Month: May 2013

Patient Satisfaction: Defenseless in the Battle of Wits

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Yesterday I came close to being able to answer the question, just how many Raisinets can a person eat in one day.  The Players Championship, the TPC, is being played in Jacksonville this week.  My hotel is overflowing with men dressed like peacocks, and wearing golf costumes, outfits they would never wear at work; plaids, loafers with no socks, Granny Smith green, amaranthine and heliotrope, and cadmium and salmon colored shirts, shorts and jackets.  When they stood together they looked a bit like a fruit salad.

Patient touchpoints.  Does your hospital realize that most patient touchpoints are not under their control?  If you are not controlling them, who is?  Does your hospital even have a global patient experience strategy for the touchpoints you can control?

Billboard, direct mail, YouTube, television, radio, email, online searches, brochure, mobile apps, Facebook, Twitter, blog, website, physician, friend, family, WebMD, online forum, family, therapist, admissions, aide, nurse, support group, call center, online chat, social worker, pharmacist.

Whew.

Did you know that thirty-four percent of patients use social media, 46% health portals, and 67% search engines?  (Ira Kaufman, Entwine Digital).  These figures do not even take into account all of the prospective patients who went to the web and upon looking at your website decided to take their healthcare to someone else.  What was it about that patient touchpoint with your hospital that failed them?

What is important to you about those figures?  They probably made you think you need to get your social media program in place.  Perhaps.  The social media aspect means that your patients are either writing about your hospital or reading what others have written about it.  One thing is certain.  Your patients are not using social media to write or read about how much patient experience has improved because of all of the reports you have purchased on patient experience data.

Most hospitals of any size have an entire staff dedicated to business development.  Billboards, ads on NPR, a single Facebook page, and direct mail.  How is that working?  Was your organization able to tie a single dollar of revenue to the billboard depicting your urology group?  One hospital I know tied twelve million dollars of revenues to its new website in the first year.  Using traditional, proven methods to develop business is outdated.  The proven methods have proven one thing, they no longer work.

The reason traditional business development tools do not work is that the hospital is unarmed compared to its opponents, the people it wants to attract.  Defenseless in a battle of wits.  Hospital business development efforts are using stone-age tools.  Prospective patients are using 1’s and 0’s.

Where is the disconnect?  Hospitals are selling hip replacements.  People are not buying hips; they are buying the ability to play golf for another ten years.  See how nicely we were able to tie this all back to the TPC?

One thing on which most of us can agree is that giving every discharged patient a copy of Celine Dion’s new CD will not improve the patient’s experience.

 

Patient Satisfaction: How Many Days Ago Was Sunday?

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How long have you been doing this?  That’s seems like a fair question to ask of anyone in a clinical situation.  It’s more easily answered when you are in someone’s office and are facing multiple framed and matted attestations of their skills.  Seen any good Patient Satisfaction or retention certificates on the walls of the people entrusted with the execution of the hospital’s patient experience endowment?  Me either. 

I have a cardiologist and he has all sorts of paper hanging from his wall.  Helps to convince me he knows his stuff.  Now, if I were to pretend to be a cardiologist—I’ve been thinking of going to night school—I’d expect people would expect to see my bona fides.

Shouldn’t the same logic apply to whoever is spending the hospital’s resources to retain patients? 

Please permit me to offer a real-life example. More than ten years ago I had a heart attack and was taken to a local hospital.  I lived, thanks for asking.  For the last ten years I have done all of my cardiac follow up at U Penn, a different hospital.  The hospital that treated me does not know that I lived; they never called, I never heard from them again.  Cost of a phone call—$30.  Cost of not retaining me as a patient—quite a bit.

(This same hospital has a large business development team and an equally large marketing department that frequently markets its cardiology offerings.  Talk about an opportunity to cut wasteful expenses.)

Imagine this discussion.

“What do you do?”

“I’m implementing something for the hospital that we have never done.”

“Why?”

“The feds say we’ve got to have it.”

“Oh.  What’s it do?”

“Nobody really knows.”

“How long have you been doing this?”

“How many days ago was Sunday?”

“What’s it cost?”

“Somewhere between this much,” he stretches out his arms, “And this much,” stretching them further.

“Do the doctors want this?”

“Some do.”

“How will you know when you’re done if you got it right?”

“Beats me.”

“Sounds like fun,” she said, trying to fetter a laugh.

Sounds like fun to me too.

 

Patient Satisfaction: When you are in a hole, stop digging

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I awoke this morning to a text message sent from my eleven year old son’s iPhone last night.  The message read, “My two girdles are killing each other.”

I was flummoxed until I spoke with my wife.  It was two gerbils that were killing each other.  Two gerbils, five dollars.  Autocomplete, priceless.

Having left my reading glasses at the hotel this morning I inquired of one of a my-gen coworker where I could buy another pair.  Judging by her stare, I do not think the twenty-something was any more familiar with the term ‘reading glasses’ than some people are with my epistles about patient satisfaction.

“Do you have trouble reading Dude, or are you looking for those Google glasses that read for you?”  She did not use the term Dude, I threw that in for effect.

