1212016 Health Care Tips and Advice Practicing Patience at .docx

12/1/2016 Health Care Tips and Advice: Practicing Patience at
the Doctors' Office - WSJ
http://www.wsj.com/articles/SB10001424052702304410504575
560081847852618 1/5
Of all the problems with the U.S. health-
care system, one of the most vexing for patients
is simply sitting in the doctor's waiting room. Being ushered int
o the exam room, only to
be left shivering in a paper gown, to wait some more, adds to th
e aggravation. It's the
health-
care equivalent of being stuck on the tarmac in a crowded plane.
The average time
patients spend
waiting to see a
health-care
provider is 22
minutes, and some
waits stretch for

hours, according to
a 2009 report by
Press Ganey
Associates, a
health-care
consulting firm,
which surveyed 2.4
million patients at more than 10,000 locations. Orthopedists hav
e the longest waits, at
29 minutes; dermatologists the shortest, at 20. The report also n
oted that patient
satisfaction dropped significantly with each five minutes of wait
ing time.
Physicians rightly bristle that they aren't serving french fries. P
atients are different, and
their needs are unpredictable. What's more, doctors say that fee-
for-service medicine
with low reimbursement rates forces them to keep packing more
patients into each day,
compounding the opportunity for delays.
"I live my life in seven-
minute intervals," says Laurie Green, a obstetrician-

gynecologist
in San Francisco who delivers 400 to 500 babies a year and says
she needs to bring in $70
every 15 minutes just to meet her office overhead.
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560081847852618
HEALTH JOURNAL
Updated Oct. 18, 2010 12:01 a.m. ET
By
MELINDA BECK
Some hospitals, like this one in Virginia, post ER wait times on
billboards. ASSOCIATED PRESS
560081847852618 2/5
Some practices, like Dr. Green's, pride
themselves on running efficiently, and others

are finding ways to streamline office-traffic
flow and cut waiting time. "Patients' time is
valuable. I think practitioners understand
that more and more," says Andre W. Renna,
executive director of a group of 14
gastroenterologists in Lancaster, Pa. He says
even the term "waiting room" has a bad
connotation. Many offices prefer "reception
area" instead.
Some steps to reduce patient wait times are as simple as leaving
a few "catch-up" slots
empty each day or stocking the same supplies in the same place
in every exam room.
"That way, doctors don't have to stick their heads out the door a
nd ask where things are.
It saves a lot of time," says L. Gordon Moore, a family physicia
n and faculty member of
the Institute for Healthcare Improvement, a Cambridge, Mass.-
based non-profit group
that advises medical practices.
Cutting waiting times is also part of the movement toward turni
ng primary-care
practices into what reformers call "patient-
centered medical homes."
For now, patients themselves can minimize waits by asking for t
he first appointment of
the day or right after lunch, when doctors are least likely to be b
acked up.
Measures the health-
care industry is trying or reviewing include:
"Open-access" scheduling: Doctors

used to think that having their
appointments booked weeks in
advance was a mark of prestige. It can
also make for delays. Patients
scheduled far in advance often cancel
or fail to show. So offices, like airlines,
tend to overbook, then struggle to fit
everyone in.
"Those things have ripple effects, and
the barometer is the waiting room,"
says Terry McGeeney, president and
CEO, of TransforMED, a subsidiary of
WHAT'S THE HURRY
A look at average wait times:
Hospital emergency room: 4 hours, 7 minutes
California Department of Motor Vehicles: 42
minutes, 32 seconds
Main security line at Hartsfield-Jackson Atlanta
International Airport during Monday morning rush:
25 minutes
PRIMARY-CARE PHYSICIAN: 22 minutes
McDonald's drive-through window: 2 minutes, 54
seconds

Sources: Press Ganey Associates;
California DMV; Transportation
Security Administration; QSR
Magazine
AUDIO
Listen: Melinda Beck reports on how some
doctors are trying to cut wait times for patients.
OFFICE HOURS
How doctor appointments can be streamlined
560081847852618 3/5
the American Academy of Family Physicians (AAFP) working t
o improve medical-
practice design.
Instead, the AAFP and other primary-
care groups now urge practices to leave as much as
70% of their schedules open for same-
day appointments. Patients with immediate
concerns are more likely to show up, on time, and stick to the p
oint. "When patients
think they may not be back in for a few months, they have a ten
dency to say, 'Can we also
talk about this other thing?' so what should have been a 15-

