December 14, 2016
3 min read

BLOG: How applying a wartime theory could help your practice

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In previous blog posts, I have argued that future practice viability depends, to some extent, on the utilization of an appointment mechanism more thoughtful than “first-come, first-served.” In today’s blog, I am going to argue for the need for a faster appointment mechanism — something that may seem difficult, given the previously established need to be more thoughtful. Alas, a modern business challenge we face is the appointment mechanism needs to be both faster and smarter.

Orthopedic practices generally serve two types of patients: type 1- acute, urgent problems (eg, femur fracture); and type 2- less acute, nagging problems (eg, radiating neck pain). Since many type 1 patients present through an emergency room (no appointment needed), the practice’s appointment system predominantly serves type 2 patients. In thinking about these type 2 patients, we may ask, “What factors motivate a patient with a nagging problem to finally act on it by securing an appointment?” But, the inverse question is more useful to a businessperson: “Why does a person with a nagging problem continue to put off solving it?” and the corollary, “What can I do to make them stop procrastinating and come see me?”

I refer to appointment procrastination as “flash-to-bang” time. During the Cold War, American soldiers were taught to count the number of seconds between the “flash” of a nuclear explosion and the impact of the pressure wave (“bang”). The time difference between the arrival of each of those two events could be reported to higher authorities (assuming the observer survived) to calculate where the bomb hit.

In orthopedics, “flash to bang” is the time interval between a patient deciding he wants a doctor to evaluate a worrisome problem (flash) and the moment he sits in an examination room (bang). In a consumer-driven environment, the practice in any market that employs the fastest and smartest “flash-to-bang” time will most often get the first crack at patients who need significant orthopedic care and drive robust practice revenue. That competitive edge delivers a preponderance of opportunity and may mean the difference between the practice’s long-term success or failure.

Let’s put ourselves in the shoes of Dave, a 52-year-old corporate executive who works 50 hours per week. For the past several weeks, he has noted worsening radiating neck pain that has kept him out of CrossFit. He initially assumed it would get better in a few weeks, but in the meantime, he’s been suffering at night and has started sleeping in a recliner. At 2 a.m. on this night, he finds himself staring at a computer screen with his left arm over his head to get relief, browsing orthopedic and neurosurgical websites (flash). He is literally reaching out for help. Unfortunately, most of the websites tell him to call back when the practice is open (which is of no help to him, as he will be at work and cannot wait on hold), while a few others offer an online appointment request where the practice makes a vague promise to call all requests back within 2 business days. After 30 minutes of frustrated browsing, he gives up, takes a leftover hydrocodone from an old injury and turns on the TV to watch SportsCenter re-runs. Maybe this will get better on its own.

Dave’s problem is your problem. Your archaic business methods are contributing to his misery. There are so many hurdles in the way of getting an appointment that he gives up, extending the “flash-to-bang” time.

Imagine having an appointment optimization solution branded to your practice where Dave could request an appointment online or an app with the cognitive ability to recognize Dave’s well-insured and probably surgical C5 disc should be overbooked today with one of your practice’s spine surgeons, not put off until the next open appointment in 4 weeks. Shortening the “flash-to-bang” time for patients like Dave is the key to practice survival in our evolving health care ecosystem, and it simply cannot be done with a telephone-based system or outsourced to a noncognitive online appointment request vendor. The technology is there — surgeons just have to push practice managers to adopt it.

Realize that patients window-shop on your practice website every night, but then procrastinate making an appointment because you made it difficult for them to get the ball rolling. They eventually wind up in an ER or a competitor’s office, when what they wanted was to be your patient. This is a daily recurring loss that you will never recover, and all because you did not build a smart and fast “flash-to-bang” system for patients to use. It does not require a Master of Business Administration degree to understand why many practices are struggling in the consumer-driven environment.

John “Jay” Crawford, MD, is a partner at Knoxville Orthopaedic Clinic and founder of nextDoc Solutions, a software company that builds custom apps for orthopedic surgery practices. His primary interest is helping private-practice orthopedic surgeons discover and implement strategies to ensure robust and sustainable business performance in a consumer-driven health care environment.