So I’m making dinner the other night and I’m reminded of a story I heard on NPR. The narrator and his wife were talking about their 50-year marriage. One of the stories the husband mentioned concerned his wife’s meatloaf. Their recipe for meatloaf was one they had learned from his wife’s mother. Over the years they had been served meatloaf at the home of his in-laws on several occasions, and on most of those occasions his wife would help her mom prepare the meatloaf.

Her mother would mix the ingredients in a large wooden bowl including the ground beef and ground pork, which were sold in one-pound packages. She’d knead the mixture together, shape into a loaf, and place the loaf into the one and a half pound baking pan, discarding the leftover mixture.

His wife always prepared the dish exactly as her mother. One day he asked her why she threw away the extra meatloaf instead of cooking it all. She replied she was simply following her mother’s recipe. The husband said, “The reason your mom throws away part of the meatloaf is because she doesn’t own a two-pound baking pan. We have a two-pound pan. You’ve been throwing it away all of these years and I’ve never known why until now.”

Therein is the dilemma. We get so used to doing things one way that we forget to question whether there may a better way to do the same thing.

Many health systems are taking a two-pound baking pan approach to hiring a patient experience (PX) officer. I think most health systems are looking for a ‘px’—lower case—patient experience officer, someone to manage and monitor HCAHPS.

But, if you happen to believe that patient experience begins before someone is admitted and lasts well after discharge a ‘px’ won’t be of much help.  If you happen to think patient experience is not just limited to patients, but also includes consumers (prospective patients), family members, caregivers, and referring physicians a ‘px’ won’t be of much help.

I believe that when it comes to hiring a ‘PX’—upper case—patient experience officer, and knowing what to do with a PX officer, a health system would be better served by paying more attention to the person’s knowledge of the ‘X’ and less attention to their knowledge of the ‘P’.  After all, your health system is chocked-full of people who understand the P-side, the clinical-side. I believe there are substantial benefits to hiring someone who is a customer experience thought leader and who has designed great experiences across a range of industries.

What most health systems need is someone who can help them envision and design a remarkable experience for every person every time on every device.

Health systems need a PX officer whose knowledge of consumer experience will cause the PX officer to fight hard to get the executive team to agree to implement a customer portal even though the system already paid for a patient portal. While that point may seem trivial to some, or seem like an excessive expenditure to others, it should be at the top of the PX officer’s to-do list.

And here is why. Your patient portal is of no value to anyone who is not a patient. Consumers, that big block of non-patients, cannot accomplish a single task. Take a second to think about your bank, and your online relationship with it. That online relationship, your entire relationship, exists in the bank’s customer portal. Chances are it took you a few hours to create your financial profile and to set up all of your vendors for automatic payment. Now that you’ve done that you carry your entire financial institution and your financial history around in your purse or back pocket. You never have to talk to your bank on the phone, never have to stand in a line to see a teller to deposit or withdraw money, never have to negotiate a mortgage face to face. No more stamps to buy.

And if another bank came to you offering free toasters to switch banks, you wouldn’t even consider it. You see the thing is that your bank made you believe that what they were doing was making things easy for you. What they really did was to make it easier for them to acquire customers and to retain them.

Health systems should look for a patient experience officer whose knowledge base comes from customer experience, someone who recognizes that the people in the cafeteria and the people in their church and the people in the grocery store are all healthcare consumers.

Health systems need someone who can create an easy button, someone who can make the experience of doing business with your system seem easy. There are two points overlooked by most health systems:

• If your system cannot make it easy for a consumer to schedule an appointment by phone, that person will never be your patient
• If people cannot conduct business with your health system using an effective and well-designed customer portal—like the one they use with their bank—they will soon change health systems

Hiring a patient experience officer is a good thing. Hiring the right patient experience officer is a better thing.

Do you find the process of pairing buyers and sellers using Craigslist or Angie’s List easy?

I just upgraded my treadmill using Craigslist. I knew what model I wanted and all I had to do was find someone who was selling that model. And bingo; new treadmill. I went back to Craigslist to see if I could find someone willing to run on my new treadmill, but that did not work as well.

It occurred to me that the reason it is so easy to match buyers with sellers is because that is what the site was designed to do. EBay does the same thing, millions of times each week. Oh, and did I mention Amazon?

The business models for all of these organizations were designed. At some point a group of people drinking lattes gathered around a table and had a conversation that went something like this:

“We want to sell stuff. And to do that we need two things; stuff and people.”

“We don’t even need to own any of the stuff. We could just find someone who wants to sell something, and then find someone who wants to buy it, and we are done.”

