Thursday, March 20, 2008


Last week, we had a celebratory lunch meeting with our office staff. It turned out to be a goldmine of ideas.

Karen presented our latest 3rd NAA stats. Still looking good:

Now we need to take the waits down to our 14 day target. Time for some small tests of change.

Three of our urologists are half-time. However, they still have their same pre-existing patients who are recalled for regular reviews. Barring changes in recall habits (hint,hint!), this internal demand now needs to be accommodated in half the time, leaving less time to see new referrals. We looked at the 3rd NAA for full-time vs. part-time physicians.

Full-timers are looking good.

Okay, here’s a problem.

We need to manage the part-timers' demand more effectively. Patients referred to them are still seeing long wait times. One opportunity to improve these patients' experience is to maximize pooled/generic referrals. Our scheduling staff feels that the ability to schedule new patients with any urologist (taking into consideration any special expertise needed) has been the major factor in reducing our wait times.

It's been a year since we sent the letter to referring physicians that invited referrals to "Urology Associates," at the physician's discretion. The change in practice was immediate and has persisted. We'll send out another similar letter to physicians in our referral area. It'll be interesting to see what changes happen with this second invitation.

A longstanding practice in our office has been coordinating testing and office appointments for patients travelling from out-of-town. Our staff goes to great lengths to arrange ultrasounds, CTs, and cystoscopies on the same day as the consultation. As our wait times have dropped however, they've found it more difficult to arrange the x-rays on short notice.

We've been successful in changing our office system because it's a closed system over which we have a lot of control. Now, our reformed system is butting up against outside systems. I think we'll need to partner with a radiology group that has their own version of Advanced Access.

We've been asking family physicians to arrange pre-consultation testing for commonly referred conditions (e.g., hematuria), so the results are available when we see the patient. If we have those results, the visit is much more valuable for the patient, and it's a more effective use of the specialist's time. Our staff feels that some FP clinics are quite reliable in forwarding these results.

We discussed why this might be. Could it be that the FP clinic's staff make that effort unbidden, or is it the FPs themselves who are conscious of the need to send us the results? Maybe a combination of factors? Regardless, we like it and would like other FP clinics to follow suit. I'll write to one of the docs at that clinic and ask what their procedures are. It’ll take more work to drop 3rd NAA to the next level, but we’ve got some new ideas to try out.

1 comment:

  1. Originally posted by John Meredith (Nautilus Operational Research Consulting) 03/20/08 1:15 PM

    Your scheduling staff have discovered for themselves a fundamental result of queueing. "A single queue feeding many 'equivalent' servers rather than individual queues for each server is a really good way to reduce overall queue size and wait times while distributing the servers' load more evenly.”