One reason I chose this title is because Amazon may be able to do it better than healthcare providers could do this, and they could probably do it in the blink of an eye.  Let us begin with this.

For two years we’ve all been besieged by the goings and comings of our fellow citizen, nay possible traitor in the eyes of many, Edward Snowden—no middle name available or required.  That in turn has led us to supposedly “learn” more about his former employer, the NSA—The Puzzle Palace. (My father’s former employer.)

Even so, I do not have a dog in this hunt.  Evidently, the NSA has been collecting data; a lot of data.  As a result of the uncovering of Mr. Snowden’s activities or proclivities, several journalists have won awards for their reporting of this story.

The Cliff Notes of the headline of the Snowden story could be stated as: Employee of organization publishes information about people the organization was tracking—clearly this is a bit of an oversimplification since the information that was published could involve national secrets.

Employee of organization publishes information about people the organization was tracking.

Now, if the organization in question was Amazon, Kayak, YouTube, or any other such firm, how would the dialog change?

To allow you to get back to what you are doing, let’s keep this simple.  Amazon.  You shop. I shop. We, she, or it shops.  And when we shop, what does Amazon do?  It recommends, based on the information it has collected about me, what movies I may want to watch—Mel Brooks, what books I may want to read—Lee Childs, and what items I may wish to purchase.

When an organization such as Amazon does this, we do not even blink. We do not shout “treason”. We may even think, “Aren’t they being helpful.”  We certainly do not think that Amazon just committed treason.  We do not jump to the conclusion that Amazon just violated our constitutional rights.

Catch your breath.  Big, awkward segue.

Hospitals.  Hospitals are the anti-Amazon, the ant-NSA.

How so?

Hospitals track everything.  If you went to any kind of healthcare conference and swung a dead cat over your head—not that I recommend you do that—you would hit several vendors selling you healthcare analytics, data warehousing, or business intelligence.

And why do they do that?  How do they use that to their benefit?  They do it to learn what else they should track.  Data collection.  Lots of data. Everything they know about the person whose data they track.

Here we go.

What is the monumental difference between the data accumulated by Amazon or Netflix and the data collected by hospitals?

The difference is that Amazon uses the data to initiate a two-way communication.  Based on this, we recommend that.

Healthcare applications—apps—do the same thing. “If you ate this, you are over the number of calories you should eat today.”  “You walked this many steps today, and you need to walk six-thousand more to maintain your planned fitness level.”  “You did not record having taken your medication today.”

These apps, apps used faithfully by millions of people every day, for the most part could have been written by two people working out of a closet in their basement.  Their users have no knowledge of the background of the people who developed the apps. 

Nonetheless, people use the apps.  They input their data, they get feedback, and based on that they do one thing or the other about their behavior.

So it seems that what is missing is that hospitals have reams of data on patients, discharged patients and former patients, and for the most part the only thing they do with it is use it internally.

So, here is my point.  What could be gained if hospitals did an Amazon, did a Netflix? Would hospitals reduce readmissions and improve population health if instead of simply collecting data they used the data they collected and made recommendations, or communicated wellness options to the people whose data they had collected?  Could they manage better the health of their population?

I think they could. What do you think?

Sometimes it is worth pointing out the obvious; or not. An analyst on CNN, talking about the missing Malaysian plane was explaining why it was so difficult to locate the plane. “Light objects float, and heavy objects sink, and a plane is heavy.”  The evolution of the lizard brain.

Years ago, because of the lizard brain, the government decided that for important decisions, decisions like launching nuclear weapons, the responsibility had to be shared between two people.  That is why two thumbs are required on two launch buttons.  I do not know how things are in your home, but in ours, for important decisions about things like deck furniture, there is only one launch button, and I do not have a user-ID.

Twice a year, in early spring and late fall, my wife and I do the lizard brain dance, and we do it about patio furniture. The spring patio furniture dance is more difficult than the fall dance because the metal patio furniture has been hibernating downstairs in the basement all winter; metal brown bears do the same thing.

Then, when the metal furniture awakens it has to be carried by hand, by the husband from the basement, up enough stairs to make me wish I had installed an elevator, to the deck—the deck that was just power washed by the same husband.  By now I am missing the snow.  I plodded along slowly like a trained pachyderm, a variety of furniture types raised overhead.

I was waiting for my neighborhood friends, guys like me, to set up lawn chairs and watch the parade, but then it occurred to me that they were either hiding from their spouses, or were having their own parades.

