Paint Is Expensive

As a seasoned practice management consultant, I generally have ideas about what might be going wrong in a practice well before I cross the threshold. This time was different. I had read the pre-consultation materials thoroughly a couple of times. The website was circa 1995, but, sadly, many are. It was a long-established, solo surgical practice in a high-end urban setting, and the patient encounter numbers and relative value units seemed adequate for a practice of its size. There were no indications of any high drama. The physician claimed that the staff lacked service orientation and efficiency. He sensed there were throughput problems, because patient satisfaction was down. Staff surveys indicated that the physician was tight with a dollar and that he didn’t appreciate them.

What if there was nothing that would make a marked improvement?

As I walked toward the practice, I was both eager and nervous. This case was just so vague. Honestly, I was a little worried. What if there was nothing that would make a marked improvement? “There’s always something,” I reassured myself, as I made my way down the street. “It may not be as obvious as the clock on the wall, but there’s something, there’s always something.”

Pausing to take a breath and begin the consultative observations, I saw that the signage was easily visible. I looked up at the beautiful brownstone, likely built about a century before the practice’s website. The vestibule was grand in an understated, antique-brass hardware, walnut crown-mouldings sort of way. It was a building that had come and gone and come into vogue again. In what must have originally been the front parlor, a reception desk and patient seating area had been arranged in a tasteful, practical way. No doubt, the physician’s frugality had saved this beautiful old building from any tragic updates.

I approached the receptionist. She eked out a lemon-sucker smile, gestured toward the four or five others waiting, and asked me to take a seat.

“Already so many waiting?” I thought to myself. I glanced around at the others. The knitting projects, 19th-century Russian literature, and heavy sighs and eye rolls told me these people had come prepared to wait and were already weary of it. I selected a seat, put my satchel down on the floor next to it, and sat. Ten seconds . . .

Tick, tock

Tick, tock

Tick, tock

Tick, tock

Tick, tock

Tick, tock

Tick, tock

Tick, tock

Tick, tock

Tick, tock . . .

Quite literally, 10 seconds had passed. I looked up at the wall in front of me and saw several clocks. The wall to my right—clocks; to the left—clocks. Slowly, I turned and looked at the long windowless wall behind me—clocks. There were pendulum clocks, round-face clocks, Roman numeral clocks, cuckoo clocks, long case clocks, lantern clocks, clocks in the shapes of animals, old clocks, and modern clocks. There were ugly clocks, cute clocks, large clocks, and small clocks. There were even freebie clocks with drug-company logos. The walls were covered in clocks. I stood slowly and walked down the long hall toward the exam rooms. There were clocks, clocks, and more clocks. Down the hall, I peeked into an empty exam room—yep, clocks.

The thought of every second of every moment of every workday being inescapable—no wonder the staff were miserable.

Every single second was marked with the surround-sound ticking of hundreds of little second hands making their way through the long day. I looked at the receptionist—what I had taken for bitterness in her smile was really pure pain. The thought of every second of every moment of every workday being inescapable—no wonder the staff were miserable.

After some of my findings and implementations had gained me credibility with the physician, I suggested that while he had a magnificent collection, perhaps the clocks were contributing to the low staff morale and patient satisfaction. I intimated that the patients probably wouldn’t even notice the long waits, if only the clocks were not there denoting every undeniable second. He was visibly pleased at the idea of enhancing patient satisfaction without having to actually change any of his own habits. Encouraged, I talked about how it could be done one room at a time so as not to disrupt his practice. At that, he looked at me quizzically. I explained, “Well you’d have to have the holes patched and the walls painted.”

“Nah,” he said. “Paint is expensive.”

A true story.