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Royal North Shore Hospital (RNS) in the heart of Sydney city has a prestigious reputation. Their Emergency Department sees sick patients within a government-determined “reasonable” time for 75% of their patients. Blacktown Hospital in Western Sydney has a reputation for mediocrity. Their Emergency Department records 61% on the same statistic. On paper, Royal North Shore justifies the urban myth that wealthy suburbs run better hospitals. But as a patient, your experience in each hospital’s Emergency Department is likely to be the same. 

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When my friend – a medical colleague, avid fisherman and a sufferer of chronic health conditions – found himself in Royal North Shore Hospital with 10/10 abdominal pain, he was given waiting number 46. The kind of number you are given when waiting in line for the butcher or fishmonger. He waited 1 hour 40 minutes before being triaged. 

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Triage, the process of assessing and prioritising a patient is the official start of the patient’s time in ED. It is where vital signs are first assessed and where first line pain management, like paracetamol, is given to manage pain. Patients will not have their names and the severity of their symptoms recorded into the emergency department’s database if they have not seen the triage nurse. 

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The key performance indicator (KPI) recorded as an indication of patient care quality in ED is the time taken from triage to being first seen by a doctor. There is no data collected for the time my friend spent in the waiting room with unmanaged pain and unassessed symptoms. 

After triage, my friend was seen in 30 minutes by a doctor. The record at RNS will show he was seen in 30 minutes. 

At Blacktown Hospital, the record would show my friend was seen in 2 hours and 10 minutes.

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And just like this, the truth has been edited. RNS is so focused on optimising their metric that the patients’ experience is largely disregarded. This is a prime example of an organisation prioritising measures over their customers. While this can lead to dire consequences in such an important setting, can RNS really be to blame? 

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Public hospitals in Sydney are run by KPIs. They are designed to maintain a baseline quality of healthcare in a complex and immense system. When a hospital's funding, their lifeline, is based on these numbers, they're incentivized to twist the truth. 

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From my personal experience working in these hospitals, I know the numbers on a page don’t always reflect reality. As the adage goes “When a measure becomes a target, it ceases to be a good measure.”

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So much of the work we do revolves around data, we need to remember that the data lies. And as scientists and healthcare professionals we can take a leaf out of the books of our UX colleagues and start with the user experience first.

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