“That is way too complex. Why do we have to find them? What if we simply enabled them to find each other? I see it happening along the lines of what happens when someone calls someone else. The phone company simply does a handoff. We should do that. Let’s say some guy in Iowa has a ’32 Chevy in his barn, and somebody in Arizona wants a ’32 Chevy. All we have to do is enable the guy in Arizona to find the guy in Iowa.”

And so they did.

EBay makes millions and millions of connections of buyers to sellers around the world.

Healthcare, on the other hand, has untold difficulty connecting one consumer to a single physician even though the two are only separated by a few miles. The consumer’s thought process is something like this:

“I have a phone. I bet the doctor has a phone. I will call and schedule an appointment.” Not so fast Skippy.

When that fails, and fail it will, the consumer thinks, “I have a computer. I bet the doctor has a computer. I will go online and make an appointment.” Not so fast Skippy.

I had dinner Saturday night with a member of the board of a very large health system in Philadelphia. She told me she had purchased her healthcare through the institution she served. She then said that she had a lot of difficulty recently making an appointment, and that after several attempts she now goes to another provider. (This is the same institution for which another of their board members told me, ‘We do not have customers, we have patients.” To which I replied, ‘Pretty soon you won’t have either.)

Health systems never bothered to think about designing how to put buyers and sellers together. ‘We are not in that business.” You most certainly are not. But you should be.

On a lark, I called a large New England health system to try to schedule an appointment with a pediatric orthopedist. I was not successful in my endeavor. I was told they did not have an orthopedist at the children’s hospital. I was not told that the health system had 181 orthopedists among their other facilities.

Suppose your doctor referred you to Dr. Joe, orthopedist at said health system. You call for an appointment, only to learn that the soonest Dr. Joe can see you is in eight weeks. A reasonable person will book the appointment, and then that person will call another health system trying to be seen sooner. What would it have taken for the health system to say, “Dr. Joe is booked, but Dr. Sally, one of our other 181 orthopedists could see you this afternoon?”

There are two groups of thought leaders on this issue. One group believes they should be able to go online, and get access to the care they want when they want it. The other group either does not think this way, or they simply have no idea that people cannot get easy access to their services.

This would seem to be a good solution to the problem of missed and canceled appointments. It would seem to be a good way to manage capacity. But then, what do I know?

Shop and click healthcare. It is really not that difficult. Unless you make it difficult.

It is easy to say, we are in the business of making people better; we are not in the business of connecting buyers and sellers.

Maybe the time has come to rethink what business you should be in.

An executive from Microsoft was seated next to me on yesterday’s flight from Seattle. So that American could earn additional revenues, we both had our knees positioned by our ears. We could not have been closer together had we been conjoined twins—brothers from different mothers. My briefcase was on the floor, about three feet from my hands. I am certain I invented a few new yoga positions in my effort to retrieve my computer.

I spent the flight trying to become familiar with my MacBook Air. My cellmate pulled a very thin device from his bag. He typed. He moved things around on the screen with his fingers and with a stylus so rapidly that it left my head spinning. Unable to reach my keyboard due to the proximity of my laptop to my chin, I watched him run his device through its paces for a while.

I have been using a portable computer since the days Compaq came out with one the size of a steamer trunk. Nobody would call me exceptionally proficient with a portable, but I get by in most situations, and when I can’t I just pretend. But this guy was doing things on his I have never seen anyone do. He opened a copy of someone’s resume. Using his stylus he highlighted some of the information. Still using the stylus, he began to circle other items, and he wrote notes to himself on the screen.

I have a MacBook. He has a laptop, a touchscreen, and the functionality of a pen and paper all on a device that weighed less than half of mine. My expectation of what a remarkable portable experience should be had changed in an instant.

And that is what this is all about, isn’t it? Great experiences are those that exceed someone’s expectations.

Now on to healthcare, customer experience, and consumerism.

Healthcare’s moonshot opportunity is consumerism. Consumerism will change healthcare more than any other change in the last fifty years.

Or it won’t.

At least for a lot of providers. The thing is, very, very few providers even seem to be aware that there is a moon worth shooting for, and even fewer are aiming for it.

If providers started now to develop a strategy to effectively implement a consumerism business model, it would take them a minimum of two years to be able to replicate the functionality their competitors had in place five years ago.

A seven year lag. Maybe it is time to start.

Just to be clear, consumerism is not valet parking. It is not we proudly serve Starbucks. And it is not free Wi-Fi in the waiting rooms.

There are all sorts of presentations and white papers on consumerism you can read. You can collect consumerism bullet points like some people collect seashells. You can create a healthcare consumerism exploratory committee—if you cater the lunch more people will be likely to attend. But it helps to know what consumerism is, and it helps to be able to explain it to someone in one sentence. So, in case you are having trouble coming up with a sentence, I’ll lend you mine:

Consumers expect to be able to carry their health system around on their smart device and interact with it to the same degree they interact with Amazon.

