What Is Your Digital Healthcare Consumerism Score?

I was standing at a busy intersection clicking my heels and repeating the phrase “there’s no place like home.”

A young woman approached me and tapped me on my shoulder.  She had a Kim Jong Un wannabe haircut.  Her heavily tattooed legs were wrapped from her thighs to her ankles in cellophane, and she had more metal in and on her body than the Tin Man.  The cellophane confused me.  I thought she might be using it as a degaussing cloak to ward off alien magnetic rays.  She asked me if I was okay. I should have asked the same question of her. I learned later that cellophane is applied to people with new tattoos to prevent the tattoos from bleeding.)

“Are we in Oz?” I asked.

“No, we are in Los Angeles.” “Is there a difference?” I asked—I can be quick when I need to be.

Most of the major streets in L.A. have what appear to be three-foot natural grass putting greens embedded in the sidewalks.  But I never saw anyone practicing their putting.  I did, however, see several dogs use the greens.  I wondered how city dogs—dogs who have never seen real grass—knew that the putting greens were for them.

“I’m sensing you’re a man of few words,” she said.  “I only use the ones that are needed,” I told her.

“So, what do you do?” she enquired.  Thinking this conversation could take more time than I had, I replied “whatever it takes” and I left the scene.

Rule number 1: If you Google something and get no hits, whatever you Googled does not exist. I Googled “Healthcare Consumerism Score.”  Zero hits.

Rule number 2: Just because you get a hit when you Google something does not mean that what your search yielded has any value. I Googled “Healthcare Consumerism Index.” 1,030 hits.  950 of them from a single firm.  And those 950 hits offer 950 uninteresting ways of trying to make their survey data sound interesting. If you are interested in reading about cost and value spending—how they define consumerism—you should get a copy of their report.  Me? I’m waiting until they make it into a movie and stream it on Netflix.

And here is my issue.  Who is interested in cost and value spending?  Health systems and the feds; not consumers.  Consumerism without consumers is no better than a tuna sandwich without the tuna.

I’ve asked dozens of healthcare executives how they define consumerism.  They don’t.  I’ve asked those same executives how they measure the consumerism capabilities of their systems.  They can’t.

And so, I’ve created the Digital Healthcare Consumerism Index—DHCI.  The index measures one attribute.  What are the digital consumer capabilities of your health system, and if they exist, how good is the user-experience?

The DHCI measures eight specific digital consumer functions, plus a mobile-first rating and rating for user experience.  Your health system either provides the function, or it doesn’t—that keeps the math pretty simple.  In theory, the scores will range from zero t0 ten.  (But who am I kidding?  I have only come across one health system that scores above a five.)

In the artifice of healthcare consumerism, a fifty percent score puts you on the top of the food chain looking down on every other health system.  “We’re better than everyone else.”  Maybe it’s good enough to be the best of the worst.

In real world consumerism, the world in which your consumers and patients live, a fifty percent consumerism score has your health system looking up at such notable consumerism failures as RadioShack, Borders, and Sears.  Healthcare consumerism needs to improve significantly just to be good enough to meet the failure threshold achieved by Fortune 500 firms.

The digital consumerism mantra—bricks to clicks—is simple, but it is simple for a reason. It works.  The consulting firm McKinsey concluded that the greatest healthcare myth is that customers do not bring the same expectations about customer experience to healthcare that they do to other industries.

The phrase “I’ll know it when I see it” was used in 1964 by United States Supreme Court Justice Harold Potter in describing his threshold test for obscenity in Jacobellis v. Ohio.

Patients and consumers use the same metric when it comes to healthcare consumerism.  They’ll know it when they see it.  So far they haven’t seen it.


Customer Experience: Dumber Than A Bowl Of Lint

We’d both sleep easier if I told you that my posts are works of fiction.  Unfortunately, that is not the case. Everything you are about to read happened today.I

I am in Los Angeles for a few weeks. Returning to my hotel tonight I overheard the conversation four Parisians were having with the hotel’s concierge, a title that grossly overstated his authority.

They arrived at the hotel one day early.  No rooms available.  They asked to store their luggage while they tried to find another hotel.

The concierge, the bowl of lint replied as follows, and I quote, “We do not offer that service.  If you want to pay for a room for this evening, we can store your luggage.”

Be still my heart.  If you’ve been hanging out with the machinations of my mind for a while, you already know that Skippy’s words made my head feel like it was about to explode.

I had the right to remain silent.  But I did not have the ability.

The concierge had just crossed hospitality’s Maginot Line.

And so I said to the concierge, “You do not have an available room for them, but you are are proposing to charge them the price of the room, the the room that is not available, to store their luggage tonight.”  No wonder the French hate us.

I know Skippy did not invent this policy from whole cloth.  An executive defined the rules for Skippy–another bowl of lint.

