Hollender, 1956; Wagner et al., 1995). Patients increasingly want to obtain information and to be involved in decision making (Deber et al., 1996; Degner and Russell, 1988; Guadagnoli and Ward, 1998; Mansell et al., 2000; Mazur and Hickam, 1997). Moreover, meeting the aim of patient-centeredness can improve the outcomes patients desire (Brown, 1990; DeBusk et al., 1994; Linden and Chambers, 1994; Mullen et al., 1987), at least in part, by increasing their participation in decision making (Greenfield et al., 1985, 1988; Kaplan et al., 1989; Mahler and Kulik, 1991; Orth et al., 1987; Stewart, 1995).

As with communication styles, patients differ in their views about how active they wish to be in decision making. In some cases, patients want a large role, and in other cases they may delegate most decision making to a clinician. The goal of patient-centeredness is to customize care to the specific needs and circumstances of each individual, that is, to modify the care to respond to the person, not the person to the care.

Timeliness

Timeliness is an important characteristic of any service and is a legitimate and valued focus of improvement in health care and other industries (Fishman, 1999; Fung and Magretta, 1998; Goldsmith, 1989; Kenagy et al., 1999; Maister, 1984; Roach, 1991; Sirkin and Stalk, 1990; van Biema and Greenwald, 1997; Womack et al., 1991). However, long waits are the norm in most doctors’ offices, in emergency rooms, on the telephone, in responses to inquiries, in specialty care, on gurneys in hallways waiting for procedures, and awaiting test results, both in institutions and in the community. In addition to emotional distress, physical harm may result, for example, from a delay in diagnosis or treatment that results in preventable complications. The long waits for appointments described in the scenario presented earlier, which are common today, may have resulted in a much more advanced diagnosis for Ms. Martinez. Lack of timeliness also signals a lack of attention to flow and a lack of respect for the patient that are not tolerated in consumer-centered systems in other service industries. It suggests that care has not been designed with the welfare of the patient at the center.

Waits also plague those who give care. Surgeons know that operations rarely start on time; doctors and nurses wait “on hold” as they try to track down vital information, and delays and barriers involved in referrals eat up the time and energy of both referring doctors and consulting specialists. In the earlier scenario, Ms. Martinez’ surgery was nearly cancelled because important information that should have been in her record was missing, and staff spent valuable time finding it and rearranging schedules to avoid having to cancel the operation.

Any high-quality process should flow smoothly. Delays should occur rarely. Waiting times should be continually reduced for both patients and those who give care. Much waiting today appears to result from the presumption that certain



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