Procedures That Drive Customers Crazy

Today, I went to the doctor to get my shots for a trip I am taking to Ethiopia. This is the first time I have had to do this. I assumed that it would take 30 minutes—tops. Not so much. It actually ended up taking almost two hours.

women pulling her hair out

I was visiting a clinic that specializes in travel, so they didn’t have any of my medical records. As a result, I first had to fill out a bunch of paperwork. All total, it took about 15 minutes. When I turned it in, the receptionist said, “You realize that insurance won’t cover these shots, right? You’ll have to pay cash.”

I really hadn’t considered that possibility. Regardless, I said, “That’s fine.” I then paused and added, “So, why did you have me fill out the insurance paperwork?”

The receptionist looked a little confused and then confessed, “Honestly, I don’t know.” She then apologized and had me take a seat. Thankfully, I had my Kindle [affiliate link] with me, so I soon got lost in my book. I waited another 20 minutes before a nurse finally called my name.

She weighed me in and took my blood pressure, pulse, and temperature. She then proceeded to ask me all the very same questions that I had spent 15 minutes answering on the forms—my medical history, allergies, medications, surgeries, etc.

It was obvious that she had not looked at the paperwork. I was mildly annoyed but tried not to think too much about it. I mainly just wanted to get my shots and get back to work. She then told me the doctor would be in shortly. I waited for another 10 minutes, resigning myself to the fact that this was going to take a whole lot longer than I anticipated.

Eventually, the doctor came in. He was very pleasant and knowledgeable. He asked me where I was going and how long I would be gone. It was clear that he specialized in travel medicine and knew all the particulars. I was impressed. However, after a few minutes, he proceeded to ask me all the same questions as the nurse had asked me—the very same ones that were on the original form!

Again, I was annoyed, but what was I going to do? By the time I received my shots—five of them, thank you very much—I had been in the clinic for almost two hours. It made me wonder, how long would it have taken if they weren’t repeating the same redundant procedures.

As I was driving back to the office, I began to speculate about how many procedures my own company has that may be superfluous? What are we doing that is no longer necessary or useful? How much cost and frustration does this add for our customers and other key constituents? Probably more than I’d like to admit.

Question: How about you? What procedures are getting in the way of your organization providing the best service possible to your customers?
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  • http://www.jillboydsplace.blogspot.com JIll

    You know, anyone can sound off about an annoyance on their blog–I do it all the time. But you took your annoyance and used it as a learning tool by mentally comparing it to your own company. I like that.

    • http://intensedebate.com/people/michaelhyatt Michael Hyatt

      You can hold up a magnifying glass to any situation—or a mirror. I have found it ore helpful to do the latter.

  • Zeke

    Redundandcy in health care is not a bad thing. The form provides a written record for your file. The doctor will ask. He wants to be sure. It is risky to base treatment on a single visit to a question.

    • http://intensedebate.com/people/michaelhyatt Michael Hyatt

      I don't mind the redundancy IF it is intentional and explained. "Mr. Hyatt, I know that you already filled out our forms; I have them here in front of me. However, I am going to ask you some of the same questions again, just to make doubly-sure that we have this right. We want to make sure that we provide exactly what you need."

  • coolspec

    Impressively, you applied that thinking to what might happen in your company. More impressive, would be to follow up with your customer service, sales and accounting dept. Critical thinking like this means progress!

  • http://www.kimmirich.wordpress.com kimmi

    Morning, Michael. First, I wanted to tell you this. The doctor leaves one room and goes immediatedly into another 'mode' to another and he's just confirming–protecting you and himself. I want a Dr. to ask questions–lots. : ) Second, I believe your insurance covers some of, if not all of those expensive shots. If you address it to them as 'prevent medicine" and the what if down the road…. Here is what I always tell my insurance: either pay a litle bit now for what you feel is not 'medically neccssary' or pay a whole lot later, and then I wait , tap my foot, while they get a supervisor on the phone to approve. Oh the what ifs, it's all about the 'what ifs' game with these people sometime.

    Aside, I'm glad you were able to use this experience to inform, educate and best to you for safe and blessed trip.

  • http://www.kimmirich.wordpress.com kimmi

    Morning, Michael. First, I wanted to tell you this. The doctor leaves one room and goes immediatedly into another 'mode' to another and he's just confirming–protecting you and himself. I want a Dr. to ask questions–lots. : ) Second, I believe your insurance covers some of, if not all of those expensive shots. If you address it to them as 'prevent medicine" and the what if down the road…. Here is what I always tell my insurance: either pay a litle bit now for what you feel is not 'medically neccssary' or pay a whole lot later, and then I wait , tap my foot, while they get a supervisor on the phone to approve. Oh the what ifs, it's all about the 'what ifs' game with these people sometime.

