, author, and professional speaker, and podcaster with experience in healthcare, manufacturing, and startups. Mark's new book is The Mistakes That Make Us: Cultivating a Culture of Learning and Innovation. He is also the author of Measures of Success: React Less, Lead Better, Improve More, the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, and the anthology Practicing Lean. Mark is also a Senior Advisor to the technology company KaiNexus.


  1. Classic case of the old adage that still applies, “What is Measured Happens!” About 6 years ago my local hospital was bought out by a for-profit health system which made me wonder about how these new for-profits will do business in my community. Much to my surprise they redid the entire ER and more importantly they have a big board tracking wait times in the ER for the staff and the patients to see. Last time I was in the hospital their average wait time was down to 12 minutes—very impressive!

  2. It might be being informally measured, but not reported high up, because it is so low it isn’t an issue any more.

    We have heard that the New Zealand Department of Child Protection is no longer reporting to their CEO the number of children in state care without an allocated case worker , because the number went from around 3,000 to close to zero. The reforms they undertook meant in was not front page news any more, and moved onto something else (or alternatively, they got very good at hiding it).

    Emergency wait times should always be measured; however, if the hospital has bigger fish to fry, say cost problems or quality issues, then these should be the measures reported to the top.

  3. Sounds similar to the old quality vs cost argument from my manufacturing days.
    In the one hospital they are focusing on quality, and not so much cost. The cost here is the wait time for the patient, as most patients do look at their time as an expense. With modern competitive markets, the market/patients determine what their willing to spend, in this case it is the their wait time.
    On the flip side, in the second hospital they are focusing on cost not quality. They mention the use of hallways, which puts up a major flag for quality folks and the DOH.

    There is limited information on what makes the newly built ED state of the art…but it sounds like with 36 beds with a 60 person waiting room has built the wait time into the facility design. The ED at my hospital was built 4 years ago, with 36 beds and similar size wait room. We are moving towards a getting patients in and start processing up front in the process, then move patients back to an “internal” waiting room assuming they are stable. This opens up bed capacity, which is the top constraint, and helps avoid the risk of having critical patients in the waiting room. Now we have to look at investing capital to building an internal waiting room, so we don’t have these patients waiting in the hallways.

    I’m surprised that after spending $30M they didn’t consider buying some bed flow software, but if they don’t operate according to performance metrics then I can see why this wasn’t something to consider.


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