I had the good fortune this week to spend three days getting oriented with about a hundred other new IBM consultants. Included in the mix were roughly fifty new college hires, all kitted out for their first day of work. Empty Dooney Burke and Coach carryall bags for the girls. Equally vacant backpacks for the boys. Seeing them reminded me of getting my children ready for their first day of school; gelled hair, teeth brushed. I suppose a bit of me wondered whether their mothers had taken them to Staples to get them their first-day-of-IBM supplies—a shiny, new pencil box, Crayola’s 64 piece coloring set, and a Flintstone lunchbox and Thermos.

Most wore shiny new shoes that hinted of a European design; the front fashioned to a point like the shoes of a jester from some ancient court. One guy’s suit, the trouser legs so narrowly tapered that it looked like if he bent his knees he would quickly end any mystery about the answer to the question, boxers or briefs, still had the tag sewn on the sleeve.

The kids had their whole careers in front of them. To a person they looked to be filled with wonderment and aspiration. Mini Lou Gerstners—freshly minted B-School graduates. They were ready to go forth and slay dragons, to go solve any of the problems that came their way, provided those problems presented themselves before mid-afternoon. For by two-o’clock each of the kids looked like they were ready for a nap. I know each of them wondered, “Do you mean we have to work nine hours a day? Nine in a row? Every day? They didn’t tell us that during the interview.” The boy with the overly-gelled hair who had brought his lacrosse stick to class had just grasped the fact that recess had been cancelled for the rest of his life.

Many of them had spent their summer traveling and trying hard to purge any remnant of their college lifestyle from their system. Several had just moved to D.C. Their minds were doing Keynesian calculations regarding the duration of their new wardrobe, wondering how long they would be able to hold out before they would run out of clothes and have to learn how to do their laundry. Life’s first big challenge. I suggested they could make a field-trip out of doing laundry; everyone could meet at the nearby Suds-for-Duds and have a kegger, and yes Skippy, you may bring your lacrosse stick.

One chipper young girl with perfect skin, who was wearing about a dozen more earrings than I would have worn had I chosen to wear the same outfit as hers, addressed me as ‘Sir.’ Her voice sounded crisp, like the sound a fresh Granny Smith apple would have made if apples knew how to speak.

“Really?” I asked. “Really what, sir?” And then she understood. “I didn’t think I should call you ‘Dude’.” I think ‘Dude’ might have made me feel better.

The New-Kids-On-The-Block. On my block. If these Mensas of the blackboards only knew how quickly their lives were about to change. There would be a phone call. For some it would come tomorrow. For others next week. They would be sitting in a cube trying to look busy, trying to look like they were consulting on something. A power-bar and their Thermos would be placed an appropriate distance from their shiny new laptops. Their Coldplay ringtone would jolt them awake, and their halcyon days would be over.

College, from what I recall, was a series of one hour wind-sprints; calculus, English, organic chemistry. Four or five sprints a day filled with hours of intermittent boredom. The only time you had to excel was during exams or while playing Ultimate Frisbee.

Consulting, they would learn, is different. In some consulting firms, consultants eat their young, and they do it smiling the way a fish does that has been laying on a bed of ice all day. Some clients make their consultants walk ten paces ahead of them, requiring the consultants to shout ‘unclean’ (Old Testament) as they make their way down the hallways.

The kids come unbidden to their first project. They will be told what they need to do and by when they need to have done it or have it done (I’m not sure about the proper syntax). Some project managers, those who believe learning works best under pressure, may not even try to translate the assigned task into English. The newbies will spend the first hour trying to figure out how to apply their undergraduate studies to the task at hand. Trying to figure out how some aspect of poly-sci, Voltaire, or the mating ritual of the African newt, could help them understand how to create a journey map of the hospital’s admission process.

The most creative ones Google, “How to create a journey map.” The most highly ranked response was, “Ask your manager.”

After an hour of letting them stew, the project manager will sneak up behind their new charges and observe their stupefaction first-hand. “You may want to consider starting with a piece of paper and a pencil,” she’ll say with all of the authority of Moses delivering the stone tablets (Also Old Testament). And then she’ll leave, returning an hour later to see her Mensaesque cadet staring at a blank sheet of paper—a note for my clients; we do not charge you for these early hours in the life of a consultant, or at least we do not charge a lot.

A lot can be learned by throwing someone, like our new consultants, into the deep end of the pool. Unfortunately, throwing someone into the deep end does not always work when it comes to healthcare patients. It often can be made to work for simple things, and it hardly ever works for complex things. More often than not, people who are sick or injured don’t have a clue about what to do first or second, and even if they had a clue they don’t have a clue how to do it.

