Patient Relationship Management, add 3 parts technology and stir

Sometimes you need to break a few eggs to get to the root of the problem. Traditional approaches to improving the patient experience usually begin with the call center. Why is that? Maybe it has something do with the fact that a call center is tangible. Something you can observe and touch. Clearly, it’s something that can be measured. However, I think the real reason is that the number of call centers in any organization is finite. You know your number of call centers. It’s not about five, or as of yesterday morning we had three, it’s a specific number. As such, it’s a reasonable target. It’s a target that can typically be dealt with through the application of technology. There’s a handful of technology, which when applied to any call center in any location will, when measured against the typical metrics, enable the call center to be “better”. If someone’s marching orders are to fix the call center, those orders fit neatly with the application of technology.

Doing something to the call center is a shotgun approach to trying to solve a problem. It’s a recipe that is very repeatable; add three parts technology and stir. It’s almost guaranteed to produce measurable and visible results. It’s also almost guaranteed to not fix a single patient problem. The reason for that is that almost all of the technology deployed in call centers has nothing to do with addressing the reason the patient called. The application of technology for the most part has to do with getting the caller to the CSR more promptly.

The big distinction in dealing with patients versus dealing with call centers is that patient problems usually can’t be resolved via the application of a shotgun solution. Clearly, if every patient that calls about a billing problem is calling about the same billing problem then the application of technology could fix it. However, patients who are calling about billing problems are usually calling regarding a problem that is specific to them. There are two ways to address this type of problem. One way is to get a clear enough understanding of problem on the call and have the patient work with the CSR to resolve the problem. That type of solution puts out the fire. The problem with this type of solution is that it has to be repeated with the CSR every time that same problem arises. The other way, and by far a more proactive way, is to figure out what caused the billing problem and to correct whatever caused the problem thereby preventing it from ever happening again. Instead of putting out the fire, the hospital prevents the fire from reoccurring.

From my perspective this is one of the major differences between Patient Relationship Management (PRM) and Patient Equity Management (PEM). I’m not convinced that PRM actually exists, at least as relates to the acronym. I think it’s either call center management or patient account management, or some combination of the two. If it does in fact somehow manage the relationship of the hospital with the patient, it’s predominantly a one-way relationship, a push relationship from the hospital to the patient. PEM, patient experience management, patient expectation management, patient equity management, requires a two-way relationship, and requires knowing more about the patient than some profile developed through data mining. For PEM to be successful, the hospital must get to the root of why the patients are calling and what can be done to solve the problem in such a manner that the patient no longer has to call. It sounds like a lot of work. It is if you take a shotgun approach to it, sort of like trying to eat the elephant in one bite. I’ve found that if I break it down into manageable pieces, each of those pieces can be designed as a small project that can be solved.

The most difficult thing about trying to implement this type of solution is that it goes against everything that we’ve been doing. This can appear to be so far out of the box that you can’t even see the box. It requires you to think in opposites. The solution begins with how you phrase the problem. Instead of viewing the problem as, “How do we improve our call centers”, we need to be asking, “How do we improve our interactions with our patients?” We’re almost asking the inverse. In mathematics, that’s easy to do; you simply multiply by -1.  Maybe that’s all that’s needed here.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

A Perfect Metaphor

Few things are perfect, and when you find something that is, it is worth examining.  One thing that is perfect is baseball, at least some aspects of it.

Think with me for a minute. 1845.  How much has changed since then?  Just about everything.  Do you know what has not changed—the distance between the bases—90 feet?  This distance may seem insignificant or inconsequential.

In the last 165 years the distance between the bases remained unchanged.  Equipment changed, improved.  The players got bigger, faster, and stronger.  It never dropped to eighty-nine feet; it never jumped to ninety-one feet.

To those who follow baseball, have you noticed how close many of the plays are at first base, or the closeness of the steals of second base?  Can you imagine what would happen to the game of baseball if the distance was shortened to eighty-nine feet?  Almost everyone stealing second base would be safe.  If the distance was ninety-one feet they would all be out.

Somehow, 165 years ago those people got it right, got it absolutely right.  Something as simple as a measurement along a dirt path has stood the test of time.  There are not even any discussions about trying to improve it.

Remember the Titanic?  If one measured all the time spent in its design, and all of the time it sailed before it sank, if you were a betting person you would have bet on the boat.  Reasonable people would have bet on the boat.  You would have been a fool to have bet it would have sunk.

You know what; the Titanic’s sinking was not a fluke. The laws of physics and ship design did not suddenly cease to work.  Do not blame the iceberg.  The Titanic was designed to sink—otherwise it would not have sunk.

