Patient Experience: Is it Right Only 5% of the Time?

Sometimes something gets stuck in my head and the only way to get it unstuck is to get the idea stuck in someone else’s head. 

A few weeks ago I came across something on one of the newsy channels having to do with a Canadian paleontologist sitting by himself on a pebbled beach in Quebec.  His life’s work revolved around pinpointing the place where fish first walked from the sea—the very fact that he was interested in finding out where fish first walked by inference implies his belief that they (fish) have walked on more than one occasion.

I know some of you are thinking, ‘And your point in writing to us about this is…”.

The television spot went on with the fellow reporting that the interesting thing is not that fish walked—which most open-minded non-Darwinians would have found sufficiently interesting all by itself—epochs later; yada yada yada—but that without them (the fish) having walked none of us (the non-fish) would be here.  It was alchemy in paleontology presented in an NPR/PBS authoritative manner, complete with a British accent, and the reporter was his Rapunzel.  If we say it on PBS it must be true.  The show did not offer any opinion to the contrary.  I wanted for someone to pop onto the set and say, “Prove it.”

What troubled me about the show was that he and his amanuensis, the reporter, with her eyes wide shut, somehow managed to create a dialogue around this notion as though it (the meaning of life) actually happened the way this fellow said it did.  I’ve seen Monty Python’s The Meaning of Life and it did not happen that way at all.  The report’s interview of the ichthyologist was like watching two left-handed men learning to dance backward without either one knowing the woman’s part.

The voices in my head started screaming epitaphs at me.  The paleontologist’s mind tacked intuitively and lurched from idea to idea untouched by the clammy hand of logic.  His premise made as much sense to me as having an oboe player in a punk rock band, yet the erstwhile reporter, with her sang-froid composure, uttered nothing more than an ‘uh-huh’ and looked as though she was watching time bend right in front of her Oliver Peoples glasses as he explained the wonders of the universe to her with his do-re-mi recitation of the facts.

Some people in front of a camera have the innate ability to insult our intelligence with boredom and futility—sometimes I do it with a blog.  His perfervid idea was stranded on the edge of reality and it worked about as well as a poorly used preposition at the end of a sentence.  As I asked blankly of the television show whether any of these walking fish were found wearing shoes, the reporter listened to his promulgation, nodded and followed him into the rabbit hole.  She never questioned whether the compass of his intellectual qualifications may have been missing its needle.

Therein lays the rub.  Simply saying something aphoristically on television does not make it true.  What was intended as an ephemeral interview now exists for the folly of all of us.  The man is guilty of sharing his ideas without having a hall pass to do so, but then again, so am I.

Maybe that is how mermaids came to be.

Segue.

A lot of people only care about fixing business problems at the eleventh hour. The problem with that approach is that you never know when it is a quarter to eleven—you only know when it is quarter after.

Leslie Nielsen in the movie Airplane notices the pilot and copilot are incapacitated.  “We need to find someone who not only knows how to fly a plane but who also did not have the fish for dinner.” 

And boys and girls, therein lies the root of the patient experience dilemma—too many of us ate the fish that have been walking around, and we believed everything we were told by the ichthyologists.  They told us that everything you ever needed to know about patient experience could be found by surveying less than five percent of the people who interacted with you, by surveying people who had experiences that went unexperienced by the other ninety-five percent, and whose experiences took place months and months ago.  And who may they be?  They may be and are those who are telling you that they did not eat the fish; the rule makers; those who are selling you your own data; and those teaching your employees to smile more.

You would not build a hospital with only five percent of the materials, you wouldn’t give a patient only five percent of her medicine.  So why spend money on a patient experience strategy that has only a five percent chance of being right?

Patient Experience: A Whinging Rebuttal to the Notion that Patients are not Customers

I really like the fact that people comment and disagree with me.  That is how I learn from them.  However, if you want to have a battle of whits, it is best not to come to the fight unarmed. Below is my third response to an individual who commented repeatedly, and concluded that I am a liability. The post that seemed to have attracted his ire can be found here http://ow.ly/t0L1Z

The surgical gloves are off, and since I’m the guy paying for this pulpit, away we go.  I would love to read your thoughts…no, really.

If you built a hospital in the woods and nobody came would it make a difference?  It would because you would not have any patients.  Let me try this again in English, even as you write that I am a liability.

