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.”

What?!

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:

Suggestion Box

Last week's staff meeting reminded me of one of the world's most famous companies. Or at least, a book I'm reading about that company.

It was a great meeting. We welcomed some new staff and oriented them to our Advanced Access project. Over lunch, we discussed staff suggestions for Clinical Practice Redesign.

A few weeks ago, we set up a suggestion box in the staff area. It sounds like a corny idea, but we wanted to see if it would encourage people to share thoughts on how we can improve our office processes. It really paid off. While none of the ideas are earth shattering, I think they'll have an immediate effect for office workflow, and they illustrate principles of quality improvement.

Which brings me to "How Toyota Became #1 – Leadership Lessons from the World's Greatest Car Company" by David Magee. He tells the story of the development and practice of the Toyota Production System, Toyota's approach to management and quality improvement. Several of our staff's ideas reminded of the principles Magee writes about. Here are some of the ideas we'll be implementing.

Just Tell Me What You Want

This week's Canadian Medical Association Journal was a goldmine.

MD Lounge's topic is "Referrals". Improving our referral system is part of our office's Clinical Practice Redesign effort, but it looks like we're reinventing the wheel! The College of Family Physicians of Canada and The Royal College of Physicians and Surgeons of Canada looked at the referral/consultation process in a 1993 task force report.

In a 2006 review, they suggested 3 features to enhance the process:

• A defined single access point within local referral/consultation systems.

We're the single access point for urology in Saskatoon, and my family physician colleagues say that's very handy for them. Imagine a single website listing all Saskatchewan specialists with their particular area of clinical interest. This would be very valuable in Saskatchewan, where there are regularly new physicians, who aren't familiar with local specialist resources.

A single access point could be leveraged by also providing wait time information (for surgery, in the following examples) for individual specialists (like Alberta), or by region or hospital (like Ontario). Of course, you would make this information public so that patients are better able to choose the specialist they wish to see. This requires a significant investment in infrastructure to measure the wait times and update the website regularly. It doesn't require any change in physician behavior, making it easier to sell to physicians.