What Are The Best 15 Ways To Guarantee Great Patient Experience?

I have developed a certain affection for the television shows Survivor, Naked and Afraid, and Life Below Zero.  If you are not familiar with the shows, their premise is to determine who among the contestants has the inventiveness and mental toughness to exist on a diet of insects or to live when the average temperature is forty below zero.

Having slept on the glacial face of a volcano at seventeen thousand feet, I fancy the notion of competing on those shows.  Give me a piece of twine and a pull-tab from a can of soda and I will construct whatever tool I need to survive.

So, last week our power was out for four days because of a thunder storm.  Instead of having to hunt narwhales while wearing nothing other than my skivvies—don’t try to picture that in your mind, I was ensconced in my home; no air conditioning, no television, and having to fight my way around obstacles at night with nothing to guide me other than my wits and the light from me cell phone.  The showers were cold, my soft drinks were warm.  I survived the first two days with nary a scratch.

By day three the lettuce was wilting and so was I.  I reflected on my not too distant halcyon days, days when I could sit in my air conditioned home and watch television shows about people trying to survive in a Brazilian dessert while eating grubs.  It was then I decided that were I able to survive my own odyssey I would put aside my dreams of living a wilderness adventure and make due with mowing my lawn.

I have no segue for this post, so here we go.

Chances are your health system’s website is a clunky old thing designed by the elderly (people over the age of thirty.)  The time to rethink what you want out of your website has come and gone; that train already left the station.  The only way to play catch-up is to dump the sclerotic vision that defines your online presence, and figure out what your stakeholders expect from it.

People who visit your website have an experience, they just have a good one.

The best way to not have to measure patient experience is to design such a good, interactive online experience that measuring it would be redundant. Design these things into your website and you will have the most progressive health system on the planet.

  • If half of your callers would rather have their needs met online, figure out how to let them do that. If you don’t know what they want to do online, ask them.
  • If half of your patients will seek a second opinion, give them a link telling them why they should stick with you
  • If half of your competitors’ patients are seeking a second opinion, give them a link telling them why they should pick you
  • If twenty percent of your callers have questions about their bills, use co-browsing and online videos to explain your bills
  • You know your patients are going to dispute their reimbursement, show them how to do that on your website; make videos explaining payer by payer how to do it
  • If a percentage of your patients want to speak with a clinician, make sure they can. Heck, make sure they can do it at a time convenient to them, which probably will not fit the hours of your call center.
  • If every single person who visits your website is either a patient or a potential patient, tailor all of its functionality to them—get rid of the other eighty links; links about the gift shop and posting baby photos online
  • If you have a scheduling center instead of a real call center—80% of your calls are not about scheduling—create a real call center.
  • Put a chat function on your website—how may I help you—and delete that silly contact us box that promises a response before the next full solar eclipse
  • Let callers on hold enter their phone numbers instead of having to wait, and have the next available agent call them back
  • Let call center agents email callers
  • If someone contacts you through your website, respond to them within an hour
  • Let people schedule appointments online
  • Since a lot of people who are considering buying healthcare from your system visit your website, give them something to do when they get their—how about a customer portal where non patients can store and track their health data like they do with apps on their smart phone, a portal whose data you can monitor.
  • Since only a fraction of your callers and website visitors are in your EMR, make sure you can meet the needs of everyone who isn’t—those people are called customers.

Prevent people from leaking at the start of their experience.  Design an experience focused on keepage, not leakage.  None of these features are difficult to accomplish using current technology.

If you do all of these things you will never have to worry about measuring patient experience.  You will already know it is great.  And maybe then we can ask why everyone in Washington is so concerned about building a wall to keep out the Canadians.

What Are The 9 Reasons to Stop Scoring Patient Experience?

