Video Game Theory applied to Healthcare IT

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My twelve-year-old son overheard a conversation I was having about EHR, Meaningful Use, and ICD-10, and I watched his eyes glaze over.  So I tried to explain it to him in terms I thought he might understand.  Maybe this explanation is the one I should have used with my client.

John and Sally have a thousand dollars in the bank.  They pool some of their money and have a hundred dollars to spend on video games.  The game they really want, Project From Hell, costs sixty dollars.  About half the people who play Project From Hell never make it to the end, and never get the chance to claim their prize.  It takes two years to play, and one or both of them could be eliminated from the game for failing to play well.

The second game is a take-off on Faust, Sell Your Soul to the Devil.  To play this game, you must first beat Project From Hell.  Sell Your Soul costs thirty dollars.  However, the upside is that if you win, which is not very likely, you can earn two dollars.

The third game, Bet Your Savings, is the most intriguing.  All kids who have a computer must play Bet Your Savings, which costs thirty-five dollars.  The way Bet Your Savings works is that if you do not play, or if you play and lose, ten percent of the money in your bank account disappears.

I asked my son which games John and Sally should buy.  He said if they bought Project From Hell and Sell Your Soul, they would only have ten dollars left, and that the reward from Sell Your Soul, two dollars, was not worth much.  He also noted they do not have enough money to buy all three, and that since Bet Your Savings was mandatory, unless John and Sally wanted to automatically lose ten percent of their savings, they must choose Bet Your Savings.

He decided they should buy Project From Hell and Bet Your Savings.

By now you have figured out the Project from Hell is your EHR, Sell Your Soul is Meaningful Use, and Bet Your Savings is your ICD-10 initiative.

Resources are scarce.  Do you have enough money to do Meaningful Use and ICD-10 correctly?  Many hospitals do not, and yet they are charging full tilt at meeting Meaningful Use to possibly net a few dollars.  Many hospitals have not invested enough to meet ICD-10.

Where should you place your limited resources?  If you are still confused, feel free to ask my son.

Video Game Theory applied to Healthcare IT

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My twelve-year-old son overheard a conversation I was having about EHR, Meaningful Use, and ICD-10, and I watched his eyes glaze over.  So I tried to explain it to him in terms I thought he might understand.  Maybe this explanation is the one I should have used with my client.

John and Sally have a thousand dollars in the bank.  They pool some of their money and have a hundred dollars to spend on video games.  The game they really want, Project From Hell, costs sixty dollars.  About half the people who play Project From Hell never make it to the end, and never get the chance to claim their prize.  It takes two years to play, and one or both of them could be eliminated from the game for failing to play well.

The second game is a take-off on Faust, Sell Your Soul to the Devil.  To play this game, you must first beat Project From Hell.  Sell Your Soul costs thirty dollars.  However, the upside is that if you win, which is not very likely, you can earn two dollars.

The third game, Bet Your Savings, is the most intriguing.  All kids who have a computer must play Bet Your Savings, which costs thirty-five dollars.  The way Bet Your Savings works is that if you do not play, or if you play and lose, ten percent of the money in your bank account disappears.

I asked my son which games John and Sally should buy.  He said if they bought Project From Hell and Sell Your Soul, they would only have ten dollars left, and that the reward from Sell Your Soul, two dollars, was not worth much.  He also noted they do not have enough money to buy all three, and that since Bet Your Savings was mandatory, unless John and Sally wanted to automatically lose ten percent of their savings, they must choose Bet Your Savings.

He decided they should buy Project From Hell and Bet Your Savings.

By now you have figured out the Project from Hell is your EHR, Sell Your Soul is Meaningful Use, and Bet Your Savings is your ICD-10 initiative.

Resources are scarce.  Do you have enough money to do Meaningful Use and ICD-10 correctly?  Many hospitals do not, and yet they are charging full tilt at meeting Meaningful Use to possibly net a few dollars.  Many hospitals have not invested enough to meet ICD-10.

Where should you place your limited resources?  If you are still confused, feel free to ask my son.

