What does it take to be the best hospital?

Below is a reply I wrote to a question raised on Hospital Impact, “What does it take to be the best hospital on the planet?”

http://bit.ly/v4pr6

I’d like to hear what you think it would take.

Great question and one that needs to be asked with much regularity.  I target my comments at the healthcare business as opposed to the business of healthcare—the clinical part.

May I begin with a statement that may have many readers reaching for their delete keys?  As one who has consulted to many industries, to me the healthcare business appears to be stuck in a 0.2 business model and is being forced to rapidly reinvent itself in a 2.0 model—my use of the term 2.0 does not imply the Internet.

My comments are based on observations, conversation, and inference.  My executives have told me privately that world-class physicians do not necessarily become world-class business executives.  Many lack the depth of experience that is needed to know what aspects of the healthcare business is broken, duplicative, wasteful, or in need of repair.  While discussing EHR, I was told recently by a former CEO of a large hospital that his peers were making multi-multi-million dollar decisions without any sense of the data needed to support those decisions, basing them on what a friend had decided, what they read in an in-flight magazine, or a conversation they had at a convention.

There seems to be significant faith placed in the notion of, “That’s the way we’ve always done it.”  That expression surfaces often when one raises the issue of why a hospital has multiple IT departments, multiple HR groups, payroll, registration, and so forth.  Why do something once if you can do it less well five times.

There seems to be enough waste that for some hospitals looking at moving forward with EHR, my first piece of advice is instead of aiming for best practices, let’s aim for a single practice.  Evaluate how to implement a shared service or managed services approach to business functions that are not part of your core business model.

I close with the notion of what other businesses call customer relationship management (CRM).  For a hospital, patient relationship management (PRM) is one of the unspoken wins waiting for someone to lead the charge.  Add a social media effort to it, and all of a sudden it’s like the hospital gave itself a facelift, at least from the perspective of the patients.

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Revising patient interactions via social media and CRM

SmidgeFor 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?

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Who was supposed to be watching the customer?

customer_relationsSometimes it’s easier if I simply shoot myself in the foot rather than having to wait around for others to do it.  Permit me to begin with a disclaimer; my comments and questions almost always pertain to the non-clinical side of healthcare.

We’ve spent time discussing how we take an industry that in many respects functions on a 0.2 business model and transform it rather quickly to one comfortable operating in a 2.0 model—effective and efficient.

So, while that’s going on, what other things are underway which will impact that transformation?  Reform is one.  What will be the impact?  Nobody knows, but it may not be pretty.  One of the largest implications of reform is that the industry is being forced to integrate.  For example, it’s one thing to build a phone company.  There is a whole new order of magnitude of difficulty when one phone company has to integrate seamlessly with all of the other phone companies.

That integration is being driven by hundreds of different teams of vendors, standards setters, certifiers, and networkers, each having its own goals and working in their own vacuum chamber.

As I’ve studied this business problem for the past few years it becomes more and more apparent that something has been overlooked.  It gets it share of lip service, however unless it is addressed concurrently with reform and EHR, EHR will prove to be of such low value as to stymie people who later have to justify the expenditure.

It’s the missing link, the customer.  I know customer is not the politically correct term in healthcare because it sort of blemishes the notion that nobody is in this for the money.  We’d rather talk about patients.  Patients are on the clinical side, customers are on the business side.  Healthcare needs systems that work for both.

Where does customer care, customer relationship management (CRM), and customer equity management (CEM) fit within the realm of EHR?  The wrong answer to this question could set your EHR effort back years and millions.

The following link takes you to a presentation of mine on CRM and discusses the merits of looking at treating customers via CEM.

 http://www.slideshare.net/paulroemer/good-CEM-deck

I am curious to learn how you are incorporating the customer into your transition.

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