Seven A.M., Saturday morning on the high school’s outdoor running track.  It reminded me of the way a community swimming pool looks during the time for the adult swim.  A dozen or so older adults were stretching and starting to make their way around the artificial surface of the track.  I hung the bag containing my workout gear on the pole of the chain-link fence. Next to the fence rested several canes and walkers.  I halfway expected to see a box of Depends and a stack of AARP magazines. So this must be what life looks like in the not-so-fast-lane.

After running for an hour I paused and I grabbed my water bottle.  A woman a few years younger than me also reached for her bottle of water. When I asked her how far she was running she said she and her father were running for eight hours. They were training for a one hundred mile run. I almost swallowed my water bottle, but I tried to appear nonplussed. It turns out she and her father, the much older man circling the track, were ultra marathoners. My ego thought about resuming my run but I decided I did not want to die today.

An article yesterday on one of the twenty-four hour news channels mentioned Frontier and Spirit Airlines rated among the worst in customer experience—did anyone need a news article to learn that?  The article went on to mention the two airlines had almost accomplished what many people believed was impossible; they almost managed to rank below Comcast and Time Warner Cable in customer service.  I’m guessing Spirit and Frontier must have had committees working around the clock for months to trying to beat out Comcast—“If we are going to offer bad customer experience, we may as well be the best at it.”  When the results were announced the airline executives tried to maintain a stiff upper lip. “They have not heard the last from us, there is always next year.  We will marshal our resources.  We will cancel more flights and buy smaller seats,” stated an anonymous employee.

Offering a poor customer experience requires hard work.  It doesn’t happen by accident, and it doesn’t happen overnight.  It requires time and dedication.

And it requires indifference. And that indifference starts at the top of the organization.  Leadership either knows the experience is poor and doesn’t care, or it doesn’t know and it doesn’t care.

Improving the access experience should be on every health system’s CEO’s plate. If it isn’t, it is time to get a new plate. Patients don’t leave their health system because they receive poor care; they leave because they perceive their health system doesn’t care.  Doesn’t care about whether they answer your calls, doesn’t care about whether it’s inconvenient for you to call while you are working, or how many times you have to call to schedule an appointment.

That same health system will have a committee studying how to reduce cancellations and no-shows.  They will have another committee performing a root-cause analysis of leakage—patients who disappear.  And they will spend a lot of money on consultants to help them find answers to nagging questions like, “Why did Mr. Waldo skip his procedure today, and why didn’t he let us know? He is scheduled for back surgery in two months. Will he show up for that? What do we have to change to prevent this from happening again and again?”

Here is how to save a million dollars studying how to answer those questions. I think all of the Mr. Waldo kinds of stories went something like this.

Mr. Waldo spent considerable time online educating himself about where to go to have two discs repaired.  He studies hospital websites, reads patient blogs and Facebook, and even watches a few YouTube videos.  And after all of that work he selected your health system.  He called and called, and he eventually made an appointment and saw a specialist.  The specialist gave him a number to call for an initial procedure.  The specialist also scheduled Mr. Waldo for surgery in two months.

It took Mr. Waldo several calls to schedule the procedure. He wasn’t happy. In fact, he was so unhappy with the experience of scheduling the procedure that he skipped it and did not even bother to cancel it.  Mr. Waldo learned that not showing for a procedure meant  he no longer had to waste time calling the hospital; now they called him.  He rescheduled the procedure and completed it.

Two months to go.  The health system reserved the OR, booked the anesthesiologist and the surgeon and the surgical team, and reserved a single room for Mr. Waldo.  While the health system was doing all of those things, Mr. Waldo kept himself busy.  Mr. Waldo knew his surgeon was one of the highest rated surgeons in the city. He read more about the hospital; it was also highly rated.  But his perception was nobody in the hospital really cared one way or the other about whether he gave them his business.  He visited more social media sites, posted his own YouTube video about his experience, and rescheduled his surgery with another hospital.  The only thing Mr. Waldo did not do was to call your hospital and cancel his surgery.

On the appointed day everything was ready.  The doctors and nurses were on standby, the OR was nice and clean, and the single room on the fourth floor—the one that overlooked the Wal-Mart—was ready to receive Mr. Waldo.  The only problem was Mr. Waldo never arrived.  A chorus of “Where’s Waldo?” echoed throughout the hospital.