 

EHR: Puppy Training Your Vendor

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To ensure we take an accurate look at the provider-vendor relationship, we must be willing to acknowledge that healthcare providers are from Mercury and the EHR vendors are from Pluto.  They exist in different orbits, and their business models are very far apart—they never intersect; not in space, and not on your project.

1. Have your own inside expert. Don’t rely on the vendor to tell you what you should be doing.  Never.  Ever.  Unless of course you think the vendor knows more about how you want to run your hospital than you do.  Remember, you select them—not the other way around.

Bringing a vendor into your hospital is a lot like bringing home a new puppy. Both need to know who runs the show. Don’t roll over.  They may not be looking to be led, but if you don’t lead them they will lead you.

You should have the expert on board at the outset, before you select the EHR vendor.  The expert should be your advocate.

2. Establish a specific executive liaison with your vendor.  This is not your new tennis partner.  This should be the person who has the authority to ensure your quantifiable wishes are being met, and whose responsibility it is to deliver the message to his troops, and marshal the resources necessary to get the job done.

3. Specify your contractual objectives. Ensure that the contract is aligned with the clinical and business objectives of the healthcare organization, not the vendor.  Before you can accomplish this, you have a lot of work to do with your team.  You must define your clinical and business objectives.  Often these two groups also have a Mercury and Pluto relationship.  Once you have these, your next task is to deliver these objectives to the vendor and have the vendor tell you in writing what they will meet, what they might meet, and what they can’t meet.  It would be nice to know these before you sign their contract.

4. Involve more people than just the IT staff. Need a rule of thumb, involve as many users as IT people—Mercury and Pluto.  You will need new processes, not just to squeeze an ROI from the EHR, but because many of your old ones have probably been around since the invention Band-Aid.

Each of these recommendations will actually help you and help your vendor be successful.  It will not be an adversarial relationship as long as you manage it.  If you don’t manage the relationship, you won’t have to worry about meeting Meaningful Use—you’ll be too busy selecting a replacement vendor.

One final thought, don’t let the vendor loose unsupervised on the oriental rugs.

 

What is the future of the EHR/N-HIN landscape?

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One may argue it is possible to build the real Brooklyn Bridge with nothing but toothpicks, and a lake filled with Elmer’s Glue.  Difficult yes; prudent, no.   Urban legend is 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 million 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.

The ability to do something is not justification for doing it.  Nor is that fact that someone has put it forth as an idea.  The willingness to do something merely because everyone is doing it or because someone instructed it be done probably has nothing to do with a business strategy, or if it does, it shouldn’t.

In the next five to seven years the business of healthcare at the provider level will have the opportunity to change markedly—the unanswered question is, will it have the ability?  To answer that at the provider level—primarily hospitals and clinics—I believe one must distinguish between the business of healthcare (how the business is run) and the healthcare business (how the care is delivered).

In many respects, the business of healthcare and the strategy surrounding it is pinned to a 0.2 business model.  Certainly there are exceptions to any aphorism, but taken as a whole, there is plenty of room for improvement.  As one hospital CEO told me, “What we really lack is adult supervision.”

So, how exactly does the toothpick bridge apply to healthcare?   Here’s my take on the situation.

  1. It may be possible to build and roll out a national network of EMRs through EHRs connected by HIEs to an N-HIN—I don’t think will happen in the next five to seven years, especially if to be effective the network requires a minimal participation of somewhere between 70 to 80 percent of healthcare providers.
  2. Even if I am wrong, why would anyone build a national EHR network out of toothpicks?  Could they possibly have devised a more complex and costly approach?
  3. The government arrived late for the party, has only limited authority, and chose to provide cash incentives instead of direction or leadership.  They passed the responsibility of the success of the national EHR roll out to hundreds of thousands of healthcare providers.
  4. The providers are burdened by having no experience in the sector, hundreds of EHR systems from which to select, no standards, hundreds of HIEs, no viable plan, no one with singular authority, a timeline that cannot be meet, and an unwritten set of Meaningful Use requirements.

