patient satisfaction

Patient Satisfaction: The Problem with Patient Surveys

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So there I was going through the mail and I happen upon a letter from a restaurant I dined at a few months ago, Le Nez Du Cochon—the nose of the pig—go figure, it is French.  Enclosed is a survey; twenty-seven questions.  Tell me if you know where this is headed.

The questions were grouped in a number of areas; food quality, communication with the wait staff, noise, and cleanliness of the restroom.  I completed the survey, but I was only guessing at my responses because it had been so long since my meal. What I do recall however were things that the survey did not cover.

I made my reservation online and that the restaurant had no record of my reservation.  I even remember calling the restaurant to confirm my reservation, which they did over the phone and then somehow had no record of it.

The directions I copied from their website were wrong. I told the maître de I had requested a table by the window and was promptly seated by the kitchen door.  When I went to pay for the meal I was overcharged because they brought me a wine different from the one we ordered.  The manager explained that since we had drunk the wine there was no way he could change the bill to reflect my order.

Needless to say, the directions to return home were also wrong.  My experience was poor from the moment I initiated contact until and after I arrived home.

But the survey did not ask anything related to the parts of my experience that related to whether I would return or not.  Having clean restrooms and a polite wait-staff did not overcome the rest of my experiences.

We all have experiences.  The problem is that not all of the experiences are satisfactory.

What hospitals fail to notice is clean restrooms, and scoring well on the other twenty-six HCAHPs questions are not reflective of a patient’s total experience, and they offer zero input as to the level of satisfaction a patient or prospective patient—a buyer of healthcare—had on the web or by phone.

Hiring coaches does nothing to improve the interaction on the web or the phone.

Buying data does less than nothing.  Putting those two efforts in place and thinking you have a handle on patient experience is as futile as counting backwards from infinity twice.

Patient satisfaction: A remarkable experience for every patient every time…on every device.

An Open Letter to Hospital Executives

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To whom it may concern,

I am passionate about improving the experience patients and prospective patients have with hospitals, from prior to be admitted and through post-discharge interactions.  HCAHPs only address a fraction of an individual’s experience, and surveying what happened months ago will not help retain or refer patients. The same are true regarding hiring coaches and purchasing patient satisfaction data.

I have improved customer experience and customer interactions for firms who have a combined customer base of more than two hundred million.  More people probable visit the hospital each day via the web and by phone than walk through its doors, yet the satisfaction of those interactions is unknown. This becomes even more important as the business model moves from heads in beds to population health. 

Below are links two documents for your consideration. One looks at defining a global patient experience strategy for the organization, the second lists twenty-seven questions about patient satisfaction left unasked.

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

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

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

Regards,

Paul Roemer

Chief Patient Experience Officer

What is the Total Quality of a Patient’s Encounter?

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My newest presentation: What is the Total Quality of a Patient’s Encounter? 

http://www.slideshare.net/paulroemer/tqe-slide

The Democratization of Patient Satisfaction

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So, how can you tell how the hospital’s patient experience improvement effort is progressing?  Perhaps this is one way to tell.

A man left his cat with his brother while he went on vacation for a week. When he came back, he called his brother to see when he could pick the cat up. The brother hesitated, and then said, “I’m so sorry, but while you were away, the cat died.”

The man was very upset and replied, “You know, you could have broken the news to me better than that. When I called today, you could have said the cat was on the roof and wouldn’t come down. Then when I called the next day, you could have said that he had fallen off and the vet was working on patching him up. Then when I called the third day, you could have said the cat had passed away.”

The brother thought about it and apologized.

“So how’s Mom?” asked the man.

“She’s on the roof and won’t come down.”

If you ask someone how the patient experience improvement effort is going and she responds by saying, “The project leader is on the roof and won’t come down,” it may be time to get a new leader.

There are more than 120,000 URLs returned when searching “’Why do patients choose’ hospital”.  Based on what I read, the URLs all take the reader to something written by the hospital.

Sixty percent of people say they use the internet to make a healthcare decision.  Sixteen percent of hospitals use social media.  Eighty-one percent of prospective patients stated that a hospital with a strong social media presence is likely to be more cutting edge—you do the math.

Whether your hospital has a strong social media presence may be less relevant because your prospective patients certainly do.  So what does that knowledge do to your organization’s patient experience strategy?   Do you double or triple you social media output?  Does your one or two person internet department try to out-social-media thousands of prospective patients, Twittering away, and constantly posting to Facebook?  Trying to catch up is like trying to walk across a room, and with each successive step cutting the remaining distance in half—you never get to the other side.

