Emergency departments are the gateway to hospitals, and thus, reducing waiting times is a fundamental pillar for both public and private healthcare providers. Quick and effective care is crucial for patients to feel comfortable and well looked after.
Each individual and each health condition must be treated uniquely, as some patients require tests, others just need a consultation, while some may need prolonged observation for hours or even days. The severity of each case must also be considered.
Nevertheless, hospitals focus on the duration it takes for individuals with health issues to register, undergo triage, and see a doctor for the first time.
The primary goal of the patient is to see a doctor as quickly as possible, prompting healthcare management to explore various strategies to encourage professionals to see more patients during their shifts.
One approach is to add an incentive per patient seen to their regular monthly salary. In this way, the more patients doctors see, the more income they earn.
Mario Miranda, a physician in Emergencies at the QuirónSalud Hospital in Madrid, discussed with Redacción Médica the financial incentives implemented at this health center aimed at reducing waiting times and increasing the number of patients seen during shifts.
Incentives for doctors in the Emergency Room
The doctor stated they earn one euro for each patient seen, and this amount is multiplied at the end of the month based on the NPS scale, which reflects patient evaluations through surveys sent via email days after their hospital visit.
“Our incentives are one euro for every patient seen, and that is multiplied according to the NPS scale by one, two, three, or four at the end of the month,” Miranda explained.
Thus, to the fixed amount of one euro per patient, additional scores for the treatment provided by each doctor are added. These ratings range from 0 to 10.
The emergency doctor emphasized that the incentives “are essential for motivating doctors further. That helps”.
Elena Fernández, an emergency physician at the HM Rivas University Hospital, noted that “it has been observed that incentives are one of the factors that help reduce waiting times in emergency services, but they are a double-edged sword. They must be carefully designed to establish different criteria for which they are awarded.”
“An important aspect to consider is, of course, the time that patients are seen, which can help reduce waiting times, as all team members will aim to assess more patients. However, caution is necessary. The Emergency Department sees patients with both trivial conditions and more complex cases. Those with simpler ailments are processed and treated more quickly. If a doctor only sees this type of patient, they will consequently see more individuals than another doctor who cares for more complex pathologies.“, Fernández added.
The HM Hospitales group physician stressed that “this is why incentives should not only focus on the quantity of patients treated but also on the quality of the reports, the types of patients seen, the number of tests conducted, and additional requests, for instance.”
Financial incentives in other hospitals
Miranda, who has experience in other facilities, pointed out that this is not the first instance he has encountered such incentives and used Torrejón Hospital as an example.
“During my time at Torrejón Hospital, there were incentives. “A small fee was charged per patient seen, and then it was dependent on the patient’s severity. It varied based on whether they were classified as green (mild), yellow (moderate), or orange (serious),” he explained.
Conversely, the emergency doctor has proposed new methods to incentivize doctors. “Ultimately, it comes down to making it a bit more appealing, and one good option could be to raise the base salary of doctors on top of the incentives, as there is a shortage of professionals in the emergency department. If it is not made more attractive, finding people to work will be challenging.”
Fernández mentioned that “none of the centers where I worked had incentives,” but she added that in the centers aware of them, they are “financial bonuses per patient seen.”
“Incentives are necessary to motivate doctors more”
Do financial incentives in emergency services promote competition?
Finally, Miranda indicated that incentives lead doctors to see more patients, resulting in shorter waiting times in the emergency room. However, she noted that in some situations, it can foster a sense of ‘competition’ that may not always sit well with colleagues.
“It varies. With incentives, you feel compelled to be more engaged and see more patients. It’s true that in some places, if someone takes on too much, it can create discomfort among colleagues. However, I would argue that it encourages emergencies to function better and prevents an increase in waiting times“, she remarked.
For Fernández, the ‘extras’ for each patient seen can indeed create a competitive atmosphere, but she added that the Emergency Coordinator is crucial in ensuring that this does not occur.
“The presence of incentives will generally foster competition within the team, but I believe that the service coordinator’s role is fundamental in this regard. If the incentives are based not only on waiting times but, as I mentioned earlier, also on other quality of care aspects, it can create healthy competition where the primary beneficiary is the patient,” she commented.
While the information may include statements, data, or notes from institutions or health professionals, the content provided in Medical News is edited and prepared by journalists. We recommend that readers consult a health professional for any health-related inquiries.