I told her I did not have trouble reading and that I am able to read two years above my age level—bada boom bada bing.

I was thinking about the time I was teaching rappelling in the Rockies during the summer between my two years of graduate school.  Each one week camp was for high school students of varying backgrounds and their counselors.  On more than one occasion, the person on the other end of my rope, the person being rappelled, would freeze up from fear and I would either have to talk them down safely or rappel down or help them.

Late one day, a thunderstorm broke quickly over the mountain, causing the counselor on the end of my rope to panic.  No amount of talking was going to get her to move either up or down, so it was up to me to rescue her.  I may have mentioned in a prior post that my total amount of rappelling experience was probably no more than a few more hours than hers.  Nonetheless, I went off belay, and within seconds, I was shoulder to shoulder with her.  We were both perpendicular to the face of the cliff and some fifty feet from the bottom.

The sky blackened, and the wind howled, raining bits of rock on us.  I remember that only after I locked her harness to mine did she begin to relax.  She needed to know that she didn’t have to go this alone, and she took comfort knowing someone was willing to help her.

That episode reminds me of a story I heard about a man who fell in a hole—if you know how this turns out, don’t tell the others.  The man in the hole continues to struggle but can’t find a way out.  A CFO walks by.  When the man pleads for help the CFO writes a check and drops it in the hole.  A while later an applications vendor walks by—I know this isn’t the real story, but it’s my blog and I’ll tell it any way I want.  Where were we?  The vendor.  The man pleads for help and the vendor pulls out the contract, reads it, circles some obscure item in the fine print, tosses it in the hole, and walks on.

I walk by and see the man in the hole.  “What are you doing there?”  I asked.

“I fell in the hole and don’t know how to get out.”

I felt sorry for the man—I’m naturally empathetic—so I hopped into the hole.  “Why did you do that?”  He asked.  “Now we’re both stuck.”

“I’ve been down here before,” I said, “And I know the way out.”

I know it is a little sappy and self-serving.  However, before you decide it’s more comfortable to stay in the hole and hope nobody notices, why not see if there’s someone who knows the way out?

John Steinbeck’s novel Of Mice and Men included the statement, ‘The best laid plans of mice and men often go astray.’  My take on it; the reason the best-laid plans of mice and men often go astray is not the because of the plan; it is the mice and men. 

The problem is mice and men have a history with the organization.  They are constrained by phrases like ‘We’ve never done it that way’ and ‘that cannot be done.’  I believe most things people think cannot be done can be done, but then I have been accused of trying to believe in as many as six impossible things before breakfast.

One of the impossible things I believe is that there are simple ways to dramatically improve patient satisfaction for all patients by creating a remarkable experience for every patient every time.  Every time a patient or prospective patient interacts with the hospital they do so in one of three ways; they call, they go to the web, or they do so in person.

Each person is either satisfied or unsatisfied from every call, web visit, and visit.  The health system needs to get these interactions right one hundred percent of the time.  What does it mean to ‘get it right’?

If I go to the web to schedule a follow up appointment and I am given a number to call rather than an appointment, the hospital failed me.  If I call the hospital to understand Medicare billing and am told to call back during normal hours, the hospital failed me.

Finally, suppose using my Bluetooth headset on Dragon I use my iPad, and with voice commands navigate to the link on the hospital’s website showing me how to retrieve a copy of my medical records.  When I get there, having used every possible form of technology, I am instructed to click a link to open a form to request my records.  I then must print the form, complete it, find an envelope and a stamp, and post my request via snail mail.  Over the next few weeks the hospital will reverse the process and eventually I will receive my records.  My satisfaction dropped?  Why?  Because the link implied I could click something and get my records; the fulfillment process was out of date and under-delivered.

The Downside of Patient Experience

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The Enchanted Forest was my first employer. My job was to direct cars to available parking, affix bumper stickers to those cars, and pick up the discarded Pampers—I lasted less than a day.

I mention that because today I had the pleasure of laboring through security at Philadelphia International Airport. Cattle awaiting slaughter in Chicago’s stockyards have a better experience.  Given the choice of being a TSA agent or picking up Pampers at the Enchanted Forest I’ll take the Pampers.  Lest we forget, all Americans should be forced to go through airport security once a year just to remember what those clowns did to us on 9-11.

I am flying USAIR; not by choice.  One of my fellow alums, our school’s poster child for success, is the CEO of USAIR.  I bet he flies Southwest, or maybe he does the John Madden thing and rides in his own bus whenever he has to travel.

Remember the old airline slogans, “We love to fly and it shows,” and “Fly the friendly skies of United,” and Delta’s “We’re ready to fly when you are”?  Today the universal slogan of the airline industry is, “We don’t like flying any more than you do, but hey, it’s a job.  We are no worse than the other airline.”  There is no pretense about competing on customer experience.  Far from it.

Airlines no longer even pretend to compete on price. It is almost as though they compete with one another to see which airline can come up with the most irritating surcharges.  Should we be forced to make an emergency water landing—as though there is anything other than an emergency water landing—your seat cushions may be used as flotation devices.  There is a five dollar non-refundable charge for those who may wish to use their seat cushions to save themselves and their loved ones.  A flight attendant will be passing through the aisle to collect payment and unlock your cushion.