Our metal, outdoor patio furniture is unlike any other patio furniture.  Unlike others in that, according to my wife, our outdoor furniture was not built to live outdoors. Not in the winter, and not in the rain.  The seats and cushions were extruded from some unidentified made-material whose half-life was probably exceeds that of the fruitcake my grandmother made when I was twelve, but if it gets wet it may do a Wicked Witch of the West and melt.

Even so, with April being the month of showers, I know I will be hauling the cushions, the same cushions that I just hauled outside, back inside the first time we see a cloud drift overhead.

“They don’t melt,” I tell her.

“Are we missing a cushion?” She asks.

“No, I’ve been soaking one in the guest bathtub all winter.  It looks good as new,” I tell her.

“That is not the same as leaving it out in the rain.” So much for trying to make a point.

So, how do we tie this into something that hopefully makes this few minutes worthwhile for you?  I think that when it comes to assessing patient experience many hospitals think that when their patients are not in the hospital that the patients are hibernating safely and soundly and without a care in the world.

That makes it worthy to ask the questions, what do hibernating patients do?  Often they call the hospital.  They want access.  And how is access defined? A patient tries to schedule an appointment or a lab. A patient needs a refill.  Or has a complication from a medication or a procedure.

Here is why something as simple as being able to answer successfully a call is the first experience for many of people.  And guess what? If we cannot answer a call it does not matter how noisy the hospital is, or how communicative the staff is because that person will not hear the noise.  They will do one of two things, neither of which are good.  They will choose a hospital who can answer the phones, or they will go to ED. Oh, and they will tell others.

A colleague was receiving chemotherapy at a top US cancer hospital.  She spent three hours on the phone trying to schedule an appointment.  Now she spends her hibernation telling others not to go to that hospital.  Hospitals cannot put that toothpaste back into the tube.

If this fall they find any debris from the missing Malaysian airliner, my guess is that they will find a seat cushion.  That cushion will have survived a fiery explosion at thirty-thousand feet, and will have spent six months floating in seawater.  I will point that out to my wife just as soon as I finish carrying my deck furniture back to the basement to begin its hibernation.

There are three ways in which bipods can err.  We can make mistakes, make a social faux pas, or we can just be stupid.  A mistake is something like doing long division and forgetting to carry the one. An example of a social faux pas is practicing your one-man recital of Les Misérables on the flight home from the Beryl conference and because you’re wearing headphones forgetting that those who aren’t can hear you.  Being stupid involves something like being on the train to DC and hoping that you left your car keys in the car, because if you didn’t you will either be sleeping on the streets of Wilmington tonight or filing a police report and hoping they recover your new car.

So in the last twenty-four hours I have accomplished two of the three, and in case you are wondering, no, I was not doing any long division.  So, that was my day.  How was yours?

If you stay abreast of all of the comings and goings in healthcare, one of the first things you note is that there are a lot of comings and goings.

One of the more popular comings is trying to associate recoveries—recoveries of mistakes—by tying them to patient management.  Think of complaint letters, missteps, and plain old mistakes.

Recoveries are a good thing.  But before we waive the flag too loudly and shout look at me, perhaps we ought to see whether all we are doing is blowing out the match that started the forest fire.

Case in point.  We can only correct what we can see.  And, we can only see what we look at or at what we want to see—woe to those with eyes who cannot see.

It seems that in the realm of patient experience the only thing that people can see is inpatients.  The line of outpatients could be wrapped around the block, but if nobody is looking, they do not matter.  The same is true with discharged patients, former patients, and people trying to schedule a first appointment.

These are the people who make up the forest that is burning while everyone is putting policies and procedures in place to blow out the match.  If you are going to try to improve patient experience by not only dealing with recovery issues, let alone walking back the cat to prevent them, why not raise all of the boats—doesn’t work well with the match metaphor, but I’m feeling a bit punkish today.

What do you think?

While you mull this over I’ll be singing Bring Him Home while I am looking for my car.

So, two nights ago, a pretty aggressive rain storm—the local weather people call it an ‘event’—was blowing through my little town.  My neighbor was traveling, and I noticed that the door on his deck was wide open.  I mentioned the open door to my wife and she suggested we might want to call the police.

She suggested we should walk over and see if the Taliban had taken over his house.  Being supportive, she offered to walk over with me.  Just before I popped my head into his family room, I looked over my shoulder only to discover only to discover that her definition of ‘we’ was very similar to a former president explain that “it depends on what your definition of ‘is’ is.”

