Streaning Star Trek: Insurrection Full Movie
6 years ago
Wednesday, September 17, 2008
Efficiency for who? (Ch 3)
The authors make an interesting point about what is considered "efficient". On page 48, they talk about visits to the doctor. Let's take a look at what it means to go to the doctor today in the US, other countries have different processes. From the patient perspective, going to the doctor is not efficient at all: first, the patient has to sign in, pay for the visit and wait. Wait varies from a few minutes to one hour. If it is the first time the patient is seeing a particular doctor then paperwork has to be completed. Then the patient has to tell the nurse the reason for the visit and wait again. And again wait varies, I have been in situation where I seriously wondered if I had been forgotten. Then the doctor's visit can start, and of course the doctor asks the reason for the visit. This is a very inefficient process with a lot of wasted time and redundancy. From the doctor's perspective, of course, the process is very efficient. But isn't this process upside down? Here the patient is sick so why society has built a process to make it even worse for the patient? It should be the other way around.
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3 comments:
That is true. The efficiency of an organization or process is often analyzed from the lense of management, for example. It is less common to find an experience where the efficiency as defined by Barnard (48) is accomplished. Perhaps he is right that true efficiency is produced when individuals' goals are satisfied "within the context of an organization's pursuit of its goals" (48). To me this means that all stakeholders' goals are satisfied as well as the goals of the organization. In this example, the hospital, the doctor and the patient would be satisfied.
The textbook agrees with your assessment that going to the doctor is not efficient from a patient's perspective: "... it's considered more efficient - that is, for the doctors, whose time is valued very highly, as opposed to the patients whose time in this case is not considered an important resource."
It seems like the hospitals in the USA are catering primarily to the doctor's perspective on efficiency and not to the patient's perspective at all. This is quite surprising, since I would imagine that the patient being the customer would at least get to have a small say in how his or her time is being spent waiting for the doctor. After all, there may be many patients who make more money than the doctor, and whose time is arguably more precious than the doctor's. It is not reasonable to expect that the patient's perspective can be completely ignored in this case.
My husband and I joined Kaiser Permanente this spring when he started his new job, and since then, I've been using their services frequently for what I refer to as "deferred maintenance" - conditions and concerns that I didn't take care of when I was without regular insurance. I've been duly impressed by what I call the Kaiser Machine - I walk in, usually get checked in immediately, carry my form to the proper place, and am rarely waiting long before I get taken back to see the doctor. I don't think I've ever waited more than ten minutes past my scheduled appointment time; the largest delays were caused by me running late and throwing the process off the track slightly - but I was never treated with anything but respect in that instance. This is in contrast to my former HMO medical center back in Michigan, where 45 minute to as long as two hour waits were the rule, not the exception. It's perhaps sad that I'm impressed by service living up to promised standards, but there you go.
I've been a patient in one HMO system or another since I was nine years old, so I'm used to the routine. My understanding of the multiple rounds of symptom describing is that the nurse needs the description for simple triage purposes, while the doctor wants to hear you describe your symptoms in your own words without relying on the nurse's relay or interpretation. Perhaps recording yourself reciting your symptoms would be a way to avoid this, but I can only imagine the problems that process would raise in patients' minds!
So far, I've only used Kaiser for maintenance appointments, not for illness. I may have also gotten lucky in encountering personable staff members and clinicians; I have heard horror stories of other Kaiser facilities. And thinking about this, I wonder how much I've adapted myself to becoming a process in the machine; whether I consciously or unconsciously try to be as "efficient" as possible in describing my needs and concerns, so as not to slow down the process - when, in fact, my needs and concerns *are*, or should be, the process.
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