Retention is nothing like re-admission.  A retained patient or customer is someone who will come back to the business the next time they need to make a purchase.  Retention is when a gall bladder patient had such a positive experience that they come back for a bad knee, for an endoscopy, blood work—anything the hospital sells that someone needs.

Using my calculations, a person is worth between $180,000 to $250,000 over twenty five years.  Managed correctly, a family of four could be worth up to a million dollars in future revenues.  That is an asset any hospital CFO would fight for.  Those numbers work whether someone was a patient, is a patient, or may be a patient.  Care for a lifetime equates to a lifetime value of a patient.

If you do not retain me as a patient, what does it cost to find another person to take my spot?  The rule of thumb across industries is that it costs ten times as much to acquire a new customer as it does to retain one.

I recently spoke with three people with PhDs in healthcare economics.  I asked them if they had seen any data about what it cost to acquire a single patient.  They had not.  Business development is one of healthcare’s black holes.

If as you wrote, these people—the ones who are not considered patients simply because they were discharged or have never been treated by the hospital—were worth nothing, as in not an asset, then I am sure you will agree that we should close the marketing department and the business development department, take down the billboards, and quit advertising on NPR.  That would free up a lot of parking spaces.

As difficult as it is to make money in healthcare, one must ask why hospitals market themselves.  Are they simply altruists?  Or, are they trying to attract patients?  If they are trying to attract patients there must be a reason.  I think it is because patients are worth something, they have a value.  Patients pay for services—we all know that there are many, many hospitals who given a choice would like to have a higher percentage of their patients who can elect to have costly procedures—high earners.  This group of patients in effect underwrites the other group of patients that cannot afford to purchase as much healthcare.

As to why a hospital should keep up with a patient after the patient is discharged, the list is too long to complete.  However, again using me as an example, my hospital got four days of revenues for treating me for the heart attack.  Penn Medicine on the other hand has received eleven years of revenues for all of the follow up related to my heart disease.  Penn Medicine, because of my positive experience, treated me and my family for other things (none of which were readmissions.)

If hospitals do not treat people as customers as well as they treat them as patients, they will have neither.  The strategy you suggest is no different than telling the hospital that it must replace its entire base of patients every year if it is to earn as much as it did this year.

Patient satisfaction should be exclusive…to everyone

Sometimes it feels like I fell out of the stupid tree and hit every branch on the way down.

Important: Do not remove the wires from your old thermostat until you have marked them with the enclosed labels.

This warning was printed on a bright red background with yellow text and hidden away in the middle of the adult-proof ballistic packaging of the new thermostat.

“Why didn’t you read the directions before you disconnected the old thermostat?” My wife asked as soon as she realized the fan was not working.

“Is there a reason one of the plants in the garden is on fire?

You have to power-wash the deck before you put the furniture on it.”  This is the heavy, metal outdoor furniture I am forced to carry indoors once the weather turns cold so that it can hibernate, and return it to the outdoors in spring. 

All my explanations about the fact that the furniture was designed for the outdoors and that it will outlast the next dinosaur ascendency go unheard.  It is this same furniture for which she has militaristically drilled the family, with the rigor of nuclear submarine crew trained to extinguish fires, to race indoors with the cushions whenever rain is expected anywhere within the lower 48 states.  Perhaps she read somewhere that if the cushions get wet they will suffer the fate of the Wicked Witch of the West and melt.

Responses are neither required nor expected of any of the questions or statements tossed at me.  To do so would be akin to arguing in a vacuum—as opposed to with a vacuum.

Pearls of wisdom, in my case, tossed amongst swine.  “Mongo just pawn in the game of life”—Mel Brooks, Blazing Saddles.

The world has changed.  Customers have changed. All businesses have changed the relationship between themselves and their customers. With few exceptions, healthcare has not changed its approach to patients, and nobody seems to own up as to why.

The way the business model used to work is the business pushes communication from the business to the customer. Businesses evolved to the point where communication between the business and the customer became a push-pull model. The business pushes something to the customer.  Sometimes the customer pulls information, and sometimes the customer pushes information to the business.

Most pushes and pulls function on a one-to-one basis; the business to a single customer (patient), and back. It occurs in secret. Customer A was never aware of the push-pull between the business and Customer B.

Communication is no longer secret. In fact, it is anything but secret, especially among customers.  As the number of customers increases, their communication about a business can go quickly viral—not between patients and the hospital, but among patients. 