She was not over my shoulder.  In fact, she was not within a hundred feet of my shoulder.  She had decided to hang back. Perhaps she was thinking that she would be closer to the phone in case she needed to call 911 if she saw my bullet-riddled body convulsing on the rain-soaked deck.

This type of thinking is probably why I am also the go-to-guy in my family for all things that have six or more legs.  Get Dad to do it—he’s expendable. 

So, enough about why I am the poster child for our local therapist.

A lot of people are thinking it would be cool to be on the reality show “Real Housewives of 7-Eleven.”

A lot of hospitals are considering hiring a patient experience (PX) officer.

So, if your hospital is among those considering hiring a PX, what should you be looking for?  If all you want is someone to manage/monitor HCAHPS, you know more about what skills that person should have than I.  I call that role a ‘px’—lower case officer.

However, if you happen to believe that patient experience begins before someone is admitted and lasts well after discharge then read on.  If you happen to think patient experience is not just limited to inpatients, but also includes outpatients, discharged patients, former patients, people with labs and therapy, and prospective patients then read on.

If you are still playing along, my contention is that when it comes to hiring a ‘PX’—upper case, and knowing what to do with a PX, pay more attention to the person’s knowledge of the ‘X’ and less to their knowledge of the ‘P’.  After all, the hospital is chocked-full of people that understand the P-side, the clinical-side.

What most hospitals need is someone who can help them with visioning a remarkable experience for every person every time on every device, not someone who can squeeze out the last decibel of noise on the floors.

Hospitals should look for someone who can ask the right questions, the questions that make everyone else uncomfortable.  Questions like:

• What if every person could go from and to:

o   I need an appointment

o   I want to schedule an appointment online

o   I want an online appointment for today

• Can patients pre-admit using their iPad
• Can patients interact with their physicians online regarding their compliance with discharge orders
• Can readmissions be reduced by recasting patient experience
• Can patient experience play an active role in population health management

While that is not an exhaustive list of the types of questions a PX officer ought to be considering, it is a pretty good start.

Being efficient at population health management that doesn’t include the patients that comprise the population is pointless. 

Suppose that on Thursday a meteorologist, or a sociologist, or a philatelist came to my little town located west of Philadelphia with the mission of reporting to their constituents the weather in Downingtown, Pennsylvania.  From three days of observation they would report the following—it doesn’t snow, the grass is always brown, and they skies are always grey.

Would they be able to produce a report that provided an accurate assessment of the weather of Downingtown, or would they only be able to produce a report of the weather for those three days?  If those individuals tried to forecast Downingtown’s weather for the year based on three days of extrapolated data they would be ridiculed, even worse, they would be wrong.

The biggest problem with most population health management efforts is that they overlook a critical success factor—the health of their patient population throughout the year.  It is too easy to scrutinize a patient during the short brief period prior to their visit, during the visit, and just after discharge.  Those are only snapshots of someone’s health, snapshots that discount what is happening during all of the days and weeks and months when the patient is not front and center.

Perhaps the second biggest problem when it comes to tackling population health management, managing the health of the population, is that the effort must include the population. Mustn’t it?  What I mean by this is the following.  Let’s say a hospital has a registry of three thousand OBGYN patients, and it discovers that one thousand of them are overdue for a mammogram.  It contacts those one thousand, and five hundred women respond and schedule their mammograms.  

Clearly, scheduling those five hundred women is a good thing.  Addressing their needs passes the test of being necessary, but it does not pass the test of being both necessary and sufficient. Doesn’t it beg the question about what is being done to manage the health of the other two thousand women?  Doesn’t it beg the question of what is being done to manage the health of the other women in their radius of service?

The problem lies with providers’ inability to interact all of the time with all of the people—patients, discharged patients, former patients, and prospective patients, that comprise the population.

Most population health efforts are based upon what the hospital knows about you, the patient.  These efforts rely solely on the data they have about you; business analytics, data warehousing, EHR—Healthcare Information Technology.

The can slice and dice your data, and the more they have the better they can manage you.  If the hospital sees you once this year, they get more data to slice and dice.  If they see you twice this year they may have twice as much data.

But for how many days of each year does the hospital not know anything about the health of the patient it is managing?  Three hundred?  Three hundred and sixty?

