WSJ: Waiting in Line

Here is a WSJ article on the science of waiting in line.  Its from back in December of last year, but I just saw it today and though I'd like to capture it.  I think the visual from the article does a great job describing several issues around the psychology of waiting:



and to go along with my recent foray into finding old Sesame Street Clips that might have something to do with a service concept, here is a video about a frog who is confused about where he stands in line:

And in other news: McDonald's is taking over the world (or at least the news)

From Fast Company: McDonald's experience design of the future:

The next phase, McDonald's execs say, depends on design. "People eat with their eyes first," says president and COO Don Thompson. "If you have a restaurant that is appealing, contemporary, and relevant both from the street and interior, the food tastes better.

As the younger generation starts to see McDonald's as a place you go to eat instead of just picking up food, you could very well change their behavior for years to come," says Darren Tristano of restaurant consultancy Technomic. "The next step," he says, "is to draw people in for a dining experience."

As previously discussed about Starbucks:

"How do you increase service speed and efficiency and optimize the customer experience at the same time?"

Line of interaction

"If Martians came to Earth and visited a McDonald's, a post office, and a bank, they wouldn't be able to tell the difference. They would just see that everything starts with a line, has a counter that acts as a divider where the money exchanges, and has something hidden going on way in the back."

On technology innovations (self service):

 A few minutes later, the mother and son try a prototype of a self-ordering kiosk. "Oh, you already know what you are ordering," Karen exclaims, when Joey starts interacting with it like a video game.  "The mom and son shared a moment while looking over that menu," he says. "And the kid obviously felt empowered by the kiosk. It gives customers more control and makes it easier to make decisions. Those are the directions we might want to explore."

On integrating design into operations:

""We don't design in a vacuum here. If an idea doesn't come alive in the restaurant, it doesn't work. Once you can see it," Weil says, "you can show it to an operations person and they can see the differences and they usually get it." And if they don't? "Repeat often," he says. "This is the only way to line up what we are doing with our business needs."

On experience design (old post on oatmeal here):

Weil has restored some live entertainment value by positioning McCafé barista stands next to the registers. Customers can view their drinks made with traditional espresso machines that pull fresh shots and steamed milk on demand -- just the way Starbucks used to do before it got too big. At breakfast, employees must stir a cup of oatmeal a minimum of 12 times before serving it to the customer, both to mix the ingredients properly and to signal homemade goodness.

On queuing or wait perception:

Weil and his team have a patent pending on a design that adds an additional window for people with enormous orders. The drive-through of the renovated Kearney store, a rural outpost just past Kansas City's suburbs, features two lanes of cars lined up at two different ordering kiosks. This rejiggered drive-through isn't going to find its way into MoMA, but functionally, it's genius: It consolidates the traffic around the restaurant so everything appears much less gridlocked.

And finally, on sequence:

Rather than the usual swinging gate in front of the trash bin, this one is open faced with a slimmer, oval-shaped slot that still seems to shield customers from an unpleasant view or smell. He leans over and slides his trash off the tray and into the receptacle. This is the last step in the customer experience. "It always took two hands to operate," he says, one to hold the gate open and one to fumble with the tray. "I wanted it to be quick and easy, to leave the customer with a good impression as they leave."

In other news, from CNN: Weddings at McDonald's or "Can you hear the fry bells ringing? Would you like an apple pie-cake with that?"  

The package has all the details to attract a wedding banquet cynic or a Golden Arches obsessive: a baked apple pie wedding cake, dress made out of party balloons, kiddie party favors for guests, and of course, catering by McDonald’s.

In still other news, McDonald's is the winner in the Cornell Hospitality Research in Practice Award competition

McDonald's has evolved its menu many times over the years, basing their modifications on customers' preferences and tastes. Their strategic plan to enter the beverage market space was no exception. Since the coffee market space was already crowded, McDonald's developed its McCafé Beverage Program by methodically testing all products in three different ways. Every product had to pass customer taste tests, operations testing, and market analysis. 

And some older McDonald's related links:

Photo of isolated seating in Japan

Smooth supply chain Smoothie roll out

hat tip: Tyler Cowen 

Posted E.R. wait times: MountainStar Health Care

I just returned from a trip to my home state of Utah and I noticed these new billboards from a health care company MountainStar HealthCare.  I stopped and took a picture of one:

According to their website, the numbers on the left of each of the billboard is the wait time as defined by:

... the time it takes to see a qualified medical professional, defined as a Doctor of Medicine (MD), Doctor of Osteopathy (DO), Physician Assistant (PA) or Advanced Registered Nurse Practitioner (ARNP). 