Hospitals can do a lot of things but they cannot put the toothpaste back into the tube.

I think patient satisfaction should be exclusive…to everyone, but then I have been accused of trying to believe in as many as six impossible things before breakfast.

Patient Experience: Can it be dumber than a bowl of mice?

I heard the bookies in Las Vegas are offering odds on the date and time for the first terrorist attack during the Winter Olympics.  “Why can’t we all just get along?”

Changing how the world thinks may be more difficult than simple changing the world.  Sometimes it would be easier to teach Hindu to a beagle.  Sometimes you have to stand on your own shoulders to be heard.  If the issue under consideration seems up for grabs, sometimes style points can make a difference—the judge from East Germany scores the routine 8.75.

When one assesses patient experience, it seems like a lot of people do things wrong, but they do things wrong, but they do wrong right. 

Case in point.

The air was getting cool. When the air gets cool you buy a winter coat. When you buy a winter coat, pretty soon it snows.  When it snows things get complicated. When things get complicated, and you happen to be out of town, your flight gets cancelled.  When your flight gets cancelled you do not make it home. When you do not make it home you do not get your mail.  When you do not get your mail you do not get your invitation to the World Economic Forum in Davos.  When you do not get your invitation to Davos, somebody else has to take over your job; someone else has to wash the dishes.  When someone else has to wash the dishes, some dishes do not get washed.  When some dishes do not get washed, the prima donnas get upset.  And, when the prima donnas get upset, the world’s economy goes in the toilet.  I have missed the last seven meetings in Davos, and I am starting to feel bad about the state of the economy.

Patient experience.  I attended a gala last night for an organization of which my wife is a board member.  At the event I was introduced by a member of the board of directors at an eminent Philadelphia hospital to a woman who is on the board of two eminent Philadelphia hospitals.  The board member I know told her fried “you really need to talk to Paul about what he is doing to help hospitals improve patient experience.”

Yada yada.  The board lady and I talked; well sort of. Just to keep me from reliving an awful experience, I’ll just hit the highlights.  I went to the netherworld and suggested that patients are also customers, that customers are an organization’s assets.

The board member started hanging strands of garlic from her neck, and she withdrew a mallet and wooden stake from her purse.  Any aspirations I had about her ability to see the bigger picture escaped through the bell tower’s window.  “Welcome to the nineties Mr. Banks”—Father of the Bride.

“We do not have customers, we have patients.  Our Patients are not the hospital’s assets,” she bellowed.

I wanted to ask, “Are you a good witch or a bad witch?” 

I have often used those close to me as a barometer.  They are the people who tell me “Take twenty-four hours before you respond.  Do not be so quick to give them a piece of your mind because you may not have enough left after you give it.”

My initial reaction was to tell the board member that I had been more challenged intellectually by a bowl of mice, to tell her that she was both rude and ignorant.  Instead I bit my tongue, hoping she would come to the same conclusion on her own.

The air was getting cool—we did this part earlier.  The hairs on my arms stood on end.  When the hairs on my arm stand on end it means something bad is about to happen.  When something bad is about to happen I try to suss it out.  When the hairs on your arm stand on end, you may be having a conversation with someone whose intellect is below that of the intellect of a bowl of mice.

When that happens, it means that the person with whom you are speaking is misguided.  When someone is misguided it means they have no notion of how healthcare has changed.  When someone has no notion of how healthcare has changed it means they should not hold a strategic position.

The board member repeated her point, “We have patients, not customers. Our patients are not customers and they are not assets.”

I finished the conversation by telling her, “Using your strategy, you will be proven correct. In a few years they will neither be your customers nor your assets.  They will be the customers and assets of another hospital.”

What is the Mastodon Model of Patient Access?

It is snowing. Flight home cancelled.  Hotel I was in cancelled. 

This is also happening for newly-minted MBAs.  Blizzard; no worries.  Smart phone, new reservations, care to join me for drinks?

I wonder how they would handle it the way we real men had to handle it in the days before Al Gore invented the internet.  Would they even know where to begin?

In the old days, when mastodons still roamed downtown Boston, a good snow storm meant you might not get home until the lawn needed mowing.  They way this mastodon remembers it, everyone in the cities affected by the storm would call the one phone number for the airline to see about rescheduling their flights.

