Your Practice, The Italian Restaurant, and Self-Service

February 16, 2011

We have - in healthcare - made the patient essentially a critical part of the process? In what other industry would we have the customer become a courier for his/her treatment or service?

We have talked about healthcare and airlines; healthcare and auto repair; and healthcare and furniture. Now we are going to talk about healthcare and restaurants.

Let’s pretend you’re going to a fine Italian restaurant: Luigi’s Pasta Emporium. A good friend has told you that Luigi’s is famous for its Shrimp Scampi, garlic bread and Caesar salads. Their tiramisu is also to die for.

Your waiter - his name is Alberto - is very polite and knowledgeable about the menu, the specials, and the colorful history of the restaurant. But you are just waiting for him to finish his spiel so you can order a fine Caesar, garlic bread, scampi, and you’re probably going to want to finish it off with a nice cappuccino and a tiramisu. He writes all this down, hands you the order, and asks you to now take it to the kitchen and give it to the kitchen staff. But wait, you have to take the bread order to the bread station, the salad order to the garde manger (cold appetizers and entres), the scampi to the poissonnier (seafood chef), and the tiramisu to the patissier (dessert station). And the cappuccino machine is in the bar so you take that order there.

What does this have to do with healthcare?

Let’s say you go in to your doctor for what I call the “old guy” (or old gal) physical. Your doctor says you should get a complete blood workup, a treadmill EKG, a chest x-ray, and just for good measure a colonoscopy or mammogram. Your doctor gives you a series of forms ordering all these tests, which you carry out of his/her office, and take them to each respective lab/clinic/testing facility.

Let’s follow just the x-ray now. You go to get the x-ray, they develop the film, hand it to you in a big paper sleeve for you to take it back to your doctor. You doctor sees a “spot” on the film and thinks you should see a pulmonologist. You take your x-ray with you to see the pulmonologist. While waiting in the respective waiting rooms, you spot several other patients, each carrying their x-ray.

(Note: During this time there are two other scenarios also happening - the airline/healthcare scenario, where you are handed a clipboard at both the imaging center and at the pulmonologist and asked to start over each time with your health history, and the auto repair/healthcare scenario, where your test results could be in limbo for days. You fight through both of those issues but that’s described in the earlier blogs.)

Can you see that we have - in healthcare - made the patient essentially a critical part of the process? In what other industry would we have the customer become a courier for his/her treatment or service?

Years ago in financial services and retail sales the state-of-the-art tool was an air tube that sent paperwork shooting around the operation. Since then, the technology has improved exponentially, and every other industry has streamlined operations, reduced costs, provided greater accuracy, and improved both employee work flow and customer satisfaction.

Why can’t we seem to figure out how to do this in healthcare?

In virtually all other industries, legions of clerks, receptionists, telephone operators, stenographers, travel agents, and others have been retrained and repurposed to fill positions that add more value to the product or service being offered. Yet in healthcare the number of caregivers has remained roughly constant for decades while the overall workforce has had the largest growth in workforce of any industry.

Many industry pundits - including practitioners whose opinions carry a lot of weight - claim that healthcare is inherently different and more complicated and doesn’t lend itself to automation. As long as that’s the belief of most providers, healthcare will not change.

Technology is mature enough to provide healthcare the kinds of process improvement and efficiency that it has for virtually all other industries. We would consider it an insult in a restaurant where we as a customer become the courier. We should - as patients - adopt the same attitude for healthcare services. Patients should not be part of the paperwork.