Patient Experience Management–What would Oprah do?

Posted by

1

If you watch too much television your brain will fry. Sometimes I feel like mine is in a crepe pan that was left sitting on the stove too long. Two nights ago I’m watching Nova or some comparable show on PBS. The topic of the show was to outline all the events that took place that helped Einstein discover that the energy of an object is equal to its mass times the speed of light squared, better known as E=mc². It was presented to the audience at a level that might best be described as physics for librarians, which was exactly the level at which I needed to hear it. It’s physics at a level that is suitable for conversation at Starbucks or any blog such as this.

So here’s what I think I understood from the show. It tracked the developments of math and physics in the 100 years prior to Einstein’s discovery. The dénouement appeared to occur when Einstein and his fiancée were riding in the bow of the small boat. Apparently, he was leaning over the side of the boat and noticed that the waves generated by the front of the boat moved at the same speed as the boat. He then noted that fact only held true for those persons in the boat, who were in fact, traveling at the same rate of speed. However for those persons watching from the shore, that same wave was not only moving slower than the boat it got further behind over time. Some other things occurred, yada, yada, yada, and there you have it. Clearly, the details are in the yada, yadas.

So here’s what happens when you watch too much television. As I’m running this morning somehow my mind takes pieces from that show and staples them together to yield the following. Let’s go back to the equation E=mc². For purposes of this discussion I’ll redefine the variables, so that:

E = the percentage of Patient Complaints/Inquiries.
m = Patient in-bound calls.
c = number of Patients

If this were true–this is an illustration, not an axiom–the number of complaints to a healthcare provider is equal to the number of in-bound calls times the square of the number of patients. So as the number of calls increases the number of complaints/questions increases and as the number of patients increases the number of complaints increases exponentially. Of course this is made up, but there appears to be a grain of truth to it. I think we can agree that a reasonable goal for a healthcare provider is to decrease the number of complaints and inquiries and to shift a hefty percentage of inquiries to some form of internet self-service vehicle.

I think sometimes the way providers assess the issue of Patient Experience Management  (PEM) is by looking at how much money is spent trying to solve the problem. Some think that if one provider has three times as many people handling calls as another provider that the provider with three times as many people must be more interested in taking care of the their patients, and might even be better at PEM.  I don’t support that belief. I think it can be demonstrated that the provider with the most Patient Service Representatives, and the most toys deployed probably has the most problems with their patients. I don’t think it’s a chicken and egg argument. If expenditures to handle patient complaints and questions increase year after year and resources are deployed continuously to solve the same types of problems, I think it’s a sign that the provider and its patients are growing more and more dysfunctional.

How does this tie to Einstein and his boat? Perhaps the Einsteins are those who work with the provider; those who are moving at the same speed, those in lockstep. From their vantage point, the waves and the boat, like the provider and its patients, are all moving forward at the same speed. Perhaps only the people standing along the shore are able to see what is actually occurring; the waves distance themselves from the boat in much the same way that the patients distance themselves from the provider.

Patient Experience Management–Manufacturing Consent

Posted by

0

Manufacturing Consent

Foxnews reports “Russian police say they have discovered the body of a local politician reported missing last week, in a barrel of cement in a garage near Moscow. Another politician has been accused of ordering the murder, over an $80 million debt.”  So, we’ve got that going for us.

This weekend I caught a bit of NPR’s “Wait, wait don’t tell me.”  One of the guests was Al Gore.  Oscar winner, recipient of the Nobel Peace Prize, a Tony, and an Emmy. The host neglected to point out that Mr. Gore, former vice president of the United States and Internet founder is standing in line to cash a check for one hundred million dollars from Al Qaeda’s (Al Jazeera’s)—you say potato I say potahto.  I know I promised not to cross the line, but that is why you read this and not some missive from the CMS.

What does it mean if when you Google a topic all of the hits to that topic link to you?  It may not mean much if the topic you Googled is “sliding revolving doors.”  But what if the topic has slightly more potiential.

I Googled—v. past tense of Google—the term “Family Experience Management” and every returned URL is to something about which I wrote.  Just so you know, the groundswell begins today.

Perhaps before we get too carried away we should define Family Experience Management (FEM).  FEM is the set of interactions a “family” of a patient has regarding a family member’s interaction with various components of the healthcare system; providers, payors, pharmacies, Medicare.  It is the superset of interactions for patient experience management (PEM).

