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URGENT MESSAGE: Ongoing success requires that the urgent care operator keep his or her eyes open for opportunities to improve the patient experience. The challenge is that the operator can become desensitized by what he/she sees every day. In this guest blog, Lou Ellen Horwitz explains that effective operators must “take their blinders off” in order to experience the operation the way patients do.

Lou Ellen Horwitz is Director of Learning at Seattle-based Immediate Clinic. She has also served as Executive Director of the Urgent Care Association of America.

Blinders. You are wearing them right now. You don’t see them, or feel them. You can read this, drive your car, and go through your entire workday wearing them. They’ve formed so slowly that you never even noticed.

Lou_Ellen_Horwitz photoYour blinders keep you from seeing what is right in front of your face every day, and they’re contagious. They’ve rubbed off on your staff and your providers. Like most contagions, however, they require a fair degree of exposure. Your patients are not infected because they aren’t in your clinic every day so, unfortunately, they see what you no longer do.

The patient experience is not just about the direct experience, but also the equally important indirect experience—which has more touchpoints than the direct experience you currently focus on.

Getting those blinders off (and keeping them off) requires targeted effort. Sometimes it requires help. If you have an extensive healthcare background, you are probably going to need a chisel to get them off. But once you get them off you are probably going to be embarrassed.

So, who’s excited to get started?
The first layer of blinders covers your eyes (yes, there’s more than one layer but let’s keep this simple for today). In almost every healthcare facility I’ve ever been in, there’s a “stuff crisis.” There’s stuff everywhere. There’s an absolute stampede of paper tigers running freely, building dens, and having lots of cubs. There are reports, files, binders, forms, notices, memos, reminders, patient messages, stickers, signs, plus more reports, files and binders and forms. There are supplies and extra supplies and backups of extra supplies (don’t even get me started on the value of that inventory), often sitting right on the counter.

There’s a pervasive myth in healthcare that once patients get out of the lobby, through the door, and into “the back” they go blind. Or maybe we think they get tunnel vision. They only see the scale you make them stand on, the smiling face of the staff we’ve trained so thoroughly in customer service, and the signs created specifically for them that tell them how to pay or to ask us about on-site dispensing. But patients see everything—much more than you do. Remember: patients don’t have your blinders.

They see that stack of boxes in your hallway that your supplier just delivered. They see all those overstuffed binders on the counters with handwritten labels (and all the extra empty ones). They look in the exam room cabinets when you are out of the room. They see that for some reason you have multiple stickers showing which credit cards you take. They see that sign you’ve had taped up for so long that its edges are curling, or worse. They see, they see, they see. And you don’t.

The best remedy for these blinders, if you have it available, is to bring your mother into the clinic, tell her what you need help with, and ask her what she sees. It won’t take long for you to start seeing it, too. If your mother’s not available, get your neatest, most obsessive friend to take her role. Same result. This person is your “spotter.”
Start with something small and impactful; your spotter can help you identify this. It should not be your office. To attack the problem, you will play a game called “what is this?” It’s simple: you pick up everything you see and identify what it is and what it’s used for. Then there are two questions for each item: 1. Do you still need it at all (is it used, is it current vs expired, etc.)? 2. Is it where it should be?

There are two considerations for #2; first is workflow, second is visual impression. If workflow always triumphed we’d just put everything on the counter so we’d never have to open a cabinet—but visual impression is as important, if not moreso. It’s worth your staff having to open a cabinet if it helps create a clean, professional environment in your exam rooms.

If an item fails #1—you don’t actually need it at all—enjoy the freedom that will come with tossing it out. It may be scary at first, but you can do it. If it’s clinical material you must dispose of it properly, but you should dispose of it. One alternative is to save the material for training purposes—if you have a good place for it to all be stored together vs cluttering up your workflow.

If an item fails #2—it’s not in the right place—it’s time to take a step back and figure out where it should be. Don’t just stick it somewhere else without thinking about it or you’ll just come across it again in a later round.
One option is to start filling a box with “I don’t know where this should go” items so you can keep making progress and not get hung up with every single item that’s not in the smartest location. That solution will only last so long though, so don’t rely on it too much!

This first round is going to take a long time if you are doing it correctly. If it doesn’t, either you are not being thorough enough or you were pretty organized in the first place. Don’t worry, the more you do it the better you will get at it, and after a while you will start having proper places for things and stop having to rely on your “I don’t know” box.

As part of this process you may find yourself examining your workflow with your team; this is a good thing! Your staff is the best source for where things should go to fit in their workflow, but you will need to be the disciplinarian of the visual impact of their recommendations. This is also a great time to start educating your team on the idea of blinders and why you are working on this in your clinic.

Keep going on area 1 until it’s fully tackled and “done.” It is very easy to get sucked into other areas as you start to move things around; that is the path to madness, and you’ll never make any visible progress—and visible progress is the goal.

Once area 1 is done, it’s time to do your office. By now you should have developed the flow of the game:

  1. What is this?
  2. Is it used?
  3. Is it in the right place?
    1. Workflow
    2. Visual impact
  4. Act (limited use of the “I don’t know” box allowed)

Why is your office second? Because it’s important for you to set the example for your team. It’s also likely to be hard for you, and if you save it until later you’ll find too many reasons not to do it (you are tired, you have more important things to do, you can close your door, patients don’t come in there, and so on). Those reasons allow you to say to your staff, “This is important for you, but not for me” and that’s not a good message—especially if you want them to maintain it.

While you are working on your office, you can deputize some of your team to get started on area 3. Just give them the questions and an “I don’t know” box of their own and set them loose. You will want to check on them regularly, however—which also will give you a nice break from dealing with your own mess!

Keep this process up until you have done every area in your clinic. Once you start cleaning up a few areas it will make the rest of them cry out to be addressed, so you should stay motivated to keep going. Just keep your blinders off and you’ll be looking good in no time.

How do you do all of this in a busy clinic? You will probably need to bring in some extra staff for a very limited time. It will be worth it. In addition to improving workflow and your visual impression, you will be signaling a shift in your thinking to the staff. You are not only making a visual impression on your patients; you also are making one on your team. Keep that in mind and watch the transformation in them match the one going on in your clinic. You will be surprised at the additional benefits that unfold.

If find you are in particularly bad shape, it bears thinking about how you got into this “mess” in the first place. After your cleanup is done, it may also be a good time to look at your inventory management processes, and anything else you discovered in this journey so you don’t find yourself back there again. Finally, schedule a quarterly quick walk-through with your blinders “off” to attack any egregious backsliding, plus a biannual deep clean.

Part 2 of this blog will encourage you to remove the auditory “blinders” that may have you and your staff working under a cone of silence—where you can’t hear your business’s cry for help.

To See a Brighter Future, Take Off Your Blinders!

Lou Ellen Horwitz, MA

Director of Staff Development & Communication at MultiCare Retail Health & Community-Based Care, Chief Operating Officer at the Urgent Care Association
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