The hotel, my hotel, has zero amenities.  It does not have an ice machine.  It does not even provide a coffee pot or a vending machine.

I told the Parisians they could store their luggage in my room–and being a devout capitalist, I offered to provide that service for a nominal fee–half of the price of the room for which they would have been charged by the hotel, plus a twenty dollar surcharge if their luggage required the use of the nonexistent ice machine.

Here’s my point.  Creating great customer experience is very simple.  Creating bad customer experience requires a lot of work. It requires failure at multiple decision points.  It requires that executives abdicate their responsibility.

Great customer experience is defined by four words–do the right thing.

Customer Experience Humor: Someone Had To Write About This

I am boarding a United flight to Los Angeles. Yesterday I watched the video of three airport security people pulling Dr. David Dao from his United flight—the world’s absolutely worst customer experience since god invented YouTube. More people have watched the video of Dr. Dao being drawn and quartered than the sum total all of the people who have ever flown on United.

Dr. Dao is now being treated by other doctors. United’s CEO being treated at a therapy center for former CEOs.  The CEO called the event ‘truly horrific.’  He won’t learn the meaning of the word ‘horrific’ until he sees how many people have viewed the video.  had there been no video of the mishap, United’s CEO would not have ever learned of the event.

United’s tagline used to be “We love to fly and it shows.” United’s new tagline e is “When we tell you to give up your seat we really mean it—‘move your bloomin’ arse’. (My Fair Lady).” (All of the punctuation in this paragraph probably wouldn’t pass muster with a third grade teacher. But I don’t write with the goal of teaching punctuation, and you don’t read my rants with the goal of learning punctuation. So, net-net, we’re good to go.)

Having watched the video of Dr. Dao, I wonder if it will be my turn today to make a video of me being dragged kicking and screaming from my United flight. Perhaps it’s my cynical nature, but I actually relish moments like these.

My understanding of the United debacle is as follows. Suppose that United, or any airline for that matter—they are equally bad, has a plane with 200 seats. The airline sells 210 tickets for the flight expecting that ten or more people wont show. Some MBA probably figured out that five percent of people don’t show up for any given flight. However, when the MBA is wrong, there is a problem.

And here’s the key point; it’s not the airline’s problem; it’s the passengers’ problem. Ten people—and here’s the part I do not understand—people who are already seated, people who got to the gate on time, have to leave to make room for the other ten people who arrived late.

MBA rule 101—first come first served—does not apply to airlines. At United, it does not even apply for doctors. Apparently, people without seats are more important than the people who have seats—Airline Customer Experience Training, Session 3, day 2. Seated passengers must be inconvenienced so that the people without seats won’t be.

This disaster did not happen by accident.  The people who assaulted the doctor followed a procedure.  A formal procedure.  A procedure defined and approved by people who still work for United.  Management.  People were paid to create that policy.  You and I on our worst days could not dream up something this onerous.  Page 142, subparagraph 2:

  • Wait until all of the passengers are seated
  • Search the manifest to see if any of the passengers is a physician
  • Upon finding a physician, contact airport security and drag the doctor from the plane
  • If the doctor has already been given a bag of stale peanuts, make sure to retrieve the peanuts and return them to the galley–since the doctor will not be on the flight he is not entitled to the peanuts

Airlines work hard to create an abysmal customer experience. Customer experience this bad doesn’t happen by accident. It requires years of dedication by executives who have exceeded the Peter Principle so many times that Peter’s dog was a puppy when the executives started to believe their own PR. Airlines are looking up at the bottom of the customer experience threshold and there is no light in the tunnel.

The best thing about a no good, very bad, awful experience is that many of those experiences can live on in perpetuity via YouTube.

Unfortunately, bad healthcare experiences never see the light of day. They never become viral. You simply own it. If your attempt to contact your provider or payer by phone is disastrous, you cannot video your call. If you get to their website and your needs are not met, you cannot video that experience.

And that is a the reason that healthcare customer care is such a disaster. The payers and providers never learn how bad their customer service is. They just keep right on doing what they’ve always done.

The only good news is that “Your call may be recorded for quality purposes.”

Well, I am still on the plane and I have lived to fight another day. 🙂

Untucked Shirts & Customer Experience

I happen to believe that there is no ‘I’ in innovation. Webster differs with me.  People with small minds believe there is only one way to spell a word—when you have a blog, you can spell words however you want.

Those same non-believers say, ‘There is no ‘I’ in team. There is, however, a ‘me’ if you use the ‘m’ and the ‘e’.

One of the commercials on television is the guy who claims to have invented the ‘untucked shirt.”  My children invented ‘untucked shirts’ well before the Untucked-Shirt-Guy laid claim to inventing them.  Everyone one who has worn a shirt figured out how to wear the shirt without tucking it into their pants. Mr. Untuck did not invent or innovate anything.