The social media “experts” would tell you that is exactly what you need to be doing—more is better.  I think the experts are wrong.

If the experts are wrong, what is the right approach?  The internet is a powerful touchpoint for both patients and prospective patients.  The internet is a large component of patient satisfaction, patient experience, and patient choice.

Rather than going wide and shallow with social media or social-CRM think about a narrower mobile digital strategy that goes deep. For example, think about your hospital’s website.  For starters, what you have is probably just that, just a website. 

There are dozens and dozens of reasons a patient or prospect would go to your site.  A high percentage of them go there because they do not want to try to accomplish something by dialing any of the hospital’s multiple phone numbers.  When they go to the website if it does not entice them to stay on the site, bookmark it, or make it their homepage, the website might as well not exist.

Your website is where purchasing decisions are made and lost by prospective patients, and where satisfaction is raised or lowered for patients.  If a patient cannot accomplish the task they set out to do in an intuitive and user-friendly way, their satisfaction with your entire organization just dropped.

Many more people go to your website than go through the front door of your hospital.  The good news is that you control the user experience of someone on your site.  The bad news is that most organizations are controlling it in a way that gives users a poor experience.  The list of things users cannot do on your website is much longer than the list of things they can do.

Having a tab that reads ‘schedule a visit’ is worth nothing unless the patient was able to schedule a visit, in fact, it probably kills satisfaction.  Having a tab that reads ‘get your health records’ that requires someone to download a PDF, print it, and mail it is equally bad for patient satisfaction.

What should your website be?  At a minimum it should be some combination of a patient portal and a knowledge management system.  It should also be your billing department, your scheduling department, admissions, discharge, housekeeping, food services, support groups, and education services.

Your website should offer every service your hospital offers with the possible exception of a hip replacement—a 24 by 7 virtual hospital minus patient care.  Two-way.  And mobile.  Available on any device at any time.

If you want to interact with your community, patients and non-patients, you need to go to where they are.  And where they are is online.  It is not good if someone with heart disease can watch an angiogram on YouTube or on a competitor’s website and on your website they cannot even find a meaningful cardiology link.  Online patient support groups at the best hospitals provide a real-time referral group—can your patients do that on your site or do they have to go to someone else’s?

Patients are democratizing information. If the information provided by your organization is asymmetrical, it has some catching up to do.

Patient satisfaction—a remarkable experience for every patient every time; in the hospital, on the web, and on the phone.

 

Patient Acquisition: Inverting the Sales Funnel

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The link below is to a presentation of mine on Slideshare about patient acquisition; how it is done and my thoughts on how it ought to be done.  In today’s world most hospitals spend a lot of money chasing people.  However, the people they are chasing are researching from which hospital they will purchase services.

If you know the cost to acquire a patient the traditional way please let me know.  The cost to  have a patient choose your facility is almost zero.

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

Please let me know what you think

 

 

Why your Website is Killing Patient Satisfaction

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Hospitals probably have more than one hundred points of contact with each patient.  These points of contact (POCs) begin before the patient is admitted and continue after the patient has been discharged.

The first contact may come by a visit to one of the hospital’s clinics, a 3 A.M. call to a primary care physician, or browsing the hospital’s website.

Yesterday I assessed whether the website of a large hospital group was functional or whether it was just a website window-dressed to look like a customer portal. I assess functionality based on whether I was able to accomplish what I set out to accomplish.

I counted dozens of different phone numbers to call. Along with the list of numbers were links for physician and employee portals, links to the board, a link for donors, wellness, specialties, medical professionals, and dozens more, all on the front page. 

There was even a link, albeit not a portal for patients—a rather important link since the number of visits by patients and prospective patients probably greatly exceeds the combined number of visits by all other visitors to the site.  Unfortunately the patient link was imbedded with six other equally weighted links.

I clicked the patient link and was greeted by two-dozen new links, each displayed as being of equal importance.  There were links for patients to use before coming to the hospital and links for them to use once they were home.  Points of contact with your hospital.  Points of satisfaction or dissatisfaction. 

I clicked some more.  Schedule an appointment.  There are actually two links for scheduling an appointment.  The first link gave me a phone number I could call M-F between 8 and 5:30 P.M.  What number do I call at 6 PM I wondered?  I tried the second link; it took me to the same place. Could I schedule an appointment online or through a mobile device?

