Can You Decrease Readmissions By 50%?

The June 10, 2014 issue of Hospitals & Health Networks (H&HN) contained the article Technology is the key to patient engagement at the individual level. It is worth reading.

It got me wondering about how we define engagement, wondering about engaging patients, and about engaged patients. I think engaged patients are the result of different efforts. Most efforts to engage patients stem from efforts made by the hospital.  They tend to be one-way, from the hospital to the patient. They reflect how the hospital feels its patients need to be engaged.  What they miss by not being two-way is a knowledge of how patients feel they need to be engaged with the hospital.

If the engagement were two-way both the patients and the hospitals would benefit.

I believe technology will be key to patient engagement. I think that designed correctly technology should play a major role in reducing readmissions. I also believe that someone should consider asking the patients how technology could help them.

I recently developed a patient access/experience strategy for the call center of a large teaching hospital. One finding was that 99% of all of the patients who asked to speak with a nurse received a voice mail stating that a nurse would get back to them within 48 hours. Because of my fear of large numbers I did not calculate the cost of those callers who went to ED, but it was orders of magnitude higher than the cost of having a nurse or two in the call center. Most of those who went to the ED did not have an emergency. Many simply wanted a refill.

Let’s look for a moment from thirty-thousand feet at how the discharge process works at most hospitals. When I am discharged I sign my discharge orders, and if I am lucky someone from the hospital calls me in a few days to ask how I am doing or feeling. If someone calls me on day three, and my wound opens on day four, or I am feeling sick, or there is a complication from my treatment or from my procedure or from my medication or from something new, what are my likely responses?

I could call the hospital—see above; I could ignore it; or I could go to ED.

If I was unsuccessful previously calling the hospital, I may not even consider that option. If I call, I might speak with someone who could help me, or I could get a busy signal, I could be put on hold, my call could be transferred, or I could be sent to voice mail—see above. Four of those responses are not good for me, and all five may not be good for the hospital.

Why? If I do not get to speak with someone, chances are that I will solve my problem by going to ED. If I do speak with someone they may tell me to go to ED or to the hospital. Chances are good that the hospital is going to incur a cost and record a visit that may
not have been necessary if the hospital had provided me with a technological

What might that technology look like?

I see it working something like this.

Before I am discharged the hospital adds me to their discharged patient portal, an interactive portal that contains information about the specifics of my illness or procedure—my meds, their side-effects, complications that could occur and what I should do about them, symptoms that may arise and what I should do about them. The portal also allows me to input data. I can input that I took my medications and any side-effects I am having. I can input any complications, my diet, exercise, BP and pulse, weight, and any
questions I may have.

The system would be designed to alert someone at the hospital each time any of the data I input is outside of the acceptable norms. This way, instead of me playing doctor and determining what I should do, the hospital can act before I act. They can have someone call me, can send a nurse to my home, or can send a physician to my home.

Not every patient will use this technology, but each one who does will not only be doing themselves and the hospital a favor, they will be more engaged and will have a better overall experience.


Patient Experience: Does it all come down to wearing sensible shoes?

The plane’s preflight music was Celine Dion, and i felt my IQ beginning to drop. Her music has the same effect on me as a Vulcan nerve pinch, making me want to curl into a fetal position. Given the choice of having to listen to an entire Celine Dion CD or sticking finger in an electrical outlet, I would give the outlet serious consideration.

Men are to talking about golf the way their counterparts are to talking about sensible shoes, only worse. Personally, I would rather listen to the discussion about espadrilles. Case in point. The gentleman on the flight. His shoes looked like they were woven from the skins of chicken ears.

“I was playing the thirteenth hole at Augusta…”–or some place, the place didn’t matter to me any more than what followed.

“Do you play?” I nodded. “What’s your handicap?”

“My swing,” I said. He smiled at me indulgently, like Ward Cleaver might have looked at June if she had accidentally dropped a brownie on the new carpet.

“The hole cat-legged to the right, and I have a natural slice. And there were three bunkers about a hundred and eighty yards out, hidden by a berm at one-seventy. You can sense my problem, can’t you.” I wanted to tell him that I did, and that it wasn’t anything that counseling couldn’t correct.

