I heard the bookies in Las Vegas are offering odds on the date and time for the first terrorist attack during the Winter Olympics.  “Why can’t we all just get along?”

Changing how the world thinks may be more difficult than simple changing the world.  Sometimes it would be easier to teach Hindu to a beagle.  Sometimes you have to stand on your own shoulders to be heard.  If the issue under consideration seems up for grabs, sometimes style points can make a difference—the judge from East Germany scores the routine 8.75.

When one assesses patient experience, it seems like a lot of people do things wrong, but they do things wrong, but they do wrong right. 

Case in point.

The air was getting cool. When the air gets cool you buy a winter coat. When you buy a winter coat, pretty soon it snows.  When it snows things get complicated. When things get complicated, and you happen to be out of town, your flight gets cancelled.  When your flight gets cancelled you do not make it home. When you do not make it home you do not get your mail.  When you do not get your mail you do not get your invitation to the World Economic Forum in Davos.  When you do not get your invitation to Davos, somebody else has to take over your job; someone else has to wash the dishes.  When someone else has to wash the dishes, some dishes do not get washed.  When some dishes do not get washed, the prima donnas get upset.  And, when the prima donnas get upset, the world’s economy goes in the toilet.  I have missed the last seven meetings in Davos, and I am starting to feel bad about the state of the economy.

Patient experience.  I attended a gala last night for an organization of which my wife is a board member.  At the event I was introduced by a member of the board of directors at an eminent Philadelphia hospital to a woman who is on the board of two eminent Philadelphia hospitals.  The board member I know told her fried “you really need to talk to Paul about what he is doing to help hospitals improve patient experience.”

Yada yada.  The board lady and I talked; well sort of. Just to keep me from reliving an awful experience, I’ll just hit the highlights.  I went to the netherworld and suggested that patients are also customers, that customers are an organization’s assets.

The board member started hanging strands of garlic from her neck, and she withdrew a mallet and wooden stake from her purse.  Any aspirations I had about her ability to see the bigger picture escaped through the bell tower’s window.  “Welcome to the nineties Mr. Banks”—Father of the Bride.

“We do not have customers, we have patients.  Our Patients are not the hospital’s assets,” she bellowed.

I wanted to ask, “Are you a good witch or a bad witch?” 

I have often used those close to me as a barometer.  They are the people who tell me “Take twenty-four hours before you respond.  Do not be so quick to give them a piece of your mind because you may not have enough left after you give it.”

My initial reaction was to tell the board member that I had been more challenged intellectually by a bowl of mice, to tell her that she was both rude and ignorant.  Instead I bit my tongue, hoping she would come to the same conclusion on her own.

The air was getting cool—we did this part earlier.  The hairs on my arms stood on end.  When the hairs on my arm stand on end it means something bad is about to happen.  When something bad is about to happen I try to suss it out.  When the hairs on your arm stand on end, you may be having a conversation with someone whose intellect is below that of the intellect of a bowl of mice.

When that happens, it means that the person with whom you are speaking is misguided.  When someone is misguided it means they have no notion of how healthcare has changed.  When someone has no notion of how healthcare has changed it means they should not hold a strategic position.

The board member repeated her point, “We have patients, not customers. Our patients are not customers and they are not assets.”

I finished the conversation by telling her, “Using your strategy, you will be proven correct. In a few years they will neither be your customers nor your assets.  They will be the customers and assets of another hospital.”

It is snowing. Flight home cancelled.  Hotel I was in cancelled. 

This is also happening for newly-minted MBAs.  Blizzard; no worries.  Smart phone, new reservations, care to join me for drinks?

I wonder how they would handle it the way we real men had to handle it in the days before Al Gore invented the internet.  Would they even know where to begin?

In the old days, when mastodons still roamed downtown Boston, a good snow storm meant you might not get home until the lawn needed mowing.  They way this mastodon remembers it, everyone in the cities affected by the storm would call the one phone number for the airline to see about rescheduling their flights.

If you could not extend your stay at your hotel, you were basically out of luck.  There was no way to Google the hotels in your zip code, there was no way to even know which hotels to call.  You would simply dial ‘411’ and start asking an operator to connect you with a hotel other than the one at which you are currently registered. 