What did I learn? There are 168 hours in a week.  Their scheduling service operates for 47.5 hours a week, 28% of the week’s hours. If I dialed that number after hours would I get a recording telling me how important my call was?  If my goal was to schedule an appointment using their website, or to schedule an appointment at any time on any device not only did the hospital not meet my expectation, it did not even offer me an alternative. A dead-end.

If it costs the hospital thirty dollars to schedule an appointment by phone and nothing to schedule an appointment online, why not complete the task correctly, the first time, and for zero cost?

I next looked at what I could do when I was home, more POCs, more chances to be satisfied or dissatisfied. 

Manage my medical records. Using the website I was able to print and mail, two very non-electronic processes, a request to have my records printed and mailed to me.  There was no way to submit my request using their website.  If I did not own a printer or did not have access to a printer my expectation was not met, and was I not offered an alternative.  Some people, a whole lot of people, actually like to complete tasks using a tablet or smart phone. Another dead-end.

Let’s try billing. For Medicaid patients there are two numbers to call for help understanding your bill. That means understanding Medicaid bills is a nontrivial exercise.  That tells me that if I asked the same Medicaid billing question of three different people I might expect to get three different answers.  Why not design the sight so that it provides one right answer to whatever question is asked?  Why not include an online chat feature? Why not create a link to a YouTube video, produced by the hospital that explains Medicaid billing?

Medicare.  No link to prequalifying, not even a phone number for questions.

How to pay your bill.  Perhaps the most difficult and least desirous task a patient must do. There is no link explaining the various components of the bill, and nowhere on the site is a copy of a sample bill explaining or highlighting the various sections of the bill.

There is also no link to understand how to file a dispute or a claim with a payer.  Maybe it is not possible to do this for every payer, but using the 80:20 rule there must be ways to help the majority of patients understand what they are up against rather than having them face down the evil empires on their own.

Patients come to the hospital’s website with expectations.  Patient satisfaction is repeatedly won or lost at your hospital’s website and on the phones.  POCs.  Having a tool that proposes to help patients with their bills that not only does not help them but that adds to their frustration will crush patient satisfaction.

Hospitals want patients to pay their bills and to pay them on time.  Patients who do not understand their bill will not pay more completely, nor will they pay faster.

The next time you look at your hospital’s website ask yourself how different it would look had someone asked a patient how it should function.

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Dinner’s warm, it’s in the dog–Patient Expectations

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ImageLet’s see what we can somehow tie this to patients; I couldn’t resist using the title. The phrase came from my friend’s wife. She’d said it to him after he and I came home late from work one night, he having forgotten his promise to call her if we were to be late. Apparently, she hadn’t forgotten his promise. We walked into the kitchen.  “Dinner’s warm—it’s in the dog.”  She walked out of the kitchen.  I think that’s one of the best lines I’ve ever heard.

He was one of my mentors. We spent a lot of time consulting on out-of-town engagements. I remember one time I took out my phone to call my wife when he grabbed me by the wrists and explained I shouldn’t do that. We had just finished working a 10 or 12 hour day of consulting and had stopped by a bar to grab a steak and beer. I remember there was loud music playing. When I inquired as to why I shouldn’t call he explained.

“When your wife is chasing three children around the house and trying to prepare dinner, she doesn’t want to hear music and laughter and clinking beer glasses. She needs to know that you are having as bad a night as she is. So call her from outside, and make it sound like tonight’s dinner would be something from a vending machine.”

“But it’s raining,” I whimpered. Indeed it was, but seeing the wisdom in his words I headed out and made my call.

So, back to the dinner and the dog, and the steak and the phone call. In reality, they are both the same thing. It all comes down to Expectations. In healthcare it comes down to patient expectations.

PEM can be a number of things; Patient experience management, Patient equity management, and Patient expectation management. In this instance, we are discussing the latter. A set of expectations existed in both scenarios. One could argue as to whether the expectations were realistic—and one did argue just that—only to learn that neither of our wives considered the realism of their expectations to be a critical success factor. In that respect, the two women about whom I write are a lot like patients, their expectations are set, and they will either be met or missed.

Each time expectations are missed, their expectation bar is lowered. Soon, the expectation bar is set so low it’s difficult to miss them, but miss them we do. What happens next? Patients leave. They leave and go somewhere they know will also fail to meet their expectations. However, they’d rather give their money to someone who may disappoint them than somebody who continued to disappoint them.

Why HCAP Scores Do Not Work

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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