Patient Equity Management

Bumble Bess & Red Velvet

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Remember as kids trying to see how many bumble bees you could catch in a jar before you panicked and they all got lose? You couldn’t get the top all the way on and all of a sudden dozens of bees exited the jar as you raced across the field of clover. That’s how customers are. You try and catch as many as you can, but once they get out it’s over. So, here we go again. Social networking. We’ll get there in a moment.

For those old enough to remember Ronald Regan, what are you able to recall about high school? If you’re like me, much of it is selective. The web seems to be changing some of that. Classmates.com. Facebook. Ever notice how there are no rules? Anyone can get to anyone else. Unhindered. Uninvited.

There are those who never grew up, and there are those who never grew older-there’s a difference. Sometimes it’s a good thing. Like for instance trading emails with the girl in the red velvet dress, the one with whom you first slow danced in the ninth grade. The Internet, pretty neat little thing.

Then there’s the other side to the social networking coin. A darker side. Unless you happened to be among the minutia of students who gamboled care freely down the crowded halls during those four years believing that the school year book should contain only your picture, graduating high school gave you your out, gave you permission to euphemistically bury the bourgeoisie characters who needed burying. People who, when you were eighteen wouldn’t put you out if you were on fire, the very people who probably set you ablaze, now knock digitally on your Facebook door asking to befriend you. Did I miss something here? The part where my Facebook-buddy-wannabe says, “Now that we’re grownup, forget I was a jerk in high school, ignore the fact that I was dumber than a bowl of mice”—sounds like I may have missed one or two of my twelve-step meetings. Recovery is progressing well—really.

Just because a hospital is paranoid doesn’t mean their patients don’t hate them. Poltergeists. The undead. The kind of like patients you’d hope you’d never hear from. And yet, those are the very ones who bother to write. They write, and blog, and YouTube your hospital. They deliberately come back and haunt. Their haunts are reflected in higher costs, fewer patients, and higher churn. Isn’t technology great?

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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Patient Relationship Management, add 3 parts technology and stir

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Sometimes you need to break a few eggs to get to the root of the problem. Traditional approaches to improving the patient experience usually begin with the call center. Why is that? Maybe it has something do with the fact that a call center is tangible. Something you can observe and touch. Clearly, it’s something that can be measured. However, I think the real reason is that the number of call centers in any organization is finite. You know your number of call centers. It’s not about five, or as of yesterday morning we had three, it’s a specific number. As such, it’s a reasonable target. It’s a target that can typically be dealt with through the application of technology. There’s a handful of technology, which when applied to any call center in any location will, when measured against the typical metrics, enable the call center to be “better”. If someone’s marching orders are to fix the call center, those orders fit neatly with the application of technology.

Doing something to the call center is a shotgun approach to trying to solve a problem. It’s a recipe that is very repeatable; add three parts technology and stir. It’s almost guaranteed to produce measurable and visible results. It’s also almost guaranteed to not fix a single patient problem. The reason for that is that almost all of the technology deployed in call centers has nothing to do with addressing the reason the patient called. The application of technology for the most part has to do with getting the caller to the CSR more promptly.

The big distinction in dealing with patients versus dealing with call centers is that patient problems usually can’t be resolved via the application of a shotgun solution. Clearly, if every patient that calls about a billing problem is calling about the same billing problem then the application of technology could fix it. However, patients who are calling about billing problems are usually calling regarding a problem that is specific to them. There are two ways to address this type of problem. One way is to get a clear enough understanding of problem on the call and have the patient work with the CSR to resolve the problem. That type of solution puts out the fire. The problem with this type of solution is that it has to be repeated with the CSR every time that same problem arises. The other way, and by far a more proactive way, is to figure out what caused the billing problem and to correct whatever caused the problem thereby preventing it from ever happening again. Instead of putting out the fire, the hospital prevents the fire from reoccurring.

