Why your Website is Killing Patient Satisfaction

Hospitals probably have more than one hundred points of contact with each patient.  These points of contact (POCs) begin before the patient is admitted and continue after the patient has been discharged.

The first contact may come by a visit to one of the hospital’s clinics, a 3 A.M. call to a primary care physician, or browsing the hospital’s website.

Yesterday I assessed whether the website of a large hospital group was functional or whether it was just a website window-dressed to look like a customer portal. I assess functionality based on whether I was able to accomplish what I set out to accomplish.

I counted dozens of different phone numbers to call. Along with the list of numbers were links for physician and employee portals, links to the board, a link for donors, wellness, specialties, medical professionals, and dozens more, all on the front page. 

There was even a link, albeit not a portal for patients—a rather important link since the number of visits by patients and prospective patients probably greatly exceeds the combined number of visits by all other visitors to the site.  Unfortunately the patient link was imbedded with six other equally weighted links.

I clicked the patient link and was greeted by two-dozen new links, each displayed as being of equal importance.  There were links for patients to use before coming to the hospital and links for them to use once they were home.  Points of contact with your hospital.  Points of satisfaction or dissatisfaction. 

I clicked some more.  Schedule an appointment.  There are actually two links for scheduling an appointment.  The first link gave me a phone number I could call M-F between 8 and 5:30 P.M.  What number do I call at 6 PM I wondered?  I tried the second link; it took me to the same place. Could I schedule an appointment online or through a mobile device?

What did I learn? There are 168 hours in a week.  Their scheduling service operates for 47.5 hours a week, 28% of the week’s hours. If I dialed that number after hours would I get a recording telling me how important my call was?  If my goal was to schedule an appointment using their website, or to schedule an appointment at any time on any device not only did the hospital not meet my expectation, it did not even offer me an alternative. A dead-end.

If it costs the hospital thirty dollars to schedule an appointment by phone and nothing to schedule an appointment online, why not complete the task correctly, the first time, and for zero cost?

I next looked at what I could do when I was home, more POCs, more chances to be satisfied or dissatisfied. 

Manage my medical records. Using the website I was able to print and mail, two very non-electronic processes, a request to have my records printed and mailed to me.  There was no way to submit my request using their website.  If I did not own a printer or did not have access to a printer my expectation was not met, and was I not offered an alternative.  Some people, a whole lot of people, actually like to complete tasks using a tablet or smart phone. Another dead-end.

Let’s try billing. For Medicaid patients there are two numbers to call for help understanding your bill. That means understanding Medicaid bills is a nontrivial exercise.  That tells me that if I asked the same Medicaid billing question of three different people I might expect to get three different answers.  Why not design the sight so that it provides one right answer to whatever question is asked?  Why not include an online chat feature? Why not create a link to a YouTube video, produced by the hospital that explains Medicaid billing?

Medicare.  No link to prequalifying, not even a phone number for questions.

How to pay your bill.  Perhaps the most difficult and least desirous task a patient must do. There is no link explaining the various components of the bill, and nowhere on the site is a copy of a sample bill explaining or highlighting the various sections of the bill.

There is also no link to understand how to file a dispute or a claim with a payer.  Maybe it is not possible to do this for every payer, but using the 80:20 rule there must be ways to help the majority of patients understand what they are up against rather than having them face down the evil empires on their own.

Patients come to the hospital’s website with expectations.  Patient satisfaction is repeatedly won or lost at your hospital’s website and on the phones.  POCs.  Having a tool that proposes to help patients with their bills that not only does not help them but that adds to their frustration will crush patient satisfaction.

Hospitals want patients to pay their bills and to pay them on time.  Patients who do not understand their bill will not pay more completely, nor will they pay faster.

The next time you look at your hospital’s website ask yourself how different it would look had someone asked a patient how it should function.

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Social Media: The Elephant in the Bored Room

Pardon the idiom, and yes, the misspelling was deliberate.  You may want to grab a sandwich, this is a long read.

For the longest time it has occurred to me that most companies find themselves in a state of what I like to label Permanent Whitewater. As they careen through the rapids, it is anybody’s guess as to whether they will capsize.  And the philistines they have appointed as commissioners would be more appropriately described as Ommissioners, as they have omitted themselves from understanding the world and leading their charges.

Now, what does that have to do with anything?  Thanks for asking.

For those of you who can find California on the map, you will recall the great turnip boycott of the nineteen seventies—I know they boycotted grapes, but I like grapes and do not like turnip, so I choose to have my own protest.  Anyway, this boycott worked, and as a result, the working conditions for migrant workers improved albeit only modestly.

