Patient Equity Management

Dinner’s warm, it’s in the dog–Patient Experience Management

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dog

Let’s see what we can somehow tie this to patients; I couldn’t resist using the title. The phrase came from my friend’s wife. She’d said it to him after he and I came home late from work one night, he having forgotten his promise to call her if we were to be late. Apparently, she hadn’t forgotten his promise. We walked into the kitchen. “Dinner’s warm—it’s in the dog.” She walked out of the kitchen. I think that’s one of the best lines I’ve ever heard.

He was one of my mentors. We spent a lot of time consulting on out-of-town engagements. I remember one time I took out my phone to call my wife when he grabbed me by the wrists and explained I shouldn’t do that. We had just finished working a 10 or 12 hour day of consulting and had stopped by a bar to grab a steak and beer. I remember there was loud music playing. When I inquired as to why I shouldn’t call he explained.

“When your wife is chasing three children around the house and trying to prepare dinner, she doesn’t want to hear music and laughter and clinking beer glasses. She needs to know that you are having as bad a night as she is. So call her from outside, and make it sound like tonight’s dinner would be something from a vending machine.”

“But it’s raining,” I whimpered. Indeed it was, but seeing the wisdom in his words I headed out and made my call.

So, back to the dinner and the dog, and the steak and the phone call. In reality, they are both the same thing. It all comes down to Expectations. In healthcare it comes down to patient expectations.

Patient Experience Management (PEM) is comprised of two things; patient equity management and patient expectation management. Ask your CFO and your Chief Marketing Officer.  Patients are assets in the same way that the laptops in the nurse’s station and the worn vinyl couch in the waiting room are assets.  They are part of the organization’s valuation.  Unlike durable goods, patients for the most part do not depreciate.  Most organizations know more about how to keep the couch from walking away than they do about preventing the patient from disappearing and never returning.

When was the last time someone in your hospital asked prospective patients about their expectations prior to admitting the patient?  Answer; never.  Chances are that someone in your organization has at some point surveyed or polled discharged patients about their satisfaction.  Those surveys were probably compiled and aggregated, and somehow a rating of high, average, or below average was derived.  What information did that rating yield?  Nothing.

Let’s say you surveyed one thousand patients and that the average patient satisfaction score was ‘below average’.  As compared to what?  Without knowing the patients’ expectations ahead of time it is not possible to calculate how far off below average is from the expectation of average, nor is it possible to know what needs to be done to improve patient satisfaction enough to increase satisfaction.

Viewing patient satisfaction in aggregate tells you very little.  Your expectations, and how your experience compared to those expectations will differ from mine.  The only way to understand how to improve the patient experience across the board is to ask.  Don’t just ask about the treatment they received because in most hospitals the treatment will be stellar.  This is where most hospitals are missing the boat when it comes to improving the patient’s experience.

Let’s say a patient is in the hospital for three days to have a certain procedure done.  The procedure was performed perfectly.  That does not mean the patient will rate their experience as high.  Many other things happen over those seventy-two hours that result in a bad overall experience; the check-in, the food, the noise in the hall, poor service, the bill.

Still not with me?  Suppose you go to Chicago for a three-day convention and you give a one hour speech on day two.  Your speech goes well but your hotel room is noisy, too hot, the cable is broken, they charge you twenty dollars a night for wireless service, and somebody else’s dinner was billed to your room.  If you are like me, when someone asks you about your trip you tell them about the problems with your room, not that your speech went well.  In fact, you probably went to the hotel manager and demanded that the hotel comp your bill.

Expectations not met.  Why?  Basic business processes were a disaster.

Back to the warm dinner in the dog and my phone call. A set of expectations existed in both scenarios. One could argue as to whether the expectations were realistic—and one did argue just that—only to learn that neither of our wives considered the realism of their expectations to be a critical success factor. In that respect, the two women about whom I write are a lot like patients, their expectations are set, and they will either be met or missed.

Each time expectations are missed, the expectation bar is lowered. Soon, the expectation bar is set so low it’s difficult to miss them, but miss them we do. What happens next? Patients leave. They leave and go somewhere they know will also fail to meet their expectations. However, they’d rather give their money to someone who may disappoint them than somebody who continued to disappoint them.

