Fifteen years ago, my consulting client was the public telephone provider of a large European country. The country had just offered competitive telephony licenses to the private sector. My project was to develop a customer experience strategy for the incumbent that would help the public phone company retain customers.

My team and I spent months visiting the various call centers throughout the country, and we visited several of their satellite phone companies in South America—sort of gives you a hint as to which country’s phone company was my client.

The most astonishing thing I learned was that the phone company had nine thousand people in the call centers—CRSs; call center representatives. Actually, as it turned out, it was the second most astonishing thing I learned. The most astonishing I learned was what happened when someone called the phone company.

Think back to the days when we had phone companies in the US. Back to when you could dial zero and speak with an operator, or dial 411 and get directory assistance. Back when your phone bill was thirty pages long. Imagine calling AT&T or USWEST, asking a question, and having your call transferred to someone who may be able to answer it. Imagine that for millions of calls a year.

That was the customer experience of my European client. They had 9,000 CRSs; nine thousand people whose job it was to take the customers’ calls. Yet unlike when you call a company today in the US with a question, when you expect the person to whom you are speaking to answer your question, that was not how it worked with my client.

The job of these 9,000 people was to listen to a caller’s question, and then determine which person or persons in the phone company should answer that question. They would write down the caller’s information and then they would give the caller the phone number of the department the caller should call to get their question answered—for example, billing—and then the CSR would hang up. The CSR would then fax the caller’s information to the appropriate department. That alone resulted in over ten million faxes a year.

Everyone has called a company and had to listen to a recording that resembled something like, “To schedule and appointment press 1, to ask a question about your bill press 2….” The technology providing the recording is called an IVR, an Interactive Voice Response System.

My European client employed a manual IVR; no system, just 9,000 people routing calls, routing calls at a fully loaded cost of about thirty dollars a call. They spent more than a billion dollars a year having people tell callers which department to call. A very expensive manual version of an IVR. They also spent untold hundreds of millions of dollars a year sending faxes, and handling repeat calls.

I presented my findings to their executives along with a vision of what they could be doing to improve customer experience. The company’s CIO—which could be an acronym for Career Is Over—walked to the white board and erased my vision. When I asked why he had done so he told me my vision was too theoretical, that it did not exist anywhere. In response, I walked to where he was seated, picked up his day timer—younger readers may need to Google the term—and told him to give me some dates that he could travel to the US and visit any number of US companies who knew how to manage customer calls.

That was fifteen years ago. At that time, I could not have invited him to visit a health system because there was nothing of value to show him about how to improve his call center.

So, has anything changed in healthcare regarding the effectiveness of customer experience in the last fifteen years?

It has not. And the facts back it up.

Whether your health system gets a hundred thousand calls a year or a million calls a year, I am eighty-seven-point-five percent convinced that your health system does not have a call center or a contact center.

I’m pretty certain, as are you, that your health system probably has a bunch of people in a large room, and in that room are a lot of phones. And that is about as far as designing the telephone customer experience strategy goes.

The phone rings.

Someone answers the call.

Then what happens? Seventy to eighty percent of those calls are transferred by your health systems CRSs to someone else in the health system in the hope that whomever the call is transferred to can answer the call.

Did someone else answer the caller’s question? Nobody knows. Did the caller have to call more than once about the same issue? Nobody knows. Did the caller wind up going to ED because the person wanted to speak with a nurse and there were no nurses to speak with? Many did. Were the caller’s needs met? Who knows?

Did you know that seventy-three percent of the times when someone may wish to call their health system there is nobody around to answer the phone? Not everyone gets sick only Monday through Friday between 8 A.M. and 5 P.M. Not everyone finds it convenient to call only Monday through Friday between 8 A.M. and 5 P.M. because, like you, they are working.  Patient experience has nothing to do with being available to answer the phone during the times you want people to call you. It has everything to do with being available when they want to call you.  Some health systems may think they provide 24 hour customer service; 8 hours each on Monday, Wednesday and Friday.

Tonight, if you find yourself awake at some odd hour, call your cable company. Somebody will answer the phone. If you do not want to call them, go to their website you can get your needs met online as well.

So, how can health systems dramatically improve patient access and reinvent patient experience? They can start by designing a call center, not just a scheduling center. They can design the access experience to enable patients to get their needs met with a single call, speaking only to a single person. The health system could also expand the hours of its call center.

Some people think doing so is pushing the envelope. I think doing these things is the bare minimum requirement. If you want to think out of the box, do not think about pushing the envelope, think about bulldozing the envelope. Design an online, interactive customer portal that can meet the same needs that a fully functional call center should meet.