Critical to success in the restaurant industry is the practice of preparation, referred to as mise en place, a French term meaning “putting in place.” In a culinary context, mise en place signifies preparing all utensils and ingredients before you start cooking. Mise en place is required in culinary schools and high-end restaurant kitchens.
Mise en place is a guiding principle in any field, increasing productivity and improving workflow.
Here are three examples of mise en place in a urologic practice.
1. Train office staff to look at the next day’s schedule and ensure all necessary reports, test results, etc., are loaded into the EMR before a patient’s appointment.
I was prepping to see a patient’s prostate biopsy patient for his 10-day follow-up after a biopsy and realized his results were not in our system. It took more than 20 minutes for the pathology department to fax the report, making the patient more anxious and putting us behind schedule.
Our practice has a daily morning huddle. This 2–3-minute meeting reviews the patients that are scheduled and what might be their anticipated needs before they are seen. If a patient had a previous procedure such as a prostate biopsy, we need to be sure that report is in the medical record before the patient is seen. This alleviates the patient’s anxiety and reduces the stress on the staff.
2. Clean/sterilize equipment as you go and be prepared with the necessary equipment for appointments or procedures ahead of time.
A colleague performing a cystoscopy needed to biopsy a lesion, but the biopsy instrument had not been sterilized after its previous use. The urologist stopped the cystoscopy for proper sterilization, which was a source of anxiety for the patient and resulted in pushing back other appointments.
3. Perform a routine check of all critical equipment, especially the crash cart.
I had a patient who experienced a syncopal episode after an injection. The nurse went to give the patient oxygen from the crash cart, but the oxygen canister was empty and had expired. Fortunately, we had a backup canister. However, the crash cart was not routinely checked. This is a setting for a potentially catastrophic event.
Bottom line: Outlining tasks and responsibilities and what is needed for each will put your practice on the road to mise en place. You cannot anticipate every situation, but you can predict the most common events. The prepared practice likely will earn better patient satisfaction scores, better patient safety, improved online reputation, and patient loyalty.
Neil Baum is a urologist.
