Not So Customer Friendly

My wife had minor outpatient surgery the other day. The facility was new, the staff engaging, and the surgeon’s manner projected competence and a sense that my wife was more than just another procedure. Protocols for ensuring that the patient and the schedule matched, that the correct body part for surgery was identified and marked, and that both patient and advocate (me) were fully informed and counseled–all were followed scrupulously. After the procedure, post-op checks and questions, medication instructions, and follow up procedures were reviewed in a friendly by-the-book manner. We are sure that the outcome (to be confirmed in a week) will be excellent. And yet… the experience was an example of root problems in health care.
1. Customer experience: We got to ambulatory surgery a little early for the 9:15 appointment. Paper-work, dressing for surgery, ensuring that patient, doctor, procedure and body part all matched took 30 minutes, not bad. The physician arrived at 10:00, introduced himself, answered questions, and marked the surgical site. And then we waited. And we waited–for the anesthetist. Eventually, we heard that he would be an hour late, due to a delay on another case, at another location. We chatted with the doctor and with the nurses, all very pleasant. But my wife was getting hungry, and the physician and nurses seemed suspended somewhere between frustration and resignation. Asked about the situation, the doctor shrugged. Nurses later said it was “not uncommon”, and offered several reasons. By then, the customers (patient, advocate, nurses and physician) were experiencing less than satisfactory service. The doctor was backed up, his time wasted; nurses scheduled to end their shifts were held over. Finally, the procedure over, we left, hungry and tired, at 1:45.
2. Muda: The word is Japanese for waste and is as distasteful in the Toyota manufacturing system as it sounds. One major source of waste is time spent waiting for value-added activity. Surgery is not auto assembly, but muda should be just as unsavory in health care. Of the more than four hours we spent at outpatient surgery, over 60% of that time was pure muda. The 20-30 minutes of preparation was unavoidable–not directly value added, but necessary. The value added time–surgery and recovery, and review of post-operation procedures and follow-up–took approximately one hour. But the time spent waiting was simply waste.
3. Consequences: The down time created dissatisfied customers, wasted money (unused operating space, nurses paid overtime, and a physician unable to practice), and generated opportunity costs (space and personnel who could have been productive and revenue-producing). Because the situation was accepted as unsurprising, systems issues appear to be causing problems in planning, scheduling and/or utilization of anesthetists and staff. And there may be more waste lurking behind the obvious.
This one simple case could easily have cost thousands. The fact that it seems systemic and accepted leads me to believe that it is not only substantial but ‘unseen’ by the system. Our insurance will pay our bill, no doubt inflated by cost assumptions that also accept the unseen muda. Multiplied by what must be millions of similar cases nationwide, the problem is symptomatic of a system that bleeds money. And we all pay for it.

Comments are closed.