Patient Experience with a JD Power Twist

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Everyone knows the elephant in the room.  Unfortunately the elephant does not know any of them.

I read Toyota’s US president has decided to change Toyota’s business strategy as a result of the latest JD Power rankings.  Even though Toyota regained the world-wide leadership in car sales on July 30, 2013, it did not have a single car listed in JD Power’s initial quality results across all body styles.

“Perhaps all of the other automobile manufacturers have discovered automotive’s secret sauce.  We sell more cars than anyone else, but what good is that if we do not meet Power’s criteria.  Sure our customers swear by us, but what do they know about cars?” Asked James Edsel. “They just want something that looks cool, has great speakers, and a USB connection.”

James continued by explaining, “We have decided to follow the strategy of the US healthcare industry.  Health systems thought they were doing pretty well with their understanding of their patients’ experiences until CMS came along with its HCAHPs ratings and told them how to really measure the entirety of patient experience.  Now hospitals can see what a tiny fraction of their patients actually thought of their care months back when they received it.  They can pay money for their own data, and hire people to make their numbers look better the next time they pay for their data.”

“After all, why rely on what all of your customers and prospective customers tell you when you can simply go to one source and have them tell us what they think we need to hear.  One report and someone else does all the work.”

I’ll leave it to you to decide if there is a workable analogy there. To be fair, I heard the analogy while speaking with someone yesterday who is way smarted than me.

JD Powers is a business.  It conducts market research based on customer surveys. It then sells the research to the automobile manufacturers.  The big difference is the automobile manufacturers are not forced to alter their business model to raise their scores.

 

Shift Happens: The Experience Failure of a Top 10 Hospital

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Sooner or later someone had to write this, and there was little doubt it was going to be me.

I was speaking with a patient experience executive at one of highest rated US News & World Report’s Best Hospitals 2013-2014.  The conversation came down to her telling me that they are on top of the patient experience issues and that because of the financial pressures being exerted by CMS their entire focus was on raising their HCAHP scores from 8.2174284 to 8.2174265.  I will not waste your time or mine calculating the ROI on that exercise, but if you are so inclined begin your calculation with negative infinity.

Just in case someone’s experience with her hospital had nothing to do with HCAHPs, what was I to do other than to go to their website?

My first test point had to do with the fact that fifty, that’s a five followed by a zero, percent of people go to a hospital’s website to determine whether they are going to purchase care from that hospital, or seek a second hospital.

Brief segue.  Hospitals and healthcare aficionados use the term “seek” care because they provide care.  Lay people, patients, purchase care.

I went to the search function and entered ‘testicular cancer’.  I did so because at the time I was treated for it Al Gore had not yet invented the internet.  The site returned a few dozen hits, all sorted by relevancy—probably a good way to sort them as opposed to sorting by favorite astrological sign.

Once I got past the requisite Lance Armstrong link, and dated white papers, way down on their list was a link for what the hospital did to treat it.  Three clicks later I actually got to the link. I was provided with information in an overview—click here, how to diagnose it, and treatment. The information provided in each link was pabulum, but at least they provided a number to call in case I was afraid of dying from testicular cancer.

Why the cynicism? I have been there, done that, and got the T-shirt.  When I self-diagnosed in 1984 in a motel in Amarillo all I wanted was answers; was I going to die, what happens next, what are my options, how long will it take, what will the experience be like, and when do I have to start?  My only resource for obtaining those answers was the Yellow Pages—younger readers may want to Google the term—in the night stand next to the Gideon Bible.

To assess whether I was being unfair with my criticism I went next to WebMD.  WebMD had more than 250 links, every one of which provided more helpful information than did the hospital’s website.  There were videos, PowerPoint’s, survivor comments.  WebMD knew why people would search for information on testicular cancer.  The hospital knew that being a US News & World Report Best Hospital was sufficient enough.  The hospital was wrong.

Were I seeking treatment today I would have immediately looked for an organization that understood what I needed from them than one that did not.

