Jerry Seinfeld said it best when someone from the Wall Street Journal called to sell him a subscription—Give me your home number and I will call you back when you are having dinner.

Companies, ne hospitals, cannot sell you anything.  So much for business development.

If you want to build your business stop trying to sell people your services.  Instead, make it easy for them to buy your services.  Become the company that is easy to do business with.

Unfortunately,few if any firms are doing that.

What would happen if a fifty-four hundred people (one person for every hospital) were standing together in a field, and they each took one step forward.  The next month they did exactly the same, and so forth and so on, ad nauseum.  The crowd would certainly have changed places, but relative to one another the individuals would all be about as far apart from each other.  Not much would have changed, at least not much that was noticeable.

Now what would happen if one person—or hospital—decided to be innovative and did something disruptive and separated themselves from the crowd?  What if hospital sprinted in a different direction?  They came to a fork in the road and they took it.

With every hospital’s focus on HCAHPs, and all of their focus on HCAHPs, it can be argued that they are all moving across the field somewhat in lock-step.  Now before anyone gets the notion that I am arguing that hospitals should stop focusing on HCAHPs that is not my intention.  Improving HCAHPs is a good thing.  Getting each hospital moving towards one hundred percent in all categories is a good thing.

However, one hundred percent is not achievable nor is it cost-effective.  At some point there are diminishing returns if the goal is to stop all pain, remove all noise, and have perfect communication.

With all hospitals taking one step forward on their goal to improve the patient experience of each surveyed patient, who then is responsible for moving the organization forward for improving the satisfaction of all patients? 

Doing what every other hospital is doing is not innovative.  It will neither drive patient retention or referrals, nor will it improve the satisfaction of those people, patients and prospective patients who visit the hospital via the web or by using the phone.  It will also have little or no effect on those who were surveyed—they have already been discharged.  It will also have a similar effect on those who were not surveyed.

Innovation is the application of new solutions to meet needs or changing market requirements.  For innovation to work an organization must acknowledge a problem/opportunity.  Like a 12-step program. Hi, my name is Paul and we have a patient satisfaction problem.

The hospital that chooses to separate itself from the pack will recognize that much of an individual’s satisfaction with their interaction with the hospital happens outside of the hospital’s four walls.  It happens before they are admitted and after they are discharged.

I like to define it as follows:

The Total Quality of a Person’s (patient & non patient) Encounter (TQE) is equal to the sum of the Patient’s Experience (HCAHPs) plus Patient Satisfaction (all of the other interactions they have with people, process, and systems.)  One way to know how your hospital is doing with TQE is the following.  If your hospital has not totally reinvented those interactions since the advent of the iPad, and defined a TQE strategy, your TQE is well below what it could be.

In case you are interested, this link is to a brief, downloadable PowerPoint presentation on creating a TQE strategy.

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

So I’m making dinner the other night and I’m reminded of a story I heard a while back on NPR. The narrator and his wife were telling stories about their 50 year marriage, some of the funny memories they shared which helped keep them together. One of the stories the husband related was about his wife’s meatloaf. Their recipe for meatloaf was one they had learned from his wife’s mother. Over the years they had been served meatloaf at the home of his in-laws on several occasions, and on most of those occasions his wife would help her mom prepare the meatloaf. She’d mix the ingredients in a large wooden bowl; 1 pound each of ground beef and ground pork, breadcrumbs, two eggs, some milk, salt, pepper, oregano, and a small can of tomato paste. She’d knead the mixture together, shape into a loaf, and place the loaf into the one-and-a-half pound pan, discarding the leftover mixture. She would then pour a mixture of tomato paste and water, along with diced carrots and onions on top of the two loaf, and then garnish it with strips of bacon.

