Why your Website is Killing Patient Satisfaction

Hospitals probably have more than one hundred points of contact with each patient.  These points of contact (POCs) begin before the patient is admitted and continue after the patient has been discharged.

The first contact may come by a visit to one of the hospital’s clinics, a 3 A.M. call to a primary care physician, or browsing the hospital’s website.

Yesterday I assessed whether the website of a large hospital group was functional or whether it was just a website window-dressed to look like a customer portal. I assess functionality based on whether I was able to accomplish what I set out to accomplish.

I counted dozens of different phone numbers to call. Along with the list of numbers were links for physician and employee portals, links to the board, a link for donors, wellness, specialties, medical professionals, and dozens more, all on the front page. 

There was even a link, albeit not a portal for patients—a rather important link since the number of visits by patients and prospective patients probably greatly exceeds the combined number of visits by all other visitors to the site.  Unfortunately the patient link was imbedded with six other equally weighted links.

I clicked the patient link and was greeted by two-dozen new links, each displayed as being of equal importance.  There were links for patients to use before coming to the hospital and links for them to use once they were home.  Points of contact with your hospital.  Points of satisfaction or dissatisfaction. 

I clicked some more.  Schedule an appointment.  There are actually two links for scheduling an appointment.  The first link gave me a phone number I could call M-F between 8 and 5:30 P.M.  What number do I call at 6 PM I wondered?  I tried the second link; it took me to the same place. Could I schedule an appointment online or through a mobile device?

What did I learn? There are 168 hours in a week.  Their scheduling service operates for 47.5 hours a week, 28% of the week’s hours. If I dialed that number after hours would I get a recording telling me how important my call was?  If my goal was to schedule an appointment using their website, or to schedule an appointment at any time on any device not only did the hospital not meet my expectation, it did not even offer me an alternative. A dead-end.

If it costs the hospital thirty dollars to schedule an appointment by phone and nothing to schedule an appointment online, why not complete the task correctly, the first time, and for zero cost?

I next looked at what I could do when I was home, more POCs, more chances to be satisfied or dissatisfied. 

Manage my medical records. Using the website I was able to print and mail, two very non-electronic processes, a request to have my records printed and mailed to me.  There was no way to submit my request using their website.  If I did not own a printer or did not have access to a printer my expectation was not met, and was I not offered an alternative.  Some people, a whole lot of people, actually like to complete tasks using a tablet or smart phone. Another dead-end.

Let’s try billing. For Medicaid patients there are two numbers to call for help understanding your bill. That means understanding Medicaid bills is a nontrivial exercise.  That tells me that if I asked the same Medicaid billing question of three different people I might expect to get three different answers.  Why not design the sight so that it provides one right answer to whatever question is asked?  Why not include an online chat feature? Why not create a link to a YouTube video, produced by the hospital that explains Medicaid billing?

Medicare.  No link to prequalifying, not even a phone number for questions.

How to pay your bill.  Perhaps the most difficult and least desirous task a patient must do. There is no link explaining the various components of the bill, and nowhere on the site is a copy of a sample bill explaining or highlighting the various sections of the bill.

There is also no link to understand how to file a dispute or a claim with a payer.  Maybe it is not possible to do this for every payer, but using the 80:20 rule there must be ways to help the majority of patients understand what they are up against rather than having them face down the evil empires on their own.

Patients come to the hospital’s website with expectations.  Patient satisfaction is repeatedly won or lost at your hospital’s website and on the phones.  POCs.  Having a tool that proposes to help patients with their bills that not only does not help them but that adds to their frustration will crush patient satisfaction.

Hospitals want patients to pay their bills and to pay them on time.  Patients who do not understand their bill will not pay more completely, nor will they pay faster.

The next time you look at your hospital’s website ask yourself how different it would look had someone asked a patient how it should function.


Patient Experience Management is abi-normal

I remember the first time I entered their home I was taken aback by the clutter.  Wet leaves and small branches were strewn across the floors and furniture. Black, Hefty trash bags stood against the walls filled with last year’s leaves. Dozens of bright orange buckets from Home Depot sat beneath the windows. The house always felt cold, very cold. After a while I learned to act normally around the clutter.

