The New York Times is written using language that can be understood by an eighth grade student. I have an eighth grade student. He refuses to read my blog even though our collective tax dollars suggest he should understand it.

It is one thing to write at a level that an eighth grader can read. It is another matter entirely to try to understand what an eighth grader can comprehend. Never the two shall meet.

A few years ago when I began my blog, I had to figure out who my audience would be, and at what reading level I should I address my remarks. Most healthcare blogs are written at a level that supersedes my ability to decipher the message, and so I wondered, is it possible to take a complex issue and relate it in terms that would resonate with those of you who are kind enough to spend a few minutes with me each week?

A friend suggested that I write in crayon and she encouraged me to use a lot of pictures. Maybe I could write a pop up book that could also serve as a conversation starter. A coffee table book.

I demurred. And from my friend’s counsel I’ve learned that the most beneficial writing style is to offer something that combines the best of Mel Brooks with the best of whomever may be your favorite cynic du-jour. And that the most important takeaway is to make one point, a point so simple that even an eighth grader would understand. Not to infer that that is all you can understand, but I write at a level that even I can understand that about which I wrote.

And so my effort to explain the machinations of healthcare to myself, because that is the reason I write, continues. To quote the eloquent Mr. Brooks, “Mongo is just a pawn in the game of life.”

I think of myself as healthcare’s Mongo. I am also thought of as the guy who likes to drag the elephant into the room.  Mrs. Roemer tends to think that my mother, the original Mrs. Roemer, raised a particularly hardy breed of idiot.

Now, on to the reason we each arrived at this spot. Healthcare and its strategy. I refer to this type of strategy as a post-factual strategy, one where myths and irrationality hold sway over what is really going on.

The great thing about tying your business strategy to luck, is that luck is free. At least at the thirty-thousand foot level. You don’t even need to allocate the cost of a planning meeting. You simply send an email that reads something like this; “this whole consumerism thing may or may not work. Let’s see what happens.” If it works you are golden, and it did not cost you a cent.

If it doesn’t work, your a priori, preprogrammed response is to blame IT.

Luck’s bill becomes due and payable when it doesn’t pan out the way you hoped it would. When it comes to the business of healthcare—how healthcare is run—basing your firm’s survival on a monkey-see-monkey-do approach could work most of the time. Everyone is focused on HCAHPS; we should focus on HCAHPS. The hospital down the road has three MRIs, we should have three MRIs. Worry about big data even though we have little data.

As long as your competitors are in lock-step with your approach, your results are no better, or no worse (plus or minus) than the firms doing exactly what your’s is doing.

Unless–in case you have not been paying close attention, this is where I start to tug on the elephant.

And therein lies the rub. Each time someone enters a room he or she has a choice, “Do I turn the lights on, or do I leave them off?” When it comes to planning patient access, evidence suggests most firms choose not to turn on the lights.

The problem comes when someone in a competitor’s IT or marketing or innovation group asks a question. Asks this Question.

“What would happen if people could do what they want when they want using any device they want? His or her colleagues begin to sweat profusely. They get the same uneasy feeling that the CVS executives must have gotten when someone asked, “What if we stop selling cigarettes?”

That question, if acted upon, throws luck under the bus. The que sera sera business strategy is now in a world of hurt.

I studied math in college—well, I sort of studied it. Statistics, probabilities, possibilities, permutations. Linear algebra—it wasn’t all that linear.

A flip of a coin. A turn of an angry card. Luck is a game of chance.

Your firm’s business strategy does not have to be.

You may have attended a few of the meetings where these toss-of-a-coin, future of your firm issues are decided. Freshly minted MBAs with Pepsident smiles, a full head of hair and wearing skinny jeans. Visio presentations—PowerPoint is too 80’s for them. Zoom in. Zoom out.

“We’ve analyzed the big-data, and it tells us that our best strategy is to stay the course.” Those same MBAs are still wondering how an ice cube sunk the Titanic. The thing overlooked by the skinny-jeans crowd is that one cannot base an argument on big-data when one has no data.

If one were to survey patients and prospective patients about what access issues bother them they would have heard two replies; we want someone to know who we are, and we want someone to know how we are.

How and who—or is it whom?

But your system cannot deal with that. If you think of your hospital as a castle, your call center serves as the castle’s moat. It instills confidence and nullifies wariness. Your electronic moat is doing exactly what is was designed to do, protecting your firm from people from getting to you.

Your call center cannot answer ‘how’ or ‘who.’ And neither can your website. “Find a doctor?” No thank you. I want to schedule an appointment with that doctor. And that is when your Cisco servers start to gurgle. It is what happens when the temperature of the core of a nuclear reactor exceeds the reactor’s ability to cool the core.

Shift Happens.

And the thing is, the thing that is overlooked each time the healthcare savants and wellness Mensas gather in the board room with their Ouija boards, they discover that patients rarely use Ouija boards when selecting their healthcare provider.

Those people are trying to answer the question for themselves, “Will I buy healthcare from you?”

That is a two-hundred thousand dollar question—the lifetime value of a new patient. This is the same individual that your marketing department spent tens of thousands of dollars trying to entice that person to call your health system.

And that is precisely where your luck ran out. Your flip of a coin just came up tails 173 times in a row, it beat down probability and it beat down possibility. And the reason that happened is that patients and prospective patients and caregivers and family members have the ability to take common sense and turn it into string theory when it comes to understanding what your organization should do to meet their needs.

Everything your health system does needs one thing; patients. A young CEO asked his mother, “Where do patients come from?”

“They come from the phones,” answered his mother. “We call that access. And access begets engagement, and engagement begets satisfaction, and satisfaction begets patients.”

And so the CEO smiled, and he pictured flying phones bringing swaddled patients to his hospital.