My son is a second year medical student who has gone on 3 rotations with 2 specialists and one primary care practices.  It is a great experience to expose medical students to the front lines of practice and he was particularly impressed by the general complaint in all the practices of no show and late appointment.  It was a daily gripe, framed in lost time, productivity and financial terms.   The issue made a great impression on him and he wondered why they didn’t just solve the problem by giving each patient a $20 incentive payment when they showed up on time.  That would certainly solve the problem that was clearly a big deal.  Our course discussion board has supplied other solution:

  • Reminder phone call
  • Reminder emails
  • Reserved parking
  • Free parking
  • Improved signage
  • Other …

What rarely is done is to identify the problem, identify the key quality characteristics that define the problem, and then perform root cause analysis.

  1. Identify the problem.

               No show is a different problem from showing up late.  Each have a different set  work flow consequences.  Identify one problem at a time and use the practice improvement process.  Let the data determine which problem to tackle first.  Inability to isolate the problem will reduce your effectiveness of any solution.

  1. Choose Key Quality Characteristics.

               These are metrics that characterize the problem.  They should be limited in number, think (2) and easy to measure.  In this case, how about number of no shows and number of lates.  Another could be financial loss or time loss.  If I have 5 no shows in a week that represents a loss of 200 minutes, and 15 late that represent 50 minutes, I now have a basis to choose which problem to address.

  1. Perform root cause analysis

               You have identified the problem, now identify the root cause.  Applying what may sound like a common sense solution:  phone calls, emails, incentive payments, is like throwing darts blindfolded.  You may hit the board but you may hit your best friend standing near the board.  Either way, bypassing root cause reduces the efficiency of the improvement activity.  You end up spending a lot of $20 or hiring a good phone message person without solving anything.   This may involve actually finding out why patients don’t show up?  Get your team together and brainstorm or brain write possible causes  and then maybe just ask the patients who no show!  Applying sound root cause technique will not only remove the blindfold but give you the ability to hit the bull eye every time.

I explained the process to my son and was gifted with a “Makes a lot of sense Dad” and who can’t use more of that from you medical student kids.