Process improvements in healthcare (mini-blog series #1)

(This is the first of my mini-blog series on process change examples in everyday life. Each example is unique to its location and surroundings. This blog does not purport to have covered all scenarios in the example nor suggest that the solutions are applicable everywhere. But some solutions have worked well in the said scenarios and similar problems in other industries/areas could benefit from applying them in a certain way. )

 

Whenever I had an appointment to visit an outpatient healthcare facility, be it in a big hospital or at the neighbourhood doctor’s clinic, I usually ended up facing two scenarios. Either I had to wait for a considerable time for the consultation, or I returned without seeing the doctor. The waiting would have been due to either the doctor arriving late, the doctor spending more time with earlier patients, etc. The return could have been due to my impatience, or the doctor urgently needing to leave, or some patients getting to meet the doctor out of turn, etc. What is also agonizing during the already unbearable waiting is the amount of shuffling around due to either housekeeping, or filling up forms, checking on how much more time to meet, keeping watch on gatecrashing patients, etc. All good scenarios for a bad process environment.

I recently got to know about a small homeopathy clinic not very far from where I live. The processes at this clinic impressed me so much that I have become a great fan of its operations. Of course, the treatments for me and my family have been effective as well. But there were a number of things that was being done so well in this clinic, that I wondered why this cannot be done in any other service businesses, let alone clinics.

  • There was no receptionist or appointment facility in the clinic – patients were asked to walk in and take a number from a ticketing machine – just like at a bank teller counter. The senior doctor himself answered any phone calls to the clinic, to quickly inform the consulting hours and walk-in method.
  • On walking in to the clinic, one could find there were two treatment rooms, numbered one and two. A father and son doctor duo consulted in each room. The ticketing system suggested the next patient number and available consulting room, which meant that the patients did not get to choose which doctor to consult among the two.
  • The doctors between them spent less than 4 minutes per patient on an average.
  • For first time patients, the doctors themselves create the patient records in a CRM (not sure which) software on their laptops, write a registration card with a patient id, and capture the clinical symptoms and treatments against the record – all within the average time of 4 minutes per patient. If it’s a repeat patient, they quickly look up the patient record on quoting the reference and record the updates and treatment.
  • Both doctors did not spend time talking too much with the patients, they just listen to the problems / symptoms and dispense the medicine. (those who are not familiar with homeopathic treatment, the medicines are generic in nature (unbranded) and doctors generally dispense the medicines themselves)
  • The clinic schedule was immaculate – open between 9 am and 12 noon, and between 5 pm and 9 pm each day. Tickets are dispensed only between these times. Weekly holiday is only on Sundays and open on all other general and public holidays. Any unscheduled holidays are put up as notice almost two weeks in advance.
  • Patients have observed that the clinic is kept clean at all times, and no one has seen housekeeping activities being done during the open hours.

Here are the metrics that show success.

  • Average number of patients visiting the clinic on any given day is 200+
  • Average number of new patients is an amazing 20 per day (calculated from the incrementing patient id number from registration cards on different dates).
  • Total patient count is reaching 40000, which for a two-member doctor team with about 30 years consulting practice between them talks a lot about their contribution to the society.
  • Average fees for consulting + medicine is 75% lesser than the typical fees in other similar hospitals or clinics

While this article is not a debate about alternative medicine vs allopathic medicine, but even the latest research in medicine are concluding that most common ailments can be treated without visiting a doctor in person and remote (video) consulting is enough to prescribe medicines for slightly more acute problems. Also, within the two doctors available, lack of choice to consult may initially appear to be restrictive, but the patient turnover proves it to be more of a perception. This clinic’s approach towards quick and effective treatment is a step towards that.

What I felt about the approach followed in the clinic is that the doctors have thought them out as design principles, such as:

  • Less wait time for patients before getting into consulting room
  • No added time for discussing patient history
  • Patients need not pay more for services they do not need
  • Reliable availability of doctors

 

I am sure that this kind of environment is achievable only by discipline, respect for patients’ time and belief in self-service. If this approach continues (along with any other improvements), I am sure that this clinic will continue to have a great practice for a long time to come. A good example of faster, cheaper and better service.

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