# Patient Experience: The Impotence of Being Earnest

The impotence of being earnest, or should I have written importance?

Four down; contumelious soccer coach—Uday Hussein

It appears the Los Angeles Dodgers are going to offer one of their pitchers, Clayton Kershaw, a ten-year, three hundred million dollar contract; roughly equal to one-fifth of the value of the entire team.  Thirty million dollars a year.

In the five years he has played, he has averaged fifteen wins a year. So let us say the Dodgers offered all that money, two million dollars a win, in the hope that he will duplicate those numbers over the next ten years.

Will the expenditure justify the result?  As it turns out, there are many, many pitchers who will win about twelve games every year.  Pitchers nobody has heard of, pitchers who do not cost even close to thirty million dollars a year.  So, what are the Dodgers really paying for?  They are not paying two million dollars per win for fifteen wins.  A lot of pitchers could get the Dodgers twelve of those wins for a lot less money.

Whether they know it or not the Dodgers are going to bet ten million dollars a win for three extra wins each year, wins thirteen, fourteen, and fifteen—wins that the no-name twelve-win pitchers may not achieve.

One hundred and sixty-two games a year.  A three hundred million dollar contract.  One fifth of the value of the organization.  To get three additional wins a year.  Three out of one hundred and sixty-two.  The contract could affect about two percent of the games, assuming the pitcher wins those games.

The contract could also affect all of the games.  How?  What if, as it turns out, the Dodgers spend so much money on that one player to try to lock down those additional three wins that they do not have the money to spend on the other twenty-four players to get the other wins they need?  Is it possible that the other twenty-four players could have an impact greater to or equal to the three games for which they were willing to spend ten million dollars each to win?

Taken to the extreme, if the Dodgers spent no money on the other players they will have accomplished nothing.  Their effort to win a World Series, to improve the total experience of their fans will have been for naught.

The Dodgers’ important, earnest effort to improve may prove to be impotent.  The impotence of being earnest.

Failing to see the forest through the trees.  Keeping so focused on the doughnut so as to miss the hole, or perhaps the whole—as in picture.

HCAHPs and patient in experience.  One-in-the-same.  That is certainly how hospitals view the entirety of patient experience, singularly focused on the trees rather than the forest.  So focused on the trees that they have become experts on tree bark.

Each year hospitals spend a lot of money on data about patients’ “experiences”.  They spend a lot of money hiring coaches.  What are they trying to buy?  They are trying to buy a tenth of a point here or two tenths of a point there.  Trying to raise a score from 7.27 to 7.37.  There are no guarantees that the score will go up.

What then is guaranteed?

1. Raising patient experience scores is not the same thing as raising patient experience.
2. Spending all of your resources to win three of one hundred and sixty two games puts your organization at risk.

So, from a hospital’s perspective what should you be doing to increase patient satisfaction, how should you allocate scarce resources to improve everyone’s access?

Today, everybody is playing on the same kickball team.  Everyone busies themselves with the realm of what’s possible.  Operational blindness.

Innovation can only happen outside the box.  The box is the hospital’s four walls.  Put all of the functionality of the hospital on the web.  All of it.  Back office.  Access.  Billing.  Discharge.  Scheduling.  Admissions.  Claims.