What do you think?

Controlling the Patient Dialog

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Remember when there were 200 firms in the Fortune 100?

How long ago was that? I think it was around the same time when people still thought you shouldn’t wear white after Labor Day. Time to drop-kick those white pumps to the back of the closet. What made me think of that bit of nonsense was a meeting I had recently with one of the sharpest people I’ve had the pleasure to meet professionally, and a classmate of mine from grad school. She happens to be the founder and president of one of the country’s go-to firms for dealing with business ethics. Having served as a board member for several publicly-traded firms, as well as chairing their audit committees, when the Andersen and Enron scandals hit she went looking for professionals who could help her help her firms. When she couldn’t find the help, she created it.

That conversation got me thinking and made me wonder why there were no longer 200 firms in the Fortune 100. Was it; is it, a matter of business ethics? How often do unethical practices come up when firms interact with their customers? A couple of takeaways from the meeting—for board members to be able to meet their obligation, they ought to do more than reply on the meeting book pulled together by the firm they serve. Simply relying on the book presumes ethical behavior, a presumption not always supported by fact—how much should one believe if the information is being provided by someone who purchased a $900 shower curtain?

What can they do? Due diligence is being reinvented, and the Social Network is leading the charge. One example is to go to Yahoo Chat to see what’s really being said about your organization. Other things I’ve done to obtain facts and opinions, things which particularly gauge how customers and employees feel about the firm include Google Reader, Facebook, Twitter, and YouTube, to name just a few. You don’t need patient focus groups to learn what’s being said, or to learn how good a job your hospital is doing. The patients already have a laser focus. In many instances the group lacking the focus is the healthcare provider.

Firms should focus on maintaining a strong Reputation Bank, one strong enough to be able to handle withdrawals, because you never know when there might be a run on the bank. Might be a good time to look at your own bank deposit slips.  Deposits can be made easily through the social media network.  You can’t stop patients from talking about you but you can shape what they say.

Healthcare Social Media: How to put it to work for you

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A cold wind is blowing in from the north, blowing so hard that at times that the rain seems to be falling sideways, echoing off the windowpanes like handfuls of pea gravel. The leaves from the walnut trees, that had prematurely yellowed, dance a minuet as they slowly make their way to the ground in the woods. It feels like the first day of fall, a day for jeans, a long sleeve shirt, and a pair of long woolen socks. The temperature has nosedived. On a normal day, the first indication of sunrise would have begun to push the darkness from the sky. But today is not a normal day. The clouds are hanging low and gray against the dark sky.

The garage door creaked and moaned as it rose along the aluminum track. Halogen headlights pierced the darkness. Its driver, an unkempt and rather rotund woman in her 40s eased the car down her driveway and proceeded through the still slumbering neighborhood. She was a friendless woman, who along with her husband and daughter kept to herself. The neighborhood children were afraid of her, too frightened to retrieve a ball if it fell into her yard and certainly too scared to Trick-or-Treat at her home.

“Were those your dogs barking? I was asleep,” she screeched at me as she exited the car wearing her oversized pajamas. The site alone was enough to frighten children and a few grown men. “I’m going to find out whose dogs were barking,” she chided. “And when I do, someone will be hearing from me. I took my last neighbors to court because their dog barked. I don’t like children. I don’t like dogs. I don’t like yard work, and I don’t want to be invited to any community activities.” I feel pretty confident she won’t have to worry about being swamped by invitations.

It was actually almost ten in the morning the day she registered her complaint—dawn to some people I guess. Three days later, the letter arrived in the mail. The return address indicated it was from a homeowners association. The letter stated that if we couldn’t control the barking of our dogs that we would be reported to the community board of directors. For second, we didn’t know how to react—then we started to laugh. The reason for the laughter was simple; my wife is on the Board of Directors. It’s like the East German Stasi are alive and well and living in Pennsylvania. I can picture this woman hiding behind her drapes, her little steno pad in hand, recording each and every bark that disrupts her bliss.