There came a time however when I simply had to ask, “Why all the buckets? What’s the deal with the leaves?”

“We try hard to keep the place neat,” she replied.

“Where does it all come from?” I asked.

“The open windows, the stuff blows right in.”

I looked at her somewhat askance. “I’m not sure I follow,” I replied as I began to feel uneasy.

“It’s not like we like living this way; the water, the cold, the mess. It costs a fortune to heat this place.  And, the constant bother of emptying the buckets, and the sweeping of the leaves.”

Trying to assume the role of thought leader I asked, “Why don’t you shut your windows? It seems like that would solve a lot of your problems.”

She looked at me like I had just tossed her cat in a blender.

When you see something abnormal often enough it becomes normal. Sort of like in the movie The Stepford Wives.  Sort of like Patient Experience Management (PEM). The normal has been subsumed by the abnormal, and in doing so is slowing devouring the resources of the hospital.

Are you kidding me? I wish. It’s much easier to see this as a consultant than it is if you are drinking the Kool Aid daily. When I talk to people about a statistic that indicates that 500 people called yesterday about their bill, and everyone looks calm and collected, it makes me feel like I must be the only one in the room who doesn’t get it—again with The Stepford Wives.

If I ask about the high call volume they always have an answer, the same answer.  “Billing calls are usually around 500 a day.”  They say that with a straight face as though they are waiting to see if I will drink the Kool Aid. It’s gotten to the point where no matter how bad things get, as long as they are consistently bad, there not bad at all.

This is the mindset that enables the PEM manager (I know you don’t have one—I am being facetious) to be fooled by his or her own metrics. When is someone going to understand that repeatedly having thousands of people calling to tell your organization you have a problem, means you have a problem?

It would probably take less than a week to pop something on your web site, and post a YouTube video explaining how to read the bill.  Next week, do the same thing and help patients understand how to file claims and disputes—granted, you may need more than a week for this one.

Healthcare IT, let’s not lose site of the patient

It is easy to remove oneself from what is important as we trade metaphorical tomatoes about what is wrong with EHR, what may happen to the healthcare reform, and why the nationwide health information network 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, $100 million 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?

Recently I learned of a real patient; a friend, 37, mother of three. She has had lots of tests. They call it Myelodysplastic Syndromes. MDS sounds more polite. One would think that because it has its own acronym that might imply good news. It does not.

The thing I like best about Google is knowing that if an answer exists, I can find it. I may have to vary the syntax of the query a few times, but sooner or later I will find what I seek. 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” is a 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.”

My friend 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. That’s 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 debate 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 probably is not going to get better, some things do not seem very important.

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

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.

Whatever happened to Healthcare Reform?

I wrote a piece last year titled ‘Robbing Peter to Pay Paul’.  Yesterday I read a thoughtful post by Kim Chandler McDonald which offered a very similar albeit somewhat different perspective on the topic of where the focus on healthcare really lies.  Kim wrote on ‘meHealth’, taking the responsibility for eHealth as the only real way to create an ROI in the space http://ow.ly/5NCPN.  For those who enjoy reading something by someone who knows the difference between an adverb and a potted plant and can actually write a proper sentence I encourage you to take a read.

Mine was on heCare and sheCare and it also speaks to the individual but does so without any attempt to disguise my belief that healthcare reform missed the mark http://ow.ly/5NDet.  Kim wrote asking what if anything has changed in the period since I penned my piece.  For those who may have missed it, and to borrow from FDR, my premise was that the only thing to fear about healthcare reform was reform itself.

For all the talking that healthcare reform created, the silence on the topic has risen to a new crescendo.  The only thing that has changed concerning reform is that the silence has grown louder.

Why has reform missed the mark and what can be done about it?  Permit me a moment to illustrate.  I would ask that all the altruists reading this post take one step forward—wait a minute Sparky, where are you going?  The reform package efforted (simple past tense and past participle of effort) to be all things to all people, especially to those who have been disenfranchised under the current system.

