“I just returned from the Prada show in Milan”—that was the opening line from a piece on NPR. Apparently this year’s runaway hit on the runways has to do with high heels, with the emphasis on the notion of high.

The following comes from the UK Telegraph: The girls looked like rabbits trapped in the headlights; their faces taut and unsmiling, their eyes wide with fear and apprehension. Were they about to undertake a parachute jump? Abseil down a 1,000 ft mountain? None of the above. All they were doing was trying to negotiate the catwalk at Prada during this week’s Milan fashion shows in shoes that were virtually impossible to walk in. At least two models tripped and fell on to the concrete floor; others wobbled and stumbled, teetering and tottering, clearly in agony, and all the while their minds were fixated on just one thing: reaching the sanctuary and safety of the backstage area without suffering a similar fate.

According to the NPR reporter, the heels are so high that regular people—women people that is—can’t seem to walk in them without falling. This problem has led to the creation of an entirely new micro-industry. In L.A. and New York, there are classes to teach ladies how to walk in very high heels without hurting themselves. These classes are being offered through dance schools that couldn’t fill their dance classes—they are now booked solid.

Tell me this isn’t the same as trying to walk and chew gum at the same time. Multitasking.

Now before I make fun of some thirty year-old who has to relearn how to walk, let us turn our attention back to those dancing—cum—walking schools. What makes this story interesting is that those dancing schools saw a need and re-engineered a part of their business to meet that need, sort of like we’ve been discussing regarding the need to improve patient satisfaction in your hospital.  With everything going on in healthcare, many things will change.  If they don’t require change, you probably have not been paying close enough attention. 

What’s important are having a plan to define what needs to change and managing the change.  Assess business processes, remove outdated duplicated processes.

Now I’m going to go saw the heels off my wife’s shoes before she hurts herself.

“I just returned from the Prada show in Milan”—that was the opening line from a piece on NPR. Apparently this year’s runaway hit on the runways has to do with high heels, with the emphasis on the notion of high.

The following comes from the UK Telegraph: The girls looked like rabbits trapped in the headlights; their faces taut and unsmiling, their eyes wide with fear and apprehension. Were they about to undertake a parachute jump? Abseil down a 1,000 ft mountain? None of the above. All they were doing was trying to negotiate the catwalk at Prada during this week’s Milan fashion shows in shoes that were virtually impossible to walk in. At least two models tripped and fell on to the concrete floor; others wobbled and stumbled, teetering and tottering, clearly in agony, and all the while their minds were fixated on just one thing: reaching the sanctuary and safety of the backstage area without suffering a similar fate.

According to the NPR reporter, the heels are so high that regular people—women people that is—can’t seem to walk in them without falling. This problem has led to the creation of an entirely new micro-industry. In L.A. and New York, there are classes to teach ladies how to walk in very high heels without hurting themselves. These classes are being offered through dance schools that couldn’t fill their dance classes—they are now booked solid.

Tell me this isn’t the same as trying to walk and chew gum at the same time. Multitasking.

Now before I make fun of some thirty year-old who has to relearn how to walk, let us turn our attention back to those dancing—cum—walking schools. What makes this story interesting is that those dancing schools saw a need and re-engineered a part of their business to meet that need, sort of like we’ve been discussing regarding the need to improve patient satisfaction in your hospital.  With everything going on in healthcare, many things will change.  If they don’t require change, you probably have not been paying close enough attention. 

What’s important are having a plan to define what needs to change and managing the change.  Assess business processes, remove outdated duplicated processes.

Now I’m going to go saw the heels off my wife’s shoes before she hurts herself.

Twin sons of different mothers.  The judgment of Solomon, splitting the baby in half.

Healthcare providers.  Permit me the literary license and allow me to cleave the baby in half as follows:

• The business of healthcare—how the business is run
• The healthcare business—the services delivered

I tend to look at it from the perspective of the business model of many hospitals.  What is the delivery model is viewed as a 2.0 model and the business of healthcare, how it is run, is viewed as an 0.2 model. How does one transform a 0.2 business model to function in today’s, let alone tomorrow’s, changing healthcare model?

The delivery model of healthcare, the healthcare business, in juxtaposition to the business of healthcare, would never quarter to the idea of buying millions of dollars of technology without first knowing how they were going to use it.

Plenty can be gained by applying what other industries have done to become more effective, more competitive.  In some respects the inherent model, tribal, cost duplication, and rigid departmental silos remind me a lot of how the various agencies under Homeland Security functioned, operating in isolation, performing much of the same work, and not sharing information.

Other industries operate with a much less tribal model than healthcare.  Hospitals have created tribes and tribal chiefs.  In some hospitals the tribes have names like radiology, general surgery, psychiatry, and OBG/YN.  Other hospitals have redundant tribes named admissions, human resources, IT, and payroll.  Each tribe is run by the tribe’s chief.  The chief’s dominant weapon is his or her budget which is lorded over its individual tribe, and a dispute vehicle with the other tribes.

The tribal organization is more a reflection of how the hospital evolved over the years, not a result of an inept business strategy.  Nobody set out to build an ineffective and internally competitive model, or one that duplicated support functions.  Acquisitions have reinforced and exacerbated the problem, duplicating and increasing costs without yielding a resultant increase in value.

Providers have to interact with and depend upon unknown influences of external influencers that each carry a much bigger stick than do they—payers, pharma, and Washington.  Before the business of healthcare is prepared to cope with the unknowns of the myriad of external influences it will face in the next few years, it must first change how it functions under its current structure.  It might begin by revisiting its present structure and making sure that its performance and quality precede the application of technology.

I frown on using the term efficient.  To me, efficiency implies speed, and doing bad things faster is no solution.  Let us work at improving effectiveness and good things will happen.