She’s a tattletale, a 40-something whose problem solving skills never grew beyond that of a third grader. She lives right next door, 100 feet away. We’ve only seen her three times in the 28 months we’ve lived here. Six months ago she sent us a fax, complaining about something or other. A fax, mind you. To her next door neighbor. This is too easy. It’s social networking run amok. She has become my poster child for bad manners, a benchmark against which all subsequent social networking commentaries will be measured.

There are many good social networking opportunities, especially for large healthcare providers.  Such as?  Do you record the number of patient calls you get each year by call type?  The fully loaded cost of each call is probably somewhere around twenty dollars.  It costs a lot of money each time you answer the phone; do you spend it effectively?

What percentage of those calls are resolved the first time?  What percentage of those calls could be answered  more effectively without the phone? How do you answer a call without a phone?  By having the caller get what they need from some form of social media site.

Imagine that in less than a few months you redesign part of your web site and you develop several YouTube presentations to explain your bills better than any single person could explain it on the phone.  You could provide a similar service for patients who need help contacting their insurance company, and need help filing a claim.  The ROI on social media is significant, and it’s nicer than sending a fax.

Well, that’s it for the moment. I’m off to the store. I think I’m going to buy a third dog.

Patient Experience Management–what is it?

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If you watch too much television your brain will fry. Sometimes I feel like mine is in a crepe pan that was left sitting on the stove too long. Two nights ago I’m watching Nova or some comparable show on PBS. The topic of the show was to outline all the events that took place that helped Einstein discover that the energy of an object is equal to its mass times the speed of light squared, better known as E=mc². It was presented to the audience at a level that might best be described as physics for librarians, which was exactly the level at which I needed to hear it. It’s physics at a level that is suitable for conversation at Starbucks or any blog such as this.

So here’s what I think I understood from the show. It tracked the developments of math and physics in 100 years prior to Einstein’s discovery. The dénouement appeared to occur when Einstein and his fiancée were riding in the bow of the small boat. Apparently, he was leaning over the side of the boat and noticed that the waves generated by the front of the boat moved at the same speed as the boat. He then noted that fact only held true for those persons in the boat, who were in fact, traveling at the same rate of speed. However for those persons watching from the shore, that same wave was not only moving slower than the boat it got further behind over time. Some other things occurred, yada, yada, yada, and there you have it. Clearly, the details are in the yada, yadas.

So here’s what happens when you watch too much television. As I’m running this morning somehow my mind takes pieces from that show and staples them together to yield the following. Let’s go back to the equation E=mc². For purposes of this discussion I’ll redefine the variables, so that:
E = the percentage of Patient Complaints/Inquiries.
m = Patient in-bound calls.
c = number of Patients
If this were true–this is an illustration, not an axiom–the percentage of complaints in the call centers of an healthcare provider is equal to the number of in-bound calls times the square of the number of patients. So as the number of calls increases the number of complaints/questions increases and as the number of patients increases the number of complaints increases exponentially. Of course this is made up, but there appears to be a grain of truth to it. As a number of calls increase the percentage of complaints is likely to increase, and as the number of patients increases there will probably be an even greater increase in the percentage of complaints incurred. I think we can agree that a reasonable goal for a healthcare provider is to decrease the percentage of complaints and perhaps to shift a hefty percentage of inquiries to some form of internet self-service vehicle.

I think sometimes the way providers like to assess the issue of Patient Experience Management  (PEM) is by looking at how much money providers throw at the problem. I think some people think that if one provider has 2 call centers, and another provider has 3 call centers, that the provider with 3 must be more interested in taking care of the their patients, and might even be better at PEM.  I don’t support that belief. I think it can be demonstrated that the provider with the most call centers, and most Patient Service Representatives, and the most toys deployed probably has the most problems with their patients. I don’t think it’s a chicken and egg argument. If expenditures increase year after year, and resources are deployed continuously to solve the same types of problems, I think it’s a sign that the provider and its patients are growing more and more dysfunctional.

