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Thursday, April 3, 2014

Are you providing a service? Or executing a process?

I'm in India this week.  Before I came I needed to get a couple of immunizations, so I called my Doctor's office and spoke with the receptionist, who told me they'd have to get with someone and have them get back to me.  Given that I had to make these travel plans pretty quickly, I was already quite late in the process, and I let her know I was leaving in 5 days.

The next day, after I didn't hear back and getting concerned, I called back.  Someone in nursing should call you today I was told.  Later (after 5pm), when I didn't hear back, I got frustrated and called one of the Urgent Care centers associated with my physician's office.  I got no help there, they couldn't even tell me if my immunizations were up to date, even though they had access to my records.  HIPAA was the argument. Having already had a conversation up the Privacy Officer chain with this organization, I knew that I was pretty stuck.  So when I went to my pharmacy later to pick up my medications, I spoke with the pharmacist.  Unfortunately in Massachusetts, the immunizations I needed required a prescription, and they couldn't help me, but, she said, try calling My Local Hospital's Travel Clinic.  I did later (note that this is now after 5:30pm), spoke with scheduling, and while they couldn't schedule me yet, they transferred me to the voice mail of someone who could help.  I got a call the next morning, and while I wasn't following the usual process, the NP assured me she would fit me in, and told me to speak with scheduling and tell them I had talked to her, and told me what to tell them so they would be able fit me in.  That call took less than 3 minutes.

Later that morning, after I had spoken to her and scheduling, the travel nurse associated with my primary called me back.  She apparently hadn't been able to get to the CDC site she usually used the day after I had called, but now that she could ... and I interrupted her and explained that I had already scheduled an appointment elsewhere, and we pretty much finished the conversation.

Needless to say I got what I needed done, but not because she provided the service I had needed.

Instead, two other people retained my business because they provided the service I needed, rather than following the process established to provide it.

You see, the first nurse couldn't do her job because she was limited to a defined process, and couldn't exceed it, either by policy or simply not understanding what else she could do.  I had already googled CDC India Immunization and found the information from the CDC I needed, but she was apparently using a different site that was down for a day.  The CDC has multiple sites sourcing information on travel an immunizations, and I could readily find what I needed there.  She couldn't even be bothered to tell me why there was a delay.

My pharmacist couldn't do what I asked her to, but she provided a needed service by telling me where I could go.  The NP couldn't follow the usual process for me, but she too provided a needed service by figuring out how she could work me through existing processes she needed to follow.

This sort of thing happens all the time in any business.  I go to one hardware store, and they report to me that they don't have the part I'm looking for.  At another, the clerk tells me that while they don't have that part, I could use this other one, and it would work even better.  And so my plumbing problem was solved, and now when I need hardware, I go to that other store first.

It should be obvious that what you do in healthcare, and what I do in healthcare IT is provide a service, and that we shouldn't let our processes get in the way of doing that.  Processes are supposed to make it easy to provide service.  When they start getting in the way, you need to revise, adapt or change them, or realize that another process might be more appropriate to apply.

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