Patient Relationship Management–A 12-step program

The room was filled with the aroma of stale coffee. The anxious looking guests made idle conversation, averting their eyes so as not to look into the eyes of the person next to them. The folding metal chairs were arrayed in a circle. At the appointed time they sat.
A man with a hardened look stood to speak. “Hi. My name is John, and I haven’t spoken to a patient in four months.” As he began to sit, the others responded in unison, “Hi John.”

The rotund woman across from him rose and composed herself. “My name is Mary, and I haven’t spoken with a patient today.”

“Hi Mary.”

This same process occurred until all who wanted had said their piece. Hospital executives. Male and female. Some had earned their stripes caring for patients.  Others, even though they were in charge, had never met one. Recovering clinicians and physicians.

The good news is that the program works. The longer the executive goes without speaking to a patient, the longer they are likely to go. The break-even point seems to be about two weeks, the same amount of time it takes to paint a house. Once an executive has gone two weeks without speaking to a patient, there is almost no chance of slipping into that nasty old habit.

When was the last time you caught one of your executives sneaking a chat with a patient?  Probably never. Old habits aren’t so tough to break, especially when those habits never existed.

PRM Roadkill

(AP) New York. CNN reported that PRM died. Services will be held next Monday at Dunkin Donuts. Patients are asked not to attend, but instead to forward their complaints to Rosie O’Donnell.

A fellow, David Phillips, wrote, “Relationships should be considered part of the intrinsic value of the corporation”—he is an auditor. I read a paper co-authored by a slew of PhDs who concluded that the six components for measuring relationships include; mutuality, trust, commitment, satisfaction, exchange relationship, and communal relationship. I feel better just knowing that.

Patient Relationship Management—PRM. I hate being the one to break the news but, PRM is dead. I didn’t kill it. It’s dead because it never existed.  Relationship Management.  Who is actually measuring a relationship? What unit of measure do you use? Inches, foot-pounds, torque? PRM Carcasses are strewn about. You can’t manage what you can’t or don’t measure.

“What are you talking about?” She hollered. “We measure. We measure everything. If it’s got an acronym, we’ve got a measure for it. KPIs. CSFs. ACD. IVR. ATT. AHT. Hold time. Abandonments. Churn.”

Just because something is being measured, it doesn’t mean that the measure has anything to do with the desired outcome. I’d wager my son’s allowance that nobody uses a single quantifiable metric that precisely points to the health of an individual patient relationship. Seems silly? No sillier than really believing you have an ability to manage something as ephemeral and esoteric as relationships.

Just how good are those relationships everyone thinks they’ve been managing? Five percent higher than last month?  Down three percent over plan?  Permit me a brief awkward segue. Joseph Stalin said, “One death is a tragedy, one million deaths are a statistic.” The point is that scale matters—a great deal.  One death versus a million.  One patient interaction versus millions.  It makes a difference. The things we do that impact patients impact them individually, one at a time.

Technology metrics apply to patients—plural. Technology metrics are averages—patients aren’t.  You are measuring against the masses.  The mass does not churn, does not leave your hospital, does not ask to speak to a supervisor.  If I am the patient, not a single metric, not a single measure in your hospital accurately depicts the success or failure of our interaction.

So, what’s a mother to do? Stop pretending you are managing your business by managing relationships—since it’s not possible to do the latter, it follows logically that you can’t possibly be doing the former.

Here’s what you can do, manage your hospital using things you can measure. You can start by defining metrics for the following;

Patient Referral Management—how many patients came via referral?

Patient Resolution Management—how many patient problems were fixed?

Patient Recovery Management—how many patients did you win back?

Patient Retention Management—how many patients did you prevent from going elsewhere?

Show these to the VP of Operations and all of a sudden you have something to talk about. Show the VP how much you reduced some global metric—so what?

The parabolic parable

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, keep the patient, lose the patient.  These are the three basic boxes where providers focus resources. How well do we do in managing that lifecycle to our advantage? We have marketing and sales to get the patient, we have patients care to keep 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. Freudian—actually, we probably have our pet names for the department who we fault for patients leaving.

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 firm’s budget is to get the patients, and another large chuck for existing patients. Almost nothing is spent to retain exiting patients.

