Rants & Musings

Acquiring New Patients: Extreme Bingo Cruises

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There are many ideas that spring to mind when one looks at how to attract new patients to a hospital.  One would be to offer extreme bingo cruises to patients after discharge.  Another option might be to sponsor open Karaoke in the admissions seating area.

Apparently nobody knows what it costs to acquire a patient.  It appears the same number of people do not know what it costs to lose one.  My take?  They are both very expensive.

It never occurred to me that hospitals actually had business development people.  While I knew they had marketing people because I see their billboards and hear their ads on NPR, I just assumed that patients were their own mini business developers—they get sick and seek out a place to get unsick.  I think more people are doing this than the business development people would like you to think, because if that is the trend then the business development role in a hospital becomes irrelevant. 

So does this business development thing work?  Can you prove it does?  I only ask because I keep asking what it takes to acquire a single new patient and nobody seems to know.  Does nobody track business development efforts or measure their costs against the number of patients acquired?  Trying to argue that fifty percent of the reason that a given patient came to your hospital to have their knee scoped is because they saw the billboard of your urologists is like trying to prove that one side of a black hole is darker than the other.  The math just does not work.

Suppose last year the combined budgets of your hospital’s business development group and its sales and marketing group were ten million dollars.  Let us also suppose that you were able to prove that your hospital acquired ten thousand new patients as a result of that ten million dollar spend.  Were that the case we could say the cost to acquire a patient was one thousand dollars.  If you acquired only one thousand new patients we would know the acquisition cost was ten thousand dollars per patient; five hundred new patients cost twenty thousand and so forth and so on.

Simple math, but nobody is saying what it costs and that is because nobody knows what it costs.  I believe strongly that if the real cost was only one thousand dollars to acquire a new patient that every chief marketing officer would put that message on a billboard and erect it outside of the CEO’s office.  Because those billboards do not exist, I am betting that it either cost substantially more or that the costs are never to be known.

So, back to costs and what is known.  We know that it is less costly to attract customers to organizations that are easy to do business with.  We know that it is less costly to do business with people who have already been your customers, probably to the tune of ten to one in terms of actual dollars.  The only glitch in that equation is that these former customers have to like you, and that they found it easy and beneficial to have done business with your hospital.

To conclude, it is much more cost effective to attract potential patients who have already demonstrated an interest in your organization.  Those people are the ones who visited you online, who called your hospital, who interact with you on social media, and who visit patients.  They are not the people who saw your billboard, heard about you on NPR or received a telemarkeintg call extolling your services.

Payers Beware: the Affordable Care Act changes the rules

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A free PowerPoint presentation about why their business model has changed.

What do you think?

Patient Experience Explained: Why Should You Quit Relying on HCAHPs?

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ImageYour hospital’s million dollar lobby.  The business process pictured below is the one called WAITING.  Is that coffee I smell?  Arrive at 6 AM for surgery.  Sit with the other people who arrived at 6 AM.  Why couldn’t these people have used their iPads to have admitted themselves online the night before?  What is the level of satisfaction for patients, friends and family members, and prospective patients?  By the way, why is the woman in the back row smiling?

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Your hospital’s WEBSITE lobby—Where is Waldo?

You came to the site to decide if you were going to seek a second opinion from another hospital.  You spend 7-10 seconds deciding if you have come to a site that can help you.  Do you stay and hunt, or do you try another website?  See if you can find the arrow to help you get what you need about getting a second opinion.  You could not find the link because it is not there.  It is not there on 99% of hospital websites, yet fifty percent of people go to your hospital website looking for it.

If 99% of the people who visit your website are either patients or prospective patients, why do you have all of the other links on your homepage?  If all of these things are so important to a visitor, why then does your hospital lobby not have all of these signs confronting visitors the moment they walk in the front door?

Did the website deliver a remarkable experience for every patient every time on every device?  Didn’t think so either.

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Your hospital’s call center ‘lobby’. How good was this experience?  Will they ever call again?  Did they call outside of 8-5 Monday through Friday?  Did they get the same answer as the last person who called with the same question?  Was the answer correct?  Was their call transferred to someone else?  Do they have to call back?