Next I tried to see what it would be like if after several rounds of chemotherapy I wanted to schedule a follow up appointment, or if as a prospective patient I wanted to schedule an initial appointment.  I found a link on the website and followed it to where you and I know it would end—a phone number to call to schedule the appointment.

My review of hospital websites tells me initially that this hospital is no worse than the others in its ability to schedule appointments online—that is why the person actually clicked the link. (Please note this is not a ringing endorsement of any of them.)

But the story gets better.  When I clicked the link I am taken to the page with the phone number to call to try to schedule an appointment—they made no mention as to whether this could be done with Bluetooth.  In addition to not meeting my need to schedule the appointment, I was presented with the following information—to me this is a lot like being on hold with Comcast when I am complaining about my cable service and being forced to listen to a recording of all of the other things they want me to buy.

  • Ethics and complains
  • Web services
  • Employment
  • Donating
  • Vendors
  • Supply chain
  • International commercial services
  • Media relations
  • Referring doctors (they used ‘physicians’ but I am trying to be obsequious—I can’t believe I spelled that correctly0
  • Email support
  • International patients
  • Health plan
  • Medical records
  • And a dozen other links

The one thing I set out to do, schedule an appointment, I could not do.  My experience was poor, and it is not even worth asking about whether I was satisfied with my experience.  This is what happens when you present your hospital online but do not involve people outside of the hospital in its design.

This could easily be your hospital.  So, here’s my point.  If you are going to have a website, why not have a real one?  One that serves patients, one that actually allows them to complete a task without having to pick up the phone or one that requires them to drive to the hospital.  Why not have one that is functional enough that if a patient went there wondering if they should seek a second opinion that they would choose your hospital?  Why not have one that if a prospective patient went there they would choose your hospital?  Why not have one that an existing patient, a sick patient, a paying patient, could complete a simple task online on their iPad?

Why not have a website that provided a remarkable experience for every person every time on any device?

Shift your thinking.  Take your bricks and mortar functionality and make it available online.  The only other question remaining to be answered is whether the woman I spoke with will happen upon this narrative.

What Patient Experience could have been

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Whether one is running at windmills as a quixotic muse, or trying to bisect an elephant with a licorice whip, to anyone observing those actions it makes no more sense than having a lint collection.

Example 1: Let us say that someone walks into a nail salon and requests a manicure and a pedicure. The salon’s owner says “We only do manicures here. You have to go across the street for a pedi.”

You get the manicure, and as you are leaving the owner asks you to complete a survey about your experience with her establishment, and then she asks you to recommend your friends.

Example 2: You call the company who provides your cable television, your internet, your wireline, and your mobile service to tell them that your cable is out and that you have a question about your wireless bill.

As you wait on hold you hear the message repeated over and over for forty-five minutes that this call may be recorded for quality purposes. When you are finally afforded the opportunity to speak with a hominid about your cable outage you are told to call the cable service number. When you ask about your mobile bill you are told those questions can only be answered between 8 AM and 5 PM Mondays through Fridays. As you are about to explain that it is 10 AM on Tuesday the operator disconnects the call.

Within a minute you receive an email from the firm asking if you would complete a brief survey about your experience with them

Example 3: (stop me if you see where this is headed) It is 6 AM. You are going to be charged for parking.  You have passed through a lobby that is as ornate as anything in one of Dubai’s finest hotels.  You and the lemmings are seated in the admissions waiting room alone.  Each of the admittors (first-person singular present passive indicative of admittor–I had to look that up) is sipping from their mocha cappuccinos. You are not because you have not been allowed to have anything to drink since the last republican administration.  As you sit and wait for your turn to be admitted you are reminded of the last time you were at the DMV to have your driver’s license renewed.

A single television, which seems to be tuned to al Jazeera, is suspended overhead.  As there is no wifi, your only other option for killing time is the copy worn of Highlights magazine announcing the upcoming 1969 moon landing.

