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 33^rd 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?