Sunday, April 22, 2012

Customer voice changes my thinking on changing our office practice

Last week, several of my partners and I had been talking about whether we should change a long-standing office procedure.  Most medical practices use a nurse or receptionist to show patients into examination rooms, where the patient waits until the doctor arrives.  In our office, we don't employ a nurse.  Instead, the doctor greets the patient at the entrance to the waiting room and shows him back to the consultation/examination room.

I'm sure that Lean practitioners would cringe to hear this.

Think about the steps in this procedure:

Doctor walks down the hallway from his consultation room to the examining room. 
Doctor calls the patient's name. (Repeat as needed) 
Patient packs up reading material, closes cell phone, removes and hangs up coat, etc. 
Doctor greets patient. 
They walk back down the hallway to the consultation room.

That takes from 1-3 minutes to complete.  It doesn't sound like much, but it's a significant proportion of our "standard" 15 minute visit.  It's time that could be spent finishing dictation of the previous consultation report, reviewing the next patient's chart, checking in-coming reports, etc.

I had recently read about the practice of "self-rooming", where patients are given instructions by the receptionist and then make their own way down to the assigned consultation room.  This would let our receptionist remain at her desk, save us the need to hire additional staff, and give the docs a few minutes of extra time between each patient visit.

What a great idea!  I ran it by a few of my partners and started thinking about how we could do try out the concept in our office.

Then, late last week, I met a man who changed my thinking entirely.

I was attending Saskatchewan's Health Quality Summit, and introduced myself to the man (I'll call him Ken) sitting next to me at one of the workshop sessions.

"Oh, yes," Ken said.  "I've visited one of your partners.  You know what impressed me about your office?  That the doctor actually came out himself to the waiting room to call for me."

What a coincidence, I told him.  We were just thinking about changing that practice because it's inefficient.  I explained the amount of time it took for doctors to perform that task.

He agreed that it may take a few extra minutes to do, but that he found it to be an important part of building the doctor-patient relationship.  He felt it showed a degree of respect and caring.

"When I meet a doctor for the first time, I make a judgment as to whether I can trust that doctor.  I think the first impression your staff make is a very good way to build that relationship," Ken said.

That was a very powerful thing for me to hear.  I have often commented to medical students and residents that specialists need to be deliberate about building a trusting relationship with patients.  Unlike family physicians who have years in which to develop a bond with patients, specialists have only a short time to do so.  This is especially important for surgeons, who may meet someone for the first time and, within the course of that visit, inform the patient about a serious diagnosis - such as cancer - and discuss performing a life-changing procedure.

Ken was telling me that the simple habit of escorting my own patients to my consultation room was a valuable step in building a trusting relationship.

That doesn't change the fact that the procedure requires an investment of time, but it does mean that, if we're going to make a change, we can't measure the outcome solely on the basis of time saved.  We would also need to consider the impact on patient experience.  As Ken went on to say, "Spending a few minutes more up front is probably saving you time later on because patients feel you are considerate and caring."

What a valuable lesson! (Even if I do have to keep learning it over and over again...)


  1. Kishore,
    Great blog! I'm always interested to see the intersection of Lean and Client and Family Centred Care. I am crazily excited about the direction our province is heading in both these important areas, but like you point out, I hope in our efforts to do all things 'lean' we don't lose sight of the balancing measures that we need to have in place to ensure that we aren't impacting our ability to provide client and family centred care. I think we're headed in the right direction though, by starting with listening to what our clients are saying! Thanks for leading on this front.
    Victoria Schmid

  2. Very, very interesting. Speaking with 25 years of emergency practice, that walk to the consult room gives you plenty of time to perform critical assessments of your patiet. You can tell quite a bit about someone by looking at their general demeanour, the way they move, how their clothes fit, their body habitus, facial colouring and expressions. Love your blog. It is often the high-point of my day. K. M. Cullen

  3. Great post Kishore. The challenge in a lean focused system, I believe, is to really understand value before ferreting out the waste - our patients, clients, and families seem best positioned to help us with this, as Ken so ably demonstrated:-) You should be commended for being so attuned and open to this input...I think it can be easily dismissed.

  4. You've made a valuable point....customer (e.g. patient-centered care) service should always be at the forefront/center of everything we do....Lean strategies should only be used if they improve the customer experience.

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