Are Hospitals Looking in the Wrong Haystack for the Needles?

“The time has come,” the Walrus said,
“To talk of many things:
Of shoes–and ships–and sealing-wax–
Of cabbages–and kings–
And why the sea is boiling hot–
And whether pigs have wings.”

Gibberish (I thought Jibberish was spelled with a J) is good, and often insightful.

Sometimes I have to rack my brain to decide what to write; other times it is handed to me, just begging for a response.  This is one of the “other” times.

In the fable of “Chicken Little” the chicken believes the sky is falling because an acorn fell on its head—the chicken was wrong.  In the fable “The boy who cried wolf” the people in the village are fooled into believing a wolf is attacking their village.  The people are wrong.

In the CMS fable “Everything a hospital ever needed to concern itself with regarding patient experience,” CMS is wrong.  And to make matters worse, CMS has all of the providers focusing all of their efforts on catching the wolf.  What many do not recognize is that providers would have been doing these things with or without the hard hand of CMS.

It is much more difficult to find the needle in the haystack when you are not on the same road as the haystack.  Hospitals have already found many of the needles.  Their problem is that the remaining needles are smaller and smaller, and more difficult to find.  Thus, finding each subsequent needle costs more.  Hospitals have also missed the fact that right next to the CMS haystack are other haystacks with needles the size of javelins waiting to be found.

Case in point.  Another one of the articles in HealthLeaders’ August issue, “Patient Experience and Cultural Transformation.”  To be fair, the article is perfectly fine and is likely spot-on in its representation of the survey responses it received.  Regular readers of this blog will recall that I also took umbrage with another article in this issue in my post “My review of HealthLeaders’ lead article “New Approaches to Patient Experience.” Where’s the “New”? ow.ly/obdPp.

HealthLeaders is reporting the facts, just like when Sergeant Joe Friday in Dragnet requested “Just the facts ma’am.”

Sometimes the facts do not tell the story.  Sometimes somebody needs to question the validity of the facts. Sometimes somebody needs to ask “What are the implications of those facts?”  somebody needed to have asked those surveyed “Why?”  This is one of those “sometimes.”

The article presented the results of a survey sent to the HealthLeaders Media Council and select members of its audience. Two hundred and ninety-nine completed surveys were received with a “margin of error of +/-5.7% at the 95% confidence interval.”

In the opinion of this writer, the data in ‘quotes’, while likely 100% accurate from the perspective of statistical sampling—meaning they analyzed the responses correctly, is probably 100% inaccurate from the standpoint of the what they should be doing.  At best, what providers are doing passes the test of being necessary, but it does not pass the test of being both necessary and sufficient.  It reflects the reality of what provider executives perceive they need to do to improve patient experience. It is also worth noting that even though the responses in the article were segmented between providers and health systems, patients and prospective patients make no such differentiation when it comes to their experience.

In the sciences, when one gets a result that does not jive with one’s hypothesis it is often helpful to reinterpret the result by multiplying by negative one or by evaluating the inverse of the result.  For purposes of this blog, we are going to do both.

The article reports what its respondents plan to do regarding addressing patient experience.  I originally thought about using the word ‘improving’ instead of ‘addressing’ but I chose ‘addressing’ because I am not convinced that these efforts, if enacted, will improve anyone’s experience.

As an example, what if two customer experience surveys were compared side-by-side.  One for hospitals and one for hotels.  Might they look like this?

HOSPITAL

   

HOTEL

 

What is the NO. 1 goal of your patient experience efforts?

 

What is the NO 1. goal of your customer experience efforts?

         

Improved HCAHPs Scores

36%

 

retaining customers

99%

Improved clinical outcomes

33%

 

getting referrals from customers

99%

Improved market share

9%

 

improved market share

99%

improved word of mouth

7%

 

improved revenue generation

99%

improved revenue generation

4%

     

improved reimbursement

2%

     

other

8%

     

No one is arguing that for hospitals to be successful at patient experience that they need to think of themselves as hotels.  No one is arguing that hospitals should stop trying to manage pain or to reduce noise.  The argument is that there are plenty of other things hospitals could be doing to compliment their current initiatives, things which would have a much greater impact on improving experience.

What is the business problem hospitals are trying to solve as they wrestle with what to do about patient experience?  Are hospitals endeavoring by their efforts to create a remarkable experience for every person every time?  If they were their approach would be entirely different.  Are they trying to retain patients, to earn referrals, to capture a higher percentage of their receivables?  If they were their approach would be entirely different. 

The problem hospitals are trying to solve is to avoid the CMS penalty.  Hospitals’ expenditures of people and capital are not targeted to solve an actual business problem; the expenditures are to avoid a problem created for them.

