Queuing Theory investigates NHS waiting times

A blog by Dr Alex Komashie, Engineering Design CentreAlex Komashie

The average Brit spends over an hour a week engaged in the vexatious business of queuing. From the post office to the pub toilet, standing in line to wait a turn is a stoically accepted yet deeply frustrating part of daily life. But within a vast organisation like the NHS, queues are more than just irksome. They have huge knock-on effects on cost, efficiency, service delivery and patient satisfaction. And when it comes to meeting NHS targets, queues carry huge political and emotional clout.

There’s a century old scientific toolkit that explains the complex nature of how queues behave and how to manage them. Queuing Theory has already been successfully used in industries including telecommunication and traffic management. The healthcare industry has already employed it to improve bed occupancy rates and predict waiting times by calculating the properties of particular queues, plotting their path and simulating how changes in speed of service for example can impact on delivery of care.

Yet in a climate where NHS targets are under intense scrutiny and the spotlight is on the patient experience, an interesting and important question has emerged. How will the drive to cut waiting times impact on hospital staff in terms of their satisfaction and performance? 

The healthcare delivery process is traditionally thought of as being made up of two separate aspects of care; the patient side and the staff side. But we’re now exploring how policies or targets applied to one side of care without the full consideration of the implications for the other, may have significant unintended consequences.

We already know that improving the queuing experience results in more satisfied patients. However consider the flip side of cutting waiting times, which may put staff under increased pressure, decreasing their satisfaction by raising stress levels and ultimately compromising quality of care. Our approach has been motivated by the fact that the ideal of shaping healthcare provision around patients’ needs and preferences must recognise the demand this places on staff resources and the risk to quality when staff are stressed.

We are proposing to use Queueing Theory for the first time to investigate the effects of reduced waiting times on both patient and staff satisfaction levels. We aim to challenge the existing view, and to gain a better understanding of where the tipping point lies and how to avoid any unintended erosion of care. Our approach is just a start, but the way in which we have connected models of patient waiting and the use of staff time enables us to develop more sophisticated models that can be dropped in later on.

And our findings?  Well, it looks like there is a ‘sweet spot’ where staff are satisfied by the quality of the job they can do and the time it takes, and patients are satisfied that they are receiving timely care without being rushed through the process.

So what will a better understanding of the relationship between the satisfaction of staff and that of patients mean? The aim is to mould more realistic expectations of healthcare systems and their performance or non-performance. It should also make it possible to know the extent to which increasing patient satisfaction by cutting waiting times may be pursued in a system with limited resources.

Dr. Alexander Komashie is  Research Associate, Engineering Design Centre (EDC) University of Cambridge

If you want to know more, you can find the paper here An Integrated Model of Patient and Staff Satisfaction Using Queuing Theory Alexander Komashie, Ali Mousavi, P. John Clarkson, Terry Young)

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