Healthcare: Are Executives Failing To Lead?

The expression used by authors who write about espionage in the Soviet Union concerning the fate of lesser dissidents is, “They were sent to count the birches.”  In other words, they were exiled to Siberia.

In the U.S., perhaps because we have fewer birches, and because we have a more temperate climate, we use a different phrase, especially when an employee fails to meet expectations.  The easiest way to fail to meet expectations is to fail to act unless of course, nobody expects you to act.  When asked when their health system is going to address improving access and engagement, some executives reply, someday.  There are five days in the work week.  Someday is not one of the five.  Instead of telling the vice president of customer service that he or she is being sent to count the birches, we tell the person that he or she will be given severance pay.

The term severance originated during the French Revolution.  More particularly, it refers to the executions of the French ruling class.  The guillotine.  “Off with their heads,” to tie it to the phrase in Alice in Wonderland.  Those whose heads were about to be severed would offer to tip the executioner in the behest that he would sever their head in a single cut.

(Nota bene: I could not find any references to support political correctness was important at the time of the French Revolution.  Hence, I chose to use the pronoun ‘he’ in the previous sentence.  Today, if beheadings were de rigueur (a French term having nothing to do with beheadings), there are those who live among us who would lambast me for my use of the pronoun ‘he.’  Those individuals (the politically correct crowd, a crowd to which I do not belong) would prefer a more inclusive pronoun when conjugating the verb to behead—he beheads, she beheads, he, she, or it beheads.)

Severance pay.

In our vernacular, the French term, severance, makes our term severance pay infinitely more benign.

In business, as is also the case in healthcare, with things having to do with information, and information systems, and information security, there are Chief Information Officers—CIOs.  Another use of the acronym CIO, when CIO’s fall out of favor, is Career Is Over.  Those individuals are given severance pay.  Had there been CIOs at the time of the French Revolution, their severance pay would have had a more ominous meaning.

Please permit me to share one additional idea tied to a piece of history.  In 1862, at Fort Leavenworth, Kansas, President Lincoln established the first of what would become one of twelve national cemeteries even though Lincoln knew the country still faced several more years of conflict.

What makes Lincoln’s action particularly noteworthy to me is that when he established Leavenworth as the first national cemetery, the Union army was losing the Civil War.  But losers do not establish national cemeteries. A president presiding over a losing civil war does not set up a national anything unless he has a vision and he truly believes the Union was going to win the war.

Lincoln had a vision and he was confident of winning.  People who lack vision and confidence rarely win anything.  This holds true in business.

There exists a solution today for everything with which healthcare is wrestling. I have yet to meet with a healthcare executive with a vision and the confidence to solve consumerism, access, and engagement.  The tools exist.

You can put a stake in the ground today and decide to change how patients and prospective patients interact with your system and with their care and wellness.

Or you can wait until someday.


Why Is Your Hospital’s Cyber Security So Insecure?

Even though we don’t always know when we are wrong, somebody knows, and they are not shy about telling us.  This is particularly true with regard to spouses and significant others.  The phrase my wife uses to let me know when I am wandering too far from my sandbox is, “I know, but”.  So I suggested to her that when she talks to me she should begin  by saying, “This conversation may be recorded for training and quality purposes.”  The person being trained is me.

I went to Google Search and typed the five letters, ‘men ar”.  The first hit is “Men are from Mars, Women Are from Venus.”  Five letters. A direct hit for your search.  Google did not reply with ‘men are idiots’ or ‘men argue’ even though fifty-percent of the population believe those responses are equally valid.  Google knows what you were looking for, sometimes even before you know.

Sit. Roll over.

There are windmills, and there are windmills (Man of la Mancha).  Businesses, including hospitals and health systems, believe their enterprise is secure from cyber attacks.  Other people believe the earth is flat and that we never landed on the moon.

Believing something does not make it true.  Most healthcare executives believe their data is secure against attacks.  They sort of have to believe it.  If they did not believe it, they would have a major effort underway to secure it.  With all due respect, however, I bet I can prove that your hospital’s cyber security is not secured against 80% of the cyber threats to your system.

2016.   MedStar.  Big hack.  Very vulnerable.

You don’t have to believe me; just read today’s news headline about WikiLeaks. Amid a trove of documents released by WikiLeaks that allegedly contains “the entire hacking capacity of the CIA” is chilling evidence that everyday devices like smart TVs and cell phones have potentially become critical tools in the effort to spy on American citizens.”