The HealthLeaders survey asked, and the article reported answers to the following questions:

  • What is the number one goal of your patient experience efforts?
  • In which of the following patient-related areas do you expect your organization to focus over the next three years for patient experience improvements?
  • Please rank your motivations for investing time or resources to improve patient experience scores
  • Who has the primary responsibility for patient experience in your organization?

Permit me to comment on these in the order in which they were presented in the article.

  • The number one goal reported by hospital executives is ‘improved’ HCAHP scores. So, let us assume the hospital achieved its goal and rocketed to the first quartile, thus removing itself from CMS’ penalty.  What do they get from that achievement? Retention, referrals? Nope?

Is this goal not an example of keeping ones focus on the hole versus the doughnut?  None of the responses listed any mention of the word ‘patient.’ Less than one in ten respondents addressed improving market share, not that the planned efforts will do much to improve share. And, none of the responses mentioned making any effort to retain patients or to attract prospective patients. 

According to the survey results, hospitals’ primary focus are on trying to meet an artificial benchmark created by CMS without knowing whether achieving this benchmark is the best thing they could be doing to create a remarkable experience for every person every time. 

What if CMS had decided that those hospitals that had the most number of physicians shorter than six feet tall would be penalized?  Would hospitals fire the height-challenged doctors?  Clearly this is absurd. Or is the analogy comparable? 

  • I am stupefied, but being stupefied has become my comfort zone.  Hospitals are going to focus their efforts exactly where they have been focusing their efforts.  If hospitals all do the same things, and they each improve by a factor of ‘X’, then has anything changed?  Forty percent are going to focus on noise reduction—earplugs—ten cents.  Twenty-five percent on housekeeping—Motel Six can give pointers and they will ‘leave the lights on.’  Better signage?  Please. 

Improving patient experience is an issue that has the attention of most hospitals.  Yet the solutions being proposed seem to be sorely lacking the following initiatives:

  1. Innovation
  2. Transformation
  3. Patient retention
  4. Patient referrals

 

  • Motivation for the effort and expenditure.  If everyone’s motivation is relatively identical, what is the likelihood that the results will be relatively identical—that is, unchanged?  At some point in time won’t the height of every hospital’s physicians be six feet or taller?

 

  • Who is responsible for patient experience?  In three percent of the hospitals the chief experience officer is responsible for the experience of the patients.  Am I missing something here?  Does that mean only three percent of hospitals have this position, or is the position merely rhetorical?  Would the cafeteria manager have scored as high or higher.

Who is responsible for the experiences of the prospective patients? Apparently nobody.  Who is responsible for the experiences of people before they come to the hospital, after they are discharged, and of those wondering if they should seek a second opinion from another hospital?  If hospitals cannot agree as to who is responsible for their current assets (patients), then we can be certain that nobody is responsible for the experience or satisfaction of prospective patients (their future assets) or for those patients seeking a second opinion.

Glaringly absent from the response categories for this survey question are the roles of chief marketing officer, sales, and business development.  If that is a true reflection of the answer to the question of who has the responsibility, then what exactly is the responsibility of those organizations?

The tallied survey responses seem to be all about raising HCAHP scores and avoiding penalties; not about improving the experience or patients and prospective patients.  Does that seem to be the case in your organization?

I have corroborated my analysis estimating that the lifetime value of a patient is somewhere between $180,000-$250,000.  That means that a prospective patient is worth the same amount.  Add to that the revenues of a patient’s family and friends and all of a sudden we are looking at numbers that demand innovation and transformation around patient experience.

Patient Equity Management. Family Equity Management.

A remarkable experience for every person every time on any device.  If this is your goal, the value of having your primary focus be reducing noise, housekeeping, and signage needs to be rethunk.

Patient Experience with a JD Power Twist

Everyone knows the elephant in the room.  Unfortunately the elephant does not know any of them.

I read Toyota’s US president has decided to change Toyota’s business strategy as a result of the latest JD Power rankings.  Even though Toyota regained the world-wide leadership in car sales on July 30, 2013, it did not have a single car listed in JD Power’s initial quality results across all body styles.

“Perhaps all of the other automobile manufacturers have discovered automotive’s secret sauce.  We sell more cars than anyone else, but what good is that if we do not meet Power’s criteria.  Sure our customers swear by us, but what do they know about cars?” Asked James Edsel. “They just want something that looks cool, has great speakers, and a USB connection.”

James continued by explaining, “We have decided to follow the strategy of the US healthcare industry.  Health systems thought they were doing pretty well with their understanding of their patients’ experiences until CMS came along with its HCAHPs ratings and told them how to really measure the entirety of patient experience.  Now hospitals can see what a tiny fraction of their patients actually thought of their care months back when they received it.  They can pay money for their own data, and hire people to make their numbers look better the next time they pay for their data.”

“After all, why rely on what all of your customers and prospective customers tell you when you can simply go to one source and have them tell us what they think we need to hear.  One report and someone else does all the work.”