People, patient people and consumers, people like Mr. Waldo do not like to call a health system any more than you do. Calling requires work. It requires work because calling doesn’t work. It requires multiple calls. And callers often give up their quest before their needs are met.  So when they finally work up the energy to call, it is not to chat.  Their call is important to them in part because it is the only call to a health system they are going to make that day.

Conversely, to the person answering the call, Mr. Waldo’s call, Mr. Waldo is just one of dozens and dozens of people they will speak with that day. This one conversation will be just a blur in their day. It’s not a blur for all of the Mr. Waldos who call each day.  They remember the call.  They tell others about the call.  And then they call some other health system.

I spent much of the last month asking patients and consumers about what matters to them about patient access.  Why did you do that, you may wonder?  Because I thought somebody should ask them.  There are dozens of firms claiming to be able to improve patient access, but have they asked patients what they think? There are hundreds of health systems claiming to be interested in improving patient access, but have any of their people asked the patients what is important to them?

I learned essentially two things:

1. The people who want better access include two groups:
   1. Patients. “Patients” means inpatients, outpatients, discharged patients, former patients
   2. Consumers.
2. Answer your phones, give me the answer I need in one phone call, give it to me by speaking with only one person, and let me call you when I want to call you, not just when you want me to call you.
3. Allow me to do what I need to do with your organization the way I can with every other firm on the planet with who I do business.

I summarized what I learned in the downloadable PowerPoint deck whose link is below. I would love to know what you think. After all, each of you has been and will be a patient.

Patient Access ROIs

Equating patient satisfaction with exceeding their expectations is equivalent to equating cosmology to cosmetology. A major reason for the disconnect is providers equate their HCAHP scores as the primary or sole metric for patient satisfaction without ever bothering to see whether those scores matter to their patients. Patient satisfaction has almost no relationship to patient loyalty.

Although patients who call your health system may be satisfied with the result of their call, they are disappointed that they had to call to have their needs met.  Not a single patient ever told a hospital administrator that they selected the hospital because of its HCAHP score or because of the pleasant experience they had calling the hospital.  People do not want to have to call your health system any more than you want to call Comcast or Aetna.  Calling requires effort, and effort makes people look for an easier alternative.

Sixty percent of the people who call a provider are calling because they could not solve their problem by going to the provider’s website.  Strike 1. The fact that the vast majority of provider call centers are really just scheduling centers further erodes patient loyalty. This happens because only about twenty percent of the calls are about scheduling.  The other eighty percent of the calls have to be transferred.  Strike 2.  The average caller has to make more than two calls to have their needs met.  Strike 3.

Let’s consider an example.  Suppose the marketing department launches a campaign to acquire new patients, or to get current patients to purchase a new service—appendectomies half-off.  Now nobody seems to know what it costs to acquire a new patient, but let’s assume that it is not cheap.  The prospective patient sees the marketing campaign on a billboard or hears about it on NPR or sees a flyer taped to the door of a hospital elevator.

That person goes to the provider’s website to sign up for the service, but there is no information about the campaign online.  Strike 1.  They call one of the many numbers on the provider’s homepage and ask Sally about the campaign.  Sally does not know about the campaign and transfers the caller.  Strike 2.  Pete answers the transferred call.  Pete works in radiology and has no idea why the call was transferred to him.  Strike 3.  The provider struck out, and chances are good that the person who called will not call again because calling requires too much effort.

Providers create loyal patients by solving their problems quickly and easily.  What does the term ‘easy’ mean in context of this discussion?

The provider’s perspective of easy: We make it easy for you to solve your problem. We give you a number to call—they usually give you dozens of numbers to call—and we give your 45 hours during which you can call.

The patient’s perspective of not easy: Our only alternative is to call, and we can only call Monday through Friday from 8 A.M. until 5 P.M.

What do patients and prospective patients—consumers—consider access easy?

• Contact at any time
• Contact on any channel; web, phone, chat, email

Eliminating the requirement that people have to call your organization to meet solve their problem also solves their single greatest complaint about their experience.  Not having to call once eliminates the need of them having to call more than once.

Many health system executives believe their website offers patients an easy alternative to calling to solve their problems.  Having a link reading ‘Schedule an appointment’ that simply provides a form for someone to complete to ‘Request an appointment’ does not actually let the person schedule an appointment.  Neither does ‘Request your Health Record’ if it only takes you to another form.