“When we think of a security hack, when we think of risks, we think of computers, phones, and tablets.  Things connected to the internet. Things with IP addresses.  Things WITHOUT IP addresses (and there are more of these than you think). All Internet of Things (IoT).  All Wi-Fi enabled devices can be hacked. Hackers can steal data, conduct espionage, and cause physical damage.”

The CIA was hacked.  Hillary was hacked. Russia hacked the U.S.  Logic should tell us that the level of encryption used by the CIA is many times better than that used in the private sector.  If the CIA can be hacked, it is beyond naive to believe that the enterprise data of hospitals–and payers–are safe.  We learned last year that putting your server in a bathroom does not work.

There are only two types of businesses.  Those that have been hacked and those that have not been hacked yet.  Your Chief Information Security Officer should be telling your board, “We have not been hacked yet.”

In fact, everyone – every public and private sector organization needs to operate like the Department of Defense does.  When it comes to how they see their networks, systems, and devices they work under “assumed breach”.  They look at it that way because their vast experience and money spent on protecting everything because they’ve already been breached.  It is hard to swallow that even the most knowledgeable security professionals – who are doing their best work – are still vulnerable – but they and their systems are.

But if you accept that you’ve already been hacked, you have a better chance of protecting yourself than if you live in denial.

Most of us have no idea that things that do not have an IP address are just as vulnerable to hacking as laptops.  Those things include all the following:

  • medical devices like heart monitors
  • implantables
  • smart TVs
  • thermostats
  • wheelchairs
  • elevators
  • HVAC systems
  • security cameras
  • energy systems
  • copiers
  • printers
  • VIOP phones
  • smart refrigerators
  • smart lightbulbs
  • elevators
  • motion detectors
  • alarms
  • window and door sensors
  • programmable coffee machines
  • personal devices used by your staff, patients and visitors that are connected to your Wi-Fi

Every single thing in a hospital that uses software to communicate to something else can be hacked.  The average hospital has more than 100,000 unsecured entry points that are vulnerable. Large health systems have more than 1,000,000 vulnerabilities, most of which do not have an IP address.

But what if you could fix all those problems right now?  What if you could protect all your systems, your patients, and your employees today with minimal effort and for minimal cost?

What if everything that was vulnerable and open to attack could be made invisible to any type of cyber-attack?  A technology to do this exists.  I saw it.

The tool discovered all the IoT vulnerabilities listed above for a health system.  The tool was demonstrated using a few of the system’s security cameras.  One minute the cameras were present on the display of the hospital’s IoT devices.  A few clicks later those cameras disappeared from the screen.  Those cameras still functioned but now they were invisible to anyone trying to hack the system.  The technology can discover all of your system’s vulnerabilities.

And even better, if someone breaches a device in your system, you know it the moment it happens and you can turn off the hacked device.  You don’t have to read about it in the Washington Post.

The technology works at health systems as large as the VA.  People who believe they’ve built a foolproof cyber plan should be waiting to be proved wrong.  If you want to learn more, let me know. Within twenty minutes you will see your risk in a real demo. And better yet, you will see how to take that risk to zero.

Patient Experience: The Terrible, Horrible, No Good, Very Bad Experience

In my thirty years of consulting, I have noticed a recurring theme when it comes to firms that give lip service to innovation.  Often, many people only recognize the window of opportunity by the sound that window makes when it slams shut.

If you think your role in your organization is too small for you impact innovation, try spending the night in a room with a few mosquitoes and you will understand how small things can make a significant impact.

There are two distinct camps when it comes to understanding how consumerism should be applied in your organization.  Your leaders are in one camp.  Your patients and customers are in the other.  Just because you are confused does not mean they are.

As you know, I’ve been the guy screaming ‘fire’ when it comes to patient and customer access.  During my run, it occurred to me that I have grossly understated the severity of the access problem.  My typical rant has started and ended with the statement that nearly 100% of access occurs in the call center.

My understatement comes from the fact that my statement ignores all the failed access attempts. The number of failed attempts, both online and on the phone, greatly exceed the number of successful attempts.  Any even for those attempts that are successful, the user experience is lacking.

For example, 70%-80% of the people who go to your website to accomplish something cannot do what they wanted.  Their attempts at access failed.  However, those who simply went to the website to read about their health system or their payer are in luck.  They are rewarded with thousands of irrelevant links to browse.  For some reason, companies view their website as a digital repository for every bit of information they’ve ever produced.  It’s sort of like healthcare’s self-styled Wikipedia.