From my perspective this is one of the major differences between Patient Relationship Management (PRM) and Patient Equity Management (PEM). I’m not convinced that PRM actually exists, at least as relates to the acronym. I think it’s either call center management or patient account management, or some combination of the two. If it does in fact somehow manage the relationship of the hospital with the patient, it’s predominantly a one-way relationship, a push relationship from the hospital to the patient. PEM, patient experience management, patient expectation management, patient equity management, requires a two-way relationship, and requires knowing more about the patient than some profile developed through data mining. For PEM to be successful, the hospital must get to the root of why the patients are calling and what can be done to solve the problem in such a manner that the patient no longer has to call. It sounds like a lot of work. It is if you take a shotgun approach to it, sort of like trying to eat the elephant in one bite. I’ve found that if I break it down into manageable pieces, each of those pieces can be designed as a small project that can be solved.

The most difficult thing about trying to implement this type of solution is that it goes against everything that we’ve been doing. This can appear to be so far out of the box that you can’t even see the box. It requires you to think in opposites. The solution begins with how you phrase the problem. Instead of viewing the problem as, “How do we improve our call centers”, we need to be asking, “How do we improve our interactions with our patients?” We’re almost asking the inverse. In mathematics, that’s easy to do; you simply multiply by -1.  Maybe that’s all that’s needed here.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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You Can’t Fix Stupid

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I spent a summer in Weaverville, North Carolina, just outside of Asheville. (I couldn’t find it on the map either.) That summer, I was the head wrangler at Windy Gap, a summer camp for high school kids. I’m not sure I’d ever seen a horse, much less ridden one, so I guess that’s why they put me in charge. I thought that maybe if I dressed the part that would help. I bought a hat and borrowed a pair of cowboy boots from a friend; the boots were a half size too small, and I spent the better part of the first night stuffing sticks of butter down them trying to get them off my swollen feet.

The ranch’s full-time hand taught us how saddle the horses and little bit about how to ride. In the mornings we had to collect the horses from the fields, bring them into the corral, and saddle them. The other wranglers would ride out to the field to bring in the horses, while I being the least experience of the wranglers would race after them in my running shoes trying to coax them back to the barn. We would take the children for a breakfast ride along a mountain path where we would let them rest and cook them a breakfast of sausage and scrambled eggs.

One morning a group of fifteen high school girls was sitting on the fence of the corral.  I walked up behind them carrying two saddle bags filled with the breakfast fare. I slung the saddlebags over the top rail of the fence, and hoping to make a good impression I placed one hand on the rail and vaulted myself over. I landed flat on my back smack dab in the middle of the pile of what horses produce when they’re done eating—so much for the good impression.

I brushed myself off and saddled my horse. The moment I gripped the reins the horse reared on two legs, made a dash for the fence and jumped it in one motion. I could tell the high school girls were impressed as I flew by them. Both of my arms were wrapped around the horse’s neck, and I had my hands locked in a death grip. I yelled, “whoa” and stop”, only to learn that the horse didn’t speak English. The horse raced the two hundred yards to the dining hall, stopped on a dime, and raced back to the corral, as the girls continued to cheer. One final leap, and I was back where I started; on the ground, in the corral, looking up at the girls. I took a bow and quickly remounted my steed. The full-time ranch hand came over and instructed me rather loudly, “You can’t let the horse do that. You have to show the horse that you’re in charge.” After that piece of wisdom he grabbed my horse by its bit, pulled its head down, and bit a hole in my horse’s ear. I’m not sure what kind of in an impression it made on my horse. I guarantee you it made an impression on me.

Horses aren’t very intelligent, but they know when you don’t know what you’re doing, when you’re bluffing—dressing like a cowboy didn’t even fool the girls, much less my horse—I guess he hadn’t seen many westerns. Here we go—you had to know where this was headed.

Patients are a lot like horses. (I just Googled that phrase and it appears you heard it here first.) You can’t fix stupid. Putting lipstick on a pig won’t make it any more attractive. Patients don’t like being ridden; don’t like being saddled with extraneous fees. One example—mobile phone providers offer many pricing options. They know their customers can’t predict how many minutes they will use. They penalize their customers for using too much time and they reap the benefits if they don’t use all of their time. Fifty percent of mobile phone providers’ income derives from those fees.

