Category Archives: waiting rooms

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Time for contemplation

coal-hole-2

Jeanette Winterson, in her fantastic memoir Why Be Happy When You Could Be Normal, writes:

“The one good thing about being shut in a coal hole is that it prompts reflection.”

She goes on to meditate on life, happiness and normalcy; results of the reflection that occurred during the many hours she was locked in the coal hole by her mother.

Now I don’t mean to suggest that a hospital waiting room is like a coal hole, but there is a similarity of ‘in-betweenness’ in the situations. In both cases, the job we have is to wait for the next phase, whether it be freedom from the coal hole or the opportunity to go in to an appointment. How we use that time is up to us, of course.

The waiting room does have more distractions than the coal hole, which is why, perhaps, Jeanette’s in-between time was more productive and profound than mine generally is. I have returned to my old ways of reading, writing and checking email in the time before I am called in. I have lost some of my capacity to just sit and ‘be’ during this time.

I would like to reactivate that part of me that knows how to wait. That will be my goal for tomorrow’s visit. Who knows what deep thoughts might appear. I’ll keep you posted.

Sam

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Tuesdays from the chemo unit, Tuesday, May 29, 2012

I know I’ve been slacking on Tuesdays since I discovered the nirvana of waiting, but there were two moving events for me in the waiting room this past Tuesday that I wanted to share.

One involved the ringing of the bell. I’ve mentioned before the bell at the chemo unit. When someone is finished their last treatment, they are encouraged to ring the bell. (I have looked longingly at that bell I must admit.) Today there was a man about my age who posed for pictures while ringing the bell. Upon walking out of the unit, him and his family all stopped and cried with happiness and hugged each other over and over again. It was such a moment of joy, optimism and accomplishment. I felt like a bit of an intruder, but also felt happy to be witnessing this celebration.

A little while later a nurse came out to speak to the woman who had been sitting waiting near me. I thought she, too, was waiting for her treatment and we both were in our own worlds. When the nurse sat down with her she said “You’re Mr. Brown’s mother? We just finished giving him his treatment and he started to shake and now has a fever. We need to send him up for blood work and it looks like we’ll need to keep him overnight.”

The mother just looked crushed. Again, I felt like an intruder into a very private moment, but I couldn’t move. The nurse was extremely kind and tried very hard to make it easier for the mother. But the man looked very young on the gurney as he passed me by and I just felt the mother’s heart ache.

This is the waiting room at the chemo unit. I bounce in every week for my treatment pretty happy most of the time, confident that this treatment is keeping me healthy and stable. But for many people, being at the chemo unit is an intense experience, full of anxiety and then, potentially, more positive feelings when the intensity is over. I’m just an observer, but I feel as if I have a window into some deep humanity by witnessing the experience of others.

It’s definitely more than just a waiting room.

 

Sam

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Tuesdays at the Chemo Unit, Tuesday, May 8, 2012

Today I began my “waiting project” with great earnestness. But perhaps I was trying too hard . I was antsy and fidgety. There also seemed to be more traffic crossing in front of me and I felt self-conscious  sitting there cross-legged on the floor with my shoes off.

A person without purpose is suspect. I even read in one blog about “those people who “just sit there” while they are waiting”. I decided to hold my notebook and pen as a “cover”. Not everyone can understand the enlightenment of waiting.

One nurse worried over me, believing that I had not been able to find a chair. Some people smiled, others just stared. One woman looked quite pointedly at my abandoned shoes as she walked by.

So the magic wasn’t there today in the waiting area. However my blood pressure was still low and I lucked out for my treatment. Today my nurse was Manny, one of the nurses about whom I have waxed eloquent before.

One of the best parts of getting Manny is that we talk about food the whole time. I asked him what he was cooking and he described the incredible shiitake/leek risotto that he made the other night. He gave me all the details (4 cups raw risotto to one box of chicken stock – he uses Campbells). He gave me some directions:

“you have to stir it for 20 minutes… not just stir, you have to be with it, you have to  love it”.

He told me about the incredible fish he ate while on vacation in Hawaii. We drooled together over the picture on his phone of the thinly sliced sashimi that he had at one of the fanciest restaurants in Maui.

Before I knew it, the treatment was over and I felt as if I had been visiting with an old friend. I came away happy and hungry. A good day.

 

Sam

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Princess Margaret Vignette #3

After all of my belly aching, Princess Margaret has finally done it: a waiting room supreme at the new outpatient chemo unit ! I wrote this entry in the unit and hoped that they would not call me in too soon because I was enjoying myself so much.

Imagine walking into a reception area with three, count them three people all waiting to attend on you. Once you have checked in, you are given a beeper, that apparently actually works anywhere in the hospital. If you choose to hang around, however, there are three different waiting areas, plus a renovated mezzanine looking out over the indoor courtyard.

One of the three rooms is a conventional type waiting room with comfy chairs, an electric fireplace and a tv that can only be seen from part of the room.

A second room  looks like a little cafe with different kinds of tables, a water machine (not coffee, but still not bad), an electric fireplace and a shelf with reading material.

The third room has a computer for patients to use as well as three other work stations if you have brought your own. I write this from one of the work stations.

The whole thing almost feels like a Starbucks – much friendlier and practical than any other waiting room I visit in Toronto. There was definitely some creative and thoughtful design involved here. Kudos to Princess Margaret!

