Patient Access: Sprinkles Are For Winners

Our perceptions are often based upon our perspective.

The perception of someone inside a building viewing a snow storm may have the perspective, “It is cold”.  The perception of someone standing in the snow storm viewing the inside of the building may have the perspective, “It is warm.”

In thinking through the issues of patient access and patient experience it occurred to me that perhaps the root of the problem is one of perspective.  It must be, unless you believe that healthcare executives are so callous as to not care about the experiences people have when they try to access their institution.

I happen to think some of the conflicts associated with poor access and poor experience have to do with two definitions, namely how healthcare defines the terms ‘access’ and ‘patient’.

Healthcare defines access as access to affordable healthcare.  Healthcare defines patient as someone receiving care even though population health may suggest that everyone living inside the health syste’s radius of care is to some degree their patient.

People—patients and consumers (prospective patients)—define access as their ability to access the health system; the institution.  Those same people define the term patient much more broadly.  For the most part, if they have purchased healthcare from any part of your institution they probably think of themselves as your patient.  Even if they simply live in the area they are likely to think “That is my hospital”.  Please note, this does not imply loyalty, it may just imply convenience.

So, knowing that healthcare executives are not callous, that they want people to have a good experience when they try to access their institution, one must assume that healthcare executives believe people do have good experiences.  Otherwise, those executives would undertake initiatives to improve those experiences.  Perception and perspective.

I think healthcare executives view the access experience their system offers like this.

Everyone is happy.


In the real world, however, the people trying to access their health system using their phones think it looks a lot more like this.


And when you ask those same people how they would like to access their health system it looks a lot more like this.

images (1)

Those same people access their bank with a smart device, and Doctors on Demand, and their phone company.  And they buy cars using a smart device, and they get a mortgage.  And they do this whenever they want; not just Monday through Friday between 8 and 5. The only thing they cannot do using a smart device is access their healthcare.

Patients know healthcare can fix this problem.  What they do not understand is why it doesn’t fix it.

Invite your health system’s leadership out for ice cream, and ask them why they don’t fix access.  If any one of them asks for sprinkles all you need to say is “Sprinkles are for winners”.

Thanks Flo.

Patient Access: Just How Long Is 48 Hours?

What do you know about the number 48?  It is the smallest number with 10 divisors, and the product of all of those ten divisors equals 484. It is also the smallest even number that can be expressed as the sum of two prime numbers in five different ways. It is a Harshad number; that means it can be divided evenly by the sum of its digits.

With 48 matchsticks you can make a triangle in 48 different ways.

In 48 hours an ant could walk a little more than eight miles.  The Apollo rocket could travel two-thirds of the way to the moon in 48 hours.

So, just how long is forty-eight hours, and why is that important?

During lunch today a visited various health system websites.  In no time at all, a period of time less than 48 hours, I found that in the Contact Us section of three health system websites the viewer could submit a question to the health system.  And those three health systems pledged to respond to the viewers’ requests within…say it with me…48 hours.

And I would be two-thirds of the way to the moon by the time I would receive my reply.

Forty-eight hours apparently doesn’t mean much to a health system, but it means a lot to those waiting on the health system. Waiting seems to be a common theme; waiting rooms, waiting on the phone, and now for those with more of a high-tech bent, you can even wait online.

Healthcare embraces the internet!

Maybe the term embrace is a little too strong.  A 48 hour wait time sure seems to undermine the purpose of having broadband.

If these health systems offered a chat function on their website the wait wouldn’t even be 48 seconds.  And why not offer that.  It sounds silly, but it takes the exact same amount of time to answer the question asked by the viewer, whether you do in online, or whether you wait two days to answer it.  No value is added to the answer by taking longer to provide it.

Some healthcare executives are probably thinking, “Well, it can’t be that important because very few people even use that service to contact us.”  Perhaps they do not use it because they have better things to do than wait 48 hours.  The rule of thumb for how long it should take to provide answers online is that they should be provided right away—right away is also less than 48 hours.

A side note: each of these three websites provided a link for people to schedule appointments online. I tried those three links, and guess what? Each link took me to a page that provided a phone number and the hours during which I could call to schedule an appointment.

What Are Patient Access’s Top Three Innovations?

