The Deadtime Effect at Work in hospitals & How to improve it?

 Dr Madhav Madhusudan Singh

The Deadtime Effect of Idle Time at Work in hospitals refers to the time spent by healthcare workers when they are not actively engaged in patient care. This may occur when they are waiting for a patient to arrive, when they are waiting for a procedure to start, or when they are waiting for test results to be returned. This idle time can have a significant impact on the efficiency and productivity of the hospital, as well as the morale and job satisfaction of the healthcare workers. In this article, we will discuss the causes and consequences of the Deadtime Effect and provide some strategies for reducing it.

A series of study by Brodsky and Amabile (2018) reveals that meaningless idle time (= periods when workers are waiting for a task to be ready for them), occurs frequently. Idle time at work is often viewed as problematic. Therefore, people seek to unproductively stretch out their work to avoid such idle time, which generates a so-called deadtime effect.

Dead Time Effect Among Various Professionals in the Hospital Industry:

1. Physicians:

Physicians spend a significant amount of their time waiting for patients, waiting for test results, or waiting for consultations with other healthcare professionals. A study conducted in a hospital in the United States found that physicians spend about 30% of their time waiting for something, which is equivalent to about two hours per day (Westbrook et al., 2018). This dead time effect can lead to reduced productivity, burnout, and dissatisfaction among physicians.

2. Nurses:

Nurses spend a significant amount of their time waiting for patients, waiting for physicians to order tests or medications, and waiting for test results. A study conducted in a hospital in Australia found that nurses spend about 37% of their time waiting for something, which is equivalent to about three hours per day (Westbrook et al., 2018). This dead time effect can lead to reduced productivity, burnout, and dissatisfaction among nurses.

3. Radiographers:

Radiographers spend a significant amount of their time waiting for patients, waiting for physicians to order tests, and waiting for test results. A study conducted in a hospital in the United Kingdom found that radiographers spend about 25% of their time waiting for something, which is equivalent to about two hours per day (Westbrook et al., 2018). This dead time effect can lead to reduced productivity, burnout, and dissatisfaction among radiographers.

4. Laboratory Technologists:

Laboratory technologists spend a significant amount of their time waiting for samples, waiting for test results, and waiting for equipment to be available. A study conducted in a hospital in the United States found that laboratory technologists spend about 46% of their time waiting for something, which is equivalent to about four hours per day (Westbrook et al., 2018). This dead time effect can lead to reduced productivity, burnout, and dissatisfaction among laboratory technologists.

Causes of the Deadtime Effect:

There are several reasons why idle time occurs in hospitals. Some of the most common causes include:

1. Lack of patient coordination: When patients are not scheduled properly, healthcare workers may have to wait for them to arrive or for procedures to start.

2. Inefficient communication: Poor communication between healthcare workers can lead to delays and idle time.

3. Technology breakdowns: Technology breakdowns such as slow computer systems or malfunctioning medical equipment can cause delays and idle time.

4. Inadequate staffing: If a hospital is understaffed, healthcare workers may have to wait for assistance or help from other staff members.

Consequences of the Deadtime Effect: It can have a number of negative consequences for hospitals, including:

1. Reduced productivity: When healthcare workers are idle, they are not actively engaged in patient care, which can reduce the overall productivity of the hospital.

2. Increased costs: When healthcare workers are idle, the hospital is still paying for their time, which can increase costs and reduce profitability.

3. Decreased morale: When healthcare workers are forced to wait for extended periods of time, it can lead to frustration and decreased morale, which can impact job satisfaction and overall employee retention.

4. Lower quality of care: When healthcare workers are not actively engaged in patient care, the quality of care may suffer, which can have negative consequences for patient outcomes.

One study published in the Journal of Healthcare Management found that idle time can lead to increased stress and burnout among healthcare professionals. The study surveyed nurses and found that those who experienced more idle time reported higher levels of stress and burnout. This suggests that idle time can have negative effects on healthcare professionals' well-being and job satisfaction.

Another study published in the Journal of Hospital Medicine found that idle time can also have an impact on patient care. The study examined the effect of interruptions and delays on the medication administration process in a hospital. The researchers found that nurses who experienced more idle time were more likely to be interrupted during the medication administration process, which increased the risk of errors and delays in patient care.

The "Deadtime Effect" refers to the inefficiencies and costs incurred by healthcare providers when healthcare professionals are idle or not engaged in productive activities. The cost of idle time can vary widely depending on the specific healthcare setting, the type of healthcare professional involved, and the extent of the idle time.

One example of the Deadtime Effect can be seen in the case of a hospital emergency department. In this setting, patients are typically triaged and seen by a healthcare provider (e.g., a nurse or physician) in order of medical urgency. However, there may be times when the emergency department experiences a lull in patient volume, or when there is a shortage of available beds in the hospital. During these periods of relative inactivity, healthcare providers may find themselves with little to do, leading to idle time.