You complete the admissions process, finally.  You ask to receive a copy of the hospital’s customer experience survey, an opinion form, or whether they have a comments box.  Check D—none of the above.  When you ask why you are told, “Mister this is a hospital.  We make you better.  That is the only experience we care about, and it should be the only one you care about.”

As the anesthesia enters your blood stream, instead of counting backwards from infinity, you are left wondering why you couldn’t self-admit the night before using your iPad.

Example 3 could also been an example of someone trying to schedule an appointment online or through the call center. It could have been someone requesting the medical records. It could have been someone trying to understand Medicare. It could have been someone trying to pay their bill. It could have been someone deciding where to buy healthcare. It could have been someone seeking a second opinion.

What hospitals do not understand is not that it could have been all these someone’s…it was and it is.  Every day more people ‘visit’ your hospital online and on the phone than walk through the Dubai lobby, and nobody is asking them about their experience.

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

Improving Patient Experience: Why not try something new?

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Success and failure are often separated by the slimmest of margins. Sometimes success hinges on how you present your idea. It is possible to force the circumstances via rapid evolution to pass from problem, to possible solution, to believable, to heroic? I believe so.

Permit me to illustrate with frozen chicken. Several hours before dinner I threw the frozen chicken breasts into the sink, choosing to thaw them with water instead of the microwave. Some twenty minutes later while checking emails I wondered what we were having for dinner. Not to be outdone by own inadequacies, I remembered we were having chicken. I remembered that we were having chicken because I remembered turning on the hot water. The only thing I couldn’t remember was turning off the hot water.

I raced to the kitchen. My memory of having forgotten to turn off the water was correct. Grabbing every towel I could find, I soaked up the man-made lake that had appeared on the hardwood flooring.  While draining the lake I thought about how I might answer to my wife if she happened to return to a kitchen during high tide. My first reaction, admittedly poor, was to tell her that I thought the countertop wasn’t level and that the only way to know for sure was to see which direction the water ran. Telling her the truth never entered my mind.

Once the major puddles had been removed, I worked on version two of the story, quickly arriving at a version of the truth that seemed more palatable—tell her I decided to wash all the towels. Why not get bonus points instead of getting in trouble? Version three looked even better. Since I was wiping the floor with the towels, instead of telling her I washed the towels, why not double the bonus points? I decided to wash the floor, and wash the towels. Husband of the year couldn’t be far off.

A few hours have passed. The floor is dry—and clean, the towels are neatly folded and back in the linen closet, and the chicken is on the grill. All the bases covered. A difficult and embarrassing situation turned into a positive by quick thinking.

A few of you have asked, let’s say we buy into what you are saying, how do you propose we create a remarkable patient experience? All kidding aside, it comes down to presentation. Clearly you can’t walk into a room with a bunch of slides showing that with all of your hospital’s efforts you have only managed to improve the experience of the patients from 7.25 to 7.27.  

The first requirement to turn stalled patient experience scores into a remarkable experience for every patient and every prospective patient every time is to quit focusing only on HCAHPs.  Think of it as a patient experience 12-step meeting; “Hi, my name is Paul, and my patient experience scores have flat-lined.”  See, that was not so difficult. 

And what needs to be done?  Why not take a deep breath and decide that the time has come to lead and innovate, and to stop relying on CMS to define what patient experience means for your hospital?

Here is a start for those looking for the first step.

Define the Total Quality of a person’s Experience (TQE). I use person instead of patient because prospective patients also have experiences when they visit family members, when they call the hospital and are on the web trying to decide where to buy healthcare.

TQE = Patient Experience (think HCAHPs) + Persons’ Satisfaction (all other touchpoints)

So, how did my chicken dinner turn out? I was feeling confident that I had sidestepped to worst of it. Overconfident, as it turned out. My son hollered from the basement, “Dad, why is all this water down here?”

 

Patient Experience: So what exactly do I do for hospitals?

