How To Fix Patient Experience: Feed The Fish


If you haven’t spent much time with people of my métier—consultants, we aren’t real high on anybody’s be-sure-to-invite-to-the-party lists. Maybe it’s the shoes. My counsel has always been, we’re okay if you paper over the rough spots.

You may think consultants are business’s Robespierres. During the French Revolution, Robes—I am the yin to his yang—backed the execution of Louis the XVI. (What I love about Google is its ability to make it seem that you have a PhD. in French History even if all you know about the French is how to make a decent Béchamel sauce.) Robes, as good as his leadership was, was guillotined a year after Louis. His fate makes me glad that we do not favor the guillotine for thought crimes that may have been committed by consultants.

If you will allow me another moment of your time and allow me to pretend that I am a historian on par with Thucydides—you can also Google him; I did—you could infer that consultants are like Torquemada, the Spanish cleric who in his spare time founded the Inquisition.

I could not help myself, and I offer an apology to those of you who have made it this far without clicking over to eBay. If you have been a reader of my blog for longer than a few months, you know that I think most business problems can be illustrated best by a reference to something written by Mel Brooks. (For information on Torquemada see History of the World, Part 1—there is no part 2.)

I try to bring a certain bon homie to your day. In the world of consulting, some would say I have what is called the Pope’s Gift. What that means is that if the Pope walked outside on a perfectly cloudless day an opened his—I’m not being sexist with my pronoun—umbrella, that every Catholic for miles around would open theirs, too. Some believe that if I opine that you have a problem, chances are pretty good that you have that problem.

I tend to raise the issues by screaming epithets—wrong word, but I like it—because I believe there are many organizations delivering lip-service about how important their customers are. The catch is that there are executives in those organizations with their hand in the cookie jar, and their first inclination is to point at the refrigerator—doesn’t it seem like the word refrigerator ought to have a ‘d’ in it somewhere?

Fixing consumerism has a lot of low-hanging fruit. The problem is that many of the people in charge of fixing consumerism and access and engagement cannot tell the difference between fruit and cannolis.

As I wrote previously, an executive vice president of a huge health system moved to a certain city to start his new job. The city is irrelevant. It could easily be your city. He—without throwing aspersions to the politically correct crowd, because he was and is a he—called his employer, to get an appointment with a PCP—primary care physician—to those of you who are still playing. And he was unsuccessful in his effort to get an appointment.

This happens hundreds of times every day. It happens at your health system.

But it happens ‘in camera.’ In camera is a legal term. The term refers to a discussion that happens in the absence of others—the people at your health system who should know that these attempts to access you health system are happening—but who do not have a clue.

Imagine you are that executive and you are sitting in your office. I am going to employ a little literary license to set the stage.

Your two hundred gallon salt-water aquarium is bubbling away on the far wall. Your desk is uncluttered. You Mont Blanc pen and pencil set sits front and center on your leather desk pad, poised to sign whatever strategic document appears on your blotter.

Three hundred square feet of polished glass walls afford you a view of whatever river happens to flow beyond your parking garage—you can pick the city and river of your choice without affecting the outcome. A nifty Degas print, uplit by an LED lamp embedded in the hand-stitched Oriental tapestry, whose colors that happen to match your socks, colors that were hand ground by lama-farming urchins in Nepal, hangs on the far wall.

Your kingdom awaits your leadership. So what do you do? Feed the fish? Adjust the Degas print?

Try this? Take off your jacket and tie—the fish won’t mind. Take the elevator to the third floor, and sit in the surgical waiting room. Talk to the person sitting under the television who happens to be reading a dated copy of the Latin American Economist magazine. Just talk and listen.

And then go to the first floor. Keep talking and keep listening. Spend the next hour in admissions. Spend another hour in the ED waiting room. And another where you do the lab tests—and bring your magazine to keep yourself from going nuts. Then go back to admissions. A lot of the people you saw earlier are still there. And leave the magazine because you don’t understand economics and you don’t speak Latin American.

Then go back to your office. Put on your tie and your jacket. Have your admin get you a cappuccino. And create a new to-do list of all of the things you learned about what you need to do to improve patient access, experience, and engagement.

And if after twenty minutes of thinking about what you need to do, and you look down at your list and realize that you have not written anything, write this:

“Feed the fish.”

That way, you will leave the office knowing that the day was not a total waste of your time.



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