A Doctor Calls: A Treatment for Efficiency

An email to the local medical practice to request medical advice produced a response advising to ‘call at 0800 for an appointment with your doctor’.

Called, waited a few minutes, selected appropriate option, 20-minute wait to be placed in a second queue.

Machine: ‘Press 1 followed by the # key to speak to a doctor’

Then a further 5-minute wait with a different ringing tone in the second queue, then a response:

Them: ‘Hello, Unnamed Town Medical Practice’

Me: ‘Hello, I would like to make an appointment to see or speak to my doctor’

Them: ‘I cannot make an appointment for you to see a GP, I can only make an appointment for the GP to call you so that THEY can decide whether to make an appointment to see you.’

Me: ‘When will they call? I am working and have other commitments’

Them: ‘I don’t know, they deal with that themselves.’

Me: ‘So, what you are offering is not an appointment with my doctor but to add my name to a list of people that a Doctor will call at some unspecifiable time in the future?’

Them ‘Well, yes’

The whole concept of ‘appointment’ having thus been redefined one was made ……..

Total time so far: 35 minutes

Two hours later, call from Doctor, issue explained, actions agreed, problem resolved, total additional time: 3 minutes

Total time overall: 38 minutes

Percentage of total time spent productively by combined parties about 8%………….

For those in doubt a productivity or efficiency rating of 8% on total resource utilisation would rarely be considered good.

So, what went wrong?

Appreciating that medical services globally have been under pressure it does not appear that, at least this part of, the medical profession has developed an understanding of how to develop and deploy a customer focused process. When we look at the 92% of the total process time that is ‘muda’ (waste) we can see that it has been imposed on the patient qua customer not the organisation. The organisation has deployed its waste to an automated telephone answering machine (which, at least for now, will not be sentient and will therefore neither know nor care that it is used as a buffer rather than a problem solver).

What might have worked better:

1: Given the step ‘Call to make an appointment’ and considering that the likely call volumes can be estimated with significant accuracy, the ‘machine’ should be equipped with the capacity to handle that volume simultaneously eliminating wasted time for the patient. A little more voice/button activation would also eliminate the need for the call answerer, that step could also be automated ‘Press 3 followed by the # key to add your name to the list of people the Doctor will call when they get round to it’

Eliminating the time spent waiting for the machine to answer reduces the total process time to 3 minutes with the Doctor plus 1 minute to press the buttons. Waste time 0, time spent productively 100%.

Overall time reduction: 34 minutes – about 89%

2: Given the email request was to speak to a doctor and the response was to ‘call for an appointment’, we would all have saved time and energy if the response had been ‘your doctor has been asked to call you and will do so within the next <time>’. The subsequent phone call would have taken the same 3 minutes.

Total process time 3 minutes, waste time 0, time spent productively 100%, time wasted by customer 0.

Overall time reduction against original process: 35 minutes – about 92%

Deploying technology to increase efficiency, reliability and quality is not just about the technology but requires thinking about the total system and the elimination of waste for BOTH provider and customer. I am not suggesting that it is always possible to eliminate all of the waste in this way OR that a reduction of 92% in process time is always possible – but it does make you think!

It is not enough for the process to embrace the technology; it must also embrace the customer.