This whole deal of the Parisian Accord troubles me.  It also troubles my whale.  I keep her in the bathtub right next to my email server.  I hope Director

Segue.

Years ago, because of the lizard brain, our government decided that for important decisions, decisions like launching nuclear weapons, the responsibility had to be shared between two people.  (If the responsibility was shared by three people, I would have used the preposition among rather than between.)  That is why two thumbs are required on two launch buttons.  I do not know how things are in your home, but in ours, when it comes to important decisions about things like deck furniture, there is only one launch button, and I am not allowed to have a user-ID.

Twice a year, in early spring and late fall, my wife and I do the lizard brain dance, and we do it regarding our deck furniture. The spring deck furniture dance is more difficult than the fall dance because the furniture must be carried up to the deck.  Our metal deck furniture has been hibernating in our basement all winter, right next to the brown bear. (Given the ramifications of us leaving the Paris Accord, once the ice caps melt, the bear may not have to hibernate.)

When our metal furniture awakens from its hibernation, it needs to be carried by hand, by the husband, from the basement, up enough stairs to make me wish I had installed an elevator, to the deck—the deck that was just power washed by the same husband.  Fifteen minutes into this exercise I am missing the snow.  With furniture raised above my head, I plod slowly up the stairs like a pachyderm from the now-defunct Barnum and Bailey circus. (The elephants are not worried about the warmer temperatures.)

I was waiting for my neighborhood friends, guys like me, to set up lawn chairs and watch the parade, but it occurred to me they were either hiding from their spouses, or they were having their own furniture parades.

Our metal outdoor deck furniture is unlike any other deck furniture.  Unlike others in that according to my wife, our outdoor furniture was not designed to live outdoors. Not in the winter, and not in the rain.  The furniture’s seats and cushions were extruded from some unidentified man-made material whose half-life probably exceeds that of the fruitcake my grandmother made when I was twelve. My wife’s concern is that if the furniture gets wet it may have a Wicked Witch of the West event and melt.

Even so, when rain threatens I will be hauling those cushions, the same cushions I just hauled outside, back inside.

“The cushions don’t melt,” I tell her.

She counts the cushions and asks, “Are we missing a cushion?”

“No, I’ve been soaking one in the bathtub all winter—right next to the whale.  It looks good as new,” I tell her.

“That is not the same as leaving it out in the rain.  And since you raised the point, why is there a whale in the tub?” So much for me trying to make a point.

So, how do we tie my furniture problem into something that makes reading this post worthy of your time?  I think when it comes to assessing patient experience many hospitals believe that when their patients are not in the hospital they are hibernating, that they don’t need access, that they don’t need to be engaged.

That belief begs the question, what do hibernating patients do?  They call their provider.  They want access.  And how is access defined?  There are two ways to consider that question—from the perspective of the health system and from the perspective of the caller.  Nota bene.  Providers don’t collect data about access and engagement.  Patients collect that data every time they call.

The most frequent experience patients and consumers have with their provider are through their provider’s call center.  And guess what?  If those providers don’t meet the expectations and needs of those callers it does not matter to them how high their provider’s HCAHPS score was.  Those callers will do one of two things, neither of which are good for the provider.  They will choose a hospital which can meet their needs, they will manage their health one their own, or they will go to ED. Oh, and they will tell others of their experience.

A colleague of mine was receiving chemotherapy at one of the leading US cancer hospitals.  She spent three hours on the phone trying to schedule a follow-up appointment.  Now she spends her period of hibernation telling others not to go to that hospital.  Health systems cannot put that toothpaste back into the tube.