I've done a lot of work on office efficiency over the years. The goal of the work is to waste less time and effort so that we have more time to spend doing the real work of patient care. For this we measure things like "cycle time" and "value added time." These measures don't come easy, but can give us a lot of information about waits and delays in our practice and hint where the opportunities for improvement lie.
There's another benefit from office efficiency. A nice little study by Lacy et al (1) confirms other studies showing us that patients are sensitive to waits and delays in the office setting (go figure!). It turns out that "you kept me waiting" is a predictor of "no-show" for a future office visit.
So I've come across another way to measure office efficiency: What percent of my patients agree with the phrase:
"When I visit my PCP's office it is well organized, efficient, and seldom wastes my time."
This is from John Wasson's work. In the Ideal Medical Practices project we found that even solo practcies could use this information to identify and improve on performance gaps. Project participants had incredibly easy access to information on efficiency that in the previous "cycle time" paradigm had been difficult and painful to gather.
Because the patient reported variable more closely correlates with other important factors that predict population health (more efficient practice -> less "no-show" -> less missed opportunity to act on preventive and chronic disease needs), I find it a more compelling approach than "cycle time." Reduced cycle time might improve the experience of care, but there are more links in that chain and the conclusions are not as clear.
The aggregate experienece of care in my office as defined by patient reported measures more accurately defines my office as a system.
It's time we put the patient at the center of our measurement universe.
L Gordon Moore
(1)Lacy, N., Pullman, A. Reuter, M., Lovejoy, B. Why we don’t come: Patient perceptions on No-shows. Annals of Family Medicine 2004;2:541-545.
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