Have You Checked the Canary in Your Coal Mine?

According to the story about the rock band, Van Halen, the band stipulates in their contract that there must be a bowl of M&M’s backstage before every concert and that all of the brown colored candies need to be removed.  I didn’t believe that an entertainer could be so demanding and capricious.  However, I did my research on Snopes.com (http://www.snopes.com/music/artists/vanhalen.as) and found that the story was indeed credible and accurate.   

The legendary "no brown M&Ms" contract clause was certainly real, but the purported motivation for it was not. The M&Ms provision was included in Van Halen's contracts not as an act of caprice.  Rather, it served a practical purpose: to provide an easy way to determine whether the technical specifications of their contract had been thoroughly read (and followed). As Van Halen lead singer—David Lee Roth—explained, Van Halen was the first band to take huge productions into tertiary, third-level markets. His show consisted of nine eighteen-wheeler trucks, full of gear, compared to the standard rock concert, which simply required three trucks. With so much equipment and so many local stagehands to help build the sets, there were often many technical errors.  

The contract rider read like a version of the Chinese Yellow Pages because there was so much equipment and so many technicalities required for proper functioning. So just as a little test, to ensure compliance with the technical aspect of the contract, it would say article number 126, "There will be no brown M&M's in the backstage area, upon pain of forfeiture of the show, with full compensation."  

So, when he would walk backstage, if he saw a brown M&M in that bowl, he knew there would likely be a lack of adherence to the more important details of the contact.  He said that a brown M&M almost guaranteed that there was going to be an error of omission about the erection of the expensive sets that could result in damage to the equipment or injury to personnel. If the local team of assistants and the promoter didn’t pay attention to the little details, the bigger and more important requirements could also be overlooked. The M&M was his “canary in the coal mine.”

So what is your canary in your coal mine? 

What clue do you have that things aren’t going to be right when it comes to caring for your patients at all levels?  In our practices, it is the restroom.  If we walk into the restroom at any time of day and see towels or tissue paper on the floor, the wastebasket overflowing, and no soap in the dispensers, then we know that the other details might not be in place or the staff is not completely engaged and ready to see patients.

Examples may include confirming that the proper chart is pulled for each patient with the appropriate chart on the door or the proper EMR encounter on the computer for the patient in the room.  Another important detail is that all of the laboratory, pathology and x-ray reports and other necessary forms for that particular patient in the chart prior to the patient being placed in the exam room.  And finally, have someone check that each exam room is fully stocked with the necessary supplies, prescription pads, and educational material to give to patients for the most common conditions.  These are critical details that have to be implemented to be fully ready to care for patients, just like the proper specifications necessary to erect a rock concert set. 

So what might be the canaries to monitor in your practice:  

  • Are staff member’s chewing gum?
  • Is the uniform neat and clean?
  • Are the staff members wearing their nametags?
  • Are the computers turned on prior to placing patients in the exam rooms?
  • Are co-pays routinely being collected?
  • How long are patients put on hold on average?
  • Is reception area clean and magazines organized throughout the day?
  • Is a patient called from reception area to their treatment room with warm greeting or is it just “Mrs. Jones”?
  • Are phones answered in a friendly fashion and with consistent script at all times?
  • When patients placed on hold is the patients asked permission “May I please put you on hold?” and when returning on call “Thank you for holding?”
  • Are all patient’s asked at the end of their visit “What additional questions doe you have?”

Bottom Line: 

These may seem like small details but are often a reflection of how larger issues are dealt with.  Some will look under the cap of the ketchup bottle to see how clean their friends and neighbors really are.  An old adage sums it up well: “It is often 5% that makes 95% of the difference.”  Or said in a different fashion: “The devil is in the details.”   Just like the blood pressure, pulse, and blood sugars are the indicators of the overall health of your patient, so are the small details that indicate your staff’s preparation for your patients.  So listen to your canaries.  If they tweet, then you can be sure you are ready and prepared with a game plan in hand.

Hal Ornstein, DPM and Neil Baum, MD