(This missive is somewhat long—this is where my mind goes when I run.)

Ever watch the show “This old House”? Something magical happens to a man when he watches somebody single-handedly rebuild a 6,000 year old home in a 30 minute program. After that no task seems too complex. As a normal male the first rule of thumb is to remember that having a master’s degree from a reputable university qualifies you for about anything short of brain surgery. The true Type A will often carry that step further by reminding himself that given another week or two of study that even neurosurgery would not be that difficult.

I did a project in one of my prior homes. It involved the simple task of rearranging bedroom furniture one Sunday afternoon; 15 minute project, total cost—nothing. After all, how difficult could that be? The truth is the actual moving of furniture involved nothing more than I’d planned. Only when I thought I was done did I notice that the television set was now located a good 20 feet away from the cable television outlet. The obvious solution would be to simply move the furniture back to its original position.

Can’t do that. To move the furniture back to the original position is either admitting defeat, or admitting I wasn’t bright enough to realize that the cable outlet and the television would be on opposite ends of the planet by the time I finished. Besides, my wife had already seen the new arrangement and if I moved it back to its original position I would have to explain why.

So when she enters the room and asks why (and she will ask why—that’s her job) there is now a 25 foot piece of black coaxial cable snaking its way diagonally across her bedroom carpeting I had better be prepared to answer. Sometimes if you’re quick, real quick, you can try and bluff your way around the problem with a technical answer. You can try and explain that all of the static electricity that was created by sliding furniture across the carpet has caused the sonic membrane surrounding the fiber optical transponders in the coax to be 6 ohms off the medium allowable temperature variation for the building codes in your neighborhood. It is called stalling, allowing for a brief period of self-correction.

The truth, having failed me, the only other option left was to try something close to the truth. I’m forced to say I knew the cable would be at opposite ends of the room before I moved the furniture. My plan all along was to call the cable company and ask them to come to the house to install another outlet on the correct wall.

It’s my wife’s job to inquire how much it will cost—she did not fail me.  This is a clear case of me answering her question without bothering to think. It is important to have a clear understanding of the underlying issues before trying to resolve the problem. I mentioned it should cost forty dollars, and we will only need to leave the cable strewn across her bedroom floor for a few days. It’s then her job to say if we put the furniture back where it was we can solve both problems in twenty minutes. Besides, the cable technician left a mess the last time they did some work, and she wasn’t going to spend more money for poor service. Stay with me here, this is how it becomes her fault, and how it relates to the topic of Patient Experience Management (PEM).

Once her issues were out in the open was a simple matter to devise a solution to address them.  The solution needed to be implemented quickly and it needed to be free. My answer came quickly—too quickly. Eighty percent of the problem could be handled by simply running the cable along the floor board, and then under the bed. That only left five feet of cable between me and a happy marriage. Unfortunately, the five feet in question is from the foot of the bed to the television and runs across the major walkway of the room, looking all the while like an undernourished blacksnake.  Did I mention she hates snakes?

Undaunted, I asked for a little assistance to move the bed. This accomplished, I headed for the garage to find exactly the proper tools for the proper job. I returned five minutes later, tools in hand. I was surprised to see the look of dismay on her face. As it turns out, her dismay resulted from the razor blade knife clutched in my hand. After twenty minutes of the best Boolean logic I could muster, I convinced her, or at least myself, that it would be a simple matter to cut a small hole in the carpet and force the cable underneath. After all, the bed would hide the hole.

The only other tool I thought I would require was a roll of duct tape and a 4’11″ broom handle.  Women know we are confused about how to proceed the moment they see men rely on the duct tape gene. Most men, when cornered believe enough duct tape, properly applied, can serve as a panacea for anything up to and including world hunger.

You’ll note I specified the exact length of the broom handle. It’s only after having attempted the project that I’m able to relate the length of the handle. Most men on a project, especially those being watched by their wife, wouldn’t bother to measure a length any more than they would ask directions while driving across Borneo with half a tank of gas.