Existing versus exiting. Winning providers 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 ex-patient is about to have with the rest of the world. How does your firm want that conversation to go?

An idea for improving Patient Relationship Management

This won’t solve all of your problems, but it’s a good start–sort of like 1,000 lawyers on the bottom of the ocean.
www.nophonetrees.com

Who knows, perhaps your organization is included.

What’s the ROI from Social Media for a hospital?

Did you know there’s a hospital in the US whose web site gets 2,000,000 hits a month?

Did you know that same hospital tracks how patients made the decision to use their services?

Did you know that more than $2,400,000 dollars in fees came about as a direct result of the web site?

I’d bet the ROI on that exceeds everything else in the hospital.

can you apply social media to Patient Relationship Management (PRM)

A consultant was on one side of the river; his client was on the other side. The client hollered, “How do I get to the other side?”  The consultant thought for a moment and hollered back, “You are on the other side.”—don’t try this at home kids, we’re professionals.

It goes without saying that rarely am I regarded as one with a high capacity of tolerance.   When things get tough or when meetings are exceedingly dull I like to go to my happy place. Sometimes I get to go to my happy place when I least expect it. Like the time my coffee machine started leaking all over the floor.

Having met such unheralded success repairing my mixer, naturally I took apart my Capresso coffee maker. Not many parts. I put it back together thinking the simple act of dismembering it might have caused it to self-heal. Fill it. Turn it on. Puddle. I called Capresso started to explain my problem. Before I had a chance to finish the rep told me what caused the problem, asked for my address, and said they would mail a new gasket overnight for free, as in F-R-E-E. No proof of purchase needed.

Talk about managing the customer experience and taking the lead on social networking.  What types of things could you be doing to improve Patient Relationship Management (PRM)?  How could social networking help you improve PRM?

Let’s talk.

Can you name your Chief Patient Officer?

(This column is not outsourced to Mexico.)

How many chiefs can you name? C-Levels, not Indians. I found these–COO, CIO, CTO, CMO, CMIO, CEO, CAO, CFO, Chief Purchasing Officer, Chief Network Officer, Chief Engineering Officer, Chief Benefits Officer, Chief Development Officer, Chief Brand Officer, Chief Staff Officer, Chief Health Officer, Chief Legal Officer, Chief Quality Officer.

Besides who gets the corner office, these titles demonstrate a firm’s commitment to those areas of their business, and these positions provide that business sector visibility all the way to the top of the firm. There’s a certain cachet that comes from having your sector of the business headed by a C-Level. Those are the ‘in’ jobs, the jobs to which or to whit one is supposed to aspire. You never see anyone clambering for a B-Level position. B-Level is the repository for all non C-Level jobs.

Remember Thanksgiving dinner when you were a child—apologies to those of who aren’t from the colonies. Anyway, if yours was anything like mine, there were two tables, the nice dining room table for the adults, and the smaller card table for the children, the B-Level guests.

So what does this have to do with patient care? You tell me. Let’s go from the premise that the C-Level positions are an accurate reflection of you firm’s focus. Why are we in business? If you go from the premise it must be because of finance, marketing, IT, Purchasing, or any of a dozen other things. The only thing missing in this view of the firm is the patient. The only entity without a seat at the grownup’s table is the person in the firm responsible for the patient. It seems to me a firm’s very existence, it’s raison d’être, is the patient. If that’s true, when do they get to eat with the grownups?

Patients Relationship Management-why not think like one?

I met last week with a number of 1st Year MBA students who have a consulting club to help them figure out if they are suited for this noblest of all professions–supposedly the second oldest profession. “How can you tell if you’ll be any good at it?” They asked.

As far as I can tell, there are two basic requirements. One, you have to be a bit out of kilter, a tad of ADHD doesn’t hurt either. You have to hate repetition.   Second, it helps if you have a belief that there is almost nothing you couldn’t figure out how to improve. While thinking it doesn’t make it true, the attitude is a critical success factor.

For example, I just returned from the post office.  Noon on the Wednesday before the holiday–lunch time rush hour.  I’m standing in a long line underneath a banner with a message emphasizing quality.

