Why Is Healthcare Like Kittens Playing With Matches?

Obama Care, Trump Care, Who Cares?

As I dyed-in-the-wool, right-of-right conservative, I cannot believe I am writing this.

Sometimes, if it is broke, don’t fix it.  Especially when it comes to healthcare reform.  Obama Care.  People who can’t afford healthcare get healthcare.  Trump Care.  People with healthcare lose it unless they pay a lot more.  George Bernard Shaw said, “A government that robs Peter to pay Paul can always depend on the support of Paul.”  Given enough time, when this line of thinking is applied to healthcare reform either Peter or Paul dies because he no longer has insurance.

Everyone in Congress has exceeded their level of competency by a lot.  A whole lot.  Guilty of operating without a hall pass.  Two rules should guide societies:

  • Kittens should not be allowed to play with matches
  • Congress should not be allowed to play with healthcare

Under the plans of both parties, the definition of patient-centric has gone from patient-centric care to patient-centric cost.  While pre-Obama was less than perfect, it sort of worked, even though it teetered on its edge.  It reminds me of the game, Jenga.  Jenga is the game where players take turns removing wooden blocks, one block at a time, from a tower of fifty-four blocks.  The more blocks that are removed, the weaker the tower becomes.

According to many, the old healthcare model had reached the point that when the next block was removed the tower would collapse.  Under Obama Care and Trump Care, it looks like both initiatives tried to fix a tower while it was collapsing.  We, you and me we, should have required our Congressional representatives to practice with wooden blocks before they practiced their wizardry on one-third of our economy.

The Democrats clicked their heels together three times and approved a bill that none of them read.  The Republicans borrowed the Democrats’ shoes and approved a bill that took less time to write than it takes to mow your lawn.  Patient-centric became party-centric.

So, just how screwed up is the plan my team submitted?  You only need to know two facts about the Republican plan to understand what a complete failure they’ve put forth:

  • One of every six people in the U.S. is sixty-seven or older
  • Under their plan, the annual cost of healthcare for someone sixty-seven or older, whose income is more than $27,000, will be $13,000—roughly fifty cents of every dollar
  • (The Republican plan’s underpinning unwittingly seems to stem from a line in Charles Dickens’s A Christmas Carol. “If they would rather die,” said Scrooge, “they had better do it, and decrease the surplus population.”  The Republicans were not so crass as to say let those people sixty-seven and older die, but a plan with such high costs will go a long way to decreasing the percentage of people sixty-seven or older.  Surplus population 101.)

While both political parties worked to fix what appears to be an insoluble problem, they did so without accounting for the only people who mattered: patients.  The impact of the party’s actions has landed on those who are the least capable of adapting to those actions—patients.

My idea?  Since the Russians are so tight with many of our elected officials, perhaps we should ask the Russians to fix our healthcare mess, or at least ask them to do their best to divert Congress’s focus away from healthcare.  What we had may not have been great, but like democracy .

If A Customer Falls In The Woods…

A man who works at a manufacturing plant that makes items for hardware stores is suspected of stealing from his employer.  Because he is under suspicion, each night he when leaves the plant, the guards search him and the wheelbarrow he is pushing.  In the wheelbarrow is always his lunchbox, thermos, hardhat, safety glasses, and overalls.  They never discovered any stolen property.

It never occurred to the guards that the man was stealing wheelbarrows—sometimes the answer is too obvious.

Customer experience is a bear.  Sometimes you eat the bear.  Sometimes the bear eats you.  If Comcast’s or Verizon’s customer service people went on strike, would anybody notice?  Sort of like the question, if a tree fell in the woods, and nobody was there, would it make a sound.

The front page banner on a recent issue of Men’s Health Magazine read, “Tons of useful stuff.”

In healthcare, none of the provider or payer websites or apps can even brag, “Here’s a half-dozen things that may be useful.”  To be even more accurate, the only four semi-useful things I’ve found on healthcare websites are:

  • Pay your bill
  • Find a doctor
  • Request an appointment
  • Contact us

A pretty lackluster set of functionality.

Your website may look pretty, but so does Monet’s painting Sunflowers.  The thing is, you can’t schedule an appointment with either of them, so pretty isn’t worth much.  If you’re confused, that’s okay, I’m not.

Patients and customers can find a cloud in each of what your health system believes are its silver linings.

Fish Lips Versus Customer Experience

Television commercial: “I’m not a bank guard, I’m just a bank monitor.”

Seattle fact: “I’m not a suspect, I’m a community member.”

