Friday, February 6, 2009


From: Doe, John SktnHR
Sent: February 3, 2009 6:37 PM
To:   Kishore Visvanathan
Subject: Physician Input for Ambulatory Care

I dread these invitations. This week, I received 4 requests to attend meetings. It’s not that the meetings are terrible; I’d like to go to all of them. The problem is the effort it takes to get to the meetings.

All of the invitations were for meetings within the next 3 weeks. What were these people thinking?  Don’t they know I’m a busy clinician? My schedule is solidly booked at least 6 weeks in advance.  If these people want input from physicians, they need to plan ahead!

Look how much effort it takes to rearrange my schedule to attend a meeting on short notice:

  • First, I have to carefully consider (triage, I suppose) whether it’s worth the trouble to my staff and patients to rearrange my schedule.
  • Next, I ask my office manager how much effort it would take to get me to the meeting. If she pulls out more than a handful of her hair, I forget about that meeting.
  • If she gives the go-ahead, our staff start calling patients to reschedule appointments. Because this is on short notice, many people have already made travel plans, booked time off work, arranged child care, and are looking forward to resolution of their health concern.
  • Where do we move these patients’ appointments?  Usually, they get shoehorned into slots at the end of the day. That means I have to rush back to the office after finishing surgery at the hospital. There’s a pretty good chance I’ll be late. It’s not pretty.
That’s a lot of extra effort for my staff, and inconvenience for my patients. So, seriously guys, if you want me to come to your meeting, give me plenty of notice. That’s a reasonable request, right?

Well, maybe. It’s reasonable, if you presume that the problem is at their end. But, what if the problem is with me? If the rest of the health care world has to plan meetings around physicians’ congested schedules, how nimble can it be in responding to new situations?

Consider the waste at the other end of this transaction. For the administrators who want to engage with physicians over health care improvement, there’s an opportunity cost from convening short-notice meetings that physicians can’t attend. Valuable input may be missed. Later in the process, skeptical physicians may reject improvement efforts because they weren’t involved in planning from the start. The process then has to be reworked. Physicians become cynical and suspicious, resisting future efforts at engagement.

But, if administrators wait a few more weeks in consideration of physicians’ schedules, opportunities for rapid decision-making are squandered.

Our long waiting lists, and resultant inflexible schedules, cause waste in cryptic ways.  (Come on, Advanced Access, there are a lot of people counting on you!)  It’s been a while since I’ve thought this much about muda. Looks like it’s still alive and well.


  1. Originally posted by Jill 02/06/09 2:45 PM

    As one of those administrators who schedule meetings with docs, I try really hard to be respectful of their schedules and to give reasonable notice etc. The frustration for me occurs when we do all that and still physicians don't attend so planning progresses while we are all aware that we are missing key input and we send meeting reminders, copies of minutes and then, wait for it .... when we go to implement, we get grief from the docs because they weren't consulted.

  2. Originally posted by Dan Florizone (Deputy Minister of Health) 02/09/09 8:15 AM

    I am one of the culprits. You can never go wrong - when you place the patient first. You have absolutely made the right choice. We will tap into your Leadership insight and perspective in a different way. We have to be more creative in gaining your very valued input than simply calling a meeting on short notice. Much of the responsibility for such muda rests with me.

  3. Originally posted by Sheribiah (from a health region in the South) 02/09/09 8:25 AM

    Hi Kishore. In answer to your dilemma about attending health system meetings called by health Admin folks from your health region (or from others) about getting creative with your person-input-communication-methodology? Who says it has to be an "in-person meeting" with Admin? If they only want your input, your advice per se - then maybe they could share their plans with you via secure internet communications? How about this thing called Webex used in conjunction with a conference call? Couldn't you meet with Admin that way? Maybe this e-communication stuff could happen right from the comforts of your clinic office? That way you could squeeze in the Admin meeting by remote access - in between seeing patients perhaps? Maybe your participation in the Admin meeting might only be 30 minutes long? I betcha you could squeeze in a quick 30 minute Webex/Conference call with Admin - and call it your "Admin Meeting". Or better yet - go techie - and meet via videoconferencing? Videoconferencing equipment is coming down in price all the time. And it's likely easier to use than some of your fancy urethroscopes!!! We have good technology resources - we just gotta use them.

  4. This was lovely thanks for sharing