patient relationship management

Patient Experience: Not understanding UX and UI is killing Patient Experience

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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?

Defining a global patient experience

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

Patient satisfaction should be exclusive…to everyone

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Sometimes it feels like I fell out of the stupid tree and hit every branch on the way down.

Important: Do not remove the wires from your old thermostat until you have marked them with the enclosed labels.

This warning was printed on a bright red background with yellow text and hidden away in the middle of the adult-proof ballistic packaging of the new thermostat.

“Why didn’t you read the directions before you disconnected the old thermostat?” My wife asked as soon as she realized the fan was not working.

“Is there a reason one of the plants in the garden is on fire?”

“You have to power-wash the deck before you put the furniture on it.”  This is the heavy, metal outdoor furniture I am forced to carry indoors once the weather turns cold so that it can hibernate, and return it to the outdoors in spring. 

All my explanations about the fact that the furniture was designed for the outdoors and that it will outlast the next dinosaur ascendency go unheard.  It is this same furniture for which she has militaristically drilled the family, with the rigor of nuclear submarine crew trained to extinguish fires, to race indoors with the cushions whenever rain is expected anywhere within the lower 48 states.  Perhaps she read somewhere that if the cushions get wet they will suffer the fate of the Wicked Witch of the West and melt.

Responses are neither required nor expected of any of the questions or statements tossed at me.  To do so would be akin to arguing in a vacuum—as opposed to with a vacuum.

Pearls of wisdom, in my case, tossed amongst swine.  “Mongo just pawn in the game of life”—Mel Brooks, Blazzing Saddles.

The world has changed.  Customers have changed. All businesses have changed the relationship between themselves and their customers. With few exceptions, healthcare has not changed its approach to patients, and nobody seems to own up as to why.

The way the business model used to work is the business pushes communication from the business to the customer. Businesses evolved to the point where communication between the business and the customer became a push-pull model. The business pushes something to the customer.  Sometimes the customer pulls information, and sometimes the customer pushes information to the business.

Most pushes and pulls function on a one-to-one basis; the business to a single customer (patient), and back. It occurs in secret. Customer A was never aware of the push-pull between the business and Customer B.

Communication is no longer secret. In fact, it is anything but secret, especially among customers.  As the number of customers increases, their communication about a business can go quickly viral—not between patients and the hospital, but among patients. 

Hospitals can do a lot of things but they cannot put the toothpaste back into the tube.

I think patient satisfaction should be exclusive…to everyone, but then I have been accused of trying to believe in as many as six impossible things before breakfast.

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Why Patients Lose Patience

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Who is responsible for patient satisfaction?  The flaw of averages suggests that the buck does not stop somewhere.

Your amygdala’s been hijacked.

The bad thing about being a former mathematician in my case is that the emphasis is on the word former. Sometimes I’m convinced I’ve forgotten more than I ever learned—sort of like the concept of negative numbers. It’s funny how the mind works, or in my case goes on little vacations without telling me. This whole parabola thing came to me while I was running, and over the next few miles of my run I tried to reconstruct the formula for a parabola. No luck.

My mind shut that down and went off on something that at least sounded somewhat similar, parables. That got me to thinking, and all of a sudden I was focused on the parable of the lost sheep, the one where a sheep wanders off and the shepherd leaves his flock to go find the lost one, which brings us to where we are today.

Sheep and effort.  Let’s rewind for a second. Permit me to put the patient lifecycle into physics for librarian style language—get the patient, treat the patient, lose the patient.  These are the three basic boxes where providers focus resources. How do manage the patient lifecycle to our advantage? We have marketing and sales to get the patient, we have patient care to treat the patient.  Can anyone tell me the name of the group whose job it is to lose the patient?  Sorry, I should have said to not lose the patient.

Patient retention.  Can anyone in your hospital tell me what specific efforts are underway to get patients to return the next time they need care?  I hope it involves more than the marketing department erecting another billboard with a picture of the urologists.

Where do most providers spend the majority of their intellectual capital and investment dollars? Hint—watch their commercials. It’s to get the patient. Out comes the red carpet. They get escorted in with the white glove treatment. Once they’re in, the gloves come off, to everyone’s detriment. Nobody ever sees the red carpet again. A high percentage of a hospital’s marketing budget is to get the patients. Almost nothing is spent to retain exiting patients.

Existing patients versus exiting patients. Why patients lose patience. 

Winning hospitals roll out the red carpet when patients exit. They do this for two reasons. One, it may cause a patient to return. Two, it changes the conversation. Which conversation? The one your patient is about to have with the rest of the world. How does your hospital want that conversation to go?

What do you have to do to get the patient to come back the next time he needs treatment? What the next visit of a patient worth to your hospital?  What about the next five visits? There seem to be a lot of questions for which answers seem to be missing.

