By February 13, 2007 2 Comments Read More →

An Open-Access Doctor’s Office

Business Week Article

Here’s a good story about how some doctors offices are trying to reduce backlogs and appointment delays, by adopting lean and operations management methods.

As the head of a large primary care department at a Kaiser Permanente facility in Northern California, Dr. Mark Murray knew he had a problem. The average wait time for an appointment was 55 days, and even then, patients had less than a 50-50 chance of seeing their own primary care physician. On a personal level, listening to complaints from his dissatisfied patients was frustrating. And as a doctor, the situation made him extremely uncomfortable. “I knew that inside those 55 days there were mammograms that needed to be done, patients with chronic conditions that were getting worse,” he says.

It sounds like the doctor had done like many manufacturers, going the technology and “work harder” route first.

During the 1990s, Murray tried everything from increasing overtime to centralizing the phone system, but nothing seemed to have any effect on the bottlenecks. He was responsible for 250,000 patients, 100-plus doctors, and 400 support staff, and nobody was happy.

That’s when he realized that his problem was one the business world had solved long ago. “If you go to Starbucks, they don’t ever say, ‘we don’t have lattes today, come back later,'” he says. “They have a plan to match their supply with your demand as quickly as possible. Why can’t [health care] be the same way?”

Well, that’s not exactly true. I heard a Starbucks counter employee, just this morning, tell a mother that they were out of stock on Vanilla milk that her son wanted. Even Dell stocks out on components and tells you, sometimes, that they can’t build and ship a certain product to you today.

The article continues to talk about creating “same day appointments” to “do today’s work today.” The article discusses some simple spreadsheet tools that are used to help calculate how many patients a doctor (or office) should be able to see and how much doctor overtime will be required to see all of the patients.

This is definitely a big improvement over 55 day waits. Could we challenge the idea of “doing today’s work today?” Since the starting point was 55 day waits, maybe the office could “level load” a bit over a two or three day period, reducing overtime while still dramatically reducing patient appointment delays? Reducing overtime might help improve quality of life for the doctors and their families.

Whatever the details are, it’s encouraging that these types of practices are spreading:

Murray estimates that as many as 20% of primary care physicians are currently using open access, but for most Americans, getting a timely doctor’s appointment remains a pressing concern. According to a study by the Commonwealth Fund, a health policy think tank, only 30% of U.S. patients in 2005 had same-day access when they needed to see a doctor, and 23% waited six days or more.

I applaud the doctors who are challenging the status quo for “how things have always been done.” I’m going to be attending the Society for Health Systems conference in New Orleans next week, where I’ll be able to learn much more about how doctors and hospitals are improving patient flow with lean.


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Mark Graban's passion is creating a better, safer, more cost effective healthcare system for patients and better workplaces for all. Mark is a consultant, author, and speaker in the "Lean healthcare" methodology. He is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as The Executive Guide to Healthcare Kaizen. His most recent project is an eBook titled Practicing Lean that benefits the Louise H. Batz Patient Safety Foundation, where Mark is a board member. Mark is also the VP of Improvement & Innovation Services for the technology company KaiNexus.

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2 Comments on "An Open-Access Doctor’s Office"

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  1. Rich says:

    Great post. My father is currently fighting a rare form of cancer that has spread rapidly through the blood stream. Although his current oncologist (who has reached the end of what she can do for him) admits that every day the risk grows, it is taking weeks to get him an appointment with a specialist who might be able to help with surgical methods. If he can help, I am sure it will take more weeks to schedule a surgery. While my failure to build to demand may cause, God forbid, and line shutdown, a Doctor’s office failure can result in deaths that could be avoided. Thanks to people like Mark that are helping hospitals and doctors see the light on how important lead time is!

  2. Josh says:

    My wife and I chose Harvard Vanguard in Boston as our provider network because they’re always able to see us – it might not be our doctor every time, but you can see a doctor, gets ome bloodwork done, and have the doctor review the results with you in under half an hour. I’d be curious how they make that work.

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