He went on to say that meatloaf night at home was one of his favorite dinners. His wife always prepared the dish exactly as she had learned from her mother. One day he asked her why she threw away the extra instead of cooking it all. She replied that she was simply following her mother’s recipe.  The husband said, “The reason your mom throws away part of the meatloaf is because she doesn’t own a two-pound baking pan. We have a two pound pan. You’ve been throwing it away all of these years and I’ve never known why until now.”

Therein lays the dilemma. We get so used to doing things one way that we forget to question whether there may a better way to do the same thing. Several of you have inquired as to how to incorporate some of the patient experience strategy ideas in your organization, how to get out of the trap of continuing to do something the same way it’s been done, simply because that’s the way things are done. It’s difficult to be the iconoclast, someone who attacks the cherished beliefs of the organization. It is especially difficult without a methodology and an approach. Without a decent methodology, and some experience to shake things up, we’re no better off than a kitchen table amateur (KTA). A KTA, no matter how well-intentioned, won’t be able to affect change. The end results would be no better than sacrificing three goats and a chicken.

So, think about how to define the problem, how to find a champion, and how to put together a plan to enable you to move the focus to developing a proper strategy, one that will be flexible enough to adapt to the changing requirements. But keep the goats and the chicken handy just in case this doesn’t work.

Dateline ESPN: The United States Olympic Committee (USOC), in a somewhat startling announcement, ruled today that the men’s decathlon had modified its rules. Because scores in the high jump, one of the ten contested events, were lower than those of other countries, starting in 2014 all decathletes would be required to spend all of their training time focused on the high jump.  In addition, the USOC would penalize any decathletes that did not improve their high jump scores.

To meet the new requirement, many decathletes have hired coaches and purchased training data to help them increase their high jump scores.  One holdout is reported as having said that the USOC has overlooked the fact that the decathlon is scored on ten events, and that to focus on a single event would only result in having failed at all of them.

There is no need to write more.  Replace the USOC with CMS, the high jump with HCAPS, the decathlete with a hospital, and the decathlon with the Total Quality of the Patient’s Encounter (TQE) and you have the whole story. 

Focusing only on improving patient experience by raising your HCAHPS’ scores is like trying to win the decathlon by only focusing on improving your high jumping.

With all of the focus on HCAHPS’ 27 questions, Press Ganey surveys and The Studer Group’s coaching, I thought I would create my own 27 questions.  You decide which list is more relevant—perhaps both are.

Is your hospital equipped to increase patient satisfaction, retain patients, and attract new patients?  If it is your hospital should be able to answer these twenty-seven questions.

1. What are your hospital’s patient touchpoints before, during, and after hospitalization
2. Which patient touchpoints are most frequented
3. Which patient touchpoints have the greatest impact on the Total Quality of the Patient’s Encounter (TQE)
4. What percentage of your hospital’s patients does it retain
5. What percentage of your hospital’s patients refer other patients
6. What is the ROI of a patient over thirty years
7. What is the ROI of a patient’s family
8. Do more people visit your hospital’s website every day than visit your hospital
9. Did your hospital spend more money to make a favorable impression on the hospital’s lobby than on the hospital’s website
10. What percentage of people call your hospital that you never hear from again
11. What percentage of people visit your website that you never hear from again
12. How does the hospital know what the hospital’s patients expect
13. Does the hospital have an effective definition of TQE for its health system
14. Why did the hospital’s patients choose your hospital
15. Why did prospective patients choose a different hospital
16. Why did patients choose not to return to your hospital
17. What could the hospital change to create ‘patients for life’
18. Do people who call the hospital receive a remarkable experience every time they call
19. What is being said about your hospital on the internet
20. What touchpoints should the hospital be benchmarking regarding TQE
21. Does the hospital’s website allow people to accomplish what they want, how do you know
22. What is the ROI of the hospital’s business development and sales and marketing group
23. What are the top three things your hospital could do to improve family experience
24. Are patients able to accomplish every task online that they could accomplish if they came to the hospital
25. Can patients accomplish these same tasks at any time on any device?
26. Who designed the hospital’s patient experience strategy, the hospital or the patients
27. What would your patients change to improve TQE

Explaining a new concept to those whose new concept quotas are full can be challenging.

