Same-Day Surgery Manager

Managing patients' time — Fair to make them wait?

By Stephen W. Earnhart, MS
Earnhart & Associates
Austin, TX

I go through 400-500 patient satisfaction surveys per month. Like you, I am relatively busy just getting through life, but these are 400 to 500 patients and their family taking time out of their lives to tell me how we are doing as a business. Regardless of what you might think, health care in 2010 is a business!

Included each month in these missives are the usual, but the ones thing that continuously stands out are:

"I waited for almost two hours before I was taken back to the changing area."

"My time is important, and why did I have to show up 90 minutes before surgery when you did nothing to me in that time?"

"If I knew I was going to have to hang around doing nothing for two hours, I would have brought my laundry with me!"

"You are getting paid for this, I am paying you. Why did you make me wait so long!?"

Come on, people! We can do better than this!

"I sat in your waiting room for an hour before anyone called my name ... I counted eight different staff people in your waiting area. Not one of them came over and told me when I would be taken care of. It was that way with all of us in the waiting room. I will never be back!" (Author note: I called her personally and apologized. She told me to go to hell -- seriously!)

"This is no way to run a business. No matter how well everything else was, the time I said around doing nothing ruined the experience for me!"

I promise you that most of your patient complaints are time-related. If you are not reading these surveys every month or distributing their contents in staff meetings, you are missing a great chance to make a difference at your facility.

When should you have the patients show up to your facility? Thirty minutes before surgery? Two hours? What is the right amount of time?

Most of us know that the surgeon puts pressure on us to have the patients arrive very early in case someone cancels or he/she is ahead of schedule. There is some merit to that, but at the inconvenience of the patient. So, question: Who should be inconvenienced, the surgeon or the patient? You can argue both very rationally, but someone is going to be put out either way. What usually happens is the surgeon wins 95% of the time. Again, you can rationalize it back and forth and make it seem right, but still -- what about the patient's time?! You've got to figure that there are many other places they would rather be than sitting in the waiting room. I mean, after all, they are the one paying for this. After they have figured out what everyone else in the room is having done, it gets pretty boring pretty quick!

If you delay a person's flight on an airline, the airline gets fined in an effort to force the airlines to be more cognitive of their travelers' time. Is that what it is going to take? Are we going to be government-regulated? (Well, we probably will be anyway.)

I estimate that I will receive a large number of e-mails after this is published defending the facility for having the patients show up earlier than they need to, just so they know the patient will be there! Or I'll receive e-mails saying that anesthesia needs to see the patient, and they need that much time. Or they'll say that their lab work cannot be ready in time. Or they'll say those cases will be canceled if they are not there two hours before surgery. Or they'll say they cannot be trusted to find the center. Or, or, or! I have heard them all before, and none of these excuses are valid.

Many centers still have the patients come in several days before surgery to have their lab work performed and to be seen by anesthesia. If you are one of those centers, then you are about 10 years behind the times and should be ashamed of the way you disrespect your patients. What you are doing is making the patients work around your schedule. It should be the other way around.

If I receive enough responses to this column, I will devote a future column to explaining, in detail, how you can have your outpatient surgery patients show up 45 minutes before surgery and not require a pre-op visit earlier in the week. If that is interesting to you, let me know. [Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management.]