Glenn Steele, Jr., MD, president and chief executive officer of Kiesinger Health System stated “Another really good example: When we, as a group of providers, whether it’s docs or PAs or nurses or pharmacists, when we hand an individual who’s got a chronic disease a prescription, we assume that they, number one, agree with our recommendations for the treatment, and we assume they’re going to get the prescription filled. Those assumptions are wrong between one-third and 50 percent of the time. Isn’t that amazing?”

Hospitals have no way of knowing if their patients refill their prescriptions or take their medications.  If hospitals knew this information they would do a much better job managing the health of those patients who make up their populations.

For hospitals to know this type of information the model for population health management would have to change. It would have to go from a 1-way model to a 2-way interactive model.

One of the critical success factors for population health management is getting patients to take ownership for those parts of their health for which they can self-manage.  Twenty-one percent of American adults, more than fifty-five million people, use healthcare apps, and half of them use those apps more than once each day.

I use MyFitnessPal, a run-tracker app, and count my steps using my phone.  The last time I interacted my hospital was to schedule my annual appointment, and I had to call them to do it.

What if population health management were two-way?  Me to the hospital and the hospital to me.  What if my communication to the hospital was daily?  What if my hospital had a way for me to upload information about my workouts, my diet, my weight, pulse and blood pressure?  What if I could upload daily when I took my medication?

What if the hospital had a way of monitoring and responding only to data I submitted that was an exception?  What if the hospital could email or text me attaboys?

Twenty percent of the population are using apps and smart devices to manage their health.  Almost none of those twenty percent are using apps developed by their hospital.

What if?  What if they could?

Sometimes I can’t help myself.  I am still stuck on the question of whether people believe that adding a screen saver to the computer terminals of hospital staff employees reminding everyone to be quiet is the equivalent of reinventing the patient experience mousetrap.

Accordingly, I thought I would offer a few ideas of my mine on that mousetrap to move the conversation in a different direction. 

A 15 cent innovation—Raise your hand if you know someone who snores.  Now, if you have ever used earplugs to combat the snoring, raise your other hand.  Now look around.  Most of you have raised both hands.  You wear the earplugs because it blocks out the noises other people make.  Offer your patients earplugs, and for good measure through in a sleeping mask. I have not done the math but I’d bet the ROI—Return on Innovation is pretty high.

A slightly more expensive investment, but what is the real cost of a comma or two when patients go somewhere else? When was the last time you called your phone company or your cable company? It is never a pleasant experience.  But, you know what? You can have that unpleasant experience 24 x 7.

You cannot do that with hospitals.  That is because most hospitals concluded that there is never a good reason to talk to you before 8 AM or after 6 PM Monday through Friday.

Banker’s hours.

Banker’s hours used to mean something.  You had to run to the bank to deposit your check before it closed.  Now you can do whatever you need to do with your bank, except get the lollipop, 24 x 7.

Try scheduling an appointment with your hospital Saturday evening. If that doesn’t work, use your time more wisely.  Call Verizon and ask them to explain your bill.

On 3/24 InformationWeek HealthCare posted the article, Hospitals Elevate Patient Satisfaction To The C-Suite. While the meat of the article may pass the test of being necessary, it did not come close to passing the test for being both necessary and sufficient.  Why?  Because the approach discussed in the article left our far more than half of the people who interface with the hospital.  The article credited the fact that one hospital created a screen saver reminding the staff to be quiet.

Hospitals continue to do a disservice to themselves and their patients by limiting their definition of patient experience to what it has always been or to how the regulators define it.  Patient experience as defined by most is defined as only those events that occur within the hospital, and only for those individuals who happen to be inpatients.

That implies that once someone is discharged, or if a patient happened to be an outpatient that any experience that person had is of no consequence.  Most hospitals sure treat it that way, and they do so at their own peril.

So, if you are a hospital administrator—CEO, CFO, COO, CMO, CIO, or CXO—why should you be alarmed?

You should be alarmed because you have no idea of the experiences of most of the people who interact with your hospital.  And not knowing whether those experiences are good or bad is costing you patients; lots of them.  Those people include outpatients, discharged patients, former patients and prospective patients.  It includes people coming for labs and therapy. It includes people trying to schedule an appointment, those calling for a refill, and those calling to speak to a nurse.

If I have a bad experience as an outpatient I will never consider being an inpatient.

If I cannot get an appointment or a refill, I will go somewhere where I can.  How many thousands of your hospital’s prospective patients do that every year?

