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No Time, No Money? Kaizen Fits Your Life
If you’re like lots of other people who want to make a change, you may say to yourself:
But how can I
reach my goal? I don’t have any money to spare—and I barely have a moment to sit down between
breakfast and bedtime!
Take heart. Like all the best things in life, small steps are free. And since they
take only a minute or two of your time, they can fit into any schedule. As proof, let me show you how a
couple of small kaizen actions—requiring only a few extra moments each day—rescued a medical clinic
from financial disaster.
When the outpatient clinic called me, it was in serious trouble. It had a high rate of patient
disenrollment, a situation with severe financial consequences. Those patients who did stay on gave it very
poor ratings. When patients were asked in written surveys why they disliked the clinic so much, their
chief complaint was the long waits.
Now, even if you aren’t a medical professional, you probably know that long wait times are a very
common problem in doctors’ offices. This problem is usually impossible to solve, given the emergencies
and unforeseen problems that crop up on a daily basis. A patient initially scheduled for treatment of a skin
rash, for example, may happen to mention a separate, more severe symptom such as dizziness or chest
pain—and suddenly a routine visit becomes much longer and throws the rest of the day off course.
This problem of timing patients was so tricky and pervasive that the clinic considered some drastic
solutions. Staff members suggested investing in expensive software that would supposedly help them
manage patient flow and help doctors determine how much time to allot per visit. Another idea was to
hire a nurse-practitioner to thoroughly screen patients over the phone in order to accurately determine
how long their office visits would take. The doctors even entertained the notion of assigning one doctor
solely to walk-in patients—a risky step, since a doctor tied up with walk-ins would not be able to take on
the new patients the clinic sorely needed. None of these solutions seemed workable or likely to fit the
office’s already strained budget. Day-to-day life at the clinic grew tense as different overworked groups
—doctors, nurses, receptionists—blamed one another for the dwindling patient rosters and the unhappy
“customers.”
This clinic faced a real challenge. But I was hopeful, because kaizen has a natural advantage in a
medical setting. Within the medical model, the ideal solution is always the smallest effective treatment,
the one that works without posing any unnecessary risk. Doctors don’t perform surgery if medicine can
help, and they don’t like to give medicine if simple rest or lifestyle changes will effect a cure. All I
needed to do was show this clinic how to recast its business problems according to these familiar,
smaller-is-better terms.
I called the staff together and asked them to talk about their best and worst experiences as consumers.
Most people talked about broken computers, hassles at the bank, and other problems. Then someone
mentioned that his best consumer experience occurred when his telephone service broke down. This was
his
best
experience? I asked. What made the experience so gratifying, he said, was that the customer
service representative immediately apologized for the problem
and
for the wait to reach the
representative. Two days later, the same representative checked in to make sure the problem had been
resolved. Other people agreed that their worst consumer experiences could easily have been turned
around by an apology and a demonstration of concern. Everyone knows, they said, that hard drives can
break down before they should and that banks can make mistakes. What makes the experience a positive
or negative one is what transpires in those few minutes when you explain your problem to the people
involved.
The group concluded that patients, like bank customers and computer owners, really do understand that
mistakes happen—and that physicians can’t always control their time. What patients really hated was that
feeling of surrender when they walked in the door, that not only their bodies but their time was in someone
else’s hands. It was a perfect moment for a kaizen question:
How can you improve the patient’s
experience of delays in a way that won’t cost anything or demand more than a few seconds of your
time?
I wasn’t surprised when the staff enthusiastically rose to the challenge. They decided that each of the
following steps could easily be implemented in the case of delay:
The receptionist would personally explain the reason for the wait to the patient and offer an
approximate time that the doctor would be available.
The patient would be offered the alternatives of seeing another physician or rescheduling.
The nurse or nursing assistant would apologize to each patient who had to wait before being
assigned to an examining room.
The doctor would apologize when walking into the examining room.
Before leaving the examining room, the doctor would thank the patient for choosing the practice.
Finally, the receptionist would offer a second thank-you as the patient walked out the door.
These changes consisted of short sentences—mainly “I apologize” and “thank you”—and were
undeniably the smallest of steps. But shortly after the staff implemented these changes, patient surveys
showed that the satisfaction rate
doubled,
and the number of patients defecting from the practice went
down by 60 percent. Keep in mind that the average waiting time remained exactly the same as before. But
now patients said things like “I’ve never felt more appreciated in a doctor’s office!” And the previously
warring factions within the practice laid down their arms, pleased that there was something simple and
productive each of them could do to achieve their goals.
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