Flow

“Curmudge, you should be distraught, but of course you never are. You arrived at work at 9:15 today, and I know that you intended to be here by 9:00. Fortunately, work hours are not a big deal with volunteers.”

“I had an appointment with a physician across town at 8:15 this morning, and I felt certain that it would be over and I’d be here by 9:00. I’m usually with the doc for five minutes at the most, and that was the case today.”

“Oh-oh. Something must have been messed up at the office. Would you tell me about your experience? Perhaps we can learn something from it. But please, no profanity or histrionics.”

“To begin with, Julie, I think the doc is great, and the receptionist has always been very accommodating. The first sign of a problem was when I arrived at the multi-specialist office building at 7:55; the line of people waiting to register stretched out the door. Ultimately, I got inside and registered by 8:10 after having confirmed all the personal information that was already in their records.”

“Since you didn’t get here until 9:15, that must not have been the end of your delays. Obviously you spent some time in the waiting room.”

“Finally the nurse (name unknown—she didn’t introduce herself) took me back to an exam room. Per our well-practiced drill, I removed my shirt and froze until the doc arrived. As expected, she was there and gone in five minutes. I stopped at the desk on the way out, made my return-in-six-months appointment, and headed for work at 8:55.”

“So, professor, what is today’s lesson, other than ‘don’t take off your shirt in a cold exam room’?"

“There was a very pertinent posting on daily kaizen last November. The title was Getting In-Flow, and it details what the author did to improve her office. To a patient, flow means moving through the appointment smoothly without needless periods of waiting. To the office staff, flow is a day without surprises, disruptions, or highs and lows in work load.”

“As we have learned, Curmudge, the office needs to practice heijunka, or level loading. If they can’t have more patient registrars at 8:00 a.m., maybe they can eliminate the operation and use registration kiosks. And in addition, they should plan ahead and not schedule potentially long appointments at the beginning of a day. I remain puzzled at how a physician’s office can be one-half hour behind by 8:15. They seemed to accept the fact that delays and lack of flow were normal.”

“Good observations, Julie. Would now be an appropriate time for me to share my observations about patient waiting?”

“It would. True flow means no waiting. Isn’t it incongruous to realize that health care facilities are still being designed to accommodate a waste—waiting—by having ‘waiting rooms’?”

“Back to reality, Ms. Perfectionist. Except for OB and Peds, a major fraction of our patients are senior citizens. We often assume that because they don’t have employment obligations or a crowded social calendar, they shouldn’t mind waiting. That may be true in the short term but quite inaccurate in the long term. By definition, a senior citizen’s days are numbered—with the number often quite unknown. If there’s something he/she wants to accomplish while still on this earth, he’d better get busy on the task. There’s no time to wait.”

“So what do you conclude, Curmudge?”

“Health care providers should implement flow and try to make their waiting rooms obsolete. Of course, my specific conclusion from my most recent office visit is that the practice of Lean in health care is not yet universal.”

Affinity’s Kaizen Curmudgeon