“I had my three-wood and I was playing a Titlest Pro–and you know what that means. The temperature was eighty-one, a ten-knot headwind, and the humidity had to be thirty-four. And since there was a waning moon, gosh only knows what that was going to do to the rotation of the ball once it reached altitude. I can’t even begin to tell you how nervous I was about having to figure in the curvature of the earth on the flight of the ball.”

“What kind of shoes were you wearing?” I asked.

I’ve read novels about the training snipers undergo to learn how to calculate the flight of a bullet and it seemed a lot less complicated than what this guy had to consider with his golf ball. I deja-vued to the scene in the movie “Airplane” when the woman seated next to the film’s protagonist on the plane hanged herself rather than having to keep listening to the whinging of the man next to her.

Not wanting to hear about the other seventeen holes, I pulled out my laptop, plugged in my earbuds, looked out of the plane’s window and tried to determine what affect the curvature of the earth would have on my writing. Negligible.

When I ponder the complexities of healthcare I wonder why payers–the dark side, and providers eschew fixing the easy problems. Population health management, ACOs, and the Affordable Care Act–the oxymoron is theirs not mine are very complex issues affecting both parties. These issues mandate that a lot of their strategic initiatives should be planned on an Etch-A-Sketch using a wije-board. Goodness knows how you run a business effectively when weekly Washington is firing SAMs at your attempts to figure it all out.

Just what are the easy problems being overlooked? Patient/Customer/Consumer experience.

Payers are going from a B to B model to a B to C model. Raise your hand if you enjoy calling your insurance company. Can you imagine what it will be like trying to get someone to talk to you in a retail insurance market? “The average wait time to speak with an agent is expected to be three-and-a-half weeks.” Payers should Google the word “churn.” People are going to be jumping off of that bandwagon like fleas off a dog sporting a new flea-and-tick collar.

Providers are starting to wonder where there next dollar is coming from. Clinics stole away many of their most profitable offerings, so they’ve been trying to add primary care providers (PCPs) to lock in revenues. Retailers (think CVS and Walgreens) hijacked many of the most profitable and most frequented offerings of the PCPs, so we can say goodbye to those revenues.

With that being the case, it would seem sensible to focus on any strategy that might help retain patients, customers, and consumers. Gone are the days when a provider could say “we don’t have customers, we have patients.” Without paying attention to the experiences and expectations of whatever you call them you will have neither.

The value payers and providers place on customers is very different from the value customers place on payers and providers. And the value gap is getting wider each time either organization fails to answer its phones, and fails to provide a way for a customer to complete their business online.

People need two things from their provider–they need to get better, and they need to be able to do business with their provider. With payers they need their claim to be covered and they need to do business with their payer.

Currently, the only way to do business with either one is to call them. And the people who have to make those calls would rather sit and listen to someone talk about golf than having to call.

Since neither business will ever provide a service that enables people to conduct all of their business needs correctly, one hundred percent of the time without being placed on hold or transferred to someone else who will not be able to help them, why not design a customer portal that can meet correctly, efficiently, and effectively all of their needs every time?

It all comes down to access.

A remarkable experience for every person every time on every device. It’s not a pipe dream, it’s a requirement.

Stay safe my friends, and may all of your shoes be sensible.

Dying to Improve Patient Experience?

I stumbled across an article on the La Brea Tar Pits.  For those unfamiliar with them, over thousands of years the gas from oil deposits close to the ground evaporated leaving the byproduct tar oozing from the ground.  As it happens, this oozing is in LA, as in Los Angeles.  To date more than three million fossils have been excavated from the tar, including fossils of saber-toothed tigers and wooly mammoths.

It made me wonder what would happen if tar pits were discovered today in other US cities. My guess is that the EPA would immediately declare the site off limits and establish it as a Superfund cleanup site.  The Feds would look into whether British Petroleum was somehow behind the leak, thinking perhaps that BP simply dumped the oil it cleaned up from the Gulf of Mexico disaster.

