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.

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.

They had a bad experience.

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.

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


Paul Roemer

Chief Patient Experience Officer

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…