McDonald’s initiates a program to improve customer experience across the board, maybe now we will be able to get the extra pickle.  So, we’ve got that to look forward to.

Have I written recently that I am not a fan of technology unless someone knows what business problem they intend to solve? It’s not so much that I have anything against any of the technology or any particular technology, it’s more that I think many are misjudging what the technology will do for them, what they have to do to it, and they forget to ask themselves how to best address the problems.

Whatever do you mean? Thanks for asking—here’s an example. When the United States first started sending astronauts into space, they quickly discovered that ballpoint pens would not work in zero gravity.

To combat the problem, NASA scientists spent a decade and $12 Billion to develop a pen that writes in zero gravity, upside down, underwater, on almost any surface including glass and at temperatures ranging from below freezing to 300C.

The Russians used a pencil.

A colleague told me yesterday that she spent three hours, nonstop, trying to schedule a follow up appointment with a specialist at the top hospital in the country—no, I will not name the hospital because you already know which one it is.

Her mistake was both obvious and unavoidable; she used her phone.  She would have done no worse had she used heliographs—look it up, it did.

Regarding patient satisfaction, hospitals have two black holes; their CRM and their call centers. Permit me to write in parenthesis for a moment.  The call centers at the hospital at which we are tossing metaphorical tomatoes close at the hour before most people on the east coast have begun their evening meal.  Never mind the fact that the hospital has several international locations.  Close paren.

Les Misérables, Act One: The Fallacy of CRM. You may want to look at this PowerPoint presentation: http://www.slideshare.net/paulroemer/crm-dead-or-dying

Most CRM (Customer Relationship Management) applications are sales force automation tools.  Does the name of the application offer a hint that it was not written with the purpose of helping you meet your patients’ needs—salesforce.com? 

Even if your CRM was designed to manage your relationships with your patients, can any organization effectively manage those relationships, or are you trying to achieve an unachievable goal?  Is the notion of CRM your hospital’s Gordian knot?  Like it or not, know it or not, your customers, neigh patients, are managing your organization.

A person thinks they may have a kidney stone. Picture two scenarios.  In the first scenario, the hospital places a billboard a mile from the hospital depicting a photo of its urologists—my hospital did just that.  Intrigued, the potential patient dials the hospital’s the phone number, the one depicted on the billboard, or even worse, dials the number shown on the hospital’s web site.  This same phone number will supposedly also get you to someone to help you to donate to the hospital, listen to a recording on erectile dysfunction, learn about the benefits of an Oreo-free diet, and correct left-handedness.  

In the second scenario, the person goes to the web—oh my goodness, do not let them do that—and they enter their zip code and spend a few minutes researching which hospital is best suited to their needs.

All of a sudden your hospital is confronted with the fact that the potential patient is going to issue a virtual request for information, an RFI, to determine which hospital is most to their liking.

I will buy lunch for anyone who in designing their call center used design thinking and cognitive inquiry to create the call center’s functionality and who included patients in its design.  Table for one, please.

The functionality of almost every hospital call center results from a meeting in which the final design functionality of the call center comes from hospital employees and IT rhetorically answering their own question, ‘what do our patients need from a call center.’  The functionality should come from direct observation of patients trying to interact with the hospital and from what is learned by asking the question of patients, ‘what do you need from a call center?’

Have a meeting about how to best plan for and implement CRM and your call centers in your hospital.  One rule, all discussion should involve patients.  A second rule, yield to process, not technology. Try first to reach consensus about what your patients want it to do, and then look at how to do it. You may find out that all you need is a pencil.

Sometimes I feel like I am guilty of sharing my ideas without a hall pass, but this is not one of those times.

The web never ceases to amaze me. I’ve gotten to the point if I can’t find something I’m looking for, no matter how obscure, I figure that I did something wrong in how I framed the search.

For example, I was trying to connect to a high school classmate, someone I hadn’t spoken with since before Al Gore invented the internet. This guy got a pair of boxing gloves for his 14^th birthday. We each wore one, and jousted only long enough for us each to land a blow on the other’s nose. It hurt—a lot. We gave up boxing.

In tenth grade biology, we bet him five dollars that he wouldn’t jump out of the second floor window. The teacher, who knew of the bet, turned her back to write on the blackboard. He jumped. Go straight to the office, do not pass GO, do not collect $200. We used to see how fast his red and white Mach II Mustang would go railing down Route 40. He was the guy you voted best person to keep away from bright shiny objects. The last I heard he went to a teaching college.

Anyway, I Googled him—from the imperative verb Google—I Google, you Google, he, she or it Googles. I can’t tell you his name for reasons that will soon become apparent. Google spits back links to things like military intelligence, think tank, counterinsurgency, small wars, and army major.  I think I’ve made a spelling mistake—this cannot be the same guy who jumped out of classroom window—and I add his middle initial to the search criteria. Up pops a link to CNN’s Larry King—the air date—just days after 9/11. The topic of the show; ‘the hunt for Osama Bin Laden’. To quote Lewis Carroll, “things keep getting curiouser and curiouser.”

The web. Social networking. A great tool if you’re one the outside searching, deadly in the hands of your customers.

If your hospital is targeted, you are pretty much defenseless. Each patient is capable of creating their own digital perception of your hospital. True or false, makes no difference. Patients are like little thunderstorms popping up everywhere. Healthcare providers scurry around like frightened mice passing out umbrellas and pretending it’s not raining. They’re late, their patients are wet, and they are telling everyone. Very few hospitals have learned that they can’t put the rain back into the clouds.

Sort of reminds me of the line in the movie Young Frankenstein, “Could be worse, could be raining.” It’s raining, and even the best hospitals have run out of umbrellas. What is your hospital doing about it?