Explaining a new concept to those whose new concept quotas are full can be challenging.

Sometimes when I am in a meeting whose tedium has it spiraling into a black hole, I tend to lose my train of thought.  Like the one I was in the other day.   I find myself inventing things to satisfy the voices in my head.  In that particular day, if I had had a box of toothpicks I might have set about building a cold fusion device.  But alas, I was armed with only my wits; in other words, I was helpless.

Undaunted, I began playing a virtual game of Trivial Pursuit with the others who were likewise trapped.  Of the redhead two seats down, I asked the question “Name a reptile with four letters in its name.”  I envisioned her, without thinking, I do not know if this was a genetic flaw or simply a misfiring synapse she replies “Spider.”  I knew at that moment she and I would not be splitting a croissant at the next Mensa meeting.  Then I envisioned her getting mad at me because in front of everyone I would have announced that spiders are not reptiles.  By the time I would have told tell her that ‘spider’ was spelled with six letters I would have been hyperventilating so badly that the meeting coordinator would have had to put a grocery bag over my head—paper or plastic?

So, back to the concept of buying into new ideas.

What if you were asked to become the new manager of the New York Yankees, and before you make your decision you are told you may watch the third inning of each of their games?  Innings one and two, and four through nine were out of bounds.

You had to base your evaluation of the team on only a fraction of the available information. Kind of a silly notion.  Who would want to make a decision with only a fraction of the information?

Almost every hospital in America does that every day when it comes to evaluating patient experience.  They look at a fraction of the information that makes up patient experience.  Why?  Because that fraction is what CMS defined as the entirety of patient experience.  Why else?  Because money is involved.

And here is a little secret that hospital CFO’s and hospital boards have either overlooked or misunderstood.  The amount of the penalty trifles in comparison to the size of the revenue gain that could be made if hospitals focused on patient retention and referrals that could come from satisfying patients.

HCAHPs.

HCAHPs surveys are like only looking at the third inning of a baseball game to judge how to improve the team.  HCAHPs surveys are based on data that is months out of date.  How does one realistically fix a problem associated with a single patient that happened six months ago?  Don’t believe me?  Can you remember how the service or food was at the restaurant you dined at last December?  Of course not.  If you filled out a customer satisfaction survey tomorrow, would you believe it would change anything at the restaurant based on your six month old experience?  How clear would your recollection be.  What could the restaurant change to make you want to return?  How would you know if they changed it?

This process is fruitless.  The only point, the only reason hospitals address patient experience through the blinders dictated by CMS is because of the penalty.  Ding-dong, Avon (substitute your favorite patient experience data selling firm) calling.  Would you like to pay us for your own data?

I get the impression that saying you do not want to buy patient experience data is like saying ‘no’ to the teenager selling magazine subscriptions.  That firm, you know the one, rings your doorbell and asks, ‘Would you like to improve patient experience?”  Recognize two things.  It is a loaded question—you cannot sleep at night if you say ‘no’.  More importantly, paying for patient experience data year after year has nothing to do with improving patient experience.  Did it improve the experience of your patients?

If the survey data indicated that Nurse Ratched did not smile enough, what course of action did you undertake?  You hired the coaching firm—you know which one, you hired the survey data selling firm—you know which one, and what was the result?  Nurse Ratched smiled.  You spent more than a hundred thousand dollars to find out that Nurse Ratched was the problem and to make sure she smiled.

What did you get for your expenditure as relates to how people perceive your hospital?  Nothing.  Why nothing?  Because the now smiling Nurse Ratched only attends a very small percentage of your total patient population.  Getting her to smile has no impact on the satisfaction of all of the other patients and all of the prospective patients.  There is no ROI on paying for smile coaching or data.

Fixing Nurse Ratched is like basing your decisions on the third inning.  If you only follow the CMS guidelines you will never improve patient experience.  Viewing CMS as though they came down from Mount Sinai with the stone tablets will get you nowhere.  What if in addition to Moses, Fred, Sally, Joe, and Leslie also had stone tablets, but those people stopped to check out the burning bush and were delayed?  I know my analogy is a stretch, but I am writing late at night.

