Something lite on trying to eat healthy

I mentioned that I am participating in something dubbed the Whole Life Challenge.  Fifty-two days eating nothing but air.  Trying to get into the spirit of the event, I went shopping at a whole foods store. From the outset, I sensed trouble, for the phrase ‘whole foods’ made no sense to me. Had I been eating ‘half foods’ my entire life?

The display case near the door had small bags of something called ‘Bark Thins’—second sign of trouble. I slipped past the bark without having to avoid stepping on any leaves or acorns.

Knowing I had to cut back on what I liked to eat, I thought I would add some flavor to what I had to eat to complete the challenge. I went to the aisle that displayed various flavors of oils in a way that reminded me of how an upmarket wine store would display its choice Beaujolais.

I inquired of the oil sommelier where I might find black truffle oil. The truffle oil was in a locked display case, in bottles the size of what you would find in your hotel minibar. When I saw that they were priced at an amount one might expect to pay for a whole truffle, I understood why the bottles were under lock-and-key. Perhaps the truffle-finding-hogs in France’s Périgord region were used to stomp the oils from the rejected tubers.

My stomach was starting to rumble, so I asked for directions to the meat emporium. The employee from whom I sought help had hair the consistency of the threads covering a coconut husk and organic metal implants threaded through both eyebrows. I asked her if she was a vegetablist.  She did not attempt a smile, and reluctantly showed me to the meats.

If something without opposable thumbs flies, swims, hops, crawls, or walks, I’ll eat it.  I will sauté, braise, roast, grill, poach, stir-fry, boil, broil, escallop, fricassee, parboil, or simmer anything that strikes my fancy, especially if it has hooves.  I like meat—the smell, the taste, the texture, and how it appears on my plate next to a sprig of cilantro.

Permit me to ask the carnivores who may be playing along, “Have you ever walked into a dinner party and introduced yourself with anything close to the following? ‘I’m republican and a carnivore.  May we slaughter the fatted calf?’”  Probably not, but I was sorely tempted to ask that of my vegetarianess tour guide.

The whole foods meats did not look like they were sold in whole portions. Each piece of meat could have fit nicely on a Wheat Thin, with plenty of room left over for a gherkin. A tablespoon of au-jus would have drowned the petifore-sized comestible.

Thirty minutes into my adventure, the only item in my organic basket was my truffle oil miniature.  I was tempted to purchase some raw macadamia nuts until I realized that the price was for an ounce rather than a pound.

All in all, I am looking forward to the next forty-nine days and seven hours of this exercise. As I was paying for my truffle oil, I asked the clerk if they had any organic, beef-flavored gum. She, too did not find me amusing.

Adding insult to injury, I had to pass a McDonalds on the way back to my car.

PX for Medical Practices: Is it a Zero-Sum Game?

This is day one of a ninja whole life challenge I entered. I began it with an omelet of egg whites without the whites, a sweet potato sorbet, and two bottles of dehydrated water.  After breakfast I had a massage; my first.  The room looked like an organic bookstore, and smelled of a collection of herbs and oils from the Far East, perhaps as far east as Newark. The CD played an infinite loop of soft sounds that reminded me of a yak herder and a wood nymph playing panflutes in the Andes, who I imagined was wearing a poncho woven by vegetarians, made from hand-carded wool of Peruvian alpacas.

Apparently, forty-thousand people have enrolled in the health challenge. I am willing to bet that I will be the only one needing a mulligan on day one as I am headed to an all-you-can-eat crab feast for dinner. Perhaps the fact that I will be eating seafood means I can collect a bye.


Around seventy percent of all interactions between a medical group and a person—patient/customers—occur on the phone. Not really surprising except for the fact that many medical groups and health networks treat patient experience as a poor stepchild, especially when it comes to the people on the phone.

So let’s say that thirty-percent of the interactions, those done in-person at the medical group provide an unbelievably good experience.

The other seventy percent of interactions are a combination of random experiences that provide the caller with levels of satisfaction such as:

  • “Our office is closed at the moment…”
  • “We are at lunch between…”
  • “May we call you back?”
  • “May we put you on hold?”
  • “Dr. Roemer is not accepting new patients.”
  • “We do not do refills over the phone.”
  • “The person who handles billing is out today”
  • “Can you arrive early to fill out the forms? No, they are not available online.”

