My phone had ceased to function as a phone and so I was at the Verizon store with little to do.  I was counting backwards from infinity, twice, and I got stuck when I got to the number fifteen; I hate when that happens. 

I think it originally what I encountered at Verizon may have happened like this.  One of Verizon’s mail clerks, Ferguson, wanted to change his phone to the iPhone. He went to the Verizon store and learned he could trade in his old phone for a shiny white iPhone and receive a thirty dollar refund for doing so provided that he signed a two-year contract.  Deal done.

Ferguson went back to work in the mail room, and since nobody actually mailed letters and packages anymore because the world had gone digital, he started to think.  He knew he was going to get the iPhone, and a $30 refund had no influence over that decision.  He thought others would have acted accordingly and would have upgraded to a new phone even without the rebate.

Using his Jot Stylus on his iPad, he channeled Jethro Bodine and commenced to ciphering.  Roughly one hundred million mobile customers.  Figure twenty-five percent of them upgrade their phones each year.  Ferguson estimated the refunds cost Verizon seven hundred and fifty million dollars a year.  Now Ferguson guessed that those customers, if for no other reason than the panache factor of having the newest, coolest phone, would have upgraded even without a rebate.

Ferguson’s hamster wheel started spinning and he wondered if the desire to have a new phone was so strong that customers would still upgrade their phones even if Verizon charged a thirty dollar upgrade fee instead of offering a thirty dollar rebate.

Ferguson gets an idea.  He scribbles out a postcard on the back of his rebate card, addresses it to Verizon’s CEO, and hand-delivers it to him on the executive bocche ball court.  The postcard posits Ferguson’s idea as follows; If we charged customers the same amount to upgrade instead of rebating them, we could swing revenues by one and a half billion dollars.

Ferguson is now the Executive Vice President of Innovation & The Hell With Customer Experience.

Nota bene, I paid the thirty dollars.

Segue.

Does the fact that there are so many different definitions of patient experience among hospitals belie that fact that there is no definition of patient experience? 

Most patient experience definitions seem to be missing a few things; they do not exist much beyond the four walls of the hospital—sort of like EHR, they are highly, if not exclusively, focused on interactions clinical interactions and on things having to do with HCAHPs.

Every day many more patients and prospective patients interact with the hospital using the internet and their phones. Much determination on patient satisfaction is made in these venues. Retention, referrals, and ‘win-backs’ are influenced here. “Buying” decisions are made and lost here.  The hospital either met or did not meet expectations.

Yet most hospitals invest almost nothing in the two areas that have the highest number of touchpoints.

If I were asked to define a goal for patient experience I would recommends “A remarkable experience for every patient every time, obtainable on any device, at any time, at any facility.”

To move towards the goal of being remarkable, one must talk to patients and observe them in those touchpoints that all patients use. Surveying patients puts out the fire, it does not prevent fires.  Their bad experience has already happened. 

Surveying patients, paying for patient experience data, and paying for coaching does nothing most of the people in your radius of influence; for all of the prospective patients and nothing for former patients whose next visit to the hospital you never learn of because it happened somewhere else.

The level of satisfaction for these individuals is determined outside of the hospital’s four walls.  There are gobs—a consulting term of art—who never decide to become patients or to become patients again that make their decisions based on a hospital’s internet presence and how their calls are handled.  HCAHP surveys will not entice them to become your patients.

They belong to a group called the unsurveyable.   They also represent a healthcare spend higher than your total revenues for last year.  Why not pay attention to their experience?

Yesterday began with the quest for a bunny my dog hid somewhere in the house, and no, we have not yet found it.

Today started with two gerbils having escaped from the cage in my son’s room.  One of the gerbils, the one I know to be the ringleader, actually has noticeable biceps.  Like in a movie of a prison escape, I halfway expected to see a chain of small tissues tied end-to-end, secured off at one end to the running wheel, and the rest of the makeshift rope dangling over the side of the cage—I decided to stop the sentence after having already used four commas.  I have trapped the gerbils in his room and will sort out that problem later.

My more immediate need is figuring out how to remove a bit of malware from my PC.  Google suggested the name of a firm and the software to use.  The link took me to a page with screenshots, sort of a Malware Removal for Dummies approach.  That approach worked only long enough when step one, start the system in safe mode, failed to work.  Fortunately, the site provided a number for me to call, and call I did.