For example, I did not agree to let my wife call 911 until I had collapsed to the floor and wondered why it felt like someone had placed the couch on my chest. I had been watching a new episode of the Soprano’s and did not want to miss the ending. Did I need a hospital, or should I crush the rest of my cigarette.

In my twenties I was working on a consulting project in Amarillo—that’s in Texas. The local news was doing a two-minute bit on the warning signs of testicular cancer. I had been having dinner with a dozen of my colleagues. I walked out of the room, entered my apartment, and looked around until I found the Yellow Pages. I found the doctor who had paid for the biggest ad, and told his answering service to wake him.

Fortunately, and unfortunately, I had guessed correctly. Twenty-five, and having my doubts about making twenty-six. Cancer, I soon discovered, doesn’t give a gosh-darn about how smart you think you are.

Patients are only faced with these kinds of challenges once every decade or so. They have no more understanding of what to do and how to do it than my newborn consultants. And being told to take out a blank sheet of paper is of little solace.

Patient experience starts before patients become patients, and it lasts long after they leave the hospital. I can’t be sick because I feel fine and I eat kale. Is the cancer really gone? How do I know it’s gone? What kind of tests do I need? Don’t tell me it is going to take you two days to read my cat scan. “I have cancer!” I remember yelling. “I am not leaving this room until you tell me if it is still there.”

There are thousands of questions, the answers to which will generate more questions. The care team may consist of a dozen people. People who wake you, and people who tell you to get some sleep. The person who gives you a menu of breakfast items that do not mix well with cis platinum. The nurse who knocked your wig off the end table and then rolled the IV stand over it.

And here is why these experiences are so important. You know you have cancer, and your doctor knows you have cancer. But the person who answers the phones in your health system’s call center has no idea that you are even a patient, let alone a patient who’s anti-nausea medicine is having such a negative affect on you so as to make you do something that may have you appearing on the late edition of CNN.

The person answering your call has no tools to help them know who you are. That person will speak to eighty to a hundred people each day. Too many healthcare executives think of these people as callers, not as patients. Pretty soon this problem will self-correct. It will self-correct because at some point these callers will have had one too many bad experiences, and they will never call back.

And the really silly thing is that the problem can be fixed in such a manner as to deliver an exceptional experience to every person who calls, every time they call. So why not fix it? Call me. I have some brand new consultants who are just itching to show you what they learned at B-School, and who could probably beat your entire staff in a game of Ultimate Frisbee.

I was trying to explain to my dad what a consultant is.  I said, “Think of executives as blindfolded people in a dark room looking for a black cat that isn’t there. A consultant is the person who finds the cat.”

I have had the good fortune to have worked in over twenty countries and in forty-eight states.  And to get to all of those places I flew, and when we were done flying we always ended up in an airport because that is how things work when you have a good pilot.  Today I was in Seattle’s airport.  That airport has something I have never seen anywhere else.  In fact, it has something that had I been sitting around with a bunch of friends and trying to come up with something odd to put in an airport, we would have never thought of adding this thing if we had sat for the next hundred years.

Across the walkway from me a woman was filling her water bottle from the water fountain that was attached to the concourse wall.  I was standing thirty feet away from her. In spite of the cacophony going on around me I could hear the water from the fountain gurgling clearly, as it was dispensed from the fountain’s mouthpiece into her empty Evian bottle.  The source of the sound wasn’t something I recognized immediately. Only after a few seconds did I understand that I was hearing was water running.  I looked up and down the concourse, left and right, searching for the source of the water sounds.  There was no obvious source, but the sound of running water remained as clear as a bell.

The gurgling sound appeared to be coming from the wall across the concourse.  Only then did I spot the water fountain.  When the woman released the fountain’s handle the water stopped and so did the sound.  She turned the handle and the sound resumed.  It wasn’t until she had finished filling her bottle and walked away that I was able to see the speaker.  It had been built into the wall directly under the fountain.

There was no reason to share this with you other than the fact that I did not want to be the only one obsessing about the water.  Staying with the water theme—continuing to obsess—and hoping my obsession might lead eventually to a series of rambling that I may be able to turn into to a blog, as I walked towards my gate I passed a seafood restaurant.  Painted on the sign above the restaurant was  a picture of a fish.  It does not matter what type of fish is was.  The background of the sign was blue.  I assumed the blue color was supposed to represent water.  The reason I assumed the fish was in water was because I knew that other than in the seafood section of a grocery store, water is usually where one finds fish.  I stared at the fish.  The fish stared back at me, and smiled the way a fish smiles when it has been laying on ice all day.

If your mind works like mine—and we do not have the time to debate whether my mind actually works—you are probably beginning to see how this is all coming together.  I haven’t figured it out yet, but I want you to know I am working really hard to make sure you are not wasting your time reading this.  As I looked up at the fish one of the voices in my head made me ask myself if the fish knew it was in the water.  Then the voice asked whether fish, in general, have any knowledge of or understanding of water?  Do fish even know they are wet?  I concluded they probably don’t, but I cannot prove it.

