Nowadays you can’t swing a cat without hitting someone who has a newer and better idea about how you can fix your organization. More often than not, those ideas include the word design: user design and human design are two of the culprits.

And that is the problem. Every business process in every firm is the outcome of human design. Somebody—a human—designed it. And chances are very good that they did not design it well.

Instead of thinking, ‘How would I design this,” executives need to be asking, “How would other people—humans—want to use this process?”

To be effective at what they do, firms need to go from user design to user-centered design. They need to go from human design to human-centered design. When talking about what makes one business more effective than another business, one word, centered, makes all of the difference.

I’ll use healthcare to illustrate the point, but the same issues apply elsewhere.

If you have ever called your payer or your provider, you know what I am talking about. Whoever built the call center you called spent way more attention selecting the color of the carpeting that was installed than they did figuring out how to solve business problems.

The same logic, minus the carpeting, applies to their websites.

Nobody ever sat down with a patient and asked, “What do you want to do, and how do you want to do it when you contact us?”

Neither did CMS when it came up with its list of what constitutes a good patient experience.

If you are a healthcare executive, consider doing this. Sit down with a patient, and have the following conversation.

Executive: “What do you want to do when you call us?”

Patient: “I do not want to call you.”

You can take it from here. If you get stuck, let me know.

I had a meeting this morning with two very well-known healthcare executives. I had a meeting this afternoon with my dentist. It is unfortunate that the timing of the two meetings could not have been reversed. A tried to multiply my calendar by negative one, but that does not work with time travel.
You see, I have, or to be more accurate, I had four temporary crowns; my four front teeth. The crowns met a sandwich and the sandwich won. So there I was meeting these two executives for the first time, and I was wearing a smile that made me look like I could have been the grown version of the banjo-playing boy sitting on the bridge in the movie Deliverance.

Affixed to the back of a bus I read an advertisement from TD Bank—America’s Most Convenient Bank. Back in the day that Deliverance was just a dream in some producer’s eyes, banks were prohibited to cross state lines for fear that they would evolve into what they are today. As a result, banks started making baby banks—brand banking.

Back then, banks were like gas stations and convenience stores—hence the name—and they had to be close to where you lived. Location, not services, defined convenience.

Like healthcare.

The only thing healthcare has in common with the term convenience is the letter ‘c’.

Today convenience in banking means the ability to do what you want, every time you want to do it, at any time you want to do it, and using whatever device you want. So that is what banking did. Banking transformed itself from bricks and mortar to bits and bytes.

They did this because they knew that once they made it easy enough for everyone to stroke all of their financial data on a customized platform, and deliver services from that platform that people would not change banks.

Healthcare should be doing the same thing, but it isn’t. It could. It could also have big data if it collected all of the data people store on their healthcare apps and wearables, but it doesn’t. Whichever firms are the first to collect and analyze that data will not only win, but those firms will be the first to truly manage the health of the populations they serve.

But until then, if you are looking for convenience think about going to 7-Eleven.

What if we’ve been going about consumerism all wrong?

Sometimes we make a mistake. Sometimes the mistake makes us.

Doing long division and forgetting to carry the 3 is a mistake.

Our biggest mistakes often come from focusing on the wrong things; like watching the big chase scene in a James Bond movie and wondering what kind of a watch Bond is wearing. (It’s an Omega Seamaster.) We allow ourselves to get distracted from what is going on around us.

Not allowing customers and patients and members to interact with you when and how they want is a distraction.   And it is fatal.

Sometimes success comes from paying attention to the smallest details. Small details can be a deal breaker. I may have mentioned that I am a bit of a clothes hound. Two of my favorite clothiers are Paul Smith and Ted Baker; British designers. What I like about them is their attention to those small details. For example, they line their blazers with an interesting and attention-grabbing silk material. At least one of the button holes is sewn using a bright thread that screams, ‘Pay attention.” They even design the inside of their shoes and line the inside with a fabric comprised of pictures.

Small details help. Unfortunately, when it comes to healthcare, being able to answer the phone and meet a caller’s need is not a small detail. It is a fail-safe point. Miss this detail, and you have lost this person as a patient or member.

