Notes on registration:

Blame it on the availability heuristic, but I feel like every conversation I’ve had in the last 24 hours has been about registration and waiting. You won’t be surprised to learn, I have feelings and opinions about this.

It started with last night’s #PXchat where we chatted about waiting rooms. Think about that term waiting rooms.

Waiting is a basic fundamental of today’s healthcare environment. We generally accept it as a given, at some, probably many, points in a healthcare visit we will wait. We’ll sit and look at our shoes, or phone, or a three month old copy of Road and Track.

Why do we have to wait? It’s rhetorical, I know why we wait. But maybe we really should ask: should we have waits? Starbucks is one of my favorite service industry examples —they use just-in-time fulfillment. We rarely wait more than a minute or two for our triple mocha frappa half caf soy Americanos.

Don’t do it. I know you are reaching for your skeptical hat. But healthcare isn’t a coffee shop, Nick… Don’t put the hat on. Don’t say those words. Just think for a minute, what if there were no waits? Woah!

Then, today a lunch, I had an inspiring chat with a colleague about identity and mindset. She shared an experiment she participated in during graduate school. Would people be more or less confident if they were made conscious of their ethnic identity?

Think about the thing we do after we wait. We go give a complete stranger a list of the little buckets we fit into, parts of our identity. We willfully give up: * Age * Gender * Home address * Ethnic background * Even some socioeconomic info

By sitting, uncomfortably, across from someone and sharing these things, we are also reminded of them. At least subconsciously, they are now at the top of our minds. Do we bring them as badges or baggage into the visit with the doctor? What impact, does that identity recall have?

I’m willing to bet, at least the initial act of registration puts us in a bit of a subservient mindset.

We don’t, in my experience, have the same feelings about hotel check in. Is that because we fill out most of our identifying information online, prior to arrival? (That one isn’t rhetorical - really, is that why?)

This afternoon, I had the chance to visit a really cool space. You know those kinds of places you see in movies or commercials and you think but no one really gets to work in places like that… Well these people do. Think modular walls, mixed soft and hard surfaces, smart screens, cool chairs and funky colors. Cool stuff!

This is what I saw when I walked in Welcome, me

Hello ego!

But it’s actually a lot neater than an ego play. Their welcome area is designed around the psychology of greating the person coming into the space for the first time. It’s insanely welcoming to see yourself on a screen. The entry area is also perched a few steps higher than the work space. So you enter with a commanding view which, in turn, puts you in the position of power, rather than feeling swallowed by a new space. You can surveil everything.

Why not have personalized welcome screens?

It’s as if a million risk manager voices just cried out at once. Stick with me.

If a doctor’s office knows you, really knows you, they’ll know your interests. Surely there’s some field in most current EMRs which would allow someone to capture that I’m into skiing. So when it’s time for my appointment, why not cycle up a clip from a Warren Miller ski film? It would be intermixed with a shot of wild flowers, representing some other patient’s passion. Neither visual gives away our personal information or identity. But both visuals would make us feel personally cared for and welcomed.

Just some notes on registration….

What do you think - what glaring opportunities for improvement do you see? What things should we be thinking about from the staff perspective to improve their work experience?