Wasted

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:

Resolutions

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:

Can't

Don't

Won't

At least be honest with me!

I Love Lines

I love standing in line.

Or, more accurately, I love what I learn from standing in line. Being stuck in traffic, waiting at the grocery store checkout – they're all golden learning experiences if you're a student of queues. But nothing beats air travel...

Over the holidays, I enjoyed a tremendous learning opportunity courtesy of a leading national airline. So many of the problems I observed at Toronto airport were analogous to the situation in physicians' offices. Because so many people have experienced the frustration of waiting in line at the airport, perhaps this could be an effective model to explain Advanced Access/Clinical Practice Redesign to novices.

Before we even arrived at the airport, we had been primed to expect a long wait. Airlines establish cultural norms with the advisory printed on every ticket: Be at the airport at least 60 (or 90, or 120) minutes before your flight departure. So we shrug our shoulders and drag our suitcases to the end of the line, because... that's the way it's always been!

Sound familiar?  It takes forever to get in to see my doctor. You'll wait a long time to see a specialist. Health care sets the same norms. Earlier this week, I heard a presentation about a new project in the Saskatoon Health Region, aimed at reducing patient wait times when they come for assessment and education at the Pre-operative Clinic. The project coordinator showed a sign currently posted at the entrance of the clinic. It showed a drawing of a man resigned to his fate (shrugging his shoulders in a C'est la vie kind of way) and said: Your visit to the pre-operative clinic may take 4-5 hours. Those are the expectations we establish for our patients. That's the promise of service we give as our patients come through our door.

Cup Holder Conundrum

Over the last few days, many of you watched, as I did, the Pan-Canadian Broadcast of IHI's National Forum. The keynote speeches weren't very cheery.

Don Berwick looked downright ticked off. Change isn't progressing fast enough for his liking. I suspect that most people involved in quality improvement share his frustration. Dr. Berwick imagined 2 letters that he would write, for his daughter to open 20 years from now. One letter presumes that the quality agenda will flourish over the next 2 decades. The second letter is an apology: Sorry we let the nay-sayers beat us down. Sorry we couldn't budge the inertia of groups with a vested interest in the status quo. Sorry that you're paying the price 20 years from now.

John Kitzhaber – ER physician and former Oregon governor – made a passionate appeal for reforming the US healthcare system before it becomes financially unsustainable. His perspective is purely American, but in the current economic situation, Canadians should take notice as well.

Gloomy!

It made me think of automobile cup-holders.

North American automakers have been pilloried as they plead (and make not-so-veiled threats) for a financial bailout. GM has made an astonishing mea culpa: We acknowledge we have disappointed you. Whether or not you think they are sincere (GM gets savaged in some of the comments below the article), some of their admissions could just as easily come from the healthcare industry.