Consumerism and commerce without an experience that makes it easy for people to interact with you have a business value of zero. If you define easy as a remarkable experience for every person every time at any time using any device, it is simple to understand just how short your organization falls from the ideal.

I believe the best way to address this problem is by designing a concept I may have just invented; Customer Experience as a Service—CXaaS. If you do this, the other C’s, consumerism and commerce, will fall right in line.

If you don’t, they will simply fall.

Of course, you could keep doing what you are doing today, customer experience as a disservice.   But that hasn’t really worked. Has it?

I came up with the concept of healthcare CXaaS over the weekend—it was a slow weekend. I searched for it on Google and didn’t find anything. That tells me that it has either been tried and failed, or it has never been tried.

An advantage of a CXaaS strategy is that integration and implementation with business partners can be both omnic hannel and immediate.

I know it seems like I write every time I fly, but there is something about the entire customer service experience that compels me.

If the Donald were to ask me what I’d like to see come out of his first term, I would tell him to make TSA and the airlines work with Swiss efficiency and German timeliness and Thai customer experience.

But, what about ISIS? You ask. My guess is that if we asked for volunteers from Texas, big guys from the oil fields with pickups and a shotgun or two suspended from their truck’s rear window, that we could teach the ISIS boys to spell infidel in Yiddish.

The TSA pre-check line was closed. Only the government would make you pay for a service and then not provide it.

TSA. Even enough said? Not really. TSA has probably screened a hundred million people since it began. If I do a task more than once I reduce it to its bit parts and figure out how to make that task efficient and effective. I figure out how to do it correctly, and how to ensure that there is no wasted effort.

The TSA does not appear to have ever analyzed how to do what they do. The screening process and experience differs by agent, time of day, airline, concourse and airport. One would have thought the after doing anything a hundred million times that the process would, if nothing else, be perfect. Even if by accident.

But it remains a crapshoot. Bags, liquids, shoes, belt…Next week I am flying naked. Frisk me. It might be the best thing that happens to me that day. I wonder if I will want a cigarette afterwards.

We boarded the American flight two and a half hours after the scheduled departure time. I used the one hundred and fifty minutes to amuse myself. I went to American’s website. Looked them up on an agglomeration of social media sites, and Googled them Would it surprise you to learn that American has executives in charge of planning and strategy and customer service and customer experience and digital design and its call centers?

I had time to fire off a few emails to the handful of corporate email addresses I found. I asked paradoxically, “If you were to fire all of those people, would anybody notice?” It’s like asking whether it would make any difference if you were driving and a t the speed of light and turned on your headlights.

The gate agent announced that they were trying to expedite the boarding process. I announced loud enough for those around me to hear, “That boat has already sailed.”

Twenty-seven priority boarding categories were announced before those of us relegated to steerage class. Boarding had ground to a halt. Getting people to move down the ramp was like trying to pass a camel through the eye of a needle—I thought I would wax biblotic.

The woman in front of me was wearing tight, giraffe-print pants, pants that should have been outlawed in forty-three states. But here is where it gets interesting, at least in the places of my mind from whence I hear the voices. The shirt she was wearing was printed with the phrase, “Comcast means placing customers first.” I almost bit through my tongue when I read it. Do you see the irony, or am I just quite the cynic?

Airline mottos, prior to the jet age, were something like, “We love to fly and it shows.” My suggestion for American’s new motto is, “We don’t like you any more than you like us. So sit down and shut up.” It’s too long to get it to fit nicely on a T-shirt, but it gets points for sincerity.

In an attempt to ameliorate their employer’s poor service, the flight attendants distributed bags of peanuts. The Giraffe lady asked for, and received, two bags. There giraffe prints was about to be stretched even further.

Flying and healthcare. Do something for the first time and you expect a few bumps and bruises. Do it a few million, and if the experience still stinks, shame on you.

The health system of provider executive I spoke with this week said her system receives more than eight million calls each year. Among overseeing her system’s digital strategy, she also oversees its call center. When asked how effective she felt her call center was, she beamed with pride and said, “I rarely get a complaint.”