Sorry for my digression.  Call centers are also a terrific way to generate hundreds of failed access attempts each day.  People call.  Those who have a bad experience speaking with your employees, or who give up while being placed on hold, or who give up while being transferred to another person, don’t call back.  Not only is that bad for business, it degrades patient care. Many of us who have called about a health issue have found it to be too much trouble to get to the right person, or have been instructed to leave a voice message simply decide to take it upon ourselves to figure out how to meet our need.

People do not want to work hard to manage their care or to do business with your firm.

Whether your organization is a provider or a payer, having a call center has nothing to do with innovation.  In fact, having a call center to manage access and engagement is about the least innovative thing any organization can do.  Having a call center is a detriment to your patients and customers.  If your patients could tell you how they feel about having to call you, they would show you a smart device and say, “Hey, Flintstone, this is the future.”

If you want to think innovative, ask “What would our organization have to do to meet the needs of our patients, customers, or members if we did not have a call center?”  Now the naysayers would have you believe that not everyone has access to a smart device.  That is a myth.  A myth that keeps call center consultants in business.  They want to help you improve your call center.  So why innovate a tool nobody wants to use?  It’s a harsh reality, but nobody wants to talk to your organization.  Netflix figured that out.  As have Amazon and Google and Facebook.  “But we are not Netflix or Amazon or Google or Facebook.”  You could be, and you probably should be.  Those firms spell innovation with a capital ‘I’.

There is a technology that can solve the problem with bad access almost overnight.  If you would like to learn about it send me a message.

Your firm is either pushing the envelope or it is in the envelope.  The good news is that in healthcare every organization is still inside the envelope.  All are equally bad when it comes to innovating access.

Customer Experience: Be afraid of the Green M&Ms

In the land of brown M&Ms, it is easy to hide another brown one.  The green one sticks out.

I have always been the green M&M.

The green one is someone who, when they have a bad experience, takes it upon themselves to speak out.  Or, in my case, tell the world about my bad experience.

Friday, I took my iPhone 6 to be fixed and repaired and in case they could not fix it, I asked them to then fix the 5.  I won’t tell you the name of the company—any inference you may draw as to its name from the italicized text is purely coincidental.

“If you fix the 6, don’t fix the 5.”

“Come back in an hour and a half,” I was told.  And I did. Come back.  Total cost, $100 for the repair and $30 for a hard case, strong enough to survive an IED. “We guarantee our work for 90 days.”

Five minutes later I was back in the store. “Do you guarantee it for 5 minutes?” I asked.

Twice more they fixed and repaired my phone.  Twice more it was neither fixed or repaired.  “You probably have a bad motherboard.  You should take it to Verizon and see what they can do.”

And so, I went.  I gave Verizon my 6 and they gave me an iPhone 7. I called the fixer people from Verizon and told them not to fix the 5.

I returned to the fix and repair place.  I asked them to refund my payment.

“We can’t do that,” a young man in skinny jeans told me—let’s call him Sparky.  Sparky explained, “For us to give you a refund, you have to give us back the screen we installed in your 6.”

Sparky was well on his way to bringing out the green in me.  “Maybe you should have mentioned that before I gave the phone to Verizon.”  I was about to melt all over the store.  “Besides, while you were at Verizon we fixed your 5. You owe us another $90 for that repair.”

I left without a refund, with a case I no longer needed, and without my 5.

I decided I was going to give the store’s owner a PhD in the impact an angry customer and social media savant can have on a business.  I began with their Facebook page. I did not click their Like Us icon.

I posted a message on their site.  The owner replied that she would not honor my request because I did not meet her request that I return the screen she installed on my 6. I told her she never told me to return the screen prior to telling me to go to Verizon.  We had reached an impasse.  I took Dylan Thomas’s advice—I did not go gentle into that good night.

I gave her my email address so she did not have to play out this dispute in public.  She replied that she was happy to continue to correspond on her store’s Facebook page.

That was her first mistake.  That said, I was ready to continue to play this out in public.  What she failed to recognize is that I define in public to mean all of the public.  This no longer had anything to do with my $130 and my hostage iPhone 5.  This had become a battle of wits, and she was unarmed. This toothpaste wasn’t going back in the tube.