How does this tie to Einstein and his boat? Perhaps the Einsteins are those who work with the provider; those who are moving at the same speed, those in lockstep. From their vantage point, the waves and the boat, like the provider and its patients, are all moving forward at the same speed. Perhaps only the people standing along the shore are able to see what is actually occurring; the waves distance themselves from the boat in much the same way that the patients distance themselves from the provider.

PEM is such an easy way to see large improvements accrue to the provider, especially using social media.

Social CRM meets Customer Equity Management

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During my run today I passed a home whose appearance made it look like an antipodean group of internationally renowned architects had competed to design the world’s ugliest building.  I forced my mind to focus on something else, like why the US has yet to invade Canada.

I enjoy writing as do many of us.  However, I have come to believe that most of us have the ability to write a sentence in some semblance of English.  What seems to separate the good writers from the less gifted is their ability to blend disguise the joins between the sentences in such a way that they do not show.  Worse yet, there are those writers whose attempt to communicate is a pox in the same unrestrained style of prose put into play by a Chinese man selling used Volkswagen Beetles along the back streets of Puerto Rico.

Judging the literary skills of some, it would appear they are wrestling with the parts of speech and fighting a losing match.  These are the same individuals who were they to write about a famous religious figure would name the Flying Nun, unaware of the non sequitur.

Oh well, enough of that, back to the business of changing business.  There may be a few dozen firms that ‘get it’…Amazon, Apple, Ebay.  The rest of them, yours included, are still busy trying to change their customers and prospective buyers to make them buy things according to their notion of how the selling and buying process works.  These are the same firms who think CRM, customer relationship management, is a valuable management tool.

CRM is everything it never was.

When a customer or prospect walks into your facility, or sees your organization online, everything you thought you knew about your business and about them is over.  The thing most firms miss is understanding that the market power has shifted from the business to the customer.

See if you can answer this question.  What is an iPhone, or a Kindle Fire?

They are shopping carts.  The moment a customer picks up the device they begin thinking about what they are going to put into that shopping cart.

The same process works whether a customer is walking into an auto dealer, a patient is walking into a hospital, or a subscriber turns on their television.  They are ready to make a buying decision and most firms are trying to manage them—good luck.

These people—customers—have done their homework, their due diligence on your firm and you offerings.  My sense of that if you were to segment customers by those who did their homework and those who did not, those who do are going to be the customers who spend the most.

The smart firms have stopped trying to manage their customers.  The very smart firms are using the social web to facilitate their customers shopping experience.

Customer Equity Management.  What is one customer or patient or subscriber worth?

 

Dinner’s warm, it’s in the dog–Patient Experience Management

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Let’s see what we can somehow tie this to patients; I couldn’t resist using the title. The phrase came from my friend’s wife. She’d said it to him after he and I came home late from work one night, he having forgotten his promise to call her if we were to be late. Apparently, she hadn’t forgotten his promise. We walked into the kitchen.  “Dinner’s warm—it’s in the dog.”  She walked out of the kitchen.  I think that’s one of the best lines I’ve ever heard.

He was one of my mentors. We spent a lot of time consulting on out-of-town engagements. I remember one time I took out my phone to call my wife when he grabbed me by the wrists and explained I shouldn’t do that. We had just finished working a 10 or 12 hour day of consulting and had stopped by a bar to grab a steak and beer. I remember there was loud music playing. When I inquired as to why I shouldn’t call he explained.

“When your wife is chasing three children around the house and trying to prepare dinner, she doesn’t want to hear music and laughter and clinking beer glasses. She needs to know that you are having as bad a night as she is. So call her from outside, and make it sound like tonight’s dinner would be something from a vending machine.”

“But it’s raining,” I whimpered. Indeed it was, but seeing the wisdom in his words I headed out and made my call.

So, back to the dinner and the dog, and the steak and the phone call. In reality, they are both the same thing. It all comes down to Expectations. In healthcare it comes down to patient expectations.

PEM can be a number of things; Patient experience management, Patient equity management, and Patient expectation management. In this instance, we are discussing the latter. A set of expectations existed in both scenarios. One could argue as to whether the expectations were realistic—and one did argue just that—only to learn that neither of our wives considered the realism of their expectations to be a critical success factor. In that respect, the two women about whom I write are a lot like patients, their expectations are set, and they will either be met or missed.

