“Waiting sounds like a peculiar subject but it has a lot of ramifications for business,” says Dr Tezcan. “I got interested in the subject of waiting while working with UPS customer contact centres. Now I analyse hospitals. The underlying services are very different but the operational principles are the same. I quickly realised that it is not just about scarcity of resources that causes waiting in hospitals; there is also a structural problem in the system.”
The elements of waiting
There are three variables at play in waiting, whether in a coffee shop or a hospital waiting room.
Variability – the different times people arrive at ED varies, clustering into peak times and quiet spells. For example, Saturday nights are often extremely busy time for emergency services. And once a few long waits have been recorded they really drag the average wait time down, especially if a ward goes on to serve only a few patients at quiet times. Also, each patient’s condition can vary, with one requiring a few stitches while another may need a series of tests to reach a diagnosis.
Utilisation – the amount a resource is used for the time it is available. Managers want to maximise how much a resource is used, but reaching 100% will result in queues because there is no slack to deal with the variability in patients’ arrival times and case complexity.
Capacity – the amount of resources available to meet demand. Increasing capacity (for example hiring more doctors or adding beds) is the most powerful way of tackling waiting times, but typically this is the most expensive solution.
Most people attribute delays in accessing healthcare to insufficient capacity. Although upping investment in capacity would provide a solution, the sums would be stratospheric and it would be hugely inefficient, according to Dr Tezcan. On the flipside, investing huge amounts to alleviate delays at peak times would lead to facilities being underused at quieter times. A solution is a trade-off between those idle times and periods where some patients have to wait. Simply increasing capacity is not enough.
How business deals with waiting
Businesses have identified effective ways to handle this efficiency-delay trade-off and developed novel strategies that tackle the three variables in different ways. At FedEx, when a plane comes in loaded with packages, a team is ready to make sure the “unproductive” time the aircraft spends on the ground is minimised. The packages are organised into fuselage-shaped crates, speeding up the time on the ground through standardised processes. Variability for a firm like FedEx might include differently packed planes arriving at different times.
FedEx knows exactly when the plane is going to land and what needs to be done to put it back in the air. The company can calculate the cost of keeping planes grounded when sorting packages and compare this to the amount needed to hire additional people and equipment to better manage the capacity-waiting time trade off.
At Disney World, managers have tackled waiting times for rides by allocating express tickets, creating fixed appointments for visitors to go on popular rides. In both the FedEx and Disney cases, they have managed fixed capacity by controlling the variability. Disney doesn’t want everyone turning up straight after lunch or whenever they feel like it – leading to long queues.