If you ignore the fact that CMS requires you to report your HCHAPs, I think a mathematical argument can be made to stop scoring patient experience.  Here are a few thoughts as to why:

  • Even without the heavy handed efforts from CMS, every health system worth its salt would be doing many of the same things to improve patient experience simply because they are the right things to do. You don’t need to be penalized to figure it out.
  • Patient experience is cumulative. By the time the experiences related to HCAHPS come into play, most patients have already formed an opinion of their overall experience based on all of their prior interactions.
  • Nobody ever asked patients their expectations with regard to what constitutes a good experience. The survey questions may or may not relate to what constitutes a good experience.
  • Most experiences that determine a person’s loyalty and stickiness occur outside of the hospital setting.
  • Using the survey as the sole measure of the experiences of a health system’s stakeholders is about as valid as having aliens land in the parking lot of a Home Depot and characterizing all Americans as people who drive pickup trucks with 4 x 8 pieces of sheetrock in the back.
  • Improving patient experience scores using just the CMS approach will have very little impact on the ability of a health system to effectively manage consumerism, wellness, and population health.
  • It is much easier to improve low HCAHPs than to improve high HCHAPS. Trying to squeeze blood from a turnip makes no sense.
  • Once your health system’s scores are in the top fifty percent, there is little material benefit—because what you are trying to do is avoid being penalized—in trying to push them much higher.
  • To raise your health system’s overall score by just one-tenth of a point you have to do one of the following;
    • Raise your scores on all 32 questions by one-tenth of a point
    • Raise your scores on 16 questions by two-tenths of a point
    • Raise your scores on 8 questions by four-tenths of a point
    • Raise your scores on 4 questions by eight-tenths of a point
    • Raise your scores on 2 questions by 1.6 points
    • Raise your scores on 1 question by 3.2 points

And what do you have after you’ve added all of your one-tenth points?  You have a marginally higher score. You may or may not have higher experience. Going from a score of 7 to 7.1 doesn’t add much value, but just to accomplish that every single one of your thirty-two initiatives has to succeed.

If your health system needs or wants to improve its scores by a meaningful amount, may I suggest the following approach, an approach based entirely on simple logic?

Compare your scores, question by question, against the average scores of all health systems.  And do the same comparison against the average scores of a grouping of the top health systems.  For any question where your score is within one or two tenths of the scores of the top health systems do not invest anything to improve your score on that issue—if the highest scoring systems are not much better than yours on those issues there may be reason to conclude there is not much you can do to drive those scores much higher. In that case, consider not working too hard to improve your results on those particular survey questions.

Now look at the survey questions for which the average scores of all health systems were the lowest.  For those survey questions where the average score among all heath systems is noticeably lower, that may be a pretty good indicator that to materially boost your system’s scores on those issues will require a significant expenditure of funds and effort.  In that case, don’t plan to raise those scores by a significant amount.

So now, we almost have a plan about where to invest your patient experience dollars.  Do not plan on fixing things where you score almost as well as the best systems, and do not plan on fixing things where you are not much worse with regard to the most difficult issues.

Let’s say that leaves us with 16 survey questions to be assessed about where to target your efforts.  Compare the issues where the average systems scored the highest to the issues where the best systems scored the highest.  For issues where both sets of average scores concern the same issue, flag that issue.  For example, if the scores from the average health systems, and the scores from the top healthcare systems, indicate both groups scored significantly better than your health system on a specific issue—take reducing noise as an example—develop a plan to target reducing noise.  And do this for every one of those types of issues.

Why?  Because if even the ‘average’ systems are markedly better, that should be a signal that your system can also be markedly better on those issues.  So, how do you figure out what to do?  Go talk to the health systems which scored higher in those areas, find out what they did, what worked and what didn’t, and borrow their ideas.

There are health system’s whose boards wants them to move their scores from let’s say an average score of ‘7’ to and average score of ‘9’—almost a thirty percent improvement across the survey, 64 total new points. Thirty-two, two-point increases, all of whose efforts must be successful to raise the total score.  The other way to do that would be to improve twenty-one categories by three points, moving those scores from a ‘7’ to a ‘10’ to net you 63 additional points.  The likelihood of scoring a ‘10’ on twenty-one categories is absurd.  That dog don’t hunt.

I hope you find some of this helpful.

The Patient Experience Emoji Challenge Board Game: Who Wins?

Perhaps we can being this post with an activity for health system executives—payers can try this also.  Stop what you are doing and go to a mall, a ballgame, the movies, or someplace where you will be able to observe a lot or people.  And observe…and email me if you think you think you know what you were to have observed.

