How do we keep track of new patient inquires? How do I get my staff to sell more products and services? How can I get my front desk to mention our newest IPL treatment or Botox pricing?
New policies and procedures are usually implemented to try and address a perceived (or real) problem, but even the most carefully crafted procedures are very seldom realized when you throw human nature into the mix. Take a look at these famous examples from a Quora thread on unintended consequences:
A particularly famous example named the Cobra Effect:
The term cobra effect stems from an anecdote set at the time of British rule of colonial India. The British government was concerned about the number of venomous cobra snakes in Delhi. The government therefore offered a bounty for every dead cobra. Initially this was a successful strategy as large numbers of snakes were killed for the reward. Eventually, however, enterprising persons began to breed cobras for the income. When the government became aware of this, the reward program was scrapped, causing the cobra breeders to set the now-worthless snakes free. As a result, the wild cobra population further increased. The apparent solution for the problem made the situation even worse.
Here's a particularly relevant one around trying to improve service times that results in exactly the opposite:
My first job was as a crew member at a Burger King. To ensure speedy service in the drive thru, a timer was installed and hooked up to a pair of sensors so that it started when the car drove up to the speaker, and stopped when the car left the drive through window. The times were aggregated throughout the day and the times for each restaurant were reported back to the district supervisor.
As a result of this system, on days when we weren't meeting our goal time (generally 3 minutes), the managers would instruct us to have each car pull around to the front of the restaurant immediately after receiving payment if their order wasn't ready yet, causing the timer to stop counting. Then, rather than handing the food out the window, we would have to step out from behind the counter, walk up to the front, deliver the order and then walk back. So the customers ended up waiting longer for their food because we had to travel farther to deliver it, and also reduced the amount of time that we could spend productively handling other customers.
If you're looking to implement a system or procedure to try and deal with a problem or need, make sure that you're not creating more work or building something that will cause unwanted behaviors in your staff. Your perception of what you need might actually be causing you more grief. Here are a couple of thoughts to remember:
- Nothing you implement exists in a vacuum: If you're asking your staff to spend time talking to patients about your newest Botox or Restylane pricing, there's going to be less time to talk about your IPL or Thermage. If your focused on making sure that patients aren't taking advantage of your time by giving them only 10 minute consultations, your customer service will suffer.
- Everyone acts in thier own 'perceived' best interest: If you're going to offer a discount for Botox treatments before noon and your nurse injector or front desk staff is bonused on total Botox revenue, don't expect them to be pushing this new program.
- There's someting at work called Braess's Paradox: It states that "Adding extra capacity to a network when the moving entities selfishly choose their route, can in some cases reduce overall performance. This is because the Nash equilibrium of such a system is not necessarily optimal."
Here are some more stories of unintended consequences from that thread:
In 2008, Airbus made the new A380 quieter than any previously-manufactured plane in an effort to improve passenger experience. Unfortunately, Airbus didn't realize until after they shipped the aircraft that the quieter cabin resulted in more unpleasant sound for passengers, in the form of bathroom noise, talking and other audible sounds (e.g. coughing, sneezing, crying). The result was a worse experience for both passengers and pilots, and caused Airbus to recall some of the fleet and re-engineer the A380 once more to add more sound back to the cabin.
The D.C. local government is a constant source of unintended consequences. Here is a great one-- recently D.C. banned the sale of single beers for the following rationale:
More often than not, single sales of alcohol are bought so they can be consumed as soon as you walk out the door – turning alleys and backyards into public restrooms and leaving empty bottles strewn through our neighborhoods."When the law passed liquor stores immediately responded with this:
The two-pack. Priced more competitively than a single, so vagrants can get twice as drunk -- for less!
In central Missouri a number of years ago, a group of concerned citizens got together to rail against the billboards that were "cluttering up the view" along Interstate 70, and they started putting together a bill that would limit the number of billboards that could be installed. The makers of the billboard signs immediately went to work putting up more, to make sure that as many signs as possible would be "grandfathered in." The legislation wound up failing, and the net result was twice as many billboards as there were when they started.
Read the rest of the Quora thread on unintended consequences here.
If you have any stories of something that you implemented that had unintended concequnces in your clinic or medspa, leave them in the comments below.