Is it really cheaper to invest so little in the experiences provided on the phone? Do providers have such a hold on their past patients that those patients would never consider going somewhere else?

Many executives continue to look at calls and callers as a cost or cost-center. Many of those same executives spend money to make outbound calls to attract patients. It is a zero sum game to attract patients only to send them away. Here is another one of Roemer’s Immutable Laws:  Calls and callers are not a cost. A poor call experience is.

Some health networks approach improving the situation the same way they handle improving their HCAHPS scores—they hire a firm to try to throw a little water on the problem; they hire a consultant and coach. And what do the expensive consulting firms and coaches do for them? From the confines of my small mind I would say not much.

For the most part, coaches sell smiles. When you are speaking with someone on the phone, make sure they hear you smile. Now there’s a value-add.  Here’s another one of Roemer’s Immutable Laws: A smiling phone agent is worth less than zero if the agent puts you on hold, transfers your call, or gives you the wrong answer.

Many call center consultants will attempt to solve your problems by telling you your solution can be found by adding technology and speed—efficiency. Too many people are on hold and too many people are abandoning the call—disconnecting. If that is how they view the symptoms they will propose one of two solutions—hire more agents (to spread the workload) or have your call center agents, the people answering the calls, talk less, thereby allowing them to talk to more people.

Neither of those answers will improve the experience for the callers.  What will improve their experiences are the following:

  • Design the caller’s experience
  • Give the people answering the phones the tools they need to provide the caller with the right information
  • Add a self-service IVR to allow callers to get what they need without having to speak with someone
  • Offload certain call types to the web to allow callers to do what they need without having to call you

Or, you can simply give callers the phone number for the Minute-Clinic.

Please consider joining  the LinkedIn group, Patient Experience Think Tank

What are Patient Experience’s 3 Immutable Laws?

I was observing the heads of my fellow passengers on the Amtrak train.  As the train angled left, the heads of the people in front of me leaned in unison and unanimously to the left.  An angle to the right yielded a similar bobble-head response to the right from everyone. For some reason the action and reaction I witnessed reminded me of a lot of meetings I had attended.

As I took my new MacBook Air out of the box, I looked to see if I had misplaced the operating manual. I found a piece of paper somewhat smaller than a cocktail napkin.  Instead of the words “Instructions” or “Manual” the piece of paper simply stated “Designed by Apple in California.”

Enough said.

User Interface. User Experience. Designed by Apple in California.

My first user experience with anything from Apple was several years ago when I downloaded iTunes. I did not know how to use it then. Because the user interface for iTunes delivers such a poor user experience I still do not know how to use it. In fact, I never even try. After three decades on a PC, switching to Mac feels like learning to use a fork with my other hand.

Two products from the same company. One requires no manual, the other requires a tutor to follow me around. Everything comes down to how easy is the product or service to use. Most people will not invest much time to learn how to use anything.  They will however invest time to find a similar product or service that is easier to use.

One of the services with which we are all familiar is healthcare.

Roemer’s First Immutable Law for Providers: Designing Access is the Most Important Initiative You Can Undertake.

The first time most people—patients and customers—will ever encounter your organization is when they try to access it, when they try and have a meaningful interaction with it. Here are components of Roemer’s 1st Law:

  • If your phone is busy your callers will hang up (feel free to add the words “and call another provider” to each of these)
  • If your callers are placed on hold they will hang up
  • If their call is transferred they will hang up
  • If their needs are not met when they call they will…call another provider
  • If I go to your hospital’s website and the link for the Gift Shop is as prominent as the link for Patients they will go somewhere else
  • If your website has dozens and dozens of links and nothing for them to do they will…go somewhere else

And who are these people who are calling and going to your website?  Roemer’s 2nd Law: Every caller and reader of your website is a potential patient.

Most website visitors are not patients. Thousands of the callers are not patients. These people include the sick, the well, people who are concerned they may be sick, family members, visitors and people at Starbucks.

The reason they are trying to access your hospital is that they want something from it. They may want healthcare. They may want to talk to Aunt Irma in room 312. Roemer’s 2nd Immutable Law For Providers: Patients and Customer do not want to have to work hard to get what they want.