When you are talking with someone, and something they say triggers the lizard part of your brain to say something witty, do you ever just go with it? I spoke today with a healthcare consulting executive.  She asked me the following question. “Providers think we are offering the same services as firms like Studer. What can we do about that?”  The lizard in me wanted to say, “Hang a string of garlic around your neck and carry a wooden stake.”  I demurred.

Permit me to begin with a disclaimer.  I am sure they are nice people.  Clearly they provide a service providers value.  If they didn’t they would not be in business.  And perhaps I live in the type of parallel universe defined in quantum physics, one where everything is upside down.  So allow me spend a minute describing how things seem in my little universe, and I will let you be the judge as to whether there are more effective ways to invest your health system’s scarce resources.

On my planet, when I spend money on a program to improve experience, I require the program to meet three criteria:

  • Will the program improve the experiences of all of my health system’s stakeholders (patients—in and out, family members, care givers, customers and referring physicians)? Or, will it only improve the experiences for a small percentage of our stakeholders—inpatients?
  • Will the program improve the experiences everywhere my health system’s stakeholders have experiences (before hospitalization, during hospitalization, and after hospitalization)? Or will it only improve hospital experiences?
  • Will the program improve experience, or will it just improve experience scores?

It’s a pretty simple test.  Will the money improve the experiences of many people, or will it only improve the experiences of one or two people.

So, let’s play the single elimination, Patient Experience Emoji board game; My strategy to improve stakeholders experience versus a strategy to improve just the experiences of inpatients.  The landscape of the game-board is the health system’s service area, its population.  Players collect emojis for each health system stakeholder whose experience they are able to improve.  The player who collects the most emojis wins.

Up for grabs in the game are the following stakeholders. Each group of stakeholders is worth various numbers of emojis. Let’s assume that the stakeholder that represents the potential service population contains 1,000 people.  The player who can demonstrate that their strategy will raise that stakeholder’s experiences earns 1,000 emojis.  The stakeholders have the following emoji values:

  • Population(consumers)                1,000 emojis
  • Former patients                                300 emojis
  • Family members                               150 emojis
  • Outpatients                                       100 emojis
  • Inpatients                                            50 emojis
  • Referring physicians                          30 emojis
  • Care givers                                         15 emojis
  • Radiology technician                           1 emoji
  • Hospital receptionist                            1 emoji
  • RN                                                          1 emoji
  • Therapist                                               1 emoji
  • Orderly                                                   1 emoji
  • Physician                                               1 emoji
  • And so forth

The game begins by a role of the dice—highest number moves first.  When you land on a spot on the game-board represented by a stakeholder, you have the option to try to raise that stakeholder’s experience.  If you pass on the option, or try to raise the experience and fail, your opponent has the chance to raise the experience.

My competitor rolls a seven and moves his piece across the board, landing on caregivers.  He decides to try his luck.  His efforts to increase the experiences of caregivers includes coaching the radiology technician, teaching the hospital receptionist to smile, and explaining how to reduce ambient noise levels on the floor fail because caregivers are not impacted by those efforts.  No emojis are awarded.

The attempt falls to me.  I explain that caregivers can do a lot of what they need to do online through the stakeholder portal’s self-service option, or they can call the health system’s new call center and be supported through the CRM tool. I win 15 emojis.

The game continues.  My worthy opponent’s approach demonstrates the ability to outdo me inside the hospital, capturing all of the available 1-point emojis.  He scores 7 emoji points.  The teach-the-employee-to-smile initiatives seem to have merit; but not for any current or former patients, and not for family members. In fact, the only people who may benefit from my opponent’s approach are only future patients, and only the smaller percentage of future patients who happen to interact with the smilers.

My approach nets 1,550 emojis.

If you are the health system executive, how do you want to spend your patient experience dollars?  One approach has the capability of improving the experiences of single stakeholders.  The other approach has the capability of raising the experiences of everyone who interacts with the health system.  It has that capability because it deals with improving the access experiences of everyone who needs to interact with the system.

Raise one boat at a time.  Or, raise all boats.

