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

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