Magazines scattered throughout a waiting room. An opening band before the main concert event. Televisions at the gate in the airport. While these types of distractions are commonplace, they definitely aren’t random. Instead, they’re an attempt to manage wait time. In the world of healthcare where waiting is generally expected, giving patients more ways to control their wait time can be an effective way to attract new customers—and keep them.
People often respond irrationally in waiting situations. In fact, people are routinely more satisfied with a clearly explained 30-minute wait than with an uncertain 20-minute wait. While it’s not rational, it is how human beings are wired.
Reaction to the experience of waiting while on hold trying to schedule an appointment, in line at the grocery store, or sitting in an urgent care waiting room, is defined less by the overall length of the wait, and more by the psychology of waiting. To create the sort of experience that attracts and retains patients, urgent care operators must look at the source of patient expectations and perceptions about waiting, rather than focusing solely on reducing its duration.
There’s been a good amount of research on the topic to validate this thesis:
In his article, “The Psychology of Waiting Lines“, operations expert David Maister, formerly of Harvard Business School, articulated a simple formula to explain satisfaction with the wait experience: S=P–E (satisfaction = perception – expectation) and proposed a model for waiting psychology that would be later validated by the research of others.
In 2002, Daniel Kahnerman was awarded the Nobel Prize in Economics for his groundbreaking work in behavioral economics, a science that shows the limits of the assumption of rational behavior. Kahnerman and Amos Tversky uncovered cognitive biases that explain quite a bit about perceptions and behavior in waiting situations.
Richard Larson from MIT identified that “the real problem isn’t just the duration of a delay. It’s how you experience that duration.”
In healthcare, researchers have established a clear link between perceived wait times, level of service, and patient satisfaction. This link affects more than just satisfaction with the wait; it colors the patient’s entire experience with the center.
The Psychology of Waiting
We now know much more about what sets people off when it comes to waiting and how to transform the experience of waiting into a competitive advantage. First, let’s look at a few items from David Maister’s work that illustrate what urgent care patients really hate about waiting:
- Waits of an uncertain duration. The perceived opportunity cost of an open-ended wait triggers loss aversion. Human beings respond about twice as strongly to the possibility of loss as they do to the possibility of gain. That’s why an uncertain wait artificially magnifies the stress of waiting more than it should, and more than we’d otherwise expect. It’s also why Disney always lets you know how long you’ll wait in line.
- Waits perceived as unfair. Waits with no visible order, like waiting for a subway train, can create tremendous anxiety. However, that’s nothing compared to the reaction when there is a visible order, but that order appears to have been violated. Think about your own reaction when someone cuts in line. Even if they cut in line behind you, it’s still upsetting.
- Unexplained waits. If an emergency requires the reordering and delay of patients, explaining this to patients fundamentally changes the context of the situation. When a patient hears, “emergency,” his context and his expectations immediately shift—usually to a much more tolerant and understanding perspective.
- Unoccupied time. The classic example is the Houston airport that received complaints about the wait at baggage claim. The airport made improvements in the wait time but complaints persisted. Finally, they decided to increase the distance between arrival gales and baggage claim. When passengers arrived at baggage claim after the long walk, their luggage was ready, and complaints vanished. By the way, a TV in the lobby showing Judge Judy reruns does not qualify as occupied time. Letting patients wait at home or drinking coffee at Starbucks does.
The Dangers of Unmanaged Waits
Richard Larson expands on the dangers of unoccupied time. He points to Disney as experts in occupying the time of guests waiting for rides. However, it’s much more difficult to make your waiting room an engaging environment than it is to simply let your patients wait somewhere else.
Dr. Larson also notes that people generally overestimate the time they spend waiting. To address this, give customers easily accessible, realistic estimates of wait times. This greatly improves the accuracy of the customers’ own guesses at how long they actually waited, and subsequently has a positive effect on satisfaction.
Kahneman and Tversky note that many cognitive biases are rooted in an overall bias for negativity. That is, humans are wired by evolution to respond more strongly to a threat than to a positive experience. A negativity bias is useful if you’re trying to avoid a saber-toothed tiger, but in modern life it often creates unnecessary discomfort. That’s why the amount of frustration we experience when the line moves slower than expected is much greater than the amount of pleasure we feel if we’re lucky to choose the fast line.
Kahneman and Tversky also noticed that the final moments of a waiting situation make the most meaningful impression. If the wait ends positively, like being seen earlier than expected, patient satisfaction goes up. Disney leverages this by overestimating wait times for their attractions so customers are pleasantly surprised when they wait less than expected. If you don’t have a reliable system to keep track of lobby waits, setting accurate expectations can be difficult to do.
People are sensitive to the value of the thing they’re waiting on. In environments where patients have options among urgent care centers, perceived value can increase with the popularity of the center. The higher the perceived value, the more the customer will be willing to wait. However, once the part of the visit perceived as valuable—usually the time with the provider—is over, patients may have less tolerance for paperwork, waiting on a prescription, or a long discharge process.
In waiting situations of identical durations, people prefer a shorter but slower-moving line to a longer but quicker-moving one. This is just one more example of irrationality associated with waiting. In traditional theory, we should be neutral to the two options, but in practice we’re not. On the surface, this appears to conflict with the idea that busy centers may have higher perceived value, but it doesn’t have to. The busy center just needs to make sure patients have options available other than sitting in the waiting room.
Be Proactive to Be Competitive
If you’re offering online reservations (similar to call-ahead restaurant seating), creating appropriate expectations is critical. Do patients think they’re creating an appointment, a flexible reservation, or simply joining a first-in, first-out line? Communication in this context is important. If someone believes they have an “appointment”, they’re happy to wait up to the appointment time. But any time after that perceived appointment time can quickly become intolerable.
Managing perceptions about wait is an important topic to every urgent care center—not just busy ones. For many patients, especially millennials, patient perceptions can start early in the process, well before they’ve shown up at your center. It may begin at your website, a mobile app, or a Yelp review.
If your competitors are skilled at managing waiting psychology, then you need to be proactive to ensure the appropriate initial impression, even if your center is new and has low volume. (Pull quote) If patients believe they have some measure of control over the waiting process, their satisfaction increases.
FACT: In an environment of uncertain, unexplained, or unfair waits, satisfaction drops precipitously, especially as the wait gets longer. In the age of online reviews, this can quickly sink a center’s reputation.
The good news is that you can dramatically improve overall patient satisfaction without the necessity of making the actual wait any shorter. You simply need to understand and address the sources of patient expectations and perceptions related to the waiting experience.
About the authors:
Dr. Garrett Bomba is a product advisor for Clockwise.MD. He serves as Medical Director at Pentucket Medical Associates, an affiliate of Partners Healthcare. He is the director of Pentucket Medical ExpressCare clinic, which sees more than 25,000 patients a year. Dr. Bomba is passionate about using technology to improve engagement with patients and to maximize operational efficiency.
Michael Burke is co-founder of Clockwise.MD and oversees business development, client relationships, and product development. Michael is also responsible for driving Clockwise.MD’s forward-thinking culture and dedication to customer service.