Swing Shift

Extending office hours from 5 to 6 pm required some negotiation. Our receptionists have agreed to try a couple of late shifts. This brought up some unanticipated issues. As it starts to get dark by 6 pm, our staff won't be comfortable walking home from work, so we'll need to provide transportation. Also, we need to check that our office building will still be unlocked at that hour.

The real test of the plan is getting physician bodies behind desks. Amanda made a sign-up sheet for two evenings next week and circulated it to the urologists. She did a nice sales job. Four doctors signed up for one evening and two for the other. Six doctors at four patients per hour means an extra 24 appointments off the backlog that week. I hope this is a small change we can sustain.

P.S. Turns out that blogging is mildly addictive. There’s a spin-off from the Advanced Access project that I’m pursuing at http://kishorevis.blogspot.com. Come on over and check out “Plain Brown Wrapper”!

Summertime Blues, Part 2

Our last team meeting was a little glum. As noted previously, summer slowed our efforts to work down our backlog.

Now we're trying to come up with a plan that will address our new target (almost 100 extra patients per week) in order to work down the backlog by the end of November. We thought about adjusting our target date: if we push it back by another few months, that would ease the work. It would also prolong this initial phase of eliminating the backlog. Already, I'm feeling enthusiasm is dampening in the office. As the project proceeds (drags on?), it's harder to keep the energy up. Moving back the target date will be like dying the death of a thousand cuts. We need a new plan. Something bold.

We already thought about asking the "half-timers" to work a few extra days seeing backlog patients. Donna mentioned that, many years ago, the urologists in our office had come to work on Saturday mornings to see patients. Amanda wondered whether working one evening a week would be more acceptable than working a weekend. Either one would be a tough sell, given the hours we're already working. Maybe we just need to see what happens during September and October, now that we're back up to full steam again.

I Love Crappy Service

I recently had the chance to observe operations at a local fast-food outlet. I stood unacknowledged at the counter while three clerks went about their business. One fellow was working hard, putting together four sundaes for a drive-through order. A girl stood at the sink, haphazardly rinsing off the milkshake equipment. The other young woman wandered back and forth behind the counter sipping on a soft drink, studiously looking away when we came close to making eye contact. When the first girl finally finished at the sink, she stepped over to the counter and stood silently at the cash register. I finally asked her if she was ready to take my order. It was atrocious customer service.

I loved every minute of it.

I used to (and occasionally still do) get upset at bad customer service. Now, I relish it by playing a little mental game similar to Switch! I spot the poor performance and try to relate it to ways I could improve my own work. I was annoyed when the restaurant staff didn't acknowledge me at the counter. Is every patient coming to my office greeted as soon as they arrive? The clerk was cleaning equipment while customers were waiting.  Am I putting patients first by not keeping them waiting while I finish paperwork or review lab tests?

When I saw the girl carelessly cleaning the milkshake equipment, I thought "What else is being done sloppily around here? Are the cooks washing their hands properly?"  One bad impression was enough to give me a pervasive negative feeling about the place. If I habitually keep people waiting, does this affect their overall impression of my ability to practice medicine in an organized and reliable way?

Embrace crappy service for the lessons it teaches us.

Summertime Blues

Summertime is giving us some insight into a source of our waiting list backlog. When we started this project in the spring, our capacity appeared to exceed demand. The problem, we thought, must be a mismatch between the two, and that it should be straightforward to fix once we get rid of our backlog. We were making good progress with our backlog until summer came along. As you would expect, having half the doctors away for most of the summer reduces our capacity. Our ability to work down the backlog is reduced further because those of us who are working are often fully booked at the hospital taking advantage of the OR time that those on holidays have left unused. Not only have efforts to work down the backlog stalled, I wonder if the backlog might be creeping up over the summer.

This Advanced Access project is like a fitness program. You set a target weight (appointment wait time) and then match your intake of calories (demand) to the amount of exercise (capacity). Of course, it takes some extra effort (reduce calories and/or increase exercise) to get rid of the flab (backlog), but once it’s gone, balancing calories and exercise should maintain your target weight. If you're like me, though, a week at the lake can throw off the whole program. Lounging at the beach plus marshmallow roasts pack on the flab and it can take weeks to get back on track again. It’s looking like the same thing has been happening every summer at our office, i.e. we shed the flab during the rest of the year when we're all working full-tilt, only to pack on the backlog during summer holidays.

We may need to reconsider how many physicians can take holidays at a time, or reconfigure our office hours to make sure our backlog doesn't creep up every summer.  Otherwise, we'll be starting from scratch every fall. It would be nice if the number of new referrals fell off over the summer, but that's not the case:

Also, in January, one of our urologists started working half-time, and as of July, two other partners are working half-time. We have a new partner joining in mid-August, but our capacity will still be down 0.5 FTE. Our most recent calculations show we have to see 97 extra patients a week just to work down our backlog by the end of November.  Considering the number of doctor-days in the clinic, each urologist will need to see between 4 and 5 extra new referrals each day they are in the clinic to work down the backlog in a 12 week time frame. That's a lot of work! Perhaps we can convince the "half-timers" to help us out by working a few days extra. If they came to work for 2 days during their month off, they could see up to 60 new patients each. That would really add up.