And here is the kicker.  An entire industry was brought to its knees.  That is not the surprising part.  The surprising part is that all of this change was brought about at a time when there were three television channels and when people actually subscribed to newspapers.

From where I sit, social media can be divided into two camps, those who have not slept since the launch of Google+, and the far larger camp of those who have not lost a minute of sleep.  Businesses, for the most part are well entrenched in the latter group.

Part of the reason why businesses are slow to adopt social media can be attributed to their lack of belief that social media matters or can impact their business one way or the other.  And frankly, I think that has a lot to do with why our economy continues to rejoice in its malaise.

So, how to those of us in the first camp get those in the second camp to see the world our way, how do we get them to jump head-first into social media.  The answer is simple.  We need to create our own turnip debacle.

They say it cannot be done, so let us show them.  The one thing that would get companies to embrace social media quickly and unashamedly would be if there was one less company.

Companies, big ones, fat ones, firms that climb on rocks—feel free to finish the tune without my help have the following issues, they think they:

–       control their market

–       own their customers

–       are managing their customers

Companies are wrong about those three assumptions and the use of social media can and will prove this.  I would ask for a company to volunteer, but that would take too long.

If ABC, CBS, and NBC were able through their coverage of the grape boycott, bring about change to an entire industry, imagine with me what impact a global, committed bunch of savvy social media users could do to a single firm.

Here is what I propose.  Let us pick one firm.  The characteristics of this firm should be that it is well known and not well liked—this way if it self-destructs we can argue that we acted on behalf of a greater good.  It should also be a firm associated with technology, a firm that ought to at least be able to spell social media.  If I were asked which firm I would choose I would pick a firm in some aspect of telecommunications, say a firm like Comcast or Verizon—an easy target, a firm facing a customer experience war armed only with their CRM.

Now, the idea of our little social project will be to provide a heads-up to all of the other companies about the start date of the importance of social media.  Let’s tentatively agree on starting on the first of November unless there is a game on television I want to watch.

The goal of the project is to demonstrate that the bourgeois, the working class, with its harmless set of social media tools, can create affect enough of a disruption to an organization to make that organization sit up and take notice, or to make it disappear.

I am sure you remember the YouTube video of the Comcast technician that fell asleep on a customer’s couch.  It went viral, but Comcast did not, and that was simply a single posting by a single customer.  What would happen if the social media mavens decided to use the tools at their disposal and concentrate their efforts at or against a single firm?

Crowdsourcing 101.

I think the end result of such an effort would have a significant impact.  The impact could easily bring about more fundamental change about how firms use social media than was brought about by the grape boycott.

Sometimes something has to be sacrificed on behalf of the greater good.  Although a rising tide lifts all boats, it can ruin your day if your firm is the one chained to the pier.

What are your ideas?

 

The Spandex Insecurity—the Ego has Landed

Now before you get all upset about the sexist picture, at least read a little bit of this to see why I selected it. Yesterday morning, five miles into my run, I was feeling pretty good about myself. I had passed seven runners, had a nice comfortable rhythm, no insurmountable aches, and Crosby Stills & Nash banging away on my MP3. I don’t like being passed—never have. Some people say I’m competitive. They say other things too, but this is a family show.

I’m a mile away from my car when I see a slight blurring movement out of the corner of my left eye. A second later I am passed by a young woman wearing a blue and yellow, midriff revealing spandex contraption. Her abs are tight enough that I could have bounced a quarter off of them. She is pushing twins in an ergonomic stroller that looked like it was designed by the same people who designed the Big Wheel. I stared at her long enough to notice that not only was she not sweating, she didn’t even appear winded. She returned my glance with a smile that seemed to suggest that someone my age should consider doing something less strenuous—like chess. Game, set, match.

Having recovered nicely from yesterday’s ego deflation, today at the gym I decide to work out on the Stairmaster, the one built like a step escalator. I place my book on the reading stand, slip on my readers—so much for the Lasik surgery, and start to climb.

Five minutes into my climb, a spandex clad woman chipper enough to be the Stepford twin of the girl I encountered on my run mounts the adjoining Stairmaster. We exchange pleasantries, she asks what I’m reading, and we return to our respective workouts. The first thing I do is to toss my readers into my running bag. I steal a glance at the settings on her machine and am encouraged that my METS reading is higher than hers, even though I have no idea whether that is good or bad.