Oh, and the bit about going to the mall or someplace with people in it.  The thing to have observed about all of those people is that every single one of them is a potential patient, a potential customer of your health system.  They are worth a lot of emojis.

Patient Access: What Would Happen If Euclid Spoke French?

Hindsight is a wonderful thing; the smart people try to get theirs in before it is needed.

Here is some timely hindsight.

Let’s take a look back at high school.  Among my studies were French and Math—I was way better in math in part because we were not graded on our pronunciation.  I was in class for three years of French.  We learned phrases that may come in handy if we are ever invaded by Quebec; Je vais aller à la bibliothèque (I am going to the library) and, la plume de ma tante (The pen of my aunt).  That is why I studied math.

I have worked in twenty countries, and my mind has remained sharp during the intervening years.  In countries other than Canada, New Zealand, and England, my brain quickly lets me know something is amiss—people are not speaking English.  They are speaking a foreign language, it tells me.  I know a foreign language, it tell it.  I knew intellectually when I was in India, and Austria, and Argentina that people were not speaking English or French. But the message was slow getting from my brain to my tongue, so when those people spoke foreign to me, I replied in foreign to them.

Lest you wonder, trying to tell people in Mumbai about my aunt’s pen did not entice them to esteem me.

The thing is, we go with what we know, and we hope that will get the job done.  Or at least we hope we can score a few bonus points by giving the impression of having tried.

I think that may be part of the reason many health system executives decided to build call centers.  The discussion in the cafeteria over a slab of Lucy’s Meatloaf and a side of mash, may have gone down something like this:

CFO:   Did you know thousands of people call us every day?

COO:  What kinds of people?

CFO:   All kinds; patients, mothers, home health agencies.

COO:  What should we do about it?

CFO:   It’s above my paygrade.  What if we bought a bunch of phones and found a big room and put a bunch of people in the big room and paid them to talk to those people?

La plume de ma tante.

Back to my mathematical journey.  I was a mathematician for the few months between the end of college and the beginning of grad school.  A remarkable feat when you consider that the dean of the math department, having failed to talk me into changing majors for the good of the university, gave me his calculator, telling me, “You need this more than I.”

There was this guy Euclid who was pretty good at math, and he did not even own a calculator.  In fact, he postulated a few axioms from which he then derived all of the same geometry we use today.  Over time, triangles do not evolve into squares in the same way PBS would have you believe we evolved from fish.

One of the Euclidian mathematical proofs is that the shortest distance between any two points is a (say it with me) straight line.  Euclid did not prove the shortest distance between these two points was a straight line, he proved that the shortest distance between any two points was a straight line.  That is pretty cool when you consider there are a lot of points floating around out there.  Clearly, if he had to prove it for every pair of points in order for it to be true, there would be no proof.  Instead, he had to construct a mathematical argument that was valid to the exclusion of any two points.

I bet every single person working in healthcare believes Euclid and his idea about the two points.   The thing is that Mr. Euclid never met our healthcare system.

Healthcare’s two point believers are big on things happening in a straight line.  They have to be.  We go with what we know—la plume de ma tante.

People call.  We should talk to them.  Buy a bunch of phones.  The shortest distance.

In healthcare there are no shortest distances.  The distance between any two points, A and B, is at best a meander if you are the person trying to access the health system.  It is a journey filled with little side trips. Side trips unwanted by the callers.  Most of the time multiple calls are required to get from A to B. On some of the side trips callers listen to a recorded voice.  One some calls they get to do that more than once.  They learn about waiting.  They learn how to ask the same question of multiple people.

And sooner or later callers start asking themselves the question, “What is so special about getting to B anyway.”  They decide to stay at point A, and nothing is going to budge them.

Healthcare Consumerism: Are You Chasing Crop Circles & Dust Bunnies?

This piece may ring true for anyone who has ever mowed their lawn more than once.  The first time you cut it your only objective is to turn tall grass into low grass. It is April or May, and the temperature may be in the high seventies.  By July, the temperature and humidity are both in the nineties, and your goal is to create low grass as fast as possible.  You are not worried about making straight lines, or about carving crop circles on the lawn; you simply want to finish quickly.