The seventies was an interesting decade to say the least. Bellbottom pants, platform shoes, long hair, and necklaces were the fashion of the day, and that wasn’t even the girls.  It was also the decade of technology, a technological boom that would never be equaled.  Slide rulers were replaced by calculators, analog watches were replaced with digital watches, music became portable with Walkmans,  your phone could be carried around the house, you could record missed calls, and you could punch a button and change the channel of your television.  Radio Shack and Texas Instruments would soon rule the business world Life was good.

I studied mathematics in college and learned about imaginary numbers. The simplest imaginary number i is equal to the square root of negative one.  The thing about imaginary numbers is that they do not exist, they are imagined.  But once you define the thing your imagination has imagined, you can do things to it. You can multiply it and divide it and tell others about it.

John Nash is the Princeton mathematician about whom the movie Beautiful Mind profiled.  Nash created an economic model about game theory and he was awarded the Nobel Prize for work showing that when multiple players are involved, for the group as a whole to win every player must choose a path that is not optimal for them, but that also does not put them in a losing outcome.  They must choose a suboptimal outcome, one that allows everyone to benefit. Part of his equation is shown below.

The point of showing this equation is to recognize that if any single variable is removed there is no equation.  By definition, both sides of an equation must be equal.  A missing piece invalidates the whole.

Health systems have their own mathematics and their own imaginary number i.  It is most frequently imagined and used to calculate Patient Experience; cal it PXi.

The traditional mathematical patient experience equation is the following, and you can tell others about it and make believe it is real:

PXi = HCAHPS (experiences of inpatients in the hospital)

Problem solved—not so fast Skippy.  The health system formulation of PXi fails because it does not include many of the variables comprising patient experience. It does not include a single experience that happens prior to treatment and after treatment. Oh, and it does not include the experiences of the majority of a health system’s stakeholders; namely outpatients, discharged patients, former patients,  family members, and the largest group of all, consumers—prospective patients.

So the real formula for patient experience is:

PX = (hospital experiences for inpatients and outpatients) + (stakeholder pre and post-hospital experiences)

Please notice there is no i in the real formula because the formula no is longer an imaginary number.  The PXi formula also fails because its calculations are based on measures tied to what CMS feels are important.  Although HCAHPS claims to represent the experiences of patients, the single most important measure missing from the CMS formulary is it does not include the perspective of a single patient. Nobody every validated the survey questions against what patients feel makes a good experience.  And therein lays the rub.

Although imaginary numbers have their place in mathematics, they are of little value in healthcare.

Sometimes it is worth pointing out the obvious; or not. An analyst on CNN, talking about the missing Malaysian plane was explaining why it was so difficult to locate the plane. “Light objects float, and heavy objects sink, and a plane is heavy.”  The evolution of the lizard brain.

Years ago, because of the lizard brain, the government decided that for important decisions, decisions like launching nuclear weapons, the responsibility had to be shared between two people.  That is why two thumbs are required on two launch buttons.  I do not know how things are in your home, but in ours, for important decisions about things like deck furniture, there is only one launch button, and I do not 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 about our all-weather deck furniture. The spring deck furniture dance is more difficult than the fall dance because the metal deck furniture has been hibernating downstairs in the basement all winter; metal brown bears do the same thing.

Then, when the metal furniture awakens it has 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.  By now I am missing the snow.  I plodded along slowly like a trained pachyderm, a variety of furniture types raised overhead.

I was waiting for my neighborhood friends, guys like me, to set up lawn chairs and watch the parade, but then it occurred to me they were either hiding from their spouses, or were having their own 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 built to live outdoors. Not in the winter, and not in the rain.  The seats and cushions were extruded from some unidentified man-made material whose half-life was probably exceeds that of the fruitcake my grandmother made when I was twelve, but if it gets wet it may do a Wicked Witch of the West and melt.

Even so, with April being the month of showers, I know I will be hauling the cushions, the same cushions that I just hauled outside, back inside the first time we see a cloud drift overhead.

“They don’t melt,” I tell her.

“Are we missing a cushion?” She asks.

“No, I’ve been soaking one in the guest bathtub all winter.  It looks good as new,” I tell her.