I learned it is very easy to file a complaint with the Better Business Bureau.  J I quickly learned that the corporation of which she is a franchisee had its own Facebook page. J  And a Twitter account.  J  it took two minutes to find the email address of the corporate CEO.  Right about now the CEO is reading my first email to him. J

Oh, I happen to have accounts on most of the most popular social networking sites. J  And I learned how to upload a video to YouTube.  JJ

In the land of brown M&Ms the green one sticks out.  Did I mention that I am a green one?

In healthcare, like in every other business, there are plenty of green M&Ms just waiting for a reason to distinguish themselves from the brown M&Ms.  Green M&Ms cause you to lose revenues.  The also do not do much for the health of the patient.  People go to your website, get frustrated, and never return.  The same thing happens when they call your health system.  While your system is calling it leakage, your patients are calling and networking with everyone who is online.

The negative impact of a dissatisfied customer is far greater than that person’s bad experience.  You have lost the chance to care for them and all their future revenues.  And some percentage of the future revenues of some of the people that customer tells.

Novices will tell you that when someone has a bad experience they will tell ten people about their experience.  That may have been true when people thought of a digital experience as an AOL account and a Palm Pilot.

My advice?  Be afraid of the Green M&Ms.

Why Should Healthcare Consumerism be 99% Invisible?

The woman walking from the hospital should have been watching where she was walking rather than speaking on her phone.  She did not see the sinkhole until she fell into it, at which point see could see it in detail.  The doctor, upon seeing her in the hole asked if she was okay.  Learning that she was in pain, he wrote her a prescription and dropped it and a pen into the hole.

A few minutes later the hospital’s director of revenue assurance walked past the hole.  She too inquired about her health.  He opened his briefcase and dropped an insurance claim form into the hole.  You should complete the form, but I don’t think having fallen into a sinkhole is covered under your plan.

The chief patient experience officer happened upon the woman and wanted to know what had happened.  Speaking with her for a few minutes, he asked the woman: how was your experience with us prior to falling in the hole?  “Would you mind filling out this patient experience survey?” He asked.  He tossed the survey and a pen into the hole and left.

The woman considered her predicament.  She thought, at least I can occupy my time by filling out the forms until I am recused.

A consultant looked in the hole.  He went by the moniker, the Voice of Reason.  (You can buy Voice of Reason t-shirts during the intermission.)  He assessed the situation and jumped into the hole.

“Now we’re both stuck,” she said.

“That’s okay,” I told her.  “I’ve been in this hole before and I know the way out.”

If you try to recast consumerism and access and engagement and experience on your own, you may find yourself in the same position as the woman.  A lot of meaningless assistance.

My experience tells me that most efforts to improve it do so without any knowledge of what their efforts should look like when they are done.

Here’s a big hint. If you design it correctly, and you must design it, it should not look like anything.  Consumerism, access, engagement, and experience should be ninety-nine percent invisible to your patients and consumers.

That ninety-nine percent should all be behind the scene.  It should be built into your consumerism architecture and platform.  The one percent seen by the patients and consumers is the hands-on user experience.

It helps if you think of it this way. Consider your tablet or phone and the underlying operating system—iOS, Android, and Windows.  Your devices are easy to use.  Their use is intuitive. What you see is the one percent.  Far more than ninety-nine percent of what makes them easy to use is invisible.  The hardware, the architecture, the processes, and the applications were designed.

And users were involved in every step of the design. It is called human-centered-design. Users knew the design would meet their needs and be simple to use before a single line of code was written.

The good news for healthcare consumerism is that a lot of the difficult work has been done for you.  The devices and the operating systems already exist.  The only remaining task is for healthcare to define what it wants to do with those tools.

Healthcare can design an experience for patients and consumers on those devices that can do everything they want, and it can be designed in a way to give them the experience they want.

Healthcare has almost everything it needs to recast consumerism.  The only thing missing is defining what it should look like when it’s done and someone with the will to do it.

Healthcare Consumerism: Only One Of Us Was Male

There were four of us in the car and we were driving to the Dallas-Fort Worth airport.

Of the three, one of us was a male. The other three were not. The math is simple; the ride was not. The three non-male members of the group were each holding their smart phones and each of them was using Google Maps.

I asked, “How much further?”

‘Seven miles,’ one of them replied. Who replied neither adds to nor detracts from the telling of the story. Seven miles turned out to be a key data point. It was key because within ten more minutes we were thirteen miles from the airport.

I used to live in Dallas, and I knew we were now headed rapidly towards Waco. I thought briefly about adding my two cents, but as I already stated, one of us was male. Male and married.  I knew from personal experience that one-on-one was not a fair fight. Three on one was just plain silly.