The plan sounds like something designed by Rube Goldberg.  Could it be done this way?  I do not think we will ever know.  Not necessarily because it will fail, but because I think the plan will be supplanted by a more realistic one from the private sector.

The government’s plan relies on a top-down approach—albeit with a missing top; from the government, to the providers, to the patients.

The private sector plan will come from firms like Apple, Google, and Microsoft.  It will work because it will be built from the bottom up; from the patients, to the providers, and back.  Personal Health Records (PHRs) will become EMRs.  This approach will allow them to flip their PHR users to EMR users, and will be adopted quickly by millions of customers (patients).  Their approach will have a small handful of decision makers calling the shots instead of hundreds.

This model’s other component will be driven from another direction, by large hospitals and clinics that connect to small hospitals, small practices, and ambulatory physicians via a SAAS model.  Something like this is underway today at the Cleveland Clinic using their offering, DrConnect.

I believe the approach will be refined even further as the distinction between PHRs and EMRs erodes.  Instead of requiring remote care providers to have their own mini-EHR integrated with their practice management system, they will be able to use the EHR of a large hospital.  I anticipate that they will be able to log on to the system to access their patients’ EMRs as though they were actually resident in the large hospital.  This will all but eliminate the role of Health Information Exchanges (HIEs).  It will also extend the reach of those large hospitals, and aid in the retention and recruiting of physicians.

Why is this important?  Because the federal plan, which won’t be viable for several years, is designed to use software solutions which address a current business issue.  By the time their networked solution is fully functional it will be well on its way to obsolescence.  The government is forcing the expenditure of more than a hundred billion dollars on a static offering to address a non-static issue.  Their approach will not be able to keep pace with the changes demanded by market forces.  It reminds me off building a plan to go to the moon based on where the moon was instead of where it will be.

 

EHR Strategy: The Wildebeest Postulate

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The Kalahari; vast, silent, deadly. The end of the rainy season, the mid-day 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 this 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. How are you addressing the change that must occur for EHR to be of any value?  EHR is not about the EHR.  It’s not about ARRA money, and it is not about IT.  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.

 

HIT: The Change Keeps Changing

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Hello to those whom I’ve yet to meet.  This is rather long, so you may wish to grab a sandwich.

I write to share a few thoughts.  I reside in the small place where those who refuse to drink the Kool Aid reside. For those who haven’t been there, it’s where those who place principle over fees dare to tread.

Where to begin? How to build your provider executive team? (Those who wish to throw cabbages should move closer to their laptops so as not to be denied a decent launching point.)

I comment on behalf of those in the majority who have either not started or hopefully have not reached the EHR points of no return—those are points at which you realize that without a major infusion of dollars and additional time your project will not succeed. Those who have completed their implementation, I dare say for many no amount of team building will help. Without being intentionally Clintonian—well, maybe a little—I guess it depends on what your definition of completed is.

If I were staffing a healthcare organization, to be of the most value to the hospital, I’d staff to overcome whatever is lying in wait on the horizon, external influences—the implications of reform and Stages 2 and 3 of Meaningful Use, and a national roll out of EHR with no viable plan to get there.  Staffing only to execute today’s perceived demands will get people shot and will fail to meet the needs of hospital. To succeed we need to exercise an understanding of what is about to happen to healthcare and to build a staff to meet those implications.

Several CEOs have shared that they are at a total loss when it comes to understanding the healthcare implications of reform and IT.  They’ve also indicated—don’t yell at me for this—they don’t think their IT executives understand the business issues surrounding EHR and reform.  I somewhat disagree with that perspective.

Here’s a simplified version of the targets I think most of today’s hospital CIOs are trying to hit.

1. Certification
2. Meaningful use
3. Interoperability—perhaps
4. Budget
5. Timing
6. Vendor management
7. Training
8. User acceptance
9. Change management
10. Work flow improvement
11. Managing upwards

There are plenty of facts that could allow one to conclude that these targets have a Gossamer quality to them.  Here’s what I think. You don’t have to accept this, and you can argue this from a technology viewpoint—and you will win the argument. I recently started to raise the following ideas, and they seem to be finding purchase—I like that word, and since this is my piece, I used it.