“That is not the same as leaving it out in the rain.” So much for trying to make a point.

So, how do we tie this into something that hopefully makes this few minutes worthwhile for you?  I think when it comes to assessing patient experience many hospitals think that when their patients are not in the hospital the patients are hibernating safely and soundly and without a care in the world.

That makes it worthy to ask the question, what do hibernating patients do?  Often they call the hospital.  They want access.  And how is access defined? A patient tries to schedule an appointment or a lab. A patient needs a refill.  Or has a complication from a medication or a procedure.

Here is why something as simple as being able to answer successfully a call is the first experience for many of people.  And guess what? If we cannot answer a call it does not matter how noisy the hospital is because the callers will never hear the noise.  They will do one of two things, neither of which are good.  They will choose a hospital which can answer their phones, or they will go to ED. Oh, and they will tell others.

A colleague was receiving chemotherapy at a top US cancer hospital.  She spent three hours on the phone trying to schedule an appointment.  Now she spends her hibernation telling others not to go to that hospital.  Hospitals cannot put that toothpaste back into the tube.

If they ever find any debris from the missing Malaysian airliner, my guess is that they will find a seat cushion.  That cushion will have survived a fiery explosion at thirty-thousand feet, and will have spent six months floating in seawater.  I will point that out to my wife just as soon as I finish carrying my deck furniture back to the basement to begin its hibernation.

Sometimes something gets stuck in my head and the only way to get it unstuck is to get the idea stuck in someone else’s head. By the way, dictionary.com had a sale on big words, and a bought a jar of them and tossed them into this blog.

A few weeks ago I came across something on one of the newsy channels having to do with a Canadian paleontologist sitting by himself on a pebbled beach in Quebec.  His life’s work revolved around pinpointing the place where fish first walked from the sea—the very fact that he was interested in finding out where fish first walked by inference implies his belief that they (fish) have walked on more than one occasion.

I know some of you are thinking, ‘And your point in writing to us about this is…”.

The television spot went on with the fellow reporting that the interesting thing is not that fish walked—which most open-minded non-Darwinians would have found sufficiently interesting all by itself—epochs later; yada yada yada—but that without them (the fish) having walked none of us (the non-fish) would be here.  It was alchemy in paleontology presented in an NPR/PBS authoritative manner, complete with a British accent, and the reporter was his Rapunzel.  If we say it on PBS it must be true.  The show did not offer any opinion to the contrary.  I wanted for someone to pop onto the set and say, “Prove it.”

What troubled me about the show was that he and his amanuensis, the reporter, with her eyes wide shut, somehow managed to create a dialogue around this notion as though it (the meaning of life) actually happened the way this fellow said it did.  I’ve seenMonty Python’s The Meaning of Life and it did not happen that way at all.  The report’s interview of the ichthyologist was like watching two left-handed men learning to dance backward without either one knowing the woman’s part.

The voices in my head started screaming epitaphs at me.  The paleontologist’s mind tacked intuitively and lurched from idea to idea untouched by the clammy hand of logic.  His premise made as much sense to me as having an oboe player in a punk rock band, yet the erstwhile reporter, with her sang-froid composure, uttered nothing more than an ‘uh-huh’ and looked as though she was watching time bend right in front of her Oliver Peoples glasses as he explained the wonders of the universe to her with his do-re-mi recitation of the facts.

Some people in front of a camera have the innate ability to insult our intelligence with boredom and futility—sometimes I do it with a blog.  His perfervid idea was stranded on the edge of reality and it worked about as well as a poorly used preposition at the end of a sentence.  As I asked blankly of the television show whether any of these walking fish were found wearing shoes, the reporter listened to his promulgation, nodded and followed him into the rabbit hole.  She never questioned whether the compass of his intellectual qualifications may have been missing its needle.

Therein lays the rub.  Simply saying something aphoristically on television does not make it true.  What was intended as an ephemeral interview now exists for the folly of all of us.  The man is guilty of sharing his ideas without having a hall pass to do so, but then again, so am I.

Maybe that is how mermaids came to be.

Segue.

A lot of people only care about fixing business problems at the eleventh hour. The problem with that approach is that you never know when it is a quarter to eleven—you only know when it is quarter after.

