I'm sorry, Doctor Famous is busy

What happens when a referring doctor insists that "Doctor Famous" see his or her patient, even when other physicians on the staff can do the job just as well? In Lean terms, waste is introduced into the system. As diagnosed below: The minute an additional seemingly unnecessary step is added to the flow it adds a huge delay. Here's an example:

A patient needed a certain kind of ultrasound. The hospital-based surgeon helpfully made the appointment call for the patient, telling the scheduling attendant that the procedure had to be done by one of two specific radiologists. Those radiologists only schedule those particular scans for a few hours a week, so the attendant quite properly replied that the next available times would be a few weeks hence.

The patient later wrote me to complain: Why would this all take so long to get scheduled?

I passed along the complaint to our chief of service, Jonathan Kruskal, who wrote:

I just wanted to get back to you about the patient complaint about scheduling an anal fistulogram. You may be interested to know that we have reviewed the actual telephone discussions that took place during the scheduling. (I am enclosing the tapes - How's that for an analytical tool!)

We developed this technique here at BIDMC and are the recognized authorities in the US. All of our ultrasound faculty can do this procedure, which takes less than 5 minutes to complete. The process issue here is that this physician only wanted Bob Kane or me to do this.

Obviously, Bob and I are not scheduled to work in ultrasound every day. To rectify this I trained all our staff to do this so that the studies can be scheduled every day. If the doc had simply scheduled the study it could have been done on any day the patient chose, and Bob or I would happily have reviewed the study even if we had not actually done it. As we all know from work flow analyses, the minute an additional seemingly unnecessary step is added to the flow it adds a huge delay, which is what happened here. We have spoken to [the surgeon] about this, but s/he still prefers to have Bob or me do these.

We do these studies from 1-2:30pm because they can only be done on a single machine (no other local hospitals have these dedicated anal imaging machines) that requires time for setup and probe cleansing. It is this same ultrasound unit that we use for guiding liver biospies (by hepatologists) in day care each morning and for intraoperative ultrasound, so we need to keep it available during mornings when these typically take place.

We've been doing this for over 15 years. Patients are usually thrilled that we offer this unique high quality service. I've never had anybody complain about access before, especially since these are never urgent studies.