Acquiring New Patients: Extreme Bingo Cruises

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.

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.

Improving Patient Experience: Why not try something new?

Success and failure are often separated by the slimmest of margins. Sometimes success hinges on how you present your idea. It is possible to force the circumstances via rapid evolution to pass from problem, to possible solution, to believable, to heroic? I believe so.

Permit me to illustrate with frozen chicken. Several hours before dinner I threw the frozen chicken breasts into the sink, choosing to thaw them with water instead of the microwave. Some twenty minutes later while checking emails I wondered what we were having for dinner. Not to be outdone by own inadequacies, I remembered we were having chicken. I remembered that we were having chicken because I remembered turning on the hot water. The only thing I couldn’t remember was turning off the hot water.

I raced to the kitchen. My memory of having forgotten to turn off the water was correct. Grabbing every towel I could find, I soaked up the man-made lake that had appeared on the hardwood flooring.  While draining the lake I thought about how I might answer to my wife if she happened to return to a kitchen during high tide. My first reaction, admittedly poor, was to tell her that I thought the countertop wasn’t level and that the only way to know for sure was to see which direction the water ran. Telling her the truth never entered my mind.

Once the major puddles had been removed, I worked on version two of the story, quickly arriving at a version of the truth that seemed more palatable—tell her I decided to wash all the towels. Why not get bonus points instead of getting in trouble? Version three looked even better. Since I was wiping the floor with the towels, instead of telling her I washed the towels, why not double the bonus points? I decided to wash the floor, and wash the towels. Husband of the year couldn’t be far off.

A few hours have passed. The floor is dry—and clean, the towels are neatly folded and back in the linen closet, and the chicken is on the grill. All the bases covered. A difficult and embarrassing situation turned into a positive by quick thinking.

A few of you have asked, let’s say we buy into what you are saying, how do you propose we create a remarkable patient experience? All kidding aside, it comes down to presentation. Clearly you can’t walk into a room with a bunch of slides showing that with all of your hospital’s efforts you have only managed to improve the experience of the patients from 7.25 to 7.27.

The first requirement to turn stalled patient experience scores into a remarkable experience for every patient and every prospective patient every time is to quit focusing only on HCAHPs.  Think of it as a patient experience 12-step meeting; “Hi, my name is Paul, and my patient experience scores have flat-lined.”  See, that was not so difficult.

And what needs to be done?  Why not take a deep breath and decide that the time has come to lead and innovate, and to stop relying on CMS to define what patient experience means for your hospital?

Here is a start for those looking for the first step.

Define the Total Quality of a person’s Experience (TQE). I use person instead of patient because prospective patients also have experiences when they visit family members, when they call the hospital and are on the web trying to decide where to buy healthcare.

TQE = Patient Experience (think HCAHPs) + Persons’ Satisfaction (all other touchpoints)

So, how did my chicken dinner turn out? I was feeling confident that I had sidestepped to worst of it. Overconfident, as it turned out. My son hollered from the basement, “Dad, why is all this water down here?”

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 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?

Patient Satisfaction: Why Hospitals Are Losing the Battle for Patient Revnues

Sometimes you choose to write; other times you have no choice but to write. This is one of those other times.

For those of you who believe most business situations can be tied to something related to Mel Brooks you will appreciate this. In his movie History of the World Part One, Brooks plays the role of Moses descending from Mount Sinai with stone tablets of the fifteen commandments.

One set of five of them falls, hence the reason there are only ten.

Several hundred of you have read my presentation Step Aside HCAHPs; The Questions Hospital Executives Should Be Able To Answer.

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

One reader remarked that HCAHPs includes thirty-two questions, not the twenty-seven that were referenced in my slide deck.  I would like to be able to argue that as I was leaving CMS I dropped the stone tablet containing questions 28-32. I would also like to be able to fly.  Unfortunately, I can do neither.

That said, focusing on the number of questions in the survey obfuscates the point.  The number of questions CMS put forth has only a little to do with the issue of whether their questions constitute the Total Quality of a Person’s Encounter (TQE) with the hospital.

As the picture above depicts, the effort to address patient experience only from the perspective of HCAHPs ignores much of what patients experience.  That same effort ignores all of what prospective patients, people who are trying to decide where to buy their healthcare, experience.

