The TSA line was not open Sunday at Philadelphia International Airport. So like everyone else I made my way through the line that resembled the cattle pens at some Midwestern stockyard. As I approached the disrobing station I watched curiously the machinations of those who proceeded me—shoes off—no you may not take off the shoes of the person next to you even if you know them, belts off, remove your laptops and implanted medical devices. Watching everyone struggle to complete these basic tasks reminded me of what it would be like to watch chimps learning to use cutlery.

The next thing I remember was the flight attendant speaking, “In the unlikely event of a water (crash) landing your seatback cushion may be used as a flotation device.” Last year was notable for a high number of water landings in the southern Pacific Ocean. Of the thousands of hours of newscasts about those landings, not a single one of them displayed a picture of any seatback cushion serving as a flotation device.

So, the entire purpose of this missive is, how did I come to be on this particular flight Sunday? It is a good story, and one I thought I would never write. All of the credit is due to Tina. And who is Tina? Permit me to tell you.

I am flying to Detroit. I knew I was scheduled to fly to Detroit at 3:35 PM. However, Detroit was in the process of getting a foot or so of snow. I called my travel agent—is there any way I can get an earlier flight or fly on another airline or fly through another city and do the bunny hop from there to Detroit?

No. There is not. Her answer was quick. Too quick for my liking. Too quick to lead me to believe that she did anything other and glance at the Weather Channel and conclude—you are toast.

The time was 9:08 AM in Philadelphia. I called USAIR. I never voluntarily call USAIR. I would rather walk barefoot across the frozen tundra than call them. But one of the many voices in my head said you have nothing to lose.

And Tina from USAIR answered my call.

I explained to Tina Philadelphia, Detroit, and everything I knew about snow. Eskimos have more than forty words for snow. Tina considered that extraneous information. There was a pause in the conversation while Tina tried to help. Everything on the earlier flights on her airline and on other airlines was sold out—everyone else flying to Detroit Sunday was smarter than me and they called Saturday to change their flights.

There was another lengthy pause then, “Can you make the 11:10 A.M. flight?” I live an hour from the airport. I started shoving clothes into my suitcase without giving any single item much consideration. I do not know exactly what I packed, but it would not surprise me to find several pairs of my wife’s sensible black pumps strewn across the Marriott’s double bed. And if that is the case, chances are that I did not pack a suit that goes well with sensible black pumps.

Kudos to Tina. I do not know her last name or her employee number. Not only did Tina get me a seat on an earlier flight, I wound up sitting in first class.

I am not double platinum, chairman’s preferred anything. I have no incriminating information on the airline. I am just a passenger; like most of you. The kind of passenger who knows they are about to travel to the dark side. The kind of passenger who is told there are no seats available. Who is told, there is one seat left but it will cost you your first-born. On top of that, I have written a lot about the folly of flying, and most of it about the folly of flying on this airline. Enter Tina, stage-right. And there I was. And nobody was more amazed than me.

So what is my point? The point is that my travel agent made no effort, and she concluded she could not help me. Tina, on the other hand, made an effort. And Tina broke every rule in the book.

If anyone reading this happens to work for USAIR, please let me know how to thank Tina. If anyone reading this happens to work for USAIR, please promote Tina to Chief Customer Experience Officer.

From the perspective of USAIR’s executives, Tina just cost USAIR revenues by not charging me for changing flights, by not charging me for flying first class, and for my extra bag of pretzels.

Customer experience is what you make of it. And it takes work. It takes doing what is right, not what is expedient, not what is measured.

I am scheduled to fly home Thursday. Since I do not have Tina’s cell phone number, I have preloaded my angst to combat what I expect will happen when I next have to be a USAIR customer.

People call your company; patients call your health system. If you know anything about customer experience you know that a single good experience does not create loyalty. In fact, the simple act of having to contact a company, a health system, makes callers four times more likely to change providers. Callers expect a bad experience. And unfortunately, companies are happy to meet those expectations, and they do so at an alarming success rate.

Tina—call me!

To be transparent, when I enter a hospital as a patient I should probably hang a sign around my neck, “You may be in my next blog.”

