What Does Remarkable Patient Experience Look Like?

My mother would tell me, if a good idea goes in one ear and out of the other there must not be anything in its path to block it.

Procrustes—nicknamed the stretcher and the subduer—was an hotelier, well sort of.  Procrustes’ problem was his bed, his iron bed.  He told his invited guests that he only had one bed, and like Goldilocks, it turns out that his bed was always either too short or too long.  I should let you know that Procrustes’ actually had two sizes of bed.  That way he could ensure himself that his bed would never fit his guests.

He was not a very good host as his tendency towards sadism demonstrated.  Once a person agreed to spend the night Procrustes’ task was to make sure his guests fit the bed.  Those guests who were too tall were shortened; the shorter ones were stretched.

Something defined as Procrustean produces strict conformity by ruthless or arbitrary means.

Iron beds. HCAHPs.  Strict conformity by ruthless—CMS penalties—or arbitrary means—thirty-two questions that do not begin to cover the breadth of a person’s experiences with a health system.  Approaching it this way may make it seem everything is in harmony, and hospitals know they are all being held hostage to the same standards, no matter how wanting or abridged those standards may be.

For those who enjoy movies, one of my favorite lines comes from The City Slickers—we don’t know where we’re going but we’re making really good time.  Aren’t we though.

What if CMS added a 33rd question to HCAHPs?  The question asked of the patients—“What percentage of the time were all of the lights in your room working?” Indeed.  Here’s what I think would happen.  Press Ganey would sell you your data telling you just how many lights were not working.  The Studer Group would offer coaching services about fixing the lights, and your hospital would form a committee to figure out how to raise your scores.

When it is spelled out like this it is easier to see the fallacy of confining yourselves to the responses of thirty-two survey questions as the sole determinant of how people perceive your hospital. Why not use twenty-nine? Why not one hundred and eight?  Is every hospital identical?  Can all of the important experiences be so nicely bundled and wrapped with a bow?

Of course they cannot.

Think about access.  Patient access.  Family access.  Physician access.  HCAHPs do not address access.  Is that because access has no bearing on the experience and satisfaction of patients and prospective patients?  If access has a bearing, one might argue it has even a greater bearing than lights that always work, bathrooms that are always clean, noiseless hallways, and smiling staff.  If people cannot access the hospital using the time and means of their choosing then it is not easy for them to do business with it.

Access should be scored as follows—A remarkable experience for every person every time on every device.  Remarkable is easy to score.  The score is binary, it was or it wasn’t.  you do not put an initiative in place to take your remarkableness from a score of 7.23 to 7.33.  you put an initiative in place to take it to remarkable.

Where does your hospital score on access with regard to being remarkable?  What is your hospital doing to improve it?

Patient Experience: Why is it like Greek Mythology, and why is that bad?

The pastor was teaching on the book of Leviticus, more specifically the part where lepers had to shout the warning “unclean” as they passed people on the street.  I had a client once who tried to induce me to yell the same warning when I passed people in his office.  Sometimes instead of consulting the idea of being Willy Loman looks pretty good.

Sometimes we decide something cannot be done and our only supporting argument is because they have never been done—meaning we have tried to do them.  Some things are difficult, some are nigh on impossible, and some are impossible.  (I usually try to accomplish two or three things before breakfast.) Greek mythology tells us of Sisyphus, a deceitful ruler who was punished by being forced to roll a giant boulder up a hill, only to watch it roll back down, and to repeat the task forever.

Here is an example of a Sisyphean task.  Place you back against the wall of whatever room you are in.  Your task is to reach the other wall, and every step you take cuts the remaining distance in half.  No matter how many steps you take you will always have half as far to go from the distance of your prior step.

We all have our boulders.  Endeavoring year after year to raise HCAHPs scores and to achieve survey ratings of one hundred percent is healthcare’s Sisyphean task. There are returns, diminishing returns, and no returns.  Is the best scoring the one that places your organization in the fiftieth percentile?  What is the business benefit of being rated first or second?

Children teach us that there is a fallacy created by using superlatives and in measuring perfection.  They begin arguments with phrases like you always and you never.  These arguments are easily rebutted, for all you need is to find the exception, the instance where the tautology does not hold.

