Hospital is a complex structure involving many departments both Clinical and NonClinical

Hospital is a complex structure involving many departments both Clinical and Non-Clinical. Doctor patient interaction does not just involve doctor and the patient, many other staffs, departments, process & procedures come into play. Each hospital or medical center has different system of functioning depending upon the population size it serves, specialties provided, space available, funding and regulations of the region.The focus of the discussion in this question is about the waiting room in the Outpatient clinics. Also if the Fee for Service has incentivized the waiting room culture. There appears to be different opinion regarding the waiting room requirement in the discussion. Traditionally, Fee for Service was the popular system of payment to Providers (Doctors & Hospitals). This system stressed more on quantity than quality as higher the number of patients & procedures performed, more the revenue to the Providers. There was unbundling of services which made healthcare costs more expensive. This system was more provider centric than patient centric. Pay by Procedure encourages overbooking patient visits so not a minute of the doctor’s time is wasted. The importance given here is for the doctor’s time and not for patient time. Hence the patients were kept waiting well beyond their scheduled appointments. A 2009 survey of 2.4million patients by Press Ganay Associated found an average waiting time of 22minutes. Shilling, G. (2016). Healthcare’s Waiting Room Problem. Available at: https://www.forbes.com [Accessed 22 Mar. 2019]. Pay by Procedure also leads to unnecessary investigations and procedures performed on the patients with financial burden on the insurance companies and government. If patients paid from their pocket it was burden on the patient.Waiting rooms formed almost part of every hospital structure. There are different types of waiting rooms in the hospital. Most of us consider waiting is a waste of time and waiting room experience in most of the hospitals is not so pleasant. Many a times waiting rooms are enforced upon, boring with chairs arranged in rows, magazines outdated that need replacement and TV channels running totally irrelevant programs, ignoring staffs and sitting uncomfortably alongside others who are ill becomes source of frustration and anxiety. Hence with the modern advancement in technology which is pervading every area including healthcare, the concept of excluding waiting room from the Outpatient clinics is attractive choice. The model of Value-based service is taking over the Fee for Service system. Patient receives more value for their time and money.Integrated Practice Units (IPU) are a structure for delivering care through highly coordinated, multidisciplinary teams, organized around a specific medical condition (or set of conditions) Chang, S. (2019). Nobody Wants a Waiting Room. Available at: https://www.catalyst.nejm.org [Accessed 21 Mar. 2019]. In this system there is a team work which takes care of patients from their hospital visit until the follow up. Here the patient need not pay separately for each service provided, they can pay once together for the package. Elimination of waiting room provides for proper utilization of space for other important hospital services. Chang, S. (2019). Nobody Wants a Waiting Room. Available at: https://www.catalyst.nejm.org [Accessed 21 Mar. 2019].The value-based model also includes covering most of the hospital services for the patients in single visit avoiding multiple visits. This system provides more control to the patient without providers losing complete control. In this system, instead of patient shuttling around the hospital, they will be assigned a patient care room where most of his/her needs are attended to. Doctors visit the patient care room which has all the equipment and supplies for patient examination. Rooms are also structured and equipped such that most of the specialties do not face any hurdles in patient examination.Upon entry into the hospital, patient and the accompanying family is assigned a room where the nurse records preliminary screening such as Blood Pressure, Pulse, height, weight and BMI. Other findings are also recorded as per the specialty requirement. Following which doctor visits the patient room and examines the patient. Care rooms are usually located close to the providers area so that traverse time is minimized. Rooms are also made for the patients to feel comfortable and at ease. If the patients and family visit earlier or later than their appointment time, they can use that time according to their choice, instead of being tied up in the waiting room with unpleasant/ unwanted experience. Some of the hospitals have come up with private and serene spaces, lounges with different chair arrangement for singles, couples and family groups. Learning libraries with books and literature providing information and education of different disease conditions, dietary advices, health tips are set up. Free Wi-Fi and plug ins for electronics are available so that people utilize their time in meaningful way. This gives patients and their families a better and less stressful experience in the clinics. In order for the patient care room to work efficiently, technology has to be used appropriately. There are chances that once the patient comes to the hospital and asked to go to assigned room, they may get lost on their way. The check-in and check-out of the patients need to be tracked for which proper coordination between the staff attending the patient in care rooms and reception desk is required. This can be addressed by using modern technologies such as RFID (Radio Frequency Identification), which gives real time location services for tracking of patients. Even the assistance can be provided by the concierge located on each floor with proper directions given on papers, passes, signage and labelling of floors and rooms. But today more and more institutions are moving towards paperless operations, therefore technology is the ideal option. Patients need not have to sit in the waiting room just to complete the registration process which can be completed later also. Virginia Masons Kirkland clinic has implemented above system and they have removed waiting rooms for their patients. Arriving patients are sent directly to an examination room thanks to hybrid RF-IR system that tracks the location of patients and staff members in real time and improves efficiency. Swedberg, C. (2009). At Virginia Mason Clinic, RFID Eliminates the Need to Wait. Available at: http://www.rfidjournal.com [Accessed 23 Mar. 2019]. Although elimination of waiting room seems to be an attractive choice as it gives many advantages like, team work, patient centric service, avoiding wastage of time and space, it has its own challenges. It involves challenging the existing traditional system wherein patients are sent to doctors’ consultation rooms, changing the mindset of patients & staff. There is always resistance when changes are implemented. To disentangle long held beliefs of people, understanding the true needs of the system and institutions resolve & commitment, role of technology, environment and people all have important role to play in the implementation of new solutions.The above model is yet to be studied completely to see how successful it turns out. Evolving changes in the disease patterns, new development in diagnosis and treatment and evolving payment mechanisms require the model to be more flexible and adaptable to sustain.