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While I hate to always be the one belaboring the obvious, here it comes.  Clearly bad experiences for patients and prospective patients happen many different ways.  None of these bad experience were caused by any cranky staff members, so you do not need to hire a firm to coach nurse Ratched.  (One Flew Over the Cuckoo’s Nest. “If Mr. McMurphy doesn’t want to take his medication orally, I’m sure we can arrange that he can have it some other way. But I don’t think that he would like it”.)

None of these bad experiences were the result of the bathrooms being 3.2% less clean than the standard deviation from the mean norm of optimal—I don’t know what that means either.  What it does mean though is buying data some firm about how people viewed your organization will not improve any of the bad experiences depicted above.

Mobile. On the web. On the phone.  In the hospital.

A remarkable experience every time for every person on every device.

Patient Experience with a JD Power Twist

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Everyone knows the elephant in the room.  Unfortunately the elephant does not know any of them.

I read Toyota’s US president has decided to change Toyota’s business strategy as a result of the latest JD Power rankings.  Even though Toyota regained the world-wide leadership in car sales on July 30, 2013, it did not have a single car listed in JD Power’s initial quality results across all body styles.

“Perhaps all of the other automobile manufacturers have discovered automotive’s secret sauce.  We sell more cars than anyone else, but what good is that if we do not meet Power’s criteria.  Sure our customers swear by us, but what do they know about cars?” Asked James Edsel. “They just want something that looks cool, has great speakers, and a USB connection.”

James continued by explaining, “We have decided to follow the strategy of the US healthcare industry.  Health systems thought they were doing pretty well with their understanding of their patients’ experiences until CMS came along with its HCAHPs ratings and told them how to really measure the entirety of patient experience.  Now hospitals can see what a tiny fraction of their patients actually thought of their care months back when they received it.  They can pay money for their own data, and hire people to make their numbers look better the next time they pay for their data.”

“After all, why rely on what all of your customers and prospective customers tell you when you can simply go to one source and have them tell us what they think we need to hear.  One report and someone else does all the work.”

I’ll leave it to you to decide if there is a workable analogy there. To be fair, I heard the analogy while speaking with someone yesterday who is way smarted than me.

JD Powers is a business.  It conducts market research based on customer surveys. It then sells the research to the automobile manufacturers.  The big difference is the automobile manufacturers are not forced to alter their business model to raise their scores.

 

Shift Happens: The Experience Failure of a Top 10 Hospital

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Sooner or later someone had to write this, and there was little doubt it was going to be me.

I was speaking with a patient experience executive at one of highest rated US News & World Report’s Best Hospitals 2013-2014.  The conversation came down to her telling me that they are on top of the patient experience issues and that because of the financial pressures being exerted by CMS their entire focus was on raising their HCAHP scores from 8.2174284 to 8.2174265.  I will not waste your time or mine calculating the ROI on that exercise, but if you are so inclined begin your calculation with negative infinity.

Just in case someone’s experience with her hospital had nothing to do with HCAHPs, what was I to do other than to go to their website?

My first test point had to do with the fact that fifty, that’s a five followed by a zero, percent of people go to a hospital’s website to determine whether they are going to purchase care from that hospital, or seek a second hospital.

Brief segue.  Hospitals and healthcare aficionados use the term “seek” care because they provide care.  Lay people, patients, purchase care.

I went to the search function and entered ‘testicular cancer’.  I did so because at the time I was treated for it Al Gore had not yet invented the internet.  The site returned a few dozen hits, all sorted by relevancy—probably a good way to sort them as opposed to sorting by favorite astrological sign.

Once I got past the requisite Lance Armstrong link, and dated white papers, way down on their list was a link for what the hospital did to treat it.  Three clicks later I actually got to the link. I was provided with information in an overview—click here, how to diagnose it, and treatment. The information provided in each link was pabulum, but at least they provided a number to call in case I was afraid of dying from testicular cancer.

Why the cynicism? I have been there, done that, and got the T-shirt.  When I self-diagnosed in 1984 in a motel in Amarillo all I wanted was answers; was I going to die, what happens next, what are my options, how long will it take, what will the experience be like, and when do I have to start?  My only resource for obtaining those answers was the Yellow Pages—younger readers may want to Google the term—in the night stand next to the Gideon Bible.

To assess whether I was being unfair with my criticism I went next to WebMD.  WebMD had more than 250 links, every one of which provided more helpful information than did the hospital’s website.  There were videos, PowerPoint’s, survivor comments.  WebMD knew why people would search for information on testicular cancer.  The hospital knew that being a US News & World Report Best Hospital was sufficient enough.  The hospital was wrong.