There are grossly diminishing returns earned from trying to hit benchmarks around always achieving a goal because you can prove the negative by finding a single false occurrence.

A month ago I was in Los Angeles.  The only thing I recall with certainty is that I stayed in a Marriott, and that the Marriott charged me twenty-nine cents for checking why my message light was lit, a message they left me welcoming me to the hotel.  I do not recall the floor my room was on, the side of the hall on which it was located, whether the employees always smiled, whether the bathroom was always cleaned, the noise level of the room, nor the color of the carpeting. Five months from now I will not be able to remember the name of the hotel.  Can you recall these details from your last trip?

It would be silly of anyone to ask me these things six months later.  If I am in a good mood I might invent positive scores.  If I am in a bad mood, who knows how I would score the questions.  I would certainly discourage the Marriott from taking my input too seriously, and I would caution them from investing any resources trying to change their processes based on my invented responses.

Riddle me this, then why does that seem to be the model under which everyone in healthcare operates, trying to hit Sisyphean standards?  People are asked to score their recollections about something that happened six months ago, that happened when they were in pain, bored, and taking medication.  For them to score their experience of the hospital the most favorably they have to say that something favorable happened one hundred percent of the time.  That is, the hospital was never noisy, the bathroom was always clean, the pain was always managed, and everyone always smiled.

Superlatives.  The wrong measure of success.  The wrong measures of patient experience, retention, and referrals.  Let’s face it.  Hospitals will have noise and employees will have bad days—and the patients know it.  So why then put all of your patient experience eggs in only one basket?

Patients have expectations, prospective healthcare buyers have expectations.  And yet nobody ever asks them about what expectations they have and nobody tries to design experiences around those expectations.

 Image

As an industry we are led to believe that we have our arms around patient experience simply because we are measuring and responding to survey responses, buying data, and hiring coaches.  The questions, and their resulting weights, were developed without ever speaking to a patient let alone speaking to hundreds of patients or prospective patients.

The point is that nobody knows what kind of experience patients and prospective patients expect of any of the contacts and interactions people have with a hospital.  We do not know because we have not asked.

We do not know what people expect to be able to do when they go to a hospital’s website to make a purchase of healthcare.  Clearly people go to a hospital’s website with some purpose in mind.  They expect to accomplish something.  There are dozens of things they would like to accomplish but nobody knows what they are because nobody has asked them.

This is real Patient Access:

I selected twenty hospital websites to see what I could accomplish using their site.  My tasks were simple; view available appointments, actually schedule an appointment, reschedule an appointment, schedule a lab, complete the pre-admission process, learn how to file a claim, issue a complaint, use online chat, download my personal health records, receive a clear explanation of my bill, understand what my procedure will cost me, get information about a second opinion.

Most hospital websites read like reading a Wiki:

I could not accomplish any tasks on any of the sites I visited. I could however get information about the hospital’s board, learn how to make a donation, find out about what hours the gift shop is open, get directions, read the hospital’s blog, “like” the hospital, learn what awards have been given, and learn about the history of the hospital.

People go to the web because they know they cannot get the information they need by calling the hospital.  Then they learn they cannot get what they need from the web.  Where do they go?  Who knows?  The only thing we know for sure is that their expectations about their experiences are not being met.  They also know that nothing is being done about it.

One final thing I did not see on any of the hospital websites I visited was the hospital’s HCAHPs score.  Why is that worth noting?  It is worth noting because if HCAHPs mattered to those buying healthcare, if hospital’s believed HCAHPs are an actual reflection of what patients think of their experience, the scores would be posted front and center.  HCAHPs are not important to patients.  HCAHP scores are not included in marketing letters; they are not posted on billboards, or spoken of on NPR commercials.

Meeting expectations determines whether people will buy healthcare from your hospital.  Improving HCAHP scores determines whether or not your hospital will be fined.

Improving HCAHP scores and improving patient experience are two very different goals.  Only one increases revenues.