Sometimes when I am in a meeting whose tedium has it spiraling into a black hole, I tend to lose my train of thought.  Like the one I was in the other day.   I find myself inventing things to satisfy the voices in my head.  In that particular day, if I had had a box of toothpicks I might have set about building a cold fusion device.  But alas, I was armed with only my wits; in other words, I was helpless.

Undaunted, I began playing a virtual game of Trivial Pursuit with the others who were likewise trapped.  Of the redhead two seats down, I asked the question “Name a reptile with four letters in its name.”  I envisioned her, without thinking, I do not know if this was a genetic flaw or simply a misfiring synapse she replies “Spider.”  I knew at that moment she and I would not be splitting a croissant at the next Mensa meeting.  Then I envisioned her getting mad at me because in front of everyone I would have announced that spiders are not reptiles.  By the time I would have told tell her that ‘spider’ was spelled with six letters I would have been hyperventilating so badly that the meeting coordinator would have had to put a grocery bag over my head—paper or plastic?

So, back to the concept of buying into new ideas.

What if you were asked to become the new manager of the New York Yankees, and before you make your decision you are told you may watch the third inning of each of their games?  Innings one and two, and four through nine were out of bounds.

You had to base your evaluation of the team on only a fraction of the available information. Kind of a silly notion.  Who would want to make a decision with only a fraction of the information?

Almost every hospital in America does that every day when it comes to evaluating patient experience.  They look at a fraction of the information that makes up patient experience.  Why?  Because that fraction is what CMS defined as the entirety of patient experience.  Why else?  Because money is involved.

And here is a little secret that hospital CFO’s and hospital boards have either overlooked or misunderstood.  The amount of the penalty trifles in comparison to the size of the revenue gain that could be made if hospitals focused on patient retention and referrals that could come from satisfying patients.

HCAHPs.

HCAHPs surveys are like only looking at the third inning of a baseball game to judge how to improve the team.  HCAHPs surveys are based on data that is months out of date.  How does one realistically fix a problem associated with a single patient that happened six months ago?  Don’t believe me?  Can you remember how the service or food was at the restaurant you dined at last December?  Of course not.  If you filled out a customer satisfaction survey tomorrow, would you believe it would change anything at the restaurant based on your six month old experience?  How clear would your recollection be.  What could the restaurant change to make you want to return?  How would you know if they changed it?

This process is fruitless.  The only point, the only reason hospitals address patient experience through the blinders dictated by CMS is because of the penalty.  Ding-dong, Avon (substitute your favorite patient experience data selling firm) calling.  Would you like to pay us for your own data?

I get the impression that saying you do not want to buy patient experience data is like saying ‘no’ to the teenager selling magazine subscriptions.  That firm, you know the one, rings your doorbell and asks, ‘Would you like to improve patient experience?”  Recognize two things.  It is a loaded question—you cannot sleep at night if you say ‘no’.  More importantly, paying for patient experience data year after year has nothing to do with improving patient experience.  Did it improve the experience of your patients?

If the survey data indicated that Nurse Ratched did not smile enough, what course of action did you undertake?  You hired the coaching firm—you know which one, you hired the survey data selling firm—you know which one, and what was the result?  Nurse Ratched smiled.  You spent more than a hundred thousand dollars to find out that Nurse Ratched was the problem and to make sure she smiled.

What did you get for your expenditure as relates to how people perceive your hospital?  Nothing.  Why nothing?  Because the now smiling Nurse Ratched only attends a very small percentage of your total patient population.  Getting her to smile has no impact on the satisfaction of all of the other patients and all of the prospective patients.  There is no ROI on paying for smile coaching or data.