Most PEM efforts I have studied are like shutting the barn door after the horses get out.  I happen to think there is much greater value in stopping the processes that have led the way to opening the barn door in the first place.

There is reality and there is perception, and with regard to PEM, rarely the two shall meet.  Some things are just true, perception be damned.  That is why what is right should always supplant who is right.  That a majority of people within any given organization have the objectivity of an insider is why the top two prevailing business rules are ‘we can’t do that’ and ‘that will not work.’

A little dissent can be a healthy thing.  Or not. 

One of my favorite axioms is ‘You don’t ask directions from somebody who has never been where you’re going.’

I am a fan of a good adage, so let us try this one on for size.  A hospital executive falls into a hole—the ‘w’ is silent.  Someone from CMS walks by and the man in the hole hollers, “I’ve fallen and I can’t get out.”  The CMS acolyte tosses down a check, and the man replies, “What is this?”

“That’s some of the ARRA Meaningful Use Lottery. We’ve got tons of it that nobody is going to collect.

An hour later a seven sigma guru passes by.  The man in the hole hollers, “I’ve fallen and I can’t get out.”  Seven Sigma man tosses him a set of workflows and a stop watch and departs.

Days later a consultant happens along.  Recognizing the man’s plight the consultant hops into the hole.

“Why did you do that?” Queries the man.  “Now we are both stuck.”

“No worries,” says the consultant.  “I’ve been down here before and I know the way out.”

Sometimes, perhaps way too often, we get trapped by our own thinking.  By the misguided belief that we already know the correct solution, or we know that the one being proposed will never work.  This is like having my son telling me he does not like broccoli even though he has never tried broccoli. 

We get caught up in the notion that we already have a vision of how we want the world to be and we are willing to do anything to make the world conform to our vision.  We limit ourselves to the possible, to what has already been done.  If however, we limit ourselves to the possible, how does progress happen?

We need to be saved from the shortsighted politicalization of our own intelligence; progresses’ Catch-22.  Once everyone thinks they are thinking out-of-the-box, are they really, or have they simply moved the box.  Sometimes it is best to be the person advocating for coloring outside of the lines.

Patient Experience Management can benefit greatly if only a handful of people began to color outside of the lines.  This link is to a presentation of mine on SlideShare I have given on how to improve patient experience management, something I also call Patient Equity Management. 

You can download it or use a yellow highlighter to help you recall the tasty bits.

I welcome your thoughts, especially learning why you may think I may be all wet.

Thanks Al for making file sharing possible.

 

 

When Patient Experience Management Fails-call the cable guy

Posted by

0

(This missive is somewhat long—this is where my mind goes when I run.)

Ever watch the show “This old House”? Something magical happens to a man when he watches somebody single-handedly rebuild a 6,000 year old home in a 30 minute program. After that no task seems too complex. As a normal male the first rule of thumb is to remember that having a master’s degree from a reputable university qualifies you for about anything short of brain surgery. The true Type A will often carry that step further by reminding himself that given another week or two of study that even neurosurgery would not be that difficult.

I did a project in one of my prior homes. It involved the simple task of rearranging bedroom furniture one Sunday afternoon; 15 minute project, total cost—nothing. After all, how difficult could that be? The truth is the actual moving of furniture involved nothing more than I’d planned. Only when I thought I was done did I notice that the television set was now located a good 20 feet away from the cable television outlet. The obvious solution would be to simply move the furniture back to its original position.

Can’t do that. To move the furniture back to the original position is either admitting defeat, or admitting I wasn’t bright enough to realize that the cable outlet and the television would be on opposite ends of the planet by the time I finished. Besides, my wife had already seen the new arrangement and if I moved it back to its original position I would have to explain why.

So when she enters the room and asks why (and she will ask why—that’s her job) there is now a 25 foot piece of black coaxial cable snaking its way diagonally across her bedroom carpeting I had better be prepared to answer. Sometimes if you’re quick, real quick, you can try and bluff your way around the problem with a technical answer. You can try and explain that all of the static electricity that was created by sliding furniture across the carpet has caused the sonic membrane surrounding the fiber optical transponders in the coax to be 6 ohms off the medium allowable temperature variation for the building codes in your neighborhood. It is called stalling, allowing for a brief period of self-correction.

The truth, having failed me, the only other option left was to try something close to the truth. I’m forced to say I knew the cable would be at opposite ends of the room before I moved the furniture. My plan all along was to call the cable company and ask them to come to the house to install another outlet on the correct wall.