As it turns out, I should’ve measured both the distance the cable had to travel under the carpet and the length of the broom handle prior to taping the cable to the handle and shoving a 4’11″ broom handle under a five-foot expanse of wall-to-wall carpet. The fact the carpeting was wall-to-wall is key to understanding what lay ahead. Let’s make certain the situation is spelled out clearly; the new carpet in our new home had a hole in it, a broom handle was now nicely buried under the carpet, and my wife was perched on top of the bed like one of Macbeth’s three witches waiting to see what I would do next.

Walking to the wall and grasping the carpet as best I could, I pulled up a good 10 feet of it from the tacking, acting all the while like I would have to have done that even had the handle not been one inch too short. Leaning with my one arm on the newly exposed carpet tacks, I solicited help in excising the handle from beneath the rug. That accomplished, and dying the death of a thousand cuts, I looked for another proper tool to complete the task. Walking through the kitchen to the garage I spent a moment wondering if the proper tool could be found in the kitchen. Naturally, it was—one half of a pair of chopsticks or, as it’s now referred to in technical terms, a broom handle extender.

Five minutes later, the broom handle extender and cable was firmly duct taped to the broom handle and once again shoved under the carpet. They both went in, but no cable came out the other side. So, I pulled the handle back out and surveyed the situation. The situation, as it turns out, was that in my hand was a perfectly good broom handle, a piece of coaxial cable, and no broom handle extender. The extender was now smack dab in the middle of the 5 foot expanse I was trying to cross, the problem being it was on the wrong side of the carpet, the underneath side. It was positioned perfectly. It was too far under to be reached from either end. In other words, the chop stick just became a permanent fixture in our bedroom.

Certainly, one small chopstick hidden beneath four hundred square feet of carpeting was not a big problem to me. It was not a problem unless you happen to be walking barefoot across the carpet and you happen not to be the one who put it there.  It became not unlike the fable The Princes and the Pea, and my princes found it immediately. In the fable, it was the princes could not sleep. In my case, I knew the non-sleeper in the story would be me for as long as the chopstick remained under the carpet.  Keeping my eyes focused firmly on the task at hand, I foolishly believed if I could resolve the cable problem, the matter of the chopstick would resolve itself.

One final trip to the garage led me to return with a second broom handle. The peanut gallery looked on in disbelief in my ability to finish what I had started without having to sell the house at a loss before I was through. The “I told you so’s” were being thought through in most of the major dialects of the Western Hemisphere.

This had ceased to be a project—it was now a quest, no lesser than that of the Holy Grail. A mile of duct tape later, both broom handles were firmly attached to one another. Even if I destroyed every square foot of carpeting in the house, I would not lose this broom handle under the carpet.  A minute later the cable emerged exactly where it should have, on the other side of the room.  I pulled the out broom handle, attached the cable and turned on the television. Everything worked, just as I had known it would.

Standing in front of the television, admiring my work in the new room arrangement, I noticed I was now a good foot taller than when I began the project. Was this an illusion brought about by my success?  As was quickly pointed out by my princess, my enhanced stature was more attributable to the fact that all of the carpet padding that used to lie between the end of the bed and the wall was now nicely compacted into a ball.  The ball of padding was located in the same twilight zone the chopstick found, right in the middle of the walkway. Trying to correct the problem only made it worse. Each time I prodded the ball of padding with the broom handle it grew larger underfoot. Within minutes it looked as though I had managed to suck up every inch of padding from every room in the house and placed it between my wife and a good night’s sleep. Resorting to logic once again, I quickly pointed out that she should walk on it because she would no longer be bothered by feeling the chopstick underfoot.

The next day I was on the phone scheduling an appointment with the carpet installation service. The carpet installer had to pull up most of the carpeting in the bedroom to be able to reach what she had affectionately labeled Chopstick Hill. I watched him work and I learned all about carpet padding and the installation of hardwood floors. He explained it was lucky for me that he came over because our padding was not good quality padding and we would not have known that had he not pulled up the carpet. I asked him why, if we would not have known about the padding, we would want to spend $300 for new padding. Without responding, he just kept slamming his knee in the carpet installer, charging one hundred dollars for his efforts and my education.

I was so impressed with his discussion of hardwood floors I almost bought one on the spot to surprise my wife. By now, we both know she wouldn’t have appreciated the surprise. Anybody who did not want to spend forty dollars on the cable repairman would probably have a little more trouble accepting five thousand dollars for a new floor.

