Monday, 30 December 2013

Journalists investigate Beijing hospitals new appointment system - and find it will never work well

translation by Michael Woodhead

Journalists from China's "Health News" have investigated Beijing hospitals' new appointment system introduced four months ago - and found that patients still face long and variable waits to be seen and probably always will unless a gatekeeper system is introduced.

Reporter Liu Zhenni and colleagues evaluated the new appointment system that has replaced the notorious "take a number" system that often meant patients and their families had to queue up for long periods in the early morning to get a registration number and then face additional waits until their number came up.
Under the new system patients can call a 114 number and get a registration number and 'appointment time' over the phone instead of having to queue up in person. However, when the reporters investigated the actual working of the system, they found that patients faced long delays despite arriving at the hospital at the nominated 'appointment' time. In one instance a woman who was given an appointment time of 8am at the Beijing Maternity Hospital outpatients clinic was not actually seen until 9.40am. Under the new system, patient are given an SMS reminder for the time to arrive at the hospital, but these did not reflect the time the patient would actually seen.
On speaking to hospital staff, the reporters found that waiting time varied considerably depending on the daily situation in the clinic, with factors such as patient numbers and illness type affecting waiting times for other patients.
Altogether, six hospitals have adopted the new system, and some had better performance times than others. At the Beijing Third Hospital the SMS reminder gave an 'estimated' appointment time of  1-2pm. The actual time seen was 2.30pm. At a gynecology clinic the suggested time was 2.45pm to 4pm, and the patient was actually seen at 3.15pm.

However, the appointment system is still better than the old 'take a number and wait' system. At the Dongzhimen Hospital which still uses the old system, the journalist arrived at 8am to queue for a number, and was not able to get one until 11am. He eventually was able to see a doctor at 11.30am -  a total wait of  3.5 hours.
At the Meitan Hospital, Dr Zheng Shanhai told reporters it would be very difficult to achieve an accurate appointment time service under the current Chinese system of seeing patients directly in hospital regardless of grading of disease severity. Dr Zheng said some other countries had a 'gatekeeper' healthcare system in which patients were first seen in community clinics and only referred to higher grade hospitals or specialist centres if they could not be treated locally. This allowed health services to predict patient numbers  and also to plan for demand and thus give accurate times for appointments. However, in the Chinese health system, doctors working in the hospital system had to be prepared to see large numbers of undifferentiated patients, said Dr Zheng. This meant that much of their time was taken up with treating minor illness, forcing patients with more serious illness to endure long waits. He likened it to catching a public bus at rush hour and having to wait in a traffic jam - under such a system it was difficult if not impossible to give an accurate estimation of the arrival time.

In the article, journalists said patients deserved to be given some idea of how long they might need to wait under the new system rather than being kept 'in the dark', but hospitals offered no information or suggestions of possible delay times. A staff member of the new 114 phone appointment system said appointment time-slots were generated by an automated system and the actual waiting time and consultation time-slot would be decided by staff in the clinics, according to 'on the ground' realities.
The journalists asked why hospitals could not provide estimated waiting times to patients, based on past experience and patient numbers. For example, if consultation times averaged 10 minutes and there were 100 patients, then it should be possible to give patients an estimated consultation timeslot according to their place in the sequence.
However, a Dr Xu at Tongren Hospital said there was no such thing as 'average' consultation time because times varied according to the patient's condition and staff availability. Hospitals were faced with an unequal and unpredictable 'supply and demand' situation, he said. It would only be possible to give an accurate appointment time if consultation times and patient numbers were strictly  controlled - and this was not the case under China's current healthcare system. With rising demand for health services it would mean patients being asked to wait weeks or even months for an appointment.
A spokeswoman for the Beijing Health Department said the new system had only been operating for four months and it was still in the initial stages of implementation. Although it had aimed to give patients a consultation time-slot within half an hour of the suggested appointment time, it was not possible for hospitals to achieve such precise waiting and treatment times in the early stages, she said.
Source: Health News

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