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A number of you have written recently asking what it is I do and how I might be able to assist their organization.

I have consulted on innovating patient/customer experience for twenty-five years, having run my own consulting firm for the last seventeen. My clients on five continents have a combined customer base of more than two hundred million.

Less than twenty percent of health systems have a working definition of patient experience, and of those that do it is defined around HCAHPs. My definition is a remarkable experience for every person (patient and prospective patients) every time on every device.  Major parts of what hospitals lack are a strategy to provide that kind of experience to both patients and prospective patients.  This includes linking a mobile experience strategy and a digital strategy.  Setting this as a goal enables hospitals to focus on improving not just the care, but also on improving patient retention, patient referrals, attracting new patients, and making it easier to do business with the hospital.

In healthcare almost every hospital regards patient experience solely as defined by CMS. That ignores the experiences and level of satisfaction of those not surveyed, people seeking second opinions, and prospective patients. It ignores the experiences occurring prior to admissions, and those occurring post-discharge. It also does not address experiences formed from nonclinical processes like scheduling, admissions, billing, claims, and complaints.

More people ‘visit’ the hospital each day by phone and on the web than walk in the front door, yet nobody knows how those people rate their experience and whether they will ever return.

Eighty percent of prospective patient’s visit a hospital’s website before determining where they will buy healthcare.  Fifty percent of patients go to a hospital’s website to determine whether they will seek a second opinion. Nobody who designed the website ever asked one of those patients what information they would need to find to help them select their hospital. 

I help organizations answer these questions.

I start by helping them define a strategy for what I call the Total Quality of a person’s (patient and prospective patient) Encounter (TQE) with the hospital.  Next I complete an assessment of where they are with regard to meeting the TQE strategy including developing:

  • A digital strategy including:
    • Websites—most hospitals have hundreds of disparate URLs
    • Social media and social CRM
  • A mobile strategy for meeting their needs on various devices
    • For example, why can’t a patient schedule an appointment online or do some form of self-admitting on an iPad rather than arriving at six AM with everyone else?
  • A Call Center Strategy
  • A strategy for improving Nonclinical business processes 

Based on the assessment we jointly set priorities and a work plan to create a remarkable experience for everyone.

Attached are a few brief presentations that offer some detail.  Please let me know if we may schedule a call or perhaps meet.

http://www.slideshare.net/paulroemer/defining-a-global-patient-experience-for-your-health-system

http://www.slideshare.net/paulroemer/step-aside-hcahps

http://www.slideshare.net/paulroemer/call-center-strategies

You can reach me at paulroemer@gmail.com, or by phone 484-885-6942.

http://www.slideshare.net/paulroemer/how-to-acquire-patients-21677042

 

Patient Satisfaction: A Normal Experience Will Never Be Amazing

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Are Hospital Executives Ignoring Their Own Survey Results?

I was reading the survey results of ache.org’s 2012 “Top Issues Confronting Hospitals: 2012”. Two things jumped out at me. Improving Patient Satisfaction was in essentially a statistical tie with two other issues for third place.

Second, Decreasing Inpatient Volume was essentially in a statistical tie for third place for financial challenges that need to be addressed.

Ache.org only reported the results. It did not draw any conclusions. It seems there is little point in surveying people unless someone acts upon the results–I may have made the same point before regarding HCAHPs.

That said, I will offer a conclusion, one that can be derived without studying the numbers.  I bet there is close to a one-to-one relationship between Patient Satisfaction and the decrease of inpatient volumes.  Fix one, fix the other.

I like that the survey labeled the issue of patient ‘satisfaction’ instead of CMS’ patient ‘experience’.  Every patient, and every prospective patient has an experience with the hospital. However, not every experience is satisfactory, and normal experiences will never be amazing.

Why not have your goal be “A remarkable experience for every patient every time and on every device? If that doesn’t work you can always erect another billboard.