minute appointment ends up
to being 30," Dr. McGeeney says.
Efficient offices also monitor their ebbs and flows in patient tra
ffic and leave more slots
open, say, on Mondays and Fridays and during flu season.
Switching to open-
access scheduling can take months of transition time, and some
doctors worry that appointment slots will go unfilled. "But the r
eality is you have the
same number of patients and the same number of problems," say
s Dr. McGeeney. "And
over time, patients flow through the office much more quickly."
Minimize office visits: Many follow-
up doctor visits could easily be handled via phone,
email or video chat. But in the past, doctors had to have patients
return to the office in
order to get reimbursed for their time and expertise. Now some i
nsurers are beginning
to cover nontraditional visits, including phone consultations in s
ome circumstances. "I
think we'll even get to the point where we'll have some of these
visits by smartphone,"
says Douglas Wood, chairman of health-
care policy and research at the Mayo Clinic in
Rochester, Minn.
Advance prep: Having patients complete registration forms, med
ication lists and other
paperwork in advance, via computer or mail, can also speed offi
ce visits considerably. So
does having a receptionist or nurse make sure that all necessary
test results and records
have been received before the patient arrives.

Some pilot programs even let patients schedule their own visits
via computer,
minimizing overbooking and making patients more aware of a d
octor's time constraints.
"Some patients say, 'Hey, it's getting close to 11:30. I better wra
p it up,'" Dr. Moore says.
Huddling up: Some of the unpredictability practices face actuall
y is predictable if
practices know their patients well.
"Here's Mr. So and So. He's in a 15-
minute slot, but we know he's a 45-minute guy," says
Dr. Moore. "Or Mrs. Jones is bringing in a kid with a sore throa
t. But we know she always
brings in the other three."
By reviewing the upcoming patient list several times a day, doct
ors and other staffers
can anticipate and plan around some delays.
Teamwork: Many primary-
care physicians spend much of the day doing tasks that other
staffers could do, experts say. If the practice is big enough, nurs
e practitioners, medical
assistants and other "physician extenders" could handle many as
pects of patient care
and cut waiting time, while the doctor is busy elsewhere. "In my
office, everyone has a
flu shot before I even get in the room," says Melissa Gerdes, a f
amily physician in
Whitehouse, Texas, who was part of a TransforMED pilot proje
ct.
Cutting "cycle time": In medical jargon, "cycle time" refers to t

he period from when a
patient first arrives at the office until departure. Many practices
are making a point to
measure and reduce it. In Dr. Gerdes's demonstration project, pa
tients themselves were
560081847852618 4/5
given clipboards to record each phase of the visit, from when th
ey arrived at the office,
time in the waiting and exam rooms, time with the physician an
d time checking out. By
identifying bottlenecks, she and her colleagues were able to cut
about 12 minutes from
the typical 40 minutes per hour.
"It did two things. It taught us how we were doing, but it also c
ommunicated to the
patients that we were serious about improving," Dr. Gerdes says
.
Keep patients informed: Simply keeping waiting patients inform
ed about delays—and
giving them the option to reschedule—
can also go a long way. "It's just like sitting on an
airplane—
you want the pilot to tell you what's going on and what to expec
t," says Roland
Goertz, president of the AAFP.

To that end, some practices now use automated programs to noti
fy patients when
they're behind schedule, even before patients get to the office.
One Web-based tool,
called MedWaitTime, lets patients check how late the doctor is r
unning, much like
airline passengers can get a flight-
update. But it does require office staffers to manually
update the information.
How we doing? Experts urge practices to periodically survey th
eir patients to find out
what they think about the office's efficiency. A simple note card
asking them to rate
aspects of the visit can yield some surprising insights.
A program called HowsYourHealth.org, designed by Dartmouth
Medical School
professor John H. Wasson, provides a detailed online questionna
ire for patients to
evaluate doctors' practices and give more detailed information a
bout their own that can
be integrated into the offices' electronic-
medical records. The system, which is free for
patients and $350 for practices, also allows doctors to compare t
heir office scores with
national averages and share ideas with other practices.
"It's really a combination of common sense, mathematics and eli
minating stupid
practices," Dr. Wasson says.
—Email [email protected]
Copyright 2014 Dow Jones & Company, Inc. All Rights Reserve
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The Informed Patient: Unsnarling Traffic Jams in the O.R.; Surg
eons Lose Coveted Perk In Scheduling Procedures;
Faster Service for Emergencies
Landro, Laura. Wall Street Journal, Eastern edition [New York,
N.Y] 10 Aug 2005: D.1.
SJSU Get Text
http://sfx.calstate.edu:9003/sanjose?url_ver=Z39.88-
2004&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&genre=unknow
n&sid=ProQ:ProQ%3Aabiglobal&atitle=The+Informed+Patient