There are two clerks, postmen, postpersons, postladies–I’m not sure which one is most appropriate, but as we both know, I’m not going to lose any sleep over it either. The line is out the door. Clerk ‘A’ tells clerk ‘B’, “I’m going on break.” At which point I turned to the person next to me and uttered, “And I’m going to UPS.”   It’s not that difficult to improve.  Not letting half of your customer-facing employees go on break during your busiest time would be a good way to start to improve things.

It’s not rocket surgery. Patient Experience Management, Patient Equity Management. Whatever you call it, big inroads can be made.  Quit thinking like an executive and start thinking like a patient and you’ll have plenty of ideas.

Patient Relationship Management-Master of the Jedi Order

They don’t call me Yoda for nothing. This little rant is for those acolytes drinking the Kool Aid of disbelief, the recipe that says that one day, if we stay the course, this will all get better, those who believe that the light at the end of the tunnel isn’t a train.
For the next few minutes try and disassociate yourself from your responsibilities at work and become a patient.  Recall a time when you’ve been a dissatisfied patient. If you’re totally honest, that simple exercise should quicken your pulse. Cold beads of sweat appear on your forehead; your palms feel a little clammy.

The transition is faster than Clark Kent in a phone booth. A mild mannered and pedestrian acolyte transformed into a right-winged, Myers-Briggs INTJ A-Type with a passion for metaphorically devouring the unfortunate person awaiting your visit.

As you think about managing the equity of your patients think about it from the perspective of the patient, goodness knows they do. That relationship is black and white—there are no shades of gray. It’s good versus evil, Yoda versus Darth Vader.

I think with most patient interactions the patients believe that the person on the other end of the line is incented to make them go away as quickly as possible and at the lowest possible expense to the provider.

For most patients, patient loyalty is a thing of the past. Who do you do business with? Why? For any product that is even close to being a commodity, I deal with the firm who I find to be the least offensive, the one that will irritate me the least. That’s why I buy cars on EBay so I never again have to hear the phrase, ‘What’s it going to take to get you into that car?” If you find yourself doing that, why is it such a stretch to believe that so many patients feel the same way? That said, could it rather naïve to believe that your firm’s current approach to patient relationship management will make any difference?

Taking Care of Patients (TCOP)

 

 

 

 

That’s me in the back row–just kidding. There are approximately 640 muscles in the human body. Yesterday I pulled 639 of them. In anticipation of the onset of winter I’ve been ramping up my workouts, and at the moment am scarcely able to lift a pencil. I came across an article that describes the full body workout used by the University of North Carolina basketball players. It involves a ten-pound medicine ball, and 400 repetitions spread across a handful of exercises. I’m three days into it and giving a lot of thought about investigating what kind of workout the UNC math team may be using. At my son’s basketball practice last night, the parents took on the boys—they are ten. That 640th muscle, the holdout, now hurts as bad as the rest of them.

So, this morning I’m running on the treadmill, because it’s cold and the slate colored clouds look heavy with rain. While I’m running, I am watching the Military History Channel, more specifically a show on the Civil War’s Battle of Bull Run—I learned that that’s what the Yankees called it, they named the battles after the nearest river, the Rebs called it the Battle of Manassas, named after the nearest town. The historian doing the narration spoke to the wholesale slaughter that occurred on both sides. He equated the slaughter to the fact that military technology had outpaced military strategy. The armies lined up close together, elbow to elbow, and marched towards cannon fire that slaughtered them. Had they spread themselves out, the technology would have been much less effective.

Don’t blink or you’ll miss the segue. You had to know this was coming. Does your hospital have one of those designer call centers? You know the ones—wide open spaces, sky lights, sterile. Fabric swatches. The fabric of the chair matches that of the cubicle, which in turn are coordinated with the carpeting. Raised floors. Zillions of dollars of technology purring away underfoot. We have technology that can answer the call, talk to the caller, route the caller, and record the caller for that all important black hole called “purposes of quality.”

The only thing we haven’t been able to do is to find technology to solve the patient’s problems. Taking Care of Patients (TCOP).  We’ve used it to automate almost everything. If we remove all the overlaying technology, we still face the same business processes that were underfoot ten years ago. Call center technology has outpaced call center strategy. Call center technology hasn’t made call centers more effective, it’s made them more efficient. Call center strategies are geared towards efficiencies. Only when we design call center strategies around being more effective will the strategy begin to maximize the capabilities of the technologies.