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Is Patient Experience Management abi-normal?

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I remember the first time I entered their home I was taken aback by the clutter.  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 open windows, the stuff blows right in.”

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.”

Trying to assume the role of thought leader I asked, “Why don’t you shut your windows? It seems like that would solve a lot of your problems.”

She looked at me 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 Patient Experience Management (PEM). The normal has been subsumed by the abnormal, and in doing so is slowing devouring the resources of the hospital.

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 daily. When I talk to people about a statistic that indicates that 500 people called yesterday about their bill, and everyone looks calm and collected, 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 the high call volume they always have an answer, the same answer.  “Billing calls are usually around 500 a day.”  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 bad things get, as long as they are consistently bad, they are not bad at all.

This is the mindset that enables the patient experience executive (I know you probably don’t have one—I am being facetious) to be fooled by his or her own metrics. When is someone going to understand that repeatedly having thousands of people calling to tell your organization you have a problem, means you have a problem?

It would probably take less than a week to pop something on your web site, and post a YouTube video explaining how to read the bill.  Next week, do the same thing and help patients understand how to file claims and disputes—granted, you may need more than a week for this one.

 

Without Control–the Patient Dialog

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Remember when there were 200 firms in the Fortune 100?

How long ago was that? I think it was around the same time when people still thought you shouldn’t wear white after Labor Day. Time to drop-kick those white pumps to the back of the closet. What made me think of that bit of nonsense was a meeting I had recently with one of the sharpest people I’ve had the pleasure to meet professionally, and a classmate of mine from grad school. She happens to be the founder and president of one of the country’s go-to firms for dealing with business ethics. Having served as a board member for several publicly-traded firms, as well as chairing their audit committees, when the Andersen and Enron scandals hit she went looking for professionals who could help her help her firms. When she couldn’t find the help, she created it.

That conversation got me thinking and made me wonder why there were no longer 200 firms in the Fortune 100. Was it; is it, a matter of business ethics? How often do unethical practices come up when firms interact with their customers? A couple of takeaways from the meeting—for board members to be able to meet their obligation, they ought to do more than reply on the meeting book pulled together by the firm they serve. Simply relying on the book presumes ethical behavior, a presumption not always supported by fact—how much should one believe if the information is being provided by someone who purchased a $900 shower curtain?

What can they do? Due diligence is being reinvented, and the Social Network is leading the charge. One example is to go to Yahoo Chat to see what’s really being said about your organization. Other things I’ve done to obtain facts and opinions, things which particularly gauge how customers and employees feel about the firm include Google Reader, Facebook, Twitter, and YouTube, to name just a few. You don’t need patient focus groups to learn what’s being said, or to learn how good a job your hospital is doing. The patients already have a laser focus. In many instances the group lacking the focus is the healthcare provider.

Firms should focus on maintaining a strong Reputation Bank, one strong enough to be able to handle withdrawals, because you never know when there might be a run on the bank. Might be a good time to look at your own bank deposit slips.  Deposits can be made easily through the social media network.  You can’t stop patients from talking about you but you can shape what they say.

Why HCAP Scores Do Not Work

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The worst part of being a consultant is when your client makes you walk three steps in front of them and requires you to shout ‘Unclean’.

Sharks cannot turn their heads.  Sometimes it seems business leaders have the same problem.  What transformation or innovation would you undertake if you were not afraid to turn your head, to look for solutions if you were not of failing?

Hospitals either have satisfied patients or they do not.  Measuring satisfaction will not yield satisfied patients any more than Comcast’s ‘Customer First’ program got them satisfied cable customers.

This may come as news, but hospital executives do not need satisfied patients.  The term ‘patients’ is a plural, and no patients satisfaction program will satisfy the plural.  The very notion of having a satisfaction program should signify that the organization, in fact has, a patients satisfaction problem.

Permit me a moment of sacrilege.  Forget the patients.  The doctors and nurses have your patients covered better than any other country on the planet.  Patients do not complain about the MRI.  Patients do not complain that the hospital replaced the wrong hip.

If a hospital is not to worry about the satisfaction of its patients, how then will it improve satisfaction?  Take out your highlighter and underline the next sentence on your monitor.

Worry about your customer.  Focus on the business processes that affect a single customer.  At least half of patient satisfaction is comprised of things that have nothing to do with why the individual is at your facility.  Patients know the clinical experience will not be fun.  They know before they get to the hospital, even if they have never been in a hospital, that the clinical experience will likely be painful, intimidating, scary, and somewhat dehumanizing.