And so while the three Amerigo Vespucci’s in the car continued to drive south—we were now sixteen miles from the airport—I played binary Sudoku on my phone–I lost. From an elevated ramp on the interstate, I asked, “Is that the Gulf of Mexico?” Fortunately for me, my remark fell upon deaf ears.

We don’t know where we are going, but we are making very good time. Or not.

Like people, businesses try to use tools to help them meet their needs. Sometimes they use the tools advantageously, sometimes they do not.

People call us; let’s build a big room and put a lot of phones in it.

People like to use the Internet; let’s build a website, and get someone to write an app.

Get a bunch of people to ‘like’ us on Facebook.

Your patients see what is going on, and they are each asking, “Is that the Gulf of Mexico?”

The Top 15 Ways To Improve Access & Engagement

I have developed a certain affection for the television shows Survivor, Naked and Afraid, and Life Below Zero.  If you are not familiar with the shows, their premise is to determine who among the contestants has the inventiveness and mental toughness to exist on a diet of insects or to live when the average temperature is forty below zero.

Having slept on the glacial face of a volcano at seventeen thousand feet, I fancy the notion of competing on those shows.  Give me a piece of twine and a pull-tab from a can of soda and I will build the iPhone 12.

So, last summer our power was out for four days because of a thunderstorm.  Instead of having to hunt narwhals while wearing nothing other than my skivvies—don’t try to picture that in your mind, I was ensconced in my home; no air conditioning, no television, and having to fight my way around obstacles at night with nothing to guide me other than my wits and the light from me cell phone.  The showers were cold, my soft drinks were warm.  I survived the first two days with nary a scratch.

By day three the lettuce was wilting and so was I.  I reflected on my not too distant halcyon days, days when I could sit in my air conditioned home and watch television shows about people trying to survive in a Brazilian rainforest eating grubs.  It was then I decided that were I able to survive my own odyssey I would put aside my dreams of living a wilderness adventure and make due with mowing my lawn.

I have no segue for this post, so here we go.

Chances are your health system’s website is a clunky old thing designed by the elderly (people over the age of thirty.)  The time to rethink what you want out of your website has come and gone; that train already left the station.  The only way to play catch-up is to dump the sclerotic vision that defines your online presence, and figure out what your stakeholders expect from it.

People who visit your website have an experience, they just have a good one.

The best way to not have to measure patient experience is to design such a good, interactive online experience that measuring it would be redundant. Design these things into your website and you will have the most progressive health system on the planet.

  • If half of your callers would rather have their needs met online, figure out how to let them do that. If you don’t know what they want to do online, ask them.
  • If half of your patients will seek a second opinion, give them a link telling them why they should stick with you
  • If half of your competitors’ patients are seeking a second opinion, give them a link telling them why they should pick you
  • If twenty percent of your callers have questions about their bills, use co-browsing and online videos to explain your bills
  • You know your patients are going to dispute their reimbursement, show them how to do that on your website; make videos explaining payer by payer how to do it
  • If a percentage of your patients want to speak with a clinician, make sure they can. Heck, make sure they can do it at a time convenient to them, which probably will not fit the hours of your call center.
  • If every single person who visits your website is either a patient or a potential patient, tailor all of its functionality to them—get rid of the other eighty links; links about the gift shop and posting baby photos online
  • If you have a scheduling center instead of a real call center—80% of your calls are not about scheduling—create a real call center.
  • Put a chat function on your website—how may I help you—and delete that silly contact us box that promises a response before the next full solar eclipse
  • Let callers on hold enter their phone numbers instead of having to wait, and have the next available agent call them back
  • Let call center agents email callers
  • If someone contacts you through your website, respond to them within an hour
  • Let people schedule appointments online
  • Since a lot of people who are considering buying healthcare from your system visit your website, give them something to do when they get their—how about a customer portal where nonpatients can store and track their health data like they do with apps on their smartphone, a portal whose data you can monitor.
  • Since only a fraction of your callers and website visitors are in your EMR, make sure you can meet the needs of everyone who isn’t—those people are called customers.

Prevent people from leaking at the start of their experience.  Design an experience focused on keepage, not leakage.  None of these features are difficult to accomplish using current technology.

If you do all of these things you will never have to worry about measuring patient experience.  You will already know it is great.  And maybe then we can ask why everyone in Washington is so concerned about building a wall to keep out the Canadians.