“Oh that is not good,” replied the lad from India.  “If it will not start in Safe Mode, you need a Microsoft Certified technician for which Best Buy will charge you $350.  However…today only…we will provide you with this service for only $250.”

“No, you will not,” I said as I hung up.  I then did what any Neanderthal would do in this situation; I banged on the PC really hard and began hitting a number of keys all at once.  At the moment I am downloading the malware fix for $220 less than my buddy’s suggested approach.

Customer experience.  I had one.  Every customer does.  The rub is being able to know whether the experience was good or bad, and if it was bad what you can do about it.

May I make a suggestion?  Pick you battles and your platforms; have a targeted plan.  Facebook does not constitute a targeted plan.  Some social media experts would argue that having a Facebook account is a necessity.  It may be necessary, but it is far from meeting the criteria of being both necessary and sufficient.

Last week I read that a certain children’s hospital has more than 700,000 ‘likes’ on Facebook.  Good for them, or not.  To me that is a little like seeing how many Twitter followers you can collect, or how many friends you have on Facebook.  It is about as relevant as you ‘liking’ Justin Bieber or Justin Timberlake—maybe there is something to the name Justin.

That hospital has not had 700,000 patients in its combined history, so having 700,000 is almost irrelevant.  Hospitals in its area also have hundreds of thousands of ‘likes’ and still acquire patients.  It may not have gained them a single extra dollar of revenue.

Is there appoint to having someone holed up in IT, marketing, or business development whose role is to try and perform Social-CRM acts of prestidigitation that in turn yield delighted patients?  Or are all of our efforts simply boosting our feelings of self-worth, sort of a, we don’t know where we are going but we are making really good time, approach to patient experience?

Mindless self-promotion. (I borrowed some of the best phrases here from Gabriel Perna’s May 24^th piece in healthcareinformatics.com.)

Here is what I think.  Your hospital cost somewhere between eight and nine figures to build, and salaries and operating expenses run well into the millions.  The lobbies in some hospitals probably cost several million dollars to build.  And why is that?  Because you know it is important to make a good impression. 

Permit me to get way off track for a paragraph.  The above photo of a hospital’s lobby looks more like a Hyatt than a hospital.  That seems to be a trend.  Make the lobby feel customer friendly.  And yet, most hospitals would rather close than acknowledge that patients are also customers.  If people can be both customers and patients, why not have programs that improve both patient experience and customer satisfaction?  They are not the same.  QED.

But guess what?

Every day more people ‘visit’ your hospital on the internet and on the phone than visit the facility.  How much did you spend on making impressions in those venues?  Can patients and non-patients accomplish the same tasks on the phone or by visiting the internet as they could if they went to your hospital?

If they cannot, your hospital has wasted its money. The navigation for most hospital websites appears to visitors like someone took a five hundred piece jigsaw puzzle and dumped all the pieces on your monitor. Most visitors will spend a few seconds looking for the corner pieces and then will give up.

If your hospital has not fully rethought its entire web strategy in the last two years it does not have a web strategy.

If you need a hint for one here’s mine—a remarkable experience for every patient every time that is mobile and available 24 x 7 on any device.

It will cost less than building a new lobby and will have a much higher ROI.

Today started on an off note with the question, “Did you find the bunny?”  The question resulted from the two furry legs dangling from my dog’s mouth.  He would not drop it so thinking I would find it before he did whatever dogs do with bunnies I let him inside knowing he would hide it somewhere in the house.  Apparently I was wrong about being able to find it.  I did however find my putter wedged under the cushions of a love seat along with a remote for a television we had donated to Goodwill because it had no remote.

I then dropped in to see the neighbors, great people who were born on the other side of the pond we call the Atlantic.  They’ve been in the states for ten years and we got to talking about sports, baseball and soccer—soccer, which I learned is a sport in their country.  Tying the two together, I learned that yesterday they attended a soccer match at Yankee Stadium.  The husband explained that he could still see the place on the ‘pitch’—an erudite term of affection for the field on which all English sports are played—where baseball pitchers pitch the ball. 