Implementing a screen saver will not improve any of those experiences.  Measuring the satisfaction of individuals at those touchpoints and designing an excellent experience will improve them.

I spoke with a woman last year who was undergoing chemotherapy at the top cancer hospital in the US.  She called the hospital to schedule an appointment because her medicines were making her ill.  She spent three hours on hold and having her call transferred.  She volunteered that she will make it her mission in life to tell others how poor her experience was with that hospital.

So, while there may be merit in trying to bump your HCAHPS score from sixty-four to sixty-five, there may be just as much merit or more in making sure that the experiences from each patient touchpoint are excellent.

More people visit your hospital every day online and by phone than are admitted.  Who is in charge of improving their experience?  Who is in charge of retaining them and their family members and making sure that their experience was so good that they refer other people to your organization?

If the answer is ‘nobody’ you had better have one heck of a screen saver.

(This missive is somewhat long—this is where my mind goes when I run.)

Ever watch the show “This old House”? Something magical happens to a man when he watches somebody single-handedly rebuild a 6,000 year old home in a 30 minute program. After that no task seems too complex. As a normal male the first rule of thumb is to remember that having a master’s degree from a reputable university qualifies you for about anything short of brain surgery. The true Type A will often carry that step further by reminding himself that given another week or two of study that even neurosurgery would not be that difficult.

I did a project in one of my prior homes. It involved the simple task of rearranging bedroom furniture one Sunday afternoon; 15 minute project, total cost—nothing. After all, how difficult could that be? The truth is the actual moving of furniture involved nothing more than I’d planned. Only when I thought I was done did I notice that the television set was now located a good 20 feet away from the cable television outlet. The obvious solution would be to simply move the furniture back to its original position.

Can’t do that. To move the furniture back to the original position is either admitting defeat, or admitting I wasn’t bright enough to realize that the cable outlet and the television would be on opposite ends of the planet by the time I finished. Besides, my wife had already seen the new arrangement and if I moved it back to its original position I would have to explain why.

So when she enters the room and asks why (and she will ask why—that’s her job) there is now a 25 foot piece of black coaxial cable snaking its way diagonally across her bedroom carpeting I had better be prepared to answer. Sometimes if you’re quick, real quick, you can try and bluff your way around the problem with a technical answer. You can try and explain that all of the static electricity that was created by sliding furniture across the carpet has caused the sonic membrane surrounding the fiber optical transponders in the coax to be 6 ohms off the medium allowable temperature variation for the building codes in your neighborhood. It is called stalling, allowing for a brief period of self-correction.

The truth, having failed me, the only other option left was to try something close to the truth. I’m forced to say I knew the cable would be at opposite ends of the room before I moved the furniture. My plan all along was to call the cable company and ask them to come to the house to install another outlet on the correct wall.

It’s my wife’s job to inquire how much it will cost—she did not fail me.  This is a clear case of me answering her question without bothering to think. It is important to have a clear understanding of the underlying issues before trying to resolve the problem. I mentioned it should cost forty dollars, and we will only need to leave the cable strewn across her bedroom floor for a few days. It’s then her job to say if we put the furniture back where it was we can solve both problems in twenty minutes. Besides, the cable technician left a mess the last time they did some work, and she wasn’t going to spend more money for poor service. Stay with me here, this is how it becomes her fault, and how it relates to the topic of Patient Experience Management (PEM).

Once her issues were out in the open was a simple matter to devise a solution to address them.  The solution needed to be implemented quickly and it needed to be free. My answer came quickly—too quickly. Eighty percent of the problem could be handled by simply running the cable along the floor board, and then under the bed. That only left five feet of cable between me and a happy marriage. Unfortunately, the five feet in question is from the foot of the bed to the television and runs across the major walkway of the room, looking all the while like an undernourished blacksnake.  Did I mention she hates snakes?

Undaunted, I asked for a little assistance to move the bed. This accomplished, I headed for the garage to find exactly the proper tools for the proper job. I returned five minutes later, tools in hand. I was surprised to see the look of dismay on her face. As it turns out, her dismay resulted from the razor blade knife clutched in my hand. After twenty minutes of the best Boolean logic I could muster, I convinced her, or at least myself, that it would be a simple matter to cut a small hole in the carpet and force the cable underneath. After all, the bed would hide the hole.

The only other tool I thought I would require was a roll of duct tape and a 4’11″ broom handle.  Women know we are confused about how to proceed the moment they see men rely on the duct tape gene. Most men, when cornered believe enough duct tape, properly applied, can serve as a panacea for anything up to and including world hunger.

