Friday, October 19, 2007

Blog Break

Kishore’s entries will resume in early November.

Until then, regularly visit his other blogging project: Plain Brown Wrapper.

Friday, October 5, 2007

Accounting for Demand

"Insanity: doing the same thing over and over again and expecting different results." Albert Einstein

Most of our efforts so far have been directed toward reducing backlog. We've had some success in other areas, particularly when we asked family physicians to consider referring to "Urology Associates" rather than a specific urologist. This let us distribute referrals to the urologist with the shortest wait list. As our backlog shrinks (wishful thinking?), we need to think about making changes to our office workflow. Otherwise, the backlog may creep back up.

"Managing demand" is the jargon for many system changes that improve workflow. We've been reducing our internal demand (patients who we recall for follow-up appointments) by carefully considering which patients truly need to be followed by a specialist and which ones should be followed by their family physician. Managing external demand (patients newly referred by family physicians) is more difficult.

Occasionally, I may receive a consultation request that can be managed without needing the patient to visit me. In those cases (especially when the patient may have to make a long trip in to see me), I'll write a letter to the family doctor giving advice on further management. Most situations, however, will require an appointment with me. How can I reduce that demand? After all, that's how I make a living!

Maybe we need to change the way we perceive external demand. At present, we consider each consultation request as being one "unit" of demand on the physician's time. What if we looked at demand units in the same way a lawyer would look at "billable hours"? Lawyers charge for each time they handle your file. This may include making phone calls to you or on your behalf, or even just picking up your dossier and thinking about the contents.