ER wait times represent a four-hour rolling average updated every 30 minutes, and is defined as the time of patient arrival until the time the patient is greeted by a qualified medical professional. Patients are triaged at arrival and are then seen by a qualified medical professional in priority order based on their presenting complaint and reason for visit.

National average wait time is one hour, according to the Centers for Disease Control and Prevention (CDC). HCA hospitals strive to beat the national average.

I found these billboards pretty interesting because just a week before we had dinner with a friend and her family in Montreal and we discussed that the typical ER wait in Canada was several (7 or 8) hours long.  They saw a similar sign during a recent trip to Florida and were impressed with short wait time in the US.

I think the fact that the hospitals have seemed to be able to really focus on shortening wait time is great, but except for impressing Canadians, I'm a bit uncertain about why they have spent so much money to display the stats on a billboard. Is there really a lot of choosing going on as you decide which ER to go to?  If you have a life or limb threatening illness or injury, do you first ask yourself "hmmm, now which hospital will probably have a shorter wait time"?  Or do you just go to the closest one?  They also post the wait time online here and have an iPhone app to check wait times here - do they expect people to check these as they travel to the ER? 

MountainStar is competing in a market dominated by Inter-Mountain Health Care (IHC) one of the largest health care providers in the country, and so they have a TV campaign with the premise that "bigger is not always better" directly attacking IHC's size. The ER wait time billboard campaign seems to be using their operational capabilities as a marketing ploy (which I think is pretty cool), but I wonder if the low wait times due to excess capacity or low demand as opposed to just smart patient processing.  The fact that they are calling out IHC and trying to actively compete for patients makes me think that they have more of a capacity / demand problem then a unique operational capability (maybe I'm wrong).

If the campaigns are successful and the hospitals start to see more ER patients, will the wait time remain low? If not, will the billboards stay up? Also, a statistic is less impressive in isolation, i.e. I want a billboard that shows the current size of the queue, the percentage of occupied beds, the ratio of patients to doctors, the average number patients per hour, the standard deviation of the wait times, etc.I also want to know what the nearest competitor is doing on the the same metrics for comparison.  But, alas, I am never happy and I am a nerd.

What do you think of the ER wait time billboards?

The good old days

I found this interesting and a bit sad that is can't still happen today.

I want to go fast!!!

Is it about speed of just fun? Can you assume that better customer experience comes because your process is faster or can you just make your experience more enjoyable?  Maybe you could do both?

Technology to improve service - Cleveland Clinic Edition

 
Cleveland Clinic has been well known for some time as progressive in terms of customer experience, something that sets them apart from many health care providers. Recently I ran into this video clip (you may have to watch a short advisement before you get to the actual report):




 
I particularly like the pitch into the segment where the reported says that a visit to the hospital can be "an intimidating place when you're sick and you're scared." At first blush, it is not clear why a patient tracking system could put someone at ease during a hospital stay. However, I see 2 things that the GPS system can do to improve service delivery:

 

1. It tracks how long a customer has been waiting in specific rooms.
   
   With this data, the hospital can improve scheduling and staffing in order to reduce the wait time. Not all wait times are created equal , and often the most annoying are those waiting around in a cold, sterile room in a hospital gown waiting for the doctor to arrive. This system will give the administrators a better idea of what the true capacity is under different levels of staffing.
   
   
   
   
2. It indicates which rooms could be filled or need attention.
   
   In many businesses, the constraint is often the physical space need to perform the service. For example, restaurants are interested in table turns per night, and hotels are interested in occupancy percentage. With this new data, the hospital will be able to track occupancy to a degree never before realized. If the process constraint becomes the examination rooms, they can put efforts into turning rooms more quickly in order to see more patients.
   
   

 
These two points should lead to a reduced wait time for patients. Still, I'm unsure how that can reduce my anxiety. Perhaps there could also be some psychological benefit of knowing that the hospital is tracking where I am and I won't be forgotten about.


 
Can you see any other benefits to the GPS tracking system?


 
This is probably a large investment to have this "airport control tower"; does the value justify the cost? I wonder how they track an improvement in patient satisfaction or patient thru put to justify its costs.