You’ll note I specified the exact length of the broom handle. It’s only after having attempted the project that I’m able to relate the length of the handle. Most men on a project, especially those being watched by their wife, wouldn’t bother to measure a length any more than they would ask directions while driving across Borneo with half a tank of gas.

As it turns out, I should’ve measured both the distance the cable had to travel under the carpet and the length of the broom handle prior to taping the cable to the handle and shoving a 4’11″ broom handle under a five-foot expanse of wall-to-wall carpet. The fact the carpeting was wall-to-wall is key to understanding what lay ahead. Let’s make certain the situation is spelled out clearly; the new carpet in our new home had a hole in it, a broom handle was now nicely buried under the carpet, and my wife was perched on top of the bed like one of Macbeth’s three witches waiting to see what I would do next.

Walking to the wall and grasping the carpet as best I could, I pulled up a good 10 feet of it from the tacking, acting all the while like I would have to have done that even had the handle not been one inch too short. Leaning with my one arm on the newly exposed carpet tacks, I solicited help in excising the handle from beneath the rug. That accomplished, and dying the death of a thousand cuts, I looked for another proper tool to complete the task. Walking through the kitchen to the garage I spent a moment wondering if the proper tool could be found in the kitchen. Naturally, it was—one half of a pair of chopsticks or, as it’s now referred to in technical terms, a broom handle extender.

Five minutes later, the broom handle extender and cable was firmly duct taped to the broom handle and once again shoved under the carpet. They both went in, but no cable came out the other side. So, I pulled the handle back out and surveyed the situation. The situation, as it turns out, was that in my hand was a perfectly good broom handle, a piece of coaxial cable, and no broom handle extender. The extender was now smack dab in the middle of the 5 foot expanse I was trying to cross, the problem being it was on the wrong side of the carpet, the underneath side. It was positioned perfectly. It was too far under to be reached from either end. In other words, the chop stick just became a permanent fixture in our bedroom.

Certainly, one small chopstick hidden beneath four hundred square feet of carpeting was not a big problem to me. It was not a problem unless you happen to be walking barefoot across the carpet and you happen not to be the one who put it there.  It became not unlike the fable The Princes and the Pea, and my princes found it immediately. In the fable, it was the princes could not sleep. In my case, I knew the non-sleeper in the story would be me for as long as the chopstick remained under the carpet.  Keeping my eyes focused firmly on the task at hand, I foolishly believed if I could resolve the cable problem, the matter of the chopstick would resolve itself.

One final trip to the garage led me to return with a second broom handle. The peanut gallery looked on in disbelief in my ability to finish what I had started without having to sell the house at a loss before I was through. The “I told you so’s” were being thought through in most of the major dialects of the Western Hemisphere.

This had ceased to be a project—it was now a quest, no lesser than that of the Holy Grail. A mile of duct tape later, both broom handles were firmly attached to one another. Even if I destroyed every square foot of carpeting in the house, I would not lose this broom handle under the carpet.  A minute later the cable emerged exactly where it should have, on the other side of the room.  I pulled the out broom handle, attached the cable and turned on the television. Everything worked, just as I had known it would.

Standing in front of the television, admiring my work in the new room arrangement, I noticed I was now a good foot taller than when I began the project. Was this an illusion brought about by my success?  As was quickly pointed out by my princess, my enhanced stature was more attributable to the fact that all of the carpet padding that used to lie between the end of the bed and the wall was now nicely compacted into a ball.  The ball of padding was located in the same twilight zone the chopstick found, right in the middle of the walkway. Trying to correct the problem only made it worse. Each time I prodded the ball of padding with the broom handle it grew larger underfoot. Within minutes it looked as though I had managed to suck up every inch of padding from every room in the house and placed it between my wife and a good night’s sleep. Resorting to logic once again, I quickly pointed out that she should walk on it because she would no longer be bothered by feeling the chopstick underfoot.

The next day I was on the phone scheduling an appointment with the carpet installation service. The carpet installer had to pull up most of the carpeting in the bedroom to be able to reach what she had affectionately labeled Chopstick Hill. I watched him work and I learned all about carpet padding and the installation of hardwood floors. He explained it was lucky for me that he came over because our padding was not good quality padding and we would not have known that had he not pulled up the carpet. I asked him why, if we would not have known about the padding, we would want to spend $300 for new padding. Without responding, he just kept slamming his knee in the carpet installer, charging one hundred dollars for his efforts and my education.