However, I walked around with a silent smirk on my face for days knowing had we done it my way from the start, called the cable man, we could’ve saved the hundred dollars and never put a hole in the carpet.

This is what can happen when your patients decide to bypass your customer service because of prior bad experiences they have had trying to solve a problem.  It usually comes down to process, bad process.  Processes are a lot easier to fix than disappointed patients, and when you disappoint them too often they go to the ED–no appointment needed, no copay, and a great way for them to get their scripts refilled.

It would have been a lot cheaper to the hospital to have just done what the patient needed when they called the hospital or their physician, but many, many hospitals can’t seem to do that.

There is a strong relationship between HIT and population health management.  This relationship is even more critical because of all of the spend in HIT, spend whose ROI doesn’t always jump out at the C-Suite.

A component of HIT that should be included is based upon the fact that without being successful at Patient Health Management, Population Health Management will not be successful.  If synergy—1 + 1 is greater than 2—ever had a place to call home, this would be one of those places.

For the population to become healthier, the individuals that comprise the population—the patients—must become healthier.  This is not a chicken-and-egg premise.  It must start with and be driven by making the people healthier.

One way to make healthier people is to get them more involved in their healthcare is by finding ways to get them more involved in their health.  And one way to do that is to facilitate that process by making it easier for them to manage their health and to do business with their providers.

Perhaps the simplest way for people to do that is through a customer portal, something most providers do not have.  A customer portal is very different from a patient portal.  A customer portal provides 2-way interaction between the hospital—think PCPs, specialists, labs, therapy, and wellness programs—and patients—think inpatients, outpatients, discharged patients, and prospective patients.

A customer portal doesn’t just let the hospital feed people information they think patients need to know—like the hours of operation of the gift shop—but allows patients to feed the hospital information, and it allows patients to accomplish processes.

Remember those questions on the SAT; If A is to B then C is to ‘X’.  You had to pick the right answer for X which was most like C.  Band-Aid is to hospital, as your hospital’s current website to a customer portal.

A well designed customer portal will improve patient access, education, outcomes, and the overall health of those patients who make up that population.

I took a week off from blogging to refill the jars in which I store my adjectives and metaphors, and to see if I might learn how to make my segues read more naturally.

I read a study in which Forester Consulting concluded that 89% of workers to deal with customers—if it makes you more comfortable go ahead and substitute the word patients—reported that those workers weren’t able to meet the expectations of those customers.

Let’s pause for a second to reflect on the business impact of that finding.

Now let us consider someone who is a patient.  As an example, someone with a chronic disease.  That person may have been an inpatient a few times over the years.  During the time when that person wasn’t an inpatient they were also someone who several times each year interfaced with the hospital, making appointments, scheduling labs or therapy, requesting refills or copies of their medical records, or trying to make sense of their bills.

Now what if when that same someone tried to interface with the hospital, the workers trying to serve the person weren’t able to meet that person’s expectations 89% of the time?  What if eighty-nine percent of the time when the patient tried to make appointments, schedule labs or therapy, request refills or copies of their medical records, or tried to make sense of their bills it didn’t happen?  What kind of experience did they have if they were put on hold or their call was transferred or they had to call back?  What if they felt the only way to get their expectations met they had to go to ED or they chose to go to another provider?

The thing is the vast majority of hospitals do not know if their employees are meeting the expectations of their patients.  They do not know because they do not observe, measure, or ask patients about those interactions.

Those types of interactions were never designed, they have just sort of evolved over time.

Hospitals look at patient experience through the monocle of HCAHPS.  If hospitals could reduce the noise in the corridors one decibel by placing rubber bumpers on the Jell-O on the food carts the rubber bumper manufacturers would be sitting pretty.

Now what if hospitals placed the same emphasis on the other enterprise-wide experiences their patients encountered?  What if every time a patient tried to schedule an appointment, a lab, or therapy they were able to do so during their first attempt?  What if they could get a refill one hundred percent of the time they needed one?

What if a hospital chose to Design each of those experiences?  What then would patient experience look like?

