Patient Experience: Binary Sudoku and the White Rabbit

Airports, heck most public places, are not good places for Myers-Briggs INTJ savants. Passengers rode the airport’s people mover—the horizontal escalator—like it was a ride at Six Flags.  It looked like my security pat-down by a burley TSA agent may wind up being one of the better parts of my day.  I felt a building pressure in my head telling me it may be time for me start thinning the herd.

The thing I like least about flying has to do with my control issues; someone else controls the plane and there is nothing I can do about it especially now that there are armed air marshals on the flights.  The pilot’s voice seemed to say “Put yourself in my hands.”  I find myself drawing caricatures of the people seated around me—I can choose do that, or I can choose to rush the cockpit and wind up being a two-minute feature on CNN with the other passengers asking how I got the gun on board.

USAIR’s SVP of customer experience wrote an article for the in-flight magazine—it was chipper, upbeat, and full of feel-good euphemisms.  Clearly she had never flown on one of the company’s flights.  During the time it took the woman in the aisle across from me to figure out how to work the seat back toggle to store her tray table I had enough time to memorize the article in three languages and translate it into Sanskrit.

The only thing I knew for certain was that my sole mission at the end of the flight was to make it into the aisle with my bag before Tray-Table lady.  This was not a lack of chivalry on my part.  It was simply a matter of trying to keep my head from exploding, for I knew whoever had the misfortune of having to queue behind her would be delayed by several hours.  I vaguely remember asking the chief steward if we could deplane in reverse IQ order.  Skippy, the name engraved on his ID, gave me look that said he and I had a different sense of humor.

Anyway, the woman seems to be resting comfortably.  She has been studiously trying to complete the same Sudoku puzzle for the last three hours.  On my cocktail napkin I quickly sketched out a binary Sudoku puzzle—four squares using only 1’s and 0’s.  I was about to pass it to her, but Skippy headed me off and took the napkin.  Maybe he did not want her to spend the next two hours struggling with it.  Maybe I should have filled in three of the four boxes.  Skippy also mentioned that several of the passengers around me were not enjoying my rendition of Tom Jones’ She’s a Lady, although an elderly woman seemed to be swooning—I must have forgotten I was wearing headphones.

I get as excited about someone sitting next to me as a dog does about a new flee crawling around on his hind quarters.  The woman next to me.  Her outfit looked like it had been knitted from some form of atomic waste.  I was tempted to ask her how she could dress like that but, I worried she would reply ‘From years of practice.’  She looked like a disaster victim might be expected to look.  The only thing missing from the scene was a reporter standing over her asking her how she felt about the plane crash.  As she gnawed angrily at her gum with her front teeth, her fingers gripped the armrests so tightly I could foresee the need to call a flight surgeon upon landing to amputate her arms at her wrists.

When I share about these things some look at me like they are staring at an unlabeled can of food and trying to guess the contents.  Perhaps objectivity is only for the truly unimaginative.

Anyway, that was my flight.  Yours?  Here’s the segue.

Some think of HCAHPs as a stupid thing.  Perhaps we should define the term ‘stupid thing’—doing long division and forgetting to carry the one is ‘a stupid thing’; mixing a red sock with a load of whites is ‘a stupid thing’.  Sometimes differences of opinion can have us all screaming infidelities.

There is nothing stupid about a hospital trying to improve its HCAHPs’ scores.  Now, if a hospital’s only focus on improving patient experience has to do with being fixated on HCAHPs perhaps that may leave the outcome a few fries short of a Happy Meal.

The thing about improving patient experience is that it is not binary Sudoku; an organization ought not to be fooled into thinking that it should only take this approach or that approach.

I just spent an hour online trying to take the perspective of a prospective patient looking at hospitals within a fifty mile radius of my home.  There are fifty hospitals; two in the top 15 in the country depending on how one scores hospitals.  For example, US NEWS & World Report ranks hospitals based on ratings of various specialties and on the cumulative ratings of the specialties.  So, as it turns out, a top fifteen hospital may not even offer the service I am seeking, or it may be the only hospital in my area that does.

Guess what else I learned?  In calculating the rankings there was no mention in the report of the dark side—CMS. No mention at all of HCAHPs.  What does that tell me as a buyer of healthcare?  Absolutely nothing since as a buyer not only do I not know how a given hospital scored, I do not know what the score means in terms of the service I need to buy, as a prospective buyer of a healthcare service I do not even know what HCAHPs means.

Let us assume for a moment that I was a highly educated consumer, someone who had heard of HCAHPs, someone who’s Happy Meal had a full complement of fries. In shopping for healthcare I went to and

Do you remember the children’s tune The bear went over the mountain?  If I recall correctly the reason the bear went over the mountain was to see what he could see.  And do you remember what he could see?  All that he could see was the other side of the mountain.  That was my take away from studying the importance to me as a purchaser of healthcare of the respective dot-gov and dot-org sites.

Some things are classified as nice-to-knows, and some things are classified as must-knows.  People who are involved, as it turns out, are much more impassioned about the nice-to-knows than are those in the must-knows.  There exists somewhere in our great country a sect from within a sect of people, the Ecological Extinction Society (EES) dedicated to preventing the extinction of the one-eyed, yellow-bellied, duck-billed, flying purple people eater (scratch that; one of the voices told me to throw that in), sap sucker.

Is it possible that among us exists an HCAHP EES mentality?  Sort of like the seniors in high school who sat at the cool kids’ lunch table and who were up to date on who liked who and who guarded and secreted that information as though only they had the keys to the kingdom?

Remember the rabbit in Alice in Wonderland?  What we know about the rabbit is that he—I only assume it was a ‘he’ because the rabbit appeared to be dressed like a ‘he’—was late for a very important date.  In the story nobody ever learns the occasion for which the rabbit was late.  The good news is that one could enjoy the story without knowing any more information about the rabbit.  Ultimately, where the rabbit was going had little if any bearing on the story.

If you understand HCAHPs, and know how your hospital scored your knowledge is limited to a small handful of people in your organization.  From the perspective of patients and prospective patients it means no more than where the white rabbit was headed.

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