Patient Experience: Not understanding UX and UI is killing Patient Experience

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UI and UX seem to be two terms that have yet to make their way into healthcare. One way I like to think of the application of design thinking in hospitals is to compare the hospital’s lobby to its website.

Millions were spent to make the lobby user friendly, to create a remarkable first impression.  There is a receptionist and maybe a sign or two pointing to the ER or the Lab.

The website is a different matter–as is the call center.  The website’s homepage offers the ‘kitchen-sink’ to visitors, patients and prospective patients. Dozens of links, Flash, every phone number you may ever need.  Users can learn about the board and make a donation. They can do everything except find the link they wanted. 

Ninety-nine percent of visitors are either patients, people trying to decide if they are going to seek a second opinion–from some hospital other than yours, or prospective patients trying to make a healthcare purchase decision. The average person spends seven seconds on a web page looking for what they want.

What that tells me is the average person is leaving the average hospital’s website unsatisfied and with a poor experience. Why is nobody interested in improving that experience?

What is the business reason for a hospital call center?

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These ten slides look at answering that question.

http://www.slideshare.net/paulroemer/call-center-strategies

Hospitals are ignoring a major patient touchpoint for improving patient satisfaction.  This touchpoint is also frequented by prospective patients and yet nobody knows if it is delivering a positive or negative experience.

Patient Satisfaction: Why Hospitals Are Losing the Battle for Patient Revnues

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Sometimes you choose to write; other times you have no choice but to write. This is one of those other times.

For those of you who believe most business situations can be tied to something related to Mel Brooks you will appreciate this. In his movie History of the World Part One, Brooks plays the role of Moses descending from Mount Sinai with stone tablets of the fifteen commandments.

http://www.youtube.com/watch?v=8YX-gqRdK_8

One set of five of them falls, hence the reason there are only ten.

Several hundred of you have read my presentation Step Aside HCAHPs; The Questions Hospital Executives Should Be Able To Answer.

http://www.slideshare.net/paulroemer/step-aside-hcahps

One reader remarked that HCAHPs includes thirty-two questions, not the twenty-seven that were referenced in my slide deck.  I would like to be able to argue that as I was leaving CMS I dropped the stone tablet containing questions 28-32. I would also like to be able to fly.  Unfortunately, I can do neither.

That said, focusing on the number of questions in the survey obfuscates the point.  The number of questions CMS put forth has only a little to do with the issue of whether their questions constitute the Total Quality of a Person’s Encounter (TQE) with the hospital.

Image

As the picture above depicts, the effort to address patient experience only from the perspective of HCAHPs ignores much of what patients experience.  That same effort ignores all of what prospective patients, people who are trying to decide where to buy their healthcare, experience.

Let’s say your hospital treats five hundred patients a week, and thirty percent of them (150) return their surveys five months later.  The hospital may then initiate a program or two to try to raise its lowest scores.  Even if it is effective, it will not impact the experience of those who completed the survey, but it may increase slightly the scores of some future group of respondents.  The only people who will ever know are future patients.

People who will never know, and who don’t know anything about your HCAHPs scores are the people who were never your patients.  In know I am stating the obvious, but I do so because the potential revenue from that group, from the non-patients and the prospective patients, is probably greater than the revenues generated by the current patients.

Let’s also say that your hospital, the one that treats five hundred patients a week, also receives a thousand phone calls a week, and that three thousand people a week ‘visit’ the hospital via the internet.  Let’s also add another five hundred people a week who visit your patients.

That totals forty-five hundred people who experience the hospital in one form or another.  Were they satisfied?  Who knows?  They were not surveyed.  Nobody asked them what they liked. Nobody asked them if they found what they were looking for.  Did any of them decide to buy healthcare from your hospital?  Why or why not?  Did your internet presence meet their need; did the call center or the switchboard?

The lifetime value of a patient is estimated to be between $180,000 to $250,000.  The average number of people per household is three. So, for every patient you can attract and retain, plus their family members, their potential value to your hospital is $540,000 to $750,000.