Can people do business with your hospital and why is that important? It seems these questions are easy enough question to answer, but how do you know the answers if you have never watched people trying to do business with your hospital?

Permit me to offer an illustration.  I dropped my phone and shattered the screen, broke the touchpad and the LCD.

He was my plan of attack. I called Verizon, my provider.  Verizon values customers at between five thousand and ten thousand dollars depending on the total number of services each subscriber has.  Figuring I was valuable to them, it occurred to me that they would want to help me find a solution for my broken phone.  I was wrong.

The Verizon representative at the store told me that since I did not have an upgrade available to me until mid-March that my only option was to purchase a new phone at the retail price.  Verizon would not waive the intervening three weeks.

I then checked with a place that repairs phones.  They could fix my phone for two hundred dollars.

I then checked with T-Mobile.  In less than an hour I had a new Samsung Note, and had unlimited talk, text, and data for eighty dollars a month—Verizon did not offer an unlimited plan.  An unlimited plan with T-Mobile will cost me less than what I was paying for a limited plan with Verizon.  T-Mobile did not require me to sign a contract.  If fact, they even paid the penalty Verizon charged for cancelling my agreement.

Two companies, supposedly in the same business, different results.

T-Mobile wanted my business, and they made it easy for me to do business with them

Which company most resembles how easy it is for people who try to do business with your hospital?  How do you know?  If you are a hospital executive, have you watched someone try to schedule an appointment or a lab? Have you listened to them on a call?  You did not watch them trying to do it from your hospital’s website because they cannot schedule an appointment from the website.

Have you watched them trying to provide your hospital with a referral, trying to pre-admit themselves, trying to order their medical records, trying to learn how to submit a claim or to understand their bill?  Only by observing people trying to do business with your hospital will you understand their frustrations.  You see, people need two things from your hospital; they need care, and they need to be able to do business with you in an effective and efficient manner.

These people, patients/customers, have a value over twenty-five years of somewhere between one hundred and eighty thousand dollars and two hundred and fifty thousand dollars.  If you are not easy for them to do business with they will make it their mission in life to find a hospital that is.

A couple of thoughts paraphrased from Gandhi.

Patients do not depend on us—they have choices.

Patients are not an interruption when they call.

Patients are not an outsider to our business—they are our business.

We are not doing patients a favor—they are doing us a favor by choosing to interact with us.

We spend millions of dollars trying to attract patients.

Why not spend a few dollars trying to retain patients and to make it easy for them to do business with us?

If you don’t, somebody else will.

Think about the answer to this question, how many nights have you spent in a hotel in the last decade?  For most of us the answer is more than one hundred.  How many nights have you spent in a hospital in the last decade?  For most of us the answer is probably between none and ten.  So then, when you go somewhere to spend the night and have your meals delivered, from which organization do your expectations about being satisfied most likely come?

Patient, customer. Hospital, hotel. Tomato, ta-mah-tow.  For those who want to argue that there are no similarities feel free to continue to do so.  For the rest of us let us look at how to improve patient satisfaction.

A few days ago I spoke with a hospital CEO about his efforts to improve the patient experience and about patient satisfaction.  He said that for years his hospital has spent a lot of money buying all sorts of data about their patients’ experiences.  The problem he said is that the company providing the data never did anything more than sell them the data.  So they kept getting all of this data but never saw any improvement in their patients’ experience that could be tied to the data they purchased.

That hospital has also hired coaches in the belief that this would help improve the experience.  The results were the same.

I asked him why he kept spending money when the expenditures failed to deliver the desired result.  He replied that the two things he knew he could do that would yield the greatest and most immediate increase in patient satisfaction would be to increase the number of parking spaces and to improve the food service.  Did he learn that from the survey data or from the coaching?  Nope.  He learned that from his patients’ family and friends.

Four rules worth remembering:

1. Experience and satisfaction are related but they are not the same.
2. Every patient has an experience but the experience does not always result in a satisfied patient.
3. Patient satisfaction cannot be improved without knowing a patient’s expectations.
4. Purchasing data and paying for coaching do not change rules 1-3.

Having thousands of data points comparing how your hospital is performing against other hospitals gives you a report card; it does not improve either the patient’s or patients’ experience. Coaching employees probably will not improve patient experience.

