The Wildebeest Postulate of Patient Satisfaction

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The Kalahari; vast, silent, deadly. The end of the rainy season, the middayImage heat surpasses a hundred and twenty. One of the varieties of waterfowl, most notably the flame red flamingo that nested in the great salt pans in Botswana, has begun its annual migration. In the muck of one of the fresh-water pools that had almost completely evaporated, writhes a squirming black mass of underdeveloped tadpoles. A lone Baobab tree pokes skyward from the middle of the barren savanna. In its shade, standing shoulder to shoulder and facing out, a herd of wildebeest surveys the landscape for predators.  Sir David Attenborough and PBS can’t be far away.

Some things never change. I make my way across the freshly laid macadam to meet the school bus. Fifty feet in front of me is a young silver maple tree, the buds of its green leaves yielding only the slightest hint of spring hidden deep within. The late afternoon sun casts a slender shadow across the sodded common area. One by one they come—soccer moms; big moms, little moms, moms who climb on rocks; fat moms, skinny moms, even moms with chicken pox—sorry, I couldn’t stop myself—as they will every day at this same time, seeking protection in its shade. My neighbors.  It’s only sixty-five today, yet they seek protection from the nonexistent heat, a habit born no doubt from bygone sweltering summer days. A ritual. An inability to change. In a few weeks the leaves will be in their full glory, and the moms will remain in the shadow of what once was, standing shoulder to shoulder facing outward, scanning the horizon for the bus. A herd. Just like wildebeest.

The children debus–I invented the word.  Mine hand me their backpacks, lunch boxes, and musical instruments.  I look like a Sherpa making my way home from K-2.

I shared the wildebeest analogy with the neighborhood moms—the bruises will fade gradually. I can state with some degree of certainty they were not impressed with being compared to wildebeest. So here we go, buckle up. By now you’re thinking, “There must be a pony in here somewhere.”

Some things never change; it’s not for lack of interest, but for lack of a changer.  For real change to occur someone needs to be the changer, otherwise it’s just a bunch of people standing shoulder to shoulder looking busy. Motion is not the equal of movement.

How are you addressing the change that must occur to improve patient experience?  Patient experience is not about CMS.  It’s not about purchasing data about patient experience, and it is not about coaching and clowns.  It is about moving from a 0.2 business model to 2.0.  You need someone who sees the vision of what is is—sorry, too Clintonian—must lead.  Be change.

One of the great traits of wildebeest is that they are great followers.

Will Showing Initiative Get you Voted Off The Island?

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Were one to judge America by what American’s read from scanning the headlines of the magazines in the supermarket’s checkout lane, the only items of note are that Jennifer Aniston may or may not be pregnant, and that another one of the Kardashian’s was married—no word as to whether or not she is pregnant but I have my fingers crossed. The headlines provided no indication that we are at war or that the economy has been outpaced by my daughter’s lemonade stand.

Anyway. I have been reading Solzhenitsyn’s The Gulag Archipelago, which should be on every reading list for Genocide 101. In the book Solzhenitsyn describes numerous offenses which could get a Russian sentenced to Stalin’s gulags. Some estimates suggest more than sixteen million people were purged under Stalin’s regime—enough people whereby those in power had to continuously invent new offenses.

In one such description Solzhenitsyn recounts a meeting of Stalin’s supporters. By law, every public gathering was attended by several members of the NKVD, Stalin’s henchmen. At the conclusion of the meeting its chairman called for a verbal salute to Stalin which resulted in all of those attending applauding. The vigorous applause continued for eleven minutes because everyone was afraid to be the first to stop applauding.

To stop applauding was to show initiative, was to be an individual. Exhausted, the chairman finally stopped clapping; immediately, so did everyone else. The chairman, a loyal communist, was arrested. During his interrogation the interrogator told him “Don’t ever be the first to stop applauding. We do not like initiative.” Darwin’s natural selection and how to grind down people with stupidity.

Nonetheless, we return to Beaver Cleaverville.

Do you ever sit in a meeting thinking it would be easier to design a revolving sliding door than to agree with or understand whatever is going on in the meeting around you? You scan the room eying the seated rams and ewes each of who view themselves as lions. Once again, the Pickle Factory’s leader had confused motion with movement. You scribble yourself a note using your favorite crayon—the cerulean blue, ‘I have seen our future and it needs work.’