What is often misjudged in business is the ill-informed notion that just because something has not collapsed it is not broken.  Hospitals are starting to collapse.  The business model of most of them almost ensures that left unchanged, many, many more will collapse.  They have been designed to collapse.  Just because they have yet to collapse does not mean they won’t, all it means is that they have not—yet.

Few things are perfect.  What discussions there are about the business model are not about improving the model, they are about cutting costs.  What do you have when there are no more costs to cut?  You have a less costly dysfunctional model.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

How to calculate Meaningful Use’s ROI

Just to make sure we are all turned to the same page in our Cliff Notes on Meaningful Use, today’s conversation is, “There is no “R” in ROI.”

Are you familiar with the Abilene paradox?  It is a paradox in which a group of people collectively decide on a course of action that is counter to the preferences of any of the individuals in the group.  It involves a common breakdown of group communication in which each member mistakenly believes that their own preferences are counter to the group’s and, therefore, does not raise objections.

I think it occurs more often than we think.  Try to recall the last meeting you attended in which you really disagreed with something that was said.  Chances are you knew some of the others in the meeting well enough to know they also disagreed.  The reason you know they also disagreed is because you had discussed the topic.  However, none of you raised your disagreement during the meeting.  Why?  Because you did not want to rock the boat.

It is similar to a pseudoconsensus.  Pluralistic ignorance.  These create a bystander effect—people are more likely to speak out about an issue when they are alone with someone than when others are present.

After further consideration I think we must consider the very real possibility that there is no ROI for Meaningful Use.  I write this in all sincerity.  Healthcare executives march in lock-step or group think to achieve the myth of finding an ROI for Meaningful Use.  The ROI is healthcare’s quest for the Holy Grail, albeit without the Monty Python sound track.  They cannot proceed without one, so they set the target, figure out what data will demonstrate that they have hit it, and disregard the reams of data that does not support the ROI.

What if the government came out with a standard stating all hospitals ought to buy, install, and use a fifty million dollar transplant device that also flosses the patient’s teeth?  This initiative is “optional”, but the government will pay the hospital a two hundred thousand dollar rebate.  There are several types of transplant flossers—the ones that deliver that fresh mint taste cost extra.

If we were having a business discussion about the ROI for the transplant device, healthcare executives would be foaming at the mouth about how impossible it would be to calculate an ROI, and rightly so.  They would argue all hospitals are different, they have different cost structures, the devices are all different.

The standards for Meaningful Use are arbitrary.  The standards were developed by people who do not need to meet an ROI.  There was no mandate in the development of those standards to create standards which when met would yield an ROI.  Any attempt to force an ROI will naturally differ in a number of ways:

  • by provider—size, structure, offering, geography
  • by their interpretation of Meaningful Use
  • by which EHR they implemented
  • when they began the implementation
  • how well they implemented the EHR

Somebody somewhere may hit a positive ROI on Meaningful Use, just like somebody playing darts may hit a bull’s eye.  Any positive ROI will be accomplished more out of chance, and from having fit the data to a predetermined ROI rather than measuring the ROI against its true impact.

Implementing an EHR can be very good for a hospital.  However, it should be a business decision for the hospital based on the same set of business rules the hospital would use to justify any other large expenditure.  If the hospital achieves an ROI it will not be because of having followed an arbitrary set of standards.  Any ROI for an EHR will come from having done it correctly.  Hitting the figure any other way means two things; it was a coincidence, or you are in for trouble down the road.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

Patient Relationship Management (PRM)

Have I mentioned I am an unapologetically type A person, for the most part an off the chart Meyers Briggs INTJ? This morning I awoke feeling no more querulous than usual—that would change rather abruptly. In general, I make it a rule never to learn anything before having my first cup of coffee. Unfortunately, today wasn’t going to be one of those days. In fact, my mood was a direct result of the instrument pictured above.

These days I am using that to make my coffee as my normal espresso maker’s LED screen is displaying a message telling me my grinder is blocked—sounds a little like something two tablespoons of Pepto should be able to fix, doesn’t it? Google was not help—three hits, each instructing me to send it back to the dealer for a $350 repair. Sounds more like a response you’d get regarding a car, not a coffee maker.

I brought this pot home from my work in Madrid. It works using the same principles as a pressure cooker. Water is placed in the bottom; an espresso grind goes above the water.Steam is forced through the grind, past a metal sieve, and into the container where as it cools it is reconstituted as a liquid—coffee. Anyway, as my coffee is cooking, I notice the metal sieve sitting on the counter. It seemed like too much work to turn it off, rinse the pot, regrind the coffee, and wait the additional five minutes. I was too tired for a do-over.

