In the summer of 1960, I had my first job as a dishwasher at a local college during summer school. I was paid an hourly minimum wage. My assignment was scrubbing and cleaning pots and pans. Since this was my first paid job, I was eager to demonstrate my energy and enthusiasm. I was able to complete my dishwashing assignment in 2 hours and sat down and looked at a magazine. (There were no cell phones at that time!) The kitchen manager asked, “What are you doing?” I told him I finished my job. The manager then told me to polish the silverware. I completed that task very quickly and he then sent me home. I was only able to be paid for working 3 hours. I did not need to be a time-and-motion expert to understand that I had to work slower to increase the hours worked and increase my income.

So, what does this have to do with the practice of medicine?

The working hours in my practice were 8 a.m. to 5 p.m., and the staff always stayed until 5 p.m. even if they were done with their workload before QT (ie quittin’ time). One of the problems we had was controlling the 3 to 5 no-shows that might occur each day. We had the receptionist call patients at home 24 hours before their appointment to remind them of their appointment. We also took the names of patients who wanted earlier appointments if slots became available. These were patients who were willing to come in on short notice.

On several occasions, there were open slots in the schedule, and I asked if patients who were willing to come in on short notice were contacted. The answer was almost always that the waiting list was not used and yet the staff was doing unproductive work waiting for 5 o’clock. Reflecting back on my days as a dishwasher, I told the staff if they were able to fill the no-show slots making use of the waiting list, and the work was completed, they would be permitted to leave before 5 p.m. Voilà, all the holes in the schedule were filled and the no-show problem was solved.

Another practice was having issues putting patients in the rooms at 9:00 a.m. to start the clinic schedule. The doctors blamed the staff for not moving the patients into the rooms at 9:00 a.m., and the staff blamed the doctor for arriving after 9:00. The office manager, the nurses and the doctors had a meeting, and they all agreed that patients would be advised to arrive at 8:30–8:45 a.m., and the doctor would also arrive at 8:45 a.m., and now the schedule commenced at 9:00 a.m. and was kept on track for most of the day.

Recently, several companies are offering 4-day work weeks because they noted a decrease in productivity on Fridays, especially Friday afternoons. Microsoft in China offered a 4-day work week and noted that productivity increased by 40%. Perhaps this could apply to medical practices. How? The staff could work 10-hour days for 4 days a week. Friday would be used for surgery–especially Friday morning–and if the urologist finished early, he or she could also go home early and spend time with the family and be home for dinner.

Bottom Line: We should reward staff for being efficient. Making the staff stay when all the patients have been seen and all the tasks have been completed is going to motivate the staff to behave like the teenage dishwasher and work slower to increase the hours worked.