The ROI of Patient Experience

As a parent I’ve learned there are two types of tasks–those my children won’t do the first time I ask them, and those they won’t do no matter how many times I ask them.  Here’s the segue.

Hospitals have a gazillion business systems.  Every business system can include the following three things; people—doing things, processes—the way and order in which things are done, technology—whatever part of those things that may be automated.  Two examples of business systems—ordering your meal in the drive-through lane at Burger King; open heart surgery.

Believe it or not, from a process standpoint, each of the hospital’s gazillion business systems can be sorted into one of two buckets—Easily Repeatable Processes (ERPs) and Barely Repeatable Processes (BRPs).

An example of an ERP industry is manufacturing which executes identical business systems thousands of times—clean the Pepsi bottle, fill the bottle with Pepsi, put on the bottle cap, and place the bottle in the box.

Healthcare, in many respects, is a BRP industry. BRPs are characterized by collaborative events, exception handling, ad-hoc activities, extensive loss of information, little knowledge acquired and reused, and untrustworthy processes. They involve unplanned events, knowledge work, and creative work.

ERPs are the easy ones to map, model, and structure. They are perfect for large enterprise software vendors like Oracle and SAP whose products include offerings like ERP, SCM, PLM, SRM, CRM.

How can you tell what type of process you are trying to incorporate in your effort to improve patient experience? Here’s one way. If the person standing next to you at Starbucks could watch you work and accurately describe the process, it’s probably an ERP.

So, why discuss BRPs and ERPs in the same sentence with patient experience? The answer is quite simple.  Think of BRPs—barely repeatable processes—as those processes associated with HCAHPs; exception handling, unplanned events, and knowledge work.

Think of ERPs—easily repeatable processes—as those associated with all of the nonclinical touchpoints patients and prospective patients have with the health system.  Those include:

  • Scheduling an appointment
  • Scheduling labs & therapy
  • Requesting medical records
  • Getting information about whether a second opinion is needed
  • Admissions
  • Billing
  • Payment
  • Submitting a claim
  • Queries
  • Complaints

Here is what is unique about a hospital’s ERPs:

  • Every time a patient or prospective patient tries to complete one of these processes they have an experience
  • That experience is either satisfactory or unsatisfactory
  • The hospital has no idea if the person was satisfied
  • The hospital has no idea if the person will continue to be or will ever become their patient
  • All of these processes happen outside of the hospital
  • They happen on the phone and on the internet
  • They have nothing to do with HCAHPs
  • Hospitals do not measure these processes
  • Hospitals do not try to improve the effectiveness of these processes

Hospitals behave as though these processes have nothing to do with patient experience.  Just because hospitals do not acknowledge the existence of or the importance these systems have on patient experience does not make them irrelevant.

True story—a Top 5 US hospital.  A cancer patient between treatments who is experiencing the after effects of chemo calls the hospital to schedule a follow up exam.  She spends almost three hours on the phone.  She told me that because of that one event she will never recommend that hospital to anyone.

Now to the meat of the matter; money.  Healthcare may argue that they are not in business for the money.  While that may be true, they are not in business if there is no money.  So let’s talk about dollars.

  • One study concluded that each time someone contacts a hospital the potential revenue in play is seven thousand dollars.  Provide a good experience during that contact you keep the money.  Provide a bad one and some other hospital gets the money.
  • The average lifetime value of a patient is between $180,000 and $250,000.
  • The average lifetime value of a person who chooses a hospital other than yours is zero.
  • The cost of poor experience is low patient retention and very low referrals.

The taxonomy of 99% of existing patient experience business systems is that they are ineffective, unmeasured, and proving awful experiences at the places where people touch the health system—the phone and the web.

Ignoring these aspects of patient experience is no different than having your hospital’s CFO drive down the highway while pouring bags of money from the window.

What do you think?

Are Hospitals Looking in the Wrong Haystack for the Needles?

“The time has come,” the Walrus said,
“To talk of many things:
Of shoes–and ships–and sealing-wax–
Of cabbages–and kings–
And why the sea is boiling hot–
And whether pigs have wings.”

Gibberish (I thought Jibberish was spelled with a J) is good, and often insightful.