Why is that? It is because nobody designed stickiness into the experience, into the user interface. Stickiness is created when someone interacts with the organization and comes away saying, “That was okay”, “That was really good”, “That was worth my time”, “That was remarkable.”

For almost every hospital, someone going to your hospital’s website is not an exercise in access because there is nothing for them to access; it is mainly a reading exercise. See spot run. Aren’t we a great hospital?  No reason to have gone to it and certainly no reason for anyone to go to it a second time.

Roemer’s 3rd Immutable Law for Providers: If you make me work hard to do business with you I will go somewhere else.

Each caller and website visitor has a potential Life-Time Value to a provider between $180,000-$250,000.  Your hospital may employ a hundred people in marketing and business development. Their mission in life is to try to get people to call the hospital and to go to the website.  Why spend a great deal of money to entice people to check out the organization if people are going to have a poor experience? When people make the effort to visit you, if they have a less than stellar experience they will leave.

Patients leave before becoming patients and they “leak” after receiving services. That seems like a very unsustainable and expensive business model, especially since nobody knows how many or why or when people leak, or which ones do not call back or return to the web site.

Patient Experience: $100M in Free Revenue for Your Hospital

Did you know that fifty-percent of patients who have selected a provider will seek a second opinion?  That means that fifty-percent of the people who chose your hospital will want information from another hospital or physician. It also means that fifty-percent of the people who chose a hospital other than yours will be seeking a second opinion, which means many of them will be contacting your institution.

However you do the math, seeking a second opinion means that over the course of the year your hospital will be hearing from as many as tens of thousands of people seeking a second opinion. And what is the question they are really trying to answer?  They are trying to answer the question—should I buy my healthcare for this situation from your hospital?

For a moment, let’s consider the officer of the Chief Financial Officer.  That person’s job is to make sure that the amount of money coming in is greater than the amount of money going out. If we look first at the going out side, it becomes apparent that the CFO wants to minimize spending money on activities that do not create a corresponding inflow of cash.

Patient acquisition costs are one of those gray areas because marketing and business development spend lots and lots of money trying to attract new patients.  And what makes that exercise difficult for the CFO is that nobody on the planet can tell the CFO what it costs to acquire a single patient. In fact, nobody can even tell you if the money spent on business development and marketing even reaches breakeven.

Add to that fact the fact that fifty-percent of patients who are scheduled to buy services from your institution are wondering if they made the right purchase decision. If they choose to go elsewhere, what you have are your patients making a decision not to be your patients.  They are making a decision that makes the CFO’s job more difficult because a great deal of money that would have been collected never even gets billed.  This is turn means that the people in business development and marketing have to kick it up a notch to replace all of those people who will be going elsewhere.

On the good side of the balance sheet though are all of the people scheduled for treatment at all of the other providers, people who may seek a second opinion from your hospital.

What is your point, you ask.

Allow me to use simple numbers so neither of us has to use a calculator—you can substitute your own figures. If your hospital sees 20,000 patients a year, and half of them (10,000) seek second opinions, what if half of them (5,000) went somewhere else?  Let’s assume an average total treatment amount of $10,000 per patient.  That amounts to $50,000,000 that just walked away from your organization, most of it without the organization’s knowledge, or a plan in place to prevent the loss, or a visible vehicle to help patients to choose to stay with you.

Knowing that the other hospitals in the area are undergoing the same process, your hospital has the chance to capture revenues from the other hospitals.  Whether you get your fair share of those revenues is a bit of a crapshoot since your hospital does not know that those people are looking elsewhere, it does not have a plan in place to capture those individuals, and it does not have a visible vehicle in place to help those patients choose your hospitals.

From the way I see it, these numbers reflect a potential revenue swing of as much as $100,000,000.

It would be easy to find fault with the math, or the variables, but somewhere in this argument are free revenues.

So my point is, why not at least have a big, blinking link on the hospital’s home page along with a plan along with resources and along with a phone number to address:

  • If you are thinking of going elsewhere, let us tell you why you should stay with us
  • If you are thinking of leaving your provider and coming here, let us tell you why we are a good choice

This seems to be a much more effective way of keeping and attracting people you know need to purchase services now, than the approach of putting up a billboard with a picture of the urology group in the hope that they may become patients later.