It’s my wife’s job to inquire how much it will cost—she did not fail me.  This is a clear case of me answering her question without bothering to think. It is important to have a clear understanding of the underlying issues before trying to resolve the problem. I mentioned it should cost forty dollars, and we will only need to leave the cable strewn across her bedroom floor for a few days. It’s then her job to say if we put the furniture back where it was we can solve both problems in twenty minutes. Besides, the cable technician left a mess the last time they did some work, and she wasn’t going to spend more money for poor service. Stay with me here, this is how it becomes her fault, and how it relates to the topic of Patient Experience Management (PEM).

Once her issues were out in the open was a simple matter to devise a solution to address them.  The solution needed to be implemented quickly and it needed to be free. My answer came quickly—too quickly. Eighty percent of the problem could be handled by simply running the cable along the floor board, and then under the bed. That only left five feet of cable between me and a happy marriage. Unfortunately, the five feet in question is from the foot of the bed to the television and runs across the major walkway of the room, looking all the while like an undernourished blacksnake.  Did I mention she hates snakes?

Undaunted, I asked for a little assistance to move the bed. This accomplished, I headed for the garage to find exactly the proper tools for the proper job. I returned five minutes later, tools in hand. I was surprised to see the look of dismay on her face. As it turns out, her dismay resulted from the razor blade knife clutched in my hand. After twenty minutes of the best Boolean logic I could muster, I convinced her, or at least myself, that it would be a simple matter to cut a small hole in the carpet and force the cable underneath. After all, the bed would hide the hole.

The only other tool I thought I would require was a roll of duct tape and a 4’11″ broom handle.  Women know we are confused about how to proceed the moment they see men rely on the duct tape gene. Most men, when cornered believe enough duct tape, properly applied, can serve as a panacea for anything up to and including world hunger.

You’ll note I specified the exact length of the broom handle. It’s only after having attempted the project that I’m able to relate the length of the handle. Most men on a project, especially those being watched by their wife, wouldn’t bother to measure a length any more than they would ask directions while driving across Borneo with half a tank of gas.

As it turns out, I should’ve measured both the distance the cable had to travel under the carpet and the length of the broom handle prior to taping the cable to the handle and shoving a 4’11″ broom handle under a five-foot expanse of wall-to-wall carpet. The fact the carpeting was wall-to-wall is key to understanding what lay ahead. Let’s make certain the situation is spelled out clearly; the new carpet in our new home had a hole in it, a broom handle was now nicely buried under the carpet, and my wife was perched on top of the bed like one of Macbeth’s three witches waiting to see what I would do next.

Walking to the wall and grasping the carpet as best I could, I pulled up a good 10 feet of it from the tacking, acting all the while like I would have to have done that even had the handle not been one inch too short. Leaning with my one arm on the newly exposed carpet tacks, I solicited help in excising the handle from beneath the rug. That accomplished, and dying the death of a thousand cuts, I looked for another proper tool to complete the task. Walking through the kitchen to the garage I spent a moment wondering if the proper tool could be found in the kitchen. Naturally, it was—one half of a pair of chopsticks or, as it’s now referred to in technical terms, a broom handle extender.

Five minutes later, the broom handle extender and cable was firmly duct taped to the broom handle and once again shoved under the carpet. They both went in, but no cable came out the other side. So, I pulled the handle back out and surveyed the situation. The situation, as it turns out, was that in my hand was a perfectly good broom handle, a piece of coaxial cable, and no broom handle extender. The extender was now smack dab in the middle of the 5 foot expanse I was trying to cross, the problem being it was on the wrong side of the carpet, the underneath side. It was positioned perfectly. It was too far under to be reached from either end. In other words, the chop stick just became a permanent fixture in our bedroom.

Certainly, one small chopstick hidden beneath four hundred square feet of carpeting was not a big problem to me. It was not a problem unless you happen to be walking barefoot across the carpet and you happen not to be the one who put it there.  It became not unlike the fable The Princes and the Pea, and my princes found it immediately. In the fable, it was the princes could not sleep. In my case, I knew the non-sleeper in the story would be me for as long as the chopstick remained under the carpet.  Keeping my eyes focused firmly on the task at hand, I foolishly believed if I could resolve the cable problem, the matter of the chopstick would resolve itself.

One final trip to the garage led me to return with a second broom handle. The peanut gallery looked on in disbelief in my ability to finish what I had started without having to sell the house at a loss before I was through. The “I told you so’s” were being thought through in most of the major dialects of the Western Hemisphere.

