Seven A.M., Saturday morning on the high school’s outdoor running track.  It reminded me of the way a community swimming pool looks during the time for the adult swim.  A dozen or so older adults were stretching and starting to make their way around the artificial surface of the track.  I hung the bag containing my workout gear on the pole of the chain-link fence. Next to the fence rested several canes and walkers.  I halfway expected to see a box of Depends and a stack of AARP magazines. So this must be what life looks like in the not-so-fast-lane.

After running for an hour I paused and I grabbed my water bottle.  A woman a few years younger than me also reached for her bottle of water. When I asked her how far she was running she said she and her father were running for eight hours. They were training for a one hundred mile run. I almost swallowed my water bottle, but I tried to appear nonplussed. It turns out she and her father, the much older man circling the track, were ultra marathoners. My ego thought about resuming my run but I decided I did not want to die today.

An article yesterday on one of the twenty-four hour news channels mentioned Frontier and Spirit Airlines rated among the worst in customer experience—did anyone need a news article to learn that?  The article went on to mention the two airlines had almost accomplished what many people believed was impossible; they almost managed to rank below Comcast and Time Warner Cable in customer service.  I’m guessing Spirit and Frontier must have had committees working around the clock for months to trying to beat out Comcast—“If we are going to offer bad customer experience, we may as well be the best at it.”  When the results were announced the airline executives tried to maintain a stiff upper lip. “They have not heard the last from us, there is always next year.  We will marshal our resources.  We will cancel more flights and buy smaller seats,” stated an anonymous employee.

Offering a poor customer experience requires hard work.  It doesn’t happen by accident, and it doesn’t happen overnight.  It requires time and dedication.

And it requires indifference. And that indifference starts at the top of the organization.  Leadership either knows the experience is poor and doesn’t care, or it doesn’t know and it doesn’t care.

Improving the access experience should be on every health system’s CEO’s plate. If it isn’t, it is time to get a new plate. Patients don’t leave their health system because they receive poor care; they leave because they perceive their health system doesn’t care.  Doesn’t care about whether they answer your calls, doesn’t care about whether it’s inconvenient for you to call while you are working, or how many times you have to call to schedule an appointment.

That same health system will have a committee studying how to reduce cancellations and no-shows.  They will have another committee performing a root-cause analysis of leakage—patients who disappear.  And they will spend a lot of money on consultants to help them find answers to nagging questions like, “Why did Mr. Waldo skip his procedure today, and why didn’t he let us know? He is scheduled for back surgery in two months. Will he show up for that? What do we have to change to prevent this from happening again and again?”

Here is how to save a million dollars studying how to answer those questions. I think all of the Mr. Waldo kinds of stories went something like this.

Mr. Waldo spent considerable time online educating himself about where to go to have two discs repaired.  He studies hospital websites, reads patient blogs and Facebook, and even watches a few YouTube videos.  And after all of that work he selected your health system.  He called and called, and he eventually made an appointment and saw a specialist.  The specialist gave him a number to call for an initial procedure.  The specialist also scheduled Mr. Waldo for surgery in two months.

It took Mr. Waldo several calls to schedule the procedure. He wasn’t happy. In fact, he was so unhappy with the experience of scheduling the procedure that he skipped it and did not even bother to cancel it.  Mr. Waldo learned that not showing for a procedure meant  he no longer had to waste time calling the hospital; now they called him.  He rescheduled the procedure and completed it.

Two months to go.  The health system reserved the OR, booked the anesthesiologist and the surgeon and the surgical team, and reserved a single room for Mr. Waldo.  While the health system was doing all of those things, Mr. Waldo kept himself busy.  Mr. Waldo knew his surgeon was one of the highest rated surgeons in the city. He read more about the hospital; it was also highly rated.  But his perception was nobody in the hospital really cared one way or the other about whether he gave them his business.  He visited more social media sites, posted his own YouTube video about his experience, and rescheduled his surgery with another hospital.  The only thing Mr. Waldo did not do was to call your hospital and cancel his surgery.

On the appointed day everything was ready.  The doctors and nurses were on standby, the OR was nice and clean, and the single room on the fourth floor—the one that overlooked the Wal-Mart—was ready to receive Mr. Waldo.  The only problem was Mr. Waldo never arrived.  A chorus of “Where’s Waldo?” echoed throughout the hospital.

People, patient people and consumers, people like Mr. Waldo do not like to call a health system any more than you do. Calling requires work. It requires work because calling doesn’t work. It requires multiple calls. And callers often give up their quest before their needs are met.  So when they finally work up the energy to call, it is not to chat.  Their call is important to them in part because it is the only call to a health system they are going to make that day.

Conversely, to the person answering the call, Mr. Waldo’s call, Mr. Waldo is just one of dozens and dozens of people they will speak with that day. This one conversation will be just a blur in their day. It’s not a blur for all of the Mr. Waldos who call each day.  They remember the call.  They tell others about the call.  And then they call some other health system.