"Still, there’s often confusion about who is caring for the patient ... " Playing off of Jimmy the Greek's comment,…
Mr. H recently threw out a challenge: “Discuss: a physical line of people waiting for something indicates a failure of technology to meet a need.” I’ll certainly take the bait on this one.
I recently needed to do three transactions at my state’s motor vehicle agency. The first involved renewing my car’s annual registration, and it was very straightforward online. Typically when you do this in person, you have to show at least four paper documents. For online renewals, though, the system is hooked up with the motor vehicle inspection sites as well as the taxation agency, to make sure everything is current. For the mere price of a $3 convenience fee, I had it completed in less than five minutes. The sticker that I needed to apply to my plates arrived in the mail less than a week later, and the emotional labor to complete the entire process was zero.
Contrast that with the other two transactions, which had to be done in person. Due to the explosion of COVID in my state, the office only allows a handful of people in the building at the time. The last time I had to go there in person was in August, and at that time I waited nearly 45 minutes outside before being able to enter the building and wait in line some more. Although they had appointments during the height of the first COVID peak, they no longer offer it, despite our current peak being significantly higher than the original.
Enter the emotional labor component of the exercise. I had to look at my work schedule, figure out when I could take off during normal business hours, and marry that up with the weather forecast to try to avoid being outside in sub-zero temperatures or freezing rain. I also had to move a couple of meetings and checked three different websites to make sure I had the correct paperwork for both transactions, because having to come back would be exasperating. On the appointed day, I dug out my heavy boots and heavy coat and decided to give it a go.
Usually there are two lines, one for vehicle-related transactions and one for driver licenses and ID cards. Likely due to the online vehicle process, there was no line for those transactions. Once I made it into the building, I found the vehicle side of the office, where three agents sat waiting. Everyone who walked in was handled in real time. When the vehicle agents had nothing to do, they would start a “pre-check” process for the people waiting in the driver license line, making sure they had all their paperwork in order to try to keep the process from bogging down. Several people were turned away from the line, which was for a while the only thing that made it appear to move. The office has two workstations that can take pictures, but one was unstaffed.
Once you got to the licensing workstation, you had to present the little paper slip that you received from the pre-check station, and the worker would key in the particulars and collect payment. Then you had to do a vision test followed by multiple computer screens that you had to validate and sign before the photo was taken. Finally, the worker printed a temporary license, punched a “void” marker on your old license, and you were done. The worker then sanitized the station and called the next person over. There were multiple delays for things like people removing coats, fluffing hair, reapplying lipstick that was smeared by masks, etc. In the time that a single patron was taken care of, the pre-check worker had reviewed at least the documents of at least four people.
I got to go through the whole scenario twice since I had two different renewals and there was no sharing of data from one transaction to another. I had to write two paper checks to pay for them. (This is sounding a lot more like healthcare, isn’t it?) In one photo, I look great, and in the other, I look like I’m on a wanted poster, so it didn’t work out too well for me (although if the process was more streamlined, I might have looked like a suspect on both).
I’m a serious process improvement nerd, so I’ll offer a couple of potential solutions. These processes have the same challenges that we have in the healthcare space, including patient / client registration, managing wait times, identify verification, demographic verification, payment collections and processing, photo acquisition, history gathering, and more. What if there were people who had dedicated their careers to improving processes like these? It’s a good thing I’ve worked with a couple of people like that. When you start thinking about solutions to these problems, they’re not always novel. Some are low tech and others are high tech, but to eliminate all the defects in the process, you could use a combination of solutions.
Let’s take a shot at it, shall we? Assuming a low staffing situation, if workers were cross-trained, they could have used the second camera workstation. Since agents on the other side had capacity, if they were able to run the slow process, it could have doubled throughput. Or, they could have used the available agents to add some additional flair to the pre-check process, asking people to remove their coats, organize their belongings, pre-write their payment checks, etc. so they would be ready for the next step in the process. If they really wanted to get fancy, they could have had the trained person run both camera stations (they were literally next to each other) and used the excess staff to assist by sanitizing the stations in between rather than it becoming a bottleneck. That person could also have voided the licenses and handed out receipts after they printed. I feel like just telling people what to expect and encouraging them to get their ducks in a row before they approached the station would have helped a lot.
On the technology side, they could dust off their appointment system since it worked during the early stages of the pandemic. Second, they could have a simple texting system that would allow people to check in and wait in their cars until they received a message that they were third in line or something like that, and to come in. If they wanted to get fancy, the state could develop an online portal where registrants could pre-submit their paperwork and have it approved remotely, verify all the information they would normally verify on the screens, and receive a confirmation ticket that they could bring to the office, eliminating the majority of the process for a subset of customers willing to start the process online (except for the vision test and photo, that is). Or, they could have a separate photo kiosk where customers could do their own photo, or have it taken by a less-trained person, so that it was already in the system and the staffer would just have to marry it up with the appropriate demographics.
Alas, though, my state is one of the last in the union to adopt such cutting-edge technologies as Real ID, immunization registries, and prescription drug monitoring programs, so I have little hope. I’m definitely keeping my eye out for consulting postings on the state procurement agency website. I might be able to monetize what feels pretty obvious.
What are your thoughts on other processes where lines of people are a failure of technology to meet a need? Leave a comment or email me.
Email Dr. Jayne.