Date:  June 29, 2015


Health Care Wait Times Vary Greatly Throughout U.S.; New IOM Report Calls for Putting Patients and Families First Using Approaches Applied Successfully in Other Sectors


WASHINGTON – Tremendous variability in wait times for health care appointments exists throughout the U.S., ranging from same day service to several months, says a new report from the Institute of Medicine.  However, there is currently an opportunity to develop “systems-based approaches” -- similar to systems-based engineering approaches applied successfully in industries beyond health care -- that aim to provide immediate engagement of a patient’s concern at the point of initial contact and can be used in in-person appointments as well as alternatives such as team-based care, electronic or telephone consultations, telehealth, and surge capacity agreements with other caregivers and facilities.  These systems-based approaches will require careful consideration of the full range of components and resources available in the interconnected health system. 


“Everyone would like to hear the words, ‘How can we help you today?’ when reaching out for health care assistance,” said Gary Kaplan, chair of the study committee that wrote the report, and chairman and chief executive officer of Virginia Mason Health System in Washington state.  “Health care that embraces this philosophy is patient- and family-centered and implements the knowledge of systems strategies for matching supply and demand.  Care with this commitment is feasible and found in practice today, but it is not common.  Our report lays out a road map to improve that.”


Delays in access to health care have negative effects on health outcomes, patient satisfaction, health care utilization, and organizational reputation, the committee found.  Reducing wait times for mental health services is particularly critical, because the longer a patient waits for such services, the greater the likelihood that the patient will miss the appointment.  Extended wait times are also associated with higher rates of appointment no-shows, as feelings of dissatisfaction and inconvenience discourage patients from attending a first appointment or returning for follow-up care. 


Causes for delays include mismatched supply and demand, the current provider-focused approach to scheduling, outmoded workforce and care supply models, priority-based queues, care complexity, reimbursement complexity, and financial and geographic barriers.  Contrary to the notion that same-day service is not achievable in most sites, same-day options have been successfully employed through a variety of strategies.


To improve access to health care, continuous assessment, monitoring, and realigning of supply and demand are required, the committee said.  In addition, alternatives to in-office physician visits, including the use of non-physician clinicians and telephone consultants, can often meet patients’ needs. 


“There is a need for leadership at both the national level and at each health care facility for progress to be made in improving health care access, scheduling, and wait times,” said Victor Dzau, president of the Institute of Medicine.  “Although a lack of available scientific evidence hinders establishing specific standards for scheduling and wait times, systems strategies and case studies can help guide successful practices until more research is completed.”


The committee issued several recommendations to help accelerate progress toward wider spread practice of immediate responsiveness.  Noting that different clinical circumstances and patient preferences will compel different approaches, it recommended that certain basic access principles should apply across all settings.  These principles include ongoing evaluation; immediate engagement of patient concerns at the time of inquiry; patient preference on timing and nature of care invited at the time of inquiry; need-tailored care with reliable, acceptable alternatives to office visits; surge contingencies in place to ensure timely accommodation of needs; and continuous assessment of changing circumstances in each care setting.


The committee further recommended that national leaders help spread and implement these basic access principles; instigate coordinated federal initiatives across multiple departments; broadly promote systems strategies in health care; and propose, test, and apply standards development.  Also, professional societies should help lead in the application of systems approaches, and public and private payers should provide financial and other tools.  In addition, the committee recommends that health care facility leaders anchor front-line scheduling practices in the basic access principles, demonstrate commitment to implementing these principles, involve patients and families in decisions regarding assessment and reform of access to care, and continuously assess and adjust at every care site.


The study was sponsored by the U.S. Department of Veteran Affairs.  Established in 1970 under the charter of the National Academy of Sciences, the Institute of Medicine provides independent, objective, evidence-based advice to policymakers, health professionals, the private sector, and the public.  The National Academy of Sciences, National Academy of Engineering, Institute of Medicine, and National Research Council make up the National Academies.  A committee roster follows.



Jennifer Walsh, Senior Media Relations Officer

Chelsea Dickson, Media Relations Associate

Office of News and Public Information

202-334-2138; e-mail

Twitter: @NAS_news and @NASciences


Pre-publication copies of Transforming Health Care Scheduling and Access: Getting to Now are available from the National Academies Press on the Internet at or by calling 202-334-3313 or 1-800-624-6242. Reporters may obtain a copy from the Office of News and Public Information (contacts listed above).

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Roundtable on Value and Science-Driven Health Care


Committee on Optimizing Scheduling in Health Care


Gary S. Kaplan, M.D. (chair)

Chairman and Chief Executive Officer

Virginia Mason Health System



Jana Bazzoli, M.B.A. M.S.A.

Vice President, Clinical Affairs

Cincinnati Children's Hospital Medical Center



James C. Benneyan, Ph.D.


Healthcare Systems Engineering Institute

Northeastern University



James B. Conway, M.S.

Adjunct Faculty

Department of Health Policy and Management

Harvard School of Public Health

Woburn, Mass.


Susan Dentzer, B.A.

Senior Policy Adviser

Robert Wood Johnson Foundation

Princeton, N.J.


Eva K. Lee, Ph.D.

Professor and Director

Center for Operations Research in Medicine and Health Care

School of Industrial and Systems Engineering

Georgia Institute of Technology



Eugene Litvak, Ph.D.

President and Chief Executive Officer

Institute for Healthcare Optimization

Newton, Mass.


Mark Murray, M.D., M.P.A.


Mark Murray and Associates LLC

Sacramento, Calif.


Thomas Nolan, Ph.D.

Senior Fellow

Institute for Healthcare Improvement

Silver Spring, Md.


Peter J. Pronovost, Ph.D., M.D.

Senior Vice President for Patient Safety and Quality, and


Armstrong Institute for Patient Safety and Quality

Johns Hopkins Medicine, and


Department of Anesthesiology/Critical Care Medicine and Surgery,

Department of Health Policy and Management

Schools of Medicine, Nursing, and Public Health

Johns Hopkins University



Ronald Wyatt, M.D., M.H.A.

Medical Director

Division of Healthcare Improvement

The Joint Commission

Oakbrook Terrace, Ill.





Marianne Hamilton Lopez, Ph.D., M.P.A.

Study Director