When that did not work, and after the bellman at your hotel tossed you onto the street, you would make your way to a copse of trees, hope you remembered your Navy SEALs training, and try to build a bivouac with your comb and toothbrush under the branches of a juniper bush.  As the snow fell in earnest you might fashion a pair mukluks from yesterday’s socks.  If you were really fortunate, you might still have a piece of adipose tissue—seal blubber—saved from the last time you were forced to play survivor.  That is how real men did it in the old days, in the days before the entire world started to function around the internet and mobile phones.

Segue.  Hospitals.  Was that a mastodon I saw in your lobby?  I just bumped into someone from IT and she dropped her computer punch-cards—you younger ones may have to Google the term.  In the last five years smart phones and the internet have changed how Americans conduct business; how we buy goods and services.

They have not, however changed how we interact with hospitals.  For those who still have phone books if you look up your hospital in the phone book you will see dozens of numbers to call.

Riddle me this Batman; which of those numbers are you supposed to call if you need to schedule a lab?  It depends.  Which number should you call for a refill?  It depends. For a follow up appointment?  And so forth and so on.

As a prelude to the snow while I slept last night, using the internet, US Airways did all of the following—cancelled my flight, messaged me to let me know the flight was cancelled, rebooked me on a flight, and sent me a message confirming my new seat.  In real-time, all while I slept.

Most hospitals cannot even schedule the original appointment using a phone, let alone reschedule it and send me a confirmation over the internet.  The mastodon model of patient access works as follows.  I call the hospital, am placed on hold, am asked for my referral, my authorization, my insurance.  Then I am transferred to someone else, am placed on hold, am asked for my referral, my authorization, my insurance.  I may get an appointment, I may not.

While I am on hold with the hospital I rebook my hotel, watch a movie on HULU, search eBay for a mastodon tusk, and show my dog a video to teach him how to shut the door.

I’m thinking this whole internet/smart-phone thing may have legs.

As a hospital, are you really comfortable offering less of a customer experience than an airline?

If you can’t laugh at yourself, you may want to engage me to do it for you.  Just kidding.

People often infer things from what others say.  They read between the lines, they try to uncover innuendo.  I am doing patient access consulting for two hospitals around the notion of creating a remarkable experience for those patients who access the hospital by phone.  I had the chance to listen to several patient calls.  Do you ever wonder what your patients infer from what they hear when they call your hospital?  Is what your patients are hearing sounding something like this?

We are getting a lot of calls today.  Well, it’s not really a lot, it just seems that way because there are only a couple of us here.  Don’t hang up, but if you have some errands you need to run, now might be a good time to knock off a few of them while you are on hold.

If you are calling to schedule an appointment for 2015 please stay on the line.

If you are calling because your doctor told you she wanted to see you in two weeks, he never told us, so you may hang up now, or you can wait your turn on hold and when we are through laughing hysterically we will tell you personally to hang up.

If you are calling because your doctor referred you to get an appointment with one of our specialists, understand this.  What you have is permission to have what you think happened evaluated by our authorizations group.  You do not have an appointment.  Should authorizations authorize your referral over the next few weeks, you can try your luck and call us back.  If you are feeling that lucky you should also consider buying a lottery ticket.

If you are calling about your bill, you know as well as we do that nobody in our organization understands those things.  Besides, your insurance company is going to override anything we tell you so you may as well call them.

If you are calling because you are not feeling well perhaps you should go to the ED.  We are not allowed to give medical advice, but that is what we do when we don’t feel well.  We could try to connect you with a nurse, but that hardly ever works.

If you are calling to request a refill on a Friday afternoon, you are just being silly.  Next time call us before you run out of medication.

When patients are discharged some hospitals label them outpatients.  I label them former patients or prospective patients.  Regardless, if you really think the word ‘patient’ somehow fits a discharged patient, a former inpatient, why in the world are their needs ignored.

