The woman I passed during my run today wore purple tights, a purple top, and a green hat—she looked like an eggplant on two feet.

Did you know that Wonder Bread has been around for ninety-six years?  It’s been an American staple for school lunches for most of those years.  One slice of bread, a slice of bologna, and a second slice of bread.  The basic sandwich for sixth-graders.  If you are not a fan of bologna, use something else; cheese, ham, or PB&J.  The bread part stays the same.

A piece of Wonder Bread in 1921 would look identical to a 2017 piece of the same bread.

Tang, the drink of choice for astronauts, was invented in 1957—four years before we invented astronauts.  The recipe has not changed in 60 years.  For lunch, kids can eat the Same Wonder Bread and drink the same Tang as their grandparents.

Some things don’t change.  Sometimes that is a good thing.

During their lunch breaks, the people who answered the phones in the call centers of hospitals in 1957 would eat their Wonder Bread sandwiches and drink their Tang.  Today, call center agents can eat the same lunch.  And when they are finished eating their lunches, they answer the same kinds of calls, using essentially the same technology that was used in 1957—from 8 a.m. until 5 p.m., Monday through Friday.

Some things don’t change.  That’s a good thing if you happen to like Wonder Bread and Tang.

It’s a bad thing if you happen to be a person who needs to access their health system. It can feel like an internecine relationship; the proletariat versus the hospitalists.

Health system executives are absent when it comes to improving access and engagement.  A lot of patients are calling.  A lot of people are having to call more than once.  And a lot of people aren’t calling back.

Taxi rides in Chicago last month were 42% lower than they were in May 2016.

Uber and Lyft.  A one-hundred-year-old industry, an industry embedded in every city in America is disappearing in less than a decade.  It is disappearing because people found an alternative solution that took them from A to B and provided a better user experience for less money.

Until healthcare decides to reinvent its business model to one that is more closely aligned with Uber, it is destined to suffer the same fate as Sears.  Patients will seek an easier solution.  They will fly to it like moths to a patio light.

A recent trend on provider websites has gone from ‘find a doctor’ to ‘request an appointment.’  To boldly go where no man has gone before.  Patients are still left chasing unicorns, the elusive online scheduling.  Had the group which designed your health system’s website taken the time to ‘open the doors, and see all the people,’ people who wanted to schedule an appointment instead of requesting one, your health system would have more new patients.

Some health systems view consumerism as though they were walking through their house in pitch darkness, confident they knew where all the furniture was, only to have someone flip the lights on and show them that nothing was where they thought.  By the way, I’m the guy at the light switch.

Novice consumerismalists want to put ‘two and two put together,’ and argue that the answer is four, as in if consumerism were any simpler we would be diagraming the issue with crayons. From my perspective, I try to appreciate their keen sense of advanced mathematics and to suggest that simply focusing on two and two does not get them where their patients and customers need them.

I ask, “have you ever heard of cognitive dissonance?  It’s when you hold on to a belief that all of the facts attest to your belief when they attest to the opposite.”  Novices study consumerism like an anthropologist on Easter Island.

If your health system’s call center is the control room in Oz, healthcare consumerism is the issue behind the curtain.  Those who feel comfortable positing a solution are the same people who misunderstood the problem.  When we meet to discuss consumerism, some hospitalists try to sit at the big people’s table.  While your system is focused on finding the needle in the consumerism haystack, your consumers are trying to tell you that they own those haystacks.

Many health systems treat consumerism as a ‘theory,’ like climate change or evolution.  They assess my intentions like they had a fifth of a second to identify me as friend or foe before they start shooting.  They look at me as though I am an unhinged refugee from a boy band. (Was I supposed to be hinged?)  We sit there mute, as if we were in a no-talking competition and serious about winning.  They like to pretend I am not there, like I am a hole in the air.  The last time they listened to a consultant, Abraham Lincoln was in short pants.