Leslie Nielsen in the movie Airplane notices the pilot and copilot are incapacitated.  “We need to find someone who not only knows how to fly a plane but who also did not have the fish for dinner.”

And boys and girls, therein lays the root of the patient experience dilemma—too many of us ate the fish that have been walking around, and we believed everything we were told by the ichthyologists.  CMS and HCAHPS; the e-all end-all of patient experience. Let’s take the CMS patient experience survey together and see how effective it is for measuring our experience.  Let us assume we are being treated for cancer at a renown hospital in a city famous for its steamed crabs.

Our mission is simple; it has been six days since our last treatment, we have a fever, and the side effects of the cisplatin are debilitating.  We are trying to speak with someone in who can tell us whether the fever means we need to be seen by someone.  We go to the hospital’s website, and see the link schedule an appointment.  Filled with optimism, we click the link.  We are taken to a new web page which tells us the phone number to call and the hours to call it. Our optimism nosedives.  Fortunately or unfortunately as it turns out, it is 11:59 A.M. on a Tuesday.  The hospital’s call center—a euphemism for scheduling center—is open.

We call.  We are placed on hold and we listen to a recording about how important our call is and that our call may be recorded for quality purposes. If you do not actually speak to someone there is nothing to record.  After a while we speak with someone and tell them about the fever and ask what we should do.  “You need to call oncology,” we are told. “Can you transfer us?” We ask. No.

We call the number for oncology and get this voice message, “The office is at lunch, please call back after 1:30 P.M.”  The nausea—from the cisplatin, not from the phone call—is getting worse.  We call the scheduling number again, and again are forced to listen to the on-hold music.  After a while we speak with someone and we ask to speak with a nurse.  We are told there are no clinicians in the call center, but the agent offers to transfer our call to a nurse.  We are transferred, and a sweet-sounding voice instructs us to leave a message and someone will return our call with forty-eight hours.  We try the main number, we are placed on hold, and the cycle continues. At 1:30 P.M. on the dot call call the oncologist’s office again.  The number is busy. There is no on-hold music, just a busy signal..

You tell me the line is busy because everyone else who called while the office employees were at lunch had the same idea as us, call at exactly 1:30.  Enough is enough. You tell me to hang up the phone and you drive me to the emergency room.

So, how was our patient experience?  Does anybody care?  Does anybody even want to know?  Will anybody ask us? Apparently not.  Patient Experience and Patient Access; CMS and HCAHPS.  Of the first twenty questions on the HCAHPS survey sixteen of them begin with the phrase “During your stay in the hospital.”

Nota bene: if your hospital cannot even answer its phones for its patients all of the questions having to do with “During your stay at the hospital” become irrelevant.  The vast majority of patient access experiences do not happen in the hospital.

The man next to me on the boarding platform at Penn Station was short in stature. He wore black leathers, and black combat boots. His wallet was affixed to his belt with a chain thick enough to have been scavenged from the Titanic. The man’s long, blond curly hair was shiny enough to land him on the cover of Cosmo. The lizard part of my brain was tempted to ask him whether he belonged to Hell’s Angels or Charlie’s Angels, but I was too tired to run if he attacked me with either a knife or a curling iron.

We wound up sitting together on the train, and when he learned that I consult on patient experience he said, “If you really want to improve patient experience, fix the billing.”

So I did.  Here is what I came up with; two simple rules to make the billing experience more palatable.

• Rule 1: If the hospital cannot explain its own bill, then you do not have to pay whatever they cannot explain.
• Rule 2: The Affordable Care Act. Ask them how they determined whether the amount they charged you was affordable to you.

Patients and health systems view the billing differently.  Health systems provide multiple bills because multiple parties are involved—one for the surgeon and one for the pain, and one for the little girl who lives down the lane. When you go to Burger King you get one bill.  Burger King could give you separate bills; one from the baker, another from the farmer that sold you the slice of tomato and the piece of iceberg lettuce. But if Burger King did that, you would eat at Wendy’s.