To board the plane I had to pass between two closely aligned, six-foot, vertical, buttered rollers that were designed to lubricate both sides of each passenger to enable passengers to squeeze into the aircraft’s Barbie Doll seats.  As I am seated in an exit row I decide to take advantage of an on-the-spot micro-business opportunity.  I stand and announce to my fellow passengers, “Should we be forced to make any type of emergency landing you may wish to exit the plane.  There is a five dollar non-refundable charge for those who may wish to exit through my window exit.  I will be passing through the aisle shortly to collect payment.”

The marketing campaign for the airline industry seems as though it was pulled almost word for word from the Les Misérables song, Master of the House.  “It doesn’t cost me to be nice, nothing gets you nothing, everything has got a little price. Master of the house, keeper of the zoo, ready to relieve them of a sous or two…charge ‘em for the lice, extra for the mice, two percent for looking in the mirror twice.”  Essentially their customer retention plan is we can do whatever we want to you…if you don’t like it you can always walk.  “Two percent for looking in the mirror twice.”

Customer experience.  Patient experience.  Driving to the airport this morning NPR ran an advertisement from a Philadelphia hospital that was touting its hip and knee replacement offering.  You may not know this, but hospitals have a department that specializes in business development—I kid you not.  Highly trained individuals, MBAs—most likely all of the airline CEO positions were taken, toil day after day trying to figure out the answer to the question that has plagued mankind since the invention of the Band-Aid, ‘How do we get sick people to come to us’?  Give us your tired, your poor, your huddled masses…healthcare’s business development strategy could be dubbed the Statue of Liberty strategy. 

Sometimes the business development people get together with the marketing people—it is like a Mensa meeting minus the mense—no need to look it up; I was just going for the alliteration.  I think this is how the billboard strategy of attracting patients came into being.  You know the one about which I am writing.  A mile or so from every hospital is a mammoth billboard depicting a photo of the hospital’s urologists—substitute your favorite specialty—all of whom are smiling.  I think the idea behind the billboard is to entice you to use their services should you happen to be passing a kidney stone as you are driving by.  (I read that in California the photo of the urologists has been replaced with a photo of the nip-&-tuck squad.)

What many hospitals seem to have failed to notice, or to have made operational, is that prospective patients choose their providers.  This has been going on for well more than a decade.  I know this because when I had my heart attack the ambulance driver determined where I was to be treated, a hospital fifteen minutes from my house.  For the last ten years I have chosen to travel more than an hour each way to the cardiologist I selected.  The original hospital, which has lost tens of thousands of dollars by not retaining me, does not even know if I am alive.  They never called to find out.  By the way, they have a lot of billboards.

Patient choice is undermining a lot of hospitals’ revenues.  As much as the healthcare industry would like us to believe that people choose their provider only based on specializations and mortality rates, other factors come into play.  One of those other factors, perhaps the biggest factor, is patient experience and their satisfaction with that experience.

Cancer Treatment Centers of America seem to have figured that out.  Their advertisements appeal to our base Freudianish needs, that the individual is special and wants to be treated as such.  CTCA does not advertise that you will not die if they treat you.  Their advertisements and their testimonials focus on the fact that their patients are treated like family. 

Essentially CTCA  have figured out that it is good business to approach cancer patients as smart customers.  CTCA cannot campaign on the fact that their patients don’t die.  Unfortunately cancer patients die, so that dog don’t hunt.  They cannot campaign on the fact that their treatment doesn’t make you nauseous, but as I also know from personal experience, chemo is awful, so that dog don’t hunt either.  So CTCA claimed the unclaimed ground, the ground over which none of their competitors are fighting; patient experience.

The CTCA’s phone lines are open 24 x 7, or you can reach them through a chat line to let them convince you about their integrated, specialized plan to treat you.  (They do not however have an iPad app which means they just lost points in the patient experience bonus round.)

Their patients travel across states at great personal expense.  Their patients are willing to pay more for even the possibility of a better experience.

I’ll close with this.  Almost every hospital has at least one MRI.  Each MRI probably delivers the same high quality images.  Each hospital probably has equally competent radiologists to read the images.  What then is your hospital’s competitive advantage?  Perhaps it is time to be able to answer that question.  The downside of competing on patient experience is that to do so you had better be pretty good at it.

The Fallacy of Call Centers

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I am willing to bet that most contact centers are not providing value to the business. Most businesses score success around the metrics of the calls and the call center. The only business reason to have a call center is to increase the customer’s satisfaction. it costs $30 to process a call and firms are trying to drive those costs down.

It costs thousands of dollars each time you lose a customer.

Business asks, ‘Did I answer the customer?’ Why not ask, ‘What did we do or not do that caused the customer to call and can we do that better?’

The reason and answers for most calls to a call center could be made available to most customers at any time on any device on a customer portal with zero wait times and a zero per transaction cost. Unfortunately, most firms who think they have a customer portal actually only have a web site.