 

 

 

You can have my blood, but please don’t take my time

Recently I was contacted by a volunteer from the American Red Cross and asked to sign up to donate blood during a blood drive on campus. I have donated blood several times during my life and have never had a reason to turn down such requests, so I signed up for a 1:30 pm appointment on a Monday. I arrived at 1:30 pm sharp and started the process of the donation. Their website recognizes the 4 step process to donation:

  1. Registration: read about the donation process and eligibility requirement.
  2. Health History and Mini Physical: personal health history questions, temperature, blood pressure, etc.
  3. Donation: Approximately 1 pint of blood is drawn from your arm
  4. Refreshments: Spend a few minutes eating sweets and drinking fluids

Again, from their website: “The donation process, from the time you arrive until the time you leave takes about an hour. The donation itself takes about ten minutes.” From a purely process management standpoint, this statement might raise an eyebrow. If it only takes 10 minutes to draw the blood, why do donors have to spend an hour to donate? The other three process steps surely don’t take 50 minutes. Answer: there is a lot of waiting done by the donors. In my case the process took nearly two hours while the donation itself took about three minutes.

I had lot of time thinking about their process and had a hard time not seeing potential process improvements during my long wait
.

Reservation/Appointment Management: As I arrived, there were about 8 donors in front of me in the registration area. It appeared that there were two separate appointment books: one from the phone calls made by a regional headquarters and one from the local blood drive supporters. My guess is that they did not synchronize the two appointment books and overbooked. In addition, they were taking walk-ins and everyone was served on a first come first serve basis; reservations did not get any priority over walk-ins.

Bottleneck and Capacity Management: With a quick glance to the donation process area, I saw six beds. If the actual donation time takes an average of ten minutes, then the capacity of the donation process is 6 beds * 60 minutes in an hour divided by 10 minutes per donation = 36 donations per hour assuming the area is properly staffed. The health history/ mini physical area also has enough space for 6 donors being service at one time and a 10 minutes average time for this process is probably reasonable. However, there was only 1 dedicated employee in this area restricting the capacity down to 6 donations per hour.

Labor Scheduling & Capacity Planning: At 1:30 employees were coming and going taking lunch breaks. I suspect that the reason there was only 1 staff member working the health history / mini physical step was because someone was on break. Labor scheduling is essentially matching system capacity with expected demand. In the case of a blood drive, the expected demand could be managed by allowing for more appointments during fully staffed times and less appointments during periods of breaks (e.g., lunch time); however, it appeared that blood drive volunteers were asked to find the same number of donors for each time period, e.g., for each half hour block find 4 donors. Perhaps the actual capacity during periods of full staff is higher than what they ask for and much lower during lunch times. This means that donors in the morning and late afternoons will be serviced very fast (maybe 30 to 40 minutes) while the donors during the lunch hours can expect long queues and much longer waits (like mine: 2 hours). The average wait may indeed be 1 hour but the variability in what is experienced by donors varies widely. Perhaps the American Red Cross tries to determine its daily capacity and asks blood drive volunteers to fill this uniformly throughout the day; however, labor scheduling forces the capacity to fluctuate throughout the day and reservations should be scheduled to match the capacity fluctuations.

What is the goal?

Again, according to their website, the number 2 reason people don’t donate after “I don’t like needles” is “I’m too busy”. Only 43% of donors are “repeat and loyal donors.” Perhaps a large percentage of the remaining 57% realized that they didn’t like needles after their first donation, but certainly some of them stopped coming because they were “too busy” which is a nice way of saying “it takes too long”. Blood is highly perishable and donations are needed every day in order to maintain adequate supply for medical patients who need blood. A top priority for the American Red Cross should be to increase the percentage of loyal donors in order to maintain the need blood supply. Any marketer will tell you it is easier and cheaper to maintain an old customer than to win a new one; however, the American Red Cross spends a great deal of its effort in finding new donors.

 
How can the principles of operations management improve donor loyalty?

Where was the bottleneck in my process? Where should it have been if donations where to me maximized?

What could the American Red Cross do to manage their appointment system better? How could they handle walk-ins?

Sources:

The blood donation process:

http://www.givelife2.org/donor/process.asp

Top 10 reason people don’t give blood:

http://www.givelife2.org/donor/top10excuses.asp

50 quick facts about donating blood (including loyalty percentages): http://www.givelife2.org/sponsor/quickfacts.asp

This was originally posted as a guest blog here.