My calculations show that a patient has a lifetime value over 25 years of between $180,000 and $250,000—I call that the Two-Mercedes Equivalent.  Let us suppose you own one Mercedes.  In your mind owning that Mercedes entitles you to be pampered.  They should answer their phones, they should let you schedule appointments online, they should come get your car when it needs to be serviced and they should leave you a Mercedes to drive until they return yours.

They should do these things so that next time you do not buy someone else’s Mercedes.  They want all of your business.

At a majority of hospitals outpatients, former patients, are treated as yesterday’s news.  That is because hospitals are hospital-centric, they are clinic-centric.

Hospitals, like Mercedes dealers, need to be customer-centric. Is it time to reinvent patient access?

  These are my new cufflinks.  I asked my wife if she liked them and she replied, they look like earrings.  This must be why lawyers operate on the premise that you never ask a question to which you do not know the answer.

I never received the email from the Republic of California stating that all speed limits had been rescinded.  This morning I am driving down “the 10” to the airport—California roads are not called routes, or highways or beltways.  Cars are passing me like I was driving a Big Wheel even though I was going seventy.  I was here like, for five days, and like, I now feel much more comfortable using the work like unnecessarily in spoken and written conversation.

But who is complaining?  The temperature was in the eighties and I am flying home to a place so cold that the groundhogs are wearing mittens.

So as I’m driving along the 10 at Mach 2, the voice in the car says, “GPS signal lost.”  Since this was my first time on the 10, I knew enough to know that if whoever lost my GPS didn’t find it quickly that I was going to have a bad day. Since the rental car did not have a good place for me to place my phone while I was looking for my GPS I placed the phone on my right thigh.

For those who did not study anatomy, thighs are round, at least mine are.  And phones are flat.  That means that if an errant neutrino should slam into the phone the force from the collision is great enough to knock the flat phone from the round thigh.

It occurred to me that the person who designed the interior of the Mustang either had flat thighs or did not own a phone.  I believe that because there is a space between the seat and the center console that is the perfect width for a phone.  The width, however is not wide enough to allow your arm to slip into the crack to try to retrieve the phone especially while traveling at Mach 2 on the 10.

I drove for thirty minutes listening to a muffled voice that sounded like it was broadcasting from beneath my bum repeating the phrase, “GPS signal lost.”

The success or failure of most experiences comes down to whether or not those experiences were designed or whether they simply evolved over time.  Case in point. I returned the car to Enterprise.  The Enterprise employee asked me the same question every Enterprise employee always asks me, “How did we do?  How was our service?”

They never ask about the car.  They know the car was excellent.  They know that when renting cars, the cars are the commodity.  They compete on customer experience, an experience they designed.

Hospitals never designed the experience.  Notice I used “designed” as a verb.  To design requires creating a vision of what is to be designed, and it requires people educated in design. For hospitals I like to use the vision “A remarkable Experience for Every Person Every Time on Every Device.”

I am willing to bet that if you evaluated your hospital’s nonclinical business processes, processes like authorization, registration, and admissions you would find that they were never designed.  They came into being decades ago when vinyl flooring was in vogue, and the only things that have changed are that the admissions area now has a synthetic carpet, the portraits of the hospital’s past presidents have been updated, and the clerical staff have gone from using quill pens, to carbon copies, to floppy disks, to flat-screens.

You come in as the sun is rising, and you sit with others on cream-colored vinyl chairs.  The local news is playing on mute on a television mounted to the ceiling.  Three-year-old copies of magazines like the Latin American Financial Manager and Make Bankruptcy Your Friend are stacked neatly on a laminated end table.  The admissions process is basically the same.  It was not a remarkable process during the Harding Administration and it is not a remarkable process now.

People call because they were told to call.  They were told they had a referral and that their referral was authorized.  “We cannot schedule you,” the voice tells them.  “We have not received your authorization.”

“Who is ‘we’?” You ask—I know that punctuation is wrong, but I do not know what the correct version is.  “Aren’t you and authorization all part of the same organization?”

“It works thusly.  It is a multi-step process that has checks and balances—think of it like Congress and the Executive Branch.”

“But that does not work very well.”

“Don’t trouble me with the facts.  The doctor gave you a referral.  You called Authorization and gave it to them.  In know all of this because I can see the authorization in your record.”