If you could not extend your stay at your hotel, you were basically out of luck.  There was no way to Google the hotels in your zip code, there was no way to even know which hotels to call.  You would simply dial ‘411’ and start asking an operator to connect you with a hotel other than the one at which you are currently registered. 

When that did not work, and after the bellman at your hotel tossed you onto the street, you would make your way to a copse of trees, hope you remembered your Navy SEALs training, and try to build a bivouac with your comb and toothbrush under the branches of a juniper bush.  As the snow fell in earnest you might fashion a pair mukluks from yesterday’s socks.  If you were really fortunate, you might still have a piece of adipose tissue—seal blubber—saved from the last time you were forced to play survivor.  That is how real men did it in the old days, in the days before the entire world started to function around the internet and mobile phones.

Segue.  Hospitals.  Was that a mastodon I saw in your lobby?  I just bumped into someone from IT and she dropped her computer punch-cards—you younger ones may have to Google the term.  In the last five years smart phones and the internet have changed how Americans conduct business; how we buy goods and services.

They have not, however changed how we interact with hospitals.  For those who still have phone books if you look up your hospital in the phone book you will see dozens of numbers to call.

Riddle me this Batman; which of those numbers are you supposed to call if you need to schedule a lab?  It depends.  Which number should you call for a refill?  It depends. For a follow up appointment?  And so forth and so on.

As a prelude to the snow while I slept last night, using the internet, US Airways did all of the following—cancelled my flight, messaged me to let me know the flight was cancelled, rebooked me on a flight, and sent me a message confirming my new seat.  In real-time, all while I slept.

Most hospitals cannot even schedule the original appointment using a phone, let alone reschedule it and send me a confirmation over the internet.  The mastodon model of patient access works as follows.  I call the hospital, am placed on hold, am asked for my referral, my authorization, my insurance.  Then I am transferred to someone else, am placed on hold, am asked for my referral, my authorization, my insurance.  I may get an appointment, I may not.

While I am on hold with the hospital I rebook my hotel, watch a movie on HULU, search eBay for a mastodon tusk, and show my dog a video to teach him how to shut the door.

I’m thinking this whole internet/smart-phone thing may have legs.

As a hospital, are you really comfortable offering less of a customer experience than an airline?

Patient Experience: What is the Two Mercedes Equivalent?

If you can’t laugh at yourself, you may want to engage me to do it for you.  Just kidding.

People often infer things from what others say.  They read between the lines, they try to uncover innuendo.  I am doing patient access consulting for two hospitals around the notion of creating a remarkable experience for those patients who access the hospital by phone.  I had the chance to listen to several patient calls.  Do you ever wonder what your patients infer from what they hear when they call your hospital?  Is what your patients are hearing sounding something like this?

We are getting a lot of calls today.  Well, it’s not really a lot, it just seems that way because there are only a couple of us here.  Don’t hang up, but if you have some errands you need to run, now might be a good time to knock off a few of them while you are on hold.

If you are calling to schedule an appointment for 2015 please stay on the line.

If you are calling because your doctor told you she wanted to see you in two weeks, he never told us, so you may hang up now, or you can wait your turn on hold and when we are through laughing hysterically we will tell you personally to hang up.

If you are calling because your doctor referred you to get an appointment with one of our specialists, understand this.  What you have is permission to have what you think happened evaluated by our authorizations group.  You do not have an appointment.  Should authorizations authorize your referral over the next few weeks, you can try your luck and call us back.  If you are feeling that lucky you should also consider buying a lottery ticket.

If you are calling about your bill, you know as well as we do that nobody in our organization understands those things.  Besides, your insurance company is going to override anything we tell you so you may as well call them.

If you are calling because you are not feeling well perhaps you should go to the ED.  We are not allowed to give medical advice, but that is what we do when we don’t feel well.  We could try to connect you with a nurse, but that hardly ever works.

If you are calling to request a refill on a Friday afternoon, you are just being silly.  Next time call us before you run out of medication.

When patients are discharged some hospitals label them outpatients.  I label them former patients or prospective patients.  Regardless, if you really think the word ‘patient’ somehow fits a discharged patient, a former inpatient, why in the world are their needs ignored.

My calculations show that a patient has a lifetime value over 25 years of between $180,000 and $250,000—I call that the Two-Mercedes Equivalent.  Let us suppose you own one Mercedes.  In your mind owning that Mercedes entitles you to be pampered.  They should answer their phones, they should let you schedule appointments online, they should come get your car when it needs to be serviced and they should leave you a Mercedes to drive until they return yours.