    Aside, I'm glad you were able to use this experience to inform, educate and best to you for safe and blessed trip.

  • http://intensedebate.com/people/michaelhyatt Michael Hyatt

    See my comment to Zeke above. Thanks also for the tip on how to sell it to the insurance company. I agree!

    • http://www.kimmirich.wordpress.com kimmi

      Oops, I need to learn your new blog set up! Thanks!

  • http://lenanelsondooley.blogspot.com Lena Nelson Dooley

    I know what you mean. I hate answering the same questions for at least three people while I'm at the doctor. That's why I've stopped letting a student doctor see me first.

  • http://www.emergingintofaith.blogspot.com Dr. David Frisbie

    If we're applying these reflections to publishing, let's hope that mainstream publishers can compete with POD timetables. Right now much time is "lost" between the date a completed mss arrives at the publisher, and the date the resulting book is launched into the market. Markets change. Using existing technologies, why can't mainstream publishers get a book into the marketing stream in 2-3 months (or less) rather than 8-12 months? If so, everyone wins.

  • Garth Bishop

    If there is anyone in any industry that does telephone customer service reading this blog, you definitely need to look in the mirror based on this experience.

    It seems like every time I call my satellite company, phone company, credit card company or bank, they ask me to say or key in my account number to the system. Then when I actually get to a person, we have to go through that again. As well, most places now make me confirm my address each and every time I talk to them. While I admit there is a legitimate business reason to confirm my address, reducing the redundancy would definitely improve the customer experience.

  • http://intensedebate.com/people/michaelhyatt Michael Hyatt

    Actually, the production and printing of the manuscript is not what is driving the development cycle. We can get books printed in a week or so. The issue is the retail sales cycle. Retailers are planning nine months out, so they can insure they have the shelf space available and the promotions lined up.

  • http://intensedebate.com/people/PFNikolai PFNikolai

    I had a similar experience at an appointment with one of my doctors earlier this week—they must really want to know what vitamins I’m taking to ask three times!

    As for application here at Nelson, we are in the process of consolidating our information into one database and then we will pull from that database for reports rather than manually maintaining those reports in Excel. In the past, something as simple as a title change had to be made in at least three places. Our goal is one system of record so that there is only one answer when somebody asks a question.

    One of the items on the Obama agenda is better medical record keeping. Medical offices should sit patients down at a computer and allow us to answer their questions properly!

  • http://www.doublehdesign.blogspot.com Lauren

    As an employee of a local government agency, this is excellent but useless advice. The system is so ridiculously broken that I don't try to fix it, esp. being low on the totem pole. What you do learn to do in my position is WORK the system.

    However, I enjoyed your blog post and it's wonderful to see you think about how it can apply to your own company. If only I had that kind of influence/voice.

  • http://thanksgivingyear.blogspot.com Jonathan Magid

    This is a great post. I think the advice to look in the mirror, as it were, is well-placed, and of course the underlying message to consider processes from the customer's point of view as well as those of the other participants in the system is wise.

    Consider that in the instance of the doctor visit, the process that appeared so redundant to you isn't redundant in the eyes of the office. This could be happening for a variety of reasons: the receptionist needs to complete a file with insurance info and documents required under HIPAA; the nurse needs to file a document indicating that a history was taken, and the doc needs to know the history and has been trained not to accept hearsay history info. These three people have probably never sat down to talk about the experience of their customers, and largely operate on the assumption that an office-patient relationship is somehow different than a business-customer relationship anyway.

    Not an excuse – instead, a deeper thanks for your post.

  • http://www.emergingintofaith.blogspot.com Dr. David Frisbie

    Is that driven by STL, Spring Arbor, et al? Or by large chains? Or? Shortening that cycle would seem to have advantages for all.

  • http://lynnrush.wordpress.com/ LynnRush

    Yeah, it's nuts how long things take, but I'm with Zeke. I am okay with repetition.

    I'm allergic to a particular medicine, yes it was on the list of allergies,and the nurse confirmed it, but then the doc says, "Oh, we'll just put you on _____"

    The one I'm allergic to.

    Yeah, so………despite them asking over and over, it still slipped through the cracks. So, ask as many times as you want, I'll not mind.

    At least you had your kindle with you **smile**

  • http://www.blomerus.org Marysol

    I know I should be interested in the intended topic, I'm just curious where you are going?