For those of you with whom I have not spoken, I should let you know that I never ask a question without having already done my homework. I had made several phone calls to her system and I wasn’t beaming. Head in the sand management.

Eight million calls is a lot. They should have discovered how to improve the experience after the first six or seven million. The same holds true for payers and PBXs. After doing anything eight million times you should be exceptional at it, should should be setting the world on fire with you efficiency and effectiveness.

Back to American Airlines for one second. The gate agent for my return flight, Dianne, Brandon, was unbelievably good. People waiting to board were commenting on how exceptionally cheerful she was.

Once I was seated, I found an American link to to write a commendation for Dianne. But the link’s form didn’t let me post a commendation. Perhaps the link was never tested, or had never been used before. If you happen to know anyone at American, please tell them about Dianne for me.

The circle of life.

If you have fifteen minutes, you can learn exactly what your patients and members and customers think of your health system and their health insurance firm.

I offer this as an exercise for your organization’s executive leadership because they are the only ones who can make a difference. And, they because they are the ones the most removed from understanding what patients and members and customers actually experience.

It is a casebook Catch-22 in its purest form. If they already knew the outcome of what I want them to do during this fifteen minutes and have not taken any steps to solve the problem, they would be negligent for having not solved the problem. If they did not know the outcome of what I want them to do during this fifteen minutes, they would be negligent for having not asked the question.

To complete the exercise you will need a:

• Board room
• Board or your executive leadership team
• Projector
• Laptop
• Phone—any phone will do

In this exercise, we will focus on providers, but it works the exact same way with payers. Note: the exercise must be done on a weekday before 6 PM.

Assemble the group; the board or your executive team. Login to the laptop and navigate to your website. Using your time wisely, try to schedule an appointment.

It did not work, did it? I knew that without even having to call the psychic hotline.

Half of all of your patients and family members and caregivers and prospective patients attempted to complete this step and one hundred percent of them got the same result you did.

Thirteen minutes left. Call your health system and try to schedule an appointment. Does anyone know what number to dial? (In order to actually schedule and appointment, it will take much longer than the thirteen minutes you have left, and it will probably take at least two calls. But in those thirteen minutes, you should get a pretty good feel for what it is like to be a patient or family member or caregiver or prospective patient.)

I do this exercise and others prior to speaking with executives. I pretend to be a new patient, new to the area, and someone who does not remember the name of my payer. The best results I achieved required thirty-seven minutes and two calls.

The CEO of a very large health system recently tried to schedule an appointment for himself by phone. He failed. He is now buying tens of millions of dollars of call center stuff. That will not solve his problem, but he did not want to hear that.

To those health systems that want me to award them partial credit because their website allows someone to find a doctor, guess again. People who go to the website for American Airlines, do not go to the site to find a flight. They go to the site to purchase a ticket.

Patients and customers who go through the trouble of going to your website or calling your firm do so for one reason—they want to do something.

Now that you know what it is like to be a patient or family member or caregiver or customer, think about redesigning how they experience your system.

“If this is a medical emergency, please hang up and dial 911.” May we waste a minute of our lives to dissect this phrase?  It makes me nonplussed. “Please hand up and dial.”  Did they add that bit of instruction because there are some people who dial without hanging up?

I think the phrase in on par with the pictorial instructions in restaurant bathrooms that show you how to wash your hands.  If you require that level of assistance, no amount of hints are going to help you.

When you arrive at the ED, there are always people on hand doing triage.  That is because the people going to the ED do not have the skills to decide for themselves what constitutes a medical emergency.

If asked, half of the people in the ED could not tell you how a thermos knows whether it is supposed to keep something cold, or whether it is supposed to keep something hot. (I am one of those people.)

Each of us has heard the same voice message when we call our doctor.  What bit of our medical training are we supposed to use to know what to do?  My qualifications to know who to call are limited to the following.  I studied math. I’ve been a patient. I know how to dial 911.  If answering that question requires more skills than what I have, I am out of luck.

Big segue.  Kim Kardashian meets healthcare.

I’m not sure exactly when it happened. Maybe it was at HIMSS, but I don’t think so. It’s been going on for decades. As a matter of fact, I don’t think healthcare got its marketing strategy from Kim, I think she got her’s from healthcare.