After a few years of mowing you trimmed thirty minutes off of what was initially an hour-long task.  You are familiar with the task.  While some think familiarity breeds contempt, it also breeds efficiency.  Do something often enough and you figure out how to delete all of the background noise.  You become a savant at creating shortcuts.

Chances are very good that the people who answer the calls to your organization, your health system, or your clinic have learned to do the same thing.  If the average call center agent speaks with ten people an hour, they answer eighty calls a day.  That is about twenty thousand calls a year.  They are extremely efficient, albeit probably not very effective.  They are not wasting time carving crop circles either.

Every phone call is a separate event, statistically independent. What if the odds of meeting the caller’s needs during their first call are fifty-fifty—in actuality the chances of being successful are probably closer to sixty-forty, but the math is easier, and a sixty percent success rate is far from laudatory?  Back to the math.  What then are the chances of your call center agent being successful four times in a row?  About six out of a hundred.  So, of those twenty thousand calls a year, even at a 60:40 success rate, that yields 8,000 dissatisfied callers, 8,000 people who will either call again, adding clutter to the call center, or worse yet, who won’t call again.

How many of them were patients, or who were people who were considering being a patient?  You see, having a call center is not about the call.  It was never intended to be about the call.

It is about the caller.  And that is the point most people do not get.

If you ever attended one of your high school reunions, one of the things you may have observed when you reconnected with someone with whom you have not spoken to in decades is that your emotional connection to that person probably picked up right where it left off.  It was as though all of the time between the two conversations did not exist.

If you were fond of the person when Nixon was busy wiretapping the democrats, you likely resumed your conversation with the same affection.  If you thought the person was a jerk forty years ago, you’ve probably spent the last decade refusing their request to friend you on Facebook for the same reason.

People remember their emotional connections with individuals, organizations, and health systems.  Those emotional connections are cumulative.  The same holds for patients and customers.  Their emotional baggage accumulates like unswept (past participle of swept—I looked it up) dust bunnies under a bed.  And it stays hidden until some force pulls it back from the dark side.  And the funny thing about the emotional relationships people develop with companies is that the accumulated detritus of the relationship never goes away.  It remains at its past worst level until an event causes it to move to a new worst level.

At some point, that emotional connection hits a point of no return for your patients and customers.  And that is when they decide they are not willing to invest another erg (a unit of energy equal to 10−7 joules) of effort to remain with you.  The relationship required too much exertion, provided too little reward, and the exertion—reward ratio became worthless; like trying to divide by zero.

Most organizations use the trite phrase when it places patients and customers and family members on hold—your call may be records for quality purposes.  You may listen to the recorded call and conclude, we handled that well.  You may have indeed done just that.  But, how well did you do on the last three calls?  How well did you do when you had to transfer the caller, or when you simply gave the caller another number to call, or when you were not able to let them speak with a nurse, or when you told them that the office would not be back from lunch for another thirty minutes?

Caller’s emotional dust bunnies get bigger and bigger. They accumulate mass.  Like a little snowball starting to roll down a hill.  Inconsequential at first. But let it roll unimpeded for a long enough time and you have an unabated force.

Companies like Studer earn their keep by trying to get you to buy-in to the notion that you only get one chance to make a first impression. Teach your employees to smile when they talk to your patients.  What the teach-you-to-smile firms fail to recognize is that first impressions were made a long time ago.  They cannot be unmade.  The impression was made the first time a patient or customer called, or it was made when they went to your system’s website and couldn’t accomplish what they set out to do.  It was added to when your neighbor told you that she spent two hours on the phone trying to schedule an appointment.  It was reinforced when your father couldn’t get anyone in billing to explain the twelve dollar charge on your bill for the Tylenol.

Just because the radiology technician smiled at the patient today during their first interaction with that particular patient will not solve your problem.  That patient has probably had years of interactions with your health system.  Today’s MRI was not their first rodeo.

Until recently, in the patient’s mind, this has always been a zero-sum game.  Good relationship. Deteriorating relationship.  Bad relationship.  Game Over.  Today providers face an additional player in the access/experience/satisfaction game.  While your patients are scoring you they are also scoring new providers, providers like CVS and Doctors on Demand.  At some point it occurs to them that their satisfaction scores with their other providers are always good.  Then it occurs to them that they can rely on some combination of those other providers to provide most of the services that they used to rely on you to provide.