What questions were on the other tablets, what questions is your hospital ignoring?  How about, “Is it easy to do business with the hospital?”  Could you schedule an appointment without spending an hour on hold—could you do it with a click of you mouse?  Did the hospital help you file a claim?  Could you admit yourself the night before on your iPad?

Surveys and CMS do not address the level of dissatisfaction from not being able to do those things.  Forget for a moment that you work at the hospital.  Become a patient.  Show up at six AM, along with all of the other people who were told to be there at six AM.  You and they have not had anything to eat or drink since the night before.  The line to be admitted looks like a Greyhound bus just dropped off forty teenagers at McDonalds.  It reminds you of why airports schedule all of their departures at the same time.  It makes you ask why someone has not come up with a better idea.

What if instead of sitting on the waiting room, waiting to be processed like cattle on their way to the slaughterhouse, you were able to self-admit at a time and on a device of your choosing?  What if you were treated as a customer, a customer whose value over the next twenty years was valued at one hundred thousand dollars; a customer whose family members increased the value of your business by another few hundred thousand?

If hospitals focused on the revenues that could be made instead of the money that might be lost everyone would benefit.

Every patient should expect a remarkable experience every time, for every interaction at any time on any device. 

That remarkable experience, in addition to their care, will contribute to their decision to return to that hospital and whether they will refer others. 

A large part of a patient’s experience comes down to this; How easy are you to do business with?

Most patients would rather be anywhere but the hospital.  They expect to be in pain, inconvenienced, frightened and humbled.  The nearest experience for comparison most of them have regarding sleeping overnight and having their meals delivered probably comes from having spent hundreds of nights in hotels. That plays into their expectations, but hospitals do not ask about their expectations ahead of time.  Instead hospitals allow CMS to define the parameters for good and bad experiences, and they package it in a survey of a few dozen questions.

What do hospitals miss if all they rely on are surveys and purchasing their own data.

1. Surveys only focus on patients.  They provide zero data on prospective patients, ignoring all of the potential patients whose opinion of the hospital is defined by a visit to the hospital’s website, calling the call center, and social media posts by prior patients.  The number of people each day who “visit” the hospital online and over the phone greatly exceeds the number treated each day.  What was the experience of the visitors? Did they select the hospital?  Why not? How many potential patients were lost because they had a bad experience online or on the phone? If patient experience warrants spending millions on business development, sales and marketing, and the hospital’s lobby, is spending an equal amount on their web presence and call center not of equal or greater value?
2. Hospitals do not know the experiential expectation of a single patient.
3. Patient expectations of their experience begin to be set the moment they first feel a lump, or when their child has a high fever in the middle of the night.  For some their experience continues well beyond when they have completed the survey and left the hospital.  Whether those interactions provide a remarkable experience will help determine where that person will go the next time they decide where to be treated.
4. Hospitals should add to their efforts to improve patient experience by also looking at touchpoints and processes that affect the experience of every patient.  They could start with their website and call center.  They should look at those business processes that map almost one-to-one with the hospitality industry.  To name a few, those processes include scheduling, admissions, billing, claims, food service, and housekeeping.

I spoke with executives at three different hospitals last week and heard the following.

A hospital CEO said, “The greatest improvement I could make to improve patient experience is to add parking and improve the food.”  An executive in charge of quality said, “Seventy percent of our patients are Hispanic.”  When I asked about their plan to make their website available in Spanish she told me they had no plan.  An executive in charge of customer satisfaction at a third hospital said they were having problems with their call centers.  Those call centers are open between the hours of eight and five-thirty.  Even cable television companies provide better hours.

I do my best writing from ideas I get while running.  For those who are thinking, ‘it must have been a while since you’ve run’ I saw that one coming.  I’ve run since I was fourteen, minus the last twelve months.  I started again Monday; even my teeth hurt.

By the way, it may be time to fire Ferguson.