The Kardashian marketing strategy. Draw attention to yourself. Love me. Pay attention to me on social media. “Like me.”

Healthcare’s marketing strategy. Draw attention to yourself. Love me. Pay attention to me on social media. “Like me.”

Follow me on Facebook. And Instagram. And Snapchat. Read about ME. Like ME. And when you do, you’ll quickly discover that there is no there there.

It’s a marketing strategy that is all hat, and no cowboy. That dog don’t hunt.

If you disagree with me, tell me.

Whether your firm is a provider, a payer, or is in life sciences, this is how your patients, members, and customers view when you market to us.

• Billboards showing a photo of your urologists. NPR commercials referencing some procedure that makes your system the go-to system for that treatment. Television commercials that tell you, if you want to schedule an appointment, go to ourladyofonline scheduling.edu. And when you go to that website, you cannot even find the word ‘scheduling.’
• Television commercials trying to entice you to hire them as your payer. They feature Stepford wives and Stepford children having a picnic. Life could not be more wonderful. Until you file a claim. And then you learn just how wonderful wonderful can be.
• Miracle drug cures that you and your doctor just don’t know about. The same Stepford-wife approach, but using different wives. A thirty-second commercial extolling the benefits of the drug. Five seconds explaining the drug’s benefits. Twenty-five seconds warning you of the drug’s possible side effects. It could kill you, but you will have had a wonderful time at the picnic.

There is no there there.

The purpose of marketing is two-fold. To build brand awareness, and to acquire and retain new patients, members, and customers. But for your strategy to be effective, there has to be a cowboy underneath the hat.

Imagine, however that your marketing strategy was more aligned to Steve Job’s marketing strategy instead of Kim’s. What would your strategy look like?

When Steve marketed, it went something like this. “Do you want to carry every song in the world with you wherever you go?” Steve holds up a device that is smaller than a half-dollar. “Then buy this.” “If you want the Swiss Army Knife of electronic devices, then buy our iPhone.”

And here’s the kicker. If Steve said his device did something, it did it. His marketing commercial was not eighty-percent disclaimers. He didn’t make promises he couldn’t deliver. Steve never said, “You may or may not be able to send text messages on the new iPhone.” If anything, Steve over-delivered.

Healthcare marketing never over-delivers. So, what should healthcare marketing look like? How about something like these?

• “At ourladyofonlinescheduling.edu, if you call us about a need you are having, we will meet that need in a single phone call, at any time of day, and without transferring your call. And if you hate having to call us, at ourladyofonlinescheduling.edu, you can carry our entire system around on a mobile device; on any mobile device. And, you can do anything you want, at any time, every time. It will be as simple as using an iPhone.
• “At com, if you call us to learn how to file a claim, we will help you do it correctly the first time you call. If you call us to file a dispute, we will help you every step of the way. And we guarantee that your dispute will be resolved to your satisfaction the very first time you call us. No longer will we make you call and call and call until we wear you down and you simply give up—that was the old payersRus. And if you hate having to call us, you no longer have to. You will be able to do anything you want, at any time, every time. It will be as simple as using an iPhone.

If you are still confused about how to acquire and retain patients, members, and customers, I encourage you to show Warren Beatty’s movie Heaven Can Wait at your next board meeting.

In this scene, Warren Beatty, the CEO of a conglomerate that sells tuna, pitches the following marketing campaign to his board of directors.

“As everybody knows, we can tuna, and in netting the tuna, we kill a number of porpoises. Since they’re mammals of alleged high intelligence, there’s been an outcry. I would just like to ask you a question. We have a responsibility to thousands of shareholders of moderate means, less well off than the ecological groups fighting us.

If we were a football team, would you call this a winning season? Would you say we got a winning season? On balance, we’ve had an extremely good year. We’ve got a winning season. What do you do when you’re ahead? You don’t make mistakes. You don’t gamble unnecessarily. You protect your lead. You don’t pass from your own end. You make sure nobody gets hurt.

You got to use these guys in the next game. We won this game. We got to stay in shape for the rest of the game.