Patients want one bill, a bill they understand, and an amount that somehow ties back to the service they signed up to purchase.  And because the bills patients receive do not correspond to that guideline the patients call and the call. And they dispute the bill, the amount, the itemization.  And then they question the value, they delay payment, or refuse to pay the full amount, or simply refuse to pay. And the next time they need to be confused by their healthcare bill, they decide to get confused by some other health system’s bill

And the health system now has a very dissatisfied patient. A patient who makes it his mission to voice his dissatisfaction to anyone who will listen. After many calls to the patient to attempt to collect payment, a process that further alienates the patient, the health system sells the patient’s bill to a collection agency.  Then the health system pays a consulting firm millions of dollars to fix their revenue cycle. And the consulting firm comes in. It creates new business processes and new business rules. And it sells your health system on the importance of six-sigma and seven-sigma.

The part health system do not seem to understand is the part that is overlooked.  Every health system that has ever looked at this problem thinks the problem is a collections problem.  And so when they meet in the big conference room with the consultants in the hospital’s administration wing, everyone’s focus is on improving collections.  If however the problem is not that people refuse to pay, but that they refuse to pay something they do not understand, how much of the problem would go away if the health system fixed billing instead of collection.  Collections may be working just fine,, but nobody will know until the bill is fixed.

Eighteen months go by.  The bill remains unpaid. The health system spent millions of dollars on consultants.  When all is said and done the health system still issues multiple bills that nobody but the consultants understand.  Perhaps the next patient who inquires about their bills should be told to call the consultants for an explanation.

I told the person next to me on the train to call his health system and to tell them the following; I will pay all of these charges as soon as someone can tell me what each charge cost the health system.  I then told him to use the money he was going to use to pay his bill to go on vacation because nobody in the health system knows the actual cost of anything other than a Tylenol.

Our perceptions are often based upon our perspective.

The perception of someone inside a building viewing a snow storm may have the perspective, “It is cold”.  The perception of someone standing in the snow storm viewing the inside of the building may have the perspective, “It is warm.”

In thinking through the issues of patient access and patient experience it occurred to me that perhaps the root of the problem is one of perspective.  It must be, unless you believe that healthcare executives are so callous as to not care about the experiences people have when they try to access their institution.

I happen to think some of the conflicts associated with poor access and poor experience have to do with two definitions, namely how healthcare defines the terms ‘access’ and ‘patient’.

Healthcare defines access as access to affordable healthcare.  Healthcare defines patient as someone receiving care even though population health may suggest that everyone living inside the health syste’s radius of care is to some degree their patient.

People—patients and consumers (prospective patients)—define access as their ability to access the health system; the institution.  Those same people define the term patient much more broadly.  For the most part, if they have purchased healthcare from any part of your institution they probably think of themselves as your patient.  Even if they simply live in the area they are likely to think “That is my hospital”.  Please note, this does not imply loyalty, it may just imply convenience.

So, knowing that healthcare executives are not callous, that they want people to have a good experience when they try to access their institution, one must assume that healthcare executives believe people do have good experiences.  Otherwise, those executives would undertake initiatives to improve those experiences.  Perception and perspective.

I think healthcare executives view the access experience their system offers like this.

Everyone is happy.

In the real world, however, the people trying to access their health system using their phones think it looks a lot more like this.

And when you ask those same people how they would like to access their health system it looks a lot more like this.

Those same people access their bank with a smart device, and Doctors on Demand, and their phone company.  And they buy cars using a smart device, and they get a mortgage.  And they do this whenever they want; not just Monday through Friday between 8 and 5. The only thing they cannot do using a smart device is access their healthcare.

Patients know healthcare can fix this problem.  What they do not understand is why it doesn’t fix it.

Invite your health system’s leadership out for ice cream, and ask them why they don’t fix access.  If any one of them asks for sprinkles all you need to say is “Sprinkles are for winners”.

Thanks Flo.

What do you know about the number 48?  It is the smallest number with 10 divisors, and the product of all of those ten divisors equals 48⁴. It is also the smallest even number that can be expressed as the sum of two prime numbers in five different ways. It is a Harshad number; that means it can be divided evenly by the sum of its digits.

With 48 matchsticks you can make a triangle in 48 different ways.

In 48 hours an ant could walk a little more than eight miles.  The Apollo rocket could travel two-thirds of the way to the moon in 48 hours.

So, just how long is forty-eight hours, and why is that important?

During lunch today a visited various health system websites.  In no time at all, a period of time less than 48 hours, I found that in the Contact Us section of three health system websites the viewer could submit a question to the health system.  And those three health systems pledged to respond to the viewers’ requests within…say it with me…48 hours.