I was listening to Imus this morning as he was interviewing a famous music promoter, Jerry Weintraub.  The promoter relayed a story about one of his clients, John Denver.  Mr. Denver was constantly complaining about a number of things on one of his European tours, and he demanded the promoter come speak with him.  Here’s a replay of the conversation.

“Yes. Well, he was in Europe, and he was on tour. And everything was wrong. He hated everything. He hated the venues. He hated – the airplanes were no good. The sound systems were no good. Everything was no good. And he said to me, you know, I’m going to fire you; everything is wrong here. I said, yeah, I know, I know.”

I sat down with him; I said, John, everything is going to be fine. He said, why? Why? I said, because I fired Ferguson. He said, why did you fire Ferguson? Why? What is firing him – going to do? I said, he’s been responsible for all the things that you’re troubled by: the hotels, the sound system, the venues, yada, yada, yada. And he said, Is it going to be OK now? I said, Yes, I’m putting other people in. Great.

And that evening, Denver and I went out to have something to eat. At dinner, I said to him, John, you know, I feel really terrible about firing Ferguson. He asked, why? I said, because it’s not like you and it’s not like me. Besides, it is almost Christmas, and Ferguson has a family.  And John Denver said to me, I agree with you; it’s not like us. What can we do to help the guy? It’s really not like me. I’ve got to help him. I said, I’ll put him in another area in the company. He’ll be fine. We’ll take good care of him. He said, that’s great, I feel so much better.

Of course, there never was a Ferguson.” Where does Ferguson work in your hospital?

It might be an interesting exercise to discover just how much patient experience data your organization has purchased since when it began purchasing data.  I bet there is a lot of it.  It might even be a more interesting exercise to discover what improvements in patient experience, if any, can be tied directly to the aforementioned purchases.

Have you ever wondered where your hospital keeps all of that data?  I envision all of the purchased data being locked away and stored in hundreds of shoe boxes, healthcare’s version of Al Gore’s lockbox.  If that is the case, maybe the data can be streamed and sold to Al Jazeera—the more liberal readers are throwing tomatoes at their screens.

Hospitals have reams of data, and there are plenty of firms trying to sell them even more; customer experience data, business analytics, EHR reports.  What does a hospital do with all of that data?  Does it have more data than it can put to good use?  Of course it does.

Here is a little something for all of the folks in the hospital’s business development and sales and marketing, a little something that all of that purchased data does not tell anyone.  The average spend for an inpatient procedure for one hospital across the sixty procedures they listed was around fifty thousand dollars. 

It is estimated that a person is admitted to the hospital once every seventeen years and goes to the ER once every three years.

The average cost for an ER visit is around twelve hundred dollars.  So, net net, the value of an average patient, when viewed as a potential asset of the hospital that needs to be managed is around $225,000 over their lifetime.  For a family of five that comes to one and a quarter million dollars—roughly the equivalent of treating a sprained ankle in Beverly Hills, or treating Michael Douglas for “throat cancer”.

So here is the question nobody seems to have answered and few are trying to answer.  Why not spend the hospital’s scarce resources trying to keep that patient as your patient for as long as they both shall live?  (Please pardon the wedding metaphor.)  Even car dealers have figured this out, they want you to buy all of your future cars from them.

If a hospital starts losing a laptop a day, they will soon figure out how to stop losing laptops.  Twenty-five hundred dollars versus two hundred and fifty thousand dollars.  A hundred-fold difference.

Imagine with me that you just underwent one of the above mentioned sixty procedures.  Statistics show that in the next seventeen years you will undergo another one and have six trips to the ER.  As will every member of your family and your extended family and your friends—tuck away these two words for later; retention and referrals.

The hospital wheels you to the front door; you clutch your bouquet of roses and wave at the people who helped you.  The hospital does not know, will not know, and has no way of knowing whether your wave meant until next time, or goodbye.  The scenario resembles a first date in high school where one person says, “I’ll call you” and the other person has no idea whether they will ever hear from that person again.

Two hundred and fifty thousand dollars may have just waved goodbye.  Plus the two hundred thousand from every member of your family, plus your extended family, plus everyone you did not refer.  That amounts to a lot of plusing. 

