Friday, April 27, 2007

We Need a New Hole

"You cannot dig a hole in a different place by digging the same hole deeper" - Edward de Bono

For the 15 years I've been in this group (currently eight urologists), the wait to see one of us has been three to four months. We squeeze in urgent cases - cancer, kidney stones - but for most urology referrals, you'll wait quite a while. Over the last four years, our group averaged about 13,000 patient visits annually. Hospital rounds start at 7 am. Every day is jam-packed with surgery, outpatient clinics, office visits, emergencies, phone calls and paperwork. Leaving the office by 5 pm is cause for celebration. We'd love to get our wait time down, but how can we possibly see more patients? We're digging this hole as fast as we can.

It's a testament to our desperation that we were willing to try something as crazy as Advanced Access (AA). I mean, who's heard of seeing a specialist within seven days of referral? I'd wonder if there was something wrong with him if his waiting list were that short! Some of the urologists were skeptical (more about that in future posts), but everyone was willing to at least try something different.

Friday, April 20, 2007


December, 2006. Orlando, Florida.  What excitement!  This place is incredible!  Disney World?  No, I'm attending the annual conference of the Institute for Healthcare Improvement (IHI). Over 5,000 people are at this international clearinghouse of ideas and techniques for - you guessed it! - Improving Healthcare. Everyone seems so thrilled to be here, it gives the conference centre a theme park atmosphere.

I've been to some great sessions, but have pretty limited expectations for the next one: "Improving Access to Primary Care". My urology group has a long wait for consultations - about 3 or 4 months. We'd like to see patients sooner, but we're all working full out as it is. The brochure says the presenter, Mark Murray, has successfully improved access to primary care in many American centres. That's great, but specialty practice is very different. Well, maybe I can pick up a few tidbits.

"Are there any specialists in the room?"

What?!  Is he going to kick us out? Family physicians only? A few hands go up - mine too.

He points at me.