What if you could click on a single link and learn about all of the innovations to a health system’s contact center or call center?  Sometimes wishes really do come true.  In the past fifty years there have been three significant contact center innovations…and they are pictured below.

phone-imagetouchtonecordlesscell phone

Rotary, to touchtone, to cordless, to mobile.  Great innovations. Unfortunately for the health system, and equally unfortunate for the callers, the innovation was not for the health system, it was for the caller.

Going from rotary to touchtone, the caller saved about three seconds dialing before being placed on hold.  Going from touchtone to cordless, while it did not save dialing time, it allowed the caller to do the dishes or feed the cat while they were waiting on hold.  It also allowed callers the ability to hit redial when they were disconnected. And going from cordless to mobile allowed callers to do all of their grocery shopping and get their car washed while they were on hold.

Pretty innovative.  In fact, using their mobile phones to schedule an appointment, the callers could place their call to the health system on hold, and drop by the Minute Clinic, or call Doctors On Demand and do a video visit right from their mobile phone.  And then they could disconnect the call they were making to the health system.  And then they could save the phone number for Doctors on Demand, as a favorite. In fact they could save the number to the same speed-dial location on their phone that they had been using for the health system.

Apparently, Doctors On Demand uses this new-fangled thing called the internet for scheduling and video conferencing.  I decided to do a little research on this internet thing.  Turns out the internet is a pretty powerful tool for businesses and consumers.  I started to make a list of things I could do on the internet and another list of things I could not do on the internet.

On the ‘things I could do side’ of the page I wrote; schedule a haircut, order food and have it delivered, pay my bills, watch movies and listen to music, get a diagnosis and a treatment plan, and buy all kinds of stuff. Oh, and I could also read all about my health system and find out what hours its gift shop was open.  And I could do all of these things any day of the week and at any time during the day and on any device I wanted.

On the ‘things I could not do’ using the internet side of the page I wrote; schedule an appointment with my health system, set up a payment plan with my health system, complete my registration, pre-admit myself, chat with a customer agent about my bill while we are both looking at it, order a refill, change an appointment, monitor my wellness—you get the idea so I will not lengthen the list. To do any of those things I would have to call my health system—say it with me—Monday through Friday between 8 A.M. and 5 P.M.

What should the health system do?  It should design a remarkable access experience for every person at every time at any time on any device.  And until it does that, the number of people using the Minute Clinic and services like Doctors On Demand will continue to grow.  And the people who use those services will use them more and more frequently because people do not want to work hard to do business with their health system.  Many health systems still do not get it.

Maybe this will help.  I calculated that the average Lifetime Value of a patient over twenty-five years is worth between $180,000 and $250,000.  If a health system wants to ballpark the ROI of designing a better access experience, send a team of people with calculators to all of the Minute Clinics within twenty miles of your health system. Have those people count all of the people who use the Minute Clinic for an entire week.  Using those calculators multiply that number by the number of weeks in a year—52 for those trying to keep up with the math, and multiple that number by the Lifetime Value of a patient.

The number you derive will have two or three commas in it.  Let’s call that the opportunity cost to the health system of having an access experience that experience that has not changed since the invention of the phone.

68 Words About How Hospitals Build Call Centers

Step 1: Find A Big Empty Room

big empty room

Step 2: Buy a bunch of phones

Stack of old broken rotary telephones on table.

Step 3: Fill the big room with the phones and people


Step 4: Check the DONE box


There are better ways to approach creating a call center. Ways that involve figuring out what business problems you are trying to solve.  Otherwise, your call center will be nothing more than a big room with a lot of phones in it.

Patient Experience: What Is It You Don’t Know?

I was sitting alone in my client’s office, observing some of the bric-a-brac she had collected during her career.  On one wall was a photograph of her and a former president.  The credenza above her desk contained white binders of what appeared to be various user manuals, each one filed chronologically from left to right.  One binder was labeled, The Purpose Of A Call Center—The Big Room With All The Phones In It.  To the right of it was one labeled, What To Do In The Event Of A Soviet Attack.

The photograph made me wonder how many people had their picture taken with a U.S. president.  Let’s say the president takes one hundred pictures a day. That amounts to around a hundred and fifty thousand photographs during a four-year term.

And here is what I think is noteworthy about having your picture taken with the president.  I am willing to bet that ninety-nine percent of the people who have their picture taken with the president display that picture prominently in their home or office.  They do so because they want to remember the experience, and because they want others to know of their experience.