Because I have an MBA, or perhaps in spite of that fact, I know that among the phyla (pl. phylum) of animals, fish are considered to be pretty good at swimming.  Perhaps that is because that when they are not on ice they spend most of their free time in water.  And swimming is probably some sort of a survival trait if you are a fish.  I know for sure it is if you are not a fish. (The entire flow of this piece is starting to remind me of the Monty Python skit about migrating coconuts.)

Do fish know they are swimming?  Do they even understand the concept of swimming? Asked the voice.  Sometimes I wish the voice would leave me alone.

So, and here we go, can we be very good at doing something we do not understand?  I think the answer is unequivocally ‘no’.  Then the voice asked whether we can be very good at doing something we have only observed, something we have never experienced.  For example, the voice postulated, whether a fish, if said fish had observed a person walking, could translate what it saw into its being able to walk.  (There are those living among us who believe that millions of years ago fish walked out of the water, and evolved into humans.)

I think those who believers are the very same people who when they smile, look the way a fish smiles that has been on ice all day.  Now, if it is true that if over millions of years of evolution, and the inability of fish to access cable television during those years, that in some inane interpretation of the survival of the fittest, resulted in fish walking from the sea, then so be it.  And if that same meshing of the roiling of the essential gasses created the biped 101 which needed Nike’s to protect their feet…yada, yada, yada…somehow explains why a small faction of today’s humanoids like to listen to Celine Dion, does the fact that today we do not observe fish walking mean the evolutionary clock is moving backwards?)

If we cannot be very good at doing something we do not understand, and if we cannot be very good at doing something we have never experienced, does that explain why customer experience is often so pathetic?  I have spent thirty years speaking with executives—those looking for the black cat that isn’t there—about innovation customer experience from the perspective of the customer.  And those conversations have always left me confused.  “Is providing a good customer experience a tenet of your organization?” I have ask them.  I have never had an executive tell me that providing an excellent customer experience wasn’t a business imperative.  When I ask, “Does your organization provide customers with good experiences?”  To a fault they answer ‘yes’.

I think their answers explains why customer experience is so bad.  The number of people in your organization who really understand customer experience would fit in a Hyundai.  And all of the people work in your call center.  The only time the other people understand customer experience is when they are experiencing a bad customer experience.

The big disconnect regarding customer experience is that employees of your organization never think of themselves as customers of your organization.  Can your executives understand what they have not experienced?  Based on the experiences I have seen, I am convinced the answer is no.  For your executives to actually understand how customer experience functions in your organization, they would have to experience it.  Knowing your firm has a call center, or walking through the call center, does not cut it.

I believe the thinking in most organizations must go something like this.  Customers call.  Our people spend time in our call center answering those calls. Therefore, we must be good at customer experience.  QED.  That assumption is no truer than assuming that making someone spend a night sleeping in their pool would make them a good swimmer.

This concept is self-proving.  Go to your health system’s website.  Did you have a good experience? If all you wanted to do was to learn what time the gift shop opened, your experience may have been okay.  Call the number shown on the home page of your health system’s website, tell the person who answers your call that you just moved to town, and ask them to schedule an appointment with a specialist the next day.  If you do not come away from that call feeling wowed—and you won’t—then you must conclude that neither will any of the other callers.

Adding valet parking, or proudly serving Starbucks, will not improve the customer experience.  For those things to matter, your customer must actually make it to your facility.  Consumers—potential customers, who never made it past your website or call center are no longer potential customers.  They are somebody else’s customers.  They will get their Starbucks at another hospital.

Most customer leakage, perhaps higher than ninety-percent of it, happens before consumers become customers.  Your executives do not understand the experiences of consumers who are exploring becoming your customers because they have no knowledge of the experience.  Your executives have no more knowledge of how many customers leaked during their first interaction with your firm than they have of the number of people who drove past their house while they were sleeping.

We’ve come full circle—water fountain, fish, and swimming pool.  (And some people believe I couldn’t create something out of nothing.)

Three illustrations involving water.  And the Lord spake, saying, “First shalt thou take out the Holy Pin. Then, shalt thou count to three. No more. No less. Three shalt be the number thou shalt count, and the number of the counting shall be three. Four shalt thou not count, neither count thou two, excepting that thou then proceed to three. Five is right out. Once at the number three, being the third number to be reached, then, lobbest thou thy Holy Hand Grenade of Antioch towards thy foe, who, being naughty in My sight, shall snuff it.