I’ll leave it to you to decide if there is a workable analogy there. To be fair, I heard the analogy while speaking with someone yesterday who is way smarted than me.

JD Powers is a business.  It conducts market research based on customer surveys. It then sells the research to the automobile manufacturers.  The big difference is the automobile manufacturers are not forced to alter their business model to raise their scores.

 

Patient Experience: So what exactly do I do for hospitals?

A number of you have written recently asking what it is I do and how I might be able to assist their organization.

I have consulted on innovating patient/customer experience for twenty-five years, having run my own consulting firm for the last seventeen. My clients on five continents have a combined customer base of more than two hundred million.

Less than twenty percent of health systems have a working definition of patient experience, and of those that do it is defined around HCAHPs. My definition is a remarkable experience for every person (patient and prospective patients) every time on every device.  Major parts of what hospitals lack are a strategy to provide that kind of experience to both patients and prospective patients.  This includes linking a mobile experience strategy and a digital strategy.  Setting this as a goal enables hospitals to focus on improving not just the care, but also on improving patient retention, patient referrals, attracting new patients, and making it easier to do business with the hospital.

In healthcare almost every hospital regards patient experience solely as defined by CMS. That ignores the experiences and level of satisfaction of those not surveyed, people seeking second opinions, and prospective patients. It ignores the experiences occurring prior to admissions, and those occurring post-discharge. It also does not address experiences formed from nonclinical processes like scheduling, admissions, billing, claims, and complaints.

More people ‘visit’ the hospital each day by phone and on the web than walk in the front door, yet nobody knows how those people rate their experience and whether they will ever return.

Eighty percent of prospective patient’s visit a hospital’s website before determining where they will buy healthcare.  Fifty percent of patients go to a hospital’s website to determine whether they will seek a second opinion. Nobody who designed the website ever asked one of those patients what information they would need to find to help them select their hospital. 

I help organizations answer these questions.

I start by helping them define a strategy for what I call the Total Quality of a person’s (patient and prospective patient) Encounter (TQE) with the hospital.  Next I complete an assessment of where they are with regard to meeting the TQE strategy including developing:

  • A digital strategy including:
    • Websites—most hospitals have hundreds of disparate URLs
    • Social media and social CRM
  • A mobile strategy for meeting their needs on various devices
    • For example, why can’t a patient schedule an appointment online or do some form of self-admitting on an iPad rather than arriving at six AM with everyone else?
  • A Call Center Strategy
  • A strategy for improving Nonclinical business processes 

Based on the assessment we jointly set priorities and a work plan to create a remarkable experience for everyone.

Attached are a few brief presentations that offer some detail.  Please let me know if we may schedule a call or perhaps meet.

http://www.slideshare.net/paulroemer/defining-a-global-patient-experience-for-your-health-system

http://www.slideshare.net/paulroemer/step-aside-hcahps

http://www.slideshare.net/paulroemer/call-center-strategies

You can reach me at paulroemer@gmail.com, or by phone 484-885-6942.

http://www.slideshare.net/paulroemer/how-to-acquire-patients-21677042

 

Patient Satisfaction: A Normal Experience Will Never Be Amazing

Are Hospital Executives Ignoring Their Own Survey Results?

I was reading the survey results of ache.org’s 2012 “Top Issues Confronting Hospitals: 2012”. Two things jumped out at me. Improving Patient Satisfaction was in essentially a statistical tie with two other issues for third place.

Second, Decreasing Inpatient Volume was essentially in a statistical tie for third place for financial challenges that need to be addressed.

Ache.org only reported the results. It did not draw any conclusions. It seems there is little point in surveying people unless someone acts upon the results–I may have made the same point before regarding HCAHPs.

That said, I will offer a conclusion, one that can be derived without studying the numbers.  I bet there is close to a one-to-one relationship between Patient Satisfaction and the decrease of inpatient volumes.  Fix one, fix the other.

I like that the survey labeled the issue of patient ‘satisfaction’ instead of CMS’ patient ‘experience’.  Every patient, and every prospective patient has an experience with the hospital. However, not every experience is satisfactory, and normal experiences will never be amazing.

Why not have your goal be “A remarkable experience for every patient every time and on every device? If that doesn’t work you can always erect another billboard.

Patient Experience: Not understanding UX and UI is killing Patient Experience

UI and UX seem to be two terms that have yet to make their way into healthcare. One way I like to think of the application of design thinking in hospitals is to compare the hospital’s lobby to its website.

Millions were spent to make the lobby user friendly, to create a remarkable first impression.  There is a receptionist and maybe a sign or two pointing to the ER or the Lab.

The website is a different matter–as is the call center.  The website’s homepage offers the ‘kitchen-sink’ to visitors, patients and prospective patients. Dozens of links, Flash, every phone number you may ever need.  Users can learn about the board and make a donation. They can do everything except find the link they wanted. 

