Patients Experience Management-why not think like one?

I met last week with a number of 1st Year MBA students who have a consulting club to help them figure out if they are suited for this noblest of all professions–supposedly the second oldest profession. “How can you tell if you’ll be any good at it?” They asked.

As far as I can tell, there are two basic requirements. One, you have to be a bit out of kilter, a strong dose of ADHD doesn’t hurt either. You have to hate repetition.   Second, it helps if you have a belief that there is almost nothing you couldn’t figure out how to improve. While thinking it doesn’t make it true, the attitude is a critical success factor.  It will also require being rather thick-skinned as some clients will require you to yell “unclean, unclean” as you walk their halls.

For example, last week I was at the post office.  Noon on the Wednesday before the holiday–lunch time rush hour.  I’m standing in a long line underneath a banner with a message emphasizing quality.

There are two clerks, postmen, postpersons, postladies–I’m not sure which one is most appropriate, but as we both know, I’m not going to lose any sleep over it either. The line is out the door. Clerk ‘A’ tells clerk ‘B’, “I’m going on break.” At which point I turned to the person next to me and uttered, “And I’m going to UPS.”   It’s not that difficult to improve.  Not letting half of your customer-facing employees go on break during your busiest time would be a good way to start to improve things.

It’s not rocket surgery. The title of the piece is not a typo.  Patients really do experience management, at least they experience many of their ill-conceived processes and rules.  Patient Experience Management, Patient Equity Management. Whatever you call it, big inroads can be made.  Quit thinking like an executive and start thinking like a patient and you’ll have plenty of ideas.


Patient Experience Management: Who is your Chief Patient Officer?

(This column is not outsourced to Mexico.)

How many chiefs can you name? C-Levels, not Indians. I found these–COO, CIO, CTO, CMO, CMIO, CEO, CAO, CFO, Chief Purchasing Officer, Chief Network Officer, Chief Engineering Officer, Chief Benefits Officer, Chief Development Officer, Chief Brand Officer, Chief Staff Officer, Chief Health Officer, Chief Legal Officer, Chief Quality Officer.

Besides who gets the corner office, these titles demonstrate a firm’s commitment to those areas of their business, and these positions provide that business sector visibility all the way to the top of the firm. There’s a certain cachet that comes from having your sector of the business headed by a C-Level. Those are the ‘in’ jobs, the jobs to which or to whit one is supposed to aspire. You never see anyone clambering for a B-Level position. B-Level is the repository for all non C-Level jobs.

Remember Thanksgiving dinner when you were a child—apologies to those of who aren’t from the colonies. Anyway, if yours was anything like mine, there were two tables, the nice dining room table for the adults, and the smaller card table for the children, the B-Level guests.

So what does this have to do with patient care? You tell me. Let’s go from the premise that the C-Level positions are an accurate reflection of you firm’s focus. Why are we in business? If you go from the premise it must be because of finance, marketing, IT, Purchasing, or any of a dozen other things. The only thing missing in this view of the firm is the patient. The only entity without a seat at the grownup’s table is the person in the firm responsible for the patient. It seems to me a firm’s very existence, it’s raison d’être, is the patient. If that’s true, when do they get to eat with the grownups?

McKinsey published a study conducted with 1,000 CEOs and COOs to rank their top 5 initiatives over the next five years.  Ninety percent of them ranked Patient Experience Management as either their first or second priority.  The punch line of the study was that they did not know who in their organization “owned” the patient.  How is that for leadership?

If they don’t own the patient, I am willing to bet the patient owns them. If that is the case, Social CRM, S-CRM, will not be doing these executives any favors.


Patient Experience Management: How to begin

Here is my new post on

Patient Experience Management (PEM) is not about Patients, but it is often designed just that way.  The problem lies with the plurality, the pesky little “s” that takes the design and implementation away from an individual patient, and places the focus on patients.

Other industries grapple with the same problem, only with them the issue comes about when designing and implementing systems and processes around customers instead of a customer.

Do you recall the talking points of the recent McKinsey survey about patient experience management?  The study made drew two conclusions.  First, ninety percent of hospital executives responded that improving PEM was their first or second priority within the next three to five years.  Second, those same individuals stated they did not expect much to happen regarding PEM because they did not know who in their organization ‘owned’ the PEM business problem.

