Eighteen Seconds
That’s the time
Jerome Groopman, M.D., says it takes most doctors to make a diagnosis.[1]
Observing the
patient’s color, breathing, body language, posture, attitude, and
quickly looking over the medical record, the doctor is ready to test his
hypothesis before even a word is spoken.
But there is more
to the story.
Thirty years ago,
Bernadine Feldman submitted a Ph.D. thesis on nineteen doctors’ practice
patterns. Here is what she found:
1.
Time spent with patients in patient care 69.4%
2.
Time spent on diagnosis:
a. History taking 6.60%
b. Physical assessment 32.64
c. Specimen collection .53
d.
Diagnostic procedures 2.41
e.
Working diagnosis/problem list 2.71
44.89%[2],[3]
So, if the time
spent with patients is 69.4%, 64.68% (44.89 ÷ 69.4 x 100) of that time
was spent on reaching a diagnosis. Coming up with the right diagnosis
may be a life or death matter. However, Dr. Groopman quotes other
studies that show 15% of the initial diagnoses are wrong. Perhaps even
more time is needed.
Doctors love to be
with patients! Before Dr. Feldman’s study was begun, the physicians
estimated that they spent 53.7% of their time with patients. They were
surprised to find that they spent 69.4% — we underestimate the time we
spend in enjoyable pursuits.
Doctors hate to be
on the telephone — they thought they spent 8.8% of the workday on the
phone, but they actually only spent 4.8%. We overestimate the time we
spend on activities we don’t like.
When the doctors
received feedback from the study, they increased the amount of time they
spent on house calls or rounds, time spent on planning, time spent on
reading or studying, and the time they spent with colleagues and staff:
All enjoyable pursuits. They reduced their waiting time, and some of
the one-to-one time (not much, just 4%).
The study verified
an old finding we had made years earlier: Improving productivity
increases satisfaction and decreases negative stress. Most of people’s
stress and dissatisfaction at work come from engaging in non-productive
behavior.
I know some people
who can beat the “eighteen seconds to diagnosis” time. They diagnose
the patient even before they see him.
The diagnosis of
the organization-as-patient is usually one of a malady that carries with
it a plan for treatment that contains the word “lean”: Like “lean”
manufacturing, “lean” six sigma, or “lean” production.
In the case where
the organization-as-patient is fat, maybe the diagnosis does little
harm. But in case the cause of the disease lies outside the company,
maybe we should look further. Here is the steep price paid by some that
did not look beyond the company walls:
·
Sony Walkman, meet iPod!
·
Kodak, meet digital
cameras!
·
Any bookstore, meet
Amazon.com!
·
Any coffee shop, meet
Starbucks!
·
Ford, GM, Chrysler — meet
Toyota!
·
Toyota, keep an eye on BMW
— and Honda . . . |
|
“Lean”
may buy you some time if it allows you to reduce price on a
product that is in the process of being commoditized. But
then you will have lost your brand advantage! Making
something that is cheaper is not enough — it must also be
better and, preferably, unique: Something no one else can
make. Then you will have regained your brand advantage.
More
importantly, you may have lost some good people in becoming
lean. Union rules often dictate those that will be let go.
It will be the young — the eager and the energetic — those
raised with computers, and games, and spreadsheets. Those
who will slide right into the knowledge economy of the
future may be the first to be let go.
Your
workforce is your biggest asset. If you can
do what you now do at one-third the cost, the two-thirds of
the resources you will be freeing should be mobilized to
find better and higher uses: More innovation, more customer
orientation, and more and better services. The worker with
thirty years of experience carries with him, on average,
187% more experiential value at work than he did when he
started (two percent improvement in performance per year).
When he leaves, his experience and deep knowledge will walk
out the door with him. Instead of letting it walk out the
door, put it to work on the future — now!
Medical
doctors, meet
“company doctors.” Should the company doctors spend nearly
two-thirds of their time on what might be wrong with the
“patient?”
Yes!
For sure!
Today,
global human life expectancy averages sixty-six years. The
average life expectancy of a company is forty-four years, if
listed on a stock exchange. It is twenty-two years if
privately held. Corporate diseases, then, are far more
deadly than are human diseases. My guess is that medical
doctors are better at diagnosis and treatment than company
doctors are.
In our
consulting practice at Tor Dahl & Associates, we spend more
than half of our time and resources on diagnosis — the rest
on implementation.
By the
time of implementation (“treatment”), everyone knows exactly
what the problems are, their causes, where we should all be
heading, and when we’ll get there. And I do mean everyone.
And
everyone has a role to play.
When
doctors hear hooves in the distance, they will not be
looking for zebras. They will be looking, though, and if a
zebra arrives, they will be ready. The rheumatic fever may
be lupus. The back pain may be cancer. The price of error
can be very high. That’s why medical doctors don’t skimp on
the time it takes to make correct diagnoses.
Neither should company doctors.
[1] Groopman, Jerome, M.D. How
Doctors Think. Houghton-Mifflin Company. March
19, 2007.
[2] Feldman, Bernadine, Ph.D.
The Measurement of Rural Physicians Time–Task
Allocation and Explanation of Planned Change.
University of Minnesota. 1977.
[3] Dr. Feldman used Extensor
instrumentation to randomly sample the behaviors,
attitudes and judgments of nineteen physicians in
central Minnesota. It was these instruments that
Peter Drucker characterized as being to the field of
management what the telescope had become to the
field of astronomy. The wider use of this
technology revealed how human performance could be
improved dramatically and quickly. We have had the
privilege of working with this technology in the
past, and we have built upon the foundation of
insights that produced 5 PhD dissertations and
dozens of case studies.
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