We’ve all noticed it: due to the coronavirus, routine healthcare came to a near standstill in March and April. The Dutch Healthcare Authority (NZa) recorded a drop in service volume of as much as 40 percent. Elective care—and elective surgeries in particular—came to a complete halt for several weeks. Outpatient visits for chronic healthcare continued to some extent in many places, partly thanks to digital alternatives. Starting in April, routine healthcare began to ramp up again, and as of June, the number of patients treated in hospitals has returned to 90% of pre-pandemic levels (measured by the number of patient contacts). Nevertheless, the impact of the shutdown is still being felt.

Waiting lists are growing, but not everywhere

Waiting lists have now increased by an average of 14 to 50 percent, with significant variation by specialty. Waiting lists have grown at outpatient clinics for dermatology, gynecology, and orthopedics, among others. Waiting times for non-urgent surgeries have also increased, by as much as 40% in orthopedics for procedures such as total hip replacements.

In neurology and internal medicine, however, waiting lists have actually decreased (www.kompasinzorg.nl). One reason for this may be that there have been fewer diagnoses of certain diseases that normally require acute care. Examples include cancer diagnoses and follow-up examinations resulting from population-based screening programs. The NZa estimates that this has resulted in up to 800,000 fewer referrals compared to the same period in previous years.

Part of this was “caught up” starting in June, because an exceptionally high number of initial consultations were recorded in hospital care beginning that month. The reduced number of referrals indicates that there is deferred healthcare on the demand side, some of which remains necessary and some of which is non-essential and will fade away over time.

Digital Healthcare as a Lifeline

The accelerated rollout (and funding) of video consultations, telephone consultations, and remote monitoring in March and April helped ensure that routine healthcare was not completely halted. It is estimated that outpatient clinics are using video calls at least five times as often as they did before 2020. Initial studies show that chronic healthcare and routine follow-ups can also be provided to a high standard using digital alternatives. Patient satisfaction is high in these cases. Why would you still need to travel to the hospital for the third follow-up on your broken collarbone? Or for a “just to be safe” checkup on your wound simply because that’s what the protocol requires? This clearly demonstrates how digital technology has accelerated the delivery of the right healthcare in the right place (JZOJP) and has partially prevented waiting lists for routine healthcare.

The Procrastinators

Still, we must also examine the portion of the waiting lists from the perspective of other factors contributing to deferred care demand. Many patients were too afraid to visit their primary care physician or the emergency department in March and April. The potential deferred care demand still coming from this group is difficult to quantify and will partly dissipate, but exactly how much? It is also difficult to determine what the consequences of this will be. An example of this is a cancer patient who enters the care process later, is diagnosed later, and consequently requires more complex treatment. This is detrimental to the patient and also places a heavier burden on the hospital, for example, in terms of inpatient days.

Leadership and Collaboration

In our efforts to eliminate waiting lists, we quickly run into an initial bottleneck: matching healthcare demand with available capacity in terms of staff and facilities. Although this has always been complex, hospitals now face a truly monumental task. Of course, significant efforts have already been made to make real-time data on changes and treatments available, thanks to national coordination by the NZa and ZorgDomein. As a result, current care demand and waiting lists within a hospital are now well documented. Furthermore, the NZa has established an urgency list for prioritizing specialized healthcare, and hospitals now have clear agreements with insurers. However, this can—especially with those growing waiting lists—lead to complex political situations within the hospital. Clear leadership from the hospital, backed by a solid step-by-step plan for (tactical) capacity management, is absolutely essential. In short, matching supply with staff and facilities demands even greater focus on (tactical) capacity management, collaboration, and hospital culture.

Outside the hospital walls

When it comes to eliminating waiting lists—especially in light of potential additional challenges caused by pent-up demand for care—it’s not just internal collaboration and a solid plan that matter. We must also take a broader view by collaborating with partners throughout the regional healthcare system. After all, triage in referrals is particularly important due to the “catch-up” in certain diagnoses and increased demand for healthcare. The transition of inpatients to primary care (follow-up) also requires extra attention. This data is not yet clearly available, as ICT & Health also notes. Moreover, collaboration is difficult when interests diverge—we’ll address that in an upcoming blog post.