Sunday, March 25, 2012

A trip to the Doctor--A case study

So here's an exercise for you and your team to liven up your next process-excellence gathering. 

The story below comes from a colleague of mine, who gave me permission to use it as written.  On the one hand, we could read it and go "tsk, tsk, why don't medical facilities improve?"  That does us no good, however.

Try this instead.  Distribute this story to your team.  Then ask one person or sub-team to take the role of the physician, another one the role of the office administrator, another the role of the patient, another the unseen director of the clinic.  Then make some proposals; how would you improve this?  How would you communicate it?  What principles would you employ?  How would you measure it?  Who would you involve in the discussion?  How would change happen in this setting? 

By looking at others we learn about ourselves.  


Went to the dr's this week for a simple dermatologic procedure. My appointment was set at 11 and I was told to expect to be there for an hour. I presumed the procedure would take about 30 minutes, and maybe prep work and post work would be the remainder. Not so.

I arrived and was promptly taken to the procedure room by my nurse. She said the procedure indeed would take 15 to 30 minutes, but I should sit tight so she could find the dr so I could meet him. Odd, I thought, I figured we could break the ice before or after my procedure. She asked that I try not to be intimidated when I meet him, because he was "a real doctor, busy busy busy, lots of patients to see". 

And then came the real kicker, she listed the questions he would ask me and indicated I should "think about the answers because he needs to move on to his next appointment quickly".  She left and returned 20 minutes later, indicating that he had another procedure scheduled at 11 and it would be an hour and a half before he could meet me. I started towards the door and told her I would need to reschedule, I couldn't wait that long. She asked that I stay; she said that she was going to be doing my procedure anyways so we could get started immediately.

The following things struck me as odd:
- Why was the appointment made longer than procedure required?
-Why did the nurse have to "hunt down" the doctor for a quick meet and greet?
-Why not stagger appointment times if this is really important?
-Why did she feel compelled to warn me of his busy nature?
-Why didn't she just finish my procedure first and give me the option to meet him afterwards?

This clicked with me for a few reasons:
- I felt like a "part", something that needed processed and moved on, not a person that had questions or concerns with a medical procedure. 
- Do I make people feel this way?
- Do I respect the time of others, or make them wait on my own busy, busy, busy schedule?

For me, a fundamental of Lean is in gaining efficiency and respecting people. This doctor had attempted to gain efficiency, but perhaps inadvertently not respected the time of others. 


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1 comment:

Robert D said...

Hi Joe

The case study though simple begs a tough question, how far do we go when with being efficient. Can you drive efficiency so far that it gets in the way of doing your business properly and in a fashion that shows you care about your customers.

Yes it is easy to see improvements that can be made, but when we are dealing with services being performed we need to stop and consider other people’s needs and wants as well as our own.

Unfortunately there are too many professionals with that doctors attitude they jam their schedule so tight that the slightest fluctuation throws it into a total mess. Yes their time is worth money, but they tend to forget that people are paying for it and expect to be treated properly including being provided service on time. We all need to stop and analyze what the possible outcomes can be and how they may affect the flow of work, leaving a little extra time in the system may seem wasteful, but in processes with natural variability it is essential to keeping them running smoothly.

I had a friend whose doctor always kept you waiting, one day he sent the doctor a bill for his time, since that day he has never waited to see that doctor again. The staff that book appoints should track appointment times for patients, so that they can get a better feel for the time requirements for treating various patients. That way they can schedule appointments to meet the needs of the doctor and the patient.

Though I can honestly say I have seen one doctor that was so organized it was almost scary. The doctor that setup the appointment told me do not be late, he will drop you in a heartbeat. I got to his office, was shown into the exam room within minutes and he walked into the room on time, he answered every question I had thoroughly in simple language, and never made me feel there was a rush, yet he was a well oiled machine never off by more than a couple minutes. He was a professional that not only demanded respect, but also showed it.

All professionals need to think about how their work reflects on them, we all want to be respected and have others shows us their respect, but what many forget is that respect is earned, by you showing that you respect others. Stopping and looking at how your system runs and seeing how it is negatively impact the customer, is one way in which professionals can start to earn the respect being in a profession once had.