Health systems form consumerism committees. They meet.  They buy bagels and muffins and a fruit tray and yogurts served in cute parfait glasses and cardboard boxes of coffee.  Because your health system has gone-green, biodegradable cups woven out of recycled hemp fibers are positioned next to the coffee.

I bite the head off a muffin.

Yellow legal pads are placed on the table, made from recycled paper from a defunct organic bookstore, directly in front of each chair.  Pens inscribed with the hospital’s name lay parallel to the pad of paper.  Post-meeting, the committee members will email their notes around like birds spread seeds from berries.  They should have hired a bunch of interns to write a term paper.

The purpose of the meeting is to suss out consumerism. Long slow periods of nothing much, with occasional bursts of something.  Like cutting the arms off an octopus; dealing with seven arms is better than dealing with eight.  Like chaos theory.  A butterfly flaps its wings in Ontario, and two hundred prospective patients wonder why they can’t schedule an appointment online.

Fortunately, slothfulness is not a capital crime.  It’s like getting a task force trying to figure out how to turn the Titanic.  While the task force may eventually succeed in turning it, they won’t accomplish it until they hit an iceberg.

The committee members are as focused as a kid with a magnifying glass focused on an anthill.  Consumerism kindergarten.  They want to go down the rabbit hole when the best approach would have been to cozy up to the Queen of Hearts.  They are looking for easy solutions, and they have the budget to make them happen.  They’ll vote on whether to use the committee’s funds to buy a philodendron for the call center.

Recasting consumerism involves taking a risk. But so does getting out of bed every morning, and a lot of people are not morning people.  Even though there is a degree of risk, it’s not like having Comey testify before Congress.  Most consumerism efforts fail.  Patients view those efforts as a Zen thing.  If health systems try to be more consumer-friendly, and their patients don’t know that their system tried to be more consumer-friendly, patient wonder whether the health system really tried at all?

One executive told me her system was going to address consumerism later.  “Later than what?” I asked.  “Is this one of those perpetually imminent initiatives?”  It felt like her strategy had no place to go, and all the time in the world to get there.

As a consultant, I’ve had to learn to roll with the punches.  Fortunately, waterboarding has gone out of favor.  Who knows, maybe they’ll name a bridge after me.

This whole deal of the Parisian Accord troubles me.  It also troubles my whale.  I keep her in the bathtub right next to my email server.  I hope Director

Segue.

Years ago, because of the lizard brain, our government decided that for important decisions, decisions like launching nuclear weapons, the responsibility had to be shared between two people.  (If the responsibility was shared by three people, I would have used the preposition among rather than between.)  That is why two thumbs are required on two launch buttons.  I do not know how things are in your home, but in ours, when it comes to important decisions about things like deck furniture, there is only one launch button, and I am not allowed to have a user-ID.

Twice a year, in early spring and late fall, my wife and I do the lizard brain dance, and we do it regarding our deck furniture. The spring deck furniture dance is more difficult than the fall dance because the furniture must be carried up to the deck.  Our metal deck furniture has been hibernating in our basement all winter, right next to the brown bear. (Given the ramifications of us leaving the Paris Accord, once the ice caps melt, the bear may not have to hibernate.)

When our metal furniture awakens from its hibernation, it needs to be carried by hand, by the husband, from the basement, up enough stairs to make me wish I had installed an elevator, to the deck—the deck that was just power washed by the same husband.  Fifteen minutes into this exercise I am missing the snow.  With furniture raised above my head, I plod slowly up the stairs like a pachyderm from the now-defunct Barnum and Bailey circus. (The elephants are not worried about the warmer temperatures.)

I was waiting for my neighborhood friends, guys like me, to set up lawn chairs and watch the parade, but it occurred to me they were either hiding from their spouses, or they were having their own furniture parades.

Our metal outdoor deck furniture is unlike any other deck furniture.  Unlike others in that according to my wife, our outdoor furniture was not designed to live outdoors. Not in the winter, and not in the rain.  The furniture’s seats and cushions were extruded from some unidentified man-made material whose half-life probably exceeds that of the fruitcake my grandmother made when I was twelve. My wife’s concern is that if the furniture gets wet it may have a Wicked Witch of the West event and melt.