Sometimes I have to rack my brain to decide what to write; other times it is handed to me, just begging for a response.  This is one of the “other” times.

In the fable of “Chicken Little” the chicken believes the sky is falling because an acorn fell on its head—the chicken was wrong.  In the fable “The boy who cried wolf” the people in the village are fooled into believing a wolf is attacking their village.  The people are wrong.

In the CMS fable “Everything a hospital ever needed to concern itself with regarding patient experience,” CMS is wrong.  And to make matters worse, CMS has all of the providers focusing all of their efforts on catching the wolf.  What many do not recognize is that providers would have been doing these things with or without the hard hand of CMS.

It is much more difficult to find the needle in the haystack when you are not on the same road as the haystack.  Hospitals have already found many of the needles.  Their problem is that the remaining needles are smaller and smaller, and more difficult to find.  Thus, finding each subsequent needle costs more.  Hospitals have also missed the fact that right next to the CMS haystack are other haystacks with needles the size of javelins waiting to be found.

Case in point.  Another one of the articles in HealthLeaders’ August issue, “Patient Experience and Cultural Transformation.”  To be fair, the article is perfectly fine and is likely spot-on in its representation of the survey responses it received.  Regular readers of this blog will recall that I also took umbrage with another article in this issue in my post “My review of HealthLeaders’ lead article “New Approaches to Patient Experience.” Where’s the “New”? ow.ly/obdPp.

HealthLeaders is reporting the facts, just like when Sergeant Joe Friday in Dragnet requested “Just the facts ma’am.”

Sometimes the facts do not tell the story.  Sometimes somebody needs to question the validity of the facts. Sometimes somebody needs to ask “What are the implications of those facts?”  somebody needed to have asked those surveyed “Why?”  This is one of those “sometimes.”

The article presented the results of a survey sent to the HealthLeaders Media Council and select members of its audience. Two hundred and ninety-nine completed surveys were received with a “margin of error of +/-5.7% at the 95% confidence interval.”

In the opinion of this writer, the data in ‘quotes’, while likely 100% accurate from the perspective of statistical sampling—meaning they analyzed the responses correctly, is probably 100% inaccurate from the standpoint of the what they should be doing.  At best, what providers are doing passes the test of being necessary, but it does not pass the test of being both necessary and sufficient.  It reflects the reality of what provider executives perceive they need to do to improve patient experience. It is also worth noting that even though the responses in the article were segmented between providers and health systems, patients and prospective patients make no such differentiation when it comes to their experience.

In the sciences, when one gets a result that does not jive with one’s hypothesis it is often helpful to reinterpret the result by multiplying by negative one or by evaluating the inverse of the result.  For purposes of this blog, we are going to do both.

The article reports what its respondents plan to do regarding addressing patient experience.  I originally thought about using the word ‘improving’ instead of ‘addressing’ but I chose ‘addressing’ because I am not convinced that these efforts, if enacted, will improve anyone’s experience.

As an example, what if two customer experience surveys were compared side-by-side.  One for hospitals and one for hotels.  Might they look like this?

HOSPITAL

   

HOTEL

 

What is the NO. 1 goal of your patient experience efforts?

 

What is the NO 1. goal of your customer experience efforts?

         

Improved HCAHPs Scores

36%

 

retaining customers

99%

Improved clinical outcomes

33%

 

getting referrals from customers

99%

Improved market share

9%

 

improved market share

99%

improved word of mouth

7%

 

improved revenue generation

99%

improved revenue generation

4%

     

improved reimbursement

2%

     

other

8%

     

No one is arguing that for hospitals to be successful at patient experience that they need to think of themselves as hotels.  No one is arguing that hospitals should stop trying to manage pain or to reduce noise.  The argument is that there are plenty of other things hospitals could be doing to compliment their current initiatives, things which would have a much greater impact on improving experience.

What is the business problem hospitals are trying to solve as they wrestle with what to do about patient experience?  Are hospitals endeavoring by their efforts to create a remarkable experience for every person every time?  If they were their approach would be entirely different.  Are they trying to retain patients, to earn referrals, to capture a higher percentage of their receivables?  If they were their approach would be entirely different. 