Except……a wonderful waiting room can only help for so long when the wait goes on………………..and on…………………….and on…………

Sam

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The psychology of waiting in line

The other day I had to visit the pharmacy at my hospital. A few years back they did renovations in order to serve me better. (That’s what the sign said, “We are doing renovations to serve you better”.  I assumed they meant me ).  Because it has been a while since I have used the pharmacy, I have forgotten what a black hole it is.

The people who work there all seem very nice, but there are long lines of people waiting to pay, many tired-looking people with numbers in hand waiting for the chance to drop off their prescriptions and another group waiting for their prescriptions to be filled.  You can almost see the spider webs gathering on the people in the waiting room.

There seems to be a problem with flow.  I would be bold enough to say that while the pharmacy looks a little bit prettier (as pharmacies go) their renovations did nothing to improve service and, thus, I don’t feel that I am being served any better.   Maybe the sign should have said “We are doing these renovations, so you will have the illusion that we are serving you better. “

As you can see from this and other posts I have a thing about waiting rooms and wait times and efficiency.  As a long-term patient, I must spend hundreds of hours a year just waiting.  When you spend hundreds of hours a year waiting, you notice little things like efficiency and effectiveness.  I don’t think that the solutions are about more money in the system, but rather about innovation and creativity. Hmm. Creativity…

I decided to do a little bit of searching for innovative approaches to reducing wait times in hospitals and the links at the bottom provide some case studies. Then I hit jackpot. I discovered there is a whole theory about waiting: Queuing Theory. There is actually a body of knowledge that looks at the psychology of waiting in line. Perhaps this is meant to be my chosen profession!

It seems there are six basic principles to the psychology of queuing. They don’t necessarily improve actual wait times, but can improve people’s perceptions of their wait time. Let’s see how we could use these to help the pharmacy:

1. Unoccupied time feels longer than occupied time:

“As William James, the noted philosopher observed: ‘Boredom results from being attentive to the passage of time itself.’…. Any activity provided by the service provider to ‘fill time’ should (a) offer benefit in and of itself, and (b) be related, in some way, to the following service encounter.” [1]

At our pharmacy there could be computers set up where you could type in all of your drugs and supplements to see about potential interactions, there could be educational brochures about types of drugs, there could be a “counsellor” who walks around answering questions ahead of time, thus saving time when people actually get to see the pharmacist.

2. People want to get started:

“People waiting to make their first human contact with a service provider are more impatient than those who have had some contact and some idea that they are getting started.” [2]

At our pharmacy, the first thing you meet is a machine that spews out a number. Then you have to wait for a loooong time to be called to even drop off your prescription. At the blood lab on the other side of the room, a volunteer hands out the numbers. She’s usually a grumpy volunteer, but at least she’s human and you have some sense that you have been processed. It seems simple enough to have a “greeter” who could hand out numbers and explain the process to people.

3. Anxiety makes waits seem longer:

Anything that makes people feel anxious that they may not be served or served in time adds to the perception of waiting.

At our pharmacy, you have people needing to get to doctor’s appointments, appointments for clinic or simply catch a train home. I think the answer to this is in the next point.

4. Uncertain waits seem longer than known, finite waits.

At our pharmacy, they could have an electronic average wait time to drop off a prescription and one to pick up a filled prescription at any given time of the day. Then perhaps they could have a map to nearby alternative pharmacies for those patients that do not need to have their prescriptions filled at the hospital itself. Some people could decide not to stay and others would at least know what they are facing. Perhaps they might choose to come back later in the day and see if the wait time is reduced. Across the street at Toronto General I almost never have to wait behind more than one person to get my prescriptions.  Why isn’t my hospital sending patients over there to get their prescriptions filled?

5. Unfair waits seem longer than known, finite waits.

People can become incredibly unhappy when they feel that someone is jumping the queue.

One day at the pharmacy I saw an elderly man who did not understand the process of taking a number. He kept waiting and seeing people cut in front of him to drop off their prescriptions because their number was called. He was practically apoplectic with frustration. Having a greeter to give out numbers would make the system much more transparent and clear to all.

6. The more valuable the service the longer the customer is willing to wait. 

This theory is what has led to express check-out lines in supermarkets. Those with just a few items are less willing to wait than those with a full cart.

Perhaps there could be some kind of express line for straightforward renewals and over the counter purchases. The new prescriptions and those requiring more patient/pharmacist time could be in the other line.

7. Solo waits feel longer than group waits:

“Whatever service organizations can do to promote the sense of group waiting rather than isolating each individual, will tend to increase the tolerance for waiting time” [3]

Any ideas for this one?

I took the information and all quotes about queuing theory from this article by David Maister, but there are many good articles out there.

Here are those links to some specific examples of innovative approaches to health care. Any other ideas or examples out there in the blogosphere?

http://www.shmula.com/staring-at-acoustic-ceiling-tiles/1717/

http://www.shmula.com/emergency-room-er-wait-times/1696/

http://www.chsrf.ca/SearchResultsNews/09-08-01/f501e73a-f901-4635-9bae-c62946253a98.aspx

http://www.leanadvisors.com/kila-resources/lean_healthcare_lab_processes/

http://www.leanadvisors.com/kila-resources/lean_healthcare_private_practice/

http://www.hospitalnews.com/oslers-innovative-approach-to-reducing-ed-wait-times/

http://www.chsrf.ca/PublicationsAndResources/PassItOn/ArticleView/10-02-01/423dea34-d2a9-431b-bc4c-567c72917e60.aspx

http://www.tsh.to/pages/Paedlink-eases-Emergency-waits

Sam