What’s The One Thing Hospital Executives Don’t Know About Patient Experience?

imagesSometimes something gets stuck in my head and the only way to get it unstuck is to get the idea stuck in someone else’s head. By the way, dictionary.com had a sale on big words, and a bought a jar of them and tossed them into this blog.

A few weeks ago I came across something on one of the newsy channels having to do with a Canadian paleontologist sitting by himself on a pebbled beach in Quebec.  His life’s work revolved around pinpointing the place where fish first walked from the sea—the very fact that he was interested in finding out where fish first walked by inference implies his belief that they (fish) have walked on more than one occasion.

I know some of you are thinking, ‘And your point in writing to us about this is…”.

The television spot went on with the fellow reporting that the interesting thing is not that fish walked—which most open-minded non-Darwinians would have found sufficiently interesting all by itself—epochs later; yada yada yada—but that without them (the fish) having walked none of us (the non-fish) would be here.  It was alchemy in paleontology presented in an NPR/PBS authoritative manner, complete with a British accent, and the reporter was his Rapunzel.  If we say it on PBS it must be true.  The show did not offer any opinion to the contrary.  I wanted for someone to pop onto the set and say, “Prove it.”

What troubled me about the show was that he and his amanuensis, the reporter, with her eyes wide shut, somehow managed to create a dialogue around this notion as though it (the meaning of life) actually happened the way this fellow said it did.  I’ve seenMonty Python’s The Meaning of Life and it did not happen that way at all.  The report’s interview of the ichthyologist was like watching two left-handed men learning to dance backward without either one knowing the woman’s part.

The voices in my head started screaming epitaphs at me.  The paleontologist’s mind tacked intuitively and lurched from idea to idea untouched by the clammy hand of logic.  His premise made as much sense to me as having an oboe player in a punk rock band, yet the erstwhile reporter, with her sang-froid composure, uttered nothing more than an ‘uh-huh’ and looked as though she was watching time bend right in front of her Oliver Peoples glasses as he explained the wonders of the universe to her with his do-re-mi recitation of the facts.

Some people in front of a camera have the innate ability to insult our intelligence with boredom and futility—sometimes I do it with a blog.  His perfervid idea was stranded on the edge of reality and it worked about as well as a poorly used preposition at the end of a sentence.  As I asked blankly of the television show whether any of these walking fish were found wearing shoes, the reporter listened to his promulgation, nodded and followed him into the rabbit hole.  She never questioned whether the compass of his intellectual qualifications may have been missing its needle.

Therein lays the rub.  Simply saying something aphoristically on television does not make it true.  What was intended as an ephemeral interview now exists for the folly of all of us.  The man is guilty of sharing his ideas without having a hall pass to do so, but then again, so am I.

Maybe that is how mermaids came to be.

Segue.

A lot of people only care about fixing business problems at the eleventh hour. The problem with that approach is that you never know when it is a quarter to eleven—you only know when it is quarter after.

Leslie Nielsen in the movie Airplane notices the pilot and copilot are incapacitated.  “We need to find someone who not only knows how to fly a plane but who also did not have the fish for dinner.”

And boys and girls, therein lays the root of the patient experience dilemma—too many of us ate the fish that have been walking around, and we believed everything we were told by the ichthyologists.  CMS and HCAHPS; the e-all end-all of patient experience. Let’s take the CMS patient experience survey together and see how effective it is for measuring our experience.  Let us assume we are being treated for cancer at a renown hospital in a city famous for its steamed crabs.

Our mission is simple; it has been six days since our last treatment, we have a fever, and the side effects of the cisplatin are debilitating.  We are trying to speak with someone in who can tell us whether the fever means we need to be seen by someone.  We go to the hospital’s website, and see the link schedule an appointment.  Filled with optimism, we click the link.  We are taken to a new web page which tells us the phone number to call and the hours to call it. Our optimism nosedives.  Fortunately or unfortunately as it turns out, it is 11:59 A.M. on a Tuesday.  The hospital’s call center—a euphemism for scheduling center—is open.

We call.  We are placed on hold and we listen to a recording about how important our call is and that our call may be recorded for quality purposes. If you do not actually speak to someone there is nothing to record.  After a while we speak with someone and tell them about the fever and ask what we should do.  “You need to call oncology,” we are told. “Can you transfer us?” We ask. No.

We call the number for oncology and get this voice message, “The office is at lunch, please call back after 1:30 P.M.”  The nausea—from the cisplatin, not from the phone call—is getting worse.  We call the scheduling number again, and again are forced to listen to the on-hold music.  After a while we speak with someone and we ask to speak with a nurse.  We are told there are no clinicians in the call center, but the agent offers to transfer our call to a nurse.  We are transferred, and a sweet-sounding voice instructs us to leave a message and someone will return our call with forty-eight hours.  We try the main number, we are placed on hold, and the cycle continues. At 1:30 P.M. on the dot call call the oncologist’s office again.  The number is busy. There is no on-hold music, just a busy signal..

You tell me the line is busy because everyone else who called while the office employees were at lunch had the same idea as us, call at exactly 1:30.  Enough is enough. You tell me to hang up the phone and you drive me to the emergency room.

So, how was our patient experience?  Does anybody care?  Does anybody even want to know?  Will anybody ask us? Apparently not.  Patient Experience and Patient Access; CMS and HCAHPS.  Of the first twenty questions on the HCAHPS survey sixteen of them begin with the phrase “During your stay in the hospital.”

Nota bene: if your hospital cannot even answer its phones for its patients all of the questions having to do with “During your stay at the hospital” become irrelevant.  The vast majority of patient access experiences do not happen in the hospital.

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