Were I seeking treatment today I would have immediately looked for an organization that understood what I needed from them than one that did not.

Next I tried to see what it would be like if after several rounds of chemotherapy I wanted to schedule a follow up appointment, or if as a prospective patient I wanted to schedule an initial appointment.  I found a link on the website and followed it to where you and I know it would end—a phone number to call to schedule the appointment.

My review of hospital websites tells me initially that this hospital is no worse than the others in its ability to schedule appointments online—that is why the person actually clicked the link. (Please note this is not a ringing endorsement of any of them.)

But the story gets better.  When I clicked the link I am taken to the page with the phone number to call to try to schedule an appointment—they made no mention as to whether this could be done with Bluetooth.  In addition to not meeting my need to schedule the appointment, I was presented with the following information—to me this is a lot like being on hold with Comcast when I am complaining about my cable service and being forced to listen to a recording of all of the other things they want me to buy.

  • Ethics and complains
  • Web services
  • Employment
  • Donating
  • Vendors
  • Supply chain
  • International commercial services
  • Media relations
  • Referring doctors (they used ‘physicians’ but I am trying to be obsequious—I can’t believe I spelled that correctly0
  • Email support
  • International patients
  • Health plan
  • Medical records
  • And a dozen other links

The one thing I set out to do, schedule an appointment, I could not do.  My experience was poor, and it is not even worth asking about whether I was satisfied with my experience.  This is what happens when you present your hospital online but do not involve people outside of the hospital in its design.

This could easily be your hospital.  So, here’s my point.  If you are going to have a website, why not have a real one?  One that serves patients, one that actually allows them to complete a task without having to pick up the phone or one that requires them to drive to the hospital.  Why not have one that is functional enough that if a patient went there wondering if they should seek a second opinion that they would choose your hospital?  Why not have one that if a prospective patient went there they would choose your hospital?  Why not have one that an existing patient, a sick patient, a paying patient, could complete a simple task online on their iPad?

Why not have a website that provided a remarkable experience for every person every time on any device?

Shift your thinking.  Take your bricks and mortar functionality and make it available online.  The only other question remaining to be answered is whether the woman I spoke with will happen upon this narrative.

What Patient Experience could have been

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Whether one is running at windmills as a quixotic muse, or trying to bisect an elephant with a licorice whip, to anyone observing those actions it makes no more sense than having a lint collection.

Example 1: Let us say that someone walks into a nail salon and requests a manicure and a pedicure. The salon’s owner says “We only do manicures here. You have to go across the street for a pedi.”

You get the manicure, and as you are leaving the owner asks you to complete a survey about your experience with her establishment, and then she asks you to recommend your friends.

Example 2: You call the company who provides your cable television, your internet, your wireline, and your mobile service to tell them that your cable is out and that you have a question about your wireless bill.

As you wait on hold you hear the message repeated over and over for forty-five minutes that this call may be recorded for quality purposes. When you are finally afforded the opportunity to speak with a hominid about your cable outage you are told to call the cable service number. When you ask about your mobile bill you are told those questions can only be answered between 8 AM and 5 PM Mondays through Fridays. As you are about to explain that it is 10 AM on Tuesday the operator disconnects the call.

Within a minute you receive an email from the firm asking if you would complete a brief survey about your experience with them

Example 3: (stop me if you see where this is headed) It is 6 AM. You are going to be charged for parking.  You have passed through a lobby that is as ornate as anything in one of Dubai’s finest hotels.  You and the lemmings are seated in the admissions waiting room alone.  Each of the admittors (first-person singular present passive indicative of admittor–I had to look that up) is sipping from their mocha cappuccinos. You are not because you have not been allowed to have anything to drink since the last republican administration.  As you sit and wait for your turn to be admitted you are reminded of the last time you were at the DMV to have your driver’s license renewed.

A single television, which seems to be tuned to al Jazeera, is suspended overhead.  As there is no wifi, your only other option for killing time is the copy worn of Highlights magazine announcing the upcoming 1969 moon landing.

You complete the admissions process, finally.  You ask to receive a copy of the hospital’s customer experience survey, an opinion form, or whether they have a comments box.  Check D—none of the above.  When you ask why you are told, “Mister this is a hospital.  We make you better.  That is the only experience we care about, and it should be the only one you care about.”