Next we have Blockbuster, the video chain that required two trips to their store for every one use of their product.  If you are wondering why there are so many Rite Aids and CVSs in the US, I’m guessing most of them are housed in former Blockbuster buildings.  Redbox will be the next and final video chain to go bye-bye.  Maybe CVS can figure out how to squeeze a Minute Clinic into a box.

Several years ago I attended a convention on customer experience whose keynote speaker was the most recognized CEO in the cable television industry.  A reporter noted that cable television subscriptions had capped at around seventy percent, and remarked that it would not get any larger due to the number of older people who do not use technology and who did not subscribe to cable.  The reporter asked the CEO how the industry would deal with that situation.  The CEO stated “We are waiting for them to die.”

Healthcare does not have the luxury of waiting on anything.  There are those who want to skirt the issue by saying that we have patients who do not use technology, people who do not have access to the internet.  Indeed there are.  However, the converse is true and it is true in much larger numbers.  Applying technology to patient experience is not a binary trap, not an either or situation.

One of the great things about technology is that it is impartial, it does not takes sides, and it is relatively difficult to hurt its feelings.  Plus it has a great memory—it gives the same answer, the correct answer, every time to the same question.

Foresight versus hindsight.  How difficult would driving be if the only view available to the driver was the view from the rearview mirror?  Three years from now the best hospitals will look back at these discussions and wonder why not reinventing patient experience was ever an option.

Three years from now the other hospitals will look back at these discussions and wonder why reinventing patient experience was never an option.

Patient Experience: What Patients Hate The Most

The world record for the high jump remained unbroken for years.  Do you know what had to happen to break it?  Somebody decided to try jumping backwards…Today we are going to look at how healthcare can jump backwards, not it time, but doing something totally different and far from its comfort zone.

My wife and I had finished having dinner at a nice restaurant and we were waiting for our check.  The waitress brought it.  I looked at the amount and it was only twenty percent of what I had expected. A moment later the wine steward appeared and laid a slip of paper on our table—forty-five dollars.  In turn came the busboy, the sous-chef, the maître d, the dishwasher, the pastry chef, and the head chef.  All told we received eight separate bills for our meal, and no single bill showed the total amount.

To say the least it made for a confusing experience.

When we bought our house, our bill—the settlement statement—showed what we owed down to the penny.  We did not get separate invoices for the plumbing, the windows, the fireplace and the roof.  We also did not get an invoice so detailed that it itemized every nail and every tube of caulk.  Somehow those costs were folded in to other costs.  Do you know how they avoided the problem of multiple bills, paid to multiple contractors with multiple terms?  The builder acted as the general contractor.

It made for a much better experience than if we had been invoiced separately.

Since we all know where this is heading, I’ll head there quickly.


  • There is no organization acting as the general contractor
  • Multiple invoices from multiple vendors
  • Different payment terms by vendor
  • Different coverage by payer
  • Excruciating line item detail—itemizing Tylenol
  • Nothing showing what is covered and what is owed and why
  • More complexity than a detailed IRS tax return
  • Patients do not know what they owe and to whom they owe it
  • Patients do not know what is covered and why other things are not covered
  • Patients do not know what anything cost ahead of time
  • Hospitals do not know their costs—they only know what they charge
  • Two people having the same procedure at the same hospital will not be invoiced the same amount

The entire hospital billing process makes for an awful patient experience.  Healthcare is the only service someone can purchase without having any idea what they owe and why.  If the amount is large enough it remains an awful experience for months and years until the amount is paid.

I’m guessing, but I would be willing to bet that not one person in fifty in a hospital could accurately explain a patient’s total charges.

The entire billing process could be reimagined, it could be reinvented.  And the reinvention could include a single bill.  For those screaming at their PCs that it cannot be done, the only reason it cannot be done is that it has not been done, and that is not a reason.

Patient experience has to do with dozens of things that are very important to patients, things that hospitals have not changed in decades.

To be the hospital of choice you have to be the hospital people choose, and people will choose the hospital that is the easiest to do business with.

Patient Experience Surveys: Too Little Too Late?

I am not a fan of surveys, not even a little bit.  For example, if I included a survey at the end of these comments to see how you feel about surveys, nobody would believe the results would impact my opinion about the value of surveys.  At best it might suggest that at least I appeared to be interested in what others thought.