It’s like when everybody was supposed to stop eating grapes. I didn’t (stop) because I like grapes. A lot of guys will keep eating tuna.

What if we had a good-guy tuna company on the porpoise team? A lot of guys would buy that so their kids wouldn’t get mad at them. We don’t care how much it costs, just how much it makes. If it costs too much, we charge a penny more. Would you pay more to save a fish who thinks?

We handle all lawsuits that way. Let other teams build plants in the wrong places. Let the other quarterback throw a gurgle so newspapers get hold of it and stockholders don’t like it.

Let’s be the team that makes the rules, plays fair, that gets the best contract, that’s popular. Forget these nuclear power plants until we know they’re safe. That refinery, we’ll have to relocate it. It’ll cost us millions, but we don’t care, because we’ll come out ahead in the end.  That plastic stuff we’re making, we’ll have to stop. We’re not here for just one game. We’re going all the way to the Super Bowl! And we’ll already have won!

Healthcare needs to want to be the good-guy tuna company.

Or, let them eat grapes.

It’s a humid Sunday in Philadelphia. The air is thick enough to cut with a feather. The people in Phoenix like to tell us; at least it’s a dry heat. My reply; so is a convection oven.

Sunday’s are a day of rest. Sundays in June, your day of rest comes with an extra serving of humidity—hold the sprinkles. On Sundays in June, your serving of humidity makes you miserable. And when you are miserable, you want to be less miserable. And when you want to be less miserable, sometimes you think of eating something cool. In the Philadelphia area on a humid June Sunday when you are miserable and when you want to eat something cool you think of eating an Italian water ice—those of you in the Midwest may need to use Goggle to figure out what a water ice is.

When you order a water ice, you can order toppings for it. Sprinkles and Gummy Bears and jellybeans.

You cannot get a water ice with a topping of sweet potatoes or broccoli. And the reason you can’t is because people don’t want them. Sweet potatoes and broccoli ice are not why they got in a hot car on a hot, humid, June Sunday. That is how the water ice business model plays out.

And then there are the payers. And their business model.

Let’s take a brief look at their business model. Suppose it is a hot humid Sunday in Philadelphia. You had planned on going out for a watermelon water ice. But before you did that, you needed to file an insurance claim with your payer. You have to file a claim because the last time you went to get a water ice on a hot, humid Sunday, your water ice caused some of the jellybeans and Gummy Bears to freeze together. And when you swallowed them they blocked your airway and you had to go to the ED.

An emergency room physician removed the blockage, but she could not save your water ice; it had melted. The hospital sent you a bill for their services. You called your payer and explained what happened. But your health insurance policy did not cover a jellybean/Gummy Bear blockage.

Each of us has called our payer trying to find out what we are paying for, and why they aren’t paying. (You’ve got to admit, calling themselves payers is about as ironic as things can get.)

The phone conversation with the payer goes something like this. Although we are not able to pay your claim, even though we would really like to pay it, there are many other reasons for you not to cancel your insurance. With your insurance policy, you get all sorts of extra benefits. We call them toppings. For example, if you sprain your ankle on a Tuesday, and if you need an Ace Bandage, we do not charge extra if you want to get a different colored Ace Bandage—it’s a member benefit. We recommend a pink bandage for girls and a blue one for boys. Another topping we offer is a ten percent discount for people who are injured while traveling to outer space.

People who pay for health insurance do so every month. Payers like to call those people who send them money members; like what country clubs call the people who send them money every month. And just like country club members, health insurance members get a little membership card to put in their wallet as a testament of their membership privileges.

If payers were to survey their members asking why those members purchased insurance, those surveyed would reply, “Because when we file a claim we want you to pay it.”

Members don’t want toppings, no matter how good those toppings may be. The payer business model could be very simple. People send us money. And when they need money, we send it to them. But if that doesn’t work, maybe on Tuesdays, your payer can give you a water ice with a broccoli topping.

Sometimes these little blogs write themselves.

Let me begin by explaining the Waffle House Theory of Patient Experience, and by telling you what the acronym IDD stands for.