%3A+Unsnarling+Traffic+Jams+in+the+O.R.%3B+Surgeons+L
ose+Coveted+Perk+In+Scheduling+Procedures%3B+Faster+Ser
vice+for+Emergencies&title=Wall+Street+Journal&issn=00999
660&date=2005-
08-10&volume=&issue=&spage=D.1&au=Landro%2C+Laura&i
sbn=&jtitle=Wall+Street+Journal&btitle=&rft_id=info:eric/
Abstract (summary)
For hospitals, spreading out elective admissions can actually bo
ost revenue and cut costs, says Eugene Litvak, director of the Pr
ogram for Management of Health Care Variability at
Boston University, and IHI's expert on patient-flow strategies. I
nstitutions that have adopted the programs can increase the num
ber of surgeries performed by 10% or more, move
patients through the emergency room faster, and reduce overtim
e pay to nursing staff. Ambulance diversions from the emergenc
y room to other hospitals can be by cut by 40%, Dr.
Litvak's studies show.
The increased efficiency can also allow surgeons to do more ope
rations. At St. John's, urgent or emergency surgeries were bump
ing hundreds of elective surgeries off the schedule
each year, overtaxing the nursing staff. So St. John's spread out
its elective surgical schedule and designated one out of 22 opera
ting rooms for unscheduled procedures. Its group of
11 orthopedic surgeons agreed to spread their operating-room ti
me over five days instead of two. With the extra hours they got
in the process, they were able to perform more
surgeries: Operating-room overtime is the lowest in recent histo
ry, and surgeons' revenue has increased by about 5%. Scheduled
cases no longer have to be bumped, so the number
of surgeries that have to be performed after 3 p.m. has dropped
by 45%.
"Our scheduled patients aren't getting bumped and the unschedu

led ones aren't waiting," says Kenneth Larson, a trauma surgeon
and director of the burn unit. "When your belly
hurts or your hip is broken, it doesn't make you happy to sit aro
und for 12 more hours."
HOSPITALS HAVE LONG offered surgeons a precious perk: sc
heduling the bulk of their elective surgeries in the middle of the
week so they can attend conferences, teach medical
students -- and leave early for the weekend.
But a growing number of hospitals are starting to challenge the
practice, which safety and efficiency experts say is one of the bi
ggest impediments to a smooth-running hospital. It
jams up operating rooms and overloads nurses at peak times. W
hen last-minute surgeries pile up over the Tuesday-through-Thu
rsday stretch, as they inevitably do, surgeons
scramble to handle urgent cases -- and patients scheduled for el
ective surgeries get bumped for hours and even days.
For patients, hospitals' efforts to spread out surgeries throughou
t the week means fewer canceled elective procedures, fewer dela
ys for emergency surgery -- and better overall safety
and care. Nurses are less likely to be burned out from back-to-b
ack procedures and overtime.
At Boston Medical Center, a leading trauma facility in New Eng
land, delays and cancellations of elective surgeries were nearly
eliminated after surgeons agreed to stop block scheduling
and dedicate one operating room for urgent or emergency cases.
There were just three cancellations in the April-September 200
4 period, compared with 334 cancellations in the year-
earlier period.
"For years people have blamed the emergency room for overcro
wding, but it's really a matter of how the entire organization is
managed," says Dennis O'Leary, president of the Joint

Commission for Accreditation of Healthcare Organizations, whi
ch accredits 4,500 hospitals accounting for 95% of all inpatient
admissions.
The commission has begun requiring hospitals to develop strate
gies to ease "patient congestion." That means smoothing out sur
gery schedules as well as pressuring doctors to
discharge patients in the morning when possible instead of late i
n the afternoon, and assigning a "bed czar" to monitor the flow
of beds and ensure patient rooms are prepared for new
patients immediately.
The commission is sponsoring a meeting in Boston tomorrow, w
here several hospitals -- including St. John's Regional Health Ce
nter in Springfield, Mo., Boston Medical Center, and
New Hampshire's Elliot Health System -- will share data from t
hree years of experience working on surgical-flow strategies de
veloped with the nonprofit Institute for Healthcare
Improvement. Some of the successful measures include reservin
g one or two operating rooms for emergencies, spreading out ele
ctive surgeries more evenly during the week, and
scheduling nursing staff accordingly.
For hospitals, spreading out elective admissions can actually bo
ost revenue and cut costs, says Eugene Litvak, director of the Pr
ogram for Management of Health Care Variability at
Boston University, and IHI's expert on patient-flow strategies. I
nstitutions that have adopted the programs can increase the num
ber of surgeries performed by 10% or more, move
patients through the emergency room faster, and reduce overtim
e pay to nursing staff. Ambulance diversions from the emergenc
y room to other hospitals can be by cut by 40%, Dr.
Litvak's studies show.
Keith Lewis, who heads Boston Medical's anesthesiology depart
ment, says that while surgeons initially resisted the changes, the