Too bad for me. Now, I’m not sure if what happened next would be found under the topic of fluid mechanics, converting steam into thermal energy, or general explosives, but it would have made for an entertaining physics experiment. In what appeared to play out in slow motion like the Challenger explosion actually occurred in a fraction of a second. It seems that metal sieve does more than strain the grinds from the steam. It also prevents a thermonuclear reaction. Apparently when the pressure passes the fail-safe point, the reaction proceeds to the next logical step. That step, which I observed, involves coffee and grinds exiting the pot so rapidly that before I could blink they covered the walls, counters, and floors as far away as ten feet. (It was actually pretty impressive to watch.) I’ve been informed that once I finish writing I will be attending to the mess.

The scene reminded me of one of the forensic shows on cable. I halfway expected the medical examiner Henry Lee to walk through my door to examine the splatter pattern.

The choice I faced was to do it over, or deal with the consequences. I was in a hurry, consequences be damned—it turns out that it wasn’t the consequences that would be damned. My guess is that I’m looking at at least thirty minutes of cleanup work.

It pays to invest the time to do something right the first time. Sort of like dealing with patients. Let’s say a certain patient call takes nine minutes to handle correctly. As many of you have observed, there are two ways to go about this. You can do it over a period of several four minute calls because your people don’t want to get dinged for exceeding their handle time allotment, or you can allow the people to talk until the patient’s need is solved.

As patients, we know you prefer the first approach. The mere fact that patients have to listen to a recording telling us how important our call is makes us leery. I think everyone who is monitoring calls and call metrics needs to come over to my house for a cup of coffee and let the people do their jobs.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

My latest post to healthsystemCIO.com

I think there is plenty of merit to quit chasing Meaningful Use and get on with your business.

http://healthsystemcio.com/2010/05/28/ten-catechisms-of-meaningful-use/

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

Is there a business argument for Meaningful Use?

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

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

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

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

“The windows.”

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

“It’s not like we like living this way; the water, the cold, the mess. It costs a fortune to heat this place.

And, the constant bother of emptying the buckets, and the sweeping of the leaves.”

“Why don’t you shut your windows? It seems like that would solve a lot of your problems.”

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

When you see something abnormal often enough it becomes normal. Sort of like in the movie The Stepford Wives. Sort of like all the scurrying around Meaningful Use.  The normal has been subsumed by the abnormal, and in doing so has created an entire entity which is slowing devouring the resources of the organization.

Are you kidding me? I wish. It’s much easier to see this as a consultant than it is if you are drinking the Kool Aid on a daily basis. When I talk with hospital executives they are marching headstrong into the Meaningful Use abyss.

It makes me feel like I must be the only one in the room who doesn’t get it—again with The Stepford Wives.

If I ask about it they always have an answer. It all boils down to something like, “We simply can’t turn down the money.”  They say that with a straight face as though they are waiting to see if I will drink the Kool Aid.  It’s gotten to the point where no matter how goofy things get, as long as they are consistently goofy, there not goofy at all.

This is the mindset that enables leaders to be fooled by their own activity. Busy replaces thinking.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

Are terrorists smarter than us?

Sri Lanka has been in a twenty-six year civil war with the Tamil Tigers. NPR reported the leader of the Tigers was killed. Within a day, the Tamil Tigers’ web site posted a blurb stating that the leader was not killed—a la Monty Python—“I’m not dead yet.”

I’ll be brief. The bad guys. These bad guys live in the jungles, others live in the Afghan mountains. As far as I’ve been able to ascertain, they don’t use Cisco servers, they don’t have a call center. There’s no marketing department, no financial analysts, no freshly minted MBAs walking the hallways telling them what to do.  They have established virtual nations.

Yet as primitive as these groups are, they know the value of rapidly employing social networking to their advantage. What amazes me is not that they do it, but that most people reading this don’t have a proactive policy and the resources required to effectively manage their social media.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

Is this a fair representation of the hospital business model?

I have been looking for a way to represent pictorially the hospital business model and the forces which act upon it.  The picture below came to me last night while playing this board game with my daughter.  It is from the children’s game, Boobytrap.  The way the game is played is that the players try to remove the red, blue, and green pieces without causing the trap to spring and displace all of the pieces.

If we represent patients as the individual playing pieces and make the assumption that each side of the game exerts pressure on the model, I think it represents fairly the external forces with which the large provider model has to battle.  As the forces increase from some combination of costs, regulation, procedure price ceilings, and payor reimbursements, the number of patients in the model will decrease and may do so in a catastrophic manner.  Without a concurrent decrease in those four forces it is unlikely that the model will support additional patients.  Clearly, without changing the size of the board it is impossible to grow the number of patients beyond the board’s capacity.

A couple rules come into play.