Even so, when rain threatens I will be hauling those cushions, the same cushions I just hauled outside, back inside.

“The cushions don’t melt,” I tell her.

She counts the cushions and asks, “Are we missing a cushion?”

“No, I’ve been soaking one in the bathtub all winter—right next to the whale.  It looks good as new,” I tell her.

“That is not the same as leaving it out in the rain.  And since you raised the point, why is there a whale in the tub?” So much for me trying to make a point.

So, how do we tie my furniture problem into something that makes reading this post worthy of your time?  I think when it comes to assessing patient experience many hospitals believe that when their patients are not in the hospital they are hibernating, that they don’t need access, that they don’t need to be engaged.

That belief begs the question, what do hibernating patients do?  They call their provider.  They want access.  And how is access defined?  There are two ways to consider that question—from the perspective of the health system and from the perspective of the caller.  Nota bene.  Providers don’t collect data about access and engagement.  Patients collect that data every time they call.

The most frequent experience patients and consumers have with their provider are through their provider’s call center.  And guess what?  If those providers don’t meet the expectations and needs of those callers it does not matter to them how high their provider’s HCAHPS score was.  Those callers will do one of two things, neither of which are good for the provider.  They will choose a hospital which can meet their needs, they will manage their health one their own, or they will go to ED. Oh, and they will tell others of their experience.

A colleague of mine was receiving chemotherapy at one of the leading US cancer hospitals.  She spent three hours on the phone trying to schedule a follow-up appointment.  Now she spends her period of hibernation telling others not to go to that hospital.  Health systems cannot put that toothpaste back into the tube.

Obama Care, Trump Care, Who Cares?

As I dyed-in-the-wool, right-of-right conservative, I cannot believe I am writing this.

Sometimes, if it is broke, don’t fix it.  Especially when it comes to healthcare reform.  Obama Care.  People who can’t afford healthcare get healthcare.  Trump Care.  People with healthcare lose it unless they pay a lot more.  George Bernard Shaw said, “A government that robs Peter to pay Paul can always depend on the support of Paul.”  Given enough time, when this line of thinking is applied to healthcare reform either Peter or Paul dies because he no longer has insurance.

Everyone in Congress who is playing with healthcare has exceeded their level of competency.  By a lot.  A whole lot.  They are guilty of policy making without a hall pass, of trying to color outside the lines without any crayons.

On May 22, 1856, a member of the U.S. House of Representatives, entered the Senate chamber and, because he disagreed with a senator, using a cane he beat the senator into unconsciousness. Today, a beating of that degree would be deemed a bridge too far. It would be politically incorrect.  However, to borrow a line from the movie Network, people who need healthcare–all of us–need to tell Congress, “we are mad as hell and we are not going to take it anymore.”

Two rules should govern our society:

• Kittens should not be allowed to play with matches
• Congress should not be allowed to play with healthcare

Under the plans of both parties, the definition of patient-centric has gone from patient-centric care to patient-centric cost.  While pre-Obama healthcare was less than perfect, it sort of worked, even though it teetered on its edge.  Congress’s efforts remind me of the game, Jenga.  Jenga is the game where players take turns removing wooden blocks, one block at a time, from a tower of fifty-four blocks.  The more blocks that are removed, the weaker the tower becomes.

According to many, the old healthcare model had reached the point that when the next block was removed the tower would collapse.  Under Obama Care and Trump Care, it looks like both initiatives tried to fix a tower while it was collapsing.  We, you and me we, should have required our Congressional representatives to practice with wooden blocks before they practiced their wizardry on one-third of our economy.

The Democrats clicked their heels together three times and approved a bill that none of them read.  The Republicans borrowed the Democrats’ shoes and approved a bill that took less time to write than it takes to mow your lawn.  Patient-centric became party-centric.