Fifteen minutes, twenty minutes. I am thirsty, and water is dripping off me like I had just showered with one of Kohler’s full body shower fixtures. I want to take a drink and I want to towel off, but I will not be the first to show weakness. Sooner or later she will need a drink. I can hold out, I tell myself. Twenty-five minutes—she breaks. I wait another two minutes before drinking, just to show her I really didn’t need it.
She eyeballs me. Game on. She cranks up her steps per minute to equal mine. Our steps are in synch. I remove my hands from the support bars as a sign that I don’t need the support. Without turning my head, I can see that she’s noticed. She makes a call from her cell to demonstrate that she has the stamina to exercise and talk.

When she hangs up I ask her how long she usually does this machine—we are approaching forty minutes and I am losing feeling in my legs. She casually replies that she does it until she’s tires, indicating she’s got a lot left in her. I tell her I lifted for an hour before I started; she gives me a look to suggest she’s not buying that. I add another ten steps a minute to my pace. She matches me step for step.

Fifty minutes. I’m done toying with her. I tell Spandex I’m not stopping until she does. She simply smiles. Her phone rings and she pauses her machine—be still my heart—and talks for a few minutes. I secretly scale down my pace, placing my towel over the readout hoping she won’t notice. She steps down from the machine. My muscles are screaming for me to quit, but I don’t until I see that she’s left the gym.

Victory at any cost. What’s the point? For what was lost, for what was gained (McKendree Spring). Men and women. Customers and companies. Most parties will deny they are competing, yet neither will yield. The customer is always right–Turns out it makes a better bumper sticker than it does a business philosophy. Nobody’s business policies reflect that attitude. If anything, were you to listen to what CSRs are instructed to do for the callers and compare that with what they are instructed not to do for the callers, it’s clear that their mandate is to minimize the negative impact to the firm, without regard to the negative impact to the customer. Remember the last time you tried to dispute an insurance claim?

Are Customers Running the Asylum?

Below is a response I wrote to a blog on customer experience management. I would love to hear what you think. http://www.ceforprofit.com/2010/08/defining-customer-experience-implications-and-all/comment-page-1/#comment-3111

One thing businesses have been slow to realize is they have lost control of the customer conversation, and as such, at least from the customer’s perspective, have forfeited their right to control the customer experience.

Traditional customer relationship management (CRM) has always been a Push.  A manages B.  Organizations manage customers.  Sort of reminds me of cowboys trying to manage a herd of cattle into the cow-pen for slaughter.  Organizations have only been marginally successful at “managing” their customers.

Customer Experience Management (CEM), CRM’s big brother, is at least a thought in the right direction.  However, most firms still do not “get it.”  The ungotten “it” is that customers have taken over the sandbox and they are not going to give it back.  Customers are now managing vendors, and the vendors have yet to figure that out.

Most firms can print a report titled “My customers” or “Our customers.”  The single most important error with these reports is the use of the pronouns ‘my’ and ‘our’.  Firms no longer own customers.  More accurately, customers now hold the power.  Customers now have “My vendor” reports; vendors they have researched and hand-culled.

If a firm wants to check out how well they are managing the customer experience all they have to do is to Google themselves, or search for themselves on YouTube.  See what people are saying about them.  Not much of it is favorable, but much of it is viral.  Videos, blogs, Tweets, and chat rooms.

Manage that?  Too little too late.  Customers are issuing virtual RFPs.  Whether customers want a large screen television or a hip replacement, they go to the web.  They find out your pricing, how well you service your customers.  They make informed decisions.  Most organizations have a long way to go just to get back into the battle to make it a fair fight.  The first step is for them to learn how they are being managed by their customers and then to learn what to do about it.

The Patient as Customer

The headline for a recently published McKinsey survey stated “Ninety percent of hospital CEOs ranked Patient Experience Management (PEM) as their first or second priority over the next three years.

Buried deep within the article was a throw away statement that little will be done regarding PEM because nobody knows who owns the patient.

Any journalism student worth their salt would tell you the real headline for the survey should read something like “Ninety percent of hospital CEOs and COOs do not know who owns the patient at their hospital.”

From a business perspective, in the conversation about patients and PEM one thing is always overlooked.  These people, the patients, also have a business avatar.  They are also customers.  PEM from a business perspective focuses on all the non-clinical aspects of the patients as a customer.

There are dozens of non-clinical processes that affect each customer (patient)—admissions, discharge, billing, scheduling, disputes, claims…

Many of these processes are ineffective and inefficient.  Many are redundant and duplicative.  Many add more cost than value.

If you want to improve the patient experience, look first at these.  You will be surprised by how much better your organization will be perceived.

Could social media be the answer?

The wheel’s still turning, but the hamster is dead. One Brady short of a bunch. I like the ocean one because it reminds me of a bit done by the comic Ron White. In the bit he talks about the time he met a woman who was wearing a bathing suit made of sea shells which he held to his ear to find out if he could hear the ocean. Maybe you had to be there.