I have had a few recent conversations with healthcare executives who have asked the question, “Why are we even discussing adding an interactive Customer Portal since we spent millions of dollars building a patient portal?”

That is a great question.  And there is a great answer that drives home the point.  The Customer Portal, designed in a UX/UI framework, can be designed to do everything that can be done with a patient portal, and dozens of things the patient portal will never be able to do.  Plus, and it is a very big plus, the Customer Portal will serve all of a health system’s stakeholders, not just those individuals whose data happens to be in the EMR.  A consumer Portal will help drive population health. And it will help convert consumers to patients.

Each of the features listed under the Customer Portal column can be designed and built today.  Please let me know what you think, and what additional features you would add.

I always thought I hated flying, and then it occurred to me that what I hated was other people flying on my flight.  Flying, especially flying coach, is a bad experience.  With bad experiences you only have two options; you can change the firm providing the service, or you can try to change the experience.  I’ve tried changing carriers, but they are all equally poor.

I am flying coach from Philadelphia to Seattle—five hours and forty-one minutes of teeth-gnawing angst.  I knew that to avoid having my neighbors being interviewed by CNN and saying things like, “He was always so polite.  We didn’t know he even owned a gun,” I had to create my own experience.  I am assigned a window seat near the rear of the plane. I place a rubber, orange roadside construction cone in the middle seat next to me to indicate that seat is closed for repairs.

Once the plane passed through ten thousand feet I begin to work to improve my experience.  A calming composition of Albinoni’s was playing through my Bose Bluetooth headphones. From the overhead bin I retrieved my luggage. Next I taped a message to the large orange cone, “Please wait for Flight Attendant to seat you.” I release the catch to the table on the seatback in front of me, and on the table I laid the large, white linen napkin I borrowed the last time I was seated in first class.  The small, glass salt and pepper shakers, also borrowed from a prior first class flight, rested on the napkin.

From my luggage I withdrew a chilled salad bowl, dinner plate, plastic tumbler, and hijacking-proof plastic utensils. A small crowd had begun to gather in the aisle.  The smaller of the two Tupperware containers in my luggage held chilled hearts of palm and asparagus.  The larger container held my entrée, an eight ounce portion of poached sea bass, grilled Brussel sprouts, and quinoa.  I plated my meal while the guy in the aisle seat began to count the number of peanuts in the small cellophane bag he had been given by the flight attendant. I politely asked the waitress to fill my tumbler with ice, and to that I added a miniature of Grey Goose and a splash of tonic.

The experience, any experience is what you make of it.  The problem with most healthcare access experiences is they were never designed.  You go the website of your provider or payer—that was a waste of my time, you tell yourself.  Then you break into a cold sweat before you call your provider or your payer, you simply know your experience over the next several minutes is going to ruin your day.  You ask yourself, “Have none of their executives ever called their own company?”

Is it that they do not care that the experience they offer is so poor, or is it that they simply do not know how poor it is?  I like to give people the benefit of the doubt.  Maybe they don’t know.  But then I think, it is their job to know.

I try to avoid thinking too hard about problems.  I have found that not thinking, when done properly, creates a pleasant numbing sensation in the brain.  There are those who will tell you that not thinking is one of my best attributes.

So this is how I’ve organized this anthill.

A healthcare provider’s opportunity to succeed at consumerism is approaching the eleventh hour.  The bad thing about the eleventh hour is that you never know when it is a quarter to, you only know when it’s five after, and counting.  Regarding healthcare consumerism, could a bag of red Twizzlers the biggest material difference between your consumerism efforts failing and succeeding at your health system?

Are you out of your mind Paul?

When I evaluate the CVS healthcare retail healthcare model as represented by the Minute Clinic three things stand out:

• CVS has customers (prospective patients), not patients
• Their customers do not have appointments, they simply show up
• Their customers become patients, are evaluated, and receive care

Healthcare provider executives are asking, “How can we imitate the CVS consumerism model?”  My response to them is, “You already are, you just aren’t doing it very well.”

Hospitals imitate the CVS retail healthcare model 365 days a year, twenty-four hours a day.  It is called the Emergency Department.

• Customers and patients come in
• Neither the customers or the patients have appointments, they simply show up
• The customers become patients, are evaluated, and receive care

The health system emergency department has evolved into a dual-care model; emergency medicine and retail medicine.  The evolution has resulted in more and more customers using the ED like a Minute Clinic.

The evolution to a dual-care system has placed tremendous burdens on emergency care.  That evolution accounts for why many emergency departments are constantly reengineering themselves, posting wait times, and spending a fortune implementing six-sigma projects.  And to what end?  The more efficient your ED becomes, the more retail customers flock to it.