y have become satisfied with the results because their
patients rarely get bumped now. "We've been able to take out th
e variability that destroys the system," he says.
The increased efficiency can also allow surgeons to do more ope
rations. At St. John's, urgent or emergency surgeries were bump
ing hundreds of elective surgeries off the schedule
each year, overtaxing the nursing staff. So St. John's spread out
its elective surgical schedule and designated one out of 22 opera
ting rooms for unscheduled procedures. Its group of
11 orthopedic surgeons agreed to spread their operating-room ti
me over five days instead of two. With the extra hours they got
in the process, they were able to perform more
surgeries: Operating-room overtime is the lowest in recent histo
ry, and surgeons' revenue has increased by about 5%. Scheduled
cases no longer have to be bumped, so the number
of surgeries that have to be performed after 3 p.m. has dropped
by 45%.
"Our scheduled patients aren't getting bumped and the unschedu
led ones aren't waiting," says Kenneth Larson, a trauma surgeon
and director of the burn unit. "When your belly
hurts or your hip is broken, it doesn't make you happy to sit aro
und for 12 more hours."
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Indexing (details)
Subject Scheduling;
Trends;
Surgeons;
Surgery;
Hospitals
Classification 9190: United States
8320: Health care industry
Title
The Informed Patient: Unsnarling Traffic Jams in the O.R.;
Surgeons Lose Coveted Perk In Scheduling Procedures;
Faster Service for Emergencies
Author Landro, Laura

Publication title Wall Street Journal, Eastern edition
Pages D.1
Publication year 2005
Publication date Aug 10, 2005
Year 2005
Publisher Dow Jones & Company Inc
Place of publication New York, N.Y.
Country of publication United States
Publication subject
Business And Economics--Banking And Finance
ISSN 00999660
Source type Newspapers
Language of publication English
Document type News
ProQuest document ID 398917051
Document URL
http://search.proquest.com.libaccess.sjlibrary.org/docview/3
98917051?accountid=10361
Copyright
Copyright (c) 2005, Dow Jones & Company Inc. Reproduced

with permission of copyright owner. Further reproduction or
distribution is prohibited without permission.
Last updated 2010-06-26
Database 2 databases View list
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d Conditions
Dr. Larson says surgeons squawked about the new schedule at S
t. John's at first, since many were already used to haggling with
anesthesiologists over start times and blaming each
other for delays. But to get both groups to work together and ad
here to new schedules and start times, the hospital offered a carr
ot and a stick: Doctors who were more than 10
minutes late 10% of the time were fined a portion of their fee; p
roceeds went into a kitty to reward those who were the best on-t
ime performers. Another penalty: revoking the
coveted 7:30 a.m. start time for surgeons, which cut the number
of procedures they could do in one day. In the first quarter of 20
03, surgeons' late starts dropped from 16% to less
than 5% and are now less than 1%.
Of course, patients pushed to Friday surgeries may have to spen
d time in hospitals over the weekend, when staffing levels in ge
neral are often lower. But that may be preferable to
being forced to wait for a hospital bed for hours after midweek
surgeries or being transferred into a unit manned by another spe
cialty group. At St. John's, orthopedic-surgery patients
sometimes ended up being transferred to the ob-gyn unit where t
here were no nurses skilled in their care. And at Boston Medical
, before the changes, patients often had to spend the
night in the recovery room because there weren't enough beds a
vailable. When flows are improved, nurses are also less likely t
o be burned out from back-to-back procedures and

overtime requirements.
Patients should ask hospitals about surgical scheduling policies
when they book procedures -- including what contingency plans
surgical units have if there is no bed available when
they come out of surgery. Though aimed at professionals, the w
ww.IHI.org Web site also has more information about surgical s
cheduling and patient-flow issues at a number of
hospitals around the world.
The promised improvements have already persuaded Cincinnati
Children's Hospital to begin revamping surgical schedules at its
425- bed facility, according to Frederick Ryckman,
Professor of Pediatric Surgery and Surgical Director of the Live
r Transplantation program.
With 21 operating rooms booked about 90% of the time in adva
nce, "we have to get much smarter about the way we manage the
flow of health care, so when everyone arrives on
the scene, the patients and staff match up to deliver top quality
care, which is everyone's goal," Dr. Ryckman says.
---
Send e-mail to [email protected]
Copyright (c) 2005, Dow Jones & Company Inc. Reproduced wit
h permission of copyright owner. Further reproduction or distrib
ution is prohibited without permission.
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