See the Light

Last time, I told you about our plan to record the number of new consultations seen by each urologist, and then share the results with the whole group. The number of new consultations seen could be considered the basic currency of our practice, that is, each new consultation holds the same relative value. Once we're confident that our data is representative, we'll share it with all the urologists.

We did the same thing with our patient recall rates. That project revealed significant variations in recall rates among our docs. Although we never set actual target rates, we did encourage docs to come up with their own ways to modify their practices to reduce recall rates. I think much of that project's success resulted from showing the frequent-recallers that there was another way to do business. Their peers, working in the same environment, shared their ideas on making changes to engrained practice habits.

I hope for the same success with the latest project. I predict that we will find (once again) a significant variation, this time in the number of new consultations seen per physician. (Yes, I have peeked at the preliminary results.) We'll circulate that information and let the docs with low numbers formulate their own plans on how to modify their practices.

That's the plan I put forward at our office meeting this week. Some docs' response to that plan was pretty pointed.

I hadn't presented any numbers; we want to collect September's data so that summer holidays aren't as much of a factor in how many new patients everyone has seen. However, at least one doc didn't see any point in making the measurements in the first place. His point was this: I'm working as hard and as long as I possibly can, so even if I am seeing fewer new patients than anyone else, I can't make up the difference. That's just the way my practice is structured and I don't see how it can change.

It's hard not to be annoyed at someone who challenges your precious new project. I mean, how dare they question the obvious benefits of the plan? Don't they see The Light?

Well, if they don't see the light, it's because we haven't made the light bright enough. His misgivings about this project were absolutely valid in the context of his current practice (i.e., culture). He's right that, barring working evenings and weekends, he can't do any extra work beyond the occasional add-on patient visit at the end of the day.

There may also be a subtext of indignation: You're saying I'm not working as hard as everyone else. You think I'm not pulling my weight.

I would address that misconception using the story I told in Juice. My sons were trying to squeeze some orange juice for Grandpa. They were failing, but not because they weren't working hard, and not because they didn't care. They were failing because they didn't know about a more efficient technique for squeezing oranges. Once they were show how to use a juicer, they applied the same energy to the same resources and were able to generate a tasty glass of cool, refreshing results in no time.

That's what I hope we'll be able to share with each other as part of this new project - the different ways each of us has developed for squeezing the maximum juice out of our work day.

When my boys struggled with Grandpa's juice, I didn't berate them for not being able to see the light, i.e., the juicer. Of course they couldn't see it - we had never shown it to them. It was the adults' responsibility to give them the tools they needed to get the job done effectively.

It is our job, as leaders, to do the same for our team mates. We need to look at the practices of the docs who are seeing the most new referrals and find out how they do it. Then we'll share those techniques with the other partners. Some ideas we're already aware of include:

• Seeing patients for a single consultation with a procedure (usually cystoscopy) done at the same time. The traditional approach is to see the patient for a separate office visit and then for the procedure. The combined approach frees up an office slot to see a newly referred patient.
• Scheduling 2 patients in a 15-minute slot usually reserved for a single patient. This is usually only possible for predictably short new patient visits, such as vasectomy referrals. (Or cut out the office visit entirely and roll the initial visit and procedure into one. See point above.)
• Have patients complete a medical information form prior to the consultation, to reduce the amount of time devoted to recitation of this information during the office visit. This may make urologists more comfortable with combining consultations with procedures in a single visit as it speeds up the overall consultation.

As this latest project progresses, I hope that other tips from my partners will shed more light for me.

P.S. I'm relieved to find out someone else (and someone reputable!) is condemning perverse incentives in healthcare.