We need to talk about what is wrong with the healthcare system
“I wonder how many cancers I could detect and provide treatment for in time, if this didn’t happen”,
I thought quietly to myself, seeing yet another appointment that was cancelled late by a patient. I started to count, mostly to get an idea of the problem. After a while, I also asked my colleagues in other clinics and thus realized that this problem is huge, considering that 5–20% of all appointments are missed due to late cancellations and no-shows. I asked the booking staff at the clinic where I work, why so many of my time slots were empty. The explanation was that the booking staff were already overwhelmed with administration such as scheduling, rescheduling, managing cancellations and so forth, meaning that there was simply no time to call patients from a waiting list. Although some clinics have staff dedicated to filling empty time slots manually, they say that it takes up to around 15 patient calls to fill one single time slot.
As a doctor, I can help the patients that visit me, but by fixing this problem I would be able to help millions of people around the world to get shorter waiting times, while at the same time relieving healthcare workers of unnecessary administration and shortening waiting lists.
Drowning in administration while time slots are being wasted
We can all agree that without healthcare professionals, the healthcare system ceases to exist. We also know that working as a doctor or a nurse requires specific education and certifications. It would be quite a waste of their skills to make all these people, specialized in providing healthcare, spend up to 50% of their time filling out paperwork, right?
Regardless of how troubling it sounds, that is the reality in the healthcare industry throughout the world. The administrative workload has been increasing over the past few decades, and while it continues to increase, governing institutions and patients require better and quicker access to healthcare (through all sorts of communication channels). No one should be surprised by the increasing number of doctors and nurses who are feeling stressed, exhausted and experiencing burnouts. Working as a healthcare professional is essentially stressful, requiring great responsibility combined with very few ways of influencing the work environment and initiating change. Therefore, it is of great importance to avoid creating additional burdens that cut the personnel’s legs out from under them.
Furthermore, both healthcare professionals and patients have to tackle obstacles within the healthcare system, such as long waiting times, an infinite amount of administration, inefficiency in terms of patients who miss appointments and cancel late (leading to wasted time slots), and insufficient patient access. In the UK alone, missed appointments cost £1 billion each year, according to the NHS’s Chief Nursing Officer, while in Germany, 5–20% of all appointments were missed in 2018. In the US, one study found that the yearly cost for missed appointments amounts to more than $150 billion.
As if all this wasn’t enough, paperwork that was digitized ages ago in other industries, still needs to be handled manually with actual paper in the healthcare industry. All these issues clutter up and slow down the healthcare system, at the expense of both healthcare workers and patients.
How to balance everyone’s needs
The healthcare system operates within its own unique universe. Compared to other industries, this industry is a bit peculiar, as it works quite like a hybrid between a planned economy and a market economy (driven by supply and demand). In some countries, the healthcare system is government funded and in other countries it is funded by insurance schemes, with the common denominator of resources being controlled by someone other than the consumers (i.e. the patients). The suppliers (i.e. the healthcare providers) are dependent on the funding institutions, whether these are governments or insurance companies, and the consumers are dependent on the suppliers, without always having the usual consumer power. The funding institutions and regulatory bodies have the power to decide what the patients need and what the healthcare providers should do, while not always being updated on current issues and hindrances, or aware of how the work is organized. Hence, we end up with a complicated system where needs are competing against each other while solutions, even though created with the best intentions, often operate to benefit one party at the expense of others.
Healthcare workers, management and patients all have different perspectives that need to be considered. As mentioned above, the usual powers on a market in terms of supply and demand, are partly put aside within the healthcare system. Therefore, it is of utter importance to ensure that all the different perspectives are taken into account, when building solutions for this universe in need of restoration. If we begin to solve problems without addressing this issue, we might end up removing one bottle neck by creating another.
Where to start?
It’s a widely accepted fact that healthcare waiting times need to be shortened, in order to make sure that patients receive the care they need in time. Moreover, waiting times are one of the most pressing issues for patients. You can have the best diagnostic equipment, the best pharmaceuticals and the best professionals, but what does any of that matter if the patients do not get appointments in time?