I was so impressed with his discussion of hardwood floors I almost bought one on the spot to surprise my wife. By now, we both know she wouldn’t have appreciated the surprise. Anybody who did not want to spend forty dollars on the cable repairman would probably have a little more trouble accepting five thousand dollars for a new floor.

However, I walked around with a silent smirk on my face for days knowing had we done it my way from the start, called the cable man, we could’ve saved the hundred dollars and never put a hole in the carpet.

This is what can happen when your patients decide to bypass your customer service because of prior bad experiences they have had trying to solve a problem.  It usually comes down to process, bad process.  Processes are a lot easier to fix than disappointed patients, and when you disappoint them too often they go to the ED–no appointment needed, no copay, and a great way for them to get their scripts refilled.

It would have been a lot cheaper to the hospital to have just done what the patient needed when they called the hospital or their physician, but many, many hospitals can’t seem to do that.

There is a strong relationship between HIT and population health management.  This relationship is even more critical because of all of the spend in HIT, spend whose ROI doesn’t always jump out at the C-Suite.

A component of HIT that should be included is based upon the fact that without being successful at Patient Health Management, Population Health Management will not be successful.  If synergy—1 + 1 is greater than 2—ever had a place to call home, this would be one of those places.

For the population to become healthier, the individuals that comprise the population—the patients—must become healthier.  This is not a chicken-and-egg premise.  It must start with and be driven by making the people healthier.

One way to make healthier people is to get them more involved in their healthcare is by finding ways to get them more involved in their health.  And one way to do that is to facilitate that process by making it easier for them to manage their health and to do business with their providers.

Perhaps the simplest way for people to do that is through a customer portal, something most providers do not have.  A customer portal is very different from a patient portal.  A customer portal provides 2-way interaction between the hospital—think PCPs, specialists, labs, therapy, and wellness programs—and patients—think inpatients, outpatients, discharged patients, and prospective patients.

A customer portal doesn’t just let the hospital feed people information they think patients need to know—like the hours of operation of the gift shop—but allows patients to feed the hospital information, and it allows patients to accomplish processes.

Remember those questions on the SAT; If A is to B then C is to ‘X’.  You had to pick the right answer for X which was most like C.  Band-Aid is to hospital, as your hospital’s current website to a customer portal.

A well designed customer portal will improve patient access, education, outcomes, and the overall health of those patients who make up that population.

I took a week off from blogging to refill the jars in which I store my adjectives and metaphors, and to see if I might learn how to make my segues read more naturally.

I read a study in which Forester Consulting concluded that 89% of workers to deal with customers—if it makes you more comfortable go ahead and substitute the word patients—reported that those workers weren’t able to meet the expectations of those customers.

Let’s pause for a second to reflect on the business impact of that finding.

Now let us consider someone who is a patient.  As an example, someone with a chronic disease.  That person may have been an inpatient a few times over the years.  During the time when that person wasn’t an inpatient they were also someone who several times each year interfaced with the hospital, making appointments, scheduling labs or therapy, requesting refills or copies of their medical records, or trying to make sense of their bills.

Now what if when that same someone tried to interface with the hospital, the workers trying to serve the person weren’t able to meet that person’s expectations 89% of the time?  What if eighty-nine percent of the time when the patient tried to make appointments, schedule labs or therapy, request refills or copies of their medical records, or tried to make sense of their bills it didn’t happen?  What kind of experience did they have if they were put on hold or their call was transferred or they had to call back?  What if they felt the only way to get their expectations met they had to go to ED or they chose to go to another provider?

The thing is the vast majority of hospitals do not know if their employees are meeting the expectations of their patients.  They do not know because they do not observe, measure, or ask patients about those interactions.

Those types of interactions were never designed, they have just sort of evolved over time.

Hospitals look at patient experience through the monocle of HCAHPS.  If hospitals could reduce the noise in the corridors one decibel by placing rubber bumpers on the Jell-O on the food carts the rubber bumper manufacturers would be sitting pretty.

Now what if hospitals placed the same emphasis on the other enterprise-wide experiences their patients encountered?  What if every time a patient tried to schedule an appointment, a lab, or therapy they were able to do so during their first attempt?  What if they could get a refill one hundred percent of the time they needed one?

What if a hospital chose to Design each of those experiences?  What then would patient experience look like?