  • The forces are all external.  They cannot be controlled or abated by the hospital.
  • The strengths of the various forces change over time
  • The forces result in some maximum number of patients which can be serviced under the hospital’s existing business model.
  • As each patient is lost, the stability of the model weakens.

Does this way of depicting the large provider business model ring true?  Does this help illustrate why the model must change?

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

Wayne Newton’s 4th law of relative immobility

Last night I was speaking with a woman at a gathering of graduates from my high school.  She got into the subject of reading glasses and then commented that she first learned she needed regular glasses since the age of four.

As she was not wearing glasses, I asked her if she’d had Lasik.  No, she said, “I always hated how I looked in them, so I quit wearing them in high school.”

“Don’t you miss being able to see things?” I asked.

“Not really.  This is how I’ve seen the world for the past thirty years.  I’ve grown comfortable with how I see the world.”

I think a lot of business leaders have the same perspective—sorry for the pun.  They get comfortable with how they see their world—comfortable with the issues and how to address them.  Given the choice, people will stay in their comfort zone.

Do you remember your physics?  Relative motion is the branch of physics that studies the motion of the body relative to the motion of another moving body (Newton).  For example, if you are in a train and another traveling at the same speed pulls alongside you, it appears to both set of passengers that neither train is moving.  If your train decelerates it will appear to you the other train has accelerated.

Now, take the perspective of someone standing on the platform viewing the two trains.  To that person, there is no illusion.  The bystander can see exactly what is happening; who is moving forward and who isn’t.

Business leaders get caught up in what I call Wayne Newton’s 4th law of relative immobility.  When they look out their windows at the executive in the hospital across the street, it appears they are both moving at the same speed and at the same direction.  That is how they have seen the world each day for the last several years.  They look at each other, wave, and then go about their business, knowing their competitor hasn’t passed them or changed course.

But you and I know why it looks that way to them.  The reason they have not been passed is because neither hospital is moving forward.  The reason they do not perceive a change of direction is that they are both moving in the same direction.  In actuality, there is no motion.  Only an outsider can see neither hospital is moving.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

Herman Melville’s take on healthcare’s business strategy

Someone once summed up one of Fred Astaire’s screen tests with the following; “Can’t sing.  Can’t act.  Balding.  Can dance a little.”  Probably the same guy who evaluated my Mensa application.  I’ve been accused of having a similar outlook.  I once accosted a guy who was walking on water, accusing him of not being able to swim—but that was a looonnngggg time ago.

The internet is full of opinions, but hopefully not full enough. One of the reasons I chose math over English as my major was the affection I held for getting the right answer, or barring that being able to know precisely where my errant efforts led me away from the answer.

In my narrow-minded view of the universe the downside of English, literature—the soft studies—was the notion held by those who taught that there was more to be divined by the story than just the story.  Those who can do; those who can’t teach.  They displayed a Stepford mentality in their obdurate ability to outthink both the author and their students, to bring forth nascent ideas of the author’s hidden meaning.

Herman Melville wrote Moby Dick.  I am willing to bet he wrote it just the way he intended to.  Nobody has uncovered a frayed notebook of Melville having penned his thoughts about the real meaning of life from a cannibal’s perspective, or suggesting Queequeg was a misunderstood cross-dressing sycophant who was never close to his mother.  We don’t come away from our reading of Moby Dick  with a more in-depth ability to understand anything except for perhaps what it felt like to live aboard a whaling ship.

These interpretations are poppycock.  Art critics do the same thing as they bloviate about the hidden meaning behind what the artist really intended to convey, meaning only they can see.  Ever notice how none of these popinjays, these opiners present their opinions as fact?  Pretentious fops.

I write and paint.  Those who’ve read my missives know there is no buried meaning.  If I had wanted to convey something else I would have written something else.  If I use dark colors and bold brush strokes when I paint it is because I feel they add to what I want to show; it is not a reflection of having missed two days of Zoloft.

Nobody will ever know what Shakespeare intended to convey with his addition of the three witches in Macbeth, or whether Joyce Kilmer had ever seen a tree.  That said, I do have a few strong opinions about where this whole business model of healthcare is headed.  I think these types of opinions; along with the opposite opinions differ from the type offered up as truths in an English Lit class.  They differ in that at some point they will be proven right or wrong—time will tell.

As I have written, I think the large provider model—the business model—is seriously flawed.  Moreover, I think it may prove fatal.  Providers will run out of costs to cut, will run out of processes to re-engineer, and will have no more Italian marble with which to line the foyer.  The good news is that they will still have the machine that goes “Ping” just in case somebody needs it.

I do wonder how Melville would have expressed his ideas about healthcare.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942
paulroemer@healthcareitstrategy.com

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer