Total Recall

At last week's team meeting, we discovered a weakness in how we measure our internal demand.

In the same way that we measure new referrals from family physicians (external demand), we've also been tracking the number of recall appointments requested by our urologists (internal demand). These recall appointments are generated when we want to follow a patient with a chronic or ongoing condition, such as cancer. We receive an average of 150 new referrals, and request about 44 recalls each week.

We can reduce recalls by returning follow-up to the patient's referring physician. This is the true role of a "consultant," that is, provide the service that requires specialty care and then, with appropriate instructions, return care to the primary physician.

Even though all the urologists have agreed that we should try to "repatriate" patients to their referring physicians (where appropriate), we haven't seen a drop in the total number of recall requests. Our project team interpreted this as inadequate implementation of this change by the doctors. However, we now think the lack of change may be an artifact of our data collection.

Uphill Both Ways

Wow! A month away from this blog. It's hard to get back to putting pixels on paper. We're making slow progress with the project, but have had some challenges over the last month. Here's an overview:

Working down the backlog is still our main goal. We've realized that we won't see the end of the backlog by November 30. This month, four out of nine urologists are on holidays. The rest of us are doing our regular work as well as looking after lab results and returning patient phone calls for our vacationing partners. There's not a lot of free time (or much appetite) for adding extra office visits. Even so, Amanda continues to recruit (successfully!) for working evening office hours (5-6 pm, once a week for each doctor). Also, our part-time partners continue to come back to work on their "month off" to work extra days.

December is also going to be a difficult month in which to mobilize extra effort toward the backlog. Hospital holiday slowdown at the end of the month should free up some of us to do extra work at the office. On the other hand, when the hospitals slowdown, we plan for half of us to take holidays over Christmas week and the other half are off New Years week. We'll try to work through as much backlog as possible over the holidays. I'm hopeful that our efforts in January and February will set us up to wipe out the backlog by the end of February.

Blog Break

Kishore’s entries will resume in early November.

Until then, regularly visit his other blogging project: Plain Brown Wrapper.

Accounting for Demand

"Insanity: doing the same thing over and over again and expecting different results." Albert Einstein

Most of our efforts so far have been directed toward reducing backlog. We've had some success in other areas, particularly when we asked family physicians to consider referring to "Urology Associates" rather than a specific urologist. This let us distribute referrals to the urologist with the shortest wait list. As our backlog shrinks (wishful thinking?), we need to think about making changes to our office workflow. Otherwise, the backlog may creep back up.

"Managing demand" is the jargon for many system changes that improve workflow. We've been reducing our internal demand (patients who we recall for follow-up appointments) by carefully considering which patients truly need to be followed by a specialist and which ones should be followed by their family physician. Managing external demand (patients newly referred by family physicians) is more difficult.

Occasionally, I may receive a consultation request that can be managed without needing the patient to visit me. In those cases (especially when the patient may have to make a long trip in to see me), I'll write a letter to the family doctor giving advice on further management. Most situations, however, will require an appointment with me. How can I reduce that demand? After all, that's how I make a living!

Maybe we need to change the way we perceive external demand. At present, we consider each consultation request as being one "unit" of demand on the physician's time. What if we looked at demand units in the same way a lawyer would look at "billable hours"? Lawyers charge for each time they handle your file. This may include making phone calls to you or on your behalf, or even just picking up your dossier and thinking about the contents.