They pull out their two score sheets.  One sheet reads—Good experience. Convenient. Good price.  Good healthcare.  That is when they realize that they no longer need two score sheets.

It’s about the caller not the call.  It’s about the thousands of dust bunnies.

Healthcare Consumerism: Should You Build A CVS Minute Clinic In Your Lobby?

“I remember where we kept those extra life vests,” the porter shouted in the water of the icy northern Atlantic.

There were roughly 900 crew members on the Titanic, most of whom performed menial tasks, tasks that were to be accomplished without ever being seen by the paying voyagers.  While many of the crew serviced the passengers, a larger group serviced the ship.  They washed the laundry, hosed down the deck chairs, and polished the miles of brass railing. The ship was staffed to do almost everything that needed doing with the possible exception of having someone in charge of making sure the ship did not sink.

A slight oversight when you think of all the other functions they did not overlook, but one that would prove to be a little more important than making sure the handrails on the aft-deck gleamed.

It should make you want to ask who is running the show.  I ask that question frequently when I look at where the provider healthcare business is headed.  Somebody should be asking, “Is that an iceberg up ahead?”

Providers, large and small, have someone or some group whose mission in life is twofold; spot the icebergs, and tell someone about them.  Those brass-polishers are most often called business planners or strategists.  They often reside on the org-chart in a tiny box labeled strategy, and they report solely to the chief executive.

Strategery.  A term coined on Saturday Night Live.  Let us draw a quick distinction between the term strategy and the term strategery.  Strategy is actionable.  Strategery is not.  It is no more real than the Easter Bunny, and holds no more value than a three-dollar bill.

An example of a valid provider strategy would have been seeing that consumerism was about to grow exponentially, and developing a plan to either turn it to your advantage, or at a minimum developing a plan to ensure it did not hit your system over the head with a two-by-four.

On the converse, a provider strategery would be recommending that the system’s flagship hospital redesign its lobby to make it look like a safari theme-park, and adding a taco bar to the cafeteria.

One adds value; one does not.

If you search Google, there are many examples of provider strategeries.  I read several of them. I then searched to see if I could find a single provider strategy that inventoried the relevant pressing issues and detailed a plan about that provider’s plans to attack those issues.  I could not find a strategy.

There seem to be two basic flaws inherent in most provider strategic plans:

  • They are not strategic
  • They do not include a plan

Most businesses begin to die the moment they open their doors.  Some work harder at it than others.  Those which die the fastest are those that mistakenly believe that a budget is the same thing as a plan.  The whole organization is expected to participate in the budget process.  IT needs additional capital to buy more stuff because the last stuff they bought did not add much value.  Marketing needs more money to attract and capture new patients even though they cannot identify by name the last patient they brought into the fold.  .

It is easy to tell the focus of a health system’s business strategy.  Just review the approved budget.  If you do you will find line dozens of line items that will add no more value than polishing the Titanic’s brass railings.  Strategery.

What you probably will not find are dollars allocated to undertaking tasks dedicated to keeping the organization in business.  Strategy.  Notably missing are investments towards and accountability for:

  • Consumerism and delivering retail services
  • Interactive digital access
  • Customer acquisition
  • Patient retention and referral
  • Backend leakage prevention
  • Frontend leakage prevention

Ask yourself this; how many dollars of revenue is your health system forecasting from delivering retail services and consumerism in 2018?  Is there a line item, or any mention in the annual report stating, “By 2018 we expect twenty-percent of our revenues, and ninety percent of our revenue growth, to come from delivering retail services?”  I am willing to bet my neighbor’s BMW that your system has not written anything even close to that.  And if it hasn’t those revenues will not exist.

The health system, Our Lady of Non-Innovation, will continue show year-over-year revenue growth.  Usually they accomplish this business wizardry by acquiring another organization. Net-net, they haven’t really grown at all.

The big trend in the nineties was the addition of coffee kiosks that proudly served Starbucks.  I am willing to bet that before this decade is out more than one health system will have explored the notion of entering consumerism by placing a CVS Minute Clinic in its lobby.  Strategery.