Instead of Patient Experience Management, hospitals should be focused on Patient Equity Management. If a hospital lost four $2,000 computers in a week, it would learn quickly how not to lose a fifth. Hospitals lose patients and potential patients every day.  They do not know how many.  They do not know why. And, they do no know how to get them back.

Now watch what happens.  What if of the forty-five hundred people—the non-patients—you could get one percent of them (45) in any given week to decide to become your patient?  What might that amount to in terms of revenues? If you can get one percent a week, over a year, 45 people become 2,340.  Twenty-three hundred and forty people multiplied by the lifetime value of a single person’s revenue is a really big number—about four hundred million—a number so big it is silly; multiplied by the value of their family members is too big for me to count.

Now there will be those who want to argue that my numbers are way off.  To you I suggest that you make them smaller, make them a lot smaller.  Even if I am off by a factor of a hundred, which I am not, that is a $4 million dollar annual increase.

Patient Experience: How Awful is your Website?

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Egypt’s Morsi, the deposed president, has a Facebook page. I am not having much luck trying to picture him sitting in his pajamas updating it with the type of music he listens too and posting pictures of himself having a beer and a dog at a ballgame.  I find myself wondering if he and Syria’s Assad have ‘friended’ each other.  One would think the club of tyrants is fairly tight.

Today’s missive provides a hands-on look at patient experience. My wife and I were up at four AM, and reached the hospital on the outskirts of Philadelphia at six.  The very first sign we saw was this announcement, “Valet Parking for Handicapped Patients is $2 off.” Was I handicapped, and arriving for surgery without having had my coffee, the two dollar discount would have me waiting with baited breath for the opportunity to complete my customer satisfaction survey.

Having a few hours on my hands, I turned to the hospital’s web site to see if it provided an experience any more remarkable than the parking.  At first blush it appeared to provide links to everything.  Many of the links led to black holes; you followed a succession of links until you hit a dead end.  You were unable to accomplish whatever it was you set out to do, but there was enough stuff to make it feel like there must be a pony hidden somewhere amongst the detritus. 

There was a link if you wanted to make a donation, one for doctors, one for nurses, one for members of the board, more than two-dozen phone numbers, some videos, how to follow them on social media—displayed in two different places, links to teach you how to ‘eat on the go’ and how to know if you are pregnant—go to CVS, a place to view all of their awards, health information, directions, contact information, and even one for patient and visitor information.

Your website’s homepage should not be a catchall for everything someone in IT can dream up. I would estimate that more than ninety-five percent of visitors to your website are either patients or potential patients. Yet, the link for patients is no more prominent than the link for learning how to eat on the go. The website actually allows you to make a donation online.  It does not allow you to pay your bill.

Many home pages have the look and feel of Craigslist but without the functionality.

Fifty percent of patients go to a hospital’s website to determine if they will get a second opinion.  Eighty percent will visit it to determine if they will become your patient.  Behind which of those links is the information that will help them make their decision?  Which bit of information will cause them to stick with your hospital?

Some people are all set to buy healthcare from another hospital, yet they are at your web site to see if maybe they should go with you.  Some people are all set to buy healthcare from your hospital, yet they are at your website to see if maybe they should go somewhere else.

Has anyone in your health system ever asked either group of people what they need to find on your website to get them to select your organization and then designed a website to accomplish that?

According to Nielsen, users will stay on a web page for 10-20 seconds.  First time visitors spend less than that. If they do not find a value proposition, something to compel them to stay they leave.  The average visitor only reads twenty percent of what is on the page.  Look at your hospital’s homepage.  Think about how much you can accomplish in ten seconds.  If you were thinking of seeking a second opinion, could you even find what you were looking for?  On average, 70% of people leave the site, and hence purchase healthcare somewhere else because they could not find what they needed.

They were dissatisfied.

They had a bad experience.

Patient experience occurs before someone gets to the hospital, and it occurs outside of the physical building.