Patient Experience: You Won’t Believe This Conversation

The entire focus of today’s post is based on a conversation I had with a frontline employee of a prominent health system in the southeast.  This quote is taken directly from our conversation:

“Because our call center is so bad, people do not cal to cancel appointments, they come to the office to cancel their appointments. They rant and rave about their bad experience, and they do it in front of patients who are waiting to check in. And then I get to sit here and listen to them telling their story to the patients in the room, who say they have experienced the same problem over and over, and they ask me why someone doesn’t fix the problem.  The other problem they get when they speak with someone in the call center is they are talking to people with no medical training about their medical problems.  People in our office could answer their questions, but our patients are told to call the call center.”

The best term I have ever heard in any industry for waving the white flag about an unsolvable business problem is healthcare’s term leakage.  It is a word providers use to describe something they believe exists, but have never seen and cannot measure—sort of like when physicists try to explain that each of us exists in a parallel universe.

Leakage often refers to patients who leave their health system and who switch to another provider.  The thing is the provider usually does not know who leaked.  They do not know when a specific patient leaked or why they leaked, and they do not know how many patients leaked. Leakage reminds me of the story of the little Dutch boy who places his finger in the leaking dike and saves Holland. But, in our story, the little Dutch boy is off playing Nintendo, and Holland is flooding.

A lot has been written about the root cause of leakage and suggestions have been made about how to deal with leakage.  I did not come across anything that led me to get excited about the prospects of understanding the problem of leakage or how to fix it.

Before we address the problem, let us make sure we understand why it is so important to stop the leakage.  The average lifetime value of a patient, and of a prospective patient, is between $180-$250,000—use your own value if you think you have a better number.  Therefore, each leaked patient creates a financial loss for your health system of around two hundred thousand dollars.

You know as well as I that if your hospital lost four laptops this week a committee would be formed and there would be a meeting next week to ensure your health system did not lose a fifth laptop.  But if you asked one of the executives what time the Leakage Committee meeting is next week that person would not understand your question.

There is no leakage committee meeting; there is only leakage.  Most health systems think of leakage occurring somewhere after a patient received their care. The patient simply disappears without telling anyone.  It is impossible to prevent someone from leaking if you do not know they leaked.

The two categories of leakage of patients and consumers are:

  • Capture Leakage—Failing to acquire a consumer who is considering purchasing their healthcare from your system
    • Marketing leakage—marketing spends considerable resources to get someone to contact the health system. The person calls and does not get the information or appointment they needed
    • Referral leakage—a primary care physician refers a patient to a specialist, but the patient is never seen
    • Out-of-network losses within an ACO model
  • Stickiness Leakage—Failing to keep a current or former patient
    • Cancellations and no-shows
    • Patients who do not buy healthcare again from your system

My solution to the problem of leakage is to ignore it. Dissolve the leakage committee.

Turn your focus to Keepage.  Treat the people calling your system, the people visiting your website, and the current and former patients as two hundred thousand dollar assets.

Health systems spend several thousand dollars to acquire each patient.  Common sense suggests health systems should spend at least that much to capture and keep the patient.  The best way to excel at Keepage is to make access ridiculously easy and to provide those doing the accessing with a remarkable user experience at a time and on the device of their choosing.

The two channels that account for over ninety-five percent of the attempts to access your health system are the phone (call center) and the internet.

Nobody wants to connect to any company which cannot stop talking about itself long enough to offer something of real value online.  The immediacy, with which your health system responds to a consumer or patient request, and its ability to meet that request, speaks volumes about your system’s interest in keeping the person.

Your health system is probably the most valuable resource in your community, but judging from most health system’s websites you wouldn’t know it.  In the online age importance is measured by the number of visitors to your website and by the number of return visitors.

Do this.  Spend a minute or two on your system’s website and then go to this website,  Scroll down to the bottom and click on the link for its YouTube channel—Will it Blend?  Their videos have been viewed two hundred million times.

Coca-Cola, American Express, and GE also seem to have a pretty good understanding of what it means to be in the business of serving customers.  If you call those companies you will also get the impression that their employees are equipped to handle customers.

Instead of worrying about leakage and patient experience management, develop a keepage program and focus on patient equity management.

4 thoughts on “Patient Experience: You Won’t Believe This Conversation

  1. What is perhaps equally disturbing in this scenario is that the frontline staff did not perceive to be empowered, let alone accountable, to promote such an obvious issue to the front burner for the company. It should be totally unacceptable for any of us to know of such a concern and allow it to recur, even one more time! Even if we do not have the “answers” or want the authority to create awareness and action, it is critical that we act (through speaking to the right people) when anything creates actual or potential harm for our patients!

    There is actual or potential harm to any patient’s delay in service or frustration to the point of considering leaving the provider! It is absolutely financial and so much more than a potential $200,000. loss to the hospital/system!

    Culture is the answer, regardless the size entity! Executives should be made aware and minimally a high level reliable department leader should know the critical importance of addressing such a major and front and center patient service issue! We are each accountable for a patient’s success and experience in our system or business! And, we should be measuring and holding ourselves, as leaders, accountable for how long these devastating scenarios occur prior to being addressed; that is a cultural issue! That requires attention … and perhaps change within leadership! And there are likely many more similar frontline issues that can and should be addressed if leaders practice with mindfulness, accountability, empowerment and caring!


  2. I think part of the problem is that clinicians and physicians think that patient experience only takes place when care is given directly to the patient. The concept of a journey throughout a system with patient touch points is foreign to them.

    Unless they are experiencing emergency care in a community outside their own, docs and nurses rely on there network connections to arrange for and receive care.

    The best analogy I can think of are people who never fly commercial airlines, experience the TSA screening, or the rush to stuff their carry-ons in the overhead luggage bin. Flying out of general aviation on a private jet to their destination creates a completely different experience.


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