It’s Harder to Tolerate Waste “When You Know What Good Looks Like…”
I recently “fired” my primary care physician. I'm lucky to not have to go to the doctor very often, but the last few times I did, I had to wait more than an hour beyond my scheduled appointment time (in a tiny windowless room, as pictured at left).
I had talked to the office manager about this before and, in the last visit, I complained that they weren't respecting my time. The office manager argued back (quite rudely) that they didn't disrespect me and that I shouldn't jump to that conclusion. But, to me, the repeated pattern was that they cared more about physician utilization than patient waiting time. It was an usual occurrence, it was a repeated habit. It's not that something went wrong that day that messed up patient flow – it was a very systemic problem.
I left without seeing the doctor and asked that he call to talk to me about why I wasn't coming back. I also called and left him a voice mail asking him to call if he was interested in why I left his practice. I never got a call back. That said way more about their lack of giving a crap than anything else. I guess their business is doing just fine without me.
So I hope to find a new PCP when I need one. I'm hoping to find a better method for choosing a physician other than 1) who takes my insurance and 2) who is close to my home. But who has public data on A) waiting times and B) effectiveness and population health? That's part of the transparency problem in healthcare – that we often don't have good data (or any data) for choosing a doctor, a hospital, or a surgeon.
Not to make it all about me in this blog post, but I have a congenital problem with some vertebrae and it's flaring up and bothering me. I was referred to a spine specialist practice and was on the phone yesterday trying to book an appointment (more than a week after my chiropractor referred me to them and they didn't me call to book an appointment without me following up twice).
I was on the phone for, no joke, 21 minutes and 37 seconds booking this appointment.
The woman on the phone was complaining to me that her office had a new computer system and it was hard for her since they hadn't trained her very well and she was now using a laptop instead of a desktop and the keyboard was funny to her. “It's like I have a handicap,” she said, which isn't very politically correct or very sensitive. Lack of training is a short-term focused cost-cutting choice that people make. It's not fair to people with real disabilities, people who don't choose to have them.
So one reason it took so long is that she was collecting (slowly) tons of information – my personal info, my wife's info, her insurance information, etc.
She then told me that I'd have to arrive 30 minutes before my appointment to fill out a new patient information form.
I asked, “What? Isn't that what we're doing right now, filling out the form over the phone with you?????”
She then asked for my wife's social security number. I hesitated and then asked, “Am I going to give it to you over the phone and THEN have write it down again on that form that I'm arriving early for, along with all of the other information that I'll likely duplicate?”
She wasn't the right person to be asking such systemic questions to, as she was just trying to do her job, So I gave her the info without further fussing. I'll suffer the “waste of overprocessing” by having to give the same information multiple times when I have my appointment on Friday.
Since I was at the offices of the ThedaCare Center for Healthcare Value when I was making his call, Dr. John Toussaint walked by right after I was done and I complained a bit about the waste in the system when he saw the frustration on my face.
He said, “When you know what good looks like…”
Yes, when you know what good looks like, it's harder to tolerate the preventable waste that we face in the healthcare system as patients or providers.
When you know that some primary care clinics and “The Lean Dentist” Dr. Sami Bahri basically have “zero waiting room” practices, the idea of waiting 60 minutes because the physician overbooked (probably intentionally) is harder to take. When you know that some hospitals have a “zero wait E.D.” it's harder to tolerate a long time in the waiting room.
An ideal patient care experience (or “what good looks like” from Dr. Toussaint's perspective) might include:
- less waiting (not waiting weeks for an appointment or not waiting many hours if you arrive at the emergency department)
- less harm (fewer infections, fewer falls, fewer medication errors)
- lower cost (as ThedaCare has demonstrated as a provider, with 20-30% lower inpatient care cost, or as an employee of the company Serigraph, where they get free on-site preventive care and have better outcomes at lower cost, as detailed in the book The Company That Solved Health Care
If you're familiar with Lean healthcare improvements, you know that “what good looks like” includes a 37-minute “door-to-balloon” time at ThedaCare for Code STEMI heart attack patients (far better than the 90-minute U.S. standard). You know good looks like more patient-focused care at lower costs and better quality… so you wonder why everybody doesn't have that now, with such excellence being demonstrated at a relatively small number of hospitals that everyone can learn from.
You wonder why the federal government has to chip in a billion dollars to drive innovation and quality improvement in healthcare, when that should already be the goal of any healthcare provider (and you can read how to do it for free online at sources like the AHRQ or for $8 (Kindle version) in books like On the Mend).
I wonder when we'll hit a “tipping point” in healthcare when enough people are now getting excellent care, as opposed to average typical care, when word will spread that “what good looks like” is out there. I think people often accept what healthcare throws at them because they think it can't possibly be better. But the truth is, it can be better – better quality, lower cost, and less waiting all with happier healthcare providers and personnel.
The frequent news reports about 100,000 Americans dying each year due to preventable medical errors and another 100,000 dying due to hospital acquired infections don't seem to be convincing anyone that things can be better. Maybe they're just convinced that things are bad…