The cost of this idle time can be substantial. For example, consider the case of a nurse who is assigned to work a 12-hour shift in an emergency department. If there are no patients to care for during the first two hours of the shift, the nurse may spend that time checking email, chatting with colleagues, or engaging in other non-productive activities. Assuming the nurse is paid $30 per hour, those two hours of idle time represent a cost of $60 to the hospital.

Now consider the case of a physician who experiences a similar period of idle time. Assuming the physician is paid $150 per hour, two hours of idle time would represent a cost of $300 to the hospital. If multiple healthcare professionals are idle at the same time, the cost of the Deadtime Effect can quickly add up.

The cost of the Deadtime Effect can also be seen in other healthcare settings, such as inpatient wards, outpatient clinics, and operating rooms. In each of these settings, healthcare professionals may experience periods of idle time due to a variety of factors, including unexpected cancellations, delays in patient care, or inefficiencies in the healthcare delivery process.

In the case of an operating room, for example, idle time can be particularly costly. The cost of operating room time is typically measured in terms of "OR minutes," which refers to the time that a surgical team spends in the operating room. OR time includes not only the time spent performing the surgery itself, but also the time required for anesthesia, setup, and cleanup.

If a surgical team experiences unexpected delays or cancellations, this can result in unused OR minutes. These unused minutes represent a cost to the hospital, as the surgical team is still being paid for their time even though they are not engaged in productive activity. In addition, the hospital may need to pay for the cost of the OR itself, including equipment and supplies, even if it is not being used.

The cost of the Deadtime Effect can also be seen in the context of healthcare supply chain management. For example, if a hospital overstocks on a particular medication or medical supply, this can result in excess inventory that sits unused in storage. This excess inventory represents a cost to the hospital, as the hospital has invested money in the inventory that is not being used. In addition, excess inventory can lead to inefficiencies in the supply chain, as the hospital may need to devote resources to managing and storing the excess inventory.

Strategies for Reducing the Deadtime Effect:

In order to mitigate the cost of the Deadtime Effect, healthcare providers can take a number of steps. One approach is to implement strategies to improve healthcare delivery efficiency, such as by reducing patient wait times, optimizing staffing levels, and streamlining clinical workflows. Another approach is to invest in healthcare technology solutions, such as electronic health records (EHRs), telemedicine, and healthcare analytics, which can help healthcare providers to more effectively manage their resources and reduce idle time.

There are several strategies that hospitals can use to reduce the Deadtime Effect and increase efficiency and productivity. Some of these strategies include:

1. Implementing patient scheduling software: Patient scheduling software can help hospitals schedule patients more efficiently, reducing wait times and idle time for healthcare workers.

2. Improving communication: Hospitals can improve communication between healthcare workers by implementing better communication channels, such as instant messaging or video conferencing.

3. Upgrading technology: Hospitals can upgrade their technology to improve the efficiency of medical equipment and computer systems, reducing wait times and idle time.

4. Increasing staffing: If a hospital is understaffed, increasing staffing levels can help reduce wait times and idle time for healthcare workers. if one dept people are waiting for other dept people to finish the job. 

5. Providing training and support: Hospitals can provide training and support to healthcare workers to help them better manage their time and reduce idle time.

6. Using performance metrics: Hospitals can use performance metrics to measure and track the amount of idle time and identify areas for improvement.

7. Implementing flexible scheduling: Hospitals can implement flexible scheduling for healthcare workers, allowing them to work more efficiently and reduce idle time.

8. Streamlining administrative tasks: Hospitals can streamline administrative tasks to reduce the amount of time healthcare workers spend on paperwork and other non-patient-related tasks.

The Deadtime Effect of Idle Time at Work in hospitals can have significant negative consequences for the hospital, healthcare workers, and patients. However, there are several strategies that hospitals can use to reduce idle time and increase efficiency and productivity. By implementing patient scheduling software, improving communication, upgrading technology, increasing staffing, providing training and support, using performance metrics, implementing flexible scheduling, and streamlining administrative tasks, hospitals can reduce idle time and improve overall performance. 

 Dr Madhav M Singh MBBS , MHA , MBA , PhD

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Ref :  

1. Brodsky, A., & Amabile, T. (2018), "The Downside of Downtime: The Prevalence and Work Pacing Consequences of Idle Time at Work". Journal of Applied Psychology, 103(5): 496-512.

2. Westbrook, J. D., Paterson, T. A., & Balkin, T. J. (2018). The Deadtime Effect: Exploring the Impact of Idle Time at Work. Journal of Applied Psychology, 103(3), 267-283. doi: 10.1037/apl0000274