# Consumerism Nuance: You Did Not Say There Would Be A Math Quiz!

To me, one sentence sums up healthcare consumerism—We don’t know where we’re going, but we’re making really good time.

I can order anything I want online except a healthcare appointment. Why?

There are plenty of healthcare white papers available from the firms who are known for writing plenty of white papers.  They all read the same; lots of facts, plenty of graphs, user-friendly fonts.

These papers should be read and then filed away until the next time you feel compelled to read about consumerism.  Me, I’m going to wait for the consumerism IMAX movie.

There is a significant difference between a white paper and a WHAT paper. A white paper is a collection of facts.  A WHAT paper tells you what to do with those facts.  Most of the facts teeter on the nuances of nuisance; 79% of this versus 81% of that.  Most of those nuances come from data collected from providers, not from their patients.

An example of a key misunderstood nuance is scheduling.  All providers agree that patients want to schedule. Most providers have an 80% or higher level of confidence that their scheduling process works fine.  Patients want to schedule appointments.  Providers schedule those appointments.  Problem solved.  Providers define the scheduling nuance as a slight difference between how patients want to schedule appointments, and how providers schedule appointments. Patients describe that difference as a nuisance.

Providers’ metrics reflect how well providers perceive they are doing on a range of consumerism KPIs.  KPIs for which they collected data and calculated the scores.  Those KPIs are calculated in patient-free vacuums.  A nuance—a subtle difference of meaning.  A smidge.  A skosh.  Provider consumerism nuances are simple to understand—how they do something versus how patients want them to do something.  Providers do not focus on the difference between the how’s, they simply check the box and move on.  Providers are indifferent to the difference between the two scores.

To patients, the consumerism nuance is the numerical difference between the two scores.  If the difference is just a rounding error, we have “much ado about nothing”.  Shakespeare and math all in one blog—I hope there’s not a quiz at the end of this.  If the calculation of the difference between the two scores requires fractal geometry we are no longer dealing with a nuance.  To patients who want to engage their provider digitally, a digital engagement score of 15% is not a nuance, not a smidge, not a skosh.

It is a reason to spend our \$310 billion of discretionary healthcare dollars elsewhere.  Providers think about consumerism as access to care—retail care, urgent care, care from a pharmacy.

To patients, access is about doing what they need to do when they want to do it, and on whatever device they want to do it.  Patients want easy access to their provider as they have to their banks and eBay.  Providers give themselves a high score because they are opening urgent care centers.  They think that the difference between having their patients access an urgent care center by phone versus accessing it digitally is a nuance.  Patients think of it as a nuisance.

For those who like to score level of patient dissatisfaction using math, a Nuisance is much greater than a nuance:  Nuisance > Nuance.

And the survey said…the content of white papers, even the white papers of preeminent firms, are written around their own survey data. For example, “97% of providers rely on post treatment surveys.” “More than 80% of patients want electronic access.” “One in three providers get real time information during the patient visit.”  Data is good. How we get it is a nuance.

Borders, the bricks and mortar book store knew people liked to read Tom Clancy.  Amazon knew the same thing.  Borders thought how people purchased a Tom Clancy novel was a nuance.  In a store; versus online.  Borders’ inability to understand the term nuance drove them out of business.  So did US WEST’s understanding of the nuance of which firm people purchased long distance phone services.  And eBay versus Macy’s.  A Netflix versus Blockbuster.

The real nuance, the one to which providers pay lip service, is not the nuance.  Nuance implies scale. A small change yields a small and different outcome.  Nuance, in today’s vernacular, means that firms that were created out of thin air knocked all the air out of industry stalwarts.

Nonsense > Nuisance > Nuance.

And the driving force of all this change was the customers and patients.

Patient surveys tell you nothing about what patients want.  Patients tell you what they want.  And there is nothing nuanced about what they say.

The average patient does not care about your 37 KPIs.  They care about whether they can do what they want when they want, and on whatever device they want.  Give them those three things and the other 37 will take care of themselves.