He also mentioned that the dirt track at the stadium had not been sodded.  After a few minutes of questioning I learned that the dirt track was in fact the infield.  I then suggested that without developing a better understanding of baseball that he was likely to lose his green card.

The conversation then turned to their trip tomorrow to DC.  They were going to see some of the things, like the really tall pointy thing with the scaffolding on it, the building with the round roof, and the lake.  I’ve been to DC a lot, but I could not tell them how to get to any of those sites.

After further questioning, I learned that the tall thing they wanted to visit is actually the Washington Monument, the round-roofed building is the Jefferson Memorial, and the lake is the reflecting pool.  Maybe they have square lakes in England.  I suggested that since we thrashed them in the war—think 1776—they could spend a little more time learning our history.  The husband replied that the bit about England losing the war was a canard, it did not lose the war, it merely retreated. Like General MacArthur, England would be returning to finish its business.

Is the notion of patient satisfaction a similar canard?  When people come to the hospital to ask a question or request information do you tell them to come back tomorrow?  Of course not.

Why then when people make a request of your hospital on the hospital’s website does the website not give an equally quick response?  In fact, why do people have to request a response?  Why can’t they get what they want or do what they want online?  The reason they can’t is because the website causes the person to reach a dead-end without being able to complete the task they set out to complete.  The website is broken. 

Most hospital websites have dozens of dead-ends and missing functions.  I have not seen a hospital website that could not be greatly improved.  I have also not seen my pancreas, but that does not mean it is not there.

Surveys show that about half of the people who are thinking about being treated will use the hospital’s website to decide whether they will seek a second opinion.  A purchasing decision is about to be made.  Stated another way; many will make the decision not to purchase based on the information on your site. 

Another phrase that can be substituted for the term ‘second opinion’ is that prospective patients want an opinion other than yours.  So let’s say the hospital Our Lady of Zero Retention treats a thousand patients a week.  The two extremes if you do the math are that all of those second opinioners picked your hospital.  That is good news.  But what if five thousand people went to your web site for a second opinion and each of them selected another hospital?

And you know what is really scary if you are the hospital’s CEO or a member of the board?  You have no idea who went to your web site to look for a second opinion.  You do not know who picked your hospital, you do not know who picked another hospital, and you do not know what influenced the decision.  That is a tough way to run a business.

Instead of retrofitting your lobby so that it looks like the Four Seasons why not retrofit your hospital’s website?

I think what a lot of presenters miss is having an understanding of what makes for a good presentation.  Here are a few of mine.

Presentation Rule 1—be entertaining.  The audience are pulling for you to do well for your sake and theirs.  There seems to be an inverse relationship between ones title and their ability to speak in front of a group of people without sounding like you are reading an eye chart.

Presentation Rule 2—most of the audience can read.  If your slides are filled with text and bullet points, their natural inclination is to read what you’ve written.  They are doing this while you are reading aloud the very same text.  If they are reading, you become superfluous.

Presentation Rule 3—the audience cannot walk and chew gum at the same time (they can’t read your words and listen to you.)  For those presenters who favor text on their slides there are two choices; read from the slides, or try to offer commentary about the slides.  For those who do not read directly from their slides and want to offer commentary it gets even more awkward.  You look at the audience and see them reading the slide.  Your natural tendency is not to interrupt their reading because you are trying to be polite and you do not want them to miss your words of wisdom.  Then your mind starts to wonder if what you are about to say is so important if you should have written it on a slide.

Presentation Rule 4—if you wear wild looking socks–see mine above–you had better be delivering one heck of a good talk.

My philosophy about presentations is not wanting people taking notes based on what is on my slides, hence I use pictures to convey an idea.  I hand-draw concepts from which I can then speak.  Since there is nothing of import on the slides, people start staring at you, something which will make a lot of presenters even more nervous.

The downside of this approach is that since everyone will now be listening to you instead of reading or writing, you better have something worth hearing.  The issue then becomes how to craft your words in a way to get your audience to remember your message.

I favor humor and telling a story.

Will these steps work for you?  I hope they do.

I felt they were working pretty well for me the other night right until the end when an attractive woman approached me me after my presentation and said, “You look like Jack Nicholson, only not as unattractive”—so at least I’ve got that going for me.