Harry Hirschman

The clinic he referred me to, as I expected, is run in accordance with what we’re taught in Operations and Information Management (OPIM). New patients are only seen in specific time slots because they take longer than returning patients and are therefore disruptive to the smooth flow of the clinic.

When I called the clinic, they predictably told me that the first available appointment for me as a new patient was weeks away. My goal was to be seen right away as per my doctor’s orders. I accepted the time and date they offered me over the phone but had no intentions of giving up.

I went over to the clinic. My goal was to put a face to the voice they had heard on the phone, to make a human connection, and to be immediately available if a slot opened up. Also important was showing them that I would be polite and easy to work with. My health was on the line.

On my first in-person visit to the clinic I met the new patient coordinator and a few others, but there were no doctors in clinic at the time so I left.

Two days later, I came back and checked in with the people I’d met and prepared to wait several hours for something to open up. I was surprised when a short while later the clinic manager emerged and introduced himself to me in the waiting room. He brought me back to a private room to chat.

Trying to identify the pictures in his head, I quickly saw that his goal was to manage my expectations of being seen. He very nicely explained how the clinic scheduled new patients and he added that my chances of being seen as a drop-in were “slim”. He assured me he would call me the night before if anything opened up, and reiterated that this was the best they could do given that clinic efficiency was their top priority.

Although it was of the utmost importance that I persuade him, I remained calm. It was very clear to me that “efficiency” was a key word for him. I empathized with him on the merits of efficiency and demonstrated that I understood why they did it that way, explaining I had taken courses on OPIM in business school.

I’ve been actively managing my own health care for many years and have learned to be politely persistent. So I subtly altered the standard under discussion by asking a pointed question: How do they prioritize patients according to urgency?

When the discussion shifted from efficiency to priority or “triage”, a glaring miscommunication revealed itself.

He did not want to seem extreme or insensitive to urgency, so he explained that while routine referrals went through the normal scheduling process, they did of course schedule urgent referrals ahead of others. He wasn’t aware that my referral was urgent and had thought mistakenly that I was just trying to skirt policy.

I explained that the referring doctor did consider mine to be an urgent referral, but that there was no way for her to indicate that in her clinic’s IT system. She had been forced to manually indicate the urgency in her notes. Once he was able to verify that my statement was true, he put the machinery in motion and I was seen later that same day by a specialist!

I often have difficulty recognizing standards and figuring out which to apply. Luckily, it came naturally this time from my previous experience working with the system.

Other key factors to a successful outcome were: Patience (trading my time by being willing to wait in their lobby), Making a personal connection, Thinking about the pictures in their head, Politeness, Remaining Calm, and Professional Appearance (business casual clothes). Another successful negotiation!- Harry Hirschman, Wharton MBA ’01, Co-Founder, Conderos Inc., San Francisco, CA.