It is not the employees that need fixing.  Broken, outdated processes result in dissatisfied patients.

Patients have multiple points of contact with the hospital; before they are admitted, while they are in the hospital, and when they go home.  If you can answer the following questions you have a basis for improving patient satisfaction.

• Which points of contact have the greatest impact on patient satisfaction?
• When did anyone last ask patients to define their expectations?
• Which points of contact affect most of your patients?
• Which points of contact are frequented most by your patients?
• What are the consequences of not knowing these answers?

The answers to these questions do not require purchasing data, nor do they require coaching.

Two highly frequented points of contact are your website and your call center.  Go to your web site and try to complete a simple task—schedule an appointment, or try to understand your bill—taks that might be done by a patient or by a patient’s family member.  Could you do it?  Were you satisfied?

Now dial the call center and ask the person who answers the phone a question about Medicaid or Medicare billing.  Could that person give you the correct answer?  Could the person they transferred you to give you the correct answer?  Did the recorded voice telling you to call back between the hours of eight and five give you the correct answer?  Were you satisfied?

If you were not satisfied, why would you expect your patients to be satisfied?  Satisfaction has everything to do about processes and customer service.  Data and smiles do nothing to improve broken processes and poor customer service.

It is a three-dog-night, and I only have two dogs.

See Paul. See Paul shiver.  We lost power 16 hours ago—ice storm, trees snapping like match sticks and landing on the power lines. The temperature in the house is fifty-one degrees and is dropping faster than my lack of affection for all things Celine Dion.  Rumor has it that we may get power back Saturday-seventy-two hours from now.  By then I should be able to just leave the refrigerator door open without worrying about the food getting too warm.   Having lived in Colorado for twelve years, I’m pulling out all of my North Face gear; crampons, gators and ice ax just in case I need to rappel down to the first floor in the morning to let the dogs out.

Southeast Pennsylvania is having a mini version of Hurricane Katrina, only nobody is being rescued by helicopter since the roofs are too slippery to climb upon.  I am writing by candlelight, like Abe Lincoln must have done, only minus the beard and the stovepipe hat.

The cell phone charge shows twenty-two percent power left.  The iPad is dead, and the gerbils powering my laptop have taken their mandatory union break.  Alferd Packer, turned to cannibalism in Colorado when he and his friends ran out of food in the cold.  I look at my dogs. They look back at me with suspicion.

Time passes.  It is forty-seven degrees—inside the house.

Several of you have written asking what it means to design someone’s experience—you can call them a patient if it makes you feel better.  I like also calling them customers—they can be both, and it does not offend them.  Maybe we should make it like the word brunch—patomers or catients.

Anyway, customer design.  He are real examples from my personal experience yesterday of firms who did not design a customer experience, firms who designed one but did it poorly, and one firm who got it right.

There are 150,000 homes in my county without power, and every person from every one of those homes made it their mission yesterday to find power at a place that also had internet. (I’m becoming a bigger Al Gore fan every day.)  I first tried the library.  There is a big sign to let people know they have free internet.  Their lights were on, but they were closed because of the weather.  Good intent, poor execution.

I next tried the mall—400,000 square feet.  Banners hanging overhead hawking their free internet service.  I walked the entire mall.  There is not a single accessible power outlet anywhere in the mall.  Good intent, poor design.

Giant Foods is a mile from my home.  A few cars were in their parking lot.  ACME Foods is another mile down the road, another clump of cars in their parking lot.  Wegman’s—my favorite food store on the planet is another three miles down the road.  Their parking lot was packed.

If you have never been to a Wegman’s, all of their stores were purposefully designed to create a great experience.  They have an eating area with eighty or so tables and a few couches and free internet.  And they have lots of electrical outlets.

My family and I went in and I went to work.  We spent six hours there and about a hundred dollars to eat two meals.  I would have done my grocery shopping but realized it would be silly to buy food if the temperature in my refrigerator was bordering on tropical.

Giant, ACME, and Wegmans.  At first glance, one would think the three companies are in the same business—groceries.  What I learned is that two of them are in the grocery business—Giant and ACME, the stores with the empty parking lots—and the third, Wegmans, is in the people experience business.