These are my issues with trying to shape or modify a business strategy based on the information reported in surveys:

  • Most of those being surveyed are no longer your patients or customers.  Once a patient is discharged their ID badge changes—it changes from patient to prospective patient.
  • Prospective patients do not know what changes you have made based on the survey results you obtained because they are not patients any longer.
  • The best results hospitals can hope for by using survey results to drive change, other than trying to avoid CMS penalties, is a campaign that says “although you may not have liked us last time, now that we’ve read your survey responses we think you should give us another shot.”
  • Hospitals are not static.  Healthcare is not static.  Surveys results and Press Ganey data are not current.  The value of trying to implement change based on data that is seven months old would be like NASA trying to get to Mars—it takes about seven months—by aiming the rocket at where Mars is today.  It will not be in the same position in seven months and neither will the hospital.
  • If every hospital is trying to change by doing the same things over and over again using old data, it would seem that the only possible outcome is that their position relative to one another will change.  If you are ranked in the 51st percentile and I am ranked in the 49th and we both try to change our scores based on survey data, aren’t we equally likely to have scores that are pretty similar to each other.

Imagine that at HIMSS 2014 CMS holds a reception and one representative from every hospital attends.  Along with your drink coupon you are given a dart.  At the end of the room is a large cork board, and above the board is a banner titled “The Patient Experience Challenge.”

The CMS representative throws the first dart.  The position of your dart as compared to the position of the CMS dart determines whether or not you will be penalized.  The fifty percent of the hospitals furthest away lose.  Now here is where it gets interesting.  Everybody retrieves their dart and we run the contest again.  If we did that I am guessing two things would happen:

  • On almost everybody’s second throw the dart will end up in a different spot from where it was on their first throw
  • Most of the people whose throws were close to the CMS dart will still be those closest to the CMS dart, those whose darts were furthest away will still be furthest away, and many of those who were borderline will exchange places.

It seems there is little merit to scoring better than the 49th percentile.  I write that because the goal of what is being contested is to avoid the CMS penalty.  If we are being candid we know that raising patient experience scores is not the same thing as raising patient experience.  The two tasks require different strategies, focus, and different resources.

The hospital that wins the patient experience battle is the hospital that chooses to do what their competitors and peers are not doing.

When Hospital Leakage Turns Into a Flood

A connection of mine on LinkedIn who is undergoing chemotherapy at Baltimore’s top hospital wrote to tell me that between treatments she called the hospital to schedule an appointment. Between being on hold, having her call transferred, and being given different numbers to call it took three hours for her to schedule the appointment.

Because the hospital failed to perform a simple business process over the phone she told me she will make it her life’s mission to tell people, whatever their illness, to get treatment at another hospital. The hospital will not retain her beyond this illness. A loss of retention and referrals. They cannot put the toothpaste back into the tube. The direct cost of the call to the hospital—thirty dollars. The cost in lost revenues to the hospital for not being able to deliver the expected level of satisfaction will probably be six figures.

There is no universal patient experience solution. HCAHPs is doing good, but hospitals were addressing those issues prior to CMS imposing their strictures. From where I sit HCAHPs does not pass the test of being both necessary and sufficient.

I am trying to raise the discussion to suggest that patient experience is more than HCAHPs. If we look up ‘patient experience’ in the dictionary it should say something other than HCAHPs. I use the Total Quality of a person’s Encounter (TQE). I use person instead of patient because the largest group of stakeholders who have experiences with a hospital are prospective patients, those who ‘visit’ the hospital online and by phone.

I define TQE as follows:

TQE = HCAHPs + all of the nonclinical touchpoints

The nonclinical touchpoints begin before a person is admitted, they begin when people are selecting a healthcare provider, and they continue after discharge.

Most people limit the impact of the Affordable Care Act to payers. Yes, people will be able to choose their payers. Hospitals need to recognize that many people will choose their payers based upon the hospital where they elect to be treated.

Today hospitals cannot even track leakage, let alone figure out how to curb it. Under the ACA people will be issuing virtual RFPs for healthcare, and if their experience on the phone or on a hospital’s website is not remarkable that hospital will be out of the running before if ever knew it was being considered.