What if every hospital, your hospital, took its business development and marketing strategy and divided it by its inverse?  The current strategy, the one for which the hospital pays hundreds of thousands of dollars a years for a Chief Marketing Officer has nothing to do with retaining you as a patient.  (Let me share an unspoken secret, a secret everyone knows—existing patient experience management strategies exist for one reason, scoring high on the HCAHPS surveys.) 

Press Ganey, Studer, the Disney Institute, et al.  Your hospital’s 1980’s growth strategy; an NPR radio public interest spot about the hospital’s ability to treat beriberi, the billboard showing the hospital’s beriberi specialists, and a shotgun telemarketing campaign trying to find people inflicted with beriberi.  Don’t know what to do, buy more data, and hire a coach.

What is the return on investment of this approach?  A million people hear the ad, ten thousand people a day see the billboard, and the hospital pays thirty dollars a call to solicit beriberi patients.  How many drive-byes result in a new patient, how many telemarketing calls? 

Whether one call in a hundred or one call in a thousand results in a new patient, it does not matter, it is not a good business decision.  Three thousand plus dollars, or thirty thousand plus dollars to get someone to walk through your door.  Are your margins so good that your hospital’s current approach is cost-effective? 

Even if you acquire this patient, will the person return?  Who knows?  Who should know?  Your hospital should know. It should be focusing its resources on knowing and ensuring two things; retention and referrals.

My phone had ceased to function as a phone and so I was at the Verizon store with little to do.  I was counting backwards from infinity, twice, and I got stuck when I got to the number fifteen; I hate when that happens. 

I think it originally what I encountered at Verizon may have happened like this.  One of Verizon’s mail clerks, Ferguson, wanted to change his phone to the iPhone. He went to the Verizon store and learned he could trade in his old phone for a shiny white iPhone and receive a thirty dollar refund for doing so provided that he signed a two-year contract.  Deal done.

Ferguson went back to work in the mail room, and since nobody actually mailed letters and packages anymore because the world had gone digital, he started to think.  He knew he was going to get the iPhone, and a $30 refund had no influence over that decision.  He thought others would have acted accordingly and would have upgraded to a new phone even without the rebate.

Using his Jot Stylus on his iPad, he channeled Jethro Bodine and commenced to ciphering.  Roughly one hundred million mobile customers.  Figure twenty-five percent of them upgrade their phones each year.  Ferguson estimated the refunds cost Verizon seven hundred and fifty million dollars a year.  Now Ferguson guessed that those customers, if for no other reason than the panache factor of having the newest, coolest phone, would have upgraded even without a rebate.

Ferguson’s hamster wheel started spinning and he wondered if the desire to have a new phone was so strong that customers would still upgrade their phones even if Verizon charged a thirty dollar upgrade fee instead of offering a thirty dollar rebate.

Ferguson gets an idea.  He scribbles out a postcard on the back of his rebate card, addresses it to Verizon’s CEO, and hand-delivers it to him on the executive bocche ball court.  The postcard posits Ferguson’s idea as follows; If we charged customers the same amount to upgrade instead of rebating them, we could swing revenues by one and a half billion dollars.

Ferguson is now the Executive Vice President of Innovation & The Hell With Customer Experience.

Nota bene, I paid the thirty dollars.

Segue.

Does the fact that there are so many different definitions of patient experience among hospitals belie that fact that there is no definition of patient experience? 

Most patient experience definitions seem to be missing a few things; they do not exist much beyond the four walls of the hospital—sort of like EHR, they are highly, if not exclusively, focused on interactions clinical interactions and on things having to do with HCAHPs.

Every day many more patients and prospective patients interact with the hospital using the internet and their phones. Much determination on patient satisfaction is made in these venues. Retention, referrals, and ‘win-backs’ are influenced here. “Buying” decisions are made and lost here.  The hospital either met or did not meet expectations.

Yet most hospitals invest almost nothing in the two areas that have the highest number of touchpoints.

If I were asked to define a goal for patient experience I would recommends “A remarkable experience for every patient every time, obtainable on any device, at any time, at any facility.”