As the anesthesia enters your blood stream, instead of counting backwards from infinity, you are left wondering why you couldn’t self-admit the night before using your iPad.

Example 3 could also been an example of someone trying to schedule an appointment online or through the call center. It could have been someone requesting the medical records. It could have been someone trying to understand Medicare. It could have been someone trying to pay their bill. It could have been someone deciding where to buy healthcare. It could have been someone seeking a second opinion.

What hospitals do not understand is not that it could have been all these someone’s…it was and it is.  Every day more people ‘visit’ your hospital online and on the phone than walk through the Dubai lobby, and nobody is asking them about their experience.

A remarkable experience every time for every person on every device.

Improving Patient Experience: Why not try something new?

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Success and failure are often separated by the slimmest of margins. Sometimes success hinges on how you present your idea. It is possible to force the circumstances via rapid evolution to pass from problem, to possible solution, to believable, to heroic? I believe so.

Permit me to illustrate with frozen chicken. Several hours before dinner I threw the frozen chicken breasts into the sink, choosing to thaw them with water instead of the microwave. Some twenty minutes later while checking emails I wondered what we were having for dinner. Not to be outdone by own inadequacies, I remembered we were having chicken. I remembered that we were having chicken because I remembered turning on the hot water. The only thing I couldn’t remember was turning off the hot water.

I raced to the kitchen. My memory of having forgotten to turn off the water was correct. Grabbing every towel I could find, I soaked up the man-made lake that had appeared on the hardwood flooring.  While draining the lake I thought about how I might answer to my wife if she happened to return to a kitchen during high tide. My first reaction, admittedly poor, was to tell her that I thought the countertop wasn’t level and that the only way to know for sure was to see which direction the water ran. Telling her the truth never entered my mind.

Once the major puddles had been removed, I worked on version two of the story, quickly arriving at a version of the truth that seemed more palatable—tell her I decided to wash all the towels. Why not get bonus points instead of getting in trouble? Version three looked even better. Since I was wiping the floor with the towels, instead of telling her I washed the towels, why not double the bonus points? I decided to wash the floor, and wash the towels. Husband of the year couldn’t be far off.

A few hours have passed. The floor is dry—and clean, the towels are neatly folded and back in the linen closet, and the chicken is on the grill. All the bases covered. A difficult and embarrassing situation turned into a positive by quick thinking.

A few of you have asked, let’s say we buy into what you are saying, how do you propose we create a remarkable patient experience? All kidding aside, it comes down to presentation. Clearly you can’t walk into a room with a bunch of slides showing that with all of your hospital’s efforts you have only managed to improve the experience of the patients from 7.25 to 7.27.  

The first requirement to turn stalled patient experience scores into a remarkable experience for every patient and every prospective patient every time is to quit focusing only on HCAHPs.  Think of it as a patient experience 12-step meeting; “Hi, my name is Paul, and my patient experience scores have flat-lined.”  See, that was not so difficult. 

And what needs to be done?  Why not take a deep breath and decide that the time has come to lead and innovate, and to stop relying on CMS to define what patient experience means for your hospital?

Here is a start for those looking for the first step.

Define the Total Quality of a person’s Experience (TQE). I use person instead of patient because prospective patients also have experiences when they visit family members, when they call the hospital and are on the web trying to decide where to buy healthcare.

TQE = Patient Experience (think HCAHPs) + Persons’ Satisfaction (all other touchpoints)

So, how did my chicken dinner turn out? I was feeling confident that I had sidestepped to worst of it. Overconfident, as it turned out. My son hollered from the basement, “Dad, why is all this water down here?”

 

Patient Experience: So what exactly do I do for hospitals?

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A number of you have written recently asking what it is I do and how I might be able to assist their organization.

I have consulted on innovating patient/customer experience for twenty-five years, having run my own consulting firm for the last seventeen. My clients on five continents have a combined customer base of more than two hundred million.

Less than twenty percent of health systems have a working definition of patient experience, and of those that do it is defined around HCAHPs. My definition is a remarkable experience for every person (patient and prospective patients) every time on every device.  Major parts of what hospitals lack are a strategy to provide that kind of experience to both patients and prospective patients.  This includes linking a mobile experience strategy and a digital strategy.  Setting this as a goal enables hospitals to focus on improving not just the care, but also on improving patient retention, patient referrals, attracting new patients, and making it easier to do business with the hospital.