Before we go there, may I share my reasoning? From a business perspective, many would say the business of healthcare must move from a 0.2 to a 2.0 business model. (This is not the same as the healthcare business—the clinical side.)  The carrot?  The ARRA incentives—an amount that for many providers will prove to be more of a rounding error than a substantive rebate.

Large healthcare providers are being asked to hit complex, undefined, and moving targets, and they are planning on adapting to reform and reforming their own business model while they implement systems which will change how everyone works.  Hospitals are making eight and nine figure purchase decisions based in part on solving business problems they have not articulated. If success is measured as being on-time, in-budget, and fully functional and accepted, for any project in excess of $10,000,000, the chances of failure are far greater than the chances of success.

Their overriding business driver seems to be that the government told them to do this. Providers are making purchasing decisions without defining their requirements. Some will spend more on an EHR system than they would to build a new hospital wing.  Many don’t know what the EHR should cost, yet they have a budget. Many don’t know if they need a blue one or a green one, if it comes in a box, or if they need to water it.

So, where would I staff to help ensure my success—this is sort of like Dr. Seuss’, “If I ran the Circus”—the one with Sneelock in the old vacant lot.  I’d staff with a heavy emphasis on the following subject matter experts:

• PMO
• Planning & Innovation
• Flexibility
• Change Management
• PR & Marketing

Contrary to popular belief, not all of these high-level people need to have great understanding of healthcare or IT. You probably already have enough medical and IT expertise to last a lifetime.

Here’s why I think this is important. Here’s what I believe will happen. Three to five years for now the government would like us to believe there will be a network of articulated EHRs with different standards, comprised of hundreds of vendor products, connected to hundred of RHIOs, and mapped to a N-HIN.  Under the proposed model, standardization will not occur if only for the fact that there is no monetary value to those vendors whose standards are not standard.

Interoperability, cost, and the lack of standardization will force a different solution—one which is portable.  I think the solution will have to be something along the lines of a single, national, open, browser-based EHR.  It will be driven by consumers.  Consumers will purchase the next generation of super-smart portable devices that offer a combination of iPad/iPhone functionality.

The Personal Health (PRH) will have evolved to become the EMR.  How is this possible?  What do smart devices do?  They do one thing, billions of times each day, and they do it perfectly—they send and receive ones and zeros.  That is what today’s EMR are—ones and zeroes.  Those next-gen devices will be EMR-capable.  Why?  Because there are more than a hundred million customers who will keep buying these devices.

The so-called N-HIN will be the new Super Internet—not some cobbled together network of RHIOs.

Firms like Apple, Google, and Microsoft will drive this change.  We already buy everything they offer, in fact, we line up at midnight to do so.  By then, those firms will care less about selling the devices than they will about transporting the ones and zeroes that comprise the data.  Their current PHRs are their way of introducing themselves to consumers as players in healthcare.

The point I am trying to drive home is that from being able to adapt to change and reform, lean towards staffing the unknown.  Staff with leaders, innovators, and people who can turn on a dime. Build your organization like turning on a dime is your number one requirement. Don’t waste time and money worrying about Certification or Meaningful Use. If anyone asks you why, you can blame me.

If you want a real reason, I have two. First, they won’t mean a thing five years from now. Second, if I am the person writing an incentive check, I want to know one and only one thing—will your system connect with the other system for which I am also writing a check?  That is the government’s home run.

 

What if hospital business models weren’t so tribal?

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I tend to look at it from the perspective of the business model of many hospitals.  How does one transform a 0.2 business model to function in today’s let alone tomorrow’s changing healthcare model?

The clinical side 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.  In some respects the inherent structure, cost duplication, and rigid departmental silos remind me a lot of how the various agencies under Homeland Security function, 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 of 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.

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.

 

Patient Relationship Mangement–who’s kidding who

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(AP) New York. CNN reported that Patient Relationship Management (PRM) and Patient Experience Management (PEM) died. Services will be held next Monday at Dunkin Donuts. Patients are asked not to attend, but instead to forward their complaints to Rosie O’Donnell.