The problem hospitals are trying to solve is to avoid the CMS penalty.  Hospitals’ expenditures of people and capital are not targeted to solve an actual business problem; the expenditures are to avoid a problem created for them.

The HealthLeaders survey asked, and the article reported answers to the following questions:

  • What is the number one goal of your patient experience efforts?
  • In which of the following patient-related areas do you expect your organization to focus over the next three years for patient experience improvements?
  • Please rank your motivations for investing time or resources to improve patient experience scores
  • Who has the primary responsibility for patient experience in your organization?

Permit me to comment on these in the order in which they were presented in the article.

  • The number one goal reported by hospital executives is ‘improved’ HCAHP scores. So, let us assume the hospital achieved its goal and rocketed to the first quartile, thus removing itself from CMS’ penalty.  What do they get from that achievement? Retention, referrals? Nope?

Is this goal not an example of keeping ones focus on the hole versus the doughnut?  None of the responses listed any mention of the word ‘patient.’ Less than one in ten respondents addressed improving market share, not that the planned efforts will do much to improve share. And, none of the responses mentioned making any effort to retain patients or to attract prospective patients. 

According to the survey results, hospitals’ primary focus are on trying to meet an artificial benchmark created by CMS without knowing whether achieving this benchmark is the best thing they could be doing to create a remarkable experience for every person every time. 

What if CMS had decided that those hospitals that had the most number of physicians shorter than six feet tall would be penalized?  Would hospitals fire the height-challenged doctors?  Clearly this is absurd. Or is the analogy comparable? 

  • I am stupefied, but being stupefied has become my comfort zone.  Hospitals are going to focus their efforts exactly where they have been focusing their efforts.  If hospitals all do the same things, and they each improve by a factor of ‘X’, then has anything changed?  Forty percent are going to focus on noise reduction—earplugs—ten cents.  Twenty-five percent on housekeeping—Motel Six can give pointers and they will ‘leave the lights on.’  Better signage?  Please. 

Improving patient experience is an issue that has the attention of most hospitals.  Yet the solutions being proposed seem to be sorely lacking the following initiatives:

  1. Innovation
  2. Transformation
  3. Patient retention
  4. Patient referrals

 

  • Motivation for the effort and expenditure.  If everyone’s motivation is relatively identical, what is the likelihood that the results will be relatively identical—that is, unchanged?  At some point in time won’t the height of every hospital’s physicians be six feet or taller?

 

  • Who is responsible for patient experience?  In three percent of the hospitals the chief experience officer is responsible for the experience of the patients.  Am I missing something here?  Does that mean only three percent of hospitals have this position, or is the position merely rhetorical?  Would the cafeteria manager have scored as high or higher.

Who is responsible for the experiences of the prospective patients? Apparently nobody.  Who is responsible for the experiences of people before they come to the hospital, after they are discharged, and of those wondering if they should seek a second opinion from another hospital?  If hospitals cannot agree as to who is responsible for their current assets (patients), then we can be certain that nobody is responsible for the experience or satisfaction of prospective patients (their future assets) or for those patients seeking a second opinion.

Glaringly absent from the response categories for this survey question are the roles of chief marketing officer, sales, and business development.  If that is a true reflection of the answer to the question of who has the responsibility, then what exactly is the responsibility of those organizations?

The tallied survey responses seem to be all about raising HCAHP scores and avoiding penalties; not about improving the experience or patients and prospective patients.  Does that seem to be the case in your organization?

I have corroborated my analysis estimating that the lifetime value of a patient is somewhere between $180,000-$250,000.  That means that a prospective patient is worth the same amount.  Add to that the revenues of a patient’s family and friends and all of a sudden we are looking at numbers that demand innovation and transformation around patient experience.

Patient Equity Management. Family Equity Management.

A remarkable experience for every person every time on any device.  If this is your goal, the value of having your primary focus be reducing noise, housekeeping, and signage needs to be rethunk.

Patient Experience with a JD Power Twist

Everyone knows the elephant in the room.  Unfortunately the elephant does not know any of them.