Many countries, for example Sweden and Germany, have unsuccessfully tried to resolve this issue. Meanwhile, the Covid-19 pandemic has left a backlog of millions of medical procedures all over the world, which is why new initiatives are being launched. For instance, the NHS in the UK has set aside £160 million to tackle long waiting lists,
However, if we speed through the process and decide to increase accessibility before assessing the availability at the clinics, many healthcare professionals will end up with an even heavier workload than before, leading to more stressed out doctors and nurses, as well as dissatisfied patients. With increased stress, the number of burnouts will increase, resulting in an increased number of workers on sick leave and fewer doctors and nurses to treat patients. This is an example of how to create a vicious cycle of stress, burnouts, decreased quality and decreased access to healthcare, along with deteriorating patient safety.
If we want to increase access to healthcare, the whole system needs to be examined in order to find ways of unburdening the healthcare workers. So where to start? As mentioned above, it’s important to understand that healthcare professionals are the key to a functioning system. So first, we need to ensure that they can focus on their primary task: providing high quality care.
If we want to maintain the quality, increase the number of treated patients and shorten waiting times, while simultaneously keeping costs under control, we need to do something differently.
So let’s take a look at the administrative workload that takes up such a large part of the healthcare workers’ time. What tasks does it include? Is there a way of reducing or removing it?
Nurses make up the group that is being hit the hardest by the administrative workload. Regarding the tasks that they need to take care of, one of the most time consuming activities is handling the whole machinery of scheduling patients. It involves triage (prioritization) of patients and referrals, scheduling, cancelling and rescheduling appointments. It also involves answering calls, calling patients and listening to the answering machine. Nearly everything is done manually. It is, as you can see, a never ending cycle of administration.
While nurses are doing their best to handle the scheduling issue while simultaneously nursing patients, time slots nonetheless end up empty due to late cancellations and no-shows. There is simply no time to find replacement patients, which is an extremely time consuming and impractical task if done manually. So how can we solve all these issues? This is where Zymego comes into the picture.
Is it possible to remove the worst barriers — while increasing the quality of care?
As a medical doctor I have first-hand experience of how healthcare staff are struggling due to the heavy administrative burden. While working at a clinic in Stockholm, I realized that although the nurses were working exceptionally hard to handle the whole scheduling machinery (manually!), many appointments were still missed by patients and thus wasted. This is all happening while thousands of patients are waiting in line to receive care, and that realization is what initiated the birth of Zymego.
There are currently three founders (Nathalie, Simon and myself — Ingmar), recently backed by a top Nordic VC, and we are now growing the team to take on our mission to declutter the healthcare space.
The first module in our software product, Zymego Now, automatically fills empty time slots, relieves healthcare workers of tedious administration and shortens waiting times for patients. Using Zymego Now, a patient could potentially be offered an appointment the next day, as opposed to waiting two or three months (or even more!).
As illustrated in the figures below, the automatch feature creates a win-win situation for management, healthcare workers and patients.
We have dedicated the last year to the development of this product (being the first of its kind globally) by talking to hundreds of healthcare professionals, management at different levels and patients of different demographics. Our CTO Simon has dived into healthcare specific regulations as well as the security aspects of cloud storage and GDPR regulations, to ensure that Zymego is compliant with all applicable laws and regulations. Our first users in Sweden (clinics in Stockholm and Gothenburg) are currently evaluating Zymego Now, and upon request from some of them, we have already started the development of additional features such as digital payments and registration of arriving patients.
To alleviate the strain of administration even further, we are in the process of developing another powerful feature, called Zymego Triage. Through AI and smart algorithms, the software significantly reduces the time spent on triage(prioritization) of referrals. We are making it possible to carry out triage automatically, and deliver a ready proposal for prioritization and scheduling of referrals, only for nurses to drag-and-drop in order to make potential adjustments. Using machine learning it improves with every adjustment, increasing both accuracy and efficiency. Our aim is to reduce the time spent on triage and scheduling of referrals by 80%.
In short, our North Star goal is to contribute to a revived healthcare system, by improving life for both healthcare workers and patients, benefiting society as a whole.
Zymego has recently launched a first version of the mobile first web application Zymego Now, focused on filling cancelled appointments through an automatic waiting list. We also make it easier for patients to cancel and reschedule their appointments, in order to eliminate no-shows. We are committed to building Zymego in cooperation with the healthcare industry and to being responsive to the professionals, in order to understand how Zymego can bring the most value. To enable a streamlined experience for healthcare workers as well as patients, we are also collaborating with electronic health record (EHR) systems, to allow for full automation of our current and planned features.