So, just how screwed up is the plan my team submitted?  You only need to know two facts about the Republican plan to understand what a complete failure they’ve put forth:

• One of every six people in the U.S. is sixty-seven or older
• Under their plan, the annual cost of healthcare for someone sixty-seven or older, whose income is more than $27,000, will be $13,000—roughly fifty cents of every dollar
• (The Republican plan’s underpinning unwittingly seems to stem from a line in Charles Dickens’s A Christmas Carol. “If they would rather die,” said Scrooge, “they had better do it, and decrease the surplus population.”  The Republicans were not so crass as to say let those people sixty-seven and older die, but a plan with such high costs will go a long way to decreasing the percentage of people sixty-seven or older.  Surplus population 101.)

While both political parties worked to fix what appears to be an insoluble problem, they did so without accounting for the only people who mattered: patients.  The impact of the party’s actions has landed on those who are the least capable of adapting to those actions—patients.

My idea?  Since the Russians are so tight with many of our elected officials, perhaps we should ask the Russians to fix our healthcare mess, or at least ask them to do their best to divert Congress’s focus away from healthcare.  What we had may not have been great, but like democracy .

A man who works at a manufacturing plant that makes items for hardware stores is suspected of stealing from his employer.  Because he is under suspicion, each night he when leaves the plant, the guards search him and the wheelbarrow he is pushing.  In the wheelbarrow is always his lunchbox, thermos, hardhat, safety glasses, and overalls.  They never discovered any stolen property.

It never occurred to the guards that the man was stealing wheelbarrows—sometimes the answer is too obvious.

Customer experience is a bear.  Sometimes you eat the bear.  Sometimes the bear eats you.  If Comcast’s or Verizon’s customer service people went on strike, would anybody notice?  Sort of like the question, if a tree fell in the woods, and nobody was there, would it make a sound.

The front page banner on a recent issue of Men’s Health Magazine read, “Tons of useful stuff.”

In healthcare, none of the provider or payer websites or apps can even brag, “Here’s a half-dozen things that may be useful.”  To be even more accurate, the only four semi-useful things I’ve found on healthcare websites are:

• Pay your bill
• Find a doctor
• Request an appointment
• Contact us

A pretty lackluster set of functionality.

Your website may look pretty, but so does Monet’s painting Sunflowers.  The thing is, you can’t schedule an appointment with either of them, so pretty isn’t worth much.  If you’re confused, that’s okay, I’m not.

Patients and customers can find a cloud in each of what your health system believes are its silver linings.

Television commercial: “I’m not a bank guard, I’m just a bank monitor.”

Seattle fact: “I’m not a suspect, I’m a community member.”

One news story this morning got my attention in spades.  It confirmed for me that the PC police have absolutely lost their collective minds. Being politically correct has become politically incorrect.  In wan announced yesterday that Seattle’s Chief of Police decided that it would be more politically correct to no longer use the term suspects.  From now on his officers will refer to suspects as community members.  For example, in the process of robbing the bank, a community member took nine people (other community members?) hostage and wounded two officers during a shootout. The police cornered an armed community member and released him.  When a local television reporter asked the police officer why he did not arrest the bloodied man holding the pistol, the officer replied, “because he is not a suspect.”

All the current talk about Russia makes me nostalgic for the days when the USSR—that’s pre-and post-Russia for those of you who weren’t alive when people had to walk to their televisions to change the channel, invaded countries each time there was a full moon.

For the theologians among us, a popular question is, why do bad things happen to good people?

That question is as unanswerable as the question, why don’t fish have lips?

The same question applies to healthcare customer experience.  Not the fish-lip question.  The bad things.  To be frank, I am rarely asked to sit at the big people’s table.

When I ask this question of people who think who think they can answer it I go into full Yosemite Sam mode. They look at me like they just spotted a flying saucer out the room’s window.  I tell them I would have flown in but my cape is at the dry cleaners.