Fixing Nurse Ratched is like basing your decisions on the third inning.  If you only follow the CMS guidelines you will never improve patient experience.  Viewing CMS as though they came down from Mount Sinai with the stone tablets will get you nowhere.  What if in addition to Moses, Fred, Sally, Joe, and Leslie also had stone tablets, but those people stopped to check out the burning bush and were delayed?  I know my analogy is a stretch, but I am writing late at night.

What questions were on the other tablets, what questions is your hospital ignoring?  How about, “Is it easy to do business with the hospital?”  Could you schedule an appointment without spending an hour on hold—could you do it with a click of you mouse?  Did the hospital help you file a claim?  Could you admit yourself the night before on your iPad?

Surveys and CMS do not address the level of dissatisfaction from not being able to do those things.  Forget for a moment that you work at the hospital.  Become a patient.  Show up at six AM, along with all of the other people who were told to be there at six AM.  You and they have not had anything to eat or drink since the night before.  The line to be admitted looks like a Greyhound bus just dropped off forty teenagers at McDonalds.  It reminds you of why airports schedule all of their departures at the same time.  It makes you ask why someone has not come up with a better idea.

What if instead of sitting on the waiting room, waiting to be processed like cattle on their way to the slaughterhouse, you were able to self-admit at a time and on a device of your choosing?  What if you were treated as a customer, a customer whose value over the next twenty years was valued at one hundred thousand dollars; a customer whose family members increased the value of your business by another few hundred thousand?

If hospitals focused on the revenues that could be made instead of the money that might be lost everyone would benefit.

Every patient should expect a remarkable experience every time, for every interaction at any time on any device. 

That remarkable experience, in addition to their care, will contribute to their decision to return to that hospital and whether they will refer others. 

A large part of a patient’s experience comes down to this; How easy are you to do business with?

Most patients would rather be anywhere but the hospital.  They expect to be in pain, inconvenienced, frightened and humbled.  The nearest experience for comparison most of them have regarding sleeping overnight and having their meals delivered probably comes from having spent hundreds of nights in hotels. That plays into their expectations, but hospitals do not ask about their expectations ahead of time.  Instead hospitals allow CMS to define the parameters for good and bad experiences, and they package it in a survey of a few dozen questions.

What do hospitals miss if all they rely on are surveys and purchasing their own data.

1. Surveys only focus on patients.  They provide zero data on prospective patients, ignoring all of the potential patients whose opinion of the hospital is defined by a visit to the hospital’s website, calling the call center, and social media posts by prior patients.  The number of people each day who “visit” the hospital online and over the phone greatly exceeds the number treated each day.  What was the experience of the visitors? Did they select the hospital?  Why not? How many potential patients were lost because they had a bad experience online or on the phone? If patient experience warrants spending millions on business development, sales and marketing, and the hospital’s lobby, is spending an equal amount on their web presence and call center not of equal or greater value?
2. Hospitals do not know the experiential expectation of a single patient.
3. Patient expectations of their experience begin to be set the moment they first feel a lump, or when their child has a high fever in the middle of the night.  For some their experience continues well beyond when they have completed the survey and left the hospital.  Whether those interactions provide a remarkable experience will help determine where that person will go the next time they decide where to be treated.
4. Hospitals should add to their efforts to improve patient experience by also looking at touchpoints and processes that affect the experience of every patient.  They could start with their website and call center.  They should look at those business processes that map almost one-to-one with the hospitality industry.  To name a few, those processes include scheduling, admissions, billing, claims, food service, and housekeeping.

I spoke with executives at three different hospitals last week and heard the following.

A hospital CEO said, “The greatest improvement I could make to improve patient experience is to add parking and improve the food.”  An executive in charge of quality said, “Seventy percent of our patients are Hispanic.”  When I asked about their plan to make their website available in Spanish she told me they had no plan.  An executive in charge of customer satisfaction at a third hospital said they were having problems with their call centers.  Those call centers are open between the hours of eight and five-thirty.  Even cable television companies provide better hours.