What Is Patient Access’s 12-Step Program?

Yesterday morning, five miles into my run, I was feeling pretty good about myself. I had passed seven runners, had a nice comfortable rhythm, no insurmountable aches, and Crosby Stills & Nash banging away through my earbuds. I don’t like being passed—never have. Some people say I’m competitive. They say other things too, but this is a family show.

I’m a mile away from the midpoint of my run when I see a slight blurring movement out of the corner of my left eye. A second later I am passed by a young woman wearing a blue and yellow, midriff-revealing spandex contraption. Her abs are tight enough to bounce a quarter off. She is pushing twins in an ergonomic stroller that looked like it was designed by Sharper Image. I stared at her long enough to notice that not only was she not sweating, she didn’t even appear winded. She returned my glance with a smile that seemed to suggest someone my age should consider doing something less strenuous—like reading. Game, set, match.

Having recovered nicely from yesterday’s ego deflation, today at the gym I decide to work out on a Stairmaster, the one built like a step climber. I place my book on the reading stand, slip on my readers—so much for the Lasik surgery, and start to climb.

Five minutes into my climb, a spandex-clad woman chipper enough to be the Stepford twin of the girl I encountered on my run mounts the adjoining Stairmaster. We exchange pleasantries, she asks what I’m reading, and we return to our respective workouts. The first thing I do is to toss my readers into my running bag. I steal a glance at the settings on her machine and am encouraged that the METS reading on my machine is higher than hers, even though I have no idea whether that is good or bad.

Fifteen minutes, twenty minutes. I am thirsty. Water is dripping off me like I had just showered with one of Kohler’s full body shower fixtures. I want to take a drink and I want to towel off, but I will not be the first to show weakness. Sooner or later she will need a drink. I can hold out, I tell myself. Twenty-five minutes—she breaks. I wait another two minutes before drinking, just to show her I really didn’t need it.
She eyeballs me. Game on. She cranks up her steps per minute to equal mine. Our steps are in synch. I remove my hands from the support bars as a sign that I don’t need the support. Without turning my head, I can see that she’s noticed. She makes a call from her cell to demonstrate that she has the stamina to exercise and talk.

When she hangs up I ask her how long she usually does this machine—we are approaching forty minutes and I am losing feeling in my legs. She casually replies that she does it until she’s tires, indicating she’s got a lot left in her. I tell her I lifted for an hour before I started; she gives me a look to suggest she’s not buying that. I add another ten steps a minute to my pace. She matches me step for step.

Fifty minutes. I’m done toying with her. I tell Spandex I’m not stopping until she does. She simply smiles. Her phone rings and she pauses her machine—be still my heart—and talks for a few minutes. I secretly scale down my pace, placing my towel over the readout hoping she won’t notice. She steps down from the machine. My muscles are screaming for me to quit, but I don’t until I see that she’s left the gym.

Victory at any cost. What’s the point? For what was lost, for what was gained. Men and women. Customers and companies. Patients and health systems. Most will deny they are competing, yet neither will yield. The customer is always right. Turns out it makes a better bumper sticker than it does a business philosophy.

Patients are never right.  They never have the opportunity to be right.  It is difficult to be right when your call is on hold.  It is impossible to be right when you are playing “Where’s Waldo” with a hundred links on the health system’s homepage trying to find a link to schedule an appointment.

The issue I have difficulty wrapping my arms around is why is access as bad as it is?  The solution to improving access is stupefyingly, are-you-smarter-than-fifth-grader simple.

Tomorrow is national “Fix Patient Access Day.”

You have no incentive to fix something that you don’t know is broken.  So here is my patient access twelve-step program.  “Hi, my name is (state your name), and I have an access problem.

Close your office door. Sit at your desk.  Now pretend you are a person trying to buy healthcare, or that you are a patient trying to access your provider.

Navigate to your health system’s homepage and take it for a test drive.  Your experience should be a little like what Alice encountered when she was looking for the rabbit hole.  Hidden among the hundreds of website links and the dozens of phone numbers may be a link that allows you to do something other than post photos of your new baby.  After a few hours of browsing and not finding an actual way to access the health system, it is best to give up.

The next exercise in futility is to try to access your health system by calling one of the numbers posted on the website. Nota bene—if you call at a time other than 8 A.M. to 6 P.M. Monday through Friday, you have to go back to Step 1.

You will encounter one of the following; a recorded message telling you how important your call is and that it may be recorded for quality purposes—a note of warning to members of the C-suite.  Your inclination will be to throw the phone against the wall and go directly to the executive dining room.  You are placed in the waiting queue.  Celine Dion’s music is piped through the phone.  You are midway through the second CD of her greatest hits—assuming she had a greatest hit—when a voice asks how you can be helped.

Nota bene2—I had to Google to learn how to do the superscript.  Unless you are going to ask to schedule an appointment, a request with about a 60:40 chance of being successful, your call is about to be transferred because schedulers are only able to schedule calls—they cannot help you with other questions.  Your call is transferred.  You are placed on hold again.  Celine is still singing her heart out.

I know how cynical this all sounds.  It would be funny if there wasn’t a lot of truth in it.

Good access is so simple it is silly.  People, patient people and prospective patient people need to communicate with your health system.  They do not want to call it, but given that they cannot accomplish anything online, calling is their only choice.

Step Two of the Access Twelve-Step program is acknowledging that access is broken; badly broken.  Steps Three through Twelve are up to you.  You either take the steps to fix it or you don’t.

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