I read Toyota’s US president has decided to change Toyota’s business strategy as a result of the latest JD Power rankings.  Even though Toyota regained the world-wide leadership in car sales on July 30, 2013, it did not have a single car listed in JD Power’s initial quality results across all body styles.

“Perhaps all of the other automobile manufacturers have discovered automotive’s secret sauce.  We sell more cars than anyone else, but what good is that if we do not meet Power’s criteria.  Sure our customers swear by us, but what do they know about cars?” Asked James Edsel. “They just want something that looks cool, has great speakers, and a USB connection.”

James continued by explaining, “We have decided to follow the strategy of the US healthcare industry.  Health systems thought they were doing pretty well with their understanding of their patients’ experiences until CMS came along with its HCAHPs ratings and told them how to really measure the entirety of patient experience.  Now hospitals can see what a tiny fraction of their patients actually thought of their care months back when they received it.  They can pay money for their own data, and hire people to make their numbers look better the next time they pay for their data.”

“After all, why rely on what all of your customers and prospective customers tell you when you can simply go to one source and have them tell us what they think we need to hear.  One report and someone else does all the work.”

I’ll leave it to you to decide if there is a workable analogy there. To be fair, I heard the analogy while speaking with someone yesterday who is way smarted than me.

JD Powers is a business.  It conducts market research based on customer surveys. It then sells the research to the automobile manufacturers.  The big difference is the automobile manufacturers are not forced to alter their business model to raise their scores.

 

Improving Patient Experience: Why not try something new?

Success and failure are often separated by the slimmest of margins. Sometimes success hinges on how you present your idea. It is possible to force the circumstances via rapid evolution to pass from problem, to possible solution, to believable, to heroic? I believe so.

Permit me to illustrate with frozen chicken. Several hours before dinner I threw the frozen chicken breasts into the sink, choosing to thaw them with water instead of the microwave. Some twenty minutes later while checking emails I wondered what we were having for dinner. Not to be outdone by own inadequacies, I remembered we were having chicken. I remembered that we were having chicken because I remembered turning on the hot water. The only thing I couldn’t remember was turning off the hot water.

I raced to the kitchen. My memory of having forgotten to turn off the water was correct. Grabbing every towel I could find, I soaked up the man-made lake that had appeared on the hardwood flooring.  While draining the lake I thought about how I might answer to my wife if she happened to return to a kitchen during high tide. My first reaction, admittedly poor, was to tell her that I thought the countertop wasn’t level and that the only way to know for sure was to see which direction the water ran. Telling her the truth never entered my mind.

Once the major puddles had been removed, I worked on version two of the story, quickly arriving at a version of the truth that seemed more palatable—tell her I decided to wash all the towels. Why not get bonus points instead of getting in trouble? Version three looked even better. Since I was wiping the floor with the towels, instead of telling her I washed the towels, why not double the bonus points? I decided to wash the floor, and wash the towels. Husband of the year couldn’t be far off.

A few hours have passed. The floor is dry—and clean, the towels are neatly folded and back in the linen closet, and the chicken is on the grill. All the bases covered. A difficult and embarrassing situation turned into a positive by quick thinking.

A few of you have asked, let’s say we buy into what you are saying, how do you propose we create a remarkable patient experience? All kidding aside, it comes down to presentation. Clearly you can’t walk into a room with a bunch of slides showing that with all of your hospital’s efforts you have only managed to improve the experience of the patients from 7.25 to 7.27.  

The first requirement to turn stalled patient experience scores into a remarkable experience for every patient and every prospective patient every time is to quit focusing only on HCAHPs.  Think of it as a patient experience 12-step meeting; “Hi, my name is Paul, and my patient experience scores have flat-lined.”  See, that was not so difficult. 

And what needs to be done?  Why not take a deep breath and decide that the time has come to lead and innovate, and to stop relying on CMS to define what patient experience means for your hospital?

Here is a start for those looking for the first step.

Define the Total Quality of a person’s Experience (TQE). I use person instead of patient because prospective patients also have experiences when they visit family members, when they call the hospital and are on the web trying to decide where to buy healthcare.

