Patients Like Walter: The Humanity of Access

Every Saturday, you’ll find me serving lunch at Atlanta-based Trinity Community Ministries. Like you, I consider service to the community central to my personal life. When Walter* came up to me this weekend with a small, white-tattered appointment card, I was surprised to discover that I could glean crucial insight to inform my professional world as well.

Walter, a resident at the center, explained that he had missed an important doctor’s appointment that week – one for which he had patiently waited for months. The social worker had been delayed getting to the center for work that morning, and the van was late to transport him to the appointment. He, therefore, missed the appointment. His next shot, he explained as his voice quivered with sadness, was three months from now. He was, therefore - in my world - a “no-show.”

Walter’s story resonated with me; I couldn’t help but think about others like him. Consider the single mom who couldn’t get to an appointment because her childcare fell through, the senior waiting on a kind neighbor to drive him to the appointment only to have the neighbor’s car breakdown, the new immigrant who has no driver’s license, or the individual who can’t register for the appointment portal because they have no email address.

As healthcare administrators, we create elaborate schedules of 10-, 20-, and 30-minute slots, perfectly balanced between new and established patients – segmented by patient type, diagnoses, and procedures. We test and refine our approach. The slots are perfectly arranged.

How can so many patients fail us? 

Sometimes we forget the lives of the people being inserted into those slots. Patients cannot be treated as cogs in the machine.   

As administrators, our lives operate on planned-out calendars, relatively easy access to childcare and transportation, and supportive colleagues and bosses. And, yet, we still struggle to manage our commitments. Solving an access problem requires us to step out of the narrative of our lives – and appreciate those like Walter’s.

This isn’t only about empathy and compassion; this recognition is crucial to solving the management problem. Once enlightened by the new optic, we may realize that calling the night before an appointment, for example, may not be an effective appointment reminder. Or directing a patient to sign up for the portal or auto-booking a post-discharge appointment. The stories are everywhere – a referral to a specialist whereby we tell the patient to “expect” a call from us: Who? When? Where? How? thinks the patient. Return-to-clinic instructions in English with fancy words like “febrile,” “incapacitated,” and “immobile.” Countless other scenarios should give us pause.

The social determinants of health may be affecting our arrival rates – by seeing our patients’ lives, we can better address them.

Consider beginning your next access meeting with a story about a patient. Patients like Walter can help us all be better stewards of access. As a leader, we must integrate human-centered design to optimize the patient experience and our system’s efficiency.  

Truly seeing access from the lens of our patients may help us understand how we can better address it.

*name changed for privacy