Customers know when a company doesn’t know what it’s doing—those companies who require their customers to sign a contract in order to prevent them from defecting. Do you have a gym membership? Their favorite customers buy long-term memberships but rarely visit the club. That allows health clubs to sell more memberships than they can accommodate, and they make it difficult for their customers cancel the contract. Long-term contracts almost guarantee poor service; after all, it’s not like the customer can up and leave.

Patients know when a company is bluffing. That’s why most people hate calling. Want to really get on someone’s nerves—make sure the recorded message mentions that the call may be recorded for purposes of quality. If it’s me on the phone, that’s when I know that I’m really going to have a difficult time getting the results I want. It appears that there is an inverse correlation between how much a firm states that it wants to help a patient and the amount of help the patient actually receives. Given a choice, sometimes I’d rather be the horse.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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Dinner’s warm, it’s in the dog–Patient Expectations

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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.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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Does your hospital have ID–Innovation Deficiency?

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When certain things reach their expiration date, no second-guessing is required. Shelf life has transformed into half-life. Milk is a good example, one that involves several of the senses. For starters, the dairy industry offers a great hint by printing the date right on the label. Smell is another indicator, unfortunately we don’t always trust that first whiff, and we take a sip thinking that it can’t be all that bad. Fortunately, our taste buds never let us down. If the milk has turned, there is a visceral, almost violent desire to spew it forth and then shave your tongue. Finally, if the consistency is such that it can be eaten with a fork, toss that puppy. Bananas turn black. Cheeses and breads sprout beards, speckled with tinctures of blues and greens. Tomatoes leak, oranges deflate, grapes wrinkle, and juice ferments.

On the other hand it’s more difficult to know when non-perishables have outlived their usefulness. Light bulbs burn out, batteries die, and DVDs freeze. The same thing happens in business; technology gets outdated, service providers lose their appeal, patients have other choices, and business processes no longer apply to today’s markets. The difference is that it’s much easier to see when a light bulb burns out than it is to recognize when 10 year-old business processes aren’t cutting it.

Sometimes ideas just wear out, and new ideas aren’t forthcoming. This happens a lot, especially as relates to customers—for purposes of this discussion we use customers to mean patients and physicians. There’s a scientific name for this phenomenon; Innovation Customer Experience Deficiency, ICED. How can you tell if your hospital’s been ICED? It’s fairly simple. If you can pinpoint the year when you last changed how you approached your customers you’ve been ICED. Customer experience management (CEM) should be occurring continually. If it is occurring continually under a design that hasn’t been updated continually something is out of sync. Do you use the same CEM systems you used 5 or 10 years ago? Have you added new processes or services during that period? If so, you’ve been ICED.

It’s sad to watch. Good hospitals wither away to upstart competitors simply because they have no new ideas about how to handle their customers. Reducing average handle time is not an innovation. Decreasing the rate of call abandonment, should not be considered a new idea. Many hospitals have lost the ability to color outside the lines—some never had the ability. It’s shameful. CEOs and other executives can be seen sneaking in to work early so they aren’t seen by their employees—their briefcases are filled with old ideas, some on a floppy disk they picked up at some useless symposium a decade ago. Their customers are making fun of them on YouTube. Even their dog is embarrassed and is thinking of moving in with some other executive, one who isn’t afraid to think.

The symptoms are classic. Unfortunately, if left unchecked, the deficiency can spread throughout the organization. Soon, billing doesn’t care if it has all the required line items. Marketing figures, why care, since our stuff isn’t innovative anyway. The front doors stay locked, because the employees don’t want the customers coming in and teasing them.

Our clients ask us, what can we do? “We’re still working on the same problems I was faced with when I was a CSR,” replied Stan Watson, Healthy Pro’s, vice president of customer care. “We’ve just added another T-1 line,” stated Stan’s boss Nancy Peppermill. “We do that about every six months or so and finally everything starts settling down.”

This is why we created the Baltimore Exposition for the Innovation Customer Experience Deficiency, BE ICED. BE ICED is a two-day exposition. It’s being held the third Monday in October, and it ends the previous Friday, that way, you still have your weekend available. How do you know if this exposition is for you? If you are still trying to fix yesterday’s problem, or you can’t color outside the lines, or find that all of your peers are thinking outside the box while you’re still trapped inside, then you should consider joining us.