TQE = Patient Experience (think HCAHPs) + Persons’ Satisfaction (all other touchpoints)

So, how did my chicken dinner turn out? I was feeling confident that I had sidestepped to worst of it. Overconfident, as it turned out. My son hollered from the basement, “Dad, why is all this water down here?”

 

Patient Experience: So what exactly do I do for hospitals?

A number of you have written recently asking what it is I do and how I might be able to assist their organization.

I have consulted on innovating patient/customer experience for twenty-five years, having run my own consulting firm for the last seventeen. My clients on five continents have a combined customer base of more than two hundred million.

Less than twenty percent of health systems have a working definition of patient experience, and of those that do it is defined around HCAHPs. My definition is a remarkable experience for every person (patient and prospective patients) every time on every device.  Major parts of what hospitals lack are a strategy to provide that kind of experience to both patients and prospective patients.  This includes linking a mobile experience strategy and a digital strategy.  Setting this as a goal enables hospitals to focus on improving not just the care, but also on improving patient retention, patient referrals, attracting new patients, and making it easier to do business with the hospital.

In healthcare almost every hospital regards patient experience solely as defined by CMS. That ignores the experiences and level of satisfaction of those not surveyed, people seeking second opinions, and prospective patients. It ignores the experiences occurring prior to admissions, and those occurring post-discharge. It also does not address experiences formed from nonclinical processes like scheduling, admissions, billing, claims, and complaints.

More people ‘visit’ the hospital each day by phone and on the web than walk in the front door, yet nobody knows how those people rate their experience and whether they will ever return.

Eighty percent of prospective patient’s visit a hospital’s website before determining where they will buy healthcare.  Fifty percent of patients go to a hospital’s website to determine whether they will seek a second opinion. Nobody who designed the website ever asked one of those patients what information they would need to find to help them select their hospital. 

I help organizations answer these questions.

I start by helping them define a strategy for what I call the Total Quality of a person’s (patient and prospective patient) Encounter (TQE) with the hospital.  Next I complete an assessment of where they are with regard to meeting the TQE strategy including developing:

  • A digital strategy including:
    • Websites—most hospitals have hundreds of disparate URLs
    • Social media and social CRM
  • A mobile strategy for meeting their needs on various devices
    • For example, why can’t a patient schedule an appointment online or do some form of self-admitting on an iPad rather than arriving at six AM with everyone else?
  • A Call Center Strategy
  • A strategy for improving Nonclinical business processes 

Based on the assessment we jointly set priorities and a work plan to create a remarkable experience for everyone.

Attached are a few brief presentations that offer some detail.  Please let me know if we may schedule a call or perhaps meet.

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

http://www.slideshare.net/paulroemer/step-aside-hcahps

http://www.slideshare.net/paulroemer/call-center-strategies

You can reach me at paulroemer@gmail.com, or by phone 484-885-6942.

http://www.slideshare.net/paulroemer/how-to-acquire-patients-21677042

 

Patient Satisfaction: A Normal Experience Will Never Be Amazing

Are Hospital Executives Ignoring Their Own Survey Results?

I was reading the survey results of ache.org’s 2012 “Top Issues Confronting Hospitals: 2012”. Two things jumped out at me. Improving Patient Satisfaction was in essentially a statistical tie with two other issues for third place.

Second, Decreasing Inpatient Volume was essentially in a statistical tie for third place for financial challenges that need to be addressed.

Ache.org only reported the results. It did not draw any conclusions. It seems there is little point in surveying people unless someone acts upon the results–I may have made the same point before regarding HCAHPs.

That said, I will offer a conclusion, one that can be derived without studying the numbers.  I bet there is close to a one-to-one relationship between Patient Satisfaction and the decrease of inpatient volumes.  Fix one, fix the other.

I like that the survey labeled the issue of patient ‘satisfaction’ instead of CMS’ patient ‘experience’.  Every patient, and every prospective patient has an experience with the hospital. However, not every experience is satisfactory, and normal experiences will never be amazing.

Why not have your goal be “A remarkable experience for every patient every time and on every device? If that doesn’t work you can always erect another billboard.

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 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.