Where hospitals seem to miss the point is that hospitals assume that the satisfaction of a patient’s entire stay is tied to whatever clinical procedure they underwent.  That kind of perspective is somewhat akin to the Ritz Carlton assuming that the satisfaction of a hotel guest’s entire stay has to do with the success of the presentation they delivered at the Xena Warrior Princess Lookalike Convention.  It does not.  Their satisfaction depends on the cumulative of all of the other experiences they had at the hotel.

Something to file away.  Every Ritz Carlton employee, down to the lowest on the org chart, is authorized up to two thousand dollars to do whatever is required to satisfy a customer, even a customer whose bill will only be five hundred dollars.

Patients view their medical procedure and their medical tests as the clinical part of their stay, a part that in their mind occupies far less than half of the hours they spend at the hospital.  That is the patient part.  It is during those processes that people see themselves as patients.

During their other waking hours, and for most of their non-waking hours, people see themselves as customers.  People paying a lot of money for a service.  Hospital employees do not see these people as customers.  And why should they?  Nothing in their DNA, nothing in their training told them that the warm body in room 207 is a customer of a two hundred dollar corporation.  And these same people base a large portion of their customer satisfaction on their experiences during those nonclinical hours. 

I realize this notion of the customer-patient/patient-customer flies in the face of everything hospital employees have been taught.  It certainly flies in the face of the business processes that have been designed to support a patient-only model.

Here is one way to view the distinction.  Patients get better or they do not.  Getting better, fixing their problem is what the patient expects; anything else is failure.  How that happens is the concern of the hospital.  Getting better is a black hole in the mind of the patient.  For the most part patients expect it will not be pleasant.  Patient satisfaction in not all wrapped up with whether the procedures the patient underwent were was painful. It can be argued that a patient’s satisfaction of their clinical treatment is somewhat binary.  Came in sick.  Walked out better.

On the other hand, patient/customers are evaluating their customer experience.  Patients measure their customer experience from before they check in until after they are discharged.

Total patient satisfaction is the sum of a patient’s patient experience and their customer experience.  HCAP is only measuring a portion of it.

Patient Experience Management–What would Oprah do?

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If you watch too much television your brain will fry. Sometimes I feel like mine is in a crepe pan that was left sitting on the stove too long. Two nights ago I’m watching Nova or some comparable show on PBS. The topic of the show was to outline all the events that took place that helped Einstein discover that the energy of an object is equal to its mass times the speed of light squared, better known as E=mc². It was presented to the audience at a level that might best be described as physics for librarians, which was exactly the level at which I needed to hear it. It’s physics at a level that is suitable for conversation at Starbucks or any blog such as this.

So here’s what I think I understood from the show. It tracked the developments of math and physics in the 100 years prior to Einstein’s discovery. The dénouement appeared to occur when Einstein and his fiancée were riding in the bow of the small boat. Apparently, he was leaning over the side of the boat and noticed that the waves generated by the front of the boat moved at the same speed as the boat. He then noted that fact only held true for those persons in the boat, who were in fact, traveling at the same rate of speed. However for those persons watching from the shore, that same wave was not only moving slower than the boat it got further behind over time. Some other things occurred, yada, yada, yada, and there you have it. Clearly, the details are in the yada, yadas.

So here’s what happens when you watch too much television. As I’m running this morning somehow my mind takes pieces from that show and staples them together to yield the following. Let’s go back to the equation E=mc². For purposes of this discussion I’ll redefine the variables, so that:

E = the percentage of Patient Complaints/Inquiries.
m = Patient in-bound calls.
c = number of Patients

If this were true–this is an illustration, not an axiom–the number of complaints to a healthcare provider is equal to the number of in-bound calls times the square of the number of patients. So as the number of calls increases the number of complaints/questions increases and as the number of patients increases the number of complaints increases exponentially. Of course this is made up, but there appears to be a grain of truth to it. I think we can agree that a reasonable goal for a healthcare provider is to decrease the number of complaints and inquiries and to shift a hefty percentage of inquiries to some form of internet self-service vehicle.

I think sometimes the way providers assess the issue of Patient Experience Management  (PEM) is by looking at how much money is spent trying to solve the problem. Some think that if one provider has three times as many people handling calls as another provider that the provider with three times as many people must be more interested in taking care of the their patients, and might even be better at PEM.  I don’t support that belief. I think it can be demonstrated that the provider with the most Patient Service Representatives, and the most toys deployed probably has the most problems with their patients. I don’t think it’s a chicken and egg argument. If expenditures to handle patient complaints and questions increase year after year and resources are deployed continuously to solve the same types of problems, I think it’s a sign that the provider and its patients are growing more and more dysfunctional.

How does this tie to Einstein and his boat? Perhaps the Einsteins are those who work with the provider; those who are moving at the same speed, those in lockstep. From their vantage point, the waves and the boat, like the provider and its patients, are all moving forward at the same speed. Perhaps only the people standing along the shore are able to see what is actually occurring; the waves distance themselves from the boat in much the same way that the patients distance themselves from the provider.