BE ICED will teach you to be bold. Day one of the exposition begins with a seminar to introduce the executive to the customer. This can be very intimidating, but we will be with you every step of the way. We will walk through mock scenarios that practice the difficult skills that we feel cause ID, innovation deficiency. Once we work on those skills, we will go live. Each executive who has customer responsibilities will be driven blindfolded to an actual hospital or clinic, whereupon they will meet live customers. Executives will receive points for correctly being able to identify a customer and for interacting with the customer. Bonus points will be awarded if the executive is able to ascertain the customer’s needs and provide the right assistance. Day two will be filled with techniques to teach the executive how to cope with and hopefully eliminate ID. Yes, ID is embarrassing, but we’re here to help.

Listen to the following testimonial. Randy Johnson is the senior vice president of CEM for the medical devices conglomerate, Panache Bed Pans. Here’s what he said after completing two-day session. “We thought we knew all there was to know about how to take care of our customers. And then I realized I had ID. Panache Bed Pans was ICED. Customers would call more than once, expecting us to have answers to their questions. Why did they think we knew anything about bed pans, other than how to make them? We began to get discouraged. We would come in late, leave early, and hide under desks, so we wouldn’t have to answer the phone. Then I heard about ID. I must admit at first I was skeptical. But they placed me in a group with other people who are just as inept as I was when it came to taking care of customers, and that made me feel comfortable. After two days, that feeling that comes with having ID began to go away. Now I know how to be innovative, and I’m starting to cope with just feeling deficient.”

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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Patient Relationship Management–lessons from Thumper

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Today it feels like I got a little too befuddled, steered into the skid, and took a left into the dementia cul-de-sac.  I like to dig a little esoteric hole right up front to test myself—hopefully I won’t overshoot.

One billion, two hundred and twenty million. That’s the number of hits on Google for ‘hotel’. A fairly competitive business one could easily surmise. A business in which one would benefit by trying to attract and retain customers, especially loyal customers. Their tagline is, ‘It happens at the Hilton’. You know what they say, ‘It happens’–it certainly does, ‘It’ happened to me. I’m standing at the Hilton Honors desk, checking in to the hotel. I’m in Memphis. Tennessee is one of the friendliest places I’ve ever been. The people are genuine. We go through the niceties of how my flight was, and what I’m doing in Memphis. Yada, yada. I then provide the clerk with my Hilton Honors number.

“I’m afraid you don’t exist, Mr. Roemer.”

I have the right to remain silent; I just don’t have the ability. I can feel it coming. I’m about to have a Roemer-minute. You know the feeling, when the words are going to jump pass the lips before you have the chance to go into lock down mode. I’m a bit of a stickler for English, so I press him to do better with his statement. “Here I am”—I am Sam, Sam I am, I wanted to add, but I didn’t know how up to speed his was with his Green Eggs and Ham reading. “How can I not exist?”

“In the system. You’ve expired—I checked my pulse to make sure I hadn’t—you’ve been deleted.”

“My reservation?”

“No, you. You are no longer an Honors Club member.”

Now I had it. I hadn’t expired, they expired me. Somebody had to think up that little gem of an idea, and somebody else had to approve it. They could have just pretended I was still in their little club and not said anything and everything would have been fine. Bambi 101. Thumper’s mother; ‘If you can’t say something nice, don’t say anything at all.” A clear violation of the rule. As competitive as the hospitality industry seems to be, how smart does one need to be to know that it is not a good idea to expire customers?

I was in the middle of my run today, four miles away from the parking lot.  Next to the dirt trail was a bright orange Igloo water cooler with a hand-written note stating it was provided by a local running store.

What have you done for your patients recently?  What makes you stand out?

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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Patient Relationship Management (PRM)-why men can’t boil water

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There was a meeting last week of the scions of the Philadelphia business community. The business leaders began to arrive at the suburban enclave at the appointed hour. The industries they represented included medical devices, automotive, retail, pharmaceutical, chemicals, and management consulting. No one at their respective organizations was aware of the clandestine meeting. These men were responsible for managing millions of dollars of assets, overseeing thousands of employees, and the fiduciary responsibility of international conglomerates. Within their ranks they had managed mergers and acquisitions and divestitures. They were group with which to be reckoned and their skills were the envy of many.