    Sounds like our neck of the woods (Africa) or possibly Asia/Latin America. Had to ask. :)

    Marysol
    http://www.blomerus.org

  • http://intensedebate.com/people/michaelhyatt Michael Hyatt

    Definitely not the distributors (e.g., STL, Ingram, etc.). They only respond to demand in the marketplace. It is driven by the big chains and retailers. For example, they are buying products for back-to-school now. They have a lot to coordinate.

  • Cricket

    I wonder if some of the redundancy is to help you get your own thoughts straight, and time to remember anything extra. It would be nicer if you could download the forms and do them at home, to save one step.

  • http://www.kenwords.com Ken Summerlin

    As someone who's owned and managed Christian bookstores for more than 12 years, I take issue with your contention that retailers need to plan 9 months out and that is what is driving the development or production schedule. Although it's necessary and helpful for all of us to plan in advance, much of the advance is driven by the publisher or supplier and their need for predictive sales based on orders. The publsher has an understandable need to know how the buyers are responding before a title goes to print. In our very uncertain economic climate, it's getting harder for me to even guess what my needs will be in 60 days, much less 9 months.

  • http://www.thewritingroad.com Beth K. Vogt

    I ran the redundancy question by my husband, who runs a solo family practice offide. While he admits some repeated questions are a waste of time, he also said sometimes it adds a needed layer of safety. How so? Oftentimes, what a patient tells his receptionist over the phone and then tells his medical assistant and then tells him (the doc) can be three very different things. Sometimes repeated questioning reveals more information–or details that a patient didn't want to discuss with anyone but his physician. In the case of a travel clinic, this isn't likely, but a different country destination or itinerary might be recalled during the third go-round.
    In your case, it was probably just that no one read the paperwork, though.

    • http://intensedebate.com/people/michaelhyatt Michael Hyatt

      Again, I don't mind the redundancy provided that it is intentional and explained. I didn't get any sense that what I experienced was intentional, nor was it explained.

  • http://intensedebate.com/people/michaelhyatt Michael Hyatt

    I was really speaking about the large chains who tend to plan further out. They have more moving parts to coordinate. The development cycle has actually gotten longer since I first began in the business 30 years ago. The chains have driven most of this.

    Certainly, publishers need to get a read on the book from book buyers. However, about 20 accounts speak for 80% of the sales, so it doesn't take long to get a pretty good indication of how the book will be received. In addition, the manufacturing cycle is so short that we don't have to be as accurate as we used to be. After the first printing, we can turn books in about seven days.

    • barbara

      Agree, Michael – Would hate to have *add* a surprise to a major chains program. Sometimes I think they would rather *miss* a trend than re-do their plan-o-gram.

  • http://intensedebate.com/people/Matt215 Matt215

    I work in health care, but can see both sides of this. On many occasions patients do not pay attention to these forms and fill them out accurately. You may be surprised. So it is sometimes necessary to "help them be accurate" so that all the necessary information is recorded. Also, patients come in and have a certain level of care (service) that they expect. Society seems to be at the point that if a customer (patient) doesn't get what they are expecting, or if there is a problem they think that a lawsuit is a viable solution. Not all patients think this way, but the medical profession has to exercise "universal precautions" and treat everyone as if they are a potential lawsuit risk. So now everyone is subject to this repetition and signing of release forms such as HIPAA and informed consent. This is unfortunate because now everyone ends up subject to the additional repetition and form signing because everyone must be treated the same as the "lowest common denominator".

  • http://McKainViewpoint.com Scott McKain

    This is a terrific example of how organizations view customer contact departmentally, not organizationally. I'd bet the farm there was never a point the entire practice came together and asked, "What would the 'Ultimate Customer Experience' be for our patients?" Instead, each faction of care is doing what they believe is expected of them. We can hold mirrors up to our organizations, ask departments what they should be doing — and merely improve the efficiency of the repetition the customer continues to receive. No one you came in contact with at the office would want to be treated in that manner if THEY were the patient. Until the customer experience is examined globally (from the customers viewpoint), and until we begin to see the customer as ourselves, these mind-numbing experiences will endure.

  • http://intensedebate.com/people/Matt215 Matt215

    we strive to do that at my office. i like to use the analogy of a symphony. the patient schedule for the day is the sheet music. everyone should be competent at their "instrument" (skill) but should know how they fit into the whole orchestra. if one "section" isn't doing thier part then it sounds like crap. i also have to reinforce the fact that everyone should be on the same page. too many people have on blinders and don't pay attention to or care what's going on outside their specific job.