While the goal is laudable, it did not pass the test of being both necessary and sufficient.  Its insufficiency is hampered by the fact that when we are ill altruism ends at our individual front doors.  It goes back to the notion of robbing Peter to pay Paul.  Do unto others, but do not undo unto me.

Most observers believe there is some dollar amount that contains the total spend available for healthcare and that to increase services to those less fortunate—the theyCare populous—means paying for it by removing services from those who presently have healthcare, the heCare and sheCare taxpayers.  And, it is those same people, the heCares and sheCares, whose support of reform has fallen silent.

While a rising tide may indeed lift all boats, it also drowns those tethered to the pier.

Patient Experience Management: Why Men Can’t Boil Water

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.

Part 2: Are 7 sigmas 8 too many?

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?


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.

Patient Experience Management: For Adults Only

This post is the first in a series that may make you rethink everything you think you know about Patient Experience Management.

Last week I checked in to a hotel for three days; seventy-two hours.  I was at the hotel for an event that required ninety minutes; one-and-half hours.

A few weeks prior to my stay someone told me where I had to be, how long I would be there, and what I would be doing.  My reservation was made, and I sorted out how I would get to the hotel.

The check-in process was flawless.  My room was ready.  My wakeup calls were timely. The room was serviced daily.  Plates with food arrived.  Plates without food departed.  The requirements for my ninety minute event were met and I was escorted to the correct room.

On hour seventy-two I checked out of the hotel and I received a copy of my bill.  The last thing I encountered was having someone asking me how my experience was.

Try thinking the remainder of this discussion through with me.

Of the seventy-two hours I was at the hotel only two percent of it (1.5 hours) had to do with my reason for being at the hotel—the presentation I was giving at the HFMA.

So, you may ask, how did it go?  The speech or the stay at the hotel.  Two different experiences.  Let us say that my speech tanked, or that people couldn’t find the room, or that the projector did not work.  If someone asked me, how “was your speech,” I might conclude by saying, “The speech was awful, but the hotel was great.”

On the other hand, what if the hotel lost my prepaid reservation, was only able to give me one night instead of two, made me sit in the lobby for two hours because my room wasn’t ready, could not get the air conditioning working in my room, and then billed me for two nights instead of one.

If that was the case I would conclude that my experience was awful, and I would go out of my way to let everyone know about it.

To those who want to argue that a hospital is not a hotel I will concede the point.  However, I will argue that for those who actually wish to significantly improve patient experience management that much of the improvement can be made by treating it as a hotel, and by treating your patients as guests.

For the time being, let us agree to have this discussion separate and apart from the Emergency department—we will address the ED in a later post.

The patient experience, which many claim to be managing, may be grouped into two parts—the treatment, and then everything else that happens to you from the time you schedule your visit to the time when you finish paying you bill.

Most patients fully expect their experience of their treatment will be very positive—that is why they came to the hospital.  Patients know that for treatable issues they will leave the hospital better than when they entered.  Therefore, it is a given that they will rate their treatment experience as a positive one.  A positive treatment is considered de rigueur.

However positive, the patient often views their treatment experience as the result of the procedure they underwent.  If they came in for their gall bladder and leave without their left leg, no amount of explaining how well the amputation went will convince them their experience was positive.

Both inpatients and outpatients spend the bulk of their time in the hospital undergoing non-patient experiences and suffering through ineffective and impersonal processes.  All patients spend most of their time simply as visitors, as customers, as guests of your facility.  Unfortunately, few hospitals spend much time improving those processes that are common to all patients.

To improve in the area of patient experience management, break the person’s experience into two categories; clinical and non-clinical.  While there is merit in reengineering the processes around a hip transplant, doing so does nothing for everyone who did not have a hip transplant.

Over the next several posts I will suggest what can be done to improve the non-clinical patient experience in a way that can change how people view your hospital.

Is this today’s evolving healthcare strategy?

Did the large provider healthcare model go from making all the ducks better to only making some of the ducks better?  Please let me know if the concept depicted below makes sense.


The Patient as Customer

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.