They arrived singularly, each bearing gifts. Keenly aware of the etiquette, they removed their shoes and placed them neatly by the door.

The pharmaceutical executive was escorted to the kitchen.

“Did your wife make you bring that?” I asked.

He glanced quickly at the cellophane wrapped cheese ball, and sheepishly nodded. “What are we supposed to do with those?” He asked as he eyeballed the brightly wrapped toothpicks that looked banderillas, the short barbed sticks a matador would use.

“My wife made me put them out,” I replied. “She said we should use these with the hors d’oeuvres.”

He nodded sympathetically; he too had seen it too many times. I went to the front door to admit the next guest. He stood there holding two boxes of wafer thin, whole wheat crackers. Our eyes met, knowingly, as if to say, “Et Tu Brutus”. The gentleman following him was a senior executive in the automotive industry. He carried a plate of freshly baked chocolate chip cookies. And so it went for the next 15 to 20 minutes, industry giants made to look small by the gifts they were forced to carry.

The granite countertop was lined with the accoutrements for the party. “It’s just poker,” I had tried to explain. My explanation had fallen on deaf ears. There is a right way and a wrong way to entertain, I had been informed. Plates, utensils, and napkins were lined up at one end of the counter, followed in quick succession by the crock pot of chili that had been brewing for some eight hours, the cheese tray, a nicely arrayed platter of crackers, assorted fruits, a selection of anti-pastas, cups, ice, and a selection of beverages. In the mind of our wives, independent of what we did for a living and the amount of power and responsibility we each wielded, we were incapable of making it through a four hour card game without their intervention.

I deftly stabbed a gherkin with my tooth pick. “Hey,” I hollered “put a coaster under that glass. Are you trying to get us all in trouble? And you,” I said to Pharmacy Boy, “Get a napkin and wipe up the chili you spilled. She’ll be back here in four hours, and we have to have this place looking just as good as when she left.”  I thought I was having the neighborhood guys over for poker; I was wrong. So were each of the other guys. We had been outwitted by our controllers, our spouses. Nothing is ever as simple as it first appears. We didn’t even recognize we were being managed until they made themselves known.

Who’s managing the show at your hospital, you or the patients?  The answer to that question depends on who owns the relationship, who controls the dialog.  If most of the conversation about your organization originates with them, the best you are doing is reacting to them as they initiate the social media spin, or try to respond once the phone started ringing.  It’s a pretty ineffective way of managing.  It’s as though they dealt the cards, and they know ahead of time that you are holding nothing.

There are times when my manager isn’t home, times when I wear my shoes inside the house—however, I wear little cloth booties over them to make certain I don’t mar the floor.  One time when I decided to push the envelope, I didn’t even separate the darks from the whites when I did the laundry.  We got in an hour of poker before I broke out the mop and vacuum.  One friend tried to light a cigar—he will be out of the cast in a few weeks.

Be afraid. Be very, very afraid.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

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I hate to be a pest…

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…but I inadvertently just proved my own point, albeit to myself. I have been fooling around–with my old MP3 player, and I couldn’t get it to turn off or on–that’s why my wife hides the power tools.

I ducked into a nearby phone booth and put on my SSCC (self-service customer care shirt)–do you realize most kids under the age of ten have never seen a phone booth? Sorry.

Off to Google. I never even considered going to the manufacturer’s web site. I typed, “Remove battery from Creative Vision:M.” Up pop several YouTube videos, each done by one of Creative’s customers, showing step-by-step with voice instructions explaining how to correctly remove the battery. I place a lot more faith in what a customer tells me than I do in what they firm tells me.  Your customers (patients and doctors) do the same thing.

The user manual that came with the device never mentions how to remove the battery.

And this is my point. Your patients know what your other patients need, and in what form it will be most useful. And, they are providing it. Now, how difficult would it be for a hospital, say your hospital, to start thinking about your patients as though you were a patient? Not very.