Let’s say your hospital treats five hundred patients a week, and thirty percent of them (150) return their surveys five months later.  The hospital may then initiate a program or two to try to raise its lowest scores.  Even if it is effective, it will not impact the experience of those who completed the survey, but it may increase slightly the scores of some future group of respondents.  The only people who will ever know are future patients.

People who will never know, and who don’t know anything about your HCAHPs scores are the people who were never your patients.  In know I am stating the obvious, but I do so because the potential revenue from that group, from the non-patients and the prospective patients, is probably greater than the revenues generated by the current patients.

Let’s also say that your hospital, the one that treats five hundred patients a week, also receives a thousand phone calls a week, and that three thousand people a week ‘visit’ the hospital via the internet.  Let’s also add another five hundred people a week who visit your patients.

That totals forty-five hundred people who experience the hospital in one form or another.  Were they satisfied?  Who knows?  They were not surveyed.  Nobody asked them what they liked. Nobody asked them if they found what they were looking for.  Did any of them decide to buy healthcare from your hospital?  Why or why not?  Did your internet presence meet their need; did the call center or the switchboard?

The lifetime value of a patient is estimated to be between \$180,000 to \$250,000.  The average number of people per household is three. So, for every patient you can attract and retain, plus their family members, their potential value to your hospital is \$540,000 to \$750,000.

Instead of Patient Experience Management, hospitals should be focused on Patient Equity Management. If a hospital lost four \$2,000 computers in a week, it would learn quickly how not to lose a fifth. Hospitals lose patients and potential patients every day.  They do not know how many.  They do not know why. And, they do no know how to get them back.

Now watch what happens.  What if of the forty-five hundred people—the non-patients—you could get one percent of them (45) in any given week to decide to become your patient?  What might that amount to in terms of revenues? If you can get one percent a week, over a year, 45 people become 2,340.  Twenty-three hundred and forty people multiplied by the lifetime value of a single person’s revenue is a really big number—about four hundred million—a number so big it is silly; multiplied by the value of their family members is too big for me to count.

Now there will be those who want to argue that my numbers are way off.  To you I suggest that you make them smaller, make them a lot smaller.  Even if I am off by a factor of a hundred, which I am not, that is a \$4 million dollar annual increase.

Patient Experience: How Awful is your Website?

Egypt’s Morsi, the deposed president, has a Facebook page. I am not having much luck trying to picture him sitting in his pajamas updating it with the type of music he listens too and posting pictures of himself having a beer and a dog at a ballgame.  I find myself wondering if he and Syria’s Assad have ‘friended’ each other.  One would think the club of tyrants is fairly tight.

Today’s missive provides a hands-on look at patient experience. My wife and I were up at four AM, and reached the hospital on the outskirts of Philadelphia at six.  The very first sign we saw was this announcement, “Valet Parking for Handicapped Patients is \$2 off.” Was I handicapped, and arriving for surgery without having had my coffee, the two dollar discount would have me waiting with baited breath for the opportunity to complete my customer satisfaction survey.

Having a few hours on my hands, I turned to the hospital’s web site to see if it provided an experience any more remarkable than the parking.  At first blush it appeared to provide links to everything.  Many of the links led to black holes; you followed a succession of links until you hit a dead end.  You were unable to accomplish whatever it was you set out to do, but there was enough stuff to make it feel like there must be a pony hidden somewhere amongst the detritus.

There was a link if you wanted to make a donation, one for doctors, one for nurses, one for members of the board, more than two-dozen phone numbers, some videos, how to follow them on social media—displayed in two different places, links to teach you how to ‘eat on the go’ and how to know if you are pregnant—go to CVS, a place to view all of their awards, health information, directions, contact information, and even one for patient and visitor information.

Your website’s homepage should not be a catchall for everything someone in IT can dream up. I would estimate that more than ninety-five percent of visitors to your website are either patients or potential patients. Yet, the link for patients is no more prominent than the link for learning how to eat on the go. The website actually allows you to make a donation online.  It does not allow you to pay your bill.

Many home pages have the look and feel of Craigslist but without the functionality.

