• Do You Need a Waiting Room? Why One Refractive Practice Eliminated Theirs

    At Durrie Vision in Overland Park, Kan., Daniel S. Durrie, MD, and his team have performed over 65,000 vision correction procedures. In a competitive market, their business is booming, and their patients couldn’t be happier. One part of their success comes from a surprising change: no waiting room.

    In this interview, Dr. Durrie explains how the wait-free experience works, how it affects patient care and how you can apply the same ideas to your own practice.

    AAOE: Why did you decide to eliminate waiting in your practice?

    Durrie Vision "Waiting” room
    Durrie Vision "Waiting” room - designed in a living room-style with minimal seating.

    It’s really just a part of our practice’s larger goal: Exceed the customer’s expectation at every touchpoint. What makes us different from other practices is that we are a patient referral–based, private-pay provider. We don’t accept private insurance or Medicare and our customers pay entirely out of pocket. Providing top-notch customer service is therefore paramount to having a successful business model.

    About 10 years ago, we started looking at the unmet needs of our patients. Traditionally, when you visit a doctor, you approach the front desk, receive a clipboard, sit down in the waiting room and remain there until someone calls you back to the exam room. You might wait 15 minutes or an hour before you actually see the physician. This begged the question, “Why is the physician’s time more valuable than the patient’s?”

    After thinking about how we could maximize our value to the customer, we came up with a new philosophy: “no clipboard, no wait.” To meet this goal, we made the waiting room unnecessary. We still have the space for it, but when Mrs. Jones arrives at 3 p.m. for her appointment, she’s met at the front desk by a technician and immediately taken back.

    AAOE: Once you had the idea, how did you go about putting it into practice?

    Our ophthalmologists and optometrists all knew a top-down approach wouldn’t work. So we gathered the staff and, as a group, asked ourselves, “What’s the best way to accomplish our goal?”

    The first thing we did was allow our patients to make appointments online and fill out paperwork at home before they get to the office. Then we had to dig a bit deeper and make sure our scheduling templates matched our patient flow. Yes, we were all going to be doing the same jobs, but how could we make sure that our technicians were able to meet the patient on time at the front desk? This is where time-management studies became very helpful.

    In our practice, seeing a new refractive surgery candidate involves four steps:

    1. Taking the patient’s history.
    2. Testing the patient.
    3. Seeing the surgeon.
    4. Counseling, if the patient elects for surgery.

    To prevent bottlenecks and have everyone ready for the next patient, we realized that each of these four steps had to take the same amount of time to perform. There was just no way we could achieve predictable patient flow if history lasted five minutes and testing lasted 25 minutes. So we keep each step at around 20 minutes. To accomplish this, we moved tasks from one step to another until we got the correct fit.

    Now with our plan in place, each technician knows exactly what patients they are responsible for any given day, whether it be the first or last patient that walks in the door. The tech knows their name and age and who to look for and then gets the patient through the first three steps. The tech is then back out in the front desk ready to rotate to the next patient.

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    AAOE: Was there any pushback from staff?

    No, everybody was excited about it. Our schedules are now very well defined. Some of our technicians can arrive later than they normally would because their first patient may not arrive until 8 a.m., and some are able to leave well before the practice closes for the day.

    And again, there was no top-down approach to this. The staff really pulled it off themselves because the physicians weren’t the ones greeting patients at the front desk. And they continue to play a huge role even after the rollout. For example, they perform time-management studies as part of our ongoing audit process. A staff member will watch the patient flow, look for bottlenecks and propose any corrections. This has really helped us adjust when patients show up early or late and in those instances when we have a snow day or a technician calls in sick.

    In the end, our process works because our staff are happy, self-responsible and capable of making their own adjustments in order to meet our overall goals. There’s an old business adage: “Culture eats strategy for lunch.” In other words, people need to buy into a culture before you can implement a strategy. And our entire team buys into our culture. We have very little turnover as a result.

    AAOE: How do your patients react to a wait-free appointment?

    The usual responses are, “I’ve never been to an office that doesn’t make me wait!” and “Nobody has ever appreciated my time this much!” So they certainly enjoy it!

    Our numbers prove it. Many refractive surgery practices have dwindling patient volume compared with the industry’s peak a few years back. But ours is up, and it continues to grow. This is due to our customer service–oriented approach. Yes, we’re a private-payer practice and we have higher prices than a lot of the competition, but we justify our value by the quality of our work and by respecting our patients’ time. We see up to 200 patients a week and try to make every one of them feel special.

    And since a lot of our business is patient-referral based, we want to make their experience something to talk about, something they will share with their friends in the community. According to our most recent satisfaction surveys, 100 percent of our patients are “likely” or “very likely” to refer a friend or relative. That type of response is unheard of in most practices.

    AAOE: Do you know of any other ophthalmology practices that are going “wait free”?

    Not at the moment, but there’s a lot of interest in what we’re doing. We have quite a few office managers and physicians from other refractive practices come in every two to three weeks to check us out and follow a patient through our process so they can see for themselves what the experience is like. In turn, we share a lot of ideas with our colleagues in other subspecialties as well, because the things we’re doing can be applied to so many other practices.

    AAOE: Are there any other innovations on the horizon?

    We’re moving into a new office this May — and there will be no waiting room at all. So as you can see, we’re heavily invested in this idea! We’ll have the same computer system, the same patient flow, the same surgery procedures. We’re just going to have a space built specifically for the most important aspect of our practice — our customers.