This had ceased to be a project—it was now a quest, no lesser than that of the Holy Grail. A mile of duct tape later, both broom handles were firmly attached to one another. Even if I destroyed every square foot of carpeting in the house, I would not lose this broom handle under the carpet.  A minute later the cable emerged exactly where it should have, on the other side of the room.  I pulled the out broom handle, attached the cable and turned on the television. Everything worked, just as I had known it would.

Standing in front of the television, admiring my work in the new room arrangement, I noticed I was now a good foot taller than when I began the project. Was this an illusion brought about by my success?  As was quickly pointed out by my princess, my enhanced stature was more attributable to the fact that all of the carpet padding that used to lie between the end of the bed and the wall was now nicely compacted into a ball.  The ball of padding was located in the same twilight zone the chopstick found, right in the middle of the walkway. Trying to correct the problem only made it worse. Each time I prodded the ball of padding with the broom handle it grew larger underfoot. Within minutes it looked as though I had managed to suck up every inch of padding from every room in the house and placed it between my wife and a good night’s sleep. Resorting to logic once again, I quickly pointed out that she should walk on it because she would no longer be bothered by feeling the chopstick underfoot.

The next day I was on the phone scheduling an appointment with the carpet installation service. The carpet installer had to pull up most of the carpeting in the bedroom to be able to reach what she had affectionately labeled Chopstick Hill. I watched him work and I learned all about carpet padding and the installation of hardwood floors. He explained it was lucky for me that he came over because our padding was not good quality padding and we would not have known that had he not pulled up the carpet. I asked him why, if we would not have known about the padding, we would want to spend $300 for new padding. Without responding, he just kept slamming his knee in the carpet installer, charging one hundred dollars for his efforts and my education.

I was so impressed with his discussion of hardwood floors I almost bought one on the spot to surprise my wife. By now, we both know she wouldn’t have appreciated the surprise. Anybody who did not want to spend forty dollars on the cable repairman would probably have a little more trouble accepting five thousand dollars for a new floor.

However, I walked around with a silent smirk on my face for days knowing had we done it my way from the start, called the cable man, we could’ve saved the hundred dollars and never put a hole in the carpet.

This is what can happen when your patients decide to bypass your customer service because of prior bad experiences they have had trying to solve a problem.  It usually comes down to process, bad process.  Processes are a lot easier to fix than disappointed patients.

 

Dinner’s warm, it’s in the dog–Patient Experience Management

Posted by

0

dog

Let’s see what we can somehow tie this to patients; I couldn’t resist using the title. The phrase came from my friend’s wife. She’d said it to him after he and I came home late from work one night, he having forgotten his promise to call her if we were to be late. Apparently, she hadn’t forgotten his promise. We walked into the kitchen. “Dinner’s warm—it’s in the dog.” She walked out of the kitchen. I think that’s one of the best lines I’ve ever heard.

He was one of my mentors. We spent a lot of time consulting on out-of-town engagements. I remember one time I took out my phone to call my wife when he grabbed me by the wrists and explained I shouldn’t do that. We had just finished working a 10 or 12 hour day of consulting and had stopped by a bar to grab a steak and beer. I remember there was loud music playing. When I inquired as to why I shouldn’t call he explained.

“When your wife is chasing three children around the house and trying to prepare dinner, she doesn’t want to hear music and laughter and clinking beer glasses. She needs to know that you are having as bad a night as she is. So call her from outside, and make it sound like tonight’s dinner would be something from a vending machine.”

“But it’s raining,” I whimpered. Indeed it was, but seeing the wisdom in his words I headed out and made my call.

So, back to the dinner and the dog, and the steak and the phone call. In reality, they are both the same thing. It all comes down to Expectations. In healthcare it comes down to patient expectations.

Patient Experience Management (PEM) is comprised of two things; patient equity management and patient expectation management. Ask your CFO and your Chief Marketing Officer.  Patients are assets in the same way that the laptops in the nurse’s station and the worn vinyl couch in the waiting room are assets.  They are part of the organization’s valuation.  Unlike durable goods, patients for the most part do not depreciate.  Most organizations know more about how to keep the couch from walking away than they do about preventing the patient from disappearing and never returning.

When was the last time someone in your hospital asked prospective patients about their expectations prior to admitting the patient?  Answer; never.  Chances are that someone in your organization has at some point surveyed or polled discharged patients about their satisfaction.  Those surveys were probably compiled and aggregated, and somehow a rating of high, average, or below average was derived.  What information did that rating yield?  Nothing.

