Friday, May 30, 2008

Spice of Life

Last week’s post brought some interesting responses. I had suggested that a large hotel’s elevator system was a good model for managing health care queues. A couple of people commented that, in principle, it might be advantageous to have a system that automatically assigns patients to the shortest wait list. However, they wanted to have a choice of which physician they saw.

They point out that personalities and skills vary among physicians, and some people will choose to wait longer so they can see someone they have confidence in.

I agree that it’s important to let patients choose their physician – recognizing that their choice may result in a longer wait. Our recently implemented "default" referral system recognizes this. As of May, all new referrals to our practice are considered "pooled" and go to the urologist with the shortest wait time. If the patient requires subspecialty attention, we set up the appointment with the appropriate urologist. However, the patient or referring physician can request ("No substitute") a specific urologist, with the understanding that there may be a longer wait.

Returning to the elevator analogy, some people may prefer the "services" of a specific elevator. Most of the elevators were glass-walled and faced out over a 40-storey atrium. Anyone with a fear of heights would be very uncomfortable with that ride and would prefer to wait for one of the enclosed elevators.

So, choice is important. But, it's not the only solution to this problem. And perhaps not the most desirable one, either.

Friday, May 16, 2008

Going Up

My wife and I spent last week in New York City. And I couldn't stop thinking about Advanced Access!

Our hotel had 49 floors and 16 elevators. I was intrigued by the elevator triage system. Rather than pressing the button and waiting for an elevator to show up, you punched in your floor number and the display directed you to the next elevator that was going to that floor. The lobby was so busy that the traditional system (pick an elevator, stand in front of the doors and elbow your way in when it shows up) would have been chaotic and inefficient. Some people would have long waits, both in the lobby and in the elevator, as it made a milk run to the 49th floor.

The hotel's automated (dare I say "expert"?) system grouped people according to their destinations, for example, batching all those going to floors 30-39 together, so the lower floors could be bypassed.

Part of my fascination with the elevators was pure yokel, i.e., in Saskatoon, we ain't got no real tall buildings. But I was also interested in the similarities between waiting for an elevator and waiting to see a specialist. In the traditional system, customers line up for an elevator/specialist without any idea of how busy that elevator/specialist is or how long they will wait. Some users, such as hotel staff/health care workers, may have inside information that helps them choose the shortest queue.

Users shouldn't need expert knowledge of the system in order to gain rapid access. There's an inherent inequity in a system that rewards expert/inside knowledge. The system should provide the expertise needed to get the user to their destination efficiently.

Friday, May 2, 2008

Cutting the Cord

When I decided that this would be my final Adventures in Improved Access blog post, I was struck with the parallels between our Advanced Access project and some changes in my personal life.

Last month, my eldest son moved away from home. He’s only a 5-minute drive away, and I see him frequently, but I wasn’t prepared for the mixed feelings I’ve had about his departure. I’m looking forward to a new relationship with an independent young man, yet I’m missing (somewhat) his regular presence around the house. On reflection, I think I’m unsettled by the fact that this change in his life signals a major change in my life.

With three children still at home, my wife and I are at least a decade away from being empty-nesters. Still, having our eldest move out heralds a new phase. Raising children brings new experiences almost daily, and the excitement of watching them grow and discover the world. Parents revel in our children’s success and wince at their failures (necessary though they may be). Our goal, as parents, is to raise happy, successful, and independent people, and then let them find their own way in life.

We’ve been having similar growth and change with our Advanced Access project. Karen has been our project advisor since its inception over a year ago. She has other duties to pursue and has let us know, over the last several weeks, that she’ll be withdrawing from the project’s ongoing management. We’ll collect and analyze all our data in-house, and continue with regular meetings with me, Donna, and Amanda, to keep the effort going.

Stephen, our patient representative, has indicated that he would also step down from the working group. His membership in the working group has changed our culture to the point that we ask the question (if he is ever absent from a meeting), “What would Stephen say about this new initiative/change?”

Likewise, Carla, our family physician colleague, will step back from regular involvement. All three of them have contributed enormously to the success of Advanced Access so far, and have graciously offered to consult if we need their advice.

We've also reached a significant milestone with the achievement of a new, stable system of reduced wait times.