  • http://www.maurilioamorim.com Maurilio Amorim

    Mike,
    Health care is painfully ineffective, therefore, expensive. Last summer I had a visit to the ER with my 10-year-old son Derek and the experience was terrible. I wrote about it here: http://is.gd/n7e7

  • http://rvcalgary.blogspot.com Fred

    The application (ie. the mirror) of this lesson is what makes the reading worth my time. From the grocery store to getting my licence renewed I think we all like effeciency. The question you ask, as others have pointed out, is the valid one? Am I like this, are my people like this, is my organization like this?

    I recently was flying and a woman ended up in my seat. She had the right boarding pass for that seat but the wrong plane. Even though she had to produce her boarding pass three times on her way to the plane no one caught the error. I'm not sure where she was going but I was happy to get into my seat. Redundancy does have its merit.

  • http://ecigarettecigar.com e cigarette

    Doctors' office are terrible about seeing patients on time. They schedule appointments every fifteen minutes which usually isn't enough time. If you go later in the day, you're more likely to wait (as all those appointments run over) I always go prepared with plenty of reading material or homework

  • http://intensedebate.com/people/Beaconhillnw Jim

    The Doc's can be the worst, especially when you are changing medical insurance carriers. That and terrible service at any coffee house or eatery is just unacceptable.

  • http://katieganshert.blogspot.com/ Katie

    I went through something very similar when I traveled to Nairobi! The amount of shots and questions are insane, aren't they? My insurance also wouldn't cover it – which I thought was just downright silly. Why wouldn't insurance cover preventative medicine? Wouldn't it just cost them a TON more money if I didn't get the shots and came home with Yellow Fever? I actually came home with salmonella – not fun. It was still the richest, coolest, most life-changing experiene of my life though – regardless of the pukies I experienced afterward.

    On to your question. As an unpublished author, I don't really have any sort of writing business to examine. But I am a 5th grade teacher. And I have to make sure I'm not engaging my students in any superflous activities, or redundant ones (they particulary hate the latter – as they will groan and say "Haven't we already done this?"). There are only one hundred-eighty school days in a year – and they all need to be used carefully.

  • http://intensedebate.com/people/PattiM PattiM

    I've always tended to be a bit of a rebel in doctor's offices. Here (in Canada) there are no insurance forms to fill in, just a health card to produce at the front desk and basic contact information to provide. I've always refused to allow a nurse to do any history for two reasons, one I often have to just repeat myself to the doctor and two, I've discovered on more than one occasion the notes made for the doctor doesn't match what I told the nurse. So, if I want the correct info passed on, I give it myself.

  • PJohno

    There is a great tool called Value Stream Mapping that is a great way to analyse these problems. It is possible to map the process flow and ask what are the value add steps in the chain and why are there all these queue and wait times, duplications in info flow, etc and what could a future state look like that could be much more efficient (and desirable to customers).

  • http://www.ronedmondson.com Ron Edmondson

    I agree. I believe sometimes they are double-checking themselves, since your health is at risk and to avoid lawsuits, but acknowledging the multiple duplicate questions would help.

    Because I'm a pastor in a military town I get to fill out paperwork and be interviewed frequently as a character reference for military and civilians seeking security clearance with the government. They ask the same question all the time, either in print, by phone or in person. Recently I received the exact same form 3 separate times. Honestly, I had forgotten some of my answers. Had I known the person 7 years or 6? Honestly I can't remember exactly, but it's more than 1 and it's long enough to observe their character. Interesting, the form actually says, "because of the complexity of this investigation you may receive this form numerous times." I still don't get it, but at least they told me in advance.

  • Lizaroonie

    Mike, Seth Godin has a good blog post about linear and parallel.

    • http://intensedebate.com/people/michaelhyatt Michael Hyatt

      I haven't read that. I'll have to check it out.

  • http://intensedebate.com/people/michaelhyatt Michael Hyatt

    My primary care physician is awesome—and an exception to the general rule. The front desk says, "If you haven't been called by a nurse within ten minutes, please let us know." I have never waited more than five minutes. Somehow, they have figured it out!

  • Madden Corner

    I understand this all to well I'm in the military. Sometimes things can be simplified to flow better. Nice way to turn around the situation.

  • http://twitter.com/heretolead @heretolead

    We recently redesigned our church communication card to stop asking certain questions. We weren't doing anything with certain information, so there's no reason to ask. Not sure why a church needs to know previous church membership or the age/grade of kids living in the homes.

    It's quite possible that we would get more information if we asked fewer questions.
    My recent post Finding Your Voice

  • Jen

    I certainly share your frustration. However, I will say the medical field is the one field where "senseless" redundancy is essential.

    In most settings an error or omission isn't a life or death matter. In a doctor's office, the most minor error or omission could kill you.

    I'd say you did exactly the right thing: accept the fact that it is just going to take TOO darn long, and see what you can learn from it. ;-)

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