Not So Happy Holidays

November and December have been lean months from the point of view of getting rid of our backlog. As we noted during the summer months, when several physicians are away, it’s difficult to find extra office capacity for the remaining physicians.

As holidays are a recurring reason for reduced clinic capacity, we need to consider if we can manage them more effectively.

The first thing I’d like to implement is a more effective way of requesting and tracking holiday requests. Our traditional method is to write the request on a scrap of paper and attach it to the paper “master calendar”. I then mark my initials on the days I want off. If there are already x number of urologists away at that time, I’m not supposed to request that time off. Special circumstances may be negotiated individually.

I need to see the actual calendar in order to check available dates. It usually lives in the holiday coordinator’s office, but it may occasionally go missing for a few days. It’s usually our office manager or the call-scheduler who have it, but it’s still a nuisance when I want to book holidays and can’t find the calendar.

The Emperor's New Clothes

I recently received this comment on my “Adventures in Improving Access” blog:

I am currently on the wait list for a vasectomy. I'm scheduled with Dr. Jana. My G.P. referred my case to Urology September 13, 2007. I didn't receive a letter from Urology after a few weeks so I followed up with the Kenderdine Clinic to see if the referral had been sent to Urology. The Kenderdine clinic said it had been faxed over. I phoned Urology but my name was not on the wait list. The reception at Urology told me that as soon as faxes come in that the name was added to the list, so they probably hadn't faxed the referral yet. I then phoned back to Kenderdine Clinic and they re-faxed the referral. I did receive a letter from Urology after those conversations. My Urological Surgeon consult appointment was booked for December 5th, 2007, I received that appointment letter on October 17th, 2007. Consult wait time was pretty much 2 months if the first request from Kenderdine would have been successful. My feeling is that I was 99% sure I was going to go for a vasectomy so I would have preferred just to have my surgery scheduled directly from the first request. Maybe even a quick phone conversation to brief me on the procedure and ensure that I wanted it. Dr. Jana did examine me to ensure he could perform the procedure on me but how many times does it happen that it's not possible to do the surgery?

I would suggest that I could have had a shorter wait time if I had been scheduled for the procedure right away.

Dr. Jana told me the likely wait time for my vasectomy would be 3 to 4 months from the December 5th consult date.

It's my opinion that waiting 2.5 months for a consult appointment is excessive then waiting another 3 to 4 months for the surgery is excessive.

Who does this guy think he is, telling me how to run my practice? Does he have any medical training? Does he know anything about assessing men before vasectomies? What experience does he have in booking surgical procedures?

Big fat zip on all counts, I’ll bet.

Yet, oddly enough, he nailed it. Right on the button. Nothin’ but net.

Without any “pertinent” experience, he’s suggested changes to our system that could not only improve service, but also eliminate unnecessary office visits.