Let’s say you surveyed one thousand patients and that the average patient satisfaction score was ‘below average’.  As compared to what?  Without knowing the patients’ expectations ahead of time it is not possible to calculate how far off below average is from the expectation of average, nor is it possible to know what needs to be done to improve patient satisfaction enough to increase satisfaction.

Viewing patient satisfaction in aggregate tells you very little.  Your expectations, and how your experience compared to those expectations will differ from mine.  The only way to understand how to improve the patient experience across the board is to ask.  Don’t just ask about the treatment they received because in most hospitals the treatment will be stellar.  This is where most hospitals are missing the boat when it comes to improving the patient’s experience.

Let’s say a patient is in the hospital for three days to have a certain procedure done.  The procedure was performed perfectly.  That does not mean the patient will rate their experience as high.  Many other things happen over those seventy-two hours that result in a bad overall experience; the check-in, the food, the noise in the hall, poor service, the bill.

Still not with me?  Suppose you go to Chicago for a three-day convention and you give a one hour speech on day two.  Your speech goes well but your hotel room is noisy, too hot, the cable is broken, they charge you twenty dollars a night for wireless service, and somebody else’s dinner was billed to your room.  If you are like me, when someone asks you about your trip you tell them about the problems with your room, not that your speech went well.  In fact, you probably went to the hotel manager and demanded that the hotel comp your bill.

Expectations not met.  Why?  Basic business processes were a disaster.

Back to the warm dinner in the dog and my phone call. A set of expectations existed in both scenarios. One could argue as to whether the expectations were realistic—and one did argue just that—only to learn that neither of our wives considered the realism of their expectations to be a critical success factor. In that respect, the two women about whom I write are a lot like patients, their expectations are set, and they will either be met or missed.

Each time expectations are missed, the expectation bar is lowered. Soon, the expectation bar is set so low it’s difficult to miss them, but miss them we do. What happens next? Patients leave. They leave and go somewhere they know will also fail to meet their expectations. However, they’d rather give their money to someone who may disappoint them than somebody who continued to disappoint them.

What do you think?

How to cure poor patient experience

Posted by

2

Listening to NPR I heard the columnist from the LA Times, David Lazarus, recount the experience of his recent stay at the UCLA Medical Center, a result of his cat trying to devour him.  Fifty-two thousand dollars; four thousand a night for the room and there was no HBO—more than the cost of the Premier Suite at the Beverly Hills Hotel.  Remember this little fact about the room; we will come back to it.

For any given patient, the highest that patient’s satisfaction will ever be is the moment it exits the hospital.  The likelihood of increasing patient satisfaction after leaving the hospital is no better than the chance of counting backwards from infinity…twice.

What happens, you see, is that while the patient is in the hospital the hospital believes it exercises some sort of control over the relationship.  Perhaps this is where the notion of patient experience management originated. 

Patient experience and patient satisfaction are always being managed.  Sometimes the management of the patient is proactive and deliberate, other times it is managed neglectfully or inadvertently.  Just because the experience is being managed does not mean the outcomes will be favorable.  Unfortunately, this surprises some executives.  Perhaps this should be a ‘predictable surprise’.  When the patient is discharged the patient reassumes control.

What if patient satisfaction and patient experience could be managed effectively for all patients?  Assuming healthcare was a business, what if patients were treated as assets—patient equity management (PEM)?  Business is not a four-letter word in healthcare.  Hospitals market to attract patients.  Why not have programs to increase patient equity management, to retain patients and their families over their lifetime? 

Why not institute a program of family experience management, family equity management?

Viewing a patient non-clinically, there are a handful of major business processes each patient encounters, processes like admissions, scheduling, meals, billing, and claims.  Each of these processes impact a patient’s experience and satisfaction.

Let us jump back to the point about the four-thousand dollar room, not the charge itself, rather the room.  A hospital’s nonclinical business processes can be mapped almost one-to-one to those of large hotel.  One difference one finds when comparing the business processes of a hospital to a hotel is that the satisfaction levels as measured against those processes of the hotel will almost always be higher.

When patients use social media to comment on their stay at a hospital, these are the processes on which they comment.  Patients rarely complain about the doctor replacing the wrong hip.  They do however complain about receiving the wrong meal or about not being able to understand their bill.  Hospitals have no weapons with which to defend themselves against the electronic 1’s and 0’s of poor satisfaction; the internet is forever.  The hospital’s only defense against poor satisfaction is to improve the patient experience.

