Goats and Apples

OK, one last post about our recall rates/internal demand. I’ve been fixated on this topic for many recent posts, and it’s probably time to move on… after I show you this chart:

Looking good!

In July, 6 out of the 8 docs who were working had patient recall rates in the single digits, and the clinic average recall rate was 6.8%. That’s the first time we’ve had a clinic average in the single digits. We need to maintain these gains, and I think we’ll be helped by a change coming to our office this fall.

Heaven

I’ve been to wait line heaven... it’s a Wal-Mart.

I studiously avoid shopping at Wal-Mart. I know it’s a popular spot, and that’s the problem – the more people who shop there, the longer the wait at the checkout. And I hate wait lines.

But, last month, while looking for a piece of summer camp equipment for my son, I paid my first visit to our local Wal-Mart outlet. They had the item in stock, so I prepared to brave the wait for the till. I headed for the express checkout line. There were over a dozen people in the first line. I looked around for a shorter line. But, there was only one queue for multiple cashiers. Now, that’s odd for a department store.

Whether by tradition, or based on hard statistical analysis and marketing research, various businesses manage wait lines differently; for example, grocery store lines vs. bank lines. At the bank, you form a single queue, at the front of which you look for the next available teller. At the grocery store (and most department stores), you size up individual lines, trying to judge who has the most groceries, which teller is the chattiest, and who will be paying with loose pennies dredged up from the bottom of their purse. Then, while standing in line, you kick yourself for not picking another line that seems to be zipping along. Queue-er’s remorse.

Stick It

You can’t manage what you don’t measure.

Q:  What’s more annoying than a worn-out cliché?

A:  A worn-out cliché that keeps on proving itself right.

Measurement is a key component of Advanced Access. For us, it’s been a source of enlightenment and discovery. While we continue to use many of the same measuring sticks that we started off with, we’ve added some new measuring sticks that have yielded some surprises.

I’ve been telling you about our efforts to reduce recall rates/internal demand. Those tests of change (call them PDSAs if you must) arose after we tallied the number of patients each urologist was asking to come back for a repeat visit. I presumed that all of us had pretty similar practice habits, but some of our staff thought that those habits varied considerably. So we did some counting. The initial data is in “Bang for your Buck”. While we don’t know whether the higher rates or lower rates of recall are more clinically appropriate, our guess was that we could provide the same quality of care, yet have necessary follow-up provided in a setting other than a specialist office.

Pyrrhic Victory

During recent lobbying for his health care reform platform, US President Obama praised organizations such as Intermountain Health for being role models in providing high-quality care, without skyrocketing costs. Obama echoed comments made by a senior Intermountain executive: “Much of the rest of the country tends to focus on the volumes of health care services they provide, because that's what the system rewards, rather than the care that's necessary to help the patient.”

Bingo.

Have you had the chance to read “On the folly of rewarding A, while hoping for B” yet? According to this classic essay, we should expect exactly the system we have, that is, pay me fee-for-service and I’ll give you lots of service. And don’t call me greedy; we’re all responsible (via elected politicians) for supporting this dysfunctional system of rewards.