The Waffle House Theory of patient experience is as follows. If the Waffle House where you live is open, there is a zero percent probability that your provider’s or payer’s call center will solve your problem. You see, the cool thing about Waffle Houses is that they are the restaurant industry’s equivalent of nature’s cockroaches—no, I am not saying that they have cockroaches. I am simply pointing out that neither rain nor sleet nor snow will prevent them from being open. So, if they remain open, no matter what, your chances of having your needs met by calling your provider or payer are zero.

(I’ve even thought that if healthcare firms changed their recorded message to, “Thank you for calling Comcast, that message might help to level-set their caller’s expectations as to what type of experience they should expect.)

IDD stands for Inattention Deficit Disorder. I think IDD is a deliberate collaboration between providers and payers to not meet the needs of patients, members, and consumers. Its premise is simple—if we do not acknowledge that a problem exists, how can we be expected to solve it?

Last week I was speaking with an executive vice president of a large payer. As a courtesy, he asked me not to mention his name because he was trying to protect the guilty party, namely his firm.

The situation is the following. His wife had been treated at a large health system. The names of the system, and the name of the payer, are not important. They are not important because you can substitute different providers and payers and it would not change the discussion.

She received a letter from her provider stating that her reimbursement claim for several thousand dollars had been denied. Two sentences. One dollar amount. Zero explanation. She started calling.

Dialing for dollars.

She called the provider. She called the payer. She asked for an itemization of the denied amount. Eleven total calls. “You have to request an itemized copy of your bill.”

“That is exactly what I am doing,” she told the person. (It does not matter whether she told a provider’s employee or a payer’s employee; knowing which it was would not affect the outcome.)

“I can’t give you that information. You have to send us a letter; something with a stamp on it. And you have to prove you are you.”

“But, I am me. I am the person to whom you are speaking.”

So, back to my conversation with the EVP about this flawed process. “Is there anything you’ve seen that can make this process better?” He asked.

“There are two possible solutions,” I said. “One of them requires that your wife likes to sing.”

“She’s in the church choir,” he replied.

“Well then, since it looks like she will be spending way more time than she wants being placed on hold as she tries to solve her problem, I find it helpful to find an activity that she enjoys to occupy those long periods of inactivity. If she likes musicals, I would recommend that she use all of her time on hold to learn each of the roles of Les Misérables. That is what I do.” (In case you are interested, I will be presenting a one-man performance of Les Misérables this summer at the National Theater in Washington, D.C.)

The EVP did not sound too keen on my first idea. “Well,” I said. “There is another way to solve the problem, and this way works one hundred percent of the time. Tell her to stop calling. Tell her not to reply to any of their emails, and if she receives any letters from either firm, just tell her to throw them away.”

“But we probably owe them money,” he said.

“I’m not suggesting that you do not pay the bill. I am only suggesting that you quit working hard trying to figure out what it is for and how much of it you actually owe. After a few months, she won’t have to call any more. They will call her. And when they call, they will be very helpful. The whole idea is for you to put the monkey on their back. Get things to the point where their whole focus is on convincing you to send them money. You’ll be surprised by how helpful they will be when they initiate the call.”

Dialing for Dollars: Part Deux.

The CEO of a large health system calls to schedule an appointment for himself. He does not know that his health system implemented the Waffle House Theory of Patient Experience in 1947.

He was unable to schedule an appointment.

Pshaw, you are thinking. (Apparently, pshaw is actually a word.)

Many of you are probably thinking that his health system is an anomaly. Once again, my response is pshaw. When you finish reading, call your health system and pretend that you want to schedule an appointment. By the thirty-minute mark of your call you will be screaming epitaphs into your phone—Sic (intentional error).

IDD—Inattention Deficit Disorder. It could also stand for Intentional Deficit Disorder.

If we do not know there is a problem, how can we be expected to fix it?

Well, now you know. Payers and providers make it very difficult for patients and members and consumers to meet their needs. Either they do not know that the problem exists. Or they know it exists, and they just don’t care.

You and I care.

There are a variety of ways for guys to prevent your spouse from adding things to the ‘Honey Do List.” I may have just created a new one.

We have several large, black exterior lights whose color has faded because of their exposure to the sun. Those faded black lights are attached to white boards, which are, in turn, attached to the home’s white stucco exterior.

