These are my new cufflinks.  I asked my wife if she liked them and she replied, they look like earrings.  This must be why lawyers operate on the premise that you never ask a question to which you do not know the answer.

I never received the email from the Republic of California stating that all speed limits had been rescinded.  This morning I am driving down “the 10” to the airport—California roads are not called routes, or highways or beltways.  Cars are passing me like I was driving a Big Wheel even though I was going seventy.  I was here like, for five days, and like, I now feel much more comfortable using the work like unnecessarily in spoken and written conversation.

But who is complaining?  The temperature was in the eighties and I am flying home to a place so cold that the groundhogs are wearing mittens.

So as I’m driving along the 10 at Mach 2, the voice in the car says, “GPS signal lost.”  Since this was my first time on the 10, I knew enough to know that if whoever lost my GPS didn’t find it quickly that I was going to have a bad day. Since the rental car did not have a good place for me to place my phone while I was looking for my GPS I placed the phone on my right thigh.

For those who did not study anatomy, thighs are round, at least mine are.  And phones are flat.  That means that if an errant neutrino should slam into the phone the force from the collision is great enough to knock the flat phone from the round thigh.

It occurred to me that the person who designed the interior of the Mustang either had flat thighs or did not own a phone.  I believe that because there is a space between the seat and the center console that is the perfect width for a phone.  The width, however is not wide enough to allow your arm to slip into the crack to try to retrieve the phone especially while traveling at Mach 2 on the 10.

I drove for thirty minutes listening to a muffled voice that sounded like it was broadcasting from beneath my bum repeating the phrase, “GPS signal lost.”

The success or failure of most experiences comes down to whether or not those experiences were designed or whether they simply evolved over time.  Case in point. I returned the car to Enterprise.  The Enterprise employee asked me the same question every Enterprise employee always asks me, “How did we do?  How was our service?”

They never ask about the car.  They know the car was excellent.  They know that when renting cars, the cars are the commodity.  They compete on customer experience, an experience they designed.

Hospitals never designed the experience.  Notice I used “designed” as a verb.  To design requires creating a vision of what is to be designed, and it requires people educated in design. For hospitals I like to use the vision “A remarkable Experience for Every Person Every Time on Every Device.”

I am willing to bet that if you evaluated your hospital’s nonclinical business processes, processes like authorization, registration, and admissions you would find that they were never designed.  They came into being decades ago when vinyl flooring was in vogue, and the only things that have changed are that the admissions area now has a synthetic carpet, the portraits of the hospital’s past presidents have been updated, and the clerical staff have gone from using quill pens, to carbon copies, to floppy disks, to flat-screens.

You come in as the sun is rising, and you sit with others on cream-colored vinyl chairs.  The local news is playing on mute on a television mounted to the ceiling.  Three-year-old copies of magazines like the Latin American Financial Manager and Make Bankruptcy Your Friend are stacked neatly on a laminated end table.  The admissions process is basically the same.  It was not a remarkable process during the Harding Administration and it is not a remarkable process now.

People call because they were told to call.  They were told they had a referral and that their referral was authorized.  “We cannot schedule you,” the voice tells them.  “We have not received your authorization.”

“Who is ‘we’?” You ask—I know that punctuation is wrong, but I do not know what the correct version is.  “Aren’t you and authorization all part of the same organization?”

“It works thusly.  It is a multi-step process that has checks and balances—think of it like Congress and the Executive Branch.”

“But that does not work very well.”

“Don’t trouble me with the facts.  The doctor gave you a referral.  You called Authorization and gave it to them.  In know all of this because I can see the authorization in your record.”

“But why couldn’t I have given it to you.  Since you have it why can’t you schedule me?”

“Because authorization needs to approve it.  That usually takes a week or two, and because if we schedule you right away the next person is going to expect the same treatment.  Anyway, even with the authorization, the first appointment we could get for you would be six weeks out.  You could go to ED.  If it was me, I would go to ED.”

People call.  Where do they think they are calling?  Do they know?  The Hospital?  A call center?  A clinic?  They call to get an appointment—a three-syllable, big-boy word for access.  They call because their physician said to come back in six months.  Unfortunately, the physician’s schedule only goes out three months.  The caller gets angry.  By the third call the caller decides he is done playing this game.  The caller goes online and finds a clinic that allows him to schedule his appointment online, authorize his insurance, and complete the paperwork online.

Almost every hospital’s call center is in reality a scheduling center—reg & sched.  The problem with that is patients do not know that, and even if they did that is not how their world works.  When people need to interact with a company what do they do?  They call it, all of it.  And when they finally speak with someone they expect that someone to be equipped to answer any and all of their qestions.

The lifetime value of a patient is somewhere between $180,000 and $250,000.  That is a pretty high price to pay time and time again.

Processes like this cannot be tweaked.  They cannot be fixed.  They need to be tossed and then designed.