And I would be two-thirds of the way to the moon by the time I would receive my reply.

Forty-eight hours apparently doesn’t mean much to a health system, but it means a lot to those waiting on the health system. Waiting seems to be a common theme; waiting rooms, waiting on the phone, and now for those with more of a high-tech bent, you can even wait online.

Healthcare embraces the internet!

Maybe the term embrace is a little too strong.  A 48 hour wait time sure seems to undermine the purpose of having broadband.

If these health systems offered a chat function on their website the wait wouldn’t even be 48 seconds.  And why not offer that.  It sounds silly, but it takes the exact same amount of time to answer the question asked by the viewer, whether you do in online, or whether you wait two days to answer it.  No value is added to the answer by taking longer to provide it.

Some healthcare executives are probably thinking, “Well, it can’t be that important because very few people even use that service to contact us.”  Perhaps they do not use it because they have better things to do than wait 48 hours.  The rule of thumb for how long it should take to provide answers online is that they should be provided right away—right away is also less than 48 hours.

A side note: each of these three websites provided a link for people to schedule appointments online. I tried those three links, and guess what? Each link took me to a page that provided a phone number and the hours during which I could call to schedule an appointment.

What if you could click on a single link and learn about all of the innovations to a health system’s contact center or call center?  Sometimes wishes really do come true.  In the past fifty years there have been three significant contact center innovations…and they are pictured below.

Rotary, to touchtone, to cordless, to mobile.  Great innovations. Unfortunately for the health system, and equally unfortunate for the callers, the innovation was not for the health system, it was for the caller.

Going from rotary to touchtone, the caller saved about three seconds dialing before being placed on hold.  Going from touchtone to cordless, while it did not save dialing time, it allowed the caller to do the dishes or feed the cat while they were waiting on hold.  It also allowed callers the ability to hit redial when they were disconnected. And going from cordless to mobile allowed callers to do all of their grocery shopping and get their car washed while they were on hold.

Pretty innovative.  In fact, using their mobile phones to schedule an appointment, the callers could place their call to the health system on hold, and drop by the Minute Clinic, or call Doctors On Demand and do a video visit right from their mobile phone.  And then they could disconnect the call they were making to the health system.  And then they could save the phone number for Doctors on Demand, as a favorite. In fact they could save the number to the same speed-dial location on their phone that they had been using for the health system.

Apparently, Doctors On Demand uses this new-fangled thing called the internet for scheduling and video conferencing.  I decided to do a little research on this internet thing.  Turns out the internet is a pretty powerful tool for businesses and consumers.  I started to make a list of things I could do on the internet and another list of things I could not do on the internet.

On the ‘things I could do side’ of the page I wrote; schedule a haircut, order food and have it delivered, pay my bills, watch movies and listen to music, get a diagnosis and a treatment plan, and buy all kinds of stuff. Oh, and I could also read all about my health system and find out what hours its gift shop was open.  And I could do all of these things any day of the week and at any time during the day and on any device I wanted.

On the ‘things I could not do’ using the internet side of the page I wrote; schedule an appointment with my health system, set up a payment plan with my health system, complete my registration, pre-admit myself, chat with a customer agent about my bill while we are both looking at it, order a refill, change an appointment, monitor my wellness—you get the idea so I will not lengthen the list. To do any of those things I would have to call my health system—say it with me—Monday through Friday between 8 A.M. and 5 P.M.

What should the health system do?  It should design a remarkable access experience for every person at every time at any time on any device.  And until it does that, the number of people using the Minute Clinic and services like Doctors On Demand will continue to grow.  And the people who use those services will use them more and more frequently because people do not want to work hard to do business with their health system.  Many health systems still do not get it.

Maybe this will help.  I calculated that the average Lifetime Value of a patient over twenty-five years is worth between $180,000 and $250,000.  If a health system wants to ballpark the ROI of designing a better access experience, send a team of people with calculators to all of the Minute Clinics within twenty miles of your health system. Have those people count all of the people who use the Minute Clinic for an entire week.  Using those calculators multiply that number by the number of weeks in a year—52 for those trying to keep up with the math, and multiple that number by the Lifetime Value of a patient.

The number you derive will have two or three commas in it.  Let’s call that the opportunity cost to the health system of having an access experience that experience that has not changed since the invention of the phone.