Each time expectations are missed, their expectationbar is lowered. Soon, the expectation bar is set so low it’s difficult to miss them, but miss them we do. What happens next? Patients leave. They leave and go somewhere they know will also fail to meet their expectations. However, they’d rather give their money to someone who may disappoint them than somebody who continued to disappoint them.

Social CRM–Patients are like little thunderstorms

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The web never ceases to amaze me. I’ve gotten to the point if I can’t find something I’m looking for, no matter how obscure, I figure that I did something wrong in how I framed the search.

For example, I was trying to connect to a high school classmate, someone I hadn’t spoken with since before Al Gore invented the internet. This guy got a pair of boxing gloves for his 14th birthday. We each wore one, and jousted only long enough for us each to land a blow on the other’s nose. It hurt—a lot. We gave up boxing.

In tenth grade biology, we bet him five dollars that he wouldn’t jump out of the second floor window. The teacher, who knew of the bet, turned her back to write on the blackboard. He jumped. Go straight to the office, do not pass GO, do not collect $200. We used to see how fast his red and white Mach II Mustang would go railing down Route 40. He was the guy you voted best person to keep away from bright shiny objects. The last I heard he went to a teaching college.

Anyway, I Googled him—from the imperative verb Google—I Google, you Google, he, she or it Googles. I can’t tell you his name for reasons that will soon become apparent. Google spits back links to things like military intelligence, think tank, counterinsurgency, small wars, and army major.  I think I’ve made a spelling mistake—this cannot be the same guy who jumped out of classroom window—and I add his middle initial to the search criteria. Up pops a link to CNN’s Larry King—the air date—just days after 9/11. The topic of the show; ‘the hunt for Osama Bin Laden’. To quote Lewis Carroll, “things keep getting curiouser and curiouser.”

The web. Social networking. A great tool if you’re one the outside searching, deadly in the hands of your customers.

If your firm is targeted, you are pretty much defenseless. Each patient is capable of creating their own digital perception of your hospital. True or false, makes no difference. Patients are like little thunderstorms popping up everywhere. Healthcare providers scurry around like frightened mice passing out umbrellas and pretending it’s not raining. They’re late, their patients are wet, and they are telling everyone. Very few firms have learned that they can’t put the rain back into the clouds.

Sort of reminds me of the line in the movie Young Frankenstein, “Could be worse, could be raining.” It’s raining, and even the best firms have run out of umbrellas. What is your firm doing about it?

 

Patient Experience as experienced by the patient…

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…is not a pretty picture.

At least that is how it seemed to me today during my son’s visit to a specialist at a renowned children’s hospital.  The hospital uses and equally renowned EHR–you can substitute the name of your favorite EHR and the story remains as relevant.

Actual face-time with the doc–30 minutes.  The clinical side of the patient experience was perfect. It could not have been any better–I awarded her bonus points.

Here’s the part I think most hospitals are missing.  There is another part of the Patient Experience which has little or nothing to do with the patient. It is also the part which lingers most in my memory and the one about which I am quick to repeat to others.  What part is that? It is the part that involves all of the non-clinical processes associated with the visit, such as:

  • Complete the forms-could have been done online
  • Provide the insurance information-was done the last two visits
  • Wait
  • Schedule the next appointment
  • Wait
  • Print out the results of this visit
  • Wait
  • Settle the charges
Total time spent on the non-clinical patient experience–30 minutes.
Any time a patient visit requires another family member or guardian to be present, Patient Experience Management by definition becomes Family Experience Management. Instead of poor processes wasting one person’s time, the time of two people are wasted by being inefficient and ineffective.
“How was the visit?” Asked my wife.
“Fine,” I reported. And then I spent two minutes telling her about the bad experience I had dealing with the non-clinical processes, those processes involved with running the business.
So, it was great to know my son is healthy, but we sort of knew that going in. It wasn’t great to be subjected to the inefficiencies and ineffectiveness of their processes and systems.  What will I remember about that experience as I am driving him to his next appointment? Will I remember how well he is doing and how professional the doctor is?  Or, will I remember to plan for an additional thirty minutes to allow the staff to perform all of the automated business processes to check us in and out?
The purpose of this post is to get us thinking that Patient Experience Management and Family Experience Management has to do with everything that happens from the time the person enters the facility until they leave it. If the only good part of the experience occurs during the examination, then the overall patient experience as experienced by the patient can be no better than mediocre.

