Patient Experience’s Teachable Moment From the VA

A few years from now, if you and your child happen to stay at hotel—could even be a Holiday Inn Express if you have savant-like tendencies—your child will look around the hotel room and ask you to explain some of what she sees.

For instance, that thing on the nightstand with the buttons on it, “What’s that for daddy?”

“In the old days, people would use it to make telephone calls.”

“And the box by the TV, what does it do?” She asked.

“People used to pay to watch movies using the box when they stayed at the hotel.”

“After they made their phone calls,” she stated as the concept became clearer.

“What do you want to do now?” The father asked.

“I am going to text my friends and tell them about these silly things, and then I am going to watch movies on my iPad on Netflix.”

For those who remember traveling when Bush the First was president, you probably remember using those phones. To use them you had to dial and 800-number, enter a lengthy PIN, and then enter the number of the person you wanted to call. That was the only way to stay in touch with your loved ones. After calling home, you would watch the national news on ABC or CBS or NBC to get updated on your world. In the morning you would read the newspaper that had been left in front of your door overnight.

Things have changed for everyone about how we learn of and interact with our world. Well almost everyone.

Today, the only way to access the vast majority of health systems is by phone or in-person. I met recently with the person who oversees patient access at a large academic medical center. Their end-to-end definition of patient access started at registration and ended at admissions. They only considered access a function of inpatients. Access consisted of many steps, some of them redundant. The final steps required the patient to be face-to-face with an access team member, a requirement that resulted in the patient making at least two trips to the hospital.

We were told that the process worked, which by default allowed the access group to conclude that it was efficient and effective. We were told that the processes that would be done by telephone were very, very effective—more on this in a second.

I asked why the in-person tasks couldn’t be done on the phone or online, and I was told that they had to be face-to-face because they needed to verify the patient’s driver’s license, and because the patient needed to sign the forms. I wanted to ask what would happen to the process if the patient did not have a driver’s license. I thought about asking why since the IRS allows people to file taxes online, why the hospital could not figure out how to get a patient’s license information and signature without a face-to-face meeting.

My colleague kicked me discretely and I demurred. Instead I asked the access director to describe the patient access process for outpatients, former patients, and prospective patients. “That is not how we define access,” is what I was told.

I was in the process of asking how her patients define access, and I moved my shins away before the next kick struck home.

Robert McDonald, the Veterans Affairs Secretary, was quoted in an article in yesterday’s USA Today saying, “The VA experience should be less like the broken bureaucracy it is currently, and more like an Apple store.”

Bingo! I wanted to hug him. If you want to improve access for your health system, remove the word ‘VA’ in Secretary McDonald’s quote and insert the name of your health system. The substitution is equally effective if you replace ‘experience’ with either ‘access’ or ‘engagement.’ Now you have a vision you can work with.

A remarkable experience for every person every time on every device.

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