call centers

How Are HCAHPs Leading You Astray?

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I dropped by the Minute Clinic for my flu shot.  The forty-something woman ahead of me, whose purse was the size of a small Winnebago, stepped up to the kiosk to sign in.  I may have mentioned in a prior post that I was at the back of the line when God was handing out patience.  After five minutes I began to get a little exasperated.  Her ability to interface with technology reminded me of a chimp learning to play the bagpipes.  Knowing she was going to be a while I retreated to the shaving aisle, grabbed a can of shave cream, a razor, and cleaned myself up a bit.

While the Minute Clinic may be a Godsend for parents in terms of convenience, cost, and immediacy, the user experience (UX) could be improved.  What user experience?  The one that has to do with their automated sign-in. The user interface (UI), although childlike in its simplicity takes more time to complete than the exam.  Your hospital’s website is probably chocked-full of UX and UI opportunities.

Moving on.

Observation may be one of our best teachers, but by failing to observe what we see every day, what is commonplace, we often miss what can be learned from it.  Here is a real-life example that occurred to me from having watched a human interest story on the local news about neighbors banding together to try and rescue someone’s pet cat that was stuck in a tree.

Ladders.  Catnip.  Clawed rescuers.  The cat eventually came down of its own accord.

Here is the observation; have you ever seen a cat skeleton in a tree?  What can be learned?  Maybe cats do not need rescuing.

Innovating patient experience has many similarities with cats stuck in trees.  Somebody overthinks the problem, regulates it, and we throw resources at the problem trying to avoid the regulators.  We establish committees, have meetings, and create reports.  We discuss the problem, we recall what happened the last time we had this type of problem, we bring in experts whose skills are particularly attuned to solving this problem, and then we attack it.

The one thing we fail to do is to validate whether the problem as defined by Washington, and the solution, as defined by Washington—raising the scores of thirty-two questions—is the right approach. This approach presupposes that higher scores are reflective of higher patient experience.  Is it possible that higher scores are simply reflective of having figured out how to avoid CMS’s penalty?

Thirty-two.  A very precise number.  Thirty-one questions were not enough.  Thirty-three would have been one too many.  Thirty-two questions was just right—sounds a little like Goldilocks and the Three Bears.

Those thirty-two questions do not address anything the patient may experience before coming to the hospitals or after leaving the hospital.  They do not address what type of experience prospective patients, people who want to buy healthcare, have when they call the hospital or look online for information about the hospital.

This link takes you to a brief deck listing questions about someone’s experience that were not asked by CMS.  The answers to these questions affect whether someone will buy healthcare from your organization, whether they will buy it again when they require additional care, and whether they will refer your organization to others.

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

I have done the math.  The financial benefits of getting favorable answers to these questions far exceeds the financial penalty imposed by CMS.  The best you can do by scoring well on CMS’s questions is to avoid a penalty.  The best you can do by scoring well on my questions is to add revenues.

You decide how you want to play it.  Meanwhile, the cat in the tree is doing just fine and does not require any help. If it does, there is always gravity.

Are Hospitals Looking in the Wrong Haystack for the Needles?

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“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.

Acquiring New Patients: Extreme Bingo Cruises

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There are many ideas that spring to mind when one looks at how to attract new patients to a hospital.  One would be to offer extreme bingo cruises to patients after discharge.  Another option might be to sponsor open Karaoke in the admissions seating area.

Apparently nobody knows what it costs to acquire a patient.  It appears the same number of people do not know what it costs to lose one.  My take?  They are both very expensive.

It never occurred to me that hospitals actually had business development people.  While I knew they had marketing people because I see their billboards and hear their ads on NPR, I just assumed that patients were their own mini business developers—they get sick and seek out a place to get unsick.  I think more people are doing this than the business development people would like you to think, because if that is the trend then the business development role in a hospital becomes irrelevant. 

So does this business development thing work?  Can you prove it does?  I only ask because I keep asking what it takes to acquire a single new patient and nobody seems to know.  Does nobody track business development efforts or measure their costs against the number of patients acquired?  Trying to argue that fifty percent of the reason that a given patient came to your hospital to have their knee scoped is because they saw the billboard of your urologists is like trying to prove that one side of a black hole is darker than the other.  The math just does not work.

Suppose last year the combined budgets of your hospital’s business development group and its sales and marketing group were ten million dollars.  Let us also suppose that you were able to prove that your hospital acquired ten thousand new patients as a result of that ten million dollar spend.  Were that the case we could say the cost to acquire a patient was one thousand dollars.  If you acquired only one thousand new patients we would know the acquisition cost was ten thousand dollars per patient; five hundred new patients cost twenty thousand and so forth and so on.

Simple math, but nobody is saying what it costs and that is because nobody knows what it costs.  I believe strongly that if the real cost was only one thousand dollars to acquire a new patient that every chief marketing officer would put that message on a billboard and erect it outside of the CEO’s office.  Because those billboards do not exist, I am betting that it either cost substantially more or that the costs are never to be known.

So, back to costs and what is known.  We know that it is less costly to attract customers to organizations that are easy to do business with.  We know that it is less costly to do business with people who have already been your customers, probably to the tune of ten to one in terms of actual dollars.  The only glitch in that equation is that these former customers have to like you, and that they found it easy and beneficial to have done business with your hospital.

To conclude, it is much more cost effective to attract potential patients who have already demonstrated an interest in your organization.  Those people are the ones who visited you online, who called your hospital, who interact with you on social media, and who visit patients.  They are not the people who saw your billboard, heard about you on NPR or received a telemarkeintg call extolling your services.