I apologize in advance for the length of this piece, but there is a lot that needs to be said. Grab a sandwich or a coffee, and set aside a few minutes.
“I’ve been working magic here. I could at least get an ‘attaboy.’” Saul Goodman—Breaking Bad
Breaking Bad, Badder, Badest. Don’t worry about the grammar, this is not freshman English. Let us assume you have heard all sorts of great feedback about the AMC show Breaking Bad, and so you decide to watch all six seasons of it. You logon to Netflix, or Amazon, or Hulu and search for the show. What you discover is that of the six seasons, the only season available to watch is season 4.
Not to be dissuaded you watch season 4. It leaves you with a feeling like having ordered a steak dinner—or a turkey burger if you are a vegetablist—and the only thing the waiter brings you are the toppings for your baked potato. Not very satisfying. Something is missing; a lot of somethings.
If that analogy does not work for you, think about buying a book only to discover that most of the chapters have been deleted.
It is important to have the whole picture, especially if you are basing a business strategy around it.
“If you’re committed enough, you can make any story work. I once told a woman I was Kevin Costner, and it worked because I believed it.” Saul Goodman.
So, I was reading the August issue of HealthLeaders magazine. The feature story was titled “New Approaches to Patient Experience.” I could not have refrained from commenting if I had been chained to the floor. Having already determined that the old approaches were not improving patient experience, I could not wait to read about the new approaches.
“Did you not plan for this contingency? I mean the Starship Enterprise had a self-destruct button.” Saul.
I read the article. I read it again, and then I read it a third time.
Perhaps the term ‘new’ is meant to have a certain nuance about it, like when a box of laundry detergent is imprinted in bold letters with the word NEW.
I began looking for the newness and I found plenty of things having to do with communications, hearing, dreams, and culture. I also learned about NPS, the Net Promoter Score, developed by Bain Consulting. For those who think that if a finding comes from Bain, Booz, or McKinsey, it must be sacrosanct, I have never been one of ‘those’.
NPS shows that the only people (patients) that will likely recommend the hospital are those whose scores are nine or ten on a ten point scale. Looking back at HCAHPs, almost every hospital has scores in one category or another that are an eight or below.
As an example of why I think it is important for someone to ‘cry wolf” or to yell ‘the sky is falling’, let us look at how the game of golf is scored. Everyone knows a golfer is given a point for every stroke above par and a point is taken away for every stroke below par. However, golf is also scored another way using the Modified Stableford System. This system involves the same players and the same number of shots—it just computes them differently.
NPS does that with patient experience. It computes the score using the same patients with the same illness undergoing the same procedures. It even admits to using basically the same questions as HCAHPs—it just computes them differently; it is somewhat akin to counting in Base 12 (think military time) instead of Base 10—whatever the number, it is still the same time in Des Moines.
Please stay with me. I am still looking for the newness regarding “HealthLeaders’ article…New Approaches to Patient Experience, still searching for innovation—I assume the article meant to include the verb ‘improving’ in its title as every patient has an experience but not all experiences are good. (You too should be.) Then I come across the bit that discusses how most of the emphasis in the article has to do with inpatient experiences, suggesting or implying that outpatient experiences are somehow or perhaps noticeably different.
Patient experience and satisfaction is listed as a top priority for 63% of hospitals. Patrick Ryan, Press Ganey’s CEO is quoted as saying “patient experience is ambiguous”. It is indeed, and improving it becomes more arcane the more nuanced it gets by looking only at the experiences as defined by CMS.
So, here are my talking points. For the following reasons I can state with a 95% or higher degree of certainty that your hospital, that 19 out of 20 hospitals are not innovating patient experience.
- Plus or minus any given experience initiative, every hospital is doing the same thing.
- It is all centered around HCAHPs or NPS—measuring a different way does not change the result
- Hospitals’ efforts to improve patient experience only deal with patients—as opposed to patients and prospective patients
- It only deals with patient interactions that occur within the hospital facility
- It mostly deals with inpatients
- The people who are excluded from all of the costly efforts to improve experience are:
- Those not surveyed
- Prospective patients
- These people are a hospital’s potential future revenue stream
- If every hospital claims they are thinking out-of-the-box regarding patient experience, the only thing that has changed is the location of the box. For example, if your firm manufactures toothbrushes, and your firm’s idea of a transformative, competitive strategic innovation, one that will gain market share, is to manufacture a purple toothbrush, think again.
- Hospitals are not focused on prospective patients—a hospital’s future revenue stream
- Hospitals do not know the experiences of patients or prospective patients for interactions that occur outside of the hospital:
- On the web
- On mobile devices
- When the call the hospital
Continuing to beat a dead horse, does not make it deader. Get out of the box, way out. Make it easier for people to do business with your hospital—that is the first step to innovating patient experience.
Study the diagram. What can you be doing to improve the experience of everyone who interfaces with your hospital?
Appreciate your comments and continue to be concerned about the lack of focus on “new” approaches to the patient experience.
As someone whose career has included a focus on customer focus outside and inside the hospital setting, I am disappointed in the lack of real attention leaders are giving this issue.
Customer service is something each of us can describe yet the intelligent leaders of our nation’s hospitals seem to be unable to bring it about within the healthcare arena.
If these leaders believe behaviors will be changed by simply telling folks to do better, they are really naïve. I would suggest they read Dr. Atul Gawande’s “Slow Change” article in the July 29th New Yorker. Change requires a person to person contact — from someone the person knows, trusts and respects. Until this occurs, there will not be an adoption of new approaches even if they come into being. The improvement in the patient experience will remain out of focus and healthcare costs will continue to rise as silos fail to be removed allowing for the collaboration needed to better serve our patients..
I do agree and have agreed with your assessments regarding what is largely a lack of service related mindset in health care. I have served in numerous capacities over 16 years in this field and am pleased now to be employed in the “1 out of 20” hospitals – Cleveland Clinic – who was one of the first hospitals I read were making this a priority several years ago. As a matter of fact, I am currently working in a newer department solely focused on the external services and relationships with referring physicians and ultimately the patients they serve.
I wholeheartedly agree! There are many cogent business reasons to create a great experience for every patient with every encounter. That topic has occupied a substantial portion of academic and administrative time over the past two decades of my medical career. I have found two key administrative components to achieving the goal: (1) provide monthly feedback on whether the patient perceived each individual provider as truly concerned and (2) collect feedback from patients in order to give them a voice and loop concerns to the leadership team.
Thank you Tom
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thank you for the kind words
Paul: I was so pleased to see that in your chart under pre-hospitalization you included the “call center” as a place where patients or prospective patients can be so unsatisfied with their experience that they to elsewhere. Thank you for recognizing that an Appointment Setting Call Center is an integral part of any health care center and the first point of contact for patients calling because of a referral, a Website contact, or they are a patient within the system.