PRM is what hospitals tend to use; it measures against their standards.  It is a push model.  PEM is what patients tend to use; it is a pull model.

A fellow, David Phillips, wrote, “Relationships should be considered part of the intrinsic value of the corporation”—he is an auditor. A group of PhDs who concluded that the six components for measuring relationships include; mutuality, trust, commitment, satisfaction, exchange relationship, and communal relationship. I feel better just knowing that.

Patient Relationship Management—PRM. I hate being the one to break the news but, PRM is dead. I didn’t kill it. It’s dead because it never existed.  Relationship Management.  Who is actually measuring a relationship?  What unit of measure do you use to measure a relationship? Inches, foot-pounds, torque?  PRM carcasses are strewn about. You can’t manage what you can’t or don’t measure.

“What are you talking about?” She hollered. “We measure. We measure everything. If it’s got an acronym, we’ve got a measure for it. KPIs. CSFs. ACD. IVR. ATT. AHT. Hold time. Abandonments. Churn.”

Just because something is being measured, it doesn’t mean that the measure has anything to do with the desired outcome. Nobody has a single quantifiable metric that precisely points to the health of an individual patient relationship. Seems silly? No sillier than really believing you have an ability to manage something as ephemeral and esoteric as relationships.

Just how good are those relationships everyone thinks they’ve been managing? Five percent higher than last month?  Down three percent over plan?  Permit me a brief awkward segue. Joseph Stalin said, “One death is a tragedy, one million deaths are a statistic.” The point is that scale matters—a great deal.  One death versus a million.  One patient interaction versus millions.  It makes a difference. The things we do that impact patient experiences impact patients individually, one patient at a time.

PRM metrics in use at hospitals apply to patients—plural.  PRM metrics are benchmarks and averages—patients aren’t.  Hospitals measure against the masses, against the pool of patients.  The patient mass does not churn, does not leave your hospital, does not ask to speak to a supervisor.  Consider a patient, not a single metric.  Not a single measure in your hospital accurately depicts the success or failure of that patient’s experience.

So, what’s a hospital to do? Stop trying to manage your hospital’s performance by managing relationships.  Here’s what you can do, manage your hospital using things you can measure. Once you can measure it you can manage it.  A hospital can start by defining metrics for the following;

Patient Referral Management—how many patients came via referral?

Patient Resolution Management—how many patient problems were fixed?

Patient Recovery Management—how many patients did you win back?

Patient Retention Management—how many patients did you prevent from going elsewhere?

If you are the CIO, show the VP of Operations your ideas for tracking the answers to these questions. This is step one to having a real PEM program.  If you are really serious about having a patient experience management program, change the word “experience” to the word “equity.”  Patient Equity Management—all of a sudden you have something worth talking about.

 

HIEs: Too Many Cooks Spoil the Broth

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Is the number of people working on developing Health Information Exchanges (HIEs) is greater than the total number of people who attended HIMSS in Orlando; more than 30,000?  Why are five hundred HIEs are being built?

Let us assume for a moment that there is a set of standards somewhere, a blueprint perhaps, for what a good HIE should be able to do.  Granted, if we are going to be honest, an HIE does not have to do very much; does it?  It does not change the data in a health record.  It does not add data.  And, it neither creates nor destroys health records.

In its simplest form, a health record comes in from some place, and that same record goes out to some other place.  And what is in that health record?  If we are trying to keep it simple in order to show the problem is in fact solvable, what is in the health record is a formatted collection of ones and zeroes.  And how does the HIE “move” the ones and zeroes?  The movement is caused by writing computer applications; code—ones and zeroes.

The blueprint for an HIE is nothing more than a pipe to move formatted zeroes from point A to point B.  Now in reality, we have about five hundred HIE teams working hard to build disparate HIEs.  To what end?  To move ones and zeroes from point A to point B.  So, the 500 HIE teams are writing 500 different HIE applications using ones and zeroes to move ones and zeroes.