“But why couldn’t I have given it to you.  Since you have it why can’t you schedule me?”

“Because authorization needs to approve it.  That usually takes a week or two, and because if we schedule you right away the next person is going to expect the same treatment.  Anyway, even with the authorization, the first appointment we could get for you would be six weeks out.  You could go to ED.  If it was me, I would go to ED.”

People call.  Where do they think they are calling?  Do they know?  The Hospital?  A call center?  A clinic?  They call to get an appointment—a three-syllable, big-boy word for access.  They call because their physician said to come back in six months.  Unfortunately, the physician’s schedule only goes out three months.  The caller gets angry.  By the third call the caller decides he is done playing this game.  The caller goes online and finds a clinic that allows him to schedule his appointment online, authorize his insurance, and complete the paperwork online.

Almost every hospital’s call center is in reality a scheduling center—reg & sched.  The problem with that is patients do not know that, and even if they did that is not how their world works.  When people need to interact with a company what do they do?  They call it, all of it.  And when they finally speak with someone they expect that someone to be equipped to answer any and all of their qestions.

The lifetime value of a patient is somewhere between $180,000 and $250,000.  That is a pretty high price to pay time and time again.

Processes like this cannot be tweaked.  They cannot be fixed.  They need to be tossed and then designed.

If you could split atoms with your mind, but nobody needed to have atoms split, is it legitimate to post atom-splitting as a skill on your LinkedIn Profile?

If you could answer eighty percent of the calls to your hospital’s call center within twenty seconds, if your hospital had a nominal hold time and abandonment for those calls, but you could not resolve the reason for which the person called, are you simply splitting atoms?  That is how plutonium was discovered.

I just finished reading reports from two consulting firms summarizing the importance of being efficient, being fast. Answer the phone calls.

Speed kills. Being efficient kills.  Being effective is what matters.

People call wanting access to the hospital, wanting answers from the hospital.  Being able to answer the call on the first ring without being able to schedule an appointment is a waste of your money and their time.  The reason people quit calling back for an appointment is because they called someone else.  The patient experience score for that interaction is zero.

To those who think I am simply splitting hairs stay with me and think through the following real scenarios.

The physician in ED tells the patient to be seen by a specialist in two weeks.

The cardiologist instructs the patient in the discharge orders to schedule an appointment in two weeks.

The surgeon instructs the patients to make an appointment to have the sutures removed in two weeks.

In these scenarios, the onus is on the patient to complete the action.  In many instances at many hospitals the patients are instructed to achieve the unachievable.  Once the patient perceives that their assigned task, scheduling an appointment is difficult or unachievable, the patient will stop trying to complete the task.

Some will continue to call.  Some patients will go to the ED.  Others will go to another hospital.  All of these options either increase the hospital’s expenses or decrease its revenues.

For almost every hospital, access was never designed, it just sort of evolved.  Chances are quite high that access at your hospital is in need of a makeover.

As long as the Harvard Business Review continues to not ask me to write an article for them then I will continue to refuse to do so.

True story.  Flying yesterday at thirty-six thousand feet I was able to exchange a look of terror with the passengers on the other plane.  A near-miss is defined as being within a thousand vertical feet of the other plane and within three nautical miles.  We were so close to the other plane that we felt our plane move from the plane’s slipstream.

Enough of my problems.

I was in the hospital’s cafeteria watching people before my meeting about reinventing patient experience with one of the hospital’s executives.  Two people stopped by my table to tell me how much they liked my socks.  It occurred to me that if my socks were noteworthy enough to warrant comments from two strangers that they may be the wrong socks to wear to meet with the executive.  I was wearing sensible shoes, so at least I had that going for me.

So, I did some work for an organization that felt it needed a call center.  And for that call center they wanted to talk about ACD’s, IVR’s, CRM, and a suitcase full of other technical things.  I thought the best way to be of service would be to stop at Costco and buy them the call-center-in-a-box startup kit.  Maybe I’d also get them the all-in-one-EHR.