“Well, here we are,” says the moderator outfitted in her J C Penney imitation Vera Wang pantsuit. For years her mind has run just fast enough to enable her thoughts to always be in the same place.

“Yeah, here is where we are,” you mumble into your cupped hand. “We have been here before and we will be here again and again.” The person across from you seems to be humming “It’s a long way to Tipperary.”

These meetings make about as much sense to you as the game the Afghan Pashtun tribesmen play—buzkashi—sort of like polo except instead of using a ball they use a headless goat. Each day the executives drag the headless carcass of their business strategy to meeting after meeting hoping to score, and the more meetings you attend the more you feel like the goat.

“What are we supposed to accomplish today?” You ask.

“Your guess is as good as mine,” replies the moderator, her mind making its way back from its visit to the land of ultima Thule.

“No, your guess is better than mine,” you say. “It is your meeting. Lock the gate,” you mumble, “before the village loses its idiot.” Everything is running behind and the team wants to make up for lost time. Your job is to try to convince them that you cannot make up for lost time; the best you can hope for is not to lose any more.

You have always known that companies which do not tolerate dissent have a tendency to ignore dissenting information but they remember the dissenters—the first person to stop clapping. In a company lacking second sight and new ideas, the old ideas are often divided evenly among the employees. The death spiral of silence—people avoiding threats of being voted off the island have a tendency to refrain from making any statement that may show them to have an original thought. Showing initiative can result in your being sent to the company’s gulag.

Have you noticed that the more a firm’s competitive edge erodes, the busier the firm appears to be? Once you have fallen through the looking glass the only way out may be for you to walk back the cat, that is travel backwards to see how it is you and the others became trapped in this wilderness of mirrors. The problem with that strategy is that to undertake it requires you to show initiative.

Every firm’s gulag is filled with people like us. At least when you get there you will be able to commiserate with people of a similar ilk.

What if you were actually able to do the one thing that you were most afraid of trying in your firm?  If the idea is good enough it may be worth getting voted off the island.

Patient Satisfaction: Defenseless in the Battle of Wits

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Yesterday I came close to being able to answer the question, just how many Raisinets can a person eat in one day.  The Players Championship, the TPC, is being played in Jacksonville this week.  My hotel is overflowing with men dressed like peacocks, and wearing golf costumes, outfits they would never wear at work; plaids, loafers with no socks, Granny Smith green, amaranthine and heliotrope, and cadmium and salmon colored shirts, shorts and jackets.  When they stood together they looked a bit like a fruit salad.

Patient touchpoints.  Does your hospital realize that most patient touchpoints are not under their control?  If you are not controlling them, who is?  Does your hospital even have a global patient experience strategy for the touchpoints you can control?

Billboard, direct mail, YouTube, television, radio, email, online searches, brochure, mobile apps, Facebook, Twitter, blog, website, physician, friend, family, WebMD, online forum, family, therapist, admissions, aide, nurse, support group, call center, online chat, social worker, pharmacist.

Whew.

Did you know that thirty-four percent of patients use social media, 46% health portals, and 67% search engines?  (Ira Kaufman, Entwine Digital).  These figures do not even take into account all of the prospective patients who went to the web and upon looking at your website decided to take their healthcare to someone else.  What was it about that patient touchpoint with your hospital that failed them?

What is important to you about those figures?  They probably made you think you need to get your social media program in place.  Perhaps.  The social media aspect means that your patients are either writing about your hospital or reading what others have written about it.  One thing is certain.  Your patients are not using social media to write or read about how much patient experience has improved because of all of the reports you have purchased on patient experience data.

Most hospitals of any size have an entire staff dedicated to business development.  Billboards, ads on NPR, a single Facebook page, and direct mail.  How is that working?  Was your organization able to tie a single dollar of revenue to the billboard depicting your urology group?  One hospital I know tied twelve million dollars of revenues to its new website in the first year.  Using traditional, proven methods to develop business is outdated.  The proven methods have proven one thing, they no longer work.

The reason traditional business development tools do not work is that the hospital is unarmed compared to its opponents, the people it wants to attract.  Defenseless in a battle of wits.  Hospital business development efforts are using stone-age tools.  Prospective patients are using 1’s and 0’s.