All day I’ve been operating as though I was one Brady short of a bunch—I actually have cufflinks with Marcia Brady’s picture on them, but we’ll save that for another day. The day’s highlight revolved around my daughter’s doubleheader field hockey matches–third and fourth grade girls. Their opponents looked better, older. In fact, I thought I saw one or two of them drive themselves to the field. Forty-eight degrees, first game at 8 AM. Not enough time to grab breakfast and get to the game on time. I dropped my daughter at the field and headed to a nearby convenience store to buy her a donut. As I pulled into the parking lot I noticed that I needed gas, so I figured why not multi-task it. I inserted the nozzle in the tank, went into the store, purchased a donut, and proceeded to drive away.

For the metrics lovers, those who like order over chaos, those whose desk is always neat, have you discovered my Brady moment? My purpose in going to the store was to buy a donut, not gas. My mind was focused on the donut, not on the gas. Once the donut was resting safely on the passenger’s seat my mission was over, or so I thought. Something was gnawing at me as I pulled away from the pump, something that flared at me in my rearview mirror. I knew what it was a full second before my body got the message to react to it. “Hit the break,” my mind screamed. I could see what remained of the black gas pump hose as it pirouetted helplessly behind my car. I fully expected the entire gas station to be consumed by a giant fireball like the one at the conclusion of the movie Rambo. Once I was convinced that neither I nor–it turns out that neither nor does not violate the rule of using a double negative in a sentence–anyone else in the vicinity was in mortal danger, I exited my car and walked to the pump.

My first reaction, and I don’t know why, was to see if the pump was still charging my credit card. Selfish? That means that subconsciously I had already made the decision to flee, but that I didn’t want to flee if my charge card was still open. I retrieved the severed hose from the ground and inserted it in the pump, thereby closing out the sale on my credit card. I looked around. There wasn’t anyone who had witnessed my little AARP moment. Since they hadn’t, I figured why bother anyone. Kismet; my turn on the hamster wheel.

I’m convinced it’s the little things that determine whether your initiatives succeed or fail. It’s usually nothing tricky, nothing that requires two commas worth of new technology. It’s being focused and being committed to excellence in the menial tasks which comprise each patient interaction, especially those that occur outside of the office. What little things are being overlooked in your practice?  Could social media solve some of these?  In a heartbeat, and for a cost that would surprise you.

Oh, and don’t forget to hang up the hose when you’re done.

 

Revising patient interactions via social media and CRM

For those who don’t have time for 140 characters, or who don’t have much to say, I’ve created an alternative, smidge.com. The Urban Dictionary defines a smidge as a small amount of something, short for smidegeon.

This will revolutionize the interaction between patient/customers and the healthcare provider. We all know how annoying customers can be. Why should providers continue to enable bad behavior? They call, fax, email, and tweet. Enough already.

It’s time providers show a little backbone, show the customers who’s in charge.

Here’s how smidge.com works. Each time a customer interacts with you, give the patient their smidegeon account. Explain to them that this is their private way to communicate with you. It’s instantaneous, totally secure, and it operates 7 x 24 x 365. No more navigating IVRs, no more being placed on hold, no longer will they be transferred to another agent, never again will they be monitored for quality control purposes. Let the customers know that anytime they want to smidge, the world is theirs.

Explain to them that you are doing away with archaic forms of interacting; closing your call centers, throwing away your fax machines, and deleting your presence on the web. What are the advantages to your firm? They’re almost too many to document. Think of the capital savings. No more IT expenditures to support those millions of whining customers. No more CSRs complaining about not being allowed to browse the web, or about not getting their mid-morning break.

And now for the best part. In order to minimize bandwidth and storage costs, each smidegeon only allows the user to use each letter of the alphabet one time, meaning the largest smidge can’t exceed 26 characters. The longest message one could get is, “The quick brown fox jumps over the lazy dog”.  That being the case, there will no longer be any justification for the customer complaining that your company didn’t resolve their problem.The roles will be reversed. The upper hand will now go to the company.

How? Let’s look at an example. The patient wants to smidge the following change of address information, “We are moving on October 13 to 1175 Harmony Hill Road, Spokane, Washington. Please forward our bill.” Since smidges don’t allow numbers, we’ve already simplified the message, and the ease of entry. Now, if we translate the message into a correctly formatted smidegeon, we get the following message, “We ar moving ctb Hny l d Spk f u b d.” Now, how can you be expected to understand that kind of nonsense? If you can’t understand it, how can your patients possibly blame you