They should do these things so that next time you do not buy someone else’s Mercedes.  They want all of your business.

At a majority of hospitals outpatients, former patients, are treated as yesterday’s news.  That is because hospitals are hospital-centric, they are clinic-centric.

Hospitals, like Mercedes dealers, need to be customer-centric. Is it time to reinvent patient access?

Is Poor Patient Experience is Filling Your ED?

Image  These are my new cufflinks.  I asked my wife if she liked them and she replied, they look like earrings.  This must be why lawyers operate on the premise that you never ask a question to which you do not know the answer.

I never received the email from the Republic of California stating that all speed limits had been rescinded.  This morning I am driving down “the 10” to the airport—California roads are not called routes, or highways or beltways.  Cars are passing me like I was driving a Big Wheel even though I was going seventy.  I was here like, for five days, and like, I now feel much more comfortable using the work like unnecessarily in spoken and written conversation.

But who is complaining?  The temperature was in the eighties and I am flying home to a place so cold that the groundhogs are wearing mittens.

So as I’m driving along the 10 at Mach 2, the voice in the car says, “GPS signal lost.”  Since this was my first time on the 10, I knew enough to know that if whoever lost my GPS didn’t find it quickly that I was going to have a bad day. Since the rental car did not have a good place for me to place my phone while I was looking for my GPS I placed the phone on my right thigh.

For those who did not study anatomy, thighs are round, at least mine are.  And phones are flat.  That means that if an errant neutrino should slam into the phone the force from the collision is great enough to knock the flat phone from the round thigh.

It occurred to me that the person who designed the interior of the Mustang either had flat thighs or did not own a phone.  I believe that because there is a space between the seat and the center console that is the perfect width for a phone.  The width, however is not wide enough to allow your arm to slip into the crack to try to retrieve the phone especially while traveling at Mach 2 on the 10.

I drove for thirty minutes listening to a muffled voice that sounded like it was broadcasting from beneath my bum repeating the phrase, “GPS signal lost.”

The success or failure of most experiences comes down to whether or not those experiences were designed or whether they simply evolved over time.  Case in point. I returned the car to Enterprise.  The Enterprise employee asked me the same question every Enterprise employee always asks me, “How did we do?  How was our service?”

They never ask about the car.  They know the car was excellent.  They know that when renting cars, the cars are the commodity.  They compete on customer experience, an experience they designed.

Hospitals never designed the experience.  Notice I used “designed” as a verb.  To design requires creating a vision of what is to be designed, and it requires people educated in design. For hospitals I like to use the vision “A remarkable Experience for Every Person Every Time on Every Device.”

I am willing to bet that if you evaluated your hospital’s nonclinical business processes, processes like authorization, registration, and admissions you would find that they were never designed.  They came into being decades ago when vinyl flooring was in vogue, and the only things that have changed are that the admissions area now has a synthetic carpet, the portraits of the hospital’s past presidents have been updated, and the clerical staff have gone from using quill pens, to carbon copies, to floppy disks, to flat-screens.

You come in as the sun is rising, and you sit with others on cream-colored vinyl chairs.  The local news is playing on mute on a television mounted to the ceiling.  Three-year-old copies of magazines like the Latin American Financial Manager and Make Bankruptcy Your Friend are stacked neatly on a laminated end table.  The admissions process is basically the same.  It was not a remarkable process during the Harding Administration and it is not a remarkable process now.

People call because they were told to call.  They were told they had a referral and that their referral was authorized.  “We cannot schedule you,” the voice tells them.  “We have not received your authorization.”

“Who is ‘we’?” You ask—I know that punctuation is wrong, but I do not know what the correct version is.  “Aren’t you and authorization all part of the same organization?”

“It works thusly.  It is a multi-step process that has checks and balances—think of it like Congress and the Executive Branch.”

“But that does not work very well.”

“Don’t trouble me with the facts.  The doctor gave you a referral.  You called Authorization and gave it to them.  In know all of this because I can see the authorization in your record.”

“But why couldn’t I have given it to you.  Since you have it why can’t you schedule me?”

“Because authorization needs to approve it.  That usually takes a week or two, and because if we schedule you right away the next person is going to expect the same treatment.  Anyway, even with the authorization, the first appointment we could get for you would be six weeks out.  You could go to ED.  If it was me, I would go to ED.”