Did you know that if you shuffle a pack of cards properly, chances are that the exact order of the cards after shuffling has probably never been seen before in the history of the universe? Another fun fact is that 10! (factorial) seconds is exactly six weeks.

Patient access blog fodder. Sometimes the simplicity of what is dysfunctional is so obvious as to make me wonder why we cannot just set aside five minutes a fix it.

The admissions clerk at my hospital told me the charge for my ultrasound would be $871. 871 is not a prime number, but since the admissions process had run beyond fifteen minutes, I thought I would add a little something to the discussion just to entertain myself during the doldrums. “Take the number 871,” I told her, “And reverse the digits to create a new number; 178. Subtract 178 from 871. Add the resulting number, 693, to the result of itself, 396, and you get 1089.” This actually works with any three-digit number whose digits are decreasing, but I did not tell her that.

Eight hundred and seventy one dollars. Not $870; not $900. It struck me as a bit odd to be able to pinpoint it to a specific dollar, especially since health systems do not know what any procedure costs. I asked a supervisor about the price.  “We do not know what something costs, we only know what we charge.”

“Does anyone know what it costs?” I asked. She told me I was wasting her time and mine with my silly questions.

Anyway, the outpatient admissions process, at a hospital where I was already in their computer system, took seventeen minutes. I gave her my phone number 4 times, my address twice, and the name of my first girlfriend once.

I asked if I could have pre-admitted myself online. She said she did not know, but she told me that the pre-admit process should have been done on the phone to save me all of these minutes. I asked if the process would have been shorter had I done it on the phone and she said it would not have been. “How then would that have saved me any time?” I asked.

By then, her eyes looked like she was in a death spiral. My eyes looked the same.

I was escorted to the waiting area. The television show, “What’s My Price” was playing loudly through the television speakers. A collection of pre-WWII magazines was scattered among the waiting room’s Formica side tables.

The rest of the ultrasound went smoothly, more or less. “Hold your breath…okay, breath.” A new radiology technician was undergoing training. Apparently the person doing her training had glossed over the part of the training relating to the bit where she was supposed to reply, “Okay, breath.”

Note to health system executives: Try and schedule an appointment—mine required three phone calls and several minutes on hold. After that, go through the admissions process and see how that leaves you feeling.

A remarkable experience for every person at any time on any device.

Or not.

None of this is rocket surgery.

The German poet Brecht was fond of saying; the man who laughs has simply not yet heard the terrible news. Perhaps you will be kind enough to allow me to be the one who delivers this news. Brecht also wrote; I go to the market where lies are bought. Hopefully I take up my place among the sellers.

Another of my favorite quotations is from Thoreau’s Walden: “I say beware of all enterprises that require new clothes and not a new wearer of the clothes.” Paraphrasing it means, I don’t need new things; I need new eyes with which to see the things I already have. I need something which allows me to see a fresh perspective; perspectacles. I just used up my quota of existentialism for the entire month.

I am convinced therein lies the crux of most business problems with which we wrestle. The opponent we wrestle is ourselves. It is a little like trying to win the battle with a gossamer opponent in a dream. We wrestle that which we see everyday because what we see everyday is limited by the blinders of our singular sense of perspective.

A dialog from the movie Airplane:

Randy: Excuse me sir, there’s been a little problem in the cockpit…

Striker: The cockpit…what is it?

Randy: It’s the little room in the front of the plane where the pilots sit, but that’s not important right now.

A dialog from a health system:

1^st person: Excuse me sir, there’s a big problem in the call center…

2^nd person: The call center…what is it?

1^st person: It’s the big room with a lot of people and a lot of phones, but that’s not important right now.

Actually, it is important right now, and the problem is only getting worse. Evidence leads me to believe the strategy behind the design of most health system call centers went something like this.

1^st person: We get a lot of calls

2^nd person: We need to answer those calls. What should we do?