This is what happens when someone reads something they shouldn’t, something which they believe gives them instant credibility on a subject of which they previously knew nothing.  I watch one of those shows about goofy problems in the ER, but even so I remain hesitant about thinking I am the right guy to insert a chest tube.  I did buy some scrubs and a white jacket just in case someone feels the need to pull me in on a procedure.

When I asked why they felt they needed to design a call center their reasons were legion.  Too many numbers, too much wait time, too many dropped calls, too many call backs.  They want job descriptions, training manuals, a system for scheduling the people who were taking the calls, and they want scripts written for every conceivable type of call.  Call-center-in-a-box.

I asked what business problem they were trying to solve, a question which branded my immediately as a heretic.  Burn him at the stake the pink-faced call center director shouted.  All I could think of was that I was glad I had not worn my fancy socks.

If they proceed along this course they will have a very efficient call center—phone rings, it is answered, both parties disconnect.  Rinse and repeat.

I am not a fan of efficiency.  Efficiency is about speed, and speed kills.

I once did some work for one of the largest telecommunications firms in the US.  They wanted a call center strategy.  I told them that they should close all of their call centers, and then I closed my laptop.  (I sensed that they wanted a little more detail so I went to the white board.)

They told me it cost about thirty dollars to answer each call, and they received millions of calls.  I then had them create an exhaustive list of the reasons people called.  I was the scribe—in consulting lingo we refer to the in the work plan as facilitation because you can charge more for facilitating than you can for writing.

We created a pretty substantial list.  We then worked through each of the reasons on the list.  For an item to remain on the list, the people in the room were asked to defend why a customer should have to call about that item.

They learned that phone calls fell into one of three areas; people needed something, people had a question about something, or people had a complaint.  They learned that whatever it was people needed should have been handled at some point upstream in the process.  They learned that the information that was needed could have been provided at some point upstream in the process.  And they learned that complaints arose from something that did not happen correctly at some point upstream in the process.

Of the few items that remained—I gave in on some to make them feel better—I asked which of those could be handled through a customer portal.

Each item that is addressed at some point upstream in the process takes the cost of the call from thirty dollars to zero dollars.  The same is true with handling an item in the customer portal.  Eliminating a call ensures there are no call-backs, no waiting time, and no abandoned calls.  It also ensures that everyone gets the same answer, the same right answer to the same question.

It also ensures and insures the brand.

Your hospital gets hundreds if not thousands of calls each day.  Your hospital has dozens of phone numbers.  Each phone number is answered differently by people with different skills and experience and having different objectives.  People are placed on hold, transferred, given other numbers to call, and given the wrong information.

The other thing this hospital wants to do is to have one phone number people can call; a noble idea and a very bad idea.  They want it to handle two-dozen different call origination types, everything from getting information about how to donate to what hours the cafeteria is open to how to schedule an appointment.

In effect, they want their call center to be the same as their web site.  Their web site has more than fifty clickable links, everything from getting information about how to donate to what hours the cafeteria is open to how to schedule an appointment.

There should be a number for patient stuff and a website for patient and prospective patient stuff—a customer portal which is not even close to what EPIC and Cerner mean by patient portal.  There should also be a number or numbers for other stuff and maybe, just maybe a single link on the customer portal for all of the other stuff.

Designing patient experience so that the experiences on the web and on the phone are similar is only beneficial if those experiences are remarkable. Designing a call center experience that mimics the lack of functionality of your website is a waste of money.

Memo to the state highway administrators in Ohio—the sign for exit 24 should come after the sign for exit 22, not before it.

Anyway, where were we?  I had a wonderful call this week with the Chief Marketing Officer of one of the leading Children’s Hospitals.  She mentioned that the average age of their patients’ mothers is twenty-seven years old.

That prompted me to do some research.  The PEW Foundation has all sort of information about people of all age groups including twenty-something moms and dads.  And guess what?  They have computers (+90%) and smart phones (+85%) and tablets (+30%).

I am visiting a hospital in the Cincinnati area today.  I walked around, visited the lobby, went to the cafeteria—the food was very good, dropped by the gift shop—they do not sell ear plugs; not good, and I generally observed people.

The Roemer Foundation reports the following—everyone from the staff to the patients to the visitors was doing something electronic.  Moms, dads, kids, and for the “old people don’t use the internet” naysayers, yes, even the grandparents were online.

