Friday, January 23, 2009


In the spirit of January, let's first take a look back, and then see what the upcoming year promises.

Responses to my last post reinforced for me the idea that illustrating the principles of wait time management with examples from everyday life may be a powerful way to engage people in tackling similar problems in health care.

My experience in an airline's check-in queue led me to conclude that organizations sometimes make the conscious choice to give their clients bad experiences. The words that an organization's leaders and employees choose when communicating with clients can reinforce this dysfunction. When a clerk tells a customer, We can't do that, “can't” suggests the customer's request is a physical impossibility, something not only unreasonable, but fantastical.

When the response is We don't do that, the clerk retreats behind the corporate mantle. What you're asking is possible, but it's not part of our culture.

What's the honest phrase? Which words acknowledge the conscious choices service providers make? We won't do that. Or, even better, I won't do that. My organization chooses not to provide the service you're requesting. (Of course, this may be a completely reasonable statement for an employee to make, i.e., don't pull up to the Tim Horton's drive-through window and demand an oil change). Won't makes the individual and organization take responsibility for their action/inaction.

Here's my idea for a (snarky) T-shirt logo, suitable to be worn anytime you're at risk of receiving poor service:


At least be honest with me!

Friday, January 9, 2009

I Love Lines

I love standing in line.

Or, more accurately, I love what I learn from standing in line. Being stuck in traffic, waiting at the grocery store checkout – they're all golden learning experiences if you're a student of queues. But nothing beats air travel...

Over the holidays, I enjoyed a tremendous learning opportunity courtesy of a leading national airline. So many of the problems I observed at Toronto airport were analogous to the situation in physicians' offices. Because so many people have experienced the frustration of waiting in line at the airport, perhaps this could be an effective model to explain Advanced Access/Clinical Practice Redesign to novices.

Before we even arrived at the airport, we had been primed to expect a long wait. Airlines establish cultural norms with the advisory printed on every ticket: Be at the airport at least 60 (or 90, or 120) minutes before your flight departure. So we shrug our shoulders and drag our suitcases to the end of the line, because... that's the way it's always been!

Sound familiar?  It takes forever to get in to see my doctor. You'll wait a long time to see a specialist. Health care sets the same norms. Earlier this week, I heard a presentation about a new project in the Saskatoon Health Region, aimed at reducing patient wait times when they come for assessment and education at the Pre-operative Clinic. The project coordinator showed a sign currently posted at the entrance of the clinic. It showed a drawing of a man resigned to his fate (shrugging his shoulders in a C'est la vie kind of way) and said: Your visit to the pre-operative clinic may take 4-5 hours. Those are the expectations we establish for our patients. That's the promise of service we give as our patients come through our door.