1^st person: We should buy a lot of phones and hire people to answer those calls

Almost every health system call center I have seen is little more a big room with a lot of people and a lot of phones. My research shows that today’s call center key performance indicators (KPIs) look a lot like this:

• More than eighty percent of the time on the phone involves waiting for something to be accomplished
• If the task cannot be completed during the call, more than 99% of the elapsed time from the start of the task to the end of the task is spent waiting for someone to do something
• On average, people have to call 1.7 times to meet their need
• People try multiple ways to contact their health system because meeting their needs by calling is rarely an easy experience
• The end to end calling process includes multiple areas of duplication, rework, and waste

Roemer’s First Perspectacle Patient Access Axiom: Answering calls is an activity, not an accomplishment. To make it an accomplishment, the perspective of what happens in the call center needs to change. That is good news if your system is open to new ideas.

On Friday I had a chance to speak with someone who reads this blog.  He mentioned that my style of writing seemed a little edgy.  I appreciate that he chose such a polite word.

That same day, as I walked through the Detroit airport to my gate I saw a sign affixed to the wall pointing to a large room—Reflection was all it said. Since my flight was two hours late I popped my head into the room and thought about possibly reflecting on why my flight was late. The reflection room looked a lot like a chapel; probably was a chapel. Perhaps to keep the jihadists at bay management changed the name of the room. Edgy.

Improving the patient access experience.  When you read the word access, think communicate.

In every health system patients communicate—try to access the health system four different ways. Many, many people try all of those ways, hoping to find one that works, or at least one that is easy.

• Online—that does not work unless all they want to do is read about the health system. Most health system websites are analogous to celebrities awarding each other plastic statuary; they simply sing their own praises.
• Phone
• Fax
• Snail mail

A health system probably receives almost as many pieces of mail each day as it does phone calls. In addition, some health systems receive a similar number of faxes daily. That same health system likely had sixty percent of its stakeholders go to the health system’s website before they called. That is a lot of communicating, or not communicating as it turns out.

I have been speaking with the stakeholders of one such health system, speaking with them to try to learn why they choose so many different ways to contact their health system. I also spoke with employees of the health system to get their perspective about why their stakeholders use so many different ways to contact the health system, and trying to understand why they did not just pick up the phone and call them.

The stakeholders gave me one answer, and the employees gave me another. What was quickly apparent is that the employees did not know why the stakeholders used so many different ways to contact them.

When I asked the stakeholders, instead of calling, why do you mail, fax, and try to meet your needs online? I received several explanations. And when I laid out the explanations and tried to find a common theme, one thing stood out—doing anything other than calling was easier.

Doing anything other than calling was easier. Now, let’s give this a moment’s thought. Writing a letter, stuffing the letter into an envelope, and driving to the post office to buy a stamp is easier than picking up the phone. The same logic held about sending a fax—it was easier than calling.

This suggests one of two things; sending letters and faxes has gotten a lot easier since the last time I wrote a letter, or…calling a health system to meet your needs is akin to calling your payer or mobile phone company.

Why take fifteen minutes to type up a fax and send it rather than place a three-minute phone call? Why indeed? For starters, there are no three-minute phone calls. Three minutes may be how much time the caller can expect to be placed on hold. And then their call is transferred, and then they are placed on hold again.

Not easy. No assurance that your needs are met.

Send a letter or a fax and you have an audit trail. A confirmation of the fax being sent. A copy of what was sent. The stakeholder takes the monkey off their back and puts the monkey, puts the required action on the back of the health system.

It costs a lot to respond to all of those faxes and letters. It costs twice as much when those faxes and letters are sent to verify the outcome of phone calls.

If your patients are spending their time looking for ways to avoid calling your health system maybe it is time to figure out why people find it so difficult to call.

If a blog falls in the woods and nobody reads it does it make a sound?

When basketball was invented players shot the ball into a peach basket.  When a player scored the game was halted to allow someone to bring over a ladder so the ball could be retrieved from the basket.  The game was very slow.  It was very slow for seven years until someone got the idea to cut the bottom out of the basket.

Suppose someone asks you to give them the Cliff Notes version of Patient Experience.  What is the best way to respond to convey such a complex issue?