“What are you, a male witch?” They asked. “There are no male witches.  If you ever watched the television show Bewitched you would know that the correct term is a warlock.” I gave them an eye role that would have scored a ten at the Olympics.

A lot of my meetings make me feel like I am trying to reason with the tinfoil hat crowd. They want to take me down the rabbit hole while they cozy up to the Queen of Hearts.  I was never very good at playing hearts.  If there’s an elephant in the room, you don’t need to look around trying to figure out who brought it in.  I did.

So, why do bad things happen to patients and customers who are simply trying to manage their care and wellness?

Health systems, like other industries, are good at creating advisory committees.  Buy donuts and coffee and ponder the fish lips question.  Study the question like an anthropologist on Easter Island.  Advisory committees, rarely come up with actionable advice.  If Columbus had an advisory committee, he would still be at the dock.

I’ve tried to reason with those committees but it’s like trying to turn the Titanic in a narrow stream.  The only way to turn it around, I tell them, is to cut off the head of the boat.  I may be able to help them change directions, but only after­ they hit the iceberg.

Most health system websites have what looks like a friendly box for visitors to contact us.  The friendly box replies to the user’s input that someone will reply to them within two to three days.  In two to three days, that user could have had a stent inserted and been discharged, delivered a baby and been discharged, recovered from Ebola, founded a multibillion-dollar tech firm, solved the question about fish lips, and been elected president of the U.S.

Doing anything in two to three days, while it may seem user-friendly to whomever in marketing or IT designed it, is a user disaster.  A lot can happen in two to three days.  But none of it will happen in your health system.

When people speak of the personal experience Disney gives its customers, some refer to it as daunting.

There’s daunting.  And then there is every other firm.  If your health system isn’t named Disney, your customers probably use the word daunting when they describe how difficult the challenge is to do business with it.

Healthcare’s first point of consumerism failure is that it does not offer a personal experience to any of its patients or customers.  Healthcare’s one size fits all approach does not fit anyone. A mass-produced healthcare experience does not work with

Disney did not add a new ride to create a better experience.  Why? Because it knew that a new ride would only improve its list of rides.  Instead, Disney focused on everyone who enters the park.  Since most of Disney’s theme park customers visit multiple parks, their digital strategy makes the whole experience prior to and after visiting a theme park a breeze. Simply adding another MRI to a health system does not improve patient or customer experience, it simply adds another tool.

In an over-competitive and commoditized market, health systems that choose to design customized and personalized experiences will acquire and retain patients and customers, and increase satisfaction.  To do that, health systems must create digital experiences that are useful, different, and convenient.

For a digital strategy to be effective, it must create value for customers that extends beyond just the service offered. Websites are a good place to present information. Mobile provides convenience. To be patient and customer-centric, your overall digital strategy should focus on your patients and customers, not on your company.

Here are three components for creating a winning digital strategy:

• Define why you are in business, why are you helping customers
• Build your strategy around answering the why, focused on bringing value to your customers instead of it being centered on meeting company objectives
• Make sure every business decision adds value to your customers. If it doesn’t, rethink the decision.

There is one component for creating a failing strategy:

• Keep doing what you are doing

Had the senator-elect driving the black, BMW 7-series known he would be killed before he reached his home in the tony neighborhood of McLean, Virginia, he might have driven a different route. That is the opening sentence of my new novel. I thought about tweeting each sentence as I write it in case any of you wanted to read it.  Freud said nobody is remembered for being normal.  Maybe I am securing my legacy one blog at a time.

Please see the attendant. That was the text displayed on the gas pump’s LED screen.  There was probably a time in my life when I might have considered complying with those instructions, but since I am not a very compliant person, I doubt I would have heeded that directive.  I studied the screen looking for a way to reply—I have money and if you want it, you come see me. That option was not available to me.  And so, I was left with a choice, walk ten feet and see the attendant, or get in my car and drive three miles to the closest gas station.

I had a pleasant three-mile drive.