People call.  Where do they think they are calling?  Do they know?  The Hospital?  A call center?  A clinic?  They call to get an appointment—a three-syllable, big-boy word for access.  They call because their physician said to come back in six months.  Unfortunately, the physician’s schedule only goes out three months.  The caller gets angry.  By the third call the caller decides he is done playing this game.  The caller goes online and finds a clinic that allows him to schedule his appointment online, authorize his insurance, and complete the paperwork online.

Almost every hospital’s call center is in reality a scheduling center—reg & sched.  The problem with that is patients do not know that, and even if they did that is not how their world works.  When people need to interact with a company what do they do?  They call it, all of it.  And when they finally speak with someone they expect that someone to be equipped to answer any and all of their qestions.

The lifetime value of a patient is somewhere between $180,000 and $250,000.  That is a pretty high price to pay time and time again.

Processes like this cannot be tweaked.  They cannot be fixed.  They need to be tossed and then designed.

 

Why Does Patient Access Need To Be Redesigned?

If you could split atoms with your mind, but nobody needed to have atoms split, is it legitimate to post atom-splitting as a skill on your LinkedIn Profile?

If you could answer eighty percent of the calls to your hospital’s call center within twenty seconds, if your hospital had a nominal hold time and abandonment for those calls, but you could not resolve the reason for which the person called, are you simply splitting atoms?  That is how plutonium was discovered.

I just finished reading reports from two consulting firms summarizing the importance of being efficient, being fast. Answer the phone calls.

Speed kills. Being efficient kills.  Being effective is what matters.

People call wanting access to the hospital, wanting answers from the hospital.  Being able to answer the call on the first ring without being able to schedule an appointment is a waste of your money and their time.  The reason people quit calling back for an appointment is because they called someone else.  The patient experience score for that interaction is zero.

To those who think I am simply splitting hairs stay with me and think through the following real scenarios.

The physician in ED tells the patient to be seen by a specialist in two weeks.

The cardiologist instructs the patient in the discharge orders to schedule an appointment in two weeks.

The surgeon instructs the patients to make an appointment to have the sutures removed in two weeks.

In these scenarios, the onus is on the patient to complete the action.  In many instances at many hospitals the patients are instructed to achieve the unachievable.  Once the patient perceives that their assigned task, scheduling an appointment is difficult or unachievable, the patient will stop trying to complete the task.

Some will continue to call.  Some patients will go to the ED.  Others will go to another hospital.  All of these options either increase the hospital’s expenses or decrease its revenues.

For almost every hospital, access was never designed, it just sort of evolved.  Chances are quite high that access at your hospital is in need of a makeover.

Patient Experience: What happens when the phone rings?

As long as the Harvard Business Review continues to not ask me to write an article for them then I will continue to refuse to do so.

True story.  Flying yesterday at thirty-six thousand feet I was able to exchange a look of terror with the passengers on the other plane.  A near-miss is defined as being within a thousand vertical feet of the other plane and within three nautical miles.  We were so close to the other plane that we felt our plane move from the plane’s slipstream.

Enough of my problems.

I was in the hospital’s cafeteria watching people before my meeting about reinventing patient experience with one of the hospital’s executives.  Two people stopped by my table to tell me how much they liked my socks.  It occurred to me that if my socks were noteworthy enough to warrant comments from two strangers that they may be the wrong socks to wear to meet with the executive.  I was wearing sensible shoes, so at least I had that going for me.

So, I did some work for an organization that felt it needed a call center.  And for that call center they wanted to talk about ACD’s, IVR’s, CRM, and a suitcase full of other technical things.  I thought the best way to be of service would be to stop at Costco and buy them the call-center-in-a-box startup kit.  Maybe I’d also get them the all-in-one-EHR.

This is what happens when someone reads something they shouldn’t, something which they believe gives them instant credibility on a subject of which they previously knew nothing.  I watch one of those shows about goofy problems in the ER, but even so I remain hesitant about thinking I am the right guy to insert a chest tube.  I did buy some scrubs and a white jacket just in case someone feels the need to pull me in on a procedure.

When I asked why they felt they needed to design a call center their reasons were legion.  Too many numbers, too much wait time, too many dropped calls, too many call backs.  They want job descriptions, training manuals, a system for scheduling the people who were taking the calls, and they want scripts written for every conceivable type of call.  Call-center-in-a-box.