To move towards the goal of being remarkable, one must talk to patients and observe them in those touchpoints that all patients use. Surveying patients puts out the fire, it does not prevent fires.  Their bad experience has already happened. 

Surveying patients, paying for patient experience data, and paying for coaching does nothing most of the people in your radius of influence; for all of the prospective patients and nothing for former patients whose next visit to the hospital you never learn of because it happened somewhere else.

The level of satisfaction for these individuals is determined outside of the hospital’s four walls.  There are gobs—a consulting term of art—who never decide to become patients or to become patients again that make their decisions based on a hospital’s internet presence and how their calls are handled.  HCAHP surveys will not entice them to become your patients.

They belong to a group called the unsurveyable.   They also represent a healthcare spend higher than your total revenues for last year.  Why not pay attention to their experience?

Yesterday began with the quest for a bunny my dog hid somewhere in the house, and no, we have not yet found it.

Today started with two gerbils having escaped from the cage in my son’s room.  One of the gerbils, the one I know to be the ringleader, actually has noticeable biceps.  Like in a movie of a prison escape, I halfway expected to see a chain of small tissues tied end-to-end, secured off at one end to the running wheel, and the rest of the makeshift rope dangling over the side of the cage—I decided to stop the sentence after having already used four commas.  I have trapped the gerbils in his room and will sort out that problem later.

My more immediate need is figuring out how to remove a bit of malware from my PC.  Google suggested the name of a firm and the software to use.  The link took me to a page with screenshots, sort of a Malware Removal for Dummies approach.  That approach worked only long enough when step one, start the system in safe mode, failed to work.  Fortunately, the site provided a number for me to call, and call I did.

“Oh that is not good,” replied the lad from India.  “If it will not start in Safe Mode, you need a Microsoft Certified technician for which Best Buy will charge you $350.  However…today only…we will provide you with this service for only $250.”

“No, you will not,” I said as I hung up.  I then did what any Neanderthal would do in this situation; I banged on the PC really hard and began hitting a number of keys all at once.  At the moment I am downloading the malware fix for $220 less than my buddy’s suggested approach.

Customer experience.  I had one.  Every customer does.  The rub is being able to know whether the experience was good or bad, and if it was bad what you can do about it.

May I make a suggestion?  Pick you battles and your platforms; have a targeted plan.  Facebook does not constitute a targeted plan.  Some social media experts would argue that having a Facebook account is a necessity.  It may be necessary, but it is far from meeting the criteria of being both necessary and sufficient.

Last week I read that a certain children’s hospital has more than 700,000 ‘likes’ on Facebook.  Good for them, or not.  To me that is a little like seeing how many Twitter followers you can collect, or how many friends you have on Facebook.  It is about as relevant as you ‘liking’ Justin Bieber or Justin Timberlake—maybe there is something to the name Justin.

That hospital has not had 700,000 patients in its combined history, so having 700,000 is almost irrelevant.  Hospitals in its area also have hundreds of thousands of ‘likes’ and still acquire patients.  It may not have gained them a single extra dollar of revenue.

Is there appoint to having someone holed up in IT, marketing, or business development whose role is to try and perform Social-CRM acts of prestidigitation that in turn yield delighted patients?  Or are all of our efforts simply boosting our feelings of self-worth, sort of a, we don’t know where we are going but we are making really good time, approach to patient experience?

Mindless self-promotion. (I borrowed some of the best phrases here from Gabriel Perna’s May 24^th piece in healthcareinformatics.com.)

Here is what I think.  Your hospital cost somewhere between eight and nine figures to build, and salaries and operating expenses run well into the millions.  The lobbies in some hospitals probably cost several million dollars to build.  And why is that?  Because you know it is important to make a good impression. 

Permit me to get way off track for a paragraph.  The above photo of a hospital’s lobby looks more like a Hyatt than a hospital.  That seems to be a trend.  Make the lobby feel customer friendly.  And yet, most hospitals would rather close than acknowledge that patients are also customers.  If people can be both customers and patients, why not have programs that improve both patient experience and customer satisfaction?  They are not the same.  QED.