Of the few hospitals which have a Patient Relationship Management (PRM) strategy or social media (SM) strategy, not too many are effective.  I’ve only seen one which uses those to increase revenues.  Most hospitals use PRM and SM to manage spin, to try to counteract what their patients are saying about them.  One can only imagine the impact a hospital could have by starting the spin, starting conversations about itself using these tools.

You know what?  You don’t have to imagine it.  It is probably the easiest project you will undertake.

Here’s a link to a PowerPoint deck on the subject of PRM.

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

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS

Who is minding your patients, your equity?

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Did I mention that I like to sing? No? Don’t tell anyone, but I just downloaded some Tom Jones to my MP3 so I can belt out a rendition of Delilah while I’m running—I only do this when I’m certain nobody is around. This doesn’t quite foot with my college collection of albums from Pink Floyd, Genesis, and Queen.

Then there was the time I was on a date at a roller rink. I was probably dressed in a pair of tight fitting bell-bottoms, an equally tight fitting rayon shirt unbuttoned to who knows where—hold the laughter. My almost shoulder length hair half-hid a puka shell necklace.

It may be important to know that although I had ice skated, I had never roller skated. There are a few not so subtle differences between the two.  Most notably, the sadist who designed the roller skate must have thought it amusing to place a large round rubberized wheel on the front of the skate in much the same position as a car bumper. I have no idea what is supposed to do. What it does do is stop you on a dime, especially when you have no intent of stopping.

Let’s see if we can tie some of this together. I’ve never felt that I actually needed to know how to do something in order to develop my own unsubstantiated delusions of adequacy—that probably explains why I’ve been consulting all these years. Anyway, back at the roller rink.

Barry Manilow’s “I Write the Songs” was being piped overhead through speakers the size of a dishwasher. Feeling much too confident for my abilities, I dragged my date to the floor. We stood side by side. I grasped her hands in a crisscrossed fashion like I had seen skaters do on television. After circling the rink for half a lap—watching my feet the entire way—I thought I should further dazzle her by singing. I should point out that it is difficult to sing and simultaneously watch your feet, a fact I didn’t learn until I was airborne. This takes me back to the rubber wheel on the front of the roller skate. We crashed to the floor and quickly took out the next thirty or so couples who were following us. It looked like a conga line run amuck. For the next hour or so it seemed like everyone in the rink pointed at me as though they were trying to warn others to stay away.

I haven’t sung any Manilow since that fabled night. Maybe it has something to do with the fact that times change and tastes change. Now I listen to groups like Dashboard Confessional and Great Lake Swimmers. I still interface with those closeted Manilow fans. Gone are the bell-bottoms and platform shoes, replaced by micro-fiber trousers, Droids, and Cole Hahns. My collar-length hair has a more monastic cut.

I’ve aged, so has my generation.  Aged to the point where they now have the power. Those people own the decision making process in most hospitals.  They may be the people calling the shots in yours. How can you tell if the person wearing the eighties polyester is one of them? Walk past her humming a few bars of Mandy or Copacabana, or something from The Captain and Tennille, and see if she hums back.

Is your Patient Equity Management (PEM) strategy is as dated as the double knits?  Or did I get ahead of myself; does your hospital even have a PEM strategy?  Odds are that there is no PEM strategy, no PEM group or executive.

Hospitals are quite good at managing their assets.  I bet your hospital has someone who can tell you how many chairs, televisions, beds and bed pans you have.  Assets.  We count them because we don’t want to lose them.  That is how businesses are managed.

In today’s dollars over their lifetime the average person in the US will spend more than $600,000 on healthcare.  Patients.  Assets.  They are a big part of your hospital’s equity base.

Who is minding your patients, your equity?  I don’t mean the doctors and nurses.  Who is responsible for making sure discharged patients return to you the next time they need a hospital?  Who manages that relationship for the hundreds of days between hospital visits?  Probably nobody; at least nobody in your organization.  Wanna’ bet somebody in the hospital on the other side of town is studying how to turn that $600,000 patient into one of theirs?

In case you’re wondering, the episode at the skating rink was our last date.