A few weeks ago somebody dropped a message into our Google Chat.
Not because they wanted to start a conversation.
More because they didn’t want to lose the thought before jumping into another meeting.
“I don’t think most healthcare waiting happens inside healthcare.”
The message sat there for a while.
That’s pretty normal for us.
Somebody was on a client call. Somebody else was driving home from seeing a patient in their home. Another teammate was buried in virtual visits. Working remotely means conversations rarely happen all at once. They unfold over a few hours. Sometimes over a few days.
Eventually somebody replied.
“What do you mean?”
Looking back, that was probably the beginning of this Field Note.
One thing we’ve learned about working remotely is that ideas don’t usually arrive fully formed.
They collect.
Someone remembers something from a meeting earlier that morning.
Another person adds a thought over lunch.
Somebody comes back after dinner because a completely different conversation suddenly feels connected.
By Friday afternoon nobody remembers who started the thread.
Only that everybody is still thinking about it.
At first we thought we were talking about waiting rooms.
Busy clinics.
Appointments running behind.
The usual frustrations.
Then somebody asked a different question.
“What happened before they ever got to the waiting room?”
The conversation stopped for a minute.
Not because nobody had an answer.
Because everybody immediately pictured someone.
One person remembered a maintenance supervisor.
His shoulder had been bothering him for weeks.
Not enough to stop working.
Enough that he kept saying he should probably have it looked at.
Monday disappeared.
Tuesday filled up.
Wednesday wasn’t much different.
A machine needed attention.
An employee called off.
Something arrived late.
Something else couldn’t wait.
By the time he remembered the appointment, the office had already closed.
He never said he chose to wait.
That’s not how he described it.
He just kept running out of day.
We’ve started using that phrase ourselves.
Not because we were looking for one.
Because it kept showing up.
A day or two later someone added another story.
Completely different employer.
A parent finally found an appointment that fit the calendar.
Thursday afternoon.
Then they remembered the school concert they’d promised they wouldn’t miss.
The appointment moved.
A couple of weeks later something else came up.
Then something else after that.
We never heard how the story ended.
Most employer conversations don’t have endings.
You leave the meeting hoping things worked out, but you don’t always know.
Maybe that’s one reason they stay with us.
Later that afternoon one of our clinicians added a comment to the Google Chat thread.
Just one sentence.
“I wonder how many healthcare problems actually started because Tuesday was already full.”
Somebody reacted with a 👍.
Another teammate replied,
“I don’t even know how we’d measure that.”
Nobody tried.
The thread drifted toward something else.
The next morning it came right back.
That happens around here more than we’d have guessed.
The conversations that keep returning are usually the ones worth paying attention to.
Something has changed in the way we listen.
When we first started Tectonic Health, we listened for healthcare problems.
Now we find ourselves listening to everything that happened before healthcare entered the story.
The shift that needed covered.
The meeting nobody wanted to cancel.
The parent who had to leave early.
The employee who kept saying they’d call tomorrow.
The stories almost always begin there.
Healthcare tends to arrive later.
Yesterday somebody asked if this Field Note was really about access.
There was a pause.
One person thought it was.
Another thought it was about calendars.
Someone else said it sounded more like competing priorities.
Nobody really defended their answer.
The conversation just kept moving.
We’re still not sure those are different conversations.
We almost called this The Waiting Room.
It felt right for a while…Then it didn’t.
The waiting room is just the first place anyone notices the waiting.
The waiting itself usually starts somewhere else.
Sometimes while standing in the kitchen before work.
Sometimes during lunch when the afternoon fills up.
Sometimes on the drive home when somebody thinks,
“I’ll call tomorrow.”
Tomorrow has a way of arriving pretty quickly.
We’ll probably still be talking about this next week.
Somebody will come back from another employer meeting.
Somebody else will remember a conversation from months ago.
The Google Chat thread will start moving again.
That’s usually how these Field Notes happen.
Not because we decide it’s time to write.
Because the conversation wasn’t finished.
The 60%
Field Note No. 002
Field Notes from the Working Majority.