But guess what?

Every day more people ‘visit’ your hospital on the internet and on the phone than visit the facility.  How much did you spend on making impressions in those venues?  Can patients and non-patients accomplish the same tasks on the phone or by visiting the internet as they could if they went to your hospital?

If they cannot, your hospital has wasted its money. The navigation for most hospital websites appears to visitors like someone took a five hundred piece jigsaw puzzle and dumped all the pieces on your monitor. Most visitors will spend a few seconds looking for the corner pieces and then will give up.

If your hospital has not fully rethought its entire web strategy in the last two years it does not have a web strategy.

If you need a hint for one here’s mine—a remarkable experience for every patient every time that is mobile and available 24 x 7 on any device.

It will cost less than building a new lobby and will have a much higher ROI.

Today started on an off note with the question, “Did you find the bunny?”  The question resulted from the two furry legs dangling from my dog’s mouth.  He would not drop it so thinking I would find it before he did whatever dogs do with bunnies I let him inside knowing he would hide it somewhere in the house.  Apparently I was wrong about being able to find it.  I did however find my putter wedged under the cushions of a love seat along with a remote for a television we had donated to Goodwill because it had no remote.

I then dropped in to see the neighbors, great people who were born on the other side of the pond we call the Atlantic.  They’ve been in the states for ten years and we got to talking about sports, baseball and soccer—soccer, which I learned is a sport in their country.  Tying the two together, I learned that yesterday they attended a soccer match at Yankee Stadium.  The husband explained that he could still see the place on the ‘pitch’—an erudite term of affection for the field on which all English sports are played—where baseball pitchers pitch the ball. 

He also mentioned that the dirt track at the stadium had not been sodded.  After a few minutes of questioning I learned that the dirt track was in fact the infield.  I then suggested that without developing a better understanding of baseball that he was likely to lose his green card.

The conversation then turned to their trip tomorrow to DC.  They were going to see some of the things, like the really tall pointy thing with the scaffolding on it, the building with the round roof, and the lake.  I’ve been to DC a lot, but I could not tell them how to get to any of those sites.

After further questioning, I learned that the tall thing they wanted to visit is actually the Washington Monument, the round-roofed building is the Jefferson Memorial, and the lake is the reflecting pool.  Maybe they have square lakes in England.  I suggested that since we thrashed them in the war—think 1776—they could spend a little more time learning our history.  The husband replied that the bit about England losing the war was a canard, it did not lose the war, it merely retreated. Like General MacArthur, England would be returning to finish its business.

Is the notion of patient satisfaction a similar canard?  When people come to the hospital to ask a question or request information do you tell them to come back tomorrow?  Of course not.

Why then when people make a request of your hospital on the hospital’s website does the website not give an equally quick response?  In fact, why do people have to request a response?  Why can’t they get what they want or do what they want online?  The reason they can’t is because the website causes the person to reach a dead-end without being able to complete the task they set out to complete.  The website is broken. 

Most hospital websites have dozens of dead-ends and missing functions.  I have not seen a hospital website that could not be greatly improved.  I have also not seen my pancreas, but that does not mean it is not there.

Surveys show that about half of the people who are thinking about being treated will use the hospital’s website to decide whether they will seek a second opinion.  A purchasing decision is about to be made.  Stated another way; many will make the decision not to purchase based on the information on your site. 

Another phrase that can be substituted for the term ‘second opinion’ is that prospective patients want an opinion other than yours.  So let’s say the hospital Our Lady of Zero Retention treats a thousand patients a week.  The two extremes if you do the math are that all of those second opinioners picked your hospital.  That is good news.  But what if five thousand people went to your web site for a second opinion and each of them selected another hospital?

And you know what is really scary if you are the hospital’s CEO or a member of the board?  You have no idea who went to your web site to look for a second opinion.  You do not know who picked your hospital, you do not know who picked another hospital, and you do not know what influenced the decision.  That is a tough way to run a business.

Instead of retrofitting your lobby so that it looks like the Four Seasons why not retrofit your hospital’s website?