I went to the websites of several well-known hospitals. None of them offered help for second opinions.

The average person probably does not know the first step about how to go about getting a second opinion—who do I call, what will it cost, will my insurance cover it?  Why not help those people be creating a phenomenal patient experience that not only helps them but leads them to your door?

What is Patient Experience’s Wow-Factor?

I spent way too much time this morning drafting a creative piece on where innovation exists in healthcare. To my chagrin I was stumped with regard to developing a cute analogy that segued into anything that would be worthy of your time and mine.

Maybe what follows will pass the test. If it does not, I apologize.

If asked, most of your employees would probably describe your organization as highly innovative.  Would those same people be able to describe the most impactful innovation in the last two years? Would they be able to describe a single innovation? Do they know who is in charge of innovation? If the answer to those three questions is not a universal and resounding ‘yes,’ then perhaps the term innovation does not really apply to your organization.

When I look at healthcare from one perspective, the perspective of the services it delivers, I see an industry that is the poster child for innovation.  Our system of healthcare delivers healthcare services that others have yet to think of.  As an example, a few months ago I watched a video of a skin cell be transformed into a beating heart muscle cell. If you Google “healthcare innovations” all of the hits have to do with the healthcare services we are able to deliver.

However, when I look at the industry from the perspective of how providers and payers operate their businesses, the term innovation does not jump out at me.  If the healthcare services delivered are reflective of a 2.0 business model, how then can the way the businesses operate continue to function under a 0.2 business model?  Because of this, is it reasonable to assume that the industry actually operates in a 1.1 model (2.0 + 0.2)/2 = 1.1?

Does the 0.2 portion of healthcare water down or dilute the value of the 2.0 services it delivers?

I think it does, or at least it makes the acquisition of those services by patients (customers) much more tedious for those doing the acquiring.

The purpose of innovation is to bring something new to the market that is so compelling that it will make customers in any industry leave one provider for the other. It is so compelling that it will make those leaving choose to stay with their new provider. It will compel those who changed providers to advocate to others that they join them.

We have just described an innovation strategy that brings about:

  • Patient Acquisition
  • Patient Retention
  • Patient Referrals

And since nobody seems to know what it costs to acquire a patient, innovation should be a strategic focus. Given a lifetime value of a patient of between $180,000 and $250,000, one should argue that innovating to acquire patients, retain them, and earn their referrals offers a substantial ROI for a very reasonable investment.

Can it also be argued that innovation can be applied to reducing readmissions by twenty percent or more, and to dramatically enhance the revenue cycle by being innovative?

It can indeed.

People need two things from their provider; they need to get well and stay well, and they need to be able to interact well with the institution.  The notion is so simple it is silly—if people cannot easily do something as basic as scheduling an appointment, they will not buy services. Or they will not buy them more than once. And they will not refer others.

So, just what is this innovation that can do all of these wonderful things?  Sometimes it is easier to first make the point of what it isn’t.  Adding valet parking, free Wi-Fi in the lobby, or a Starbucks coffee cart are not examples of innovation. Neither is implementing a new ERP system or enhancing the organization’s website.

Innovation should have heft. It should foment change.

Innovation is not only about doing things that other organizations are not doing, but discovering and doing those things that offer compelling reasons for your customers and theirs to switch their business to you, to stay with you, and to compel others to join you.

Some examples of firms that have innovated how people do business with them include:

  • Netflix: eliminated what their customers did not see as convenient or valuable processes; two trips to get and return the video, eliminated the rewinding, late fees, and offered unlimited rentals for a single fee
  • CVS: eliminated calling the PCP, scheduling the visit, and having to drive to the pharmacy for medications. CVS just added the ability for people to refill their prescriptions by taking a photo of their prescription bottle
  • Banking: instead of having to deposit a check at a bank or ATM, people can deposit the check electronically by photographing the check.

And here is the part that most of their customers overlook. The innovation wasn’t just a win for the customers, it has been a huge win for the institutions who innovated.

So, how does knowing what Netflix and CVS did help my organization understand what we should do to innovate?