In healthcare almost every hospital regards patient experience solely as defined by CMS. That ignores the experiences and level of satisfaction of those not surveyed, people seeking second opinions, and prospective patients. It ignores the experiences occurring prior to admissions, and those occurring post-discharge. It also does not address experiences formed from nonclinical processes like scheduling, admissions, billing, claims, and complaints.

More people ‘visit’ the hospital each day by phone and on the web than walk in the front door, yet nobody knows how those people rate their experience and whether they will ever return.

Eighty percent of prospective patient’s visit a hospital’s website before determining where they will buy healthcare.  Fifty percent of patients go to a hospital’s website to determine whether they will seek a second opinion. Nobody who designed the website ever asked one of those patients what information they would need to find to help them select their hospital. 

I help organizations answer these questions.

I start by helping them define a strategy for what I call the Total Quality of a person’s (patient and prospective patient) Encounter (TQE) with the hospital.  Next I complete an assessment of where they are with regard to meeting the TQE strategy including developing:

  • A digital strategy including:
    • Websites—most hospitals have hundreds of disparate URLs
    • Social media and social CRM
  • A mobile strategy for meeting their needs on various devices
    • For example, why can’t a patient schedule an appointment online or do some form of self-admitting on an iPad rather than arriving at six AM with everyone else?
  • A Call Center Strategy
  • A strategy for improving Nonclinical business processes 

Based on the assessment we jointly set priorities and a work plan to create a remarkable experience for everyone.

Attached are a few brief presentations that offer some detail.  Please let me know if we may schedule a call or perhaps meet.

http://www.slideshare.net/paulroemer/defining-a-global-patient-experience-for-your-health-system

http://www.slideshare.net/paulroemer/step-aside-hcahps

http://www.slideshare.net/paulroemer/call-center-strategies

You can reach me at paulroemer@gmail.com, or by phone 484-885-6942.

http://www.slideshare.net/paulroemer/how-to-acquire-patients-21677042

 

Patient Satisfaction: A Normal Experience Will Never Be Amazing

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Are Hospital Executives Ignoring Their Own Survey Results?

I was reading the survey results of ache.org’s 2012 “Top Issues Confronting Hospitals: 2012”. Two things jumped out at me. Improving Patient Satisfaction was in essentially a statistical tie with two other issues for third place.

Second, Decreasing Inpatient Volume was essentially in a statistical tie for third place for financial challenges that need to be addressed.

Ache.org only reported the results. It did not draw any conclusions. It seems there is little point in surveying people unless someone acts upon the results–I may have made the same point before regarding HCAHPs.

That said, I will offer a conclusion, one that can be derived without studying the numbers.  I bet there is close to a one-to-one relationship between Patient Satisfaction and the decrease of inpatient volumes.  Fix one, fix the other.

I like that the survey labeled the issue of patient ‘satisfaction’ instead of CMS’ patient ‘experience’.  Every patient, and every prospective patient has an experience with the hospital. However, not every experience is satisfactory, and normal experiences will never be amazing.

Why not have your goal be “A remarkable experience for every patient every time and on every device? If that doesn’t work you can always erect another billboard.

Patient Experience: Not understanding UX and UI is killing Patient Experience

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UI and UX seem to be two terms that have yet to make their way into healthcare. One way I like to think of the application of design thinking in hospitals is to compare the hospital’s lobby to its website.

Millions were spent to make the lobby user friendly, to create a remarkable first impression.  There is a receptionist and maybe a sign or two pointing to the ER or the Lab.

The website is a different matter–as is the call center.  The website’s homepage offers the ‘kitchen-sink’ to visitors, patients and prospective patients. Dozens of links, Flash, every phone number you may ever need.  Users can learn about the board and make a donation. They can do everything except find the link they wanted. 

Ninety-nine percent of visitors are either patients, people trying to decide if they are going to seek a second opinion–from some hospital other than yours, or prospective patients trying to make a healthcare purchase decision. The average person spends seven seconds on a web page looking for what they want.

What that tells me is the average person is leaving the average hospital’s website unsatisfied and with a poor experience. Why is nobody interested in improving that experience?