Having your picture taken with the president is a big deal.  You remember everything about that experience; the date, what you were wearing, even what you ate for breakfast that day.

Now for the irony.  If you were to visit the Oval Office, or the president’s living quarters on the second floor of the White House, you would learn that he does not have the photo of the two of you displayed in a prominent position.  In fact, he does not have it displayed anywhere. Nor does he have any of the other one hundred and fifty thousand photos on display.  Pressed, he will not remember the date he was photographed with you, what he was wearing, or what he ate for breakfast that day. He would not even remember you if he sat next to you on the plane.

Here is the distinction.  He is the only president you met, so it is easy for you to remember the experience.  You however are merely one of a hundred and fifty thousand people he met, and chances are there was nothing special or memorable for him of your interaction.

And here is how the point relates to the business of healthcare.  The people who answer the phone at your health system’s call center—the big room with all of the phones in it—probably speak to a hundred different people each day, five hundred a week.  Twenty-six thousand people a year.  After a while, one call sounds like the next to the people answering the phones.  The calls all blur together.  The call center agent will not recall the date she spoke with one of your patients, or what she was wearing that day, or what she had for breakfast.  It is sort of like the president remembering the person in any single photograph.

Now, what if we reverse the roles and look at the call from the perspective of the caller—the patient or the consumer on the phone.  That caller, every caller, will remember every detail of that call.  They will remember how long they were placed on hold, how many times their call was transferred, and how many times they had to call your health system.  They will remember the date of their call, what they were wearing that day, and what they had for breakfast.

And if they had to call more than once, their ability to recall their experience will be reinforced.

People do not want to call your health system any more than they want to call Verizon.  They call because they have to.  They call because they have no real alternative to calling.  One in four callers, no matter how good their experience during the call, will think about changing providers just because they had to call.

The bad news is that nobody in your health system knows what kind of experience any single caller had.  They do not know because they do not ask.  More people, patients and consumers, interact with your health system by phone every day, than in any other way.  Most probably wish they did not need to call.  Most hope they will not have to call again.  And many won’t call again.

And if you are keeping score, that is a bad thing for you.

Patient Experience: What is the ROI?

As a parent I’ve learned there are two types of tasks–those my children won’t do the first time I ask them, and those they won’t do no matter how many times I ask them.  Here’s the segue.

Hospitals have a gazillion business systems.  Every business system can include the following three things; people—doing things, processes—the way and order in which things are done, technology—whatever part of those things that may be automated.  Two examples of business systems—ordering your meal in the drive-through lane at Burger King; open heart surgery.

Believe it or not, from a process standpoint, each of the hospital’s gazillion business systems can be sorted into one of two buckets—Easily Repeatable Processes (ERPs) and Barely Repeatable Processes (BRPs).

An example of an ERP industry is manufacturing which executes identical business systems thousands of times—clean the Pepsi bottle, fill the bottle with Pepsi, put on the bottle cap, and place the bottle in the box.

Healthcare, in many respects, is a BRP industry. BRPs are characterized by collaborative events, exception handling, ad-hoc activities, extensive loss of information, little knowledge acquired and reused, and untrustworthy processes. They involve unplanned events, knowledge work, and creative work.

ERPs are the easy ones to map, model, and structure. They are perfect for large enterprise software vendors like Oracle and SAP whose products include offerings like ERP, SCM, PLM, SRM, CRM.

How can you tell what type of process you are trying to incorporate in your effort to improve patient experience? Here’s one way. If the person standing next to you at Starbucks could watch you work and accurately describe the process, it’s probably an ERP.

So, why discuss BRPs and ERPs in the same sentence with patient experience? The answer is quite simple.  Think of BRPs—barely repeatable processes—as those processes associated with HCAHPs; exception handling, unplanned events, and knowledge work.

