Friday, October 31, 2008

Business as Usual

All models are wrong, but some are useful. – George Box

Earlier this year, I was running late in my cystoscopy clinic. As I greeted my next patient, I apologized for keeping him waiting.

“That’s OK, I understand.” he said. “I’m in the service industry too.”


I felt vaguely insulted.

I’m not in the service industry; I’m a doctor!

But, what would happen if I pretended to be in the service industry? I mean, could I use the service industry model to improve my quality of care? Obviously, there are significant differences between business and medicine. The doctor-patient relationship is special, and doesn’t happen in the service industry. But, models are just tools to achieve an end, and we don’t need to buy into them all the way.

For example, my 2 little boys groan when I take them grocery shopping with me. But, if we pretend we’re soldiers attacking Safeway, then they hit the ground running. The “assault team” model/game works from several aspects: following the commander’s (Dad’s) orders, carrying out risky missions (Rescue a can of tomato soup from aisle 3!) and getting the team in and out on the double. (Also, commandos don’t ask for a packet of Smarties while waiting in the checkout line.)

Here’s how a service industry model could be useful:

Customer-focused service /Patient-centred care

The customer comes first. Businesses exist to serve customers. They must understand what the customer wants. That means asking the customer with surveys, or actually involving customers in the design of a product or service through focus groups.

(For those physicians who object to calling patients “customers” or “clients” – remember, this is just a game. You’ll still have a unique doctor-patient relationship. Don’t get hung up on the words.)

A growing body of evidence describes the benefits of involving patients in this way.


The bowl of Tim Horton’s chili I had in Calgary airport tasted the same as the one in Toronto airport. (I’ve been on the road a lot this month!) Ditto the Starbucks chai lattes in Calgary and Toronto. Customers demand the same quality product every time, and companies take great pains to standardize their processes, and train their staff to ensure consistency.

Shouldn’t patients expect (demand!) the same consistent result from procedure X, no matter where, when, or by whom it’s performed? We should embrace “cookbook medicine,” rather than ridiculing it.


Companies invest considerable time and money into developing their brand – the unique way they want to be perceived by their customer. It’s their corporate personality. Often expressed in vision and mission statements, the corporate brand guides all aspects of companies’ interactions with customers.

As a urologist, I might choose something like “Patients value the exceptional urologic care I provide” as my brand/mission. This catchphrase would be a reminder of 2 principles that I want to guide my practice: Patient-centred care and ongoing quality improvement. (Note that it’s the patient/client/customer who gets to decide on the value of my service.)

This model breaks down when I try to consider the competitive nature of the service industry. While there is competition for referrals/patients between some physician groups, for the most part (in Canadian medicine), the shortage of physicians ensures plenty of work for everyone. Maybe competition could be created by challenging different groups to improve quality of care or give better customer/patient satisfaction, and then rewarding them with funding, other resources, or just recognition.

Select aspects of a business model fit with medical practice, if we accept that models are just games we play to achieve our goals. We don’t have to give up the special physician-patient relationship in order to play this game.

1 comment:

  1. Originally posted by Joy Dobson 11/04/08 9:00 AM

    Can I make your blog mandatory reading for CPD credits? This one dovetailed so well with the supper conversation at our family kitchen table - Imagine just for one minute what it would be like if when a patient entered the front doors, a doctor and nurse were waiting to greet them, saying "We are your care team. How can we help you?"