Emergencies are the Gateway to Hospitals: Reducing Waiting Times
Emergencies often serve as the gateway to hospitals, making the management of waiting times essential for both public and private healthcare institutions. Fast and effective care is not only crucial for patient comfort but also impacts overall health outcomes. As patients arrive at the emergency department, the nuances of their conditions demand that each one be treated individually. Some patients may require quick consultations while others may need lengthy observation or extensive testing. Therefore, healthcare systems need to streamline the process from registration and triage to the initial assessment by a physician.
The Importance of Efficient Emergency Care
Hospital management has recognized that the time taken for patients to register, undergo triage, and consult with a doctor significantly impacts their overall satisfaction and health experience. Patients expect to see a doctor as soon as possible, which has prompted health centres to explore various strategies for enhancing physician productivity and reducing waiting times.
- Streamlined Registration Processes: Hospitals are investing in advanced patient management systems to decrease registration times.
- Effective Triage Practices: Optimizing triage ensures that patients with life-threatening conditions receive immediate attention.
- Health Professional Incentives: Implementing financial incentives encourages healthcare workers to attend to a higher volume of patients during their shifts.
Incentive Structures for Emergency Department Physicians
To motivate physicians in emergency departments, hospitals have begun implementing incentive structures. One such example comes from QuirónSalud Hospital in Madrid, where doctor Mario Miranda highlighted that emergency physicians receive an additional euro for every patient seen. This amount is subsequently multiplied based on patient satisfaction ratings collected via NPS (Net Promoter Score) surveys sent after the consultation. This not only motivates physicians to treat more patients but also to maintain quality care standards.
The NPS Incentive Model
| Incentive Component | Details |
|---|---|
| Base Pay per Patient | 1 Euro per patient |
| NPS Multiplier | Varies from 1-4, based on patient satisfaction ratings |
| Total Potential Earnings | Base Pay + NPS Multiplier Earnings |
Miranda emphasizes that these financial incentives are crucial for increasing patient throughput while also ensuring that doctors remain engaged in providing quality care. Notably, colleagues like Elena Fernández from HM Rivas University Hospital point out that while productivity is important, it is essential to be wary of an overly competitive environment that can arise from such incentive structures. The complexity of cases seen by different physicians must also be taken into account to ensure equitable compensation.
Considerations in Financial Incentives
While incentives can effectively reduce waiting times, complexities arise in how they are structured. Fernández argues that financial incentives should not solely focus on the number of patients treated. Instead, they should encompass the quality of care provided as well as the types of cases seen. For instance, a physician focusing on more complicated cases may not see as many patients as one treating less severe conditions.
Core Considerations for Implementing Incentives
- Quality of Care: Develop metrics to evaluate not just the number of patients seen but the quality of care provided, including thoroughness in diagnoses and treatments.
- Case Complexity: Consider implementing a tiered incentive plan that rewards doctors based on the complexity of cases handled.
- Team Coordination: Emphasize the role of emergency coordinators to ensure that incentives foster teamwork rather than unhealthy competition.
Case Studies: Other Hospitals and Their Approaches to Incentives
In Miranda’s experience with the Torrejón Hospital, patients were classified by the severity of their conditions, which directly influenced the financial incentives received. This approach ensured that the compensation system was not only based on the quantity of patients seen but also aligned with the urgency of care provided. Such frameworks can help balance workload and care quality.
Alternative Incentive Structures
Some hospitals have begun to explore alternatives to purely financial rewards. Suggestions include:
- Professional Development: Offering training and development opportunities can enhance staff satisfaction and engagement.
- Recognition Programs: Establishing programs that celebrate exemplary care can motivate healthcare workers without the pitfalls of direct competition.
- Work-Life Balance Initiatives: Implementing measures that improve the work-life balance for healthcare professionals can lead to higher job satisfaction and productivity.
Balancing Incentives and Care Quality
Balancing monetary incentives with quality care provision is crucial. Doctors should be motivated to see patients quickly but also ensure that thorough assessments and appropriate treatments are carried out. It is up to health management to create a system where these balance adequately. The incorporation of team performance metrics and peer evaluations can augment this approach, thus leading to overall improved care in emergency settings.
Conclusion
As hospitals continue to evolve in their approaches to care, understanding the complexities and dual nature of incentives in emergency departments will help enhance the patient care experience. Addressing waiting times effectively, while ensuring quality care and patient satisfaction, is essential for the continued success of healthcare providers. With the right balance of incentives and recognition of the challenges faced by health professionals, hospitals can create an ecosystem where both patients and providers thrive.
Although this article includes insights from healthcare professionals, always consult with a health expert for any personal medical concerns or questions.