Ignoring that issue, if only for the reason that almost everyone else seems to be taking the same approach, what if a hospital wanted to move forward and deal with PEM in a meaningful way—not meaningful as in the term Meaningful Use—but in a way whereby having a PEM system actually yielded something for the hospital?

Few industries have done a stellar job with Customer Experience Management (CEM).  What can be learned from their failures?  Plenty.  The failure of CEM systems originates at the get-go. The organization does a poor job of defining its business problem, deciding it needs a system to manage its customers, as though all customers are the same.  With that as its target, it goes out and finds and implements such a system.

Here is the problem from the perspective of PEM, and in some regards for EHR.  Whatever system you choose for PEM, CEM, or for that matter EHR has been designed to address thousands of individuals as a single entity called “our patients” or “our customers.”  The system is build upon managing the experiences of a core set of patient attributes.  Chances are good that whatever PEM system you select—they really are pretty much the same—will address roughly seventy percent of the functional requirements of this entity called “our patients.”

Applications vendors build solutions and hope to find a problem which matches the system they built.  If all your individual patients fit neatly into their vision of this “our patients” entity your worries are over.  If however, patients are different, which they are, they will have many needs which lie outside of the boundary of their application.  It is these set of needs—functional requirements—upon which the success or failure of your PEM will be based.  These same needs are the ones that are unmet today.  These are the ones, the outliers, which raise the ire of your patients and the ones lowering your organizations PEM scores; assuming you track this.

One way to solve this problem, in fact, to my knowledge to only way is to start by defining rigorously the functional requirements of one patient, a super-patient, which encompasses every requirement.  With this done, you have a PEM model, based on a single patient.  Now instead of having PEM requirements which lie outside of the boundaries or core competencies of what a vendor wants to sell you, you have a turbo charged set of requirements.  The diverse PEM requirements of your individual patients are contained within the capabilities of the defined super-patient.

If you approach PEM this way you have defined for yourself a solvable problem.  You now have a problem looking for a solution instead of a vendor with a solution looking for a problem.

To some patients, EHR is a non-issue


It is easy to remove one’s self from what is important as we trade metaphorical tomatoes about what is wrong with EHR, what may happen regarding reform, and why the N-HIN is DOA.  Debating healthcare IT on the internet is an esoteric and antiseptic conversation, one with few if any catastrophic implications to anyone other than the person trying to sell a used, hundred million dollar EHR on eBay.

We write about the fact that it is supposed to do something to benefit the patient.  Is there a more sterile word than patient?  Whether we use patient or patients, we keep it faceless, nameless, and ubiquitous.  They do not have to be real for us to accomplish our task; in fact, I think we do our best work as long as we keep them at arm’s length.

We calculate ROIs for EHR around people who exist to us only by their patient IDs.

What if these hominoid avatars turned out to be real people?  What if indeed?

Two weeks ago I learned of a real patient; a friend, thirty-seven, mother of three.  Lots of tests.  They call itmyelodysplastic syndromes, MDS—MDS sounds more polite.  One would think that because it has its own acronym that might infer good news.  It does not.

The thing I like best about Google is knowing that if an answer exists to a query, I can find it.  I may have to vary the syntax a few times, but sooner or later I will find that for which I am looking.  The converse can be quite disquieting, especially if you happen to enter a phrase like, ‘survival rates for MDS.’  After a few tries I realized that the reason I was not getting any hits to my query had nothing to do with poor syntax.  It had everything to do with a lack of survivors.

Last Christmas—rather strange title for a blog.  In this instance the title has nothing to do with anything religious.  It is simply a line in the sand, a statement with a high degree of probability.  Unfortunately, “Last Christmas” does not have the same meaning as the phrase, ‘this past Christmas.’

She has had thirty-eight Christmases.  Apparently, MDS is able to alter simple mathematical series.  If presented with the numerical series 1, 2, 3…37, 38, 39, and if we were asked to supply the next number, we would all offer the wrong answer—40.  In her case there may be no next number; the series will likely end with 39.  MDS math.

Then there are the three children, each one of them in the same grade as my three children.  They will be learning a different version of MDS math.  All the numerical series in their lives will reset and begin again with the value of one.  First Christmas since mom died.  First birthday since mom died.  Every life event will be dated based on its relationship to an awful life-ending event.

It will be their B.C and A.D.