They were texting and talking and reading and emailing and downloading and watching.  The only thing they were not doing was interacting with the hospital on a mobile device.  Why?  In large part because the hospital does not have an app that is worthy of their time, an app that would allow them to do anything.

The whole of America has gone wireless.  This is how we interact, how we communicate, and how we do business.

Riddle me this Batman—if Americans in ever increasing numbers are conducting all of their business affairs online and your hospital does not allow them to do that, won’t those people find a hospital who allows them to conduct all of their business online in much the same way as Amazon?

There is no patient experience without experiencing your patients.

The temperature showing on the car’s digital display in the garage was thirty-two degrees.  Two minutes after exiting the garage the temperature displayed was zero.  The weatherperson on NPR stated the actual temperature was minus four with a wind-chill of minus seventeen.  NPR also reported that the lowest attainable temperature is somewhere around minus four hundred and sixty degrees, a point at which molecules no longer move—apparently it is the movement of molecules which create heat.

Zero or minus four, I was still some four hundred and fifty-six degrees away from absolute zero, so at least I had that going for me.  The sound made by my car’s contracting metal and glass was that of too-thin ice cracking on a frozen lake.  Regardless of which temperature reading was accurate, the takeaway was that it was cold.

It bugs me when things are named something but the name is either inappropriate or gives the impression of being something it is not.  Snowplow is one of those things.  A plow is something that tills the earth, turns it inside out.  What was on top is now on the bottom and vice-versa.  A snowplow does not do that to snow, it pushes the snow away.  I’m thinking it should be relabeled as a snow bulldozer. 

The car’s thermometer was programmed to display degrees from zero to some upper, unknown limit.  It was not programmed to display negative numbers.  On most days, if I told the person next to me the outside temperature, I would be reporting accurate information.  I would not be guilty of only reporting a generalization of the temperature, something like ‘it’s really cold.’

We do that with how we measure and report patient experience.  We do it with precision, precision gleaned from data we purchase.  We state with certainty that our patient experience is 7.23 on a scale from one to ten.  That is like saying it is fifty-nine degrees on a similar scale.

The number loses value unless one has something with which to compare it.  Yesterday morning it was fifty-nine, and twenty four hours later it was minus four.  Where we live fifty-nine is an anomaly for January, but then again, so is minus four.  But if your measurement tool stops at zero it is fair to say that the tool is flawed.

In the same way that there are temperatures that my car was not measuring, there are patient experiences that HCHAPs is not measuring.  In fact, there are significantly more experiences that are not being measured.

We measure, report, and design our experience improvement efforts on:

• thirty percent of inpatients
• zero percent of inpatient experiences before they enter the hospital and after they leave it
• zero percent of outpatients
• zero percent of prospective patients, visitors, and family members

So, if you are reporting how your organization is doing regarding patient experience, how valid is it to stand before the operating committee or the board and report that your organization scored a 7.23?  The only value of that number comes from where it places your hospital on the continuum of the scores of all of the other hospitals.  It tells you whether your hospital will be penalized.

This is worth restating.  Your score is only a measure of whether your organization will be penalized.  It also helps you understand how far away your hospital is from either getting out of the penalty box or from falling into it.

Your score is not a measure of patient experience.  In order to report patient experience you would have to measure all of the components of patient experience, something hospitals are not doing.  In order to measure someone’s experience you would have to ask them and observe them having those experiences.  What was your experience the last time you called to schedule an appointment?  Were you able to get help about filing a claim by using your iPad?

Patient Experience.  Using the current vernacular of the term, if I looked it up in the dictionary I would expect to see the following:

Patient Experience: (noun), see Snowplow

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

Sometimes the job of being a consultant is eerily similar to the job of being an intelligence analysts.  Being an intelligence analyst assume that there is, that is, intelligence worthy of analysis.

We like to put a bomb in the water to see where the dead fish land.  Unfortunately, sometimes the clients suspect they are one of the fish.