Where is the disconnect?  Hospitals are selling hip replacements.  People are not buying hips; they are buying the ability to play golf for another ten years.  See how nicely we were able to tie this all back to the TPC?

One thing on which most of us can agree is that giving every discharged patient a copy of Celine Dion’s new CD will not improve the patient’s experience.

 

Patient Satisfaction: How Many Days Ago Was Sunday?

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How long have you been doing this?  That’s seems like a fair question to ask of anyone in a clinical situation.  It’s more easily answered when you are in someone’s office and are facing multiple framed and matted attestations of their skills.  Seen any good Patient Satisfaction or retention certificates on the walls of the people entrusted with the execution of the hospital’s patient experience endowment?  Me either. 

I have a cardiologist and he has all sorts of paper hanging from his wall.  Helps to convince me he knows his stuff.  Now, if I were to pretend to be a cardiologist—I’ve been thinking of going to night school—I’d expect people would expect to see my bona fides.

Shouldn’t the same logic apply to whoever is spending the hospital’s resources to retain patients? 

Please permit me to offer a real-life example. More than ten years ago I had a heart attack and was taken to a local hospital.  I lived, thanks for asking.  For the last ten years I have done all of my cardiac follow up at U Penn, a different hospital.  The hospital that treated me does not know that I lived; they never called, I never heard from them again.  Cost of a phone call—$30.  Cost of not retaining me as a patient—quite a bit.

(This same hospital has a large business development team and an equally large marketing department that frequently markets its cardiology offerings.  Talk about an opportunity to cut wasteful expenses.)

Imagine this discussion.

“What do you do?”

“I’m implementing something for the hospital that we have never done.”

“Why?”

“The feds say we’ve got to have it.”

“Oh.  What’s it do?”

“Nobody really knows.”

“How long have you been doing this?”

“How many days ago was Sunday?”

“What’s it cost?”

“Somewhere between this much,” he stretches out his arms, “And this much,” stretching them further.

“Do the doctors want this?”

“Some do.”

“How will you know when you’re done if you got it right?”

“Beats me.”

“Sounds like fun,” she said, trying to fetter a laugh.

Sounds like fun to me too.

 

Patient Satisfaction: When you are in a hole, stop digging

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I awoke this morning to a text message sent from my eleven year old son’s iPhone last night.  The message read, “My two girdles are killing each other.”

I was flummoxed until I spoke with my wife.  It was two gerbils that were killing each other.  Two gerbils, five dollars.  Autocomplete, priceless.

Having left my reading glasses at the hotel this morning I inquired of one of a my-gen coworker where I could buy another pair.  Judging by her stare, I do not think the twenty-something was any more familiar with the term ‘reading glasses’ than some people are with my epistles about patient satisfaction.

“Do you have trouble reading Dude, or are you looking for those Google glasses that read for you?”  She did not use the term Dude, I threw that in for effect.

I told her I did not have trouble reading and that I am able to read two years above my age level—bada boom bada bing.

I was thinking about the time I was teaching rappelling in the Rockies during the summer between my two years of graduate school.  Each one week camp was for high school students of varying backgrounds and their counselors.  On more than one occasion, the person on the other end of my rope, the person being rappelled, would freeze up from fear and I would either have to talk them down safely or rappel down or help them.

Late one day, a thunderstorm broke quickly over the mountain, causing the counselor on the end of my rope to panic.  No amount of talking was going to get her to move either up or down, so it was up to me to rescue her.  I may have mentioned in a prior post that my total amount of rappelling experience was probably no more than a few more hours than hers.  Nonetheless, I went off belay, and within seconds, I was shoulder to shoulder with her.  We were both perpendicular to the face of the cliff and some fifty feet from the bottom.

The sky blackened, and the wind howled, raining bits of rock on us.  I remember that only after I locked her harness to mine did she begin to relax.  She needed to know that she didn’t have to go this alone, and she took comfort knowing someone was willing to help her.

