Within seconds of walking into an Apple Store, customers are greeted by a blue-shirted employee who shepherds them to whatever service or product they’re interested in. There’s very little upselling, few transactions require customers to stand in line, and the employees are reliably friendly and knowledgeable. As a consumer, all you have to do is show up and your needs are met.
There’s a reason Apple is known for its design. The Apple Store experience isn’t like other retail stores, and it’s certainly not like the average clinic. But Keith Seidel, the medical director at Southeast Health Center in the Bayview neighborhood of San Francisco wondered why not. Seidel started to investigate what changes would have to take place in order to make his center a more patient-friendly place from the moment someone opens the door. Just as it happens when you walk into an Apple Store with a phone that’s not working, Seidel says, “I’m trying to develop the clinic so that any time anyone walks in—even if they don’t know what their needs are—they get their needs met.”
- Modify the appointment structure so it is 50 percent pre-planned, 50 percent day of.
- Become proactive about public health, regularly generating personalized patient communications. Call patients for appointment reminders, health screenings, and immunizations.
- Empower a “tactical” nurse to triage patients when they walk in the door.
In a pilot that's been rolling out in stages since the Fall of 2014, Seidel started adjusting his clinic's infrastructure. A major problem was the waiting room; there were too many people in it—some 20-30 on average. Patients had to wait too long to get an appointment. And when they arrived, they had to sit in the waiting room for too long. When Seidel started at the clinic in 2013, the third next available appointment—an Institute for Healthcare Improvement quality measure—was 99 days out.
Seidel took a three-pronged approach to clearing the waiting room backup. First, he modified the appointment system so only 50 percent of available slots were open for patients to book ahead of time. The rest he kept open for same day and walk-in patients. Next, Seidel aggressively went after population size, “actively recalling people and managing care at a much higher level,” he says. Monthly, a staff member with an interest in public health would pull lists of people who were late on a required appointment and call them to come in. This strategy opened up the capacity for the clinic to take people who needed help immediately while also getting patients in need of regular check ups back into the clinic. Seidel recalls, “It was lovely when it rolled out, to see us moving away from productivity-based medicine to value-based medicine.”
Finally, Seidel installed his own version of an Apple Store greeter. When a patient walks into Southeast Health Center they’re welcomed by a “tactical” nurse who possesses a deep operational knowledge of the facility as well as a solid understanding of who a patient needs to see. If someone comes in to drop off paperwork, the nurse takes the papers right then and there. For immunizations, sore throats, or mental health issues, the nurse triages the patient on the spot, making sure they are ushered to the clinician who will best meet their needs.
Today, the health center’s third next available appointment is only five days out. There are typically around three people in the waiting room, and the time it takes patients to get from the door to the exam room is roughly four minutes. Southeast Health Center has embraced an Apple Store-esque design that truly honors the population it serves, respecting both their time and their health inside of the clinic and out.
Seidel wants to get patients into exam rooms even faster than his current four-minute average. One thing slowing down patients is the manual game of telephone that has to happen to alert greeters to clean exam rooms. Making the alert process electronic and immediate would shave off more of a patient’s waiting time. Seidel is hoping to partner with people who could help him with the technology to make it happen, which would in turn support one of San Francisco’s neediest populations.