There are some 5,000 hospitals in the US.  There are some 2,500 hospitals being penalized for having poor patient experience scores.  As compared to what, did anybody ask the patients?  Use a highlighter or underline this on your monitor—being in the top half of the patient experience scores does not mean that your patients are satisfied with your hospital. All it means is that you scored high on the CMS survey.  Nobody ever asked patients and consumers what factors determine their satisfaction.

To the chagrin of the ‘six sigmaists’, here is a news flash.  Shaving twenty-two seconds off of the time it takes to be admitted does not yield satisfied patients.  If making the admitting the process shorter is a good thing, would it not make sense that doing away with the patient admitting process would be a really good thing?  Maybe it is time to cut the bottom out of this peach basket–make it easy for your patients

How would you like to be admitted if you were going to the hospital two days from now?  If you are like me, you would want to navigate to the hospital’s web site the evening before you are scheduled to check in–sixty percent of people go to an organization’s website before they call the organization.  You want to pull out your iPad, go to the provider’s customer portal, upload a copy of your insurance card, complete the forms, and be given a QR code.

Patient satisfaction just went up. Patient experience is not the same thing as patient satisfaction.  Everyone has an experience. Many of those experiences are not satisfactory.

If your hospital has not recently reinvented how it electronically interacts with patients and potential patients through a world class customer portal, it is way out of touch with how patients interact with other organizations with which they do business.

I went to the fifties-looking diner at the airport, sat at the worn Formica counter, and ordered toast.

The waitress—I did not opt for the politically correct waitperson because the person with whom I was about to converse was in fact a she—rocked back and forth on her rubber-soled shoes. “Do you see toast on the menu?” She asks.

I scanned the laminated and crusted placemat cum menu. “I do not. But the toaster is right there,” I said as I pointed to the spot on the laminated counter next to the display case holding the lemon meringue pie and some kind of turnover that looked like it had last been turned over days ago.

“The toaster is for the toasted tuna sandwich,” and she pointed to the menu. And there it was. About a half-inch to the right from what looked to be a yolk smear, and an inch or so down from what appeared to my untrained culinary eyes to be a glob of jelly. The glob appeared to be strawberry jelly, but it could just as easily have been congealed ketchup.

Jelly. Next to the bowl of creamers and the small box of sweeteners was a woven wired device with rows of jelly stacked like Legos. “Why is there jelly if you do not serve toast?” She looked around like she was wondering if she should call her manager.  I heard her misquote under her breath a line from Shakespeare’s Romeo and Juliet, “A pox upon your house.”

By now I no longer wanted the toast, but I could not convince myself to just step away from the counter and admit defeat. I read the menu’s chipper narrative about the sandwich. Whole white albacore tuna, harvested in dolphin-free waters. Served on your choice of fresh bread, lightly toasted—there was the word I sought. The tuna sandwich came with lettuce and cheese and tomato. And tuna.

And toast. “May I have it without the cheese?” I asked—raise your hand if you think you know where this is headed. She nodded affirmatively.

“You know what? Now that I am thinking about it, let’s skip the lettuce and the tomato.”

“What will you have to drink?” I ordered a Diet Coke.

And as she began to turn to take my order to the kitchen I made a final request. “And hold the tuna.”

Toast. Customer experience.

It was the worst of times; it was the worst of times. It was never and never will be the best of times if you fly USAIR or American. My trip to the dark side of customer service was via American Airlines, on a flight I booked on USAIR, on a plane flown by Republic Airlines. That way, I would have to work hard to know which airline to blame for my bad experience. It seemed the airline troika had secreted away the culpable party like nested Russian dolls, or in much the same way John le Carré would launder clandestine funds through a series of Swiss banks and offshore accounts.

Having finished my tuna sandwich, sans tuna, I arrive at the airline terminal in time to catch an earlier flight; fifteen minutes before they shut the door. “May I get on this flight?” I inquire of the gate guardian.

“It will cost you seventy-dollars,” she tells me.

Still amped from my toast experience, I say, “Think about it this way. You have empty seats, seats you will not sell because there is not time left. It costs you nothing to put my backside in one of those seats. And in doing so,” as I build to the climax of my logical argument, “You then free up a seat for the next flight, an unpaid seat that you might sell.”

