Playing a trivia game as an ice-breaker at a networking event, the question was, “A five-letter word for a reptile.”

The woman next to me shouted out, “Spider!” (For those of you who may not be herpetologists and who did not win the Scripps Spelling Bee, spider has six letters and spiders are not reptiles.)  Hence my angst.

Foolishly I hoped the woman wasn’t actually replying to the question, but was responding to the fact that perhaps a Brazilian Wandering Spider—the deadliest spider on the planet—had just entered her alimentary canal.

As it turned out, there was no spider in her ear, and there was not much between her ears. My IQ dropped several notches. I decided that I had broken enough ice for one day.

I looked at my wife.  She told me she had to call Dallas.

“All of it?” I asked. She rolled her eyes at me. I am a stickler for syntax, for terminology. I think when we use words we should, at a minimum, know the meaning of the words we use.

Anyway, let’s look at what healthcare can learn from the airline industry for a second. Whose experiences does the airline industry care about?  Only one group of passengers seem to matter.  This group boards first.  They are sipping mimosas while the rest of the cattle are herded to the rear of the plane.  They have their own rest room. And when they are hungry someone places a linen table cloth on their tray table, and they are given baby salt-and-pepper shakers with which they can season their filets.  The rest of us, those whose experiences do not matter, are trying to figure out how to allocate the contents of a bag of peanuts across four time zones.

The airline does not care about the experiences of the other ninety percent of the passengers on the plane.  And here’s the kicker. They do not care about the experiences of anyone before they get on the plane, and they do not care about the experiences of anyone after they leave the plane.

Let us take a minute to define who and what we are talking about when we use the word patient. A health system needs patients who are committed to their system—the chicken is involved with breakfast, the pig is committed.

I posit that from the patient’s perspective the word patient has a much broader definition than the way most health systems define it. Health systems, for the most part, define patient as someone undergoing a billable event. Someone producing revenue in real-time.

I believe there are five types of patients, patient personas.  Each persona has a specific question they are trying to answer when they try to access a health system:

• Consumers: Will I buy healthcare from this institution
• Outpatients: Will I but more healthcare from this institution?
• Inpatients: Committed, at least for the moment to the institution. Will I buy healthcare again from this institution?
• Discharged patients: Will I buy healthcare again from this institution?
• Former patients: Will I buy healthcare again from this institution?

The best way to get a patient committed to an institution is to know a patient’s expectations, and to meet or exceed those expectations by delivering a great experience.  And whose experiences does the health system know? Just those of the inpatient.  And which of those experiences do they know? Only the ones experienced in the hospital?

And why is that important?  Because a lot of experiences happen before the person is admitted and after they are discharged.

Health systems only measure and address the experiences of inpatients in the hospital—like only caring about the experiences of the first class passengers during the flight.

If the personas of a person’s patient life-cycle can be traced from consumer, to outpatient, to inpatient, to discharged patient to former patient, the hospital knows almost nothing about those experiences.  It’s not like those experiences are unknowable.  Health systems made a deliberate choice not to care about those experiences.

Yesterday, the COO of a health system asked me if I had any interest in interviewing for the position of Chief Patient Experience Officer.  I asked her if her health system had any interest in addressing any of the experiences other than those measured by HCAHPS.  She said she didn’t, and I said I didn’t.  Maybe nothing will change until CMS decides to penalize a health system for requiring three phone calls to schedule an appointment.

I would write more but I have a flight to catch. I wish I could remember where I left that bag of peanuts.