Ninety percent of improving patient experience takes place from the neck up.  The other ten percent comes from CMS.  There are two camps.  The ten percent camp’s members are those that say “we can’t do that”, “that will never work here”, and “CMS already defined everything we need to know about patient experience.”

There is what I call the ninety-ten rule; it is a corollary of the eighty-twenty rule. In the ninety-ten rule ninety percent of the executives work today on what they were working on yesterday.  That leaves ten percent of the executives working on the ninety percent of the issues that can change the industry, the neck-up issues.  Innovation is not about spraying WD-40 on the wheels of the service cart to cut down on the noise.

Case in point—a case study.  Sooner or later there had to be a hospital that gets it.  A hospital that approaches the issue of improving patient experience from the neck up.  As you read through this, see if you can name the hospital.  I warn you in advance that many of you will take umbrage with some of their terminology and with how they present themselves to the market.  My suggestion is that you focus on the approach and the message, not on whether it would play in your hospital’s bureaucracy.

Eighty percent of people looking to purchase healthcare—inpatient and ambulatory—go to a hospital’s website prior to making their purchasing decision.  Fifty percent of people who are scheduled to purchase healthcare from your hospital go to your hospital’s website to decide whether or not they should go to another hospital for service.

In short, they are looking for help deciding where to buy healthcare.  The hospital in this study recognized that and decided to help prospective patients choose them.  They designed a business system—people, processes, and technology—whose goal was to make it easy for people to do business with them.

One of the unifying themes in healthcare is that hospitals do not know what services cost, but they do know what they charge for those services.  Prospective patients do not know either the cost of those services or what they will be charged.

Here is what this hospital did.  The hospital assumed that ninety-nine percent of the people who visited their website were either patients or were people who could become patients.  Based on that they concluded that the information presented on their website should reflect that audience.  They did away with information about their board of directors; they did away with links about making a contribution.  In fact their homepage did away with everything that distracted those ninety-nine percent of their visitors.

In place of those links they created a page that reflected the needs and interests of people who were in the market to purchase healthcare.  They permitted visitors to their website to complete a number of tasks.  For most outpatient procedures and all lab services visitors could:

• Check the price of the procedure or service
• Compare how the hospital’s price compared against other hospitals
• Determine the amount of the service or procedure that would be covered by the individual’s insurance
• Check available appointments
• Schedule the appointment
• Complete the automated preadmissions process
• Read information about the physicians who would be performing the procedure
• Read feedback from other patients
• Read the requirements about what to do prior to coming to the hospital and what to do upon departing the hospital
• Learn how to file a claim with their specific payer
• Interact with the hospital or physician group using online chat

What this hospital learned is that patients and prospective patients have a lot of experiences and have differing degrees of satisfaction from those experiences that have nothing to do with HCAHPs.  These experiences occur when people are shopping for healthcare and they occur after someone leaves the hospital.  These experiences answer questions like:

• Was it easy to do business with this hospital
• Would I come back to this hospital the next time I needed to purchase healthcare
• Would I recommend this hospital to my family and friends

The other benefit is that the marginal cost to the hospital of enabling patients to perform these tasks online was zero.

I try usually not to destroy my credibility until later in the blog, but by now several of you have discovered that the hospital I used in this case study exists only in my mind.

In an era of ACOs and population health in order for a hospital to compete on patient experience—and that is where it will be competing—it is pointless to compete in that arena unless you are prepared to compete on all of the experiences that patients and prospective patients have with your hospital.

Many may wish to argue that this cannot be done or that it should not be done.  For those in that camp I would ask them to present business reasons to support their claim.  For the rest of us maybe its time to approach the problem from the neck up.