“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.

In 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