Fifty percent of patients go to a hospital’s website to determine if they will get a second opinion.  Eighty percent will visit it to determine if they will become your patient.  Behind which of those links is the information that will help them make their decision?  Which bit of information will cause them to stick with your hospital?

Some people are all set to buy healthcare from another hospital, yet they are at your web site to see if maybe they should go with you.  Some people are all set to buy healthcare from your hospital, yet they are at your website to see if maybe they should go somewhere else.

Has anyone in your health system ever asked either group of people what they need to find on your website to get them to select your organization and then designed a website to accomplish that?

According to Nielsen, users will stay on a web page for 10-20 seconds.  First time visitors spend less than that. If they do not find a value proposition, something to compel them to stay they leave.  The average visitor only reads twenty percent of what is on the page.  Look at your hospital’s homepage.  Think about how much you can accomplish in ten seconds.  If you were thinking of seeking a second opinion, could you even find what you were looking for?  On average, 70% of people leave the site, and hence purchase healthcare somewhere else because they could not find what they needed.

They were dissatisfied.

Patient experience occurs before someone gets to the hospital, and it occurs outside of the physical building.

Patient Satisfaction: The Problem with Patient Surveys

So there I was going through the mail and I happen upon a letter from a restaurant I dined at a few months ago, Le Nez Du Cochon—the nose of the pig—go figure, it is French.  Enclosed is a survey; twenty-seven questions.  Tell me if you know where this is headed.

The questions were grouped in a number of areas; food quality, communication with the wait staff, noise, and cleanliness of the restroom.  I completed the survey, but I was only guessing at my responses because it had been so long since my meal. What I do recall however were things that the survey did not cover.

I made my reservation online and that the restaurant had no record of my reservation.  I even remember calling the restaurant to confirm my reservation, which they did over the phone and then somehow had no record of it.

The directions I copied from their website were wrong. I told the maître de I had requested a table by the window and was promptly seated by the kitchen door.  When I went to pay for the meal I was overcharged because they brought me a wine different from the one we ordered.  The manager explained that since we had drunk the wine there was no way he could change the bill to reflect my order.

Needless to say, the directions to return home were also wrong.  My experience was poor from the moment I initiated contact until and after I arrived home.

But the survey did not ask anything related to the parts of my experience that related to whether I would return or not.  Having clean restrooms and a polite wait-staff did not overcome the rest of my experiences.

We all have experiences.  The problem is that not all of the experiences are satisfactory.

What hospitals fail to notice is clean restrooms, and scoring well on the other twenty-six HCAHPs questions are not reflective of a patient’s total experience, and they offer zero input as to the level of satisfaction a patient or prospective patient—a buyer of healthcare—had on the web or by phone.

Hiring coaches does nothing to improve the interaction on the web or the phone.

Buying data does less than nothing.  Putting those two efforts in place and thinking you have a handle on patient experience is as futile as counting backwards from infinity twice.

Patient satisfaction: A remarkable experience for every patient every time…on every device.

An Open Letter to Hospital Executives

To whom it may concern,

I am passionate about improving the experience patients and prospective patients have with hospitals, from prior to be admitted and through post-discharge interactions.  HCAHPs only address a fraction of an individual’s experience, and surveying what happened months ago will not help retain or refer patients. The same are true regarding hiring coaches and purchasing patient satisfaction data.

I have improved customer experience and customer interactions for firms who have a combined customer base of more than two hundred million.  More people probable visit the hospital each day via the web and by phone than walk through its doors, yet the satisfaction of those interactions is unknown. This becomes even more important as the business model moves from heads in beds to population health.

Below are links two documents for your consideration. One looks at defining a global patient experience strategy for the organization, the second lists twenty-seven questions about patient satisfaction left unasked.

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

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

Please let me know if we may meet or schedule a call.

Regards,

Paul Roemer

Chief Patient Experience Officer

Patient Acquisition: Inverting the Sales Funnel

The link below is to a presentation of mine on Slideshare about patient acquisition; how it is done and my thoughts on how it ought to be done.  In today’s world most hospitals spend a lot of money chasing people.  However, the people they are chasing are researching from which hospital they will purchase services.

If you know the cost to acquire a patient the traditional way please let me know.  The cost to  have a patient choose your facility is almost zero.

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

Please let me know what you think