Great customer experience is so much easier to achieve than companies make it out to be. If you are at all like me, plus or minus a comprehensive psychological evaluation, you don’t suffer fools gladly.  It is important to make a distinction between those delivering the poor experience and those who created the poor experience. Person A is simply a victim.  Person B is the overpaid mastermind who created the experience.

People with whom you are interacting are just following procedures.  Rules.  More often than not, bad rules.  Rules designed to save the offending company a nickel.  When we are affronted by those rules, we know how inane the rules are. We scream silent epitaphs (sic) at the rules. And then we create those same affronting rules for whatever company at which we are employed.

It is possible, albeit improbable, to think in terms of what is best for our customers.  Instead, senior decision makers, after multiple meetings to figure out what is best for the company, come up with rules that ignore the company’s customers.

What most firm’s executives don’t consider are the expectations of their customers.  Customer expectations are not considered because nobody bothered to ask. As a result, the first thing firms do to deal with customer interactions is to build a call center.  Customers call us.  We should build a large room, buy a bunch of phones, and hire a bunch of people to answer customer calls.

You don’t want to call any company you do business with.  Neither do your customers.

So why make them?

Picture yourself standing in a field with someone else, standing a hundred feet from a barn.  The person next to you raises a rifle and takes dozens of shots at the side of the barn.

Afterward, he walks up to the side of the barn where he was shooting and draws a target on the barn’s wall centered on the area where the best cluster of his shots impacted the barn’s wall. Now, instead of a random scattering of shots on a barn wall, the shots are associated with a target.  They have a purpose.

Their differences are ignored and their similarities are stressed.

Looking at data in this way is called the Texas Sharpshooter’s Fallacy.  It is a clustering illusion, a tendency in human cognition to invent a correlation when in fact, the correlation does not exist.  This fallacy is how many experts interpret Nostradamus’ musings.

Today, the Sharpshooter Fallacy is often used, albeit inadvertently, to explain away business problems.  In healthcare, the fallacy is used to justify a health system’s efforts to improve consumerism and patient experience.

Patients and consumers need to interact with their provider.  To try to meet their needs they go online and they call their health system.  Their calls and their use of the Internet are perceived by their health system as rifle shots at a barn door.

The data tells the health system that patients are calling and going online.  By creating a call center and a website the health system thinks it has designed a solution to fix what it perceives as its problem.  The health system draws a target around the cluster of shots believing it has developed a solution to the problem.

They system’s fallacy is characterized by a lack of a specific hypothesis prior to gathering the data.  People call.  Therefore, we should build a big room, buy a bunch of phones, and hire a bunch of people, and we will have solved the problem.  They solved the problem without ever understanding the problem.

The solution to improving patient and customer experience is not answering phone calls.  The solution comes from understanding why people are calling.

Judging by the coddling elite colleges are providing to the students, the world must have gotten a lot more stressful than it was when I was a student.

After Trump’s election, ‘safe rooms’ were created on Ivy League campuses.  The purpose of those rooms was to give traumatized students the opportunity to overcome their gossamer cases of PTSD.  Cases of mental trauma were devouring students faster than the Bubonic Plague devoured the citizens of Europe.  The safe rooms were equipped with puppies and crayons.  Classes were canceled and exams were postponed. (Just writing about this is making me feel more cathartic.)

This week Harvard announced that it eliminated the fifty-cent a month fine for students who have overdue library books.  Why?  To relieve the stress of its students.  Henry Kissinger, Bill Gates, and FDR, attended Harvard. I can only wonder how much more they would have contributed to mankind had their minds not been so traumatized by the fines they had to pay for their overdue books.

The world became more stressful but nobody notified me.  We got a puppy last month—not because we were stressed; we just thought she was cute.  Maybe I should buy a box of crayons for her.

Bad patient experiences cause a lot of stress.  Patients who do not pay their bills on time are fined.  Maybe hospitals should eliminate overdue payment fines.  Maybe hospitals should build ‘safe rooms’ for patients.  They could put crayons and puppies in the rooms.