I give her my second-best smile. “Do you want to get on this flight?” She asked me without giving me her second-best smile.

I looked at my watch. There were two hours before the next flight, and I was still hungry. “No thank you. I think I’ll go get a tuna sandwich,” I told her.

What would you do differently if you knew that sixty percent of the people who are calling your health system were already disappointed by your health system?

Would everyone have better experience if the health system closed its call center? Quite possibly. Why run the risk of disappointing the other forty percent of your callers for the first time, and disappointing the other sixty percent for the second time?

And how could we have already disappointed sixty percent of the callers if this is the first time they are calling us?

A fair question. An important question; one with an answer steeped in fact.

National call center data shows that sixty percent of an institution’s customers will go to the institution’s website to solve their problem before giving in and calling the institution. That same data shows people do not want to call a company because their expectation is that the experience will be poor.

So, for those call center managers who are using willow witching techniques report how high their first call resolution is, whatever numbers you are reporting are way too high.

First call resolution has already come and gone. Sixty percent of your callers have already had at least one failed attempt to access your health system. They went to your website and could not find what they needed to find.

So, what do we know?

• We know people expect a bad experience if they call so they go to the website
• People get a bad experience on the website—a bad experience is defined as wanting to accomplish something and being unable to do so
• Because they could not get their needs met online they call the contact center
• They will not return to the website the next time they need something because they know their needs will not be met
• Many of their expectations of having a bad experience when they call are met
• This makes it even less likely that they will call the next time they need something

Poor access online. Poor access on the phone.

Many, if not most health systems provide a user access experience that is less satisfying that the experience patients get when they call their payer to file a dispute.

User experience equals access experience. User experience equals patient experience. How good is your health system’s user experience?

See what you can accomplish online. See how easy it is to accomplish anything on the phone. Unless you come away saying, “Wow, that was easy,” your health system has a lot of work to do.

Fifteen years ago, my consulting client was the public telephone provider of a large European country. The country had just offered competitive telephony licenses to the private sector. My project was to develop a customer experience strategy for the incumbent that would help the public phone company retain customers.

My team and I spent months visiting the various call centers throughout the country, and we visited several of their satellite phone companies in South America—sort of gives you a hint as to which country’s phone company was my client.

The most astonishing thing I learned was that the phone company had nine thousand people in the call centers—CRSs; call center representatives. Actually, as it turned out, it was the second most astonishing thing I learned. The most astonishing I learned was what happened when someone called the phone company.

Think back to the days when we had phone companies in the US. Back to when you could dial zero and speak with an operator, or dial 411 and get directory assistance. Back when your phone bill was thirty pages long. Imagine calling AT&T or USWEST, asking a question, and having your call transferred to someone who may be able to answer it. Imagine that for millions of calls a year.

That was the customer experience of my European client. They had 9,000 CRSs; nine thousand people whose job it was to take the customers’ calls. Yet unlike when you call a company today in the US with a question, when you expect the person to whom you are speaking to answer your question, that was not how it worked with my client.

The job of these 9,000 people was to listen to a caller’s question, and then determine which person or persons in the phone company should answer that question. They would write down the caller’s information and then they would give the caller the phone number of the department the caller should call to get their question answered—for example, billing—and then the CSR would hang up. The CSR would then fax the caller’s information to the appropriate department. That alone resulted in over ten million faxes a year.

Everyone has called a company and had to listen to a recording that resembled something like, “To schedule and appointment press 1, to ask a question about your bill press 2….” The technology providing the recording is called an IVR, an Interactive Voice Response System.

My European client employed a manual IVR; no system, just 9,000 people routing calls, routing calls at a fully loaded cost of about thirty dollars a call. They spent more than a billion dollars a year having people tell callers which department to call. A very expensive manual version of an IVR. They also spent untold hundreds of millions of dollars a year sending faxes, and handling repeat calls.

