A connection of mine on LinkedIn who is undergoing chemotherapy at Baltimore’s top hospital wrote to tell me that between treatments she called the hospital to schedule an appointment. Between being on hold, having her call transferred, and being given different numbers to call it took three hours for her to schedule the appointment.

Because the hospital failed to perform a simple business process over the phone she told me she will make it her life’s mission to tell people, whatever their illness, to get treatment at another hospital. The hospital will not retain her beyond this illness. A loss of retention and referrals. They cannot put the toothpaste back into the tube. The direct cost of the call to the hospital—thirty dollars. The cost in lost revenues to the hospital for not being able to deliver the expected level of satisfaction will probably be six figures.

There is no universal patient experience solution. HCAHPs is doing good, but hospitals were addressing those issues prior to CMS imposing their strictures. From where I sit HCAHPs does not pass the test of being both necessary and sufficient.

I am trying to raise the discussion to suggest that patient experience is more than HCAHPs. If we look up ‘patient experience’ in the dictionary it should say something other than HCAHPs. I use the Total Quality of a person’s Encounter (TQE). I use person instead of patient because the largest group of stakeholders who have experiences with a hospital are prospective patients, those who ‘visit’ the hospital online and by phone.

I define TQE as follows:

TQE = HCAHPs + all of the nonclinical touchpoints

The nonclinical touchpoints begin before a person is admitted, they begin when people are selecting a healthcare provider, and they continue after discharge.

Most people limit the impact of the Affordable Care Act to payers. Yes, people will be able to choose their payers. Hospitals need to recognize that many people will choose their payers based upon the hospital where they elect to be treated.

Today hospitals cannot even track leakage, let alone figure out how to curb it. Under the ACA people will be issuing virtual RFPs for healthcare, and if their experience on the phone or on a hospital’s website is not remarkable that hospital will be out of the running before if ever knew it was being considered.

I believe that within three years the best hospitals—those that offer a remarkable experience every time on every device—will be those that a person can carry that hospital’s functionality around on their iPad, just like they can carry around the functionality of Amazon today.

People feel they are paying a hospital for two things:

• Outstanding care
• Ease of doing business with the hospital

While outstanding care is valued higher than whether the hospital can answer their phones, if they cannot answer their phones they may not be given the opportunity to showcase their care.