Monday, May 5, 2008

Richness and Reach

The Boston Consulting Group is one of America’s premier consulting groups on strategy and management. In 2004 Philip B. Evans and Bob Wolf published an article called richer sourcing that discussed the trade off between richness and reach. In business terms they explained it as follows:

“The underlying logic is embedded in the economics of information. There is a near-universal trade-off between richness and reach. Richness is variously the amount, quality, specificity, recency, or trust-worthiness of the information shared in a transaction; and reach is the number of people or entities involved. Typically, we can transact with lots of richness if we are willing to give up reach (a conversation) or with lots of reach if we are willing to give up richness (a newspapers ad). But we cannot have both at once.”

In a busy practice the same trade off is going to exist between quality of service and wait times. In other words, you can see people fast or you can give good service but you can’t see people good and fast.

Quality – “First, do no harm”

It’s a sin qua non that certain aspects of quality have to be maintained in any practice. I’m not arguing that lowering wait times should come at the expense of proper diagnosis or higher infection rates. Rather, what most people would term bed-side manner may be compromised. If quality is maintained at the highest possible rate, what is an acceptable level of “bed-side manner”?

Ironically, some emergency physicians have customer satisfaction survey results built into their pay structure. One would think that the quality measures such as re-admission rates, mortality, infection rates, diabetes control, etc… would be on the scale first then customer satisfaction surveys second but that’s not the case.

Trading Etiquette for Wait

Some clinicians choose to give the maximum amount of time to every individual. If you need a standard consultation you receive a ½ hour appointment and all the time will be used. Other practitioners choose to book a wave of patients (3-4 people each ½ hour) and rush through as many as possible – some get lots of time and others get less. The up side to strategy one is there is a depth of richness to the appointment. The down side is the person will wait longer to get in. The opposite is true in the second strategy because, the 3rd law of inertia applies to appointment structure and wait times. For every action there will be an equal and opposite reaction.


Each practice will have to choose an individualized balance between appointment richness and longer health care wait times based on the nature of patients typically served. The best that each practice can accomplish is to be aware of the trade off, measure and monitor the results. The three measures of service need to be quality, wait time and patient satisfaction.

Bench marks exist for the level of quality in various specialties. Similarly, greater research is being directed at wait times to better define when excessive waits will compromise quality. Defining the relationship between health care wait times and customer satisfaction is a little more ethereal in nature. Because expectations in waiting vary by specialty and urgency of illness a standard acceptable wait time is more difficult to characterize. For practices that are in over-serviced areas (with low wait times) now is the time to start defining acceptable health care wait times, customer satisfaction surveys and levels of quality. As a practice becomes busier and wait times develop the tools will already be in place. For those practice that already have wait – what measures do you have? The future of health care will result in cost cutting, rationing services and greater demands on quality. The practices that master the balance between richness and reach will be those that flourish.

For an extension of the discussion to the impact of the internet on Richness and Reach in clinical practice click here


Dr Aniruddha Malpani, MD said...

Dear Dr Ian Furst,

Thanks so much for including a link to my blog ( Doctor and Patient - India) on your blog roll. Unfortunately, the url is mis-typed. Can you please correct this ?

Thanks !

It should be

Dr Aniruddha Malpani, MD
Medical Director
HELP - Health Education Library for People
Excelsior Business Center,
National Insurance Building,
Ground Floor, Near Excelsior Cinema,
206, Dr.D.N Road, Mumbai 400001
Tel. No.:65952393/65952394

Ian Furst said...

done - thanks. Ian.