You and I know there is no point asking me to reengineer your ED.  At least that is what I thought before I started writing this piece.  But the more I thought about it the more it occurred to me that I could make a suggestion that would benefit the ED, benefit the real ED patients, benefit your customers—people who don’t have an emergency who just want to be seen by a medical professional, and the people in your health system who are tasked with acquiring new patients—marketing.  I am correct, your time reading this will have been well spent.  If I am wrong, I am sure I will hear from you.

Every provider already has a steady stream of non-ED patients who only require the level of treatment provided by a Minute Clinic.  Wouldn’t it make sense for providers to set aside a few hundred square feet of space and direct those customers who don’t require emergency care to another area so they can be seen by a clinician?  Wouldn’t that enable the ED to be more effective?  And if it was determined that the clinic patients needed urgent care services, you have a doozey right around the corner.

And what about all of your other facilities?  Could some of them adapt to this model?  Probably.

The ED of one of my clients was seeing around a hundred asthmatic patients every day.  The vast majority of those patients did not need emergency care.  Some needed refills, some needed instruction on how to use a nebulizer.  We recommended they set up an asthma clinic right next to the ED.  And it worked.

What are the benefits of co-locating a Minute Clinic concept next to the ED?

• It frees up the ED for those who require emergency care
• It converts clinic customers into new patients in your health system
• And it does so at a very low Customer Exertion Score:
  • Customers do not have to wait until their PCP can see them
  • Customers do not have to call
  • Customers do not have to make an appointment
  • Customers have immediate access to care
  • Customers pay only a copay, not ED rates

It makes sense to me.  But then again it should since it’s my idea.  Decide amongst yourselves if this idea is worth exploring—if the decision is close, you may wish to reach a conclusion based on style points.  Maybe that deafening noise I am hearing is the sound of all of the pieces falling into place.  And if you want to give your clinic more of a CVS feeling, consider adding a candy aisle.

For those who may be wondering how to talk for ten minutes without using a word that contains the letter ‘A’, just start counting…one, two, three.

The very first thing you say when communicating an idea has everything to do with whether your audience will pay attention to the rest of your message.  For example, if you are writing a suspense novel a good first sentence might be, “The man sitting across from me in the diner did not know he had less than ten minutes to live.”  If the man was truly enjoying his breakfast during those last ten minutes, another good opening sentence might be, “It was the best of times, it was the worst of times”—but somebody already used that line.

When presenting and idea to a hostile audience it doesn’t do to leave a live dragon out of your calculations.  Sometimes you can get lead your audience to where you want them to go by leaving a trail of breadcrumbs.  There are times, however, when the audience looks like they are still trying to figure out why Gilligan never got off the island.  That is when you know leaving a trail of breadcrumbs won’t suffice, and you the only way you can get them to follow your train of thought is by leaving entire loaves of bread.

During my last presentation I should have hijacked an entire bakery.  A woman in the front row kept shaking her head each time I spoke.  She was slim and trim, poised and preppy, and had the look of someone of keen intellect—the final step in the evolution of the species; or perhaps she was supposed to have been in the Wellesley Tri-Delta sorority reunion across the hall. I was trying my best to explain that healthcare consumers’ use of technology in other industries is what created healthcare’s driving force towards consumerism.  She looked at me as though I had suggested subliminally that she should assassinate the president of Colombia. I did not know if she was going to faint, cry, or ask for asylum in Iowa.  Though I thought she and I were on the same journey, I had overlooked the fact that she may not have been issued a roadmap.

Her behavior had usurped what little poise I had. “You’re not really into complex sentence structures, are you?” I thought of asking her, and then I said, “If you display the slides in reverse order it says ‘Paul is dead.’” (For those of you who didn’t grow up listening to the Beatles you may have to Google the allegory.)

Trying to explain healthcare’s immediate need to move towards consumerism to some people is like trying to explain the idea of cholesterol to a Big Mac; they don’t get it.  Judging from the looks of some members of my audience I realized I could have communicated the idea of consumerism better had I displayed a single slide depicting the game Wheel of Fortune, and prefilled the slide with C, O, N, S, U, M, E, R, I, S, _, leaving them wondering whether they needed to buy a vowel.  I mentally texted myself to start my next presentation with something more upbeat like the music, Ride of the Valkyries.

There is a worn military expression which states the diversion you are ignoring is really the main attack. I suggest respectfully to the provider community that healthcare consumerism is not a diversion or a feint; it is the main attack.

I displayed a slide showing how healthcare consumers expect to be able to interact with their providers.  Click-to-buy.  Twenty-four-seven access.  Up-to-date records of all interactions and real-time health data. (The concept sort of follows a generalized retail business model, but that is the idea because their model works.)  If you count yourself among the healthcare consumerism misanthropes you may be better served by opting out of the rest of this blog.

“Have you ever seen the model you are describing being used by a provider?”  A gentleman in the back row asked.

