The woman in front of me at the checkout line in the grocery store had two shopping carts piled to the rim with food.  She began placing her items on the belt, one item at a time, sorting them into neat categories; perishables, organic, canned goods.  I tried using ventriloquism, repeating the phrase “get out of the line…get out of the line.”  I could see her looking around trying to place the voice, but she remained fixated on her sorting…place the frozen Salisbury steak next to the TV dinners.

I felt a bead of cold sweat trickle down between my shoulder blades, and a slight shiver overtook me. I started picturing the woman in front of me at a salad bar, inspecting individual chickpeas prior to placing them on her plate.  The only other thing that could have made my morning more untenable is if the grocer decided to play a Celine Dion CD over the loud speakers.

After about twenty minutes the last of her items had been scanned, and the clerk announced the amount. The woman fumbled about in her purse, pulled out a large white envelope, and from it she withdrew a fistful of coupons.  The voice in my head whispered to me “I thought we agreed there would be no killing this time.”  Ten more long minutes passed; my grapes were turning into raisins.

The store manager and I simultaneously saw her reach back into her purse.  Even before we saw it, we both knew she was reaching for her checkbook.  The manager knew he only had a couple of seconds to try to stop the bedlam that was about to explode.  He vaulted the service counter, pushed aside the boy bagging the groceries and flung me to the floor.  A Good Samaritan in the next aisle straddled my legs while the manager hooked me up to an IV of Benadryl, and shielded my view from the woman.

That was my day.

If experience teaches us anything it teaches that if we represented the people who think they understand business strategy and planning on a Venn diagram, and also represented the people who actually understand business strategy and planning on the same diagram, the number of those who actually understand it would be like comparing the circumference of the donut to the circumference of the donut hole.

About one hospital in seven has a defined customer/patient experience strategy, and of those that do almost all of those strategies focus exclusively on what occurs within the hospital, and almost all of them rely exclusively on improving HCAHP scores.

That said, we can make a few observations about why it is difficult for any hospital to make any significant improvements regarding patient experience:

• 85% of hospitals do not have a system-wide experience strategy even though ninety percent of hospital executives rank improving patient experience as their first or second priority over the next three to five years.
• Of the fifteen percent with a strategy the vast majority of those strategies are constrained by what occurs to the patient in the hospital.
• Most hospitals do not measure the experiences or levels of satisfaction of their outpatients, former patients, or family members.
• It is possible that no hospitals measure the experiences or levels of satisfaction of prospective patients.

Should providers be improving HCAHP scores or improving patient experience? While it may seem like splitting hairs, the two efforts are not the same. You can improve the scores without improving the experience, but you cannot improve the experience without having it raise the scores.

What is the health system’s definition of improvement?  Where is the plan?  For most health systems the goal is to raise their score. Move the number from A to B. But then what? Where is the strategy? What is the retention goal?  The referral goal?

Not a single patient or consumer in the country can tell you the HCAHPS score of their health system. I bet none of Press Ganey’s employees can tell you the score of their provider.  HCAHPS are so material that they have become immaterial.  They are immaterial because nobody ever asked a patient what experiences are material to them.

And what is the pink unicorn in the patient experience waiting room, what is the question nobody is asking? It is this—why are providers trying to improve their scores? Managing HCAHPS is an aversion strategy mandated by the finance department.  It is similar to meeting Meaningful Use; maximize the EHR rebate and avoid the penalty. Other than not being penalized, how does the provider benefit from having a higher score?

Alternatively, how would a provider benefit by actually improving patient experience? Actually improving patient experience, patient access and patient engagement results in:

• Higher patient retention
• Higher patient referrals
• Improved revenue cycle
• Lower customer service costs
• Reduced admissions and readmissions

Now that seems to be a strategy that I were I the CEO or CFO or COO or CNO I could get my arms around.