The German poet Brecht was fond of saying; the man who laughs has simply not yet heard the terrible news. Perhaps you will be kind enough to allow me to be the one who delivers this news. Brecht also wrote; I go to the market where lies are bought. Hopefully I take up my place among the sellers.

Another of my favorite quotations is from Thoreau’s Walden: “I say beware of all enterprises that require new clothes and not a new wearer of the clothes.” Paraphrasing it means, I don’t need new things; I need new eyes with which to see the things I already have. I need something which allows me to see a fresh perspective; perspectacles. I just used up my quota of existentialism for the entire month.

I am convinced therein lies the crux of most business problems with which we wrestle. The opponent we wrestle is ourselves. It is a little like trying to win the battle with a gossamer opponent in a dream. We wrestle that which we see everyday because what we see everyday is limited by the blinders of our singular sense of perspective.

A dialog from the movie Airplane:

Randy: Excuse me sir, there’s been a little problem in the cockpit…

Striker: The cockpit…what is it?

Randy: It’s the little room in the front of the plane where the pilots sit, but that’s not important right now.

A dialog from a health system:

1^st person: Excuse me sir, there’s a big problem in the call center…

2^nd person: The call center…what is it?

1^st person: It’s the big room with a lot of people and a lot of phones, but that’s not important right now.

Actually, it is important right now, and the problem is only getting worse. Evidence leads me to believe the strategy behind the design of most health system call centers went something like this.

1^st person: We get a lot of calls

2^nd person: We need to answer those calls. What should we do?

1^st person: We should buy a lot of phones and hire people to answer those calls

Almost every health system call center I have seen is little more a big room with a lot of people and a lot of phones. My research shows that today’s call center key performance indicators (KPIs) look a lot like this:

• More than eighty percent of the time on the phone involves waiting for something to be accomplished
• If the task cannot be completed during the call, more than 99% of the elapsed time from the start of the task to the end of the task is spent waiting for someone to do something
• On average, people have to call 1.7 times to meet their need
• People try multiple ways to contact their health system because meeting their needs by calling is rarely an easy experience
• The end to end calling process includes multiple areas of duplication, rework, and waste

Roemer’s First Perspectacle Patient Access Axiom: Answering calls is an activity, not an accomplishment. To make it an accomplishment, the perspective of what happens in the call center needs to change. That is good news if your system is open to new ideas.