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?