One news story this morning got my attention in spades.  It confirmed for me that the PC police have absolutely lost their collective minds. Being politically correct has become politically incorrect.  In wan announced yesterday that Seattle’s Chief of Police decided that it would be more politically correct to no longer use the term suspects.  From now on his officers will refer to suspects as community members.  For example, in the process of robbing the bank, a community member took nine people (other community members?) hostage and wounded two officers during a shootout. The police cornered an armed community member and released him.  When a local television reporter asked the police officer why he did not arrest the bloodied man holding the pistol, the officer replied, “because he is not a suspect.”

All the current talk about Russia makes me nostalgic for the days when the USSR—that’s pre-and post-Russia for those of you who weren’t alive when people had to walk to their televisions to change the channel, invaded countries each time there was a full moon.

For the theologians among us, a popular question is, why do bad things happen to good people?

That question is as unanswerable as the question, why don’t fish have lips?

The same question applies to healthcare customer experience.  Not the fish-lip question.  The bad things.  To be frank, I am rarely asked to sit at the big people’s table.

When I ask this question of people who think who think they can answer it I go into full Yosemite Sam mode. They look at me like they just spotted a flying saucer out the room’s window.  I tell them I would have flown in but my cape is at the dry cleaners.

“What are you, a male witch?” They asked. “There are no male witches.  If you ever watched the television show Bewitched you would know that the correct term is a warlock.” I gave them an eye role that would have scored a ten at the Olympics.

A lot of my meetings make me feel like I am trying to reason with the tinfoil hat crowd. They want to take me down the rabbit hole while they cozy up to the Queen of Hearts.  I was never very good at playing hearts.  If there’s an elephant in the room, you don’t need to look around trying to figure out who brought it in.  I did.

So, why do bad things happen to patients and customers who are simply trying to manage their care and wellness?

Health systems, like other industries, are good at creating advisory committees.  Buy donuts and coffee and ponder the fish lips question.  Study the question like an anthropologist on Easter Island.  Advisory committees, rarely come up with actionable advice.  If Columbus had an advisory committee, he would still be at the dock.

I’ve tried to reason with those committees but it’s like trying to turn the Titanic in a narrow stream.  The only way to turn it around, I tell them, is to cut off the head of the boat.  I may be able to help them change directions, but only after­ they hit the iceberg.

Most health system websites have what looks like a friendly box for visitors to contact us.  The friendly box replies to the user’s input that someone will reply to them within two to three days.  In two to three days, that user could have had a stent inserted and been discharged, delivered a baby and been discharged, recovered from Ebola, founded a multibillion-dollar tech firm, solved the question about fish lips, and been elected president of the U.S.

Doing anything in two to three days, while it may seem user-friendly to whomever in marketing or IT designed it, is a user disaster.  A lot can happen in two to three days.  But none of it will happen in your health system.

Consumerism Strategy: Quit Doing What You Are Doing

When people speak of the personal experience Disney gives its customers, some refer to it as daunting.

There’s daunting.  And then there is every other firm.  If your health system isn’t named Disney, your customers probably use the word daunting when they describe how difficult the challenge is to do business with it.

Healthcare’s first point of consumerism failure is that it does not offer a personal experience to any of its patients or customers.  Healthcare’s one size fits all approach does not fit anyone. A mass-produced healthcare experience does not work with

Disney did not add a new ride to create a better experience.  Why? Because it knew that a new ride would only improve its list of rides.  Instead, Disney focused on everyone who enters the park.  Since most of Disney’s theme park customers visit multiple parks, their digital strategy makes the whole experience prior to and after visiting a theme park a breeze. Simply adding another MRI to a health system does not improve patient or customer experience, it simply adds another tool.

In an over-competitive and commoditized market, health systems that choose to design customized and personalized experiences will acquire and retain patients and customers, and increase satisfaction.  To do that, health systems must create digital experiences that are useful, different, and convenient.

For a digital strategy to be effective, it must create value for customers that extends beyond just the service offered. Websites are a good place to present information. Mobile provides convenience. To be patient and customer-centric, your overall digital strategy should focus on your patients and customers, not on your company.

Here are three components for creating a winning digital strategy:

  • Define why you are in business, why are you helping customers
  • Build your strategy around answering the why, focused on bringing value to your customers instead of it being centered on meeting company objectives
  • Make sure every business decision adds value to your customers. If it doesn’t, rethink the decision.

There is one component for creating a failing strategy:

  • Keep doing what you are doing

Customer Experience: Please See The Attendant

Had the senator-elect driving the black, BMW 7-series known he would be killed before he reached his home in the tony neighborhood of McLean, Virginia, he might have driven a different route. That is the opening sentence of my new novel. I thought about tweeting each sentence as I write it in case any of you wanted to read it.  Freud said nobody is remembered for being normal.  Maybe I am securing my legacy one blog at a time.