I presented my findings to their executives along with a vision of what they could be doing to improve customer experience. The company’s CIO—which could be an acronym for Career Is Over—walked to the white board and erased my vision. When I asked why he had done so he told me my vision was too theoretical, that it did not exist anywhere. In response, I walked to where he was seated, picked up his day timer—younger readers may need to Google the term—and told him to give me some dates that he could travel to the US and visit any number of US companies who knew how to manage customer calls.

That was fifteen years ago. At that time, I could not have invited him to visit a health system because there was nothing of value to show him about how to improve his call center.

So, has anything changed in healthcare regarding the effectiveness of customer experience in the last fifteen years?

It has not. And the facts back it up.

Whether your health system gets a hundred thousand calls a year or a million calls a year, I am eighty-seven-point-five percent convinced that your health system does not have a call center or a contact center.

I’m pretty certain, as are you, that your health system probably has a bunch of people in a large room, and in that room are a lot of phones. And that is about as far as designing the telephone customer experience strategy goes.

The phone rings.

Someone answers the call.

Then what happens? Seventy to eighty percent of those calls are transferred by your health systems CRSs to someone else in the health system in the hope that whomever the call is transferred to can answer the call.

Did someone else answer the caller’s question? Nobody knows. Did the caller have to call more than once about the same issue? Nobody knows. Did the caller wind up going to ED because the person wanted to speak with a nurse and there were no nurses to speak with? Many did. Were the caller’s needs met? Who knows?

Did you know that seventy-three percent of the times when someone may wish to call their health system there is nobody around to answer the phone? Not everyone gets sick only Monday through Friday between 8 A.M. and 5 P.M. Not everyone finds it convenient to call only Monday through Friday between 8 A.M. and 5 P.M. because, like you, they are working.  Patient experience has nothing to do with being available to answer the phone during the times you want people to call you. It has everything to do with being available when they want to call you.  Some health systems may think they provide 24 hour customer service; 8 hours each on Monday, Wednesday and Friday.

Tonight, if you find yourself awake at some odd hour, call your cable company. Somebody will answer the phone. If you do not want to call them, go to their website you can get your needs met online as well.

So, how can health systems dramatically improve patient access and reinvent patient experience? They can start by designing a call center, not just a scheduling center. They can design the access experience to enable patients to get their needs met with a single call, speaking only to a single person. The health system could also expand the hours of its call center.

Some people think doing so is pushing the envelope. I think doing these things is the bare minimum requirement. If you want to think out of the box, do not think about pushing the envelope, think about bulldozing the envelope. Design an online, interactive customer portal that can meet the same needs that a fully functional call center should meet.

Some days, the best thing you can do is to be present. Last week I had such a day. I arrived for my meeting with the director of a large VA facility. The taxi dropped me several buildings away from my meeting, so I created my own way-finding path through the hospital.

During my ten-minute walk I passed dozens of unknown heroes. Veterans of all ages, colors, and backgrounds. As I made my way down an almost vacant polished hall, I was confronted by a man’s raspy voice.

“Where are you going young man?”

The gentleman had my attention just by referring to me as young. He was seated in a wheelchair that was parked next to the wall. To set the scene, he is African-American—in know the English majors will write me saying that I just messed with a past present participle about something having to do with the tense I used, but he was, and thankfully he is.

The veteran wore a black baseball-style cap, the embroidery commemorating his service in Korea. A medal was affixed to his worn sweatshirt. Not being an anthropologist, I estimated the gentleman, the gentleman who sought my attention, was in his eighties. (That made me a young man.)

A brief aside. I was vey uncomfortable. I was uncomfortable not because I might be late for my meeting, not for being called out by a stranger, but for feeling inadequate and unworthy to say anything that could be of much value to him.

Nobody had ever shot at me. I have never knowingly spent the night in in a foxhole thousands of miles from my home wondering if I would be alive for breakfast. The gentleman before me probably had. His eyes looked through me as though I was simply a prop in something he had endured long ago.

“I’m Bill,” he told me. We shook hands. His fingers were long and sinuous, and weathered with age. I noticed his yellowed fingernails were neatly manicured. Bill paused, and I attributed his pause to him reflecting over what I assumed to be decades of memories. I was grateful for the pause, because I did not have any idea about what he hoped for in terms of a response from me.

