hospital

Everything You Need To Know About Patient Experience

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Which of the following statements are false?

  • Forty-eight percent of us believe aliens have visited the earth
  • Thirty-four percent of us believe in ghosts
  • One percent believes the earth is flat—“I put a post in a hole and adjusted it until it was level. That means the earth is flat.”
  • Eighty-to ninety percent of hospitals CEOs believe improving patient experience is one of their top three objectives in the next three to five years.

I can believe the chair next to me will support my weight, but unless I actually sit in the chair merely believing is not worth anything.

Hospitals would have us believe that what is important to consumers of healthcare is that the product—healthcare—is the same as the process of interacting with it or buying it are one in the same, or their belief that process has nothing to do with it.

Take flying for example.  Airlines want us to focus on the product, getting us from Point A to Point B.  They do not want us to focus on the fact that they will charge you if you use your flotation device, your flight will be late, and that they have packed more people into the plane than were in your high school.

My hospital has a website, let’s move on.

The US economy has developed a dependence on digital performance, including the twenty percent tied to healthcare.  Healthcare, hospitals in particular, have developed a digital illiteracy, independence, or naive indifference on all things digital and on all things related to process.

Believing that because your hospital has a website means it understands the impact the digital world should play in its business model is like believing that reading Oliver Swift gives you keen insight into what it is like to be an orphan.

The C-Suite needs to understand that technology is not the same as digital; in fact they have little in common.  In a hospital technology equates to cost—to back-office functions, to supply-chain, to why ICD-10 may be a disaster, and how it is possible to spend three hundred million dollars on EHR and see productivity take a nose-dive.

Digital is different.  It is not some emergent trend.  Please do not stop reading here even though many will disagree with what follows.  Digital is Amazon and eBay, but not in the way most people think about them.  It has nothing to do with CDs, movies, or laptops.  It has nothing to do with what they sell or the price at which it is sold.  It has everything to do with the process by which customers act with what is being sold.

The process, the processes are everything.  They are everything that the processes within a hospital are not, everything that the health exchange is not.  The processes are:

  • Intuitive
  • Easy

And the processes are intuitive and easy because they were designed to be that way.  We are not talking about tweaking things.

The less you understand about the importance of having a remarkable digital presence the less likely you are to have one.  Hospital executives may understand it least of all.  The poorer your understanding, the poorer the delivery of your product is, and the poorer its perception is in the marketplace.

And to make a bad story worse, by the time your hospital gets it your competitors will have already passed you by.

We are not talking about being better at what you are—the grammar is poor but the intent is not.  The discussion that your customers are begging for, the discussion they expect is about your hospital becoming what you are not.

And what does being what you are not look like?

In less than three years every hospital process, every single nonclinical function that is performed today by nonclinical employees will be performed by your patients and by prospective patients.  Every process will be performed without waiting and without error and without much cost.  It will performed digitally and on a device and at a time of the person’s choosing.

Your customers will carry your hospital around in the purses and briefcases.  And that is how I define improving patient experience.

The ROI of Patient Experience

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As a parent I’ve learned there are two types of tasks–those my children won’t do the first time I ask them, and those they won’t do no matter how many times I ask them.  Here’s the segue.

Hospitals have a gazillion business systems.  Every business system can include the following three things; people—doing things, processes—the way and order in which things are done, technology—whatever part of those things that may be automated.  Two examples of business systems—ordering your meal in the drive-through lane at Burger King; open heart surgery.

Believe it or not, from a process standpoint, each of the hospital’s gazillion business systems can be sorted into one of two buckets—Easily Repeatable Processes (ERPs) and Barely Repeatable Processes (BRPs).

An example of an ERP industry is manufacturing which executes identical business systems thousands of times—clean the Pepsi bottle, fill the bottle with Pepsi, put on the bottle cap, and place the bottle in the box.

Healthcare, in many respects, is a BRP industry. BRPs are characterized by collaborative events, exception handling, ad-hoc activities, extensive loss of information, little knowledge acquired and reused, and untrustworthy processes. They involve unplanned events, knowledge work, and creative work.

ERPs are the easy ones to map, model, and structure. They are perfect for large enterprise software vendors like Oracle and SAP whose products include offerings like ERP, SCM, PLM, SRM, CRM.

How can you tell what type of process you are trying to incorporate in your effort to improve patient experience? Here’s one way. If the person standing next to you at Starbucks could watch you work and accurately describe the process, it’s probably an ERP.

So, why discuss BRPs and ERPs in the same sentence with patient experience? The answer is quite simple.  Think of BRPs—barely repeatable processes—as those processes associated with HCAHPs; exception handling, unplanned events, and knowledge work.