Mr. Lazarus from the LA Times met with the president of the UCLA Medical Center to discuss his bill.  The president told him that not only did he not understand Mr. Lazarus’ bill, he did not even understand his own bill.  Mr. Lazarus noted that in his article and on NPR.  The circulation of the LA Times is slightly above a million.  No amount of effort is going to put the toothpaste back into that tube.

Some, who feel their way along in near-perfect darkness, have what might be described as the fatally limited hypothesis that there is not much to be gained by improving nonclinical processes.  The individual with a single hypothesis about how to improve matters feels more comfortable with the status quo. 

I am in the process of meeting with a dozen hospital executives to discuss what can be done to improve their nonclinical business processes. If you would like to include your organization in this process please let me know.

Social Media: The Elephant in the Bored Room

Posted by

0

Pardon the idiom, and yes, the misspelling was deliberate.  You may want to grab a sandwich, this is a long read.

For the longest time it has occurred to me that most companies find themselves in a state of what I like to label Permanent Whitewater. As they careen through the rapids, it is anybody’s guess as to whether they will capsize.  And the philistines they have appointed as commissioners would be more appropriately described as Ommissioners, as they have omitted themselves from understanding the world and leading their charges.

Now, what does that have to do with anything?  Thanks for asking.

For those of you who can find California on the map, you will recall the great turnip boycott of the nineteen seventies—I know they boycotted grapes, but I like grapes and do not like turnip, so I choose to have my own protest.  Anyway, this boycott worked, and as a result, the working conditions for migrant workers improved albeit only modestly.

And here is the kicker.  An entire industry was brought to its knees.  That is not the surprising part.  The surprising part is that all of this change was brought about at a time when there were three television channels and when people actually subscribed to newspapers.

From where I sit, social media can be divided into two camps, those who have not slept since the launch of Google+, and the far larger camp of those who have not lost a minute of sleep.  Businesses, for the most part are well entrenched in the latter group.

Part of the reason why businesses are slow to adopt social media can be attributed to their lack of belief that social media matters or can impact their business one way or the other.  And frankly, I think that has a lot to do with why our economy continues to rejoice in its malaise.

So, how to those of us in the first camp get those in the second camp to see the world our way, how do we get them to jump head-first into social media.  The answer is simple.  We need to create our own turnip debacle.

They say it cannot be done, so let us show them.  The one thing that would get companies to embrace social media quickly and unashamedly would be if there was one less company.

Companies, big ones, fat ones, firms that climb on rocks—feel free to finish the tune without my help have the following issues, they think they:

–       control their market

–       own their customers

–       are managing their customers

Companies are wrong about those three assumptions and the use of social media can and will prove this.  I would ask for a company to volunteer, but that would take too long.

If ABC, CBS, and NBC were able through their coverage of the grape boycott, bring about change to an entire industry, imagine with me what impact a global, committed bunch of savvy social media users could do to a single firm.

Here is what I propose.  Let us pick one firm.  The characteristics of this firm should be that it is well known and not well liked—this way if it self-destructs we can argue that we acted on behalf of a greater good.  It should also be a firm associated with technology, a firm that ought to at least be able to spell social media.  If I were asked which firm I would choose I would pick a firm in some aspect of telecommunications, say a firm like Comcast or Verizon—an easy target, a firm facing a customer experience war armed only with their CRM.

Now, the idea of our little social project will be to provide a heads-up to all of the other companies about the start date of the importance of social media.  Let’s tentatively agree on starting on the first of November unless there is a game on television I want to watch.

The goal of the project is to demonstrate that the bourgeois, the working class, with its harmless set of social media tools, can create affect enough of a disruption to an organization to make that organization sit up and take notice, or to make it disappear.

I am sure you remember the YouTube video of the Comcast technician that fell asleep on a customer’s couch.  It went viral, but Comcast did not, and that was simply a single posting by a single customer.  What would happen if the social media mavens decided to use the tools at their disposal and concentrate their efforts at or against a single firm?

Crowdsourcing 101.

I think the end result of such an effort would have a significant impact.  The impact could easily bring about more fundamental change about how firms use social media than was brought about by the grape boycott.

Sometimes something has to be sacrificed on behalf of the greater good.  Although a rising tide lifts all boats, it can ruin your day if your firm is the one chained to the pier.