Being by looking at what your organization would have to look like from the perspective of your customers to create a remarkable user experience each time someone interacts with it—in-person, on the phone, and online.  Start by asking your organization’s stakeholders; customers and patients. Then define the wow-factor, define remarkable—not better, not new and improved. And then design that remarkable experience at each touch point.  You will know it when you see it because people will tell you when they see it.

What Happens When Patient Experience Encounters Spiderman?

I had some questions for my provider.  That is not accurate, I had a bunch of things I needed to accomplish, and questions I had been saving up for the simple reason that I did not want to put myself through the process of interacting with the hospital multiple times. I thought it might hurt less if I did them all at once.

Some of the things and questions on my provider to-do list included:

  • Scheduling a follow up appointment
  • Refilling two prescriptions
  • Setting up a payment plan for myself
  • Learning how to file a dispute with my payer
  • Getting additional information regarding my discharge orders
  • Learning if there was a way for me to add personal health data to my health record
  • Get a copy of my personal health record
  • Learning if I could track my vital signs, diet, exercise, and medications on their system.

I thought I would try get some of these sorted on the phone and others online.

As I was reveling that I was able to do all of these with a single call and a single visit to the hospital’s customer portal my wife woke me.

“You were having that crazy nightmare again, weren’t you?” She asked.

“What nightmare?” I wondered.

“The one where you suspend disbelief, and you go to that hospital’s website and do all of those things . You have that dream every time you wear your Spiderman pajamas. Tonight you wear your Flintstones pajamas so I can get some sleep.”

Patient Experience Meets Roemer’s Laws of Evolution

There are people who believe that to improve the effectiveness of a business you must belong to one of two camps; the business process camp where you get the same result every time—a structure for predictability, or the creative process camp where you get a different result every time—a structure for possibility.

Let’s look at the here-and-now.

Most businesses, including hospitals, have, according to Roemer’s Laws of Evolution—think Darwin without the bit about fish walking from the sea—processes in place that have evolved over time.  Individual processes have evolved from multiple ways of performing a task to a single way of doing a task.  Inefficient ways were eliminated, and we settled on one efficient—fast—way of executing a process. If we still do not like the process, we hire and expensive firm and squeeze out a few more seconds by using some form of twelve-sigma approach.

When we are done, what we have left is a process that is as fast as we know how to make it, a process by which we get the same result every time. We have created a structure of predictability.

The process may not even be necessary, and the results from the process may not be correct—think effective, but we have figured out how to make that ineffective process very fast. And after all, fast is good. Right?

Having arrived at this point in the process evolution process, we have arrived at a point of stagnation.  There is very little left to tweak, and the last person who uttered the words ‘change’ or ‘innovate’ in a meeting is now working as a barista at Starbucks.

That is why patient experience improvement efforts have stagnated. What inertia there was to improve it has become the inertia of passivity.

I am not arguing that having patient experience processes and patient access processes that yield the same result every time is a bad thing. In fact, I believe that result to be the goal; processes that do the same thing every time.  However, what would happen if a priori to this singular way of doing things we added a structure for possibility?  What if we allowed creativity into the mix?

For example, what if?

What if instead of asking how do we improve the process people experience when they call the hospital we asked—what if people did not have to call the hospital? Do you know why people call the hospital? They call because they have no other alternative to meeting their needs.  What if—and I know this borders on the edge of credulity—people did not need to call? What would that entail? What would the business look like?

What if instead of asking how do we improve the process people experience when they are admitted to the hospital we asked—what if people did not have to be admitted?  But what would we do with the waiting area, the admissions desks, and all of those outdated copies of Highlights Magazine, you ask. 

There is not rule that requires you to keep a process just because the process is efficient.

Eliminating a process yields the ultimate in efficiency.

Instead of shaving thirty-two seconds off of the time it takes to admit someone, why no eliminate admissions? What would that look like?

One of my consulting clients had seventeen call centers.  They asked me to help them create a call center strategy. At the kickoff meeting I announced we were going to operate under the assumption that we were going to close all of the call centers. One executives argued, “You cannot close all of the call centers because we receive over four-hundred-thousand calls each month about our bills.”

I replied, “At thirty dollars a call, you are spending $144,000,000 a year, each year, talking to your customers about your bills. Can’t you fix your bills for less than $144,000,000, or eliminate your bills?”

Once you get that process fixed make it repeatable, make it yield the same result every time.