Think of ERPs—easily repeatable processes—as those associated with all of the nonclinical touchpoints patients and prospective patients have with the health system.  Those include:

  • Scheduling an appointment
  • Scheduling labs & therapy
  • Requesting medical records
  • Getting information about whether a second opinion is needed
  • Admissions
  • Billing
  • Payment
  • Submitting a claim
  • Queries
  • Complaints

Here is what is unique about a hospital’s ERPs:

  • Every time a patient or prospective patient tries to complete one of these processes they have an experience
  • That experience is either satisfactory or unsatisfactory
  • The hospital has no idea if the person was satisfied
  • The hospital has no idea if the person will continue to be or will ever become their patient
  • All of these processes happen outside of the hospital
  • They happen on the phone and on the internet
  • They have nothing to do with HCAHPs
  • Hospitals do not measure these processes
  • Hospitals do not try to improve the effectiveness of these processes

Hospitals behave as though these processes have nothing to do with patient experience.  Just because hospitals do not acknowledge the existence of or the importance these systems have on patient experience does not make them irrelevant.

True story—a Top 5 US hospital.  A cancer patient between treatments who is experiencing the after effects of chemo calls the hospital to schedule a follow up exam.  She spends almost three hours on the phone.  She told me that because of that one event she will never recommend that hospital to anyone.

Now to the meat of the matter; money.  Healthcare may argue that they are not in business for the money.  While that may be true, they are not in business if there is no money.  So let’s talk about dollars.

  • One study concluded that each time someone contacts a hospital the potential revenue in play is seven thousand dollars.  Provide a good experience during that contact you keep the money.  Provide a bad one and some other hospital gets the money.
  • The average lifetime value of a patient is between $180,000 and $250,000.
  • The average lifetime value of a person who chooses a hospital other than yours is zero.
  • The cost of poor experience is low patient retention and very low referrals.

The taxonomy of 99% of existing patient experience business systems is that they are ineffective, unmeasured, and proving awful experiences at the places where people touch the health system—the phone and the web.

Ignoring these aspects of patient experience is no different than having your hospital’s CFO drive down the highway while pouring bags of money from the window.

What do you think?

Patient Satisfaction: A Normal Experience Will Never Be Amazing

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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 Satisfaction: Why Hospitals Are Losing the Battle for Patient Revnues

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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.

http://www.youtube.com/watch?v=8YX-gqRdK_8

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.

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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?

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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.

They had a bad experience.

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

Patient Satisfaction: Still buying Data and Coaching, Why?

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Think about the answer to this question, how many nights have you spent in a hotel in the last decade?  For most of us the answer is more than one hundred.  How many nights have you spent in a hospital in the last decade?  For most of us the answer is probably between none and ten.  So then, when you go somewhere to spend the night and have your meals delivered, from which organization do your expectations about being satisfied most likely come?

Patient, customer. Hospital, hotel. Tomato, ta-mah-tow.  For those who want to argue that there are no similarities feel free to continue to do so.  For the rest of us let us look at how to improve patient satisfaction.

A few days ago I spoke with a hospital CEO about his efforts to improve the patient experience and about patient satisfaction.  He said that for years his hospital has spent a lot of money buying all sorts of data about their patients’ experiences.  The problem he said is that the company providing the data never did anything more than sell them the data.  So they kept getting all of this data but never saw any improvement in their patients’ experience that could be tied to the data they purchased.

That hospital has also hired coaches in the belief that this would help improve the experience.  The results were the same.

I asked him why he kept spending money when the expenditures failed to deliver the desired result.  He replied that the two things he knew he could do that would yield the greatest and most immediate increase in patient satisfaction would be to increase the number of parking spaces and to improve the food service.  Did he learn that from the survey data or from the coaching?  Nope.  He learned that from his patients’ family and friends.

Four rules worth remembering:

  1. Experience and satisfaction are related but they are not the same.
  2. Every patient has an experience but the experience does not always result in a satisfied patient.
  3. Patient satisfaction cannot be improved without knowing a patient’s expectations.
  4. Purchasing data and paying for coaching do not change rules 1-3.

Having thousands of data points comparing how your hospital is performing against other hospitals gives you a report card; it does not improve either the patient’s or patients’ experience. Coaching employees probably will not improve patient experience.

It is not the employees that need fixing.  Broken, outdated processes result in dissatisfied patients.

Patients have multiple points of contact with the hospital; before they are admitted, while they are in the hospital, and when they go home.  If you can answer the following questions you have a basis for improving patient satisfaction.

  • Which points of contact have the greatest impact on patient satisfaction?
  • When did anyone last ask patients to define their expectations?
  • Which points of contact affect most of your patients?
  • Which points of contact are frequented most by your patients?
  • What are the consequences of not knowing these answers?

The answers to these questions do not require purchasing data, nor do they require coaching.

Two highly frequented points of contact are your website and your call center.  Go to your web site and try to complete a simple task—schedule an appointment, or try to understand your bill—taks that might be done by a patient or by a patient’s family member.  Could you do it?  Were you satisfied?

Now dial the call center and ask the person who answers the phone a question about Medicaid or Medicare billing.  Could that person give you the correct answer?  Could the person they transferred you to give you the correct answer?  Did the recorded voice telling you to call back between the hours of eight and five give you the correct answer?  Were you satisfied?

If you were not satisfied, why would you expect your patients to be satisfied?  Satisfaction has everything to do about processes and customer service.  Data and smiles do nothing to improve broken processes and poor customer service.

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