What are your ideas?

 

“New & Improved” Isn’t Innovative

Posted by

0

(AP) Redmond Washington.  After a much heralded launch, the buzz around Microsoft’s launch of Windows 8.0 is centered on the fact that when the computer crashes that users will no longer see the blue screen of death.  Instead, users will now see a friendly screen requesting that they restart their systems.

“Which is why we have decided to close the company at the start of 2012,” said CMO Droid Nelson.  “I mean when you spend two hundred million dollars just to market 8.0 and the only chatter is about the crash screen, the time has come.  We have not offered anything of interest to early adopters since 1997.  After all, what are we supposed to do?  If we continue on at this rate sooner or later we will hold a news conference for Windows 17.0 and Office 2024 and nobody will care.”

“How many times can we put a new ribbon around the same old software?  It is not like we can make it run any faster or any easier to navigate.  And Office is still Office.  When was the last time we added anything to that suite?  Most of our customers already cannot use half of the features we built, why should we keep building until we get that figure up to eighty percent?”

“The innovation train left the station around the time Starbucks came out with their half-caf-decaf with a double shot.  We made ourselves irrelevant.  Hell, I use an iPad and Google Docs.”

Can you name what Microsoft launched the last time you were willing to tailgate to be the first one to own it?  Nobody can.

Can you name the last time your customers were willing to tailgate to be the first one to purchase your firm’s newest offering?  Didn’t think so.

The thing to remember about new and improved is that it isn’t either.  If it was so brand spanking new, you wouldn’t have to tell anyone.

New is not a feature.

Improved is not a feature.

When Apple launched the first iPod their pitch was something along the lines of every song you every wanted to listen to in this little box.

Customers stand in line for innovation.  Is there a line outside your door?

IT Vendors: What’s not to like?

Posted by

0

We were being entertained at a friend’s house whose interior looked like it had been designed by one of those overly made up, energetic divorcees who only take cash.  The walls were painted a stark white; the overstuffed club chairs and the couch were upholstered in a soft white leather.  The white carpet was thick enough to hide a chiwawa.

The hostess locked askance at me when she saw me seated in the club chair.  Perhaps my outfit did not look good on white.  A paperback which looked out of place lay on the end table next to my glass of Ovaltine.   I picked it up and began to read the back cover to get a feel for the storyline…which got me thinking about writing and authors.

The paperback story filled five hundred and seventeen pages.  Whether they were well-written, whether there was a story nestled inside, could only be learned by reading the book.  I read many books, and I read often, especially when I travel.  When I am unprepared I am forced to purchase a book at one of the shops in the airport concourse.  The purchase decision lasts only as long as it takes to read the back cover—the publisher’s only chance to make a first and last impression.

Those first impressions have fooled me often.  Ten minutes into the book I wind up stuffing it into the kangaroo pouch in the seatback in front of me.  More often than I would like, I find that the person who wrote the book summary on the back flap is a better writer than the person who wrote the book.  The summary writer is able to create an interest in the story and a need to see how it ends, an interest and need for which the book’s author is unable to deliver.

The book is rarely better than the back cover suggests it will be.  Often it is as good, sometimes it is not.  The book summary is the upper limit for what you can expect by way of enjoyment.

It works the same way in business only instead of paperback books they use brochures.  Never trust the brochure.  Whatever is written in the vendor’s brochure is the upper limit of what you can expect to receive.  Those who remember the dismantling of nuclear arms remember the adage ‘Trust, but verify.”  When it comes to dealing with vendors, I suggest ignoring the part about trusting.

Take software vendors for example.  What’s not to like?

The product never leaves you feeling the way you felt after reading the brochure.  Remember the photos?  Attractive people, smartly dressed, ethnically diverse.  Their teeth bleached so white the reflection of the monitor is visible in their incisors.  Seated in their clutter-free offices, they are all smiling.

Did your users look like them when they started to use the product?  Did you get your brochure moment?  In order to find customers, vendors have to position their product in the most positive light.

Maybe there should be a cigarette-like warning printed on every software vendor’s brochure, something like this:

  • We hired the people pictured in the brochure—nobody is ever that happy
  • Most of you will never learn how to use all of the functionality
  • To have any chance of getting the software to do what you need it to do will probably cost you twice as much as you contracted
  • There is no way you will implement in the timeframe you discussed

They know, and we know, nobody implements brochures.  If we did, IT departments would be much smaller.  Maybe that is why vendors give away pens and T-shirts to all of their customers, to soften their sense of guilt.