The point is that unless your hospital has defined the type of experience it wants people to have when they visit your hospital online or call it the experience you are providing those people is probably poor.

Too many hospitals think that because they have a web site and because someone is answering their phones entitles them to check the box indicating “mission complete.”  Your customers and patients are checking their boxes too.  They come away from their experience saying it was pointless to go online because they could not do anything once they got to your web site.  They are saying it was pointless to call the hospital because they never accomplish what they set out to do when they called.

The result of an undersigned experience is a failed experience.

The result of too many failed experiences is that the person will go somewhere else to purchase their healthcare.

One final kudos for Wegmans. I found a vegetable that I hadn’t seen since I worked in Taiwan—yu choy.  I Googled it, went to Wegmans’ web site and searched for it.  Wegmans’ web site asks you to enter your zip code.  When you hit enter they site tells you in which aisle in the store closest to you your item can be found.  It also tells you its price, the nutritional information, and provides you the recipe, along with others, of how they prepared the vegetable in their buffet.

Many hospitalists do not want to call their patients customers. Those people are hurting how the hospital presents itself to the public.  Maybe it is time for them to go grocery shopping.

You awaken, look outside, and see that the ground is covered with snow.  You did not see it snow, but not seeing it snow does not discount the fact that it snowed.

A patient calls your hospital and over a period of three hours their call is placed on hold and they are transferred from person to person as they try to schedule a follow up appointment.  You did see the person calling, you did not see their bad experience.  You also did not see the hundreds of other people each day who called the hospital trying to accomplish one task or another.

The fact that neither you nor your colleagues saw those people having disastrous patient experiences does not discount the fact that they did.

These types of experiences happen at every hospital every day.  They are unseen and unmeasured.  Nobody in the hospital knows about them.  And if nobody knows about them those bad experiences are treated as though they do not exist.

There are people who know about those bad experiences.  Those people do not work for your hospital, they are your future patients.  Those are the people on Twitter and Facebook and LinkedIn and YouTube.

It has been snowing every day at your hospital and until someone does something about it the snow will keep getting worse.  Either that, or it may be time to by a bigger shovel.

Groundhog Day, the movie.  Bill Murray is trapped in time, every day is the same day, Groundhog Day.

Numbers can be rather interesting.  For example, the number 81 is one of two numbers whose digits, when added and then squared give you the number: 8 + 1 = 9; 9 squared is 81. Or the number 3,435.  Take the digits and then take three to the third, plus four to the fourth, plus three to the third, plus five to the fifth equals 3,435.

Healthcare loves using numbers to measure how it is doing improving patient experience.  Most of the numbers I have seen contain very little information.

The December issue of HealthLeaders Magazine had an article about changing the culture to change patient experience.  The article featured a chart in the HealthLeaders Media Intelligence Report, Patient Experience Beyond HCAHPS.  Nothing to complain about so far, right?

The chart showed what healthcare executives rated as the biggest stumbling blocks to creating an effective patient experience strategy in their organization. It yielded these as the top four issues:

• 49% difficulty changing organizational culture
• 20% too many other higher priorities
•  11% lack of funding
•    8% lack of leadership commitment

Essentially, the leaders’ responses rank the reasons why they are unable to improve patient experience in their organization.  Listing why something cannot be accomplished does not lead to accomplishing it.  Leadership.

Changing organizational culture, 49%.  What if you could dramatically improve patient experience without having to worry one iota about changing the organization’s culture?  Would you do it then?

Improving patient experience beyond HCAHPS requires hospitals to define what is beyond HCAHPS.  HCAHPS happens within the provider’s facilities.  Inside the facilities is where cultural change would occur.  That is the place for which hospitals purchase data and hire smile coaches.  Beyond HCAHPS happens outside of a provider’s facilities.  In general, it does not need to involve people who wear scrubs, and it should not only be about people who have been admitted but not yet discharged.

It needs to involve other people, people who do not work for the hospital and people who are not inpatients.  Who are these people?  They are patients, former patients, and prospective patients.  They are you and me.

Here are the two stumbling blocks those surveyed should have listed about why they cannot create an effective patient experience strategy.  Nine of ten healthcare organizations, that is 90% for those who are not mathematically inclined, do not have a definition of patient experience or a written patient experience strategy.