“You look like a school principal,” he told me—suit, briefcase, polished shoes.

Not caring if I would be late for my meeting, I knew the most important, and best part of my day was going to happen in the next few minutes. Bill’s skin hung from his frame like sheets of wrinkled wallpaper that were no longer affixed to the wall. Without any knowledge of the appropriate decorum for how to address the gentleman facing me, the former soldier, I placed my briefcase on the floor, and sat cross-legged on the worn, linoleum tile.

I recall wishing that I had been wearing clothes from the Salvation Army, not because I did not want to dirty my suit, but because I was afraid my clothing might have made me standoffish. Bill was not put off by my attire, and by God’s grace, I sensed he knew his did not put me off.

I wish I understood everything Bill said. I sensed he simply wanted someone to speak with him, and so that is what we did. All he wanted was someone’s ear, and I was lucky to have two ears that were not being used.   We did not trade great insights, we simply shared a few minutes of time. Sometimes, if you are lucky, you can improve someone’s patient experience for free.  Maybe you can even make someone’s day. He sure made mine.

Please know, I was not prompted to write this because of me, this has nothing to do with what a great guy Paul is for spending a few minutes with an elderly veteran.

My only reason for writing today is to share that I will end this day better than I started it. I hope I will be better for having had it, for having participated. I will end it without knowing what this gentleman did to earn my respect and fealty, but I know he did.

It is time we pull back the curtain and tell the truth about patient access and scheduling. The points of truth are:

• Almost all access happens by phone
• Most health systems do not have a “call center”. What they have is a room with a lot of phones and a lot of people whose job is to schedule appointments
• Less than thirty percent of inbound calls are about scheduling
• More than seventy percent of calls are transferred into a black hole where call resolution cannot be measured
• Of the scheduling calls, only about 59% are completed on the first call

Just so we are on the same page when it comes to measuring how bad is bad, the cable television industry only transfers around 11% of its calls. Scheduling a healthcare appointment takes about 60% longer than it takes to schedule a cable appointment. If scheduling a healthcare visit at your health system is more disappointing and less productive than scheduling an appointment with Comcast, if you have to up your game considerably just to be able to state “we are just as good as the cable company”, then alarm bells ought to be going off in somebody’s office.

After all, people do not need cable, but they do need healthcare. On average, an astonishing 30% of callers who do not have their needs met will not call back. They will not call back, but many of them will head straight to the ED. That’s an expensive cost to pay for not being able to manage a phone call.

Twelve percent of people who have to call more than once will change their provider—now there’s an easy way to understand one component of leakage. At an average lifetime value of a patient of between $180,000 to $250,000, a health system should calculate the loss of these assets in the millions of dollars. Again, that is an expensive cost for not being able to manage a phone call.

In most industries, the measure that has the greatest impact on customer satisfaction is first call resolution; were the caller’s needs met the first time they called? There is actually a one-to-one correlation—increase first call resolution by two points and customer satisfaction increases by two points. And did I mention that a part of the Affordable Care Act has to do with patient satisfaction?

So, if that news isn’t bad enough, permit me to raise the angst bar even higher.

People used to say things like I have to go to the doctor. That phrase is falling out of favor because people no longer have to go to the doctor. They can go somewhere else when they are not feeling well. Last year, my family went to the CVS Minute Clinic thirteen times. We went to the doctor three times, and we only did that because the nurse at the Minute Clinic recommended we see the doctor.

How many times did I have to call the Minute Clinic to schedule an appointment? How many times did I have to pull out my credit card, or call to get someone to explain the bill? How many times did I have to make an extra trip to get my prescription filled?

None. It is like hitting the Easy Button.

None of your patients wants to work hard to give you their business. None of them want to work hard to have their needs met. So why not design patient access and patient experience so people do not have to work hard?

CVS, and all of the other healthcare retailers, did one thing that your health system did not do, and it shows. They designed the access experience. Instead of saying how do we make scheduling an appointment easier and faster—a six-sigma approach—they eliminated scheduling.

And please note, from a patient’s perspective every health system has its own version of the Minute Clinic. It’s called ED.