“No,” I replied. “But I’ve never seen my pancreases either, but that doesn’t mean it doesn’t exist.”

The most material difference between retail firms approaching healthcare from the perspective of consumers, and healthcare providers approaching patient acquisition and retention from the antediluvian perspective of the new-kids-on-the-block, the new-kids are actually adding customers hand over fist. If you do the math, they are actually adding customers hand over fist, and hand over fist…and so forth.

And here’s my point—yes, it took me a while, but hopefully it was worth the wait.

So, if you are a provider executive, or a board member of a provider, you should be screaming at someone.

Most of the people in your health system’s radius of service, the population you serve—think population health management—are regularly spending their healthcare dollars everywhere else but with you, spending it on retail providers.

Perhaps you are thinking, “We can’t make money testing people for strep throat.” CVS has a line of dump trucks carting away the money they are making from performing those tests.  Provider executives vehemently decried they are not in the business of healthcare consumerism. And they are correct in their declarations.  They aren’t.

Maybe they should be.

If you were asked what the biggest difference is between the game of chess and playing poker, how you respond? In most games of poker, the players are the only ones can see their own cards.  In chess, you and your opponent both see the same thing.  You see their pieces, and they see yours.

Yet which game is more deceptive?  I believe chess is far more deceptive than poker even though you can see everything.  The only thing you cannot see is what is going on in your opponent’s head.  The entire strategy of your opponent’s play is too try involve you in an intellectual sleight of hand, to believe he or she is going to do something other than what he has planned.  Their goal is to convince you to alter your strategy to defend a phantasmal strategy. And you know that is what you are doing, but if your opponent is better than you, you won’t be able to stop yourself from falling into their trap.

Now permit me to ask, how would you respond if you were asked to describe the biggest difference between your healthcare organization and other top companies?  Amazon. Disney.  FedEx and UPS. Nordstrom. Southwest Airlines.  Apple.  Marriott and Hilton.

Those companies are on lists; on multiple lists.  The health system you work for, or the health plan you work for are not on those lists.  Neither are the providers you use for treatment, or the payers you use.  And they are a long way from even being considered.

The most respected companies. The most customer-friendly companies.  Ritz Carlton is not on the list.  Neither are American Express or Coca-Cola.  Nor Aetna, Cigna, Hopkins, or the Cleveland Clinic.

Missing in action.  The difference between the best companies and your employer, between them and your provider or payer is not that your companies are not on the lists of the best companies.  The lists simply serve as scorecards.  The difference is that none of the firms in other businesses are trying to imitate how healthcare firms run their businesses.

The best firms got to be the best as a result of deliberate, exacting business strategies.  Other companies figure out what the best firms are doing, and then they try to apply that business model to theirs.

None of the companies in other industries try to imitate the business strategies of the best providers or the best payers—assuming that phrase even makes sense. There has never been a strategy meeting during which someone states, “We need to change our consumerism approach to be more like Aetna’s.”

The business strategies of the best firms are built around supercharging the notion of consumerism. I define consumerism as giving the purchasing power and the decision-making to customers and potential customers.

The most consumer-friendly firms do not even have call centers for people to call.  Why?  Because those firms engineered away all of the business processes that would cause people to call. The vast majority of inbound calls to every company are initiated because something that should have been done correctly further upstream of the call wasn’t.

Take Amazon as an example.  There are no phone numbers for customer service. There is no one to call to ask questions or to resolve complaints.  That is not because there are no questions or complaints, but because Amazon designed an interactive, online customer portal to meet every one of their customers’ needs.  And even without a call center, or in spite of not having a call center, Amazon is rated as the most customer-friendly firm in the U.S.  Amazon’s customer portal, when viewed from the perspective of their customers, is the face of the company.  Everything happens through the portal.

If healthcare began tomorrow with a full-court press to design and implement a consumerism business model, one that includes a customer portal and a mobile strategy, it would take two years for healthcare just to be able to do what the best firms were doing five years ago.  Health care is so far behind the consumerism curve that it can’t even see the curve.

Your firm’s executives can say “We are not in the consumerism business.”  And technically, they would be correct.  However, being correct and being right are different things.

Healthcare consumerism may or may not be essential to providers with regard to patients in the ED, at least for ED patients with a real emergency.  People seeking treatment for a real emergency don’t have time to worry about the wait times posted on your website; heck, they don’t even have time to visit your website.  When I was gazing at the ceiling of the ambulance while being rushed to the hospital, I was not asked to which hospital I wanted to go.  We simply went.  This was no time to discuss patient experience or issues surrounding consumerism.

Giving the purchasing power and the decision-making to customers and potential customers. What happens if your organization doesn’t give it?  Customers will take it anyway, or they will find an organization that does give it.