Part 2: Are 7 sigmas 8 too many?

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The worst part about being wrong in public is having an audience.  Yesterday marked the eight-and-a-half year point since my heart attack.  I celebrated with a six mile run.  Instead of hiding my car keys under the bumper like I always do, I stuck them in the pouch of my MP3 case.

I was back within the hour and in a hurry to get to my water bottle that I had locked in the car.  No keys.  After considerable thought and machinations of my considerable cerebral skills I decided to retrace my steps; all twelve thousand of them.  Still no keys.  I called my wife and she retraced my route.  No keys.

I had apparently out-thunk myself.  We called AAA to get them to make us a key, and waited—two hours.  After several failed attempts Sparkie finally unlocked the car.  I opened the door, placed the palm of my right hand on the keys, reached across the seat for my water bottle…

The keys, locked inside the car right where I had left them.  No need to worry about missing any subsequent MENSA meetings.  My wife simply gave me the look—men, you know the look.  It is the one that means I will not tear into you now; instead I will save this for when I really need it.

I threw all seven of my sigmas at solving a zero-sigma problem, looking for a complex solution when an easy one would have worked.

Patient Experience Management (PEM) solutions are often approached in the same manner—sigma overkill—reengineering some arcane, one-off process without taking time to understand the real nature of the problem or its outcome.

In yesterday’s blog we drew a comparison between clinical PEM and non-clinical PEM (http://wp.me/pyKA6-Ih).  We also inferred that non-clinical PEM processes are not unlike some of the process employed by hotels.

So, what might be done to improve non-clinical PEM?  What easy wins can be achieved?

When you arrive at a hotel for an event or an overnight stay where do you go?  You go to Reception or to the front desk to check in.  When you leave you go to the same place to check out, or you bypass the process and simply leave.  You can do that because you have been a guest of the hotel.

Now let us look at the same process at a hospital.  Where do you go?  You go to Admissions, and to leave you go to Discharge.  Other than hospitals, can you think of another establishment that uses the terms admissions and discharge?

Prisons.

Admission and Discharge are suggestive of many things, but the feeling that does not spring to mind is the notion that anyone working at the prison cares much about inmate experience management.  Admissions and Discharge do not evoke warm, welcoming feelings.  They do not lead you to feel that your stay is in any way voluntary.  In fact, even ignoring that the medical vernacular for the term discharge is often used with adjectives of color—the yellowish discharge—the term discharge infers that you do not have permission to leave until you are discharged.

Ever notice the big open space right next to admissions?  Know what it is called?

The Waiting Room.  What happens there?  You wait.  It is a special, nicely furnished place designed for you and others to do nothing, prepared for you to waste your time.

Your appointment was scheduled weeks ago.  You are probably apprehensive and a little worried about what may happen to you over the next few hours or days.  You have blocked out your calendar to be there—taken off from work, arranged for a baby sitter, and arranged for someone to prepare meals for the children while you are away.  You probably needed someone else to adjust their calendar to ensure you get to the hospital on time.  The hospital told you when to arrive.  You are there on time but someone somewhere is not ready for you.

Did they forget you were coming, or does the very nature of having a waiting room infer that their time is more valuable than theirs?  The hospital is not only okay with the idea that you will be made to wait, they have preplanned it as part of the patient experience and built a special place for that activity to occur.

This waiting experience reminds me of my flight arriving at the airport only to find out that there is no gate at which to park the plane or no attendant to roll the jet-way to the plane’s door.  How is this possible?  Have they not known for the last several months that every day at such and such time this plane will be arriving?

So, here we are.  We have not even been admitted and our non-clinical patient experience is already negative.

Sometimes the best solutions are the first ones overlooked.

The Patient as Customer

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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.