Is the C-suite Fiddling while EHR Burns?

Posted by

0

There is an adage in the military—different spanks for different ranks.  It speaks to a double standard; less egregious punishment for similar offenses, similar misjudgments.

We see that every day in business, and we see it a lot in healthcare, especially in hospitals.  Physicians are held accountable for medical errors.  Hospitals pay millions for malpractice insurance knowing that mistakes will be made and people will be held accountable for those mistakes.

But what about on the business side?  Who is held accountable for business mistakes?  An acquisition that failed to deliver.  An expensive new service offering that bled the company dry.  A decline in the number of patients. The failure of a major IT initiative to deliver results.

Take EHR.  Some of you are saying, “Yes, please take it.”

  • Around sixty percent of the large EHR projects have failed in one respect or another
  • Egregious productivity losses
  • A large number of hospitals are on their second implementation of EHR

Who is going to be fired for the two hundred million dollar misstep?  The board?  Never.  The CEO—no.  The COO or CFO?  Unlikely.  The CIO?  That is the safe bet.

Did the CIO authorize the expenditure?  Probably not.  Did the CIO get all the dollars needed to be successful, all the user support?  Unlikely.

In most cases the CIO has all of the responsibility and only some of the authority.  There are a handful of people in each organization tasked with the oversight of the large project.  They are the ones who should be asking the right questions, the ones who should be demanding answers.

Even worse, hospitals have accepted the productivity loss as their new steady state.

A failed project, a failed strategy should not come as a surprise.  The only people who will be wearing EHR 2.0 T-shirts are those who authorized EHR 1.0.

EHR: Step away from the computer

Posted by

0

Our middle school child is in the middle of a family consumer science project (home economics) to organize one room in our home.  He has redefined the project so that he reorganizes during commercials, and he is seven hours into a project involving our walk-in closet.

While watching the news it occurred to me that something is missing from my life, I do not belong to a gang, not even a little one.  So, I have decided to start one, a white collar gang of consultants.  A rough and tumbled, manicured group of professionals.

Instead of gang emblem, I am thinking each member of the gang will have their own embossed business card.  We will come up with creative gang nicknames.  For myself I am vacillating between ‘Dr. Knowledge’ and ‘The Voice of Reason.’  Instead of Harleys, we will roll through town to our national rallies on monogrammed Segways, and instead of leathers we will dress in Armani.

Mothers will hide their children from us as we power noiselessly down Main Street at four miles an hour, and their CPA husbands will turn green with envy.  We might not win many fights, but we will have the satisfaction of knowing we are smarter than those who beat us to a bloody pulp.

Sounds too good to be true, doesn’t it?

There are days when it doesn’t pay to be a  serial malingerer, and when it does, the work is only part time, but I hear the benefits may be improving as I think I heard somebody mention healthcare is being reformed.

I don’t know if you are aware of it, but there are actually people who have taken an Alfred E. Newman, “What, me worry” attitude towards EHR.  For the youngsters in the crowd, Alfred was the poster child for Mad Magazine, not Mad Men.

Just to be contrarian for a moment–as though that’s out of character for me–most providers have no need to fear–does this happen to you?  You are writing aloud, trying to make a point, and the one thing that pops into your mind after, ‘there’s no need to fear’ is “Underdog is here.”

Anyway, since many providers haven’t completed the process, there is still time for them to lessen the risk of failure from an EHR perspective.  Many don’t want to talk about it, the risk of failure.

Here’s another data set worth a look (The Chaos Report).  They went a little PC on us calling them ‘Impaired” factors.  EHR impairment.  Step away from the computer if you are impaired, and take away your friend’s logon if they are.  These are failure factors.

Project Impaired Factors % of  the Responses
1. Incomplete Requirements 13.1%
2. Lack of User Involvement 12.4%
3. Lack of Resources 10.6%
4. Unrealistic Expectations 9.9%
5. Lack of Executive Support 9.3%
6. Changing Requirements & Specifications 8.7%
7. Lack of Planning 8.1%
8. Didn’t Need It Any Longer 7.5%
9. Lack of IT Management 6.2%
10. Technology Illiteracy 4.3%
11. Other 9.9%

My take on this is with overall “failures” so high, several respondents could have replied to “all of the above.”  Also of note is that these failure reasons differ from the ones listed previously.

Who knows, maybe if we multiply them by minus one we can call them success factors.