I believe that within three years the best hospitals—those that offer a remarkable experience every time on every device—will be those that a person can carry that hospital’s functionality around on their iPad, just like they can carry around the functionality of Amazon today.

People feel they are paying a hospital for two things:

• Outstanding care
• Ease of doing business with the hospital

While outstanding care is valued higher than whether the hospital can answer their phones, if they cannot answer their phones they may not be given the opportunity to showcase their care.

How Are HCAHPs Leading You Astray?

I dropped by the Minute Clinic for my flu shot.  The forty-something woman ahead of me, whose purse was the size of a small Winnebago, stepped up to the kiosk to sign in.  I may have mentioned in a prior post that I was at the back of the line when God was handing out patience.  After five minutes I began to get a little exasperated.  Her ability to interface with technology reminded me of a chimp learning to play the bagpipes.  Knowing she was going to be a while I retreated to the shaving aisle, grabbed a can of shave cream, a razor, and cleaned myself up a bit.

While the Minute Clinic may be a Godsend for parents in terms of convenience, cost, and immediacy, the user experience (UX) could be improved.  What user experience?  The one that has to do with their automated sign-in. The user interface (UI), although childlike in its simplicity takes more time to complete than the exam.  Your hospital’s website is probably chocked-full of UX and UI opportunities.

Moving on.

Observation may be one of our best teachers, but by failing to observe what we see every day, what is commonplace, we often miss what can be learned from it.  Here is a real-life example that occurred to me from having watched a human interest story on the local news about neighbors banding together to try and rescue someone’s pet cat that was stuck in a tree.

Ladders.  Catnip.  Clawed rescuers.  The cat eventually came down of its own accord.

Here is the observation; have you ever seen a cat skeleton in a tree?  What can be learned?  Maybe cats do not need rescuing.

Innovating patient experience has many similarities with cats stuck in trees.  Somebody overthinks the problem, regulates it, and we throw resources at the problem trying to avoid the regulators.  We establish committees, have meetings, and create reports.  We discuss the problem, we recall what happened the last time we had this type of problem, we bring in experts whose skills are particularly attuned to solving this problem, and then we attack it.

The one thing we fail to do is to validate whether the problem as defined by Washington, and the solution, as defined by Washington—raising the scores of thirty-two questions—is the right approach. This approach presupposes that higher scores are reflective of higher patient experience.  Is it possible that higher scores are simply reflective of having figured out how to avoid CMS’s penalty?

Thirty-two.  A very precise number.  Thirty-one questions were not enough.  Thirty-three would have been one too many.  Thirty-two questions was just right—sounds a little like Goldilocks and the Three Bears.

Those thirty-two questions do not address anything the patient may experience before coming to the hospitals or after leaving the hospital.  They do not address what type of experience prospective patients, people who want to buy healthcare, have when they call the hospital or look online for information about the hospital.

This link takes you to a brief deck listing questions about someone’s experience that were not asked by CMS.  The answers to these questions affect whether someone will buy healthcare from your organization, whether they will buy it again when they require additional care, and whether they will refer your organization to others.

I have done the math.  The financial benefits of getting favorable answers to these questions far exceeds the financial penalty imposed by CMS.  The best you can do by scoring well on CMS’s questions is to avoid a penalty.  The best you can do by scoring well on my questions is to add revenues.

You decide how you want to play it.  Meanwhile, the cat in the tree is doing just fine and does not require any help. If it does, there is always gravity.

Everything You Need To Know About Patient Experience

Which of the following statements are false?

  • Forty-eight percent of us believe aliens have visited the earth
  • Thirty-four percent of us believe in ghosts
  • One percent believes the earth is flat—“I put a post in a hole and adjusted it until it was level. That means the earth is flat.”
  • Eighty-to ninety percent of hospitals CEOs believe improving patient experience is one of their top three objectives in the next three to five years.

I can believe the chair next to me will support my weight, but unless I actually sit in the chair merely believing is not worth anything.

Hospitals would have us believe that what is important to consumers of healthcare is that the product—healthcare—is the same as the process of interacting with it or buying it are one in the same, or their belief that process has nothing to do with it.

