Left Without Being Seen in an Urgent Care – Is this a Culture issue?

Left Without Being Seen in an Urgent Care – Is this a Culture issue?

Are you experiencing a productivity barrier? Perhaps you have an EHR adoption issue and/or a fundamental EHR workflow issue? Or possibly you have problems with getting timely results from the lab or the imaging department.  If any of these things sound familiar, you may have a problem with “Left Without Being Seen (LWBS)” in your organization. Maybe patients are not feeling welcomed and like they are a priority.  You may be surprised to know that some of these issues can be addressed by changing your organization’s Culture.

If the issue is productivity related, there is a cure for that. Physicians are fundamentally geared to produce.  In order to support their ability to produce, providers must also be able to drive performance by being an effective leader.  To do this, they should understand their data and analytics as well as understand the main barriers affecting maximum production.  Having a leader who possesses the skill set to optimize performance and eliminate barriers that affect patient flow is a lot more common than you think. 

So, what are the main barriers to achieving optimal productivity? There are a variety of issues that may occur.  Some issues may be difficult to resolve, such as patient flow due to the physical design of the facility.  Easier issues to tackle are slow test results, registration bottlenecks, and/or EHR challenges. 

Identifying the Right Leaders

Having the right leader in place is crucial for successfully increasing physician productivity. In an Urgent Care setting, the provider is the best person suited to lead the initiative to reduce and/or prevent LWBS issues. Representatives from the clinical support area, as well as clerical support, should be included with any problem resolution initiatives.  Ideally, a provider will be paired with a nurse/nurse tech and a registration representative to share goals, metrics for success, and accountability. 

Appointing the correct participants is a critical decision.  They must have a high level of emotional intelligence, but they also need to understand performance management techniques. 

Measuring Your Results

Patients generally state the wait was too long, which is why they decided to leave.  So, the first step is to measure your organization’s wait time.  This should be measured at key intervals of a patient visit:

  • Arrival to Registration Completion
  • Registration Completion to Rooming
  • Rooming to Assessment
  • Assessment to Provider
  • Provider to Orders Being Input
  • Orders Being Input to Lab/Medication Admin/X-ray
  • Lab/Medication Admin/X-ray to Results
  • Results to Provider Completion
  • Provider Completion to Discharge

Pinpointing where the delay originates should be used to define efforts to resolve the problems. 


Cultural Alignment

Building a team that understands the goals and initiatives of your organization from the start is important. Sometimes, you will have team members who embrace an organization’s overall cultural statements, and then you have those team members who are only there for a paycheck. For those individuals who are financially motivated, develop an incentive program that is focused on the overall objective of the organization’s performance expectations. Then, you will often see those individuals adopting the culture without realizing it.  When determining an incentive program, make sure you know the difference between a “carrot” and a “stick.” 


Culture is everything that people do. Culture is not just the mission or a vision defined by management. It goes well beyond a poster full of motivational quotes and inspiring purposes. The more meaningful and sustainable actions are those organically created by the employees rather than “the management.”


“We hire professionals for their expertise, but then they end up bringing their personalities to work.”  —  Anonymous


Organizational culture is something dynamic. That’s why it is important to look for cultural fitness rather than cultural fit. Many organizations forget the importance of culture and put strategy first. Organizational culture means taking care of each other to do more for the work with your services.


Outcomes and Benefits

Productivity based initiatives, such as a reduction of LWBS, encompasses the right tool, metrics, and incentives, will drive the appropriate changes necessary to resolve the root cause of the problem. This will directly impact the visit volume.  As a secondary benefit, well designed productivity-based programs that encompass the organization’s overall mission will lead to enhanced reputation and quality, which further promotes increases in volume and satisfaction from your patients. 


For more information on how to perform an Operational Assessment or to complete a Time Study, contact Stacy Calvaruso at 903-831-7270 or via email at [email protected].


Medical Practice Success, LLC is a premier full-service Revenue Cycle optimization organization that assists multi-specialty organizations with services that include physician coding and documentation training, medical practice analytics, managed care contracting analysis, credentialing, billing, practice enhancement initiatives, and so much more.     


Stacy Calvaruso, MBA, CHAM

Chief Executive Officer

Medical Practice Success