Doing the math—500 HIE teams * 1 HIE application per team = 500 different HIE applications.  If done correctly—which is an entirely different conversation—we will have 500 HIEs, each of which are capable of doing the exact same thing; which is—moving ones and zeroes.

Let us dissect the ones and zeroes concept for a moment.  When Al Gore created ones and zeroes he did so with the premise that all ones were created equal, all zeroes are created equal, and that ones and zeroes are equal.

Now, what makes the one and zero concept particularly great with regard to HIEs and all of healthcare IT is there is never a need for a “two”.  No CIO worth his or her salt will ever sit at a steering committee meeting and state, “If I only had a 2, this whole problem would go away.”

If one looks correctly at the issue of HIEs by breaking it down to its simplest elements, it is a unique problem to solve.  Unique—as in singular.  Two HIEs do not solve the problem better than one HIE.  Once you have two, you no longer have a unique solution, and when you have 500 HIEs, you have a mess.

Here is the kicker to this argument.  What else do you have when you have a single HIE capable of reading the data from all of the various EHR platforms?  Exactly.  You have the N-HIN—the Nationwide Health Information Network.  Why?  Because when push comes to shove, the N-HIN is nothing more than a glorified HIE.

However, once you have more than one HIE, you then need an HIE for the HIEs, which is the only reason there is any discussion about building an N-HIN.

So, in addition to the fact that 500 HIEs are 499 too many, do they create any other problems?  Of course they do.  They add a very high and unnecessary degree of additional complexity to the healthcare IT systems of every healthcare provider.  Some providers offer services within many different HIE footprints.  Every provider will need to adapt their systems so that the provider’s healthcare records can be accepted by their corresponding HIE pipe.

Instead of building 500 HIEs, and forcing them to some semblance of a standard, why not just build one HIE and have that be the standard?

 

Abi-normal

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I remember the first time I entered their home I was taken aback by the clutter.  Wet leaves and small branches were strewn across the floors and furniture. Black, Hefty trash bags stood against the walls filled with last year’s leaves. Dozens of bright orange buckets from Home Depot sat beneath the windows. The house always felt cold, very cold. After a while I learned to act normally around the clutter.

There came a time however when I simply had to ask, “Why all the buckets? What’s the deal with the leaves?”

“We try hard to keep the place neat,” she replied.

“Where does it all come from?” I asked.

“The open windows, the stuff blows right in.”

I looked at her somewhat askance. “I’m not sure I follow,” I replied as I began to feel uneasy.

“It’s not like we like living this way; the water, the cold, the mess. It costs a fortune to heat this place.  And, the constant bother of emptying the buckets, and the sweeping of the leaves.”

Trying to assume the role of thought leader I asked, “Why don’t you shut your windows? It seems like that would solve a lot of your problems.”

She looked at me like I had just tossed her cat in a blender.

When you see something abnormal often enough it becomes normal. Sort of like in the movie The Stepford Wives.  Sort of like Patient Experience Management (PEM). The normal has been subsumed by the abnormal, and in doing so is slowing devouring the resources of the hospital.

Are you kidding me? I wish. It’s much easier to see this as a consultant than it is if you are drinking the Kool Aid daily. When I talk to people about a statistic that indicates that 500 people called yesterday about their bill, and everyone looks calm and collected, it makes me feel like I must be the only one in the room who doesn’t get it—again with The Stepford Wives.

If I ask about the high call volume they always have an answer, the same answer.  “Billing calls are usually around 500 a day.”  They say that with a straight face as though they are waiting to see if I will drink the Kool Aid. It’s gotten to the point where no matter how bad things get, as long as they are consistently bad, there not bad at all.

This is the mindset that enables the PEM manager (I know you don’t have one—I am being facetious) to be fooled by his or her own metrics. When is someone going to understand that repeatedly having thousands of people calling to tell your organization you have a problem, means you have a problem?

It would probably take less than a week to pop something on your web site, and post a YouTube video explaining how to read the bill.  Next week, do the same thing and help patients understand how to file claims and disputes—granted, you may need more than a week for this one.