When things go awry in a meeting, especially if I may have caused the angst, I am the one most likely to try to change the morbidity of the meeting by saying, “What if we agree to bring down the tension in the room?  I don’t know about you, but I have a heart condition.  I have fatty deposits in my arteries and I have a stent.”  That usually buys me a second or two and may make them question locking me in an Iron Maiden for a fortnight. 

One of my resolutions this year is to affect a British accent, something from Oxford or Cambridge, somewhat like the person doing the color commentary during a golf tournament.  I do not know if that will allow me to charge more per hour, but at a minimum it may cause people to think twice before they question my grammar.

Some days, deciding which organization gave you the worst experience is difficult.  Today I had two solid candidates by 10 AM—US Air and American Express.  I was booking a flight and was going to pay for it using a new American Express card.  I made the reservation, and authorized the card online.  When I went to pay US Air logged me out and required I re-enter all of the information. I hit ‘pay’ and was told my card was not authorized even though AmEx online stated it was.

I called AmEx, used the automated attendant, and again authorized my card.  Back to US Air, and surprise, I was logged out. Re-entered my flight information–the price I had been quoted was not longer avasilable, re-entered my credit card information, hit ‘pay’ and my card was not authorized.  It reminded me of the directions on a shampoo bottle—although why we need directions on how to use shampoo is beyond me—wash hair, rinse, repeat.

An hour and ten minutes later I actually had made my reservation and paid for the tickets.

So, how are those kind of experiences working for your patients?  When was the last time you called your hospital to ask to schedule an appointment or lab, or wanted to speak with someone about your bill?  How long was your wait?  Did you get the right answer without being transferred or without being given another number to call or without getting a recording telling you to call back during business hours?

Does it work any better if you try to accomplish anything online?  On your laptop, or even worse on a tablet?  Of course it did not.

At best, most hospital websites are online libraries.  They were never designed to be functional, they were designed to be read.  You can read about almost anything the hospital has ever thought you might need to read.  But try to schedule an appointment, pre-admit yourself, order your health records, or look up your discharge information and you are flat out of luck.

Some people actually believe that using EPIC’s or Cerner’s patient portals will make it easy for people to do business with your hospital.  Those people are in for a nasty surprise.

Three years from now the best hospitals will be those whose functionality can be carried around on someone’s iPad.  The rest of them will be like trying to book a flight with US AIR.

People, client-people, expect that if you are going to question their best efforts about something of theirs that you exercise a bit of decorum.  I am that way around the house.  I often tell my family you can tell me what to do, or you can tell me how to do it but you cannot do both.

Take dusting as an example in principle.  I was asked to do the dusting.  The person asking me to dust is five feet one-and-a-quarter inches tall.  I asked myself do I need to dust any furniture whose height exceeds that of the person who will be inspecting my work.  I concluded that no furniture higher than five feet tall needed to be dusted.

Later in the day my wife asked my son what he was doing.  He replied that he was writing his name in the film of dust on the top of her dresser.  Apparently there are times when I need to be told what to do and how to do it.  Apparently it is not sufficient only to do the portion of the task that is being inspected by others.

The current approach to the task of improving patient experience is not unlike the approach I took to dusting.  CMS only measures hospitals against a five-foot tall ruler.  HCAHPs.  Hospitals focus their patient experience improvement efforts on those patient touchpoints that are being measured.  That is how the game is played, for the way CMS defined the rules of the game hospitals will be penalized for failure and will not be rewarded for doing anything more.

What many hospitals have failed to discover is that by doing only what is asked of them they are only hurting themselves.

How are hospitals hurting themselves?  Let me illustrate it with a single business process—Access. 

1. Hospitals are not measuring and addressing the experiences of people who Access the hospital on the web and on the phone.
2. Hospitals do not assess the Access experiences of prospective patients, outpatients, or inpatients.
3. One hundred percent of the people accessing the hospital online and by phone are prospective patients.
4. Patients Access the hospital before they are admitted and after they are discharged, sometimes for months and years after they are discharged.

It is worth imagining how much better everyone’s experiences would be if they could Access the hospital at a time and on a device of their choosing.  A remarkable experience for every person every time on every device.

The story about me and the dusting is fictional, although the idea did cross my mind.