Every one of us feels a high level of anxiety when we are made to wait. In grocery stores, we jockey back and forth to the line we perceive is moving the fastest and easily get frustrated when we choose the “wrong” line. When driving, we will swerve across multiple lanes of traffic to avoid a line at a toll booth or to position ourselves in the lane that we think will get us to our destination the fastest. Even in elevators, we hate waiting so much that we push the “door close” button so often that those buttons typically have a different shine than all other buttons on the elevator panel because of the disparate use of that one button.
Knowing that we all hate to wait for just about anything, I haven’t quite figured out yet why so many doctors are okay with making their patients wait. Patients are customers, and most businesses try to focus on doing what they can to keep their customers happy, yet waiting is one of the top reasons why customers are annoyed or frustrated by an experience they have with a business. In an advertisement for Federal Express, the voiceover states that “waiting is frustrating, demoralizing, agonizing, aggravating, annoying, time consuming and incredibly expensive.” Waiting generally results in negative perceptions of businesses by customers. So, why do doctors think it is okay to make their patients wait?
Sometimes, it is unavoidable in a medical practice that patients will have to wait; unexpected things come up that may not always be able to be controlled. It is certainly in a practice’s best interests to look into how wait times can be avoided, or at least diminished, to improve the patient experience. But even if waiting cannot be completely avoided, there are ways to handle the waiting experience of patients. Understanding influences on people’s perceptions of waiting can provide better insight into what can be done to make waiting a less negative experience.
There has been a good deal of research done on the psychology of waiting. In my quest to better understand this process, I happened to read a paper by David Maister, titled “The Psychology of Waiting Lines.” Below, I would like to share a number of insights regarding waiting that were highlighted by David Maister in order to help you better understand how your patients feel when they are kept waiting for an appointment.
1. Unoccupied time feels longer than occupied time. You know the expression “a watched pot never boils”? When you are sitting and doing nothing while waiting, it seems like the time takes forever to pass. Maister quotes William James, a noted philosopher, in his paper, highlighting his observance that “boredom results from being attentive to the passage of time itself.”
Many businesses understand this concept and some try to do things to change the perception of the passage of time. For example, theme parks such as Disney keep guests entertained while waiting in lines by providing entertainment through music, TV or live performances. Most medical practices understand this concept to a point and provide patients with loads of paperwork (most that have been copied over and over) to work on while waiting so that patients are occupied for at least a portion of the wait time.
If you need to keep patients waiting for awhile, make it more fun and entertaining for them so that they are occupied while waiting and so that time seems to pass more quickly. For example, keep magazines fresh and make sure topics are in line with those your patients might find interesting. Provide iPad minis (tether them to furniture so they don’t “disappear”) to give patients something to do while they wait. Although I am personally not a big fan of having televisions running with daytime talk shows, I do observe that they work to keep patients entertained.
2. People want to get started. Patients want to feel like they are getting closer to seeing the doctor, so it is in your practice’s best interest to have patients feeling like they are getting started on time, or as close to on time as possible. Have an assistant start the appointment right at the scheduled time by taking patients back to the room where they will be seen (and thus, leaving the waiting room).
Even if taking the patient back to the room is not an option, consider some type of “triage” system, whereby all patients are first met by a nurse who can enter the patients’ name, information and symptoms into the computer and then can decide whether the patient can be treated by a registered nurse practitioner or whether they should wait to see the doctor. Even if this step has no impact on the time it takes for a patient to see a medical service provider, surveys have shown that patients were pleased with “reduced waiting times” because their appointments seemed to start on time, since they had at least been entered into the system and the “process” of the appointment had begun.
This is another good reason to give patients forms to fill out, but I challenge you to take it to the next level past just filling patients’ time with forms by putting in place a process that makes them feel like their appointment is getting started, even if they still have to wait to see the doctor. Even if there’s no option about who to see, having a nurse start the process (by taking blood pressure, height and weight, symptoms, etc.), makes the patient feel like the appointment has begun on time.
3. Anxiety makes waits seem longer. When people are anxious, the process of waiting appears longer than it otherwise might. Just think about how it feels when you’re line hopping at the grocery store and you are anxious about whether you really choose the best checkout line. Standing there waiting for your turn to check out seems like it takes forever and you’re sure it would’ve been faster somewhere else. Or, maybe you’re at the airport and you have to wait in line to go through security. You’re anxious about the process of whether you’ll be pulled aside for additional screening once you’ve sent your wallet, keys and laptop through the x-ray machine, or whether you’ll get to your gate on time, and that makes the wait seem to be interminable.
Chances are that your patients are already anxious while sitting in your waiting room. Most reasons for heading to a doctor’s office leave people with some level of anxiety. So, since you know that your patients are anxious and you now know that anxiety makes waits seem longer, it’s important for you to remove as many of the other seven factors noted here that add to wait anxiety as you can in order to improve your patients’ experience.