I asked what business problem they were trying to solve, a question which branded my immediately as a heretic.  Burn him at the stake the pink-faced call center director shouted.  All I could think of was that I was glad I had not worn my fancy socks.

If they proceed along this course they will have a very efficient call center—phone rings, it is answered, both parties disconnect.  Rinse and repeat.

I am not a fan of efficiency.  Efficiency is about speed, and speed kills.

I once did some work for one of the largest telecommunications firms in the US.  They wanted a call center strategy.  I told them that they should close all of their call centers, and then I closed my laptop.  (I sensed that they wanted a little more detail so I went to the white board.)

They told me it cost about thirty dollars to answer each call, and they received millions of calls.  I then had them create an exhaustive list of the reasons people called.  I was the scribe—in consulting lingo we refer to the in the work plan as facilitation because you can charge more for facilitating than you can for writing.

We created a pretty substantial list.  We then worked through each of the reasons on the list.  For an item to remain on the list, the people in the room were asked to defend why a customer should have to call about that item.

They learned that phone calls fell into one of three areas; people needed something, people had a question about something, or people had a complaint.  They learned that whatever it was people needed should have been handled at some point upstream in the process.  They learned that the information that was needed could have been provided at some point upstream in the process.  And they learned that complaints arose from something that did not happen correctly at some point upstream in the process.

Of the few items that remained—I gave in on some to make them feel better—I asked which of those could be handled through a customer portal.

Each item that is addressed at some point upstream in the process takes the cost of the call from thirty dollars to zero dollars.  The same is true with handling an item in the customer portal.  Eliminating a call ensures there are no call-backs, no waiting time, and no abandoned calls.  It also ensures that everyone gets the same answer, the same right answer to the same question.

It also ensures and insures the brand.

Your hospital gets hundreds if not thousands of calls each day.  Your hospital has dozens of phone numbers.  Each phone number is answered differently by people with different skills and experience and having different objectives.  People are placed on hold, transferred, given other numbers to call, and given the wrong information.

The other thing this hospital wants to do is to have one phone number people can call; a noble idea and a very bad idea.  They want it to handle two-dozen different call origination types, everything from getting information about how to donate to what hours the cafeteria is open to how to schedule an appointment.

In effect, they want their call center to be the same as their web site.  Their web site has more than fifty clickable links, everything from getting information about how to donate to what hours the cafeteria is open to how to schedule an appointment.

There should be a number for patient stuff and a website for patient and prospective patient stuff—a customer portal which is not even close to what EPIC and Cerner mean by patient portal.  There should also be a number or numbers for other stuff and maybe, just maybe a single link on the customer portal for all of the other stuff.

Designing patient experience so that the experiences on the web and on the phone are similar is only beneficial if those experiences are remarkable. Designing a call center experience that mimics the lack of functionality of your website is a waste of money.

There is no patient experience without experiencing your patients.

Memo to the state highway administrators in Ohio—the sign for exit 24 should come after the sign for exit 22, not before it.

Anyway, where were we?  I had a wonderful call this week with the Chief Marketing Officer of one of the leading Children’s Hospitals.  She mentioned that the average age of their patients’ mothers is twenty-seven years old.

That prompted me to do some research.  The PEW Foundation has all sort of information about people of all age groups including twenty-something moms and dads.  And guess what?  They have computers (+90%) and smart phones (+85%) and tablets (+30%).

I am visiting a hospital in the Cincinnati area today.  I walked around, visited the lobby, went to the cafeteria—the food was very good, dropped by the gift shop—they do not sell ear plugs; not good, and I generally observed people.

The Roemer Foundation reports the following—everyone from the staff to the patients to the visitors was doing something electronic.  Moms, dads, kids, and for the “old people don’t use the internet” naysayers, yes, even the grandparents were online.

They were texting and talking and reading and emailing and downloading and watching.  The only thing they were not doing was interacting with the hospital on a mobile device.  Why?  In large part because the hospital does not have an app that is worthy of their time, an app that would allow them to do anything.

The whole of America has gone wireless.  This is how we interact, how we communicate, and how we do business.

Riddle me this Batman—if Americans in ever increasing numbers are conducting all of their business affairs online and your hospital does not allow them to do that, won’t those people find a hospital who allows them to conduct all of their business online in much the same way as Amazon?

There is no patient experience without experiencing your patients.