Back in the 1970’s, I worked with a training program where we took students into rural Appalachian communities in Kentucky to observe and analyze the health care systems found in small towns. In those towns where there was a physician’s office or clinic the service model was the most basic. There were no appointments because a lot of people did not have phones or lived lives such that keeping appointments was impossible. Patients just showed up and waited for the doctor. And since he was the only one around, there might be 100 patients a day and they all waited for their five to ten minutes with the doctor. People waited all day because they had no where else to go.

Nowadays even in rural areas, there are more physicians, everyone has a phone, and appointments are taken, but usually one still waits… 20 minutes, 30 minutes, 45 minutes for that 10 minutes with a physician.

The PBS Newshour had a segment this week on a large clinic that, among other efficiencies, has worked to eliminate the waiting room (Bowser, 2012). This came about when the clinic staff was visiting the Toyota Automobile Company in Japan to learn about efficiency in production systems.

Modern manufacturing uses the just-in-time model for production. The idea is to always be moving towards completion and never waiting. Employees show up at appointed times and the materials they need to work show up at the same moment. Everything is orchestrated into a dance that maximizes efficiency.

One of Toyota’s efficiency guys pointed out that long waiting times were a sign of inefficiency, waste of resources and, in addition, disrespectful towards the patient. The clinic staff actually reported feeling ashamed to admit how long they routinely kept people waiting for scheduled appointments. They went back and redesigned their patient flow procedures to eliminate waiting and eliminate waiting rooms as well.

Health care is a complicated activity. There are many reasons why people seek health care and health care issues can be difficult to resolve. However, as the US spends 2.5 times more than anybody else on health care there must be efficiencies somewhere in the process (Kane, 2012). Eliminating waiting is certainly a positive step.


  1. Bowser, BA. Should Hospitals Eliminate Waiting Rooms? PBS Newshour – Health, 10-25-2012 (
  2. Kane, J. Health Costs: How the U.S. Compares With Other Countries. PBS Newshour – Health, 10-22-2012 (