This piece may ring true for anyone who has ever mowed their lawn more than once.  The first time you cut it your only objective is to turn tall grass into low grass. It is April or May, and the temperature may be in the high seventies.  By July, the temperature and humidity are both in the nineties, and your goal is to create low grass as fast as possible.  You are not worried about making straight lines, or about carving crop circles on the lawn; you simply want to finish quickly.

After a few years of mowing you trimmed thirty minutes off of what was initially an hour-long task.  You are familiar with the task.  While some think familiarity breeds contempt, it also breeds efficiency.  Do something often enough and you figure out how to delete all of the background noise.  You become a savant at creating shortcuts.

Chances are very good that the people who answer the calls to your organization, your health system, or your clinic have learned to do the same thing.  If the average call center agent speaks with ten people an hour, they answer eighty calls a day.  That is about twenty thousand calls a year.  They are extremely efficient, albeit probably not very effective.  They are not wasting time carving crop circles either.

Every phone call is a separate event, statistically independent. What if the odds of meeting the caller’s needs during their first call are fifty-fifty—in actuality the chances of being successful are probably closer to sixty-forty, but the math is easier, and a sixty percent success rate is far from laudatory?  Back to the math.  What then are the chances of your call center agent being successful four times in a row?  About six out of a hundred.  So, of those twenty thousand calls a year, even at a 60:40 success rate, that yields 8,000 dissatisfied callers, 8,000 people who will either call again, adding clutter to the call center, or worse yet, who won’t call again.

How many of them were patients, or who were people who were considering being a patient?  You see, having a call center is not about the call.  It was never intended to be about the call.

It is about the caller.  And that is the point most people do not get.

If you ever attended one of your high school reunions, one of the things you may have observed when you reconnected with someone with whom you have not spoken to in decades is that your emotional connection to that person probably picked up right where it left off.  It was as though all of the time between the two conversations did not exist.

If you were fond of the person when Nixon was busy wiretapping the democrats, you likely resumed your conversation with the same affection.  If you thought the person was a jerk forty years ago, you’ve probably spent the last decade refusing their request to friend you on Facebook for the same reason.

People remember their emotional connections with individuals, organizations, and health systems.  Those emotional connections are cumulative.  The same holds for patients and customers.  Their emotional baggage accumulates like unswept (past participle of swept—I looked it up) dust bunnies under a bed.  And it stays hidden until some force pulls it back from the dark side.  And the funny thing about the emotional relationships people develop with companies is that the accumulated detritus of the relationship never goes away.  It remains at its past worst level until an event causes it to move to a new worst level.

At some point, that emotional connection hits a point of no return for your patients and customers.  And that is when they decide they are not willing to invest another erg (a unit of energy equal to 10⁻⁷ joules) of effort to remain with you.  The relationship required too much exertion, provided too little reward, and the exertion—reward ratio became worthless; like trying to divide by zero.

Most organizations use the trite phrase when it places patients and customers and family members on hold—your call may be records for quality purposes.  You may listen to the recorded call and conclude, we handled that well.  You may have indeed done just that.  But, how well did you do on the last three calls?  How well did you do when you had to transfer the caller, or when you simply gave the caller another number to call, or when you were not able to let them speak with a nurse, or when you told them that the office would not be back from lunch for another thirty minutes?

Caller’s emotional dust bunnies get bigger and bigger. They accumulate mass.  Like a little snowball starting to roll down a hill.  Inconsequential at first. But let it roll unimpeded for a long enough time and you have an unabated force.

Companies like Studer earn their keep by trying to get you to buy-in to the notion that you only get one chance to make a first impression. Teach your employees to smile when they talk to your patients.  What the teach-you-to-smile firms fail to recognize is that first impressions were made a long time ago.  They cannot be unmade.  The impression was made the first time a patient or customer called, or it was made when they went to your system’s website and couldn’t accomplish what they set out to do.  It was added to when your neighbor told you that she spent two hours on the phone trying to schedule an appointment.  It was reinforced when your father couldn’t get anyone in billing to explain the twelve dollar charge on your bill for the Tylenol.

Just because the radiology technician smiled at the patient today during their first interaction with that particular patient will not solve your problem.  That patient has probably had years of interactions with your health system.  Today’s MRI was not their first rodeo.

Until recently, in the patient’s mind, this has always been a zero-sum game.  Good relationship. Deteriorating relationship.  Bad relationship.  Game Over.  Today providers face an additional player in the access/experience/satisfaction game.  While your patients are scoring you they are also scoring new providers, providers like CVS and Doctors on Demand.  At some point it occurs to them that their satisfaction scores with their other providers are always good.  Then it occurs to them that they can rely on some combination of those other providers to provide most of the services that they used to rely on you to provide.

They pull out their two score sheets.  One sheet reads—Good experience. Convenient. Good price.  Good healthcare.  That is when they realize that they no longer need two score sheets.

It’s about the caller not the call.  It’s about the thousands of dust bunnies.