Please see the attendant. That was the text displayed on the gas pump’s LED screen.  There was probably a time in my life when I might have considered complying with those instructions, but since I am not a very compliant person, I doubt I would have heeded that directive.  I studied the screen looking for a way to reply—I have money and if you want it, you come see me. That option was not available to me.  And so, I was left with a choice, walk ten feet and see the attendant, or get in my car and drive three miles to the closest gas station.

I had a pleasant three-mile drive.

Great customer experience is so much easier to achieve than companies make it out to be. If you are at all like me, plus or minus a comprehensive psychological evaluation, you don’t suffer fools gladly.  It is important to make a distinction between those delivering the poor experience and those who created the poor experience. Person A is simply a victim.  Person B is the overpaid mastermind who created the experience.

People with whom you are interacting are just following procedures.  Rules.  More often than not, bad rules.  Rules designed to save the offending company a nickel.  When we are affronted by those rules, we know how inane the rules are. We scream silent epitaphs (sic) at the rules. And then we create those same affronting rules for whatever company at which we are employed.

It is possible, albeit improbable, to think in terms of what is best for our customers.  Instead, senior decision makers, after multiple meetings to figure out what is best for the company, come up with rules that ignore the company’s customers.

What most firm’s executives don’t consider are the expectations of their customers.  Customer expectations are not considered because nobody bothered to ask. As a result, the first thing firms do to deal with customer interactions is to build a call center.  Customers call us.  We should build a large room, buy a bunch of phones, and hire a bunch of people to answer customer calls.

You don’t want to call any company you do business with.  Neither do your customers.

So why make them?


Patient Experience & The Sharpshooter’s Fallacy

Picture yourself standing in a field with someone else, standing a hundred feet from a barn.  The person next to you raises a rifle and takes dozens of shots at the side of the barn.

Afterward, he walks up to the side of the barn where he was shooting and draws a target on the barn’s wall centered on the area where the best cluster of his shots impacted the barn’s wall. Now, instead of a random scattering of shots on a barn wall, the shots are associated with a target.  They have a purpose.

Their differences are ignored and their similarities are stressed.

Looking at data in this way is called the Texas Sharpshooter’s Fallacy.  It is a clustering illusion, a tendency in human cognition to invent a correlation when in fact, the correlation does not exist.  This fallacy is how many experts interpret Nostradamus’ musings.

Today, the Sharpshooter Fallacy is often used, albeit inadvertently, to explain away business problems.  In healthcare, the fallacy is used to justify a health system’s efforts to improve consumerism and patient experience.

Patients and consumers need to interact with their provider.  To try to meet their needs they go online and they call their health system.  Their calls and their use of the Internet are perceived by their health system as rifle shots at a barn door.

The data tells the health system that patients are calling and going online.  By creating a call center and a website the health system thinks it has designed a solution to fix what it perceives as its problem.  The health system draws a target around the cluster of shots believing it has developed a solution to the problem.

They system’s fallacy is characterized by a lack of a specific hypothesis prior to gathering the data.  People call.  Therefore, we should build a big room, buy a bunch of phones, and hire a bunch of people, and we will have solved the problem.  They solved the problem without ever understanding the problem.

The solution to improving patient and customer experience is not answering phone calls.  The solution comes from understanding why people are calling.


Can Puppies & Crayons Improve Patient Experience?

Judging by the coddling elite colleges are providing to the students, the world must have gotten a lot more stressful than it was when I was a student.

After Trump’s election, ‘safe rooms’ were created on Ivy League campuses.  The purpose of those rooms was to give traumatized students the opportunity to overcome their gossamer cases of PTSD.  Cases of mental trauma were devouring students faster than the Bubonic Plague devoured the citizens of Europe.  The safe rooms were equipped with puppies and crayons.  Classes were canceled and exams were postponed. (Just writing about this is making me feel more cathartic.)

This week Harvard announced that it eliminated the fifty-cent a month fine for students who have overdue library books.  Why?  To relieve the stress of its students.  Henry Kissinger, Bill Gates, and FDR, attended Harvard. I can only wonder how much more they would have contributed to mankind had their minds not been so traumatized by the fines they had to pay for their overdue books.

The world became more stressful but nobody notified me.  We got a puppy last month—not because we were stressed; we just thought she was cute.  Maybe I should buy a box of crayons for her.

Bad patient experiences cause a lot of stress.  Patients who do not pay their bills on time are fined.  Maybe hospitals should eliminate overdue payment fines.  Maybe hospitals should build ‘safe rooms’ for patients.  They could put crayons and puppies in the rooms.