Remember, you read that here first.

Something magical can happen only when an institution turns a thought into written words.  The next time you are sitting in a meeting and wondering whether the Cubs are winning their afternoon game, do this.  Leaving plenty of blank space in your leather notebook write these three words: issue, opportunity, approach.  Then fill in the blank space.

And then show what you wrote to someone.  Who knows, maybe that someone will have written the same three words.  And if they did, you now have your own planning committee.  That is as far as I am willing to take you today.  The rest is up to you.

Should You Buy The Pistachios? How To Improve Patient Experience

imagesI read today that someone high up in the government commented on the fact that ISIS’s use of mustard gas may have just been a step too far, “something civilized people do not do.”  Perhaps the person who commented had not heard about the beheadings and the other butchery, or perhaps in the view of the government all of the other atrocities were not considered to be a step too far.  Sorry for opining, but sometimes things make me want to scream epitaphs.

Anyway, I’ve always enjoyed observing people.  Recently I’ve spent my weekends volunteering at a large produce center, serving hundreds of people each day.  Plenty of time to make observations.

And I’ve observed something I believe may be helpful;to  at least half of you.  A lot of couples come to the center.  And one half of each couple does not need to be there.  But he does not seem to understand that he does not have a purpose.  Most of the men walk a few steps behind the woman.

Sometimes the male half of the partnership will sneak up to the counter by himself, with a smile on his face like a puppy who just found a ham sandwich sitting on the couch.  He will scan the fruits and vegetables with a sense of anticipation, an anticipation built around the idea that he is about to decide what to buy all by himself.

I see him working up the courage to decide between buying okra or roasted pistachios.  He looks quickly over his shoulder.  He doesn’t see her.  He asks for the pistachios.  Even though I know what will happen I humor him and hand him the nuts. Only then does he realize that she did not give him his allowance, and that he is going to have to ask her for the money.  He now looks like the puppy who was caught eating the ham sandwich.

She walks up and asks what he is doing.  “You can’t have those,” she insists.  “You know they give you gas.” He then asks for a bad of red apples. “You still have those apples you asked me to buy you last week,” she tells him.  I think I see his Y chromosome trying to beat a path to the door.  The guy to his left feels for him, but he is standing next to his wife, and he knows he is not allowed to show his support.

She looks at me.  I simply shrug my shoulders.  “I thought about warning him,” I told her, “But somehow I knew you would make sure to tell him he had overstepped his bounds.  You might have let him buy the okra, wouldn’t you?  Just to humor him.”

She gives me a slight wink. “The men are slow to catch on to the fact that just because they are let out of the house to go for a drive doesn’t mean that they are off the leash.”

The couple behind them comes to the counter. I can see that in his hand is a small piece of paper.  Written in crayon on the paper, a badly misspelled is a list of items he planned to purchase.  He looks me in the eye, almost pleading for my help. I simply shake my head and he crumples the paper and shoves it into his pocket.

I believe I could go to the store and manage to buy fruit without making too many mistakes; I just no longer have the courage. I do not know when I lost control, I just know that I did.  “A man’s got to know his limitations.” Clint Eastwood, Magnum Force.

The same principle applies in the office.  I know that watching the show, “Untold Stores in the ER,” does not give me the expertise to insert a chest tube.  But the same concept applies in reverse.  If your entire perspective of patient experience is formulated from the other end of a stethoscope, or from the C-Suite, is it possible that your ability to recast patient experience and access in a manner that aligns with how patients and customers access other businesses may be a bit limited?

Do you know how many times the average person has to call your health system to have their needs met?  If your answer was less than three, your perspective is limited.  Do you know how many business processes your customers can complete on your website?  If your answer was greater than zero, your perspective is limited.  Do you know what types of questions the people in your call center can answer? If your answer was anything other than schedule an appointment, your perspective is limited.

However, the perspective of your patients and customer is not limited.  They know these things. They have to exert a lot of effort to communicate with your health system.

Perhaps the time has come to turn to someone with a better perspective.  And remember, do not buy the pistachios—they give you gas.