Jobs Applied: Simplicity


“It takes alot of hard work, to make something simple, to truly understand the underlying challenges and come up with elegant solutions”  Steve Jobs

Steve Jobs was famous for his focus on making complex problems and products more simple.  When Apple wanted to disrupt a market – it looked for industries or categories that were making products more complex than they needed to be.  I think itunes is a great example of this.  Love it or hate it, it is simple to use.  So simple, in fact, that millions of people prefer to pay $1 or more per song, when they can quite easily find the same music for free.  You might argue its about copyright infringement, but I’d argue its about simplicity.

“Simplicity is the ultimate sophistication.” – Leonardo DaVinci

Surely the US healthcare system could use a dose of simplification!  Let’s review the steps required for a patient to come in to see me in my private practice.

  1. Get hurt (simple)
  2. Make physician appointment (referral required by law in most states)
  3. Explain to physician that physical therapy can help injury
  4. Brush off advice to take medication and ‘actively rest’
  5. Obtain physical therapy referral
  6. Schedule physical therapy appointment
  7. Give receptionist ~30 pieces of data for insurance verification
  8. Fill out 8-10 pages of paperwork
  9. See physical therapist and begin treatment (unless its a work injury, then see steps 10 – 12)
  10. Physical therapist sends in paperwork requesting permission to begin treatment
  11. Wait 5-7 days
  12. Begin treatment

This got me thinking.  A great deal of this could be simplified by moving to Pennsylvania (a direct access state – remove 2,3,4 and 5) and by accepting cash only (that would take care of 7, half of 8 and 10-12 ).  The downside, of course, is that this simple solution only works in certain states and for patients with cash to burn.  There is alot of this that is simply outside of our control other than advocating for a change.

Simplicity is about subtracting the obvious and adding the meaningful.” – John Meada

Steven Covey writes about a useful principle called the ‘circle of concern’ vs. the ‘circle of control’ (here’s a neat review).  Clearly most of the steps a patient has to go through would fall into our circle of concern, but outside of our circle of control.  However, there are a few that we do control directly.  Probably the highest leverage item in our list that we could simplify is #8. the paperwork a patient fills out when they hit our door.

intimidating_stack_of_divorce_forms_and_papersIn most practices we already had to collect more information than the patient has to give to get a credit line to verify their insurance.  Looking through my forms (yes, guilty!) we ask the patient to write their name and birthdate no less than 7 times, their social security number 3 times, etc.   We also ask them to describe their pain numerically, graphically and in detail… then proceed to ask them about it verbally not 5′ later.  The entire process is redundant, since we use an EMR anyway.

A believer in the circle of control – I’ve got a new Next Action.  I’m going to think like Steve Jobs and simplify steps 7 and 8 for every patient trying to connect with our practice.

Next: Take Responsibility End to End

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4 thoughts on “Jobs Applied: Simplicity

  1. What I think is more sad… the information we require is already in someone’s system! Think of how some patients reach you… PCP to specialist to Dx testing to maybe surgery then to you! Want to talk about redundant! They give all that information to every single provider along the way! It would be so cool to be able to have all the systems talk to each other and be fully integrated so info flows in and out of various systems. I have heard of hubs of this actually happening – maybe one day…

    I hear your point… at the same time, when it does come to paper work, I certainly hope everything we ask has some reasonable rationale and is actually used for something.

    Nice thoughts!

    • Thanks for your thoughts, Selena! We certainly have the technology to accomplish this. We should be able to swipe a card like we do a credit card and pull up everything from coverage to medical history. The information piece is more about money and consensus than it is about technology.

      For us, though, we can stick to our sphere of influence and try to make our own part of the system less broken.

  2. David,
    Excellent blog post. Pennsylvania is an excellent state for PT access & opportunity. A cash based option certainly can bode well in our environment. The take home message is a great one.
    Keep it simple.
    Thank you for the reminder.
    I am certain our clients will appreciate your message after we heed your suggestions & simplify.
    Always a pleasure to read your insight.


    • Thanks Lisa! This got me thinking also about the ‘most important question in business’ which some evidence indicates is moving from ‘would you refer your friends and family’ and customer service experience to also include convenience. i.e. Amazon doesn’t have great customer service – they have incredible convenience! Sometimes you are almost surprised by how easy it was to order something. Making PT more convenient is definitely something we could strive for – and simplifying our process can help.