With the new office we put in 7 consult and 2 post-op rooms assuming everyone would already be seated and things would flow alot better. Big error in judgement. Look at the floor map below.
Everyone has to walk a lot further. People walk in and register, sit down, get an xray, sit down, go into the consult room and have a medical history, wait for the doctor, have their consult then leave. The front desk can't just direct them to the proper room -- they have to be escorted there (or they'll get lost/ wander into someone elses room).
I decided to look at our sigma values for wait. Anything greater than 50 minutes is too long. In 2005 we had a sigma value of 53915 defects per million (almost 4-sigma, not great but respectable). In 2006 it increased a bit; I thought it was becaue of patient volume and the new office would cure that. In 2007 it turned into 120294 per million! Almost down to 2-sigma.
We're working at it but it goes to show you that the numbers don't lie and assumptions are just that. Everytime a patient has to sit in another area and wait or everytime they have to move it adds another step to the process. That introduces a greater chance of error and the person that is responsible for that step being unavailable. Complexity can greater rather than cure problems (as we found out). The solution to the problem (I think) is to improve the flow of patients. We've eliminated the wait when we can at the front (have them seated in the consult room right away) and thought hard about when to have people arrive so there is no back ups at the front desk. I'll post our 2008 number some time soon and hopefully they'll be better.