Throw Me a Bone

“Are we there yet?” - Every kid since the dawn of time

Look at this crazy graph!

It looked like our 3rd next available appointment (3NAA) time was dropping, then, BOOM! it's back up again! What's going on? We're working hard on the backlog:

So why don't we see the 3rd NAA time dropping?


Maybe it has to do with the way we're reducing the backlog. When we started to work down our backlog by seeing extra patients, we had to choose between 2 methods.  We could take all the appointments booked 3 months in advance and move them up into the extra "backlog slots." That would mean contacting all those patients a second time (muda!). To avoid that rework, we went with option 2: use our backlog slots for all referrals received from that time on. This reduced staff workload, but meant that people being referred next week would actually be seen sooner than those referred a month ago! (Is this practical solution fair? Is it ethical?)

But as we get closer to the end of our backlog, the 3NAA should go down, regardless of which system we chose. I still don’t see the problem.

Maybe we’re being swamped by new referrals:

Nope, that looks pretty steady.

I’m not seeing the results we want. I'm getting frustrated! And I'm the project champion!  How do I keep everyone else engaged in a long-term project like this?

The solution (according to Leading Change author John P. Kotter): Plan for and create short-term wins. But do we have any "wins" yet?

We did have a pretty good result from our appeal for "pooled" referrals (sent April 20).

It looks like the effects are sustained. This lets us distribute new referrals to take advantage of everyone’s extra backlog slots.

I suppose getting wider interest in the project (as measured by blog hits) is considered a win, given our objective of spreading the gospel of improved access.

Most importantly, we have success stories: Positive comments from patients. Staff finding it easier to schedule new appointments.

Last week, Amanda had a call from a patient who wanted to be seen for a flare-up of a problem. With our old system, it would be many weeks before an appointment was available, so she would leave a message for the urologist to phone the patient. At the best of times, that meant trying to squeeze in yet another phone call at the end of the work day (irritated urologist). At worse, it meant playing telephone tag for several days (frustrated patient). However, because backlog slots were available, this patient was booked promptly to see his urologist during regular office hours. Satisfied patient and urologist.

These stories are much more powerful than a dumb old chart. We need to keep collecting and sharing them. I hope it’s enough to keep up the energy. We can’t maintain this extra work indefinitely. We need to start seeing light at the end of the tunnel.

Hey kids, cross your legs and hold on. I think there’s a gas station around the next corner.

PS - Here's my homework from last week.  How did yours go?