Social media isn’t what it never was.

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Social media isn’t what it never was.

The term ‘social media’ is too polite to effectively communicate its importance to what it means for healthcare.  To me, Social Media sounds more like a coffee clutch or a discussion that would take place on Oprah or on The View.

Social media (SM) is often a targeted, violent dialogue fraught with vitriol.  There is nothing convivial or social about it.  It is not undertaken with your organization’s permission or its wellbeing in mind.

It may be easier to understand what it is not than to describe what it is.  SM is not B2B Facebook—it is not throngs of people who want to friend your organization and share nice comments about what it does.  SM usually begins with someone who has a bone to pick with your organization.  Their intent is to fan the flames of their discontent and turn it into a digital conflagration.  It need not be fair or honest.  For the most part SM is propaganda, and its purpose is to sway others to the propagandist’s way of thinking.

If your firm is looking at how to participate in SM, it is best to begin with an understanding of the ground rules—you have some, your opponents do not.  Their approach is like guerilla warfare.  Who knows where they will appear next.  Twitter, Youtube, blogging?

Most organizations who are considering enhancing their SM presence look at it as in IT initiative—enhance the web site, put up a Facebook page, maybe even starting to Twitter.  Just so you know, none of the opposition is throwing social jabs at your IT department.  IT can get you a presence.  What the presence consists of belongs to the likes of marketing, operations, and the executives.

If you have a good PR firm, pull them into the conversation.  It will be like taking your firm to a therapist and starting its own twelve-step program.

Patient Relationship Management (PRM)

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If you watch too much television your brain will fry. Sometimes I feel like mine is in a crepe pan that was left sitting on the stove too long. Two nights ago I’m watching Nova or some comparable show on PBS. The topic of the show was to outline all the events that took place that helped Einstein discover that the energy of an object is equal to its mass times the speed of light squared, better known as E=mc². It was presented to the audience at a level that might best be described as physics for librarians, which was exactly the level at which I needed to hear it. It’s physics at a level that is suitable for conversation at Starbucks or any blog such as this.

So here’s what I think I understood from the show. It tracked the developments of math and physics in 100 years prior to Einstein’s discovery. The dénouement appeared to occur when Einstein and his fiancée were riding in the bow of the small boat. Apparently, he was leaning over the side of the boat and noticed that the waves generated by the front of the boat moved at the same speed as the boat. He then noted that fact only held true for those persons in the boat, who were in fact, traveling at the same rate of speed. However for those persons watching from the shore, that same wave was not only moving slower than the boat it got further behind over time. Some other things occurred, yada, yada, yada, and there you have it. Clearly, the details are in the yada, yadas.

So here’s what happens when you watch too much television. As I’m running this morning somehow my mind takes pieces from that show and staples them together to yield the following. Let’s go back to the equation E=mc². For purposes of this discussion I’ll redefine the variables, so that:
E = the percentage of Patient Complaints/Inquiries.
m = Patient in-bound calls.
c = number of Patients
If this were true–this is an illustration, not an axiom–the percentage of complaints in the call centers of an healthcare provider is equal to the number of in-bound calls times the square of the number of patients. So as the number of calls increases the number of complaints/questions increases and as the number of patients increases the number of complaints increases exponentially. Of course this is made up, but there appears to be a grain of truth to it. As a number of calls increase the percentage of complaints is likely to increase, and as the number of patients increases there will probably be an even greater increase in the percentage of complaints incurred. I think we can agree that a reasonable goal for a healthcare provider is to decrease the percentage of complaints and perhaps to shift a hefty percentage of inquiries to some form of internet self-service vehicle.

I think sometimes the way providers like to assess the issue of Patient Relationship Management  (PRM) is by looking at how much money providers throw at the problem. I think some people think that if one provider has 2 call centers, and another provider has 3 call centers, that the provider with 3 must be more interested in taking care of the their patients, and might even be better at PRM.  I don’t support that belief. I think it can be demonstrated that the provider with the most call centers, and most Patient Service Representatives, and the most toys deployed probably has the most problems with their patients. I don’t think it’s a chicken and egg argument. If expenditures increase year after year, and resources are deployed continuously to solve the same types of problems, I think it’s a sign that the provider and its patients are growing more and more dysfunctional.

How does this tie to Einstein and his boat? Perhaps the Einsteins are those who work with the provider; those who are moving at the same speed, those in lockstep. From their vantage point, the waves and the boat, like the provider and its patients, are all moving forward at the same speed. Perhaps only the people standing along the shore are able to see what is actually occurring; the waves distance themselves from the boat in much the same way that the patients distance themselves from the provider.

PRM is such an easy way to see large improvements accrue to the provider, especially using social media.