Untucked shirts are no more innovative than charging people for a bottle of water.

People and firms, that claim to be innovative, those of the great unwashed, the bourgeoisie, have little understanding of what constitutes innovation.

Nobody invented untucked shirts.

Likewise, nobody invented customer experience.

Customer experience has been around since the time a caveman bartered a fish with another caveman for a Sony Walkman.  Their experiences were either good or they were not.

Customer experience has declined ever since.  It has become so poor that we are pleased even when we have a marginal experience.  We are grateful simply because the experience wasn’t worse.  We have been trained to feel like firms are doing us a favor for simply doing what we ask of them.

What customer experience has in common with untucked shirts is that neither were invented and neither have been innovated.

Traffic Lights, Hammers & Sears

At some point,  the obvious should be obvious.  Or not.

I’ll keep this post short because the point does not take a lot of words to express.

Traffic lights.  A perfect design.  A design that has not been changed in more than fifty years.  Around the world.  Whether you are driving in the U.S., China—Gyna, South Africa, or Bosnia, when someone comes to a traffic light they know what to do.  RED—stop.  YELLOW—prepare to stop.  GREEN—go.  When you get your driving learner’s permit, you are not given a manual that explains traffic lights.

Even in third world countries, countries with no understanding of human-centered-design, its people know the meaning of red, yellow, and green.  A simple design.  No one who comes to a traffic light is confused.  They know what to do and they know when to do it.

Hammers.  Another perfect design.  A design that has not been changed since it was designed.  Like traffic lights, everyone knows the purpose of a hammer.  There are no manuals explaining how to use a hammer.  People who have never seen a hammer know how to use it.  Nobody mistakes a hammer for a fork.  Nobody uses a hammer’s handle to pound a nail.

Think retail: Sears, RadioShack, and Staples.  Retail chains with no idea how to transition from brick and mortar to hammers and traffic lights.  Nicely designed stores.  Aisles with plenty of room.  Good lighting.  Knowledgeable sales people.  A business model from the 1950’s.

Companies that could not spell digital if they were hit over the head with ones and zeroes.

Customers knocked on their doors only to discover that their lights were on but nobody was home.

Healthcare.  Providers. Payers. They are neither hammers nor traffic lights.

Netflix, Amazon, and CVS transitioned their business model from hammers and traffic lights to one that meets how their customers want to interact with them.  Sears, RadioShack, and Staples did not.

Pick your favorite healthcare firm.  How do they relate to a digital business model?  How do they relate to what their customers demand?

They don’t.

Healthcare’s Lipstick on a Goldfish

Had I titled this post ‘Lipstick on a Pig,’ you may have skipped it thinking it was a bit too much Sarah Palin and not enough healthcare.  Hence, ‘Lipstick on a goldfish.’  Besides, I found it amusing wondering how one gets a goldfish to stay still long enough to apply the lipstick.

Sticking with the pig theme, Winston Churchill, Mr. Prime Minister to those of us who had a less formal relationship with the man—those who were decades away from the zygote phase of our lives, stated, ‘I am fond of pigs.  Dogs look up to us.  Cats look down at us.  Pigs treat us as equals.”

Knowing that, I dedicate myself each day to be a better pig (or fish).  Having realized that dedicating myself once a day was not yielding the results for which I aspired, I commenced to rededicating myself twice a day.  Having rededicated myself twice a day, I wrestled the pig to the ground and schmeared on Katy Kat Pearl Lipstick.


For more than a decade I have been running on a trail along a river.  During that same decade, weather permitting, I always encountered two groups of individuals; cyclists and fly fishermen.  And for more than a decade, there was a singular constant.  Both groups dressed the part of their respective sports.

The fishermen—I could have written the fishermen or the fisherwomen, but by now you know I have little patience when it comes to appeasing those who are politically correct. The people standing in the river are dressed like they had bought every possible fishing accessory from Orvis.  Neoprene waders, a fly-fishing vest—one with enough pockets to resemble the type of vest a war photographer in Falluja wore, a Filson Parker Hat, and a Wetfly wooden catch and release net.

The cyclists also dressed the part.  They dressed as though they were competing in the Tour de France—expensive cycling shoes, and cycling jerseys and pants festooned with labels of manufacturers of different cycling products.  Had I bothered to look closer, I am certain I would have noticed that many of them had shaved their legs to streamline their ride.

During that decade, I never saw a single fishing-person—my attempt to be gender neutral—catch a single fish.  Also, I never saw a cyclist who looked like he or she would be competitive in a cycling time-trial.

It is almost as though their mindset is that if they dress the part, good things will happen.  Lipstick on a goldfish—or is it goldfishes?

Dressing it up does not yield favorable results.

