Friday, June 29, 2007

Gimme 5!

Our project goal: Reduce appointment wait times. Why? Well, because that would be good, right? Good for our office efficiency, the flexibility of our appointment system, and our financial bottom line. But ultimately, we want to improve the service we provide to our patients. Who gets to decide if we've succeeded? We could use our 3rd next available appointment time to show what a great job we're doing. But what waiting time will our patients be happy with? Two weeks? One week? Same-day service? I guess we'll have to ask them.

Patient surveys are completely new for us, as I suspect is the case for most physicians. After all, we're not really a business. Not like a car dealership. Wow, those guys are nuts for customer surveys. Every time I take my car in for servicing, they give me a card with an online link to complete a survey. If I don't do the survey, I get a reminder phone call. It's not good enough for them to know I'm getting my oil changed regularly, they want to know how I feel about it! Geez, you'd think they wanted satisfied customers or something.

When we started the Advanced Access project, we began giving out satisfaction surveys to patients checking in for their appointments. They're "experience" surveys because they don't just ask one all-inclusive question like "Were you satisfied?" Our survey breaks down various aspects of the patient's visit with us:

Patient Satisfaction Survey

Please circle the number that shows how satisfied you are in each of the following areas, for this appointment: 1 Poor, 2 Fair, 3 OK, 4 Good, 5 Great

  • Listens to you
  • Takes enough time with you
  • Explains what you want to know
  • Gives you good advice and treatment
Receptionist and office staff:
  • Friendly and helpful to you
  • Answers your questions
  • Number of days it took to get in to see the specialist (length of time between your doctor's referral and this appointment)
  • The day that was chosen for this appointment
  • Length of time in waiting room
  • Length of time in examining room
  • Comfort and safety while waiting
  • Privacy
Overall experience:
  • Overall, my experience with this appointment was: 1 Poor, 2 Fair, 3 OK, 4 Good, 5 Great

I wondered how to interpret the results we were getting. First, I averaged the numbers and plotted each day's results. (This was before my Enlightenment. Now I know the dangers of winging it with data.)  That was so useless that I'm not even going to show you the chart. It was basically a line wavering slightly around an average of 4. Then it was explained to me that even though the responses are given numerical values, it is not a continuous scale. Good does not equal 2 X Fair.

So how do we interpret them?

I asked Mark Ogrady, the Regina ENT surgeon who's already implemented AA. His system? "Just look at the 5s. That's what Disney does - they want 100% Great experiences."

Disney? That's ridiculous! Disney has nothing to do with delivering health care. Sure, they're world famous for providing exceptional service to their customers…Oh. Well then, let's shoot for Great!

Here's the percentage of patients who rated their appointment access as Great:

Not looking so good. Well, if you're not satisfied with the data, what's the first thing you do? Deny, of course. Maybe the problem isn't our service. Maybe the problem is we see a lot of hard-to-satisfy patients who are really cranky about everything. They're not happy with anything we do and would rate everything poorly. Let's look at overall satisfaction.


Our patients seem happier with the actual service they get, but are unhappy with their access to that service. So it looks like our goals of improving access and increasing patient satisfaction do align nicely. But, we need to remember that our ultimate goal is patient satisfaction; improving access is just the tool to get us there. It's a little unnerving that we'll be judging our success by asking about how patients experienced their care. Scoring 5s will require a lot more effort than just working down the backlog and bragging about our miniscule 3NAA time. It’s not Mickey Mouse.

P.S. Check out Tom Peters' book "Re-Imagine". It's (supposedly) a business management book, but if you mentally substitute "health care" and "patient" for "business" and "customer," it's actually an amazing rant about being patient-centred and, well, re-imagining health care. You'll find something thought-provoking anywhere you jump into this book.


  1. Originally posted by Joy Dobson 6/29/2007 1:26 PM

    Keep it up, Kishore. I plan to buy Re-Imagine today as I am on holidays, with some leisure time!

  2. Originally posted by Cathy Fooks (CEO, The Change Foundation) 7/3/2007 6:58 PM

    Kishore, This is the best yet. You are absolutely on the right track in trying to understand what your patients expect. Not to say you must always deliver it but starting the communication is brilliant. From communication comes mutual understanding of perspectives and the art of the possible.

    We watch from afar and keep our fingers crossed!

    Perhaps you would consider a visit to Ontario to illuminate your work?