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!

Looking back at our 3rd NAA gives me mixed feelings. It's nice to see that we broke the back of that alarming, late-2008, upward climb. But maybe our efforts don't deserve the credit. Considering that we saw the same trend at the end of 2007, perhaps this is the natural annual rhythm of our practice. Maybe we've been taking credit for wait time changes that have been going on for years! That's a sobering thought.

This undertaking began as an Advanced Access project with a specific wait time target and completion date (which then migrated with experience), but it's shifted to a broader Clinical Practice Redesign enterprise in which we're trying to improve many aspects of our practice. As such, while we still want to shorten our wait times, we no longer have all my eggs in the 3rd NAA basket. And so, on to my New Year's resolutions...

I've stacked the odds of success in my favor. The 2 projects are bite-sized, and I'm making my resolutions public. Transparency is a great motivator. Last year, I posted my resolution on Plain Brown Wrapper, and I've been very consistent with that promise. (Even though it's a new year, you can still feel free to call me on it, if you spot me reneging on last year's resolution.)

First, I want to build on a previously successful initiative – streamlining patients' evaluation for microhematuria. Patients with this condition only require one urology visit. All necessary information (history, lab tests, radiology results) should be available to the urologist, who can then perform the cystoscopy (the only “specialist” part of the assessment), and summarize all the result for the patient. A “pre-cystoscopy” office visit, to ask about their medical history, doesn't give our patients good value. A single consultation should be our practice standard.

Second, I want to use my time with patients more productively, rather than asking them to regurgitate their past medical history, medications, allergies, etc. Of course, a universal electronic medical record would obviate that, as would consistent transmission of a comprehensive patient profile from all referring physicians. But, I don't think either of those is going to happen anytime soon. I checked Plain Brown Wrapper's archives and found I'd made plans to solve this problem last year and haven't followed up on it yet. So much for the exhortative powers of transparency! (The post was in February, however, so not technically a New Year's resolution...) I'll have to keep in mind the comments “Joe Black” left on the blog post – very insightful.

Have a happy and transparent New Year!

1 comment:

  1. Originally posted by Sadie 01/26/09 2:00 PM

    Recently I had to refer a patient for investigation of hematuria. I recieved a letter back suggesting other investigations which could and should be done prior to the appointment with the specialist. I could and did arrange for those other investigations and forwarded all the data in once completed. When the patient questioned me about the tests and why I was asking them to have them done without even seeing the specialist I explained that we had received the request from them and the tests were requested so when they went in for their appointment they would not have to go through all of this again and would be able to get an answer sooner and for the specialist to have a better picture of the problem prior to their appointment. The patient was then very receptive to this and thankful that they would not have to be making many appointments to get these tests done and see the specialist again. This process recognizes that everyone’s time is important and valuable. I could provide/order the required investigations, the patient was able to have the investigations done closer to home and on a one day appointment schedule and then follow-up with the specialist with all the required data available to him/her to provide an accurate diagnosis for the hematuria. Perhaps all referrals to specialists could be configured to provide better and more efficient time management if this process was followed with other practices.