I should have known better. I was trying to be helpful. Trying to do something without being asked. And so I went to the hardware store and purchased a few cans of black spray paint. Did I mention that the color of the paint is black?

The exterior lights protrude from the side of the house by about a foot. Someone smarter than me might have approached spray-painting the lights with a little more preparation. They may have approached the problem with a roll of duct tape and sheets of plastic to cover the white boards and the white stucco. Did I mention that the color of the boards and the stucco is white?

It would be easy for me to tell you that a sudden gust of gale force wind was responsible for changing the intended path of the spray paint as it left the can. But, there was no wind. The lights are once again black, but

The lights are once again black, but so are the boards and the surrounding stucco.  The refurbished lights look very good. High gloss black accentuated against a white background. Or, as it turned out, a background that is now white-ish.

Trip number two to the hardware store to buy two cans of white spray paint. White boards and white stucco, as I learned after I tried to touch up my overspray of the black paint, becomes a tad less white after ten years. So, try to picture my current dilemma. Black lights. Off-white boards and stucco. And a bright white repair job wedged between two of my new favorite colors; black and off-white. As I look at the results of my work, I am reminded of the Doctor Seuss book, The Cat In The Hat Comes Back, when the pink stain that spreads across everything confronts them.

Enough about cats.

Would you think less of me if I tell you about the voices? I was having trouble sleeping. The sheep-counting thing wasn’t working for me, so I decided to listen to the voices in my head. They gave me a choice between two tasks before they would allow me to sleep; listen to an entire Celine Dion CD, or tie together four disparate facts in a way that made sense. I opted for the facts.

Fact One: Marie Osmond’s never-ending commercial for weight loss. “I’m Marie, and I lost 50 pounds on Nutri-System.” Marie must have been really big.

Fact Two: The never-ending commercial about Mario Perillo advertising trips to Italy. “You may remember my father.”

Fact Three: The spam emails I get from someone named Olga who wants to meet me.

Fact Four: The spam emails I get from Mr. Mumbagi telling me that my uncle left me a large inheritance

And this is what I came up with.

“Can’t wait to meet you, Olga,” I replied. But I wanted to lose weight before I met Olga, so I called Marie, and asked her to tell me about her weight loss secret. Then I emailed Olga, and I suggested that she meet me in Italy. But I didn’t know anything about getting to Italy, so I called Mario Perillo’s son to find out what it cost to go to Italy—it isn’t cheap, even if you bring your own Chianti.   And that left me with no other choice than to reply to Mr. Mumbagi’s email to ask him to expedite the payment of my uncle’s inheritance.

Sooner or later, all of the facts make sense. The circle of life.

The circle of life plays out pretty much the same way in healthcare. Examine these four facts—they happened to the same person who was spray-painting his exterior lights.

Fact One: A patient goes online to try to find the date and time of his appointment

Fact Two: A patient calls his health system to find out what day his appointment is. However, he does not remember the name of his doctor at the specialty practice.

Fact Three: A patient arrives for his hand surgery only to discover that the surgery does not take place at the doctor’s office

Fact Four: A patient calls the health system to ask where he is supposed to be for surgery

But what if our friend, the spray-painter with the bad hand, had an interactive app from the health system that would have made facts 1-4 irrelevant? What would have happened if the interactive app had sent him, or me, a reminder of his appointment that included the date and time and location and a map?

What would have happened is that the surgeon, after asking why my hand was covered with patches of black and white spray paint, would have performed the surgery. And the poor patient would have returned home with his hand wrapped in bandages. And the patient’s wife, who wanted to chastise him for having spray-painted the white boards and stucco black, would have seen the bandages, and she would have been sympathetic to the patient instead of asking why the stucco was black. She would have directed him to his favorite chair, put his feet up on the ottoman, turned on Fox News, and brought him a glass of kale juice.

But there was no interactive app. There was no way for the patient to learn the location of his surgery. And so the patient returned home only to discover that a team of contractors had constructed scaffolding around his entire house, and had removed all of the stucco.

Healthcare’s circle of life.

Design an app.

Save a husband.