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.

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.

How To Keep Losing Prospective Patients

ImageHalcyon days.  This is what the seventies created.  For those thinking this is the lead guitarist for Aerosmith, Dream On.  Where were my parents when I was thinking this was cool?

While running this weekend I was passed by someone who was the spitting image of me at seventeen. Long, loping strides, not an ounce of visible fat, his hair tied back in a ponytail.  (I would keep the fat in a heartbeat to get my hair back.)  At the end of my run my neighbor asked me why I was executing the yoga funeral position on her front lawn—I was reclined fully, my arms by my sides, had I been wearing an oxygen monitor it would have redlined.  I thought I was simply trying to breath.

On Friday one of my favorite people on the planet, someone I had not heard from in thirty years, viewed my profile on LinkedIn.  I invited her to connect.  As of now the invitation has not been accepted.  And as she is an assistant DA, in an effort not to have her last memory of me as that of a stalker, I am inclined to assume I am no longer thought of as one of her favorite people.  Cherchez la femme.

Apparently you cannot go back.  Unless you happen to run a hospital.

I find it helps to separate the business of healthcare—how it is run—from the healthcare business—the services delivered.  I focus on how it is run; an 0.2—if you read this aloud as ‘oh-dot-2’ the use of ‘an’ makes more sense–model with outdated business processes and seventies technology trying to operate in a 2.0 world.

Most hospital executives would agree they are striving to achieve a common goal.  From where I sit, that goal should be sustainability.  You can deliver the best care in the world, but if you cannot afford to keep the lights on, your skill at delivering great care sort of becomes secondary.

Sustainability has two factors;

  • the ability to retain patients
  • the ability to attract new patients.

Patient attraction and retention are very closely connected to the answer to the question, “How easy is it to do business with your hospital?”

Unfortunately, I would wager that there is not a single person in your hospital who can answer correctly that question.  The only people who can answer that question are the people who buy healthcare from your hospital, and those who considered buying it from your hospital but who chose another hospital.

And nobody is asking them.

What if those people ‘in the know’ at your hospital, those who manage the budgets, those whose last image of a patient was when they had their tonsils removed, could see how patients and prospective patients perceive your hospital.

Ignoring chronic disease, I am willing to bet the more than fifty percent of your hospital’s revenues in the next five years will come from new patients. Who are they, who could they have been, and why did they or did they not choose your hospital are pretty important questions to answer.  Does your hospital have the tools to answer those questions?

The questions would seem much less inconsequential if there was a way for your executives to view how people decide if they are going to choose your hospital to deliver their care.  How would those executives react if they were able to view prospective patients (customers) visiting and then quickly leaving the hospital’s website?

Imagine the executives seated in the board room, drinking their café mochas, and watching live feeds of people going to your web site.  The first visitor spends a minute on the home page, and then clicks on the link for ‘Our Lady of Patient Experience Hospital.’  Your executives look at each other wondering why the person went somewhere else.  They pull up the homepage, assess it, and find it to be exceptional.  Every piece of information, including forty-seven phone numbers, is depicted on the page.  What more could people want, wonder the executives?

The executive committee spends several hours watching people interact with their website.  They do not know how many people will return to the site, how many people selected their hospital for services, how many people had a remarkable experience, or why people went elsewhere.

Before hospital executives try to answer the question about the hospital’s sustainability, they ought to consider what it would take to answer those four questions.

If it is not easy for people to do business with your hospital, they won’t.

Defining a global patient experience

My presentation, according to Slideshare, “Defining a global patient experience for your health system”  is being talked about on Linkedln more than anything else on SlideShare…

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

Please let me know what you think



The Wildebeest Postulate of Patient Satisfaction

The Kalahari; vast, silent, deadly. The end of the rainy season, the middayImage heat surpasses a hundred and twenty. One of the varieties of waterfowl, most notably the flame red flamingo that nested in the great salt pans in Botswana, has begun its annual migration. In the muck of one of the fresh-water pools that had almost completely evaporated, writhes a squirming black mass of underdeveloped tadpoles. A lone Baobab tree pokes skyward from the middle of the barren savanna. In its shade, standing shoulder to shoulder and facing out, a herd of wildebeest surveys the landscape for predators.  Sir David Attenborough and PBS can’t be far away.

Some things never change. I make my way across the freshly laid macadam to meet the school bus. Fifty feet in front of me is a young silver maple tree, the buds of its green leaves yielding only the slightest hint of spring hidden deep within. The late afternoon sun casts a slender shadow across the sodded common area. One by one they come—soccer moms; big moms, little moms, moms who climb on rocks; fat moms, skinny moms, even moms with chicken pox—sorry, I couldn’t stop myself—as they will every day at this same time, seeking protection in its shade. My neighbors.  It’s only sixty-five today, yet they seek protection from the nonexistent heat, a habit born no doubt from bygone sweltering summer days. A ritual. An inability to change. In a few weeks the leaves will be in their full glory, and the moms will remain in the shadow of what once was, standing shoulder to shoulder facing outward, scanning the horizon for the bus. A herd. Just like wildebeest.

The children debus–I invented the word.  Mine hand me their backpacks, lunch boxes, and musical instruments.  I look like a Sherpa making my way home from K-2.

I shared the wildebeest analogy with the neighborhood moms—the bruises will fade gradually. I can state with some degree of certainty they were not impressed with being compared to wildebeest. So here we go, buckle up. By now you’re thinking, “There must be a pony in here somewhere.”

Some things never change; it’s not for lack of interest, but for lack of a changer.  For real change to occur someone needs to be the changer, otherwise it’s just a bunch of people standing shoulder to shoulder looking busy. Motion is not the equal of movement.

How are you addressing the change that must occur to improve patient experience?  Patient experience is not about CMS.  It’s not about purchasing data about patient experience, and it is not about coaching and clowns.  It is about moving from a 0.2 business model to 2.0.  You need someone who sees the vision of what is is—sorry, too Clintonian—must lead.  Be change.

One of the great traits of wildebeest is that they are great followers.