That episode reminds me of a story I heard about a man who fell in a hole—if you know how this turns out, don’t tell the others.  The man in the hole continues to struggle but can’t find a way out.  A CFO walks by.  When the man pleads for help the CFO writes a check and drops it in the hole.  A while later an applications vendor walks by—I know this isn’t the real story, but it’s my blog and I’ll tell it any way I want.  Where were we?  The vendor.  The man pleads for help and the vendor pulls out the contract, reads it, circles some obscure item in the fine print, tosses it in the hole, and walks on.

I walk by and see the man in the hole.  “What are you doing there?”  I asked.

“I fell in the hole and don’t know how to get out.”

I felt sorry for the man—I’m naturally empathetic—so I hopped into the hole.  “Why did you do that?”  He asked.  “Now we’re both stuck.”

“I’ve been down here before,” I said, “And I know the way out.”

I know it is a little sappy and self-serving.  However, before you decide it’s more comfortable to stay in the hole and hope nobody notices, why not see if there’s someone who knows the way out?

John Steinbeck’s novel Of Mice and Men included the statement, ‘The best laid plans of mice and men often go astray.’  My take on it; the reason the best-laid plans of mice and men often go astray is not the because of the plan; it is the mice and men. 

The problem is mice and men have a history with the organization.  They are constrained by phrases like ‘We’ve never done it that way’ and ‘that cannot be done.’  I believe most things people think cannot be done can be done, but then I have been accused of trying to believe in as many as six impossible things before breakfast.

One of the impossible things I believe is that there are simple ways to dramatically improve patient satisfaction for all patients by creating a remarkable experience for every patient every time.  Every time a patient or prospective patient interacts with the hospital they do so in one of three ways; they call, they go to the web, or they do so in person.

Each person is either satisfied or unsatisfied from every call, web visit, and visit.  The health system needs to get these interactions right one hundred percent of the time.  What does it mean to ‘get it right’?

If I go to the web to schedule a follow up appointment and I am given a number to call rather than an appointment, the hospital failed me.  If I call the hospital to understand Medicare billing and am told to call back during normal hours, the hospital failed me.

Finally, suppose using my Bluetooth headset on Dragon I use my iPad, and with voice commands navigate to the link on the hospital’s website showing me how to retrieve a copy of my medical records.  When I get there, having used every possible form of technology, I am instructed to click a link to open a form to request my records.  I then must print the form, complete it, find an envelope and a stamp, and post my request via snail mail.  Over the next few weeks the hospital will reverse the process and eventually I will receive my records.  My satisfaction dropped?  Why?  Because the link implied I could click something and get my records; the fulfillment process was out of date and under-delivered.

The Downside of Patient Experience

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The Enchanted Forest was my first employer. My job was to direct cars to available parking, affix bumper stickers to those cars, and pick up the discarded Pampers—I lasted less than a day.

I mention that because today I had the pleasure of laboring through security at Philadelphia International Airport. Cattle awaiting slaughter in Chicago’s stockyards have a better experience.  Given the choice of being a TSA agent or picking up Pampers at the Enchanted Forest I’ll take the Pampers.  Lest we forget, all Americans should be forced to go through airport security once a year just to remember what those clowns did to us on 9-11.

I am flying USAIR; not by choice.  One of my fellow alums, our school’s poster child for success, is the CEO of USAIR.  I bet he flies Southwest, or maybe he does the John Madden thing and rides in his own bus whenever he has to travel.

Remember the old airline slogans, “We love to fly and it shows,” and “Fly the friendly skies of United,” and Delta’s “We’re ready to fly when you are”?  Today the universal slogan of the airline industry is, “We don’t like flying any more than you do, but hey, it’s a job.  We are no worse than the other airline.”  There is no pretense about competing on customer experience.  Far from it.

Airlines no longer even pretend to compete on price. It is almost as though they compete with one another to see which airline can come up with the most irritating surcharges.  Should we be forced to make an emergency water landing—as though there is anything other than an emergency water landing—your seat cushions may be used as flotation devices.  There is a five dollar non-refundable charge for those who may wish to use their seat cushions to save themselves and their loved ones.  A flight attendant will be passing through the aisle to collect payment and unlock your cushion.

To board the plane I had to pass between two closely aligned, six-foot, vertical, buttered rollers that were designed to lubricate both sides of each passenger to enable passengers to squeeze into the aircraft’s Barbie Doll seats.  As I am seated in an exit row I decide to take advantage of an on-the-spot micro-business opportunity.  I stand and announce to my fellow passengers, “Should we be forced to make any type of emergency landing you may wish to exit the plane.  There is a five dollar non-refundable charge for those who may wish to exit through my window exit.  I will be passing through the aisle shortly to collect payment.”

The marketing campaign for the airline industry seems as though it was pulled almost word for word from the Les Misérables song, Master of the House.  “It doesn’t cost me to be nice, nothing gets you nothing, everything has got a little price. Master of the house, keeper of the zoo, ready to relieve them of a sous or two…charge ‘em for the lice, extra for the mice, two percent for looking in the mirror twice.”  Essentially their customer retention plan is we can do whatever we want to you…if you don’t like it you can always walk.  “Two percent for looking in the mirror twice.”

Customer experience.  Patient experience.  Driving to the airport this morning NPR ran an advertisement from a Philadelphia hospital that was touting its hip and knee replacement offering.  You may not know this, but hospitals have a department that specializes in business development—I kid you not.  Highly trained individuals, MBAs—most likely all of the airline CEO positions were taken, toil day after day trying to figure out the answer to the question that has plagued mankind since the invention of the Band-Aid, ‘How do we get sick people to come to us’?  Give us your tired, your poor, your huddled masses…healthcare’s business development strategy could be dubbed the Statue of Liberty strategy. 

Sometimes the business development people get together with the marketing people—it is like a Mensa meeting minus the mense—no need to look it up; I was just going for the alliteration.  I think this is how the billboard strategy of attracting patients came into being.  You know the one about which I am writing.  A mile or so from every hospital is a mammoth billboard depicting a photo of the hospital’s urologists—substitute your favorite specialty—all of whom are smiling.  I think the idea behind the billboard is to entice you to use their services should you happen to be passing a kidney stone as you are driving by.  (I read that in California the photo of the urologists has been replaced with a photo of the nip-&-tuck squad.)

What many hospitals seem to have failed to notice, or to have made operational, is that prospective patients choose their providers.  This has been going on for well more than a decade.  I know this because when I had my heart attack the ambulance driver determined where I was to be treated, a hospital fifteen minutes from my house.  For the last ten years I have chosen to travel more than an hour each way to the cardiologist I selected.  The original hospital, which has lost tens of thousands of dollars by not retaining me, does not even know if I am alive.  They never called to find out.  By the way, they have a lot of billboards.

Patient choice is undermining a lot of hospitals’ revenues.  As much as the healthcare industry would like us to believe that people choose their provider only based on specializations and mortality rates, other factors come into play.  One of those other factors, perhaps the biggest factor, is patient experience and their satisfaction with that experience.

Cancer Treatment Centers of America seem to have figured that out.  Their advertisements appeal to our base Freudianish needs, that the individual is special and wants to be treated as such.  CTCA does not advertise that you will not die if they treat you.  Their advertisements and their testimonials focus on the fact that their patients are treated like family. 

Essentially CTCA  have figured out that it is good business to approach cancer patients as smart customers.  CTCA cannot campaign on the fact that their patients don’t die.  Unfortunately cancer patients die, so that dog don’t hunt.  They cannot campaign on the fact that their treatment doesn’t make you nauseous, but as I also know from personal experience, chemo is awful, so that dog don’t hunt either.  So CTCA claimed the unclaimed ground, the ground over which none of their competitors are fighting; patient experience.

The CTCA’s phone lines are open 24 x 7, or you can reach them through a chat line to let them convince you about their integrated, specialized plan to treat you.  (They do not however have an iPad app which means they just lost points in the patient experience bonus round.)

Their patients travel across states at great personal expense.  Their patients are willing to pay more for even the possibility of a better experience.

I’ll close with this.  Almost every hospital has at least one MRI.  Each MRI probably delivers the same high quality images.  Each hospital probably has equally competent radiologists to read the images.  What then is your hospital’s competitive advantage?  Perhaps it is time to be able to answer that question.  The downside of competing on patient experience is that to do so you had better be pretty good at it.

The Fallacy of Call Centers

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I am willing to bet that most contact centers are not providing value to the business. Most businesses score success around the metrics of the calls and the call center. The only business reason to have a call center is to increase the customer’s satisfaction. it costs $30 to process a call and firms are trying to drive those costs down.

It costs thousands of dollars each time you lose a customer.

Business asks, ‘Did I answer the customer?’ Why not ask, ‘What did we do or not do that caused the customer to call and can we do that better?’

The reason and answers for most calls to a call center could be made available to most customers at any time on any device on a customer portal with zero wait times and a zero per transaction cost. Unfortunately, most firms who think they have a customer portal actually only have a web site.

Patient Experience: Is it worse than your cable company?

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Several of you wrote to inquire about a term I used, churn.  Customers churn, and patients churn.  Churn is the opposite of retention.  Instead of retaining patients, they churn, they go somewhere else.  It’s like multiplying retention by negative one.

I am curious to learn if any of us consistently has good customer experiences with the professional services firms we use.  I bet we do not.  We have satisfactory experiences; we have portions of our experience that are somewhat satisfying, perhaps even bordering on good.  Because our experiences in general have degraded over time, what would have been viewed as a poor experience a few years ago now hides behind the veneer of acceptability.  Our standards of what is acceptable have declined right along with the professional services we consume.

Professional services firms include accounting, law, cable, phone, healthcare, and there are many others.  One characteristic about buying professional services has everything to do with the service; that is why ‘service’ is in the name.

A while ago I spent two days in Nashville at the Loews. Great hotel. The clerk in their lost and found gave me a power cord for my phone. The attendant in the exercise room thanked me for allowing him to serve me during my workout. Sort of makes me feel like I should return the towels—just kidding.  At the end, they asked me, “How did we do?” They didn’t ask about my room, or the food—they knew those things were perfect. They asked about how the people performed. Competing on service.

Last week I rented a car from National.  I always rent from Enterprise.  Enterprise has no perks, no frequent renter upgrades.  I get a car, the same car I could have received from any other rental company.  National gave me a car. I was the only person in line and it took twenty minutes.  I had to initial eighteen times.  National’s car was fine; same as what I would have rented from Enterprise. 

I will not rent from National again.  Why?  They did not ask me how did we do, and how they did was poorly.  Enterprise knows their car will be perfect; they do not need to ask is everything with the car was okay.  Enterprise always asks how they did.  They do not need to ask because their service is always perfect, but they do ask.  They asked how the people performed.  They compete on service, not on cars.  The cars are the commodity.

Most professional services firms know you are no longer a customer because you cancel their service.  Actually, the firm does not know.  It is a closely held secret among you, the person with whom you spoke, the recording of your call—for quality and training purposes–, and the 1’s and 0’s in the computer storing your customer record.

Healthcare is unique in that hospitals never know you are no longer their customers.  Suppose two years ago you, or a family member, had their gall bladder removed at Our Lady of Perpetual Satisfaction.  Or, suppose last week you took your son in for x-rays for an injury sustained playing baseball, and the x-ray showed that surgery was needed to repair the bone.

The hospital has no way of knowing two very important things.  One, they do not know that you had you appendix removed six months ago at another hospital or that your son had his surgery somewhere else.  Two, they do not know why you chose not to return to them for care.

Look at your call center for example.  It probably closes around 6:30.  Not even Comcast closes at 6:30.  This means from a customer experience standpoint your hospital’s customer experience is already worse than that of your cable company.  By the way, that is not a good thing.

For the most part, minus chronic care, every patient is a new patient even though the patient may have been there several times before.  Each time the patient visits a hospital they have a choice about which hospital they will visit.  Unlike cellular companies, hospitals cannot lock in patients for a two-year term.

If hospitals do not know that you left, they will not make any effort to get you to come back.  Since they do not know why you left, they have no way of knowing what they could have done differently that would have caused you to stay.

That makes for a pretty tough business model.

The funny thing about being in a services business is that there are always plenty of people selling the same service.  I can probably get me hip replaced or my knee scoped at a dozen hospitals within ten miles of my home.  I believe that no matter which of these twelve hospitals I choose, my hip or my knee will be better when I leave.

I also believe that by definition the service I receive can only be the best at one of those hospitals.

Who among us is competing on service?

Just to throw a metaphorical tomato at the screen, buying patient experience data, or being able to recite your HCAP scores does not enable you to compete on service.

Why not Improve Satisfaction Instead of Measuring it?

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­One of the uncomfortable things about flying is how close you are to the other passengers.  On my return flight from Florida I could see from his teeth that the passenger in the window seat must have had spinach for lunch.  The most troubling part of my observation was that the passenger was in another plane, and neither of our planes was on the ground.

To back track for a second, I observed something else on my drive to the airport.  We are all familiar with the painted white lines that divide the road lanes.  On some roads, raised reflectors have been inserted into the road’s surface in addition to the painted lines.  At night these road nibs reflect your car’s headlights helping you to stay in your lane.

What’s your point?  If asked the color of these nibs we would response that they are white, just like the white strips.  Those who answered white would be half right.  As I looked in my rearview mirror I caught a glimpse of the backside of the nibs, and for some reason I was surprised to see that unlike the front, the backs of the reflectors were red.  It occurred to me that the reason they are red is to warn you that if you see red you are going the wrong way.

It goes to show you that just when you think you have the answer it may be time to look in your rearview mirror; you may be going the wrong way.

That may be where some, if not most, hospitals are with regard to patient satisfaction.  But, don’t feel you have to take it from me.  According to Amednews.com, “The study by Rozenblum and his colleagues said there seems to be more emphasis among health care organizations on measuring patient satisfaction rather than on improving the patient experience.” March 13, 2013.

This bears repeating…there seems to be more of an emphasis among health care organization on measuring patient satisfaction rather than on improving the patient experience.

Stack all the reports your organization has purchased concerning patient experience data.  Those reports show your hospital’s scores, how your hospital compares to other hospitals, means, averages, standard deviations, and the square root of the hypotenuse.  Now, next to the stack of reports, stack all of the money your hospital has saved by implementing what it has learned from the reports.

I’m sorry, can you speak up?  Oh, you said you have not saved any money.  Well, let’s try another tactic.  Let’s have dinner for every patient that the experience data helped the hospital retain plus all of the new patients referred based on the things learned from the patient experience data.

J’ai mangé seul.  That is French for ‘I ate alone’.

9% of Hospitals Have a Patient Satisfaction Plan

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The phone rang last fall. It was the school nurse asking me if I would pick up my seven year-old son. When I inquired as to the reason she informed me he delivered an organ recital—a long-winded recitation of ones ailments—the classic symptoms of the crud; tummy-ache, non-responsive, crying. She’s the nurse, so without better information, who was I to question her diagnosis?

We got into the car and his tears started flowing. “Do you feel like you’re going to be sick?” I asked as I looked at the leather upholstery. He didn’t answer me other than to whimper. He didn’t seem sick at breakfast. I remembered that he was crying last night, but his tears had nothing to do with his stomach. While he was crying he was hugging his favorite dog, our five year-old Bichon.

We had just learned that the Bichon was very ill and will never be a six year-old Bichon. The person having the most difficulty with the news is my youngest. I asked him if that was why he was crying in class and he confirmed it was. Dads know everything, at least some times.

So, here’s the deal. The school nurse had done all the right things to diagnose my son’s problem, but she stopped short of determining what was wrong. Let’s try a more relevant situation from the perspective of patients and what they think of their interaction with the hospital. 

A survey of 1,004 physicians and nurses in four countries found that 90.4% said improving satisfaction of patients during hospitalization was achievable. But only 9.2% said their department had a structured plan to boost patient satisfaction, March BMJ Quality and Safety.

What does the hospital know about what their patients think about them?  Has anyone ever asked of a patient, “What do you expect from us throughout your experience?”

At minimum patients expect that when they call the hospital they will receive a correct answer to any question they ask one hundred percent of the time.  At minimum patients expect that when they go to the hospital’s website they will find what they need or accomplish a given task one hundred percent of the time.

Does that happen?

Didn’t think so.  Planning to meet expectations without knowing what they are is a lot like playing on the tail on the donkey; blindfolded, spun around, and set off to hit the target.  Failing to plan for patient satisfaction is planning to fail at satisfying patients.

Hospitals are spending a lot of money and losing a lot of patients by trying to diagnose their patient satisfaction problems.  The problem is they quit diagnosing the problem before they find the answer.  To make matters worse, very few hospitals are even looking in the right place.

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