Paul, where are you going with this, you may ask.

Fair enough.

Payers and providers have websites.  Some have as many as a thousand URLs.  And like it or not, from a patient’s or member’s or customer’s perspective, those websites have no more value than lipstick on a pig or on whatever may be your favorite animal.

The people who created those websites—I thought about using the word ‘designed’ instead of the word ‘created’—never spoke with a patient, member, or customer.

More often than not, those websites are nothing more than a joint effort of your marketing and IT departments.  The websites are pretty.  They have hundreds of clickable links.  They have dozens of phone numbers.

From the perspective of your patients, members, and customers, those websites are a waste of digital 1’s and 0’s. They look important.  They look useful.  But they provide nothing of value to the people who go to the site.  Healthcare websites have no more value to your customers than the outfits I saw that were worn by the people I passed who are fishing and biking.

Lipstick on a pig, a goldfish, or an armadillo.

Dressing it up does not deliver results.



Why Is Customer Experience Like Deck Furniture?

Sometimes there is value pointing out the obvious; or not. An analyst on CNN was updating the story about the missing Malaysian plane. He explained why it had been so difficult to locate the plane. “Light objects float, and heavy objects sink, and a plane is heavy.”  Physics for librarians–the evolution of the lizard brain.

Years ago, because of the lizard brain, the government decided that important decisions, decisions like launching nuclear weapons, the responsibility had to be shared between two people.  That is why two thumbs are required on two launch buttons.  I do not know how things are in your home, but in ours, for important decisions about things like deck furniture, there is only one launch button, and I do not have a user-ID.

Twice a year, in early spring and late fall, my wife and I do the lizard brain dance, and we do it regarding our deck furniture. I am the lizard. She is the brain.  The spring deck furniture dance is more difficult than the fall dance because our metal deck furniture has been hibernating downstairs in the basement all winter; metal brown bears do the same thing.

Then, when our metal furniture awakens from its hibernation, it has to be carried by hand, by the husband, from the basement, up enough stairs to make me wish I had installed an elevator, to the deck—the deck that was just power washed by said husband.  By now I am wishing that snow still covered our deck.  My lizard brain tried to explain that it wanted to watch the NCAA tournament.  The lizard lost.  I plodded along like a trained pachyderm, a number of pieces of our deck furniture raised over my head.

I was waiting for my neighborhood friends, guys like me, to set up lawn their chairs and watch the trained lizard carrying its furniture, but then it occurred to me that they were either hiding from their spouses or they were having their own deck furniture parades.

Our metal outdoor deck furniture is unlike any other deck furniture.  Unlike others in that, according to my wife, our outdoor furniture was not built to live outdoors. Not in the winter, and not in the rain.  The chairs and cushions were extruded from some unidentified man-made material whose half-life probably exceeds that of the fruitcake my grandmother made when I was twelve, but if said furniture gets wet it may do a Wicked Witch of the West and melt.

Even so, with April being the month of showers, I know I will be hauling in the cushions, the same cushions that I had just hauled outside, back inside the first time we see a cloud drift overhead.

“They don’t melt,” I tell her.

“Are we missing a cushion?” She asks.

“No, I’ve been soaking one in the guest bathtub all winter.  It looks good as new,” I tell her.

“That is not the same as leaving it out in the rain.” So much for trying to make a point.

So, how do we tie this into something that hopefully makes this few minutes worthwhile for you?  What would your patient experience have to look like in order for you health system not to have to apologize for it?

I think when it comes to assessing patient experience many hospitals think that when their patients are not in the hospital their patients are hibernating safely and soundly and without a care in the world.  Like deck furniture.

That assumption makes it worth asking the question, what do hibernating patients do?  Often they call the hospital.  They want access.  And how is access defined? A patient tries to schedule an appointment or a lab. A patient needs a refill.  Or he or she has a complication from a medication or a procedure.  Or, they simply need to complete a business task like setting up a payment plan.

Here is why something as simple as being able to successfully answer a patient’s call is that patient’s first healthcare experience for many people.  And guess what? If we cannot answer that call it does not matter how noisy your hospital is because those callers will never hear the noise.  They will do one of two things, neither of which are good.  They will choose a hospital which can answer their phones, or they will go to ED. Oh, and they will tell others.

A colleague was receiving chemotherapy at a top US cancer hospital.  She spent three hours on the phone trying to schedule an appointment.  Now she spends her hibernation telling others not to go to that hospital.  Hospitals cannot put that toothpaste back into the tube.

By the way, when they found the debris from the missing Malaysian airliner, they found a seat cushion.  That cushion survived a fiery explosion at thirty-thousand feet and had spent six months floating in seawater.  This fall I will point that out to my wife just as soon as I finish carrying my deck furniture back to the basement to begin its hibernation.