I had never heard the term “throughput” before a meeting at our hospital two years ago. It was used to discuss how the emergency department (ED) could yield greater profits by faster patient turnover. Coordinating various duties (including intake, admitting, and cleaning staff; lab and radiology; nurses and doctors) patients could be shuttled into and out of the ED earning the hospital $2 million more per year.
This strategy was implemented in our ED, but failed to maintain efficiency: Intake floundered obtaining vital signs; admitting incorrectly spelled names and entered wrong insurance information; the cleaning staff was not always available; blood tests were drawn erroneously; nurses were bogged down with expanded computer work; and doctors spent less time with patients. It is still a work in progress.
Faster turnover meant relegation of less interpersonal patient time, a greater tendency for mistakes, and the sacrifice of the most important element of healthcare: Quality.
“Throughput” is a tool used in business management and generally means “the maximum rate at which something can be processed in a given amount of time.” A good example is the drive-thru line at a fast food restaurant.
Having purged myself of adulterated artificial foods many years ago by reading labels, it is rare I find myself in a drive-thru line. Out of convenience though, it happens.
Our nonagenarian mother lives alone tending her garden and two cats. She is not able to do all household chores, so my brothers and I share specific duties assuring a semblance of cleanliness in her home.
One recent weekend, I prepared myself wearing old shoes and brown corduroy pants to clean, sweep, and dust. Since it was early, I decided to pick up breakfast at a nearby fast food restaurant, but the drive-thru line wrapped around the building. A line inside was also long, but my order was taken quickly, allowing 4 minutes and 35 seconds (yes there was a timer on my receipt!) to watch workers prepare meals.
It was like watching the LA Philharmonic with everyone moving in harmony. Workers in the back saw computerized orders with take-home containers lined up and filled, so magically I was on my way in less than 5 minutes! For those who have had their french fries forgotten, nothing was omitted from our two deluxe breakfasts.
For me though it was an uneasy adventure, but for my 94 year old mother who doesn’t read labels, it obviously has had no effect on her longevity.
As a doctor, I ask questions that provide clues to a patient’s problem. Driving to her home, my antennae were up when I smelled the whiff of styrofoam container emanating with the hot food.
Mom agreed the pancakes were very good, and the scrambled eggs not bad. It’s hard to ruin an English muffin, but the next clue was when a blotch of imitation butter landed on the nooks and crannies of my pants permanently removing the brown!
I liked the sausage, but an ominous confirmation of my reticence against this fast-food adventure was shortly revealed. With too much food on her plate, my mother placed a small piece of sausage next to one of her begging cats. He sniffed it, and ran away PDQ! Yikes!
Now, “throughput” is being applied in many other areas of our hospital. Is it good for patients when they are rushed through a conveyor belt of services to maximize profit? Even with our breakfast being provided quickly and efficiently, hospitals applying drive-thru techniques like “throughput” will effect quality.
In healthcare, patients should be treated like human beings, not like fast food take-out.
Gene Uzawa Dorio, M.D.
Charlie Chaplin’s film, “Modern Times”, shows him serially squeezing a large pair of pliers on an assembly-line. Every thing is predictably fine, if boring, until the pace increases and he is eventually carried away. That is happening to American medicine, as detailed in T.R. Reid’s book, “The Healing of America.”
I have just come out of the hospital having suffered an episonde of congestive heart failure. My experience during my stay has been clarified by this “drivethrough” article. It ewems clear that Gene, in writing this article is not bound by any choice of topic or limitation of space. You even show off your vast common culture vocabulary: “Yikkes!!!”
There is however the other side of the coin: No matter how much the institutions of hospitals throughout the country may try to squeeze the humanity out of the system so as to maximize profit, it seems that some doctors still manage to show their patients that their is a heartfelt interest that goes beyond their medical training or hospital pressures. Some doctors still manage to convey in their contact with patients within the limited allocated time the with just a fleeting eye contact, or in the touch of their hand when they listen to the beating of the patient’s heart that it is not just another mechanized extension of the computer keyboard that is pusheng them through the system requirements. With such simple gestures convey: “Hey, I really care whether you live or die!”
1. Thank you for writing this.
2. Drive-Thru Medicine is the step before “Drive-By” Medicine, because of lost time, accuracy, and money. In a word, the inmates have taken over the asylum:
MBA + JD > MD + JD.
3. Anyone in disagreement with these statements may want to read this book, The Healing of America, by T. R. Reid.
H. E. Butler III M.D., FACS
To help push these patients through the conveyor belt there is a horde of volunteers performing non specialized functions in hospital rooms. When will hospitals recruit unskilled volunteers to perform specific tasks that should require medical training? …Or is it happening now?
Yes, in healthcare patients should be treated as human beings.
Hospitals and doctors have to follow guidelines, and those guidelines are against the needs of the people to have clear and whole discussions and understanding. Do these guidelines come from health insurances for doctors? 20 minutes of consultation and you have to leave the doctor’s office. Hospitals are here to make money, big money. I hope something is going to change.
Unfortunately, this is what is happening in the whole country and with almost all healthcare delivery systems in the US. Add to this the burden of electronic records and having to satisfy arbitrary quality metrics such as PQRS (maybe next year XYZ or something), is taking time away from patients. National policy makers don’t seem to have any idea that patient care is suffering because of all these requirements that are being imposed on doctors and nurses. I’m not sure they even care as long as their balance sheets look good. I fail to see how spending endless hours documenting on your EHR is going to improve quality of health care delivery! We should be spending that time with patients. Healthcare workers have become glorified clerks and most of our time is now spent in front of computers, and not with patients. It is not surprising that quality of care suffers. This is not what I became a doctor for.