The Animal Planet channel is advertising a show, Treetop Cat Rescue about rescuing cats that climbed a tree. The premise of the show must be that cats only know one way to climb; up. I have never seen a cat skeleton in a tree or on a roof.  That got me thinking; either there are a lot of cat rescuers who are very good at what they do, or the cats do not need rescuing and they are able to find their own way down.

Keeping with the cat theme.  While I was on vacation my mother and brother were taking turns checking on my house and bringing up the mail.  My brother called three days into my trip, and told me that cat died.  I said, “You can’t just drop that kind of news on someone.  You have to work up to it gradually.”

“And how do you propose I should have done that?” He asked.

I said, “You start off slowly, maybe saying something like the cat got out and it climbed up the side of the house, and now the cat’s on to the roof, and it won’t come down.  And you tried to get it down using a ladder, but the ladder was not long enough.  Then you say you called animal rescue, and a guy got hold of the cat, but the cat jumped out of his arms and died.

Two days later I called him again.  “How is everything going?”  I asked.

He was quiet for a few seconds, and said, “Mom’s on the roof, and she won’t come down.”

Sometimes it is about the words we use.  Sometimes it is about how we use the words.  Occasionally it has to do with the meanings others take away when they hear the words.  And that mnemonic certainly plays itself out in healthcare.

The words; access, engagement, experience.

Let’s try to level-set this for a moment.  What are they in your organization; nouns, verbs?  I think they are business processes, but for them to be processes they would have to exist, they would have to have a beginning and an end.

I got a call last week from an executive of a very large health system.  She said, “All three of these processes are on the roof and they won’t come down”.  (Try herding cats.)

One characteristic of a process is that you can watch it; you can watch it from start to finish.  And you can map it, assess it, and move the bits and pieces around to optimize it.

Can anyone at your health system map any of those three processes from start to finish?  Highly unlikely.  And it is unlikely because if they could, they would, and then they would find out that they probably missed ninety percent of the process.

There is a very good health system in Washington—not the state—with the letters GEORGE in its name.  Its entire, enterprise-wide access department is four women in a closet-sized office who provide registration services for patients the day before surgery. If I had blinked I would have missed it.  Goodness knows all of that health system’s other stakeholders have been missing it for years.

One can deduce that if a health system has taken the trouble to define what access is, by default it has also defined what access isn’t.  The good news in the case of this health system is that the people in its transformation and innovation department can map out their entire access process during lunch on the back of a cocktail napkin.

Most health systems believe access, engagement, and experience are important.  Important enough to warrant assigning three separate teams of people to deal with them.  Three separate teams dealing with three separate, different problems—perhaps as different as oncology, cardiology, and epidemiology.  It is difficult to find fault with that approach unless access, engagement, and experience are not like oncology, cardiology, and epidemiology; unless of course access, engagement, and experience are one in the same.

By the time in the process health systems concern themselves with what is happening regarding the access, engagement and experience of consumers (people deciding where they will buy healthcare) those are no longer issues for many of its consumers.  Those consumers are gone.  Gone because of very poor access and zero engagement.  And those are two of the three components of experience.

To understand someone’s experience you do not have to measure it, analyze it, or survey it.  Those tools are only needed by health systems who have already lost the patient experience battle.  By the time they think they need to get their tools out, the experiences of many people have already been cast.  The only output of value from those tools is to tell the system by how much it has lost the battle.  Just because your system may have a good HCAHPS score does not invalidate it having lost the access/engagement battle.  My rule of thumb is that the more fervent a system’s focus is on HCAHPS the less it knows about wat is occurring outside of HCAHPS.

The third component of everyone’s experience, the component sitting alone in the waiting room, or waiting on hold on the phone, is expectations.  And nobody can tell you anyone’s expectations for one simple reason—nobody every bothered to ask.

Until people in your health system believe it is important to ask patients and consumers what they expect when they interact with it, until they develop a plan to meet those expectations, there is no reason for anyone to believe any of the rhetoric about how important your experience is.

Remember however, “Your call may be recorded for quality purposes.” Or maybe not.