Take flying for example.  Airlines want us to focus on the product, getting us from Point A to Point B.  They do not want us to focus on the fact that they will charge you if you use your flotation device, your flight will be late, and that they have packed more people into the plane than were in your high school.

My hospital has a website, let’s move on.

The US economy has developed a dependence on digital performance, including the twenty percent tied to healthcare.  Healthcare, hospitals in particular, have developed a digital illiteracy, independence, or naive indifference on all things digital and on all things related to process.

Believing that because your hospital has a website means it understands the impact the digital world should play in its business model is like believing that reading Oliver Swift gives you keen insight into what it is like to be an orphan.

The C-Suite needs to understand that technology is not the same as digital; in fact they have little in common.  In a hospital technology equates to cost—to back-office functions, to supply-chain, to why ICD-10 may be a disaster, and how it is possible to spend three hundred million dollars on EHR and see productivity take a nose-dive.

Digital is different.  It is not some emergent trend.  Please do not stop reading here even though many will disagree with what follows.  Digital is Amazon and eBay, but not in the way most people think about them.  It has nothing to do with CDs, movies, or laptops.  It has nothing to do with what they sell or the price at which it is sold.  It has everything to do with the process by which customers act with what is being sold.

The process, the processes are everything.  They are everything that the processes within a hospital are not, everything that the health exchange is not.  The processes are:

  • Intuitive
  • Easy

And the processes are intuitive and easy because they were designed to be that way.  We are not talking about tweaking things.

The less you understand about the importance of having a remarkable digital presence the less likely you are to have one.  Hospital executives may understand it least of all.  The poorer your understanding, the poorer the delivery of your product is, and the poorer its perception is in the marketplace.

And to make a bad story worse, by the time your hospital gets it your competitors will have already passed you by.

We are not talking about being better at what you are—the grammar is poor but the intent is not.  The discussion that your customers are begging for, the discussion they expect is about your hospital becoming what you are not.

And what does being what you are not look like?

In less than three years every hospital process, every single nonclinical function that is performed today by nonclinical employees will be performed by your patients and by prospective patients.  Every process will be performed without waiting and without error and without much cost.  It will performed digitally and on a device and at a time of the person’s choosing.

Your customers will carry your hospital around in the purses and briefcases.  And that is how I define improving patient experience.

The Ten Commandments of Patient Experience

According to social media mavens, people are a lot more likely to read your blog if the title includes phrases like the five best, the six most, and seven things you should never do.

Hence, the ten commandments of patient experience.

When I began commenting about improving patient experience I drew comparisons of a hospital’s business processes to those in the hospitality industry, and I was liberal with my use of the word customer instead of patient.  Readers used to throw metaphorical tomatoes at their monitors.  Over time that angst subsided, was replaced by indifference, and most readers began to accept the notion that having a heretic in their midst was the new steady-state.

Few have accepted the notion that most hospitals ought to at least augment their patient experience focus to include what happens outside of the hospital—prior to admissions and after discharge, and fewer still are paying any attention to the largest group of stakeholders—non-patients.

After all, patient experience for non-patients is a non sequitur.  Or is it?  Most people who are discharged change their status; they change from patient to prospective patient.  For them to become a patient again, to be treated for something new or to undergo a new procedure, the hospital must acquire them. 

The unique thing about prospective patients is that all of them reside outside of the hospital.  If your patient experience focus is entirely within the hospital you have no idea what experiences those people have and whether or not those experiences are even satisfactory, a poor benchmark by anyone’s standards.

What are those unmeasured and unreported experiences?  They include access in all of its forms.  Scheduling, admissions, second opinions, billing, complaints, labs, and discharge.  They happen online and on the phone. 

And, if they do not happen well, they will not happen again.  Those people, whose experiences of trying to do business with the hospital are poor, will go somewhere else.  Those people, the hospital’s assets with a lifetime value of between $180,000 to $250,000, will move that asset to another hospital.  They are the same people who cost less to acquire as patients than do the ones who are not even looking at your hospital’s website or calling the switchboard.

Anyway, back to the commandments.  There is only one—

A remarkable experience for every person every time on any device.