Ninety-nine percent of visitors are either patients, people trying to decide if they are going to seek a second opinion–from some hospital other than yours, or prospective patients trying to make a healthcare purchase decision. The average person spends seven seconds on a web page looking for what they want.

What that tells me is the average person is leaving the average hospital’s website unsatisfied and with a poor experience. Why is nobody interested in improving that experience?

Defining a global patient experience

My presentation, according to Slideshare, “Defining a global patient experience for your health system”  is being talked about on Linkedln more than anything else on SlideShare…http://www.slideshare.net/paulroemer/defining-a-global-patient-experience-for-your-health-system

The Democratization of Patient Satisfaction

So, how can you tell how the hospital’s patient experience improvement effort is progressing?  Perhaps this is one way to tell.

A man left his cat with his brother while he went on vacation for a week. When he came back, he called his brother to see when he could pick the cat up. The brother hesitated, and then said, “I’m so sorry, but while you were away, the cat died.”

The man was very upset and replied, “You know, you could have broken the news to me better than that. When I called today, you could have said the cat was on the roof and wouldn’t come down. Then when I called the next day, you could have said that he had fallen off and the vet was working on patching him up. Then when I called the third day, you could have said the cat had passed away.”

The brother thought about it and apologized.

“So how’s Mom?” asked the man.

“She’s on the roof and won’t come down.”

If you ask someone how the patient experience improvement effort is going and she responds by saying, “The project leader is on the roof and won’t come down,” it may be time to get a new leader.

There are more than 120,000 URLs returned when searching “’Why do patients choose’ hospital”.  Based on what I read, the URLs all take the reader to something written by the hospital.

Sixty percent of people say they use the internet to make a healthcare decision.  Sixteen percent of hospitals use social media.  Eighty-one percent of prospective patients stated that a hospital with a strong social media presence is likely to be more cutting edge—you do the math.

Whether your hospital has a strong social media presence may be less relevant because your prospective patients certainly do.  So what does that knowledge do to your organization’s patient experience strategy?   Do you double or triple you social media output?  Does your one or two person internet department try to out-social-media thousands of prospective patients, Twittering away, and constantly posting to Facebook?  Trying to catch up is like trying to walk across a room, and with each successive step cutting the remaining distance in half—you never get to the other side.

The social media “experts” would tell you that is exactly what you need to be doing—more is better.  I think the experts are wrong.

If the experts are wrong, what is the right approach?  The internet is a powerful touchpoint for both patients and prospective patients.  The internet is a large component of patient satisfaction, patient experience, and patient choice.

Rather than going wide and shallow with social media or social-CRM think about a narrower mobile digital strategy that goes deep. For example, think about your hospital’s website.  For starters, what you have is probably just that, just a website. 

There are dozens and dozens of reasons a patient or prospect would go to your site.  A high percentage of them go there because they do not want to try to accomplish something by dialing any of the hospital’s multiple phone numbers.  When they go to the website if it does not entice them to stay on the site, bookmark it, or make it their homepage, the website might as well not exist.

Your website is where purchasing decisions are made and lost by prospective patients, and where satisfaction is raised or lowered for patients.  If a patient cannot accomplish the task they set out to do in an intuitive and user-friendly way, their satisfaction with your entire organization just dropped.

Many more people go to your website than go through the front door of your hospital.  The good news is that you control the user experience of someone on your site.  The bad news is that most organizations are controlling it in a way that gives users a poor experience.  The list of things users cannot do on your website is much longer than the list of things they can do.

Having a tab that reads ‘schedule a visit’ is worth nothing unless the patient was able to schedule a visit, in fact, it probably kills satisfaction.  Having a tab that reads ‘get your health records’ that requires someone to download a PDF, print it, and mail it is equally bad for patient satisfaction.

What should your website be?  At a minimum it should be some combination of a patient portal and a knowledge management system.  It should also be your billing department, your scheduling department, admissions, discharge, housekeeping, food services, support groups, and education services.

Your website should offer every service your hospital offers with the possible exception of a hip replacement—a 24 by 7 virtual hospital minus patient care.  Two-way.  And mobile.  Available on any device at any time.

If you want to interact with your community, patients and non-patients, you need to go to where they are.  And where they are is online.  It is not good if someone with heart disease can watch an angiogram on YouTube or on a competitor’s website and on your website they cannot even find a meaningful cardiology link.  Online patient support groups at the best hospitals provide a real-time referral group—can your patients do that on your site or do they have to go to someone else’s?

Patients are democratizing information. If the information provided by your organization is asymmetrical, it has some catching up to do.

Patient satisfaction—a remarkable experience for every patient every time; in the hospital, on the web, and on the phone.