Please be on the lookout for my one-man production, Paul Sings Les Misérables. Those of you who have been on a recent train or plane with me may have heard me practicing.

There are around 4,100,000 hotel rooms in the US. People who study obscure facts recommend pillows be replaced every two months. If we assume that each hotel room has four pillows, the hospitality industry should replace about a hundred million pillows a year. I travel a fair amount, and I have yet to see a pile of discarded pillows at any hotel

It occurred to me that if one measured healthcare’s attempts to improve patient experience and patient access in dog years, we might understand that the expiration date of those efforts have come and gone.

And so I wondered, how might we alter our efforts in order to get a better result?

Health systems, for the most part, have created a generic persona of this entity we call a patient. In almost all of those personas, the persona’s attributes are limited to those of inpatients. In other words, not only are the attributes not tied to any specific individual, they exclude most of a health system’s stakeholders.

And as much as we would like to believe that access and experience have improved, if we look at how hard people have to work to interact with a provider, most of it still happens by phone. The only innovation in patient access over the last fifty years does not come from health systems, it comes from the companies that make the phones—rotary phones to touch tone phones to mobile phones.

Even with all of that innovation, the people who call are still subjected to having to wait to talk with someone, and to having to speak with someone who cannot meet their needs. It is the same old problem, only now we have cooler devices.

Let’s spend a minute looking at whether there is merit in unbundling the attributes we associate with a patient or consumer. Let’s start with a sample group of a million people. We naturally segment people into groups; for example, dog people and cat people. Suppose in a sample of a million people, six hundred thousand of them are dog people.

Of those six hundred thousand, suppose seventy percent are coffee drinkers and thirty percent prefer tea. That gives us four hundred and twenty thousand people who like dogs and drink coffee. Of that group, half favor football and half favor baseball; two hundred and ten thousand dog-loving, coffee-drinking football fans. And of those who like dogs, drink coffee, and favor football, ten percent are fans of the Dallas Cowboys; 21,000. Five percent of those people live in Seattle, and of them, twenty percent hate the fact that rains often in Seattle—that gets us to a group of 420. Of the 420 dog loving, coffee drinking, football loving, Cowboy fans who live in Seattle and that hate the rain, thirty percent of which refuse to carry an umbrella—123 people. Seventeen of the 123 have red hair, nine of the seventeen are married, three of the nine do not have children, and one of the three is a republican.

Sooner or later segmentation comes down to the preferences of one person.

What if the sample was population one million people who at some point have been patients, and all of who will be patients again? They do not fit easily into a homogenous group. Some of those individuals are patients, some were patients, and some will be patients. Some battle chronic diseases. Some have children. And some, for reasons understood only to them are Dallas Cowboy fans.

They have their own experiences, and they have their own expectations of what those experiences should be. To be blunt, an individual does not care about how great everyone else’s experience were. A person cares about how great their experience will be.  Their is not a patient or a consumer in the US who can tell you the HCHAPS score of their provider.

Healthcare is not eCare, heCare, or sheCare.  It is meCare.

Measuring patient experience using just HCAHPS assumes homogeneity. That approach relies on the fact that creating a homogeneous experience will keep everyone happy. Try that same approach on a married and childless, wet Dallas Cowboy fan and his dog that live in Seattle, and who voted for Mitt Romney in the last election.

Improving patient access and experience requires making it feel like it was designed to meet the needs of each individual. And since the only thing that seems to change is the type of phone being used, if you want to really improve access and experience, get rid of the phones and let people interact with your health system online.