Your patients don't want a shorter wait. They want to know how long it is.
By Craig Joseph, MD ·
Health systems have spent a decade trying to compress the time patients spend waiting. It is expensive, it is slow, and it is mostly the wrong project. The cheaper win, and the one almost nobody funds, is telling patients where they stand.
Why did four hours at a stadium feel fine?
Because I always knew where I was in the sequence. I was told to arrive four hours before a World Cup match at the stadium in Foxborough, Massachusetts, and I expected to be miserable. I wasn’t. Patriot Place, the shopping and dining complex wrapped around the stadium, gave me somewhere to be. More to the point, I knew when gates opened, where to go, and what to do with the interval.
None of that shortened the wait. It made the wait legible.
Sitting inside that same complex is a Mass General Brigham healthcare center — primary care, specialties, imaging, day surgery. Which raises an awkward question. If a stadium can persuade me to show up four hours early in a good mood, why does the clinic a parking lot away produce the opposite reaction in nearly everyone who walks into it?
Did Mass General Brigham build that on purpose?
No, and the reason matters more than the coincidence does.
The Foxborough center opened in 2009 as a conventional ambulatory strategy decision: capture growth, reduce dependence on expensive downtown campuses, and put services in a high-growth suburban corridor with good highway access. It was a real estate and volume calculation. Nobody was trying to make healthcare entertaining.
The pleasant surroundings came free, attached to a sound outpatient economic decision. The system did not manufacture foot traffic and a reason to be there. It rented adjacency to an organization that already had both, and let that organization carry the fixed cost of being interesting.
That is the transferable insight, and it has almost nothing to do with amenities.
Does a shorter wait actually make patients happier?
Less than you would expect. The advertising executive Rory Sutherland has spent years making a version of this argument about the psychology of waiting: most of us would rather wait seven minutes for a train we know is coming than four minutes for one that might never turn up. What makes waiting intolerable is not duration. It is uncertainty, and the absence of any sense of progress.
Transit agencies figured this out and bolted dot-matrix arrival boards onto platforms and bus shelters. No train got faster. Riders got happier anyway, because someone finally told them the truth about the wait.
Sutherland’s broader complaint lands squarely on healthcare: we are fixated on optimizing the things we can measure, and we have almost no metrics for the things that shape how people actually experience their day.
We have spent a decade making the wait shorter and almost no effort making it legible.
So what are we measuring instead?
Speed and volume, nearly to the exclusion of everything else. Door-to-doctor minutes. Cycle time. Patients per provider per hour. Third next available.
Every one of those is worth tracking. Not one of them captures whether the patient understands what is happening or what comes next. We have built an elaborate measurement apparatus around the dimension that is easiest to count, and left the dimension patients actually describe to their families almost entirely unmonitored.
This is the same argument I have made about wayfinding and about the unglamorous mechanics of inpatient experience — that maps, meals, and posted wait expectations do more work than most of what gets a ribbon cutting. The ambulatory version is identical. The information is the intervention.
What should a health system fund first?
Three things, in this order.
Borrow the foot traffic instead of building it. When you site an ambulatory location, look hard at places that already have crowds, parking, and a reason to exist. Let somebody else absorb the cost of being a destination. This is not a patient experience strategy dressed up as real estate; it is a real estate strategy that happens to pay an experience dividend.
Spend on certainty before decor. Honest wait-time transparency and real queue position are a software and workflow problem, not a construction project, and they cost a rounding error next to the renovation that usually gets approved instead. A patient who knows they are third in line and roughly forty minutes out is a fundamentally different person than one who has been abandoned to a pile of magazines with no information at all.
Apply a blunt test to every amenity proposal. Does it drive volume? Does it deepen loyalty? Does it measurably reduce unavoidable wait pain? Or is its primary output a press release? The renovated lobby usually fails that test. The queue-position display usually passes, at a fraction of the cost.
The point is not to make the clinic a spectacle
Nobody needs a food court attached to the infusion center. The stadium is not a model for how care should feel.
It is a demonstration that people tolerate delay remarkably well when someone tells them the truth about it, and tolerate it badly when nobody does. The lesson for the clinic was the countdown clock, not the mall.