How Can Reinventing Patient Experience Decrease Readmissions?

As I was going up the stair, I met a man who wasn’t there.

Then I read an article espousing the ROI of EHR.  I leave it to you to decide if these two activities are one in the same.

I also read an article on reducing readmissions in this month’s HealthLeaders, Readmissions: The Big Picture.  Perhaps it is because my synapses do not work the way they were intended to work, but the first thing that came to mind for me was How could Patient Experience be reinvented to help contribute to the goal of reducing readmissions?  Could deliberately coloring outside of the lines help to solve a real problem?

It absolutely can.  One reason patients readmit is because of their failure to comply with their discharge instructions.  They do not do what they are supposed to do, they do not do it with the frequency with which they are supposed to do it, or they do not understand what to do, who to contact, how to contact them or when when something goes akimbo.  And worst of all, nobody at the hospital knows anything about these failures until the patient is readmitted.

Many of us have been discharged.  I remember the discharge process as the only thing standing between me and the front door.  I would have nodded to anyone and signed anything to be home and to have the hospitalization behind me.  I would read the fine print once I was paroled, once I had a real television remote in my hand, not some off-white three-channel device that was tethered to the hospital bed.  Is it possible that more than a handful of patients feel this way?

Since you cannot give patients a test to confirm they understand their instructions prior to discharging them, and you have no control of patients once they leave, is the situation hopeless?

Patient experience continues once patients are discharged.  Or it could.  Post discharge, most patient experiences—and family experiences—consist of calling the hospital for a variety of reasons; understanding discharge instructions, scheduling a follow-up appointment, scheduling a lab, understanding a bill, filing a claim—reasons very similar to those encountered by patients before they are admitted.  Unfortunately, the people being called may not know the right answer to any of these questions.  Unfortunately, the line may be busy; it may be after hours, or during the lunch break.  Access 8 a.m. until 6 p.m.

They call the hospital.  How well did that work?  If the answer is not well, they may be on their way to having a very poor experience.  If it concerns their discharge instructions they may be on their way to being readmitted.

Here’s how we can tie reducing readmissions to patient experience.  It is not complex, it does not require and MD or a PhD, and it is not really all that innovative unless innovation means looking at solving the problem in a way that differs from the way solving problems is normally looked at.

It is all about access, two-way access.  Two-way access between the hospital and the patient.  Digital and mobile access.  Twenty-four by seven.  I know you do not do it this way, and the natural reaction to this idea is that some of you will have a long list of reasons why this cannot be done or why it will never work at your hospital.  It won’t work for people who do not want it to work, or who may not have the skills. One invalid excuse for it not working is not because it cannot be done.  It can, someone just has to tell someone to make it happen.

Let us take a non-natural reaction, just for a minute.  I envision the following—this is not exhaustive, it does not come from hours of research.  It is just a back-of-the-napkin idea that I would like your opinion as to whether it is worth another napkin or two.

What if the complete discharge summary, and everything patients needed to do, could be available to the patient and the primary care provider in real-time, at the time of discharge?  What if the patient’s behavior and compliance could be recorded, tracked, and reported?  Online access.  Perhaps on an iPad type of device.  Let’s use me as an example, me, the guy who was in too big of a hurry to get discharged to pay attention to my instructions.

Now that I am home I read the instructions.  I register on the website using some form of secure ID that pulls up what I need.  I read about my medications—what they are for, when I have to take them, possible side effects.  I discover that I can track my recovery progress on the site, enter when I take my meds, record when I may have exercised or gone to therapy, perhaps enter what I ate, my blood pressure, and weight. 

Maybe my wife logs in and helps me schedule an appointment, therapy, or a lab. If I schedule a lab the site tells me my instructions prior to having the lab work done, and I provide an electronic signature to confirm my understanding of those instructions.

If I have questions I use the online chat function, or I submit a question that will be replied to within an hour.

My primary care provider can access my progress.

This is certainly not an exhaustive list of tasks, and it deserves more consideration than the twenty minutes it took to write this post.  However, if you pair the idea of decreasing admissions and increasing access, and do so using user-centered design to create an intuitive user experience you may be surprised by the results.