You cannot have an effective strategy if you do not have a strategy.

The second stumbling block is that in general providers have no idea of the experiences of 95% of the people who interact with their organization.  People whose experiences are unknown, unmeasured, and unasked include:

• Outpatients
• Discharged patients
• Former patients
• Future patients

Some hospitals will try to argue that I am wrong.  Their argument will be based on the fact that they survey this group or that group, or that they have a secret shopper program, that somehow this gives them insight about the experiences of those stakeholders.

There is very little profundity to be gained from surveys or secret shoppers.  None.

If a hospital is serious about improving patient experience it should do the following:

• Define patient experience
• Include all of the stakeholders in the definition, not just current inpatients
• Develop a patient experience strategy

The strategy should include tasks to enable you to answer yes to all of the following:

• Can people access the organization?
• Can they access it when and how they want?
• When they access it can they get the information they need?
• Can they accomplish the tasks they needed to accomplish?

Being able to access the hospital, which in most cases means that someone answers the phone when they call is critical.  Today, many hospitals cannot answer a high percentage of calls.  Of those calls that are answered, they are only answered for a brief number of hours.  Of those callers, whose calls were answered because they called at the right time, a huge percentage of them will not get the information they needed or they will not be able to accomplish the tasks they set out to accomplish.

You do not need a survey to measure their experience, and you do not need the threat of being penalized by CMS to understand their experience.  Their experience was poor.

If you shift some of the execution of those experiences to the web, people get the same results, poor results.  If you design your web solutions correctly, those experiences will be remarkable.

When you can answer yes to these questions you will have improved patient experience.  You will have done so without having to purchase any more data and without having to hire someone to teach your employees to smile.

If you cannot manage to deliver a remarkable experience for someone who is considering purchasing healthcare from your organization, you will not have to worry about surveying that person, about whether the hospital room was noisy or whether the radiology nurse didn’t smile, because the person with the bad experience will never have chosen your hospital.

Patient Experience: A remarkable experience for every person every time on every device.

The CEO of Texas Health Resources stated in the December 2013 issue of HealthLeaders Magazine that “hospitals are used to being accountable for about 4.5 days.”  4.5 days represents the average length of stay for inpatients—I think the use of the word ‘inpatients’ could be considered redundant.

Also in the article is the fact that Texas Health Resources is transforming the delivery of healthcare from hospital-based to community-based including, education, wellness, prevention, primary care, rehab, home, long-term, palliative, and hospice care.

Accountable.  Accountable for care. 4.5 days.  Accountability probably includes reducing readmissions, which includes making sure more people complete more of their discharge orders.

Transforming delivery away from the hospital.

Today hospitals define patient experience as an inpatient function.  Patient Experience efforts must also last on average 4.5 days, and it must not apply much to outpatients or prospective patients.

Here’s where I get confused.  As care is moved from being hospital-centered to community-based I assume that means patient experience will change from being exclusively inpatient care.  It will have to include education, wellness, prevention, primary care, rehab, home, long-term, palliative, and hospice care.  Patient experience will have to be available 365 days a year, 24 hours a day, and on any device.  Essentially at a time and on a device of the patient’s choosing.

The problem is that patient experience like that does not exist today.

You may find education information about a smoking cessation program taped to the wall of a hospital elevator, or via snail-mail, or hidden in a Where’s-Waldo fashion among dozens of other links on the hospital’s web site.

Patients, and prospective patients, should be able to complete dozens of business functions by phone or on the web at any time and on a device of their choosing—access, authorizations, referrals, scheduling, admissions, billing, complaints, refills, discharge—for community-based services like education, wellness, prevention, primary care, rehab, home, long-term, palliative, and hospice care.

Just because patients are not in the hospitals does not mean they are not still your patients.  If you treat them as though they aren’t they will go be somebody else’s patients.

Patient experience needs to occur for as long as the hospital thinks of that individual as either a patient or as a prospective patient.  Sometimes that is over a period of years.

Just because the hospital has never designed that experience or measured it does not mean that the person is not having an experience.  They are, they are just not having a very good one.