4. Uncertain waits are longer than known or finite waits. It’s been shown that when a person knows how long they can expect to wait, they are less anxious and the wait time seems to pass more quickly and less unpleasantly. Think about how you feel again at the airport. If you arrive an hour before your flight and get to the gate 30 minutes before departure, you are fine with the wait time because you know what to expect and can pass the time accordingly, doing whatever you want or need to do before the flight leaves. But, if you are sitting at the gate for just a few minutes past the scheduled departure time and you have not been told when the plane will board, you immediately get very anxious and the minutes tick by like hours while you sit at the edge of your seat growing more and more anxious.
The same holds true for theme parks. If you see a sign that is posted about how long the wait time will be, the time seems to go by much faster and with less stress than when you’re standing in a line that appears to not be moving very fast and you have no idea how long you can expect to be standing there.
So, it is important that your staff provide specific information related to how long patients’ waits will be. If your staff just says “the doctor will see you soon”, the patient may assume your staff is lying or bluffing and will automatically be in a more anxious state. That’s because when we don’t know how long a wait is, we become more agitated and less patient. Time moves by at a snail’s pace.
But, if we know the exact amount of time that we will have to wait, we can settle into a new reality. It frees us from the anxiety of the unknown and allows us to control what we do with the time we know we have to wait. We can read a magazine, make a phone call, check some emails or even step away for a cup of coffee, rather than watching the constant tick of the clock, wondering when our wait will end.
5. Unexplained waits are longer than explained waits. The second we are told why we are waiting for something, we usually relax a bit. For example, if we are sitting at an airplane gate and the flight is late but there is no agent at the gate or we are provided with no reason for the delay, we get frustrated and anxious and the wait time seems to take forever because we’re not really sure why we have been made to wait. But, if the airline agents are there and they explain the reason for the late departure, we come to a level of understanding and our frustration level is somewhat reduced.
I often see reception staff in doctors’ offices managing patients’ inquiries about delayed appointments by using “white lies”. The front desk staff may say things like “the doctor is at the hospital” or “the doctor got called into an emergency”, but without a valid explanation about why the doctor is delayed and how long the patient can expect to wait due to a specific situation, patients get annoyed (and rightfully so). Sometimes, the patient doesn’t believe the explanation (or it’s an untrue explanation), but even if the reason for the delay is valid, a patient that doesn’t receive a fair explanation of the situation will feel frustrated, anxious and will perceive that the wait is taking forever.
6. Unfair waits are longer than equitable waits. When we are waiting for something to occur, we are very sensitive to what we deem is unfair or unbalanced. Think about a time when you were sitting at a restaurant waiting for your order to be taken or food to be served, only to see a party you know walked in after you enjoying their food before you. Even if you had no issue with waiting up until that point, you suddenly feel like you’ve been waiting too long because it is unfair that they were served so quickly and you are still waiting for your food, so you immediately get agitated and start looking for your waiter to get some answers about when you can expect your food.
Similarly, if you are sitting in a waiting room at a doctor’s office and someone else that walks in after you is taken back before you, you view this as being unfair and it makes you more agitated. Chances are you’ll head to the front desk to immediately make sure that they didn’t “forget about you” or to find out why you weren’t taken first. That’s why it is so important to make it very clear to patients why their wait may be different from another person’s wait. For example, if there are multiple practitioners in the office, your patients deserve an explanation that some patients may experience different wait times dependent on each individual practitioner’s schedule.
A triage nurse or the person who greets patients at the front desk can manage any expectations of fairness by providing information about variations in wait times with a valid explanation.
7. The more valuable the service, the longer the customer will wait. This may be the one point regarding waiting that leans in a physician’s favor. I have had to wait several hours to see a particular specialist after it taking me months to “get in” to see the doctor in the first place. So, even though the wait was extremely long, I wasn’t about to give up my appointment and walk out, only to have to possibly wait several more months to get back in to see this specialist.
However, although this point might provide a reason for your patients to grin and bear it while they wait for you, it still is not good for business in general to make your patients wait. So, this may buy you some time, but don’t rely on it as a reason to validate your constantly backed up schedule.
8. Solo waits feel longer than group waits. When you’re waiting in a restaurant, an airport or an amusement park, there’s no doubt that time seems to pass much more quickly when you are with a group of people. You’re talking, laughing and having a good time and, unless the wait is egregiously long, you tend to hardly notice. When you’re alone, wait times generally feel much longer because you are more focused on the passage of time and are not as distracted from the actual act of waiting.
Now, I’m not advocating that you have your patients show up with a big group of friends so they have people with them to make the wait go by faster, but in the absence of companions, I suggest again that you keep your patients distracted and entertained with things like iPad minis, up to date magazines, or a TV tuned to a popular program.
I challenge the physicians that I consult with to minimize wait times. It is simply the one best thing that you can do to improve the perception of your practice. If your patients come in and are seen on-time they will certainly rave about you to their friends. Your competitor most likely isn’t seeing patient’s on-time; instead of lowering your practice to what has become standard, long waits, set your practice apart by seeing your patients as scheduled. It is the easiest way to differentiate your practice.
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