My internist of many years, Dr. Gulden, never ceased to amaze me before he retired. For every scheduled appointment, I was seen within 5 minutes of my arrival! This led to research I did in 1994, when I found that the average wait time in doctors’ offices in the US was 20.6 minutes, costing about $15 billion per year in lost productivity.
I guess this topic was of interest since the finding made the front page of papers around the country, from the Boston Globe to the Miami Herald. Yesterday, The Wall Street Journal (Oct.19,2010), with the headline “The Doctor Will See You Eventually“, announced that the “average time patients spend waiting to see a health care professional is now 22 minutes, and some waits stretch for hours”. Are any of us who teach OM shocked?
This is a great article to discuss when you cover waiting line models in Module D. But it may also be useful in Supp.7, Capacity and Constraint Management, because the Journal talks about cutting cycle time. In one doctor’s office, patients helped measure their times from arrival until departure. By identifying bottlenecks, the doctor was able to cut 12 minutes from the typical 40 minute stay.
So why was Dr. Gulden so successful in keeping on-schedule? I think there was one main reason: he made all his staff understand that each patient’s time was as valuable as his was.
Discussion questions:
1. Ask your students to rank the seven methods the article discusses in terms of what they think are the best for time savings payoff.
2. Many hospitals now advertise their ER wait times. What have they done to improve their process flows?
3.What kind of queuing models can be used in a doctor’s office?
I have an old journal article from the 1950’s that calculated how the doctors value patients time, relative to theirs, based on how much they make patients wait. The doctors didn’t value the patient’s time nearly as highly as they valued their own. This is a long-standing problem.
Doctors like to be the fully-utilized resource. As in a factory, if you insist any resource be 100% utilized, you end up with lots of WIP (in the case of the office, lots of waiting patients). I’ve seen cases where doctors INTENTIONALLY schedule patients for an hour before the doctors arrive. This way, they are guaranteed a queue and 100% utilization even if one patient didn’t show up.
A better way is doing things like “buffer time” during the day (doing charting in small batches if you have extra time, instead of doing it all at the end of the day).
Forget queuing theory until the doctors decide it’s important for patients to not wait – as your doctor did. It’s more of a social and political problem than a technical one.
One of the reasons that doctors do not value patient time may be because the patients are not their paying customers. The paying customer is the insurance company, and they do not share the the patients’ concerns about time. If a doctor is lean and mean in terms of utilizing the resources of their customer (insurance companies) then they get preferred status. If they move patients through efficiently and effectively, do they end up getting more or less money from the insurance companies per patient? I don’t know the answer to that question, I only know that the incentive to move patients through quickly does not generally come from the paying customer.
Unfortunately, this discussion makes me feel sick. Guess I will go wait to be seen.
I always cover Module D in my class since many of our students At U. of Rhode Island work part-time in the service industry. The news of Whole Food’s waiting line is very interesting. I have to say that Waiting Line Management is so dynamic… and it is hard to let students understand how important it is to business and to the customers. In this module, I also add some consumer psychology and how businesses can properly adjust their systems to make consumers engaged and feel less waiting.
Sorry, the link of that news connects with my name. Here it is:
http://www.nytimes.com/2007/06/23/business/23checkout.html