David Norris, MD, MBA

Be Aware of the Effects that Bottlenecks Have on Patients

Any service will have some downtime or wait time. It's safe to say your office will encounter bottlenecks. A bottleneck is a part of a process that constrains or restricts capacity and typically results in queues for your employees or patients. Queues aren't fun, and too much time spent in one can ruin the customer experience. Sometimes people tolerate the queue, and other times they don't.

Recall the last time you had to wait for a flight or the last time you had to wait to be seated at a restaurant. How did you feel about the wait? How did it affect your perception of the entire experience? That's what your patients feel when they wait in your clinic.

Given the dynamic nature of clinical medicine, bottlenecks and queues will happen, but you can improve your patients' experience by planning for them.

The Effects of Queues

When your patients experience bottlenecks, they consume time that accomplishes nothing. Since you too have experienced the frustration of waiting, you should seek to understand how your practice's queues might affect your patients.

  1. Perceived wait times. When we ask people to wait, their perception of the length of wait time doesn't correlate to the time they actually spend waiting. In fact, they perceive it as being longer than it actually is. Our society provides a lot of instant gratification, from microwave dinners to next-day shipping. We don't like waiting, and we become unhappy whenever we're forced to wait. Keep that in mind as you work to relieve bottlenecks. You can't eliminate queues, but having a patient do nothing while waiting their turn will distort their perception of reality.

  2. Waiting while unoccupied. Sometimes we can occupy our waiting time. We can read, watch the news, solve a puzzle, chat with a friend or family member, or complete many "necessary" forms. Waiting ten minutes while checking email on your phone feels shorter than ten minutes staring at the walls. Look for ways to occupy your patients' waiting time. It might mean giving them forms to complete, providing reading material, turning on the news or other programs, or encouraging them to bring someone to the appointment with whom they can chat.

  3. Anxiety makes waiting worse. Feeling anxious only makes the wait seem longer. An anxious, worried patient perceives their wait to be much longer than it is. Look for ways to help them relax. Try to put them at ease before their arrival. Encourage them to bring a friend or loved one to help comfort them. It's a balancing act between how much information you release before the appointment with what you must withhold until the appointment. Always be aware of how you and your staff present the appointment. You might unwittingly be contributing to the patient's anxiety.

  4. Uncertainty makes waiting worse. Not knowing what will happen, or when it will happen, makes the waiting seem longer. This is especially true in a hospital's pre-operative area. Patients who know what will happen during their procedure are less worried and more content while waiting than patients who are in the dark about such matters. Do all you can to inform your patients about what will take place during their procedure.

  5. Unexplained waiting is the worst. Anytime someone (the doctor or the patient) has to wait without being given an explanation is when tempers are likely to flare. If you know you're running behind schedule, have your staff inform your patients of the delay. Your patients might not be happy, but their perception of the wait time will be shorter than if you leave them sitting in the room without an explanation.

  6. The value of what their medical service. The more they value your service, the longer they're willing to wait. Recall the last time you decided not to wait at a restaurant. Why did you leave? It's likely you left because the food's value wasn't worth the time you'd have to spend waiting for it. Your patients will perform the same type of calculation in your waiting room. Ensure that you are creating the greatest possible value for your patients.

  7. Waiting alone makes waiting seem longer. Encourage patients to have friends or family accompany them to your practice. This will make the wait more enjoyable and improve the perception of your overall service. If a patient arrives alone, the staff should check in on them frequently.

  8. Waiting in discomfort makes waiting much longer. Discomfort of any kind makes the wait seem longer. Do what you can to make your patients' wait as comfortable as possible. Music, lighting, and (if possible, medication) can help put them at ease.

  9. New patients perceive the wait to be longer than returning patients. The first wait will seem longer than later ones. My children experienced this when we went to an amusement park. The first time they waited for a ride, the time seemed to crawl for them. They waited just as long for subsequent rides, but they didn't seem to mind as much. Once they knew the value of the ride, they expected the wait. The same thing will happen to new patients. Have your office staff prepare new patients for the anticipated wait times and give them things to do or people with whom to talk while they wait. The wait time might be the same when they visit again, but they likely won't experience it that way.

Queues are inevitable, and bottlenecks will form in clinical medicine. You can, however, increase the satisfaction of your patients by improving their perception of their wait times.

Thought for the Day

Are you aware of how perceptions regarding waiting can change depending on the factors outlined above? Write down what you can do to change your patients' perception of their inevitable wait times.

About the Author

David Norris, MD, MBA is a practicing anesthesiologist who is dedicated to improving the business intelligence of all healthcare providers. As an author, speaker, and teacher, he helps other providers develop the practice they desire. And as someone who is passionate about enabling physicians to deliver quality care in an efficient manner, David is proud to serve on PrefTech's board of advisors. You can learn more about David at