Think of ERPs—easily repeatable processes—as those associated with all of the back office support processes patients and prospective patients have with the health system.  Access processes.  Those include:

  • Scheduling an appointment
  • Scheduling labs & therapy
  • Requesting medical records
  • Getting information about whether a second opinion is needed
  • Admissions
  • Billing
  • Payment
  • Submitting a claim
  • Queries
  • Complaints

Here is what is unique about a hospital’s ERPs:

  • Every time a patient or prospective patient tries to complete one of these processes they have an experience
  • That experience is either satisfactory or unsatisfactory
  • The hospital has no idea if the person was satisfied
  • The hospital has no idea if the person will continue to be or will ever become their patient
  • All of these processes happen outside of the hospital
  • They happen on the phone and on the internet
  • They have nothing to do with HCAHPs
  • Hospitals do not measure these processes
  • Hospitals do not try to improve the effectiveness of these processes

Hospitals behave as though these processes have nothing to do with patient experience.  Just because hospitals do not acknowledge the existence of or the importance these systems have on patient experience does not make them irrelevant.

True story—a Top 5 US hospital.  A cancer patient between treatments who is experiencing the after effects of chemo calls the hospital to schedule a follow up exam.  She spends almost three hours on the phone.  She told me that because of that one event she will never recommend that hospital to anyone.

Now to the meat of the matter; money.  Healthcare may argue that they are not in business for the money.  While that may be true, they are not in business if there is no money.  So let’s talk about dollars.

  • One study concluded that each time someone contacts a hospital the potential revenue in play is seven thousand dollars.  Provide a good experience during that contact you keep the money.  Provide a bad one and some other hospital gets the money.
  • The average lifetime value of a patient is between $180,000 and $250,000.
  • The average lifetime value of a person who chooses a hospital other than yours is zero.
  • The cost of poor experience is low patient retention and very low referrals.

The taxonomy of 99% of existing patient experience business systems is that they are ineffective, unmeasured, and proving awful experiences at the places where people touch the health system—the phone and the web.

Ignoring these aspects of patient experience is no different than having your hospital’s CFO drive down the highway while pouring bags of money from the window.

What do you think?

Patient Experience: Are You Chasing Mediocrity?

People will tell you that health systems cannot sell them anything even though they have large marketing and business development departments.  Patients are not sold healthcare by the health system, they purchase healthcare from the health system.  Patients hold the power.

If you want to build your business stop trying to sell people your services.  Instead, make it easy for them to buy your services.  Become the health system that is easy to do business with.

Unfortunately, few if any health systems are doing that.

What would happen if a fifty-four hundred people (one person for every hospital) were standing together in a field, and they each took one step forward.  The next month they did exactly the same, and so forth and so on, ad nauseum.  The crowd would certainly have changed places, but relative to one another the individuals would all be about as far apart from each other as they were when they started.  Not much would have changed, at least not much that was noticeable. To a prospective buyer all they can see is a lot of chaff and no wheat.

Now what would happen if one person—or hospital—decided to be innovative and did something disruptive and separated themselves from the crowd?  What if hospital sprinted in a different direction?  They came to a fork in the road and they took it.

With every hospital’s focus on HCAHPs, it can be argued that they are all moving across the field somewhat in lock-step.  Now before anyone gets the notion that I am arguing that hospitals should stop focusing on HCAHPs that is not my intention.  Improving HCAHPs is a good thing.  Getting each hospital moving towards one hundred percent in all categories is a good thing. Sort of.  Just remember, nailing HCAHPs is not the same thing as nailing patient experience.

With every health system taking one step forward on their goal to improve the patient experience of each surveyed patient, who then is responsible for moving the organization forward for improving the satisfaction of all patients?

Doing what every other health system is doing is not innovative.  It will neither drive patient retention or referrals, nor will it improve the satisfaction of those people, patients and prospective patients, who visit the hospital via the web or by using the phone.  It will also have little or no effect on those who were surveyed—they have already been discharged.  It will also have a similar effect on those who were not surveyed.

Innovation is the application of new solutions to meet needs or changing market requirements.  For innovation to work an organization must acknowledge a problem/opportunity.  Like a 12-step program. Hi, my name is Paul and we have a patient satisfaction problem.

The health system that chooses to separate itself from the pack will recognize that most of an individual’s satisfaction with their interaction with the health system happens outside of the hospital’s four walls.  It happens before they are admitted and after they are discharged.

I like to define it as follows:

The total quality of a person’s (patient & non patient) encounter is equal to the sum of the Patient’s Experience (HCAHPs) plus Patient Satisfaction (all of the other interactions they have with people, process, and systems.)  If your health system has not totally reinvented those interactions in the last three years the access experience you are providing is well below what it could be.