EHR probably has very little value when you break it down to the level of an individual patient.  Stalin said something like, “one death is a tragedy, and a thousand deaths is a statistic.”  While it is unlikely that he was discussing patient outcomes, the import is the same.

Rule One: There are some awful diseases that will kill people.

Rule Two: Doctors are not allowed to change Rule One.

I guess it goes to show us that as we debated things that we view as being crucial components of whatever lies under the catch-all phrase of healthcare, when it comes down to someone you know who you know is probably not going to get better, they do not seem very important.

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.


Patient Relationship Management–why patients and hospitals collide

When universes collide, or is universi the plural? Not that is matters. I was watching NOVA.  The show focused on the lead singer of the Indie group The Eels.  The show walked through the singer’s attempt to understand was his father had done for a living.  His father was a physicist, in fact he was the person who came up with the notion of colliding universes. Colliding universes has something to do with quantum mechanics and cosmology—did you also wonder what makeup had to do with particle physics? In its rawest meaning, parallel universes have something to do with the notion of identical worlds living side-by-side, with no notion of each other, with differing outcomes from similar events. Got it?  Me either.

I’ll try to illustrate if for nothing else than my own attempt to understand. Let’s say I’m concurrently teaching my two sons to play two different card games, Poker and War. Poker, albeit a game of chance, is heavily rules-based—when to bet, when to fold, when to raise. On the other hand, War is purely a game of chance. The poker player likes rules and order. The one playing war—he’s seven—likes to win, and will do what is required to bring about that outcome. Each one plays independent of the other, using the tools at their disposal to direct the outcome of the game in their favor. They are oblivious to the goals and tactics employed by the person sitting beside them. Parallel universes.

What if we allowed these two universes to collide, to come into conflict with one another? For example, let’s say I have them play each other and I re-deal the cards, giving one the cards he needs for a poker hand, and the other the cards to play war. I then instruct them to play one another. The poker player becomes focused on the rules, and the one playing war has a laser focus on one thing—winning. The poker player quickly caves, knowing that he is engaged in a futile endeavor. This does not bother the other one whose only focus was to win.

Imagine if you will—sort of Rod Serlingish—two other games going on simultaneously, one team whose sole focus is winning, the other whose focus is on the rules. For the rules-based team there is no winning. The best they can ever hope to do is to measure up to the rules by which they are judged. Millions have been spent on technology to help ensure that adherence. Adherence to the rules will be monitored, recorded, reported, and measured. The rules-based team’s ability to continue to play the game will be based solely on how well they follow the rules. Now imagine that the universes in which these two teams are playing collide and these two teams play their separate games but against each other. One team having never been told how to win, never been instructed to win, never even given permission to win. The other team’s only purpose is to win.

This is a nonsense game. One we play every day.  One team is the hospital’s patients the other team is the employees who are tasked with patient customer care, patient relationship management (PRM).  The patients are focused on winning, those tasked with customer care or PRM are not permitted or equipped to win.

It’s possible for these two groups to change the outcome, to take away the nonsense.  To make that happen, the rules must change.  PRM can be very effective provided that it is designed to help the patients “win”, designed to facilitate favorable outcomes for patients.  The trick to changing the outcome is that the hospital must understand that a win for the patients in most cases is also a win for the hospital.


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, 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 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

You Don’t Need an MD to Fix Patient Experience Management

This is my new post in, I’d like to get your thoughts.

Your brand ain’t what it was

Many brands have been redefined by a hospital’s patients through their patients’ use of social media.  Your brand is now what their patients—their social mediaphiles—say it is.  How’s that for a wakeup call?

Hospitals spend millions of dollars each year marketing to build their internal and external image; to what end?  At best, a hospital’s only barometer for how well they are getting their message across is a metric for name recognition.  Do more people know your name than they did a year ago?

I bet they do.  I would also bet most hospitals would have the same recognition factor if they did not spend a dollar on marketing.  Many organizations have no return on their marketing investment.  Installing a billboard on a highway a mile away from the hospital depicting a picture of smiling urologists is not bringing new patients or helping you retain current patients.

It may be time to figure out what the market and your employees are saying about your organization.  Chances are good that many of their messages are far different from your hospital’s vision statement and mission.  Chances are also good that their bandwidth and access to your customer base is significantly higher than yours.

Patient Relationship Management (PRM)

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 Relationship Management  (PRM) 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 PRM.  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.

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