It's a pretty common facilitation technique to do a “plus / delta” discussion at the end of a meeting, exercise, etc.
In the plus column go the things that went well, were enjoyable, were helpful, and should repeated.
The “deltas” (which is meant to seem more positive than saying “minuses,” I guess) are the things that could be improved upon. A “delta” is a gap between where you are and where you want to be.
Last week, I was hit really hard by a case of the flu. You, the dear reader, might not have noticed because I thankfully had an inventory of blog posts built up that were scheduled to go out. For shame, Mark the Lean blogger sometimes has inventory? Well, sometimes inventory is useful :-)
On Monday, when I felt this coming on, I called my normal primary doctor and I was able to get in for an appointment an hour later, because there had been a cancelation.
PLUS: Being able to get same day access to an appointment (even if some luck had been involved)
After being in the office for just over an hour, nobody said “let's plus / delta your visit before you go.” That never happens in a clinic setting. At best, you might get some sort of survey after the fact. But, the point of a good constructive “plus / delta” discussion is to give immediate feedback to those who might be able to make some improvements.
Can you imagine how a clinic might improve if an office manager or somebody at the front desk did a short “plus / delta” with each patient? Does anybody, anywhere do this?
IF they had asked, these would have been the plus / deltas from my visit. Even when running a fever, I have an eye for waste.
DELTA: When I parked my car and walked up the flight of the stairs to the clinic (which wasn't easy when feeling really weak from the flu), I was asked, “Can I see your insurance card?” I'm a regular patient and they don't normally ask for the card each time. “Well, the doctor has decided we need to see the card every time now.” Thankfully, I keep the card in my car. I had to walk down and back up. Ugh. If they had a policy change, they should have told me over the phone, “Be sure to bring your card.”
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PLUS: I was able to book the appointment without waiting on hold or having to press a ton of numbers on the phone to get to the right place. Thanks.
DELTA: I got roomed into an exam room and saw this sign. Too little too late. That sign is only helpful for the second visit after you see that sign.
DELTA: The paper on the exam table gets changed, but do the vinyl chairs get wiped down between visits? That's a question, not a criticism.
DELTA: I complained of a 101.5F temperature and the MA didn't take my temperature in our first encounter.
DELTA: The MA came back in later carrying a thermometer and seemed annoyed, as if she had been waiting on it or had trouble finding it.
As an aside, I did some consulting work for a primary care clinic some years back where the office had ONE digital thermometer for ten exam rooms. The staff were always waiting on the thermometer (and so would the patients). It was an obvious and inexpensive solution to buy a thermometer for each room. But, nobody on the staff had ever thought to ask and the managers were unaware of that problem. The staff just “put up with it” instead of complaining. Or, maybe they had complained and gave up.
DELTA: I already have a headache and the fluorescent bulbs overhead are buzzing loudly while I wait.
DELTA: After swabbing my nose for the flu test, the MA just left. It would be better to set expectations like, “Please hang tight, this test takes about 15 minutes to run and then the doctor will see you.” It sucks to be in that jail cell of an exam room not knowing how long you'll be waiting.
The flu test came back negative. The doctor said it could be because the symptoms had just come on. Or, I wondered if the MA had really gotten the swab far enough up there, since she tried twice and didn't seem real sure of herself.
So, then I was done with my appointment. The doctor said Tamiflu wouldn't help and I just needed to rest and get a lot of liquids. The front desk said, “nope you're done” when I asked them if I needed to pay or anything.
PLUS: Having insurance.
They were done with me without asking for any input or feedback. They don't follow up with surveys or anything. I like my doctor, but it bothers me that they don't seem too concerned about the “voice of the customer.”
How many patients just walk away with their complaints or their grumbles because the clinic doesn't ask for feedback? Sure, you might get some unreasonable feedback (such as my complaint about buzzing lights), but I'm sure a lot of these things could be improved upon to provide better service and better patient satisfaction.
It seems like spending a little time on that, when patients are willing to talk, would be good for patient retention and good for business.
So why doesn't anybody do this? Or, do you know of examples where this happens? Are you willing to give this a try? Do you have any “plus / deltas” on this blog post? Leave a comment…
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