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.

Healthcare:

  • 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.

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.

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 Satisfaction: Why Hospitals Are Losing the Battle for Patient Revnues

Sometimes you choose to write; other times you have no choice but to write. This is one of those other times.

For those of you who believe most business situations can be tied to something related to Mel Brooks you will appreciate this. In his movie History of the World Part One, Brooks plays the role of Moses descending from Mount Sinai with stone tablets of the fifteen commandments.

http://www.youtube.com/watch?v=8YX-gqRdK_8

One set of five of them falls, hence the reason there are only ten.

Several hundred of you have read my presentation Step Aside HCAHPs; The Questions Hospital Executives Should Be Able To Answer.

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

One reader remarked that HCAHPs includes thirty-two questions, not the twenty-seven that were referenced in my slide deck.  I would like to be able to argue that as I was leaving CMS I dropped the stone tablet containing questions 28-32. I would also like to be able to fly.  Unfortunately, I can do neither.

That said, focusing on the number of questions in the survey obfuscates the point.  The number of questions CMS put forth has only a little to do with the issue of whether their questions constitute the Total Quality of a Person’s Encounter (TQE) with the hospital.

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As the picture above depicts, the effort to address patient experience only from the perspective of HCAHPs ignores much of what patients experience.  That same effort ignores all of what prospective patients, people who are trying to decide where to buy their healthcare, experience.

Let’s say your hospital treats five hundred patients a week, and thirty percent of them (150) return their surveys five months later.  The hospital may then initiate a program or two to try to raise its lowest scores.  Even if it is effective, it will not impact the experience of those who completed the survey, but it may increase slightly the scores of some future group of respondents.  The only people who will ever know are future patients.

People who will never know, and who don’t know anything about your HCAHPs scores are the people who were never your patients.  In know I am stating the obvious, but I do so because the potential revenue from that group, from the non-patients and the prospective patients, is probably greater than the revenues generated by the current patients.

Let’s also say that your hospital, the one that treats five hundred patients a week, also receives a thousand phone calls a week, and that three thousand people a week ‘visit’ the hospital via the internet.  Let’s also add another five hundred people a week who visit your patients.

That totals forty-five hundred people who experience the hospital in one form or another.  Were they satisfied?  Who knows?  They were not surveyed.  Nobody asked them what they liked. Nobody asked them if they found what they were looking for.  Did any of them decide to buy healthcare from your hospital?  Why or why not?  Did your internet presence meet their need; did the call center or the switchboard?

The lifetime value of a patient is estimated to be between $180,000 to $250,000.  The average number of people per household is three. So, for every patient you can attract and retain, plus their family members, their potential value to your hospital is $540,000 to $750,000.

Instead of Patient Experience Management, hospitals should be focused on Patient Equity Management. If a hospital lost four $2,000 computers in a week, it would learn quickly how not to lose a fifth. Hospitals lose patients and potential patients every day.  They do not know how many.  They do not know why. And, they do no know how to get them back.

Now watch what happens.  What if of the forty-five hundred people—the non-patients—you could get one percent of them (45) in any given week to decide to become your patient?  What might that amount to in terms of revenues? If you can get one percent a week, over a year, 45 people become 2,340.  Twenty-three hundred and forty people multiplied by the lifetime value of a single person’s revenue is a really big number—about four hundred million—a number so big it is silly; multiplied by the value of their family members is too big for me to count.

Now there will be those who want to argue that my numbers are way off.  To you I suggest that you make them smaller, make them a lot smaller.  Even if I am off by a factor of a hundred, which I am not, that is a $4 million dollar annual increase.

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.

Patient Acquisition: Inverting the Sales Funnel

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

 

 

Could a Zagat-type Patient Satisfaction Rating Work?

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The woman next to me on the plane was eating a croissant.  I asked her if she could hear Paris if she held it to her ear.  Maybe you had to be there.

The rest of this piece will make more sense if you have Wagner’s Valkyrie from the scene in Apocalypse Now playing in the background.  This weekend we did a once in a lifetime family activity.  Paintball.  It was once in a lifetime because I knew we would never want to do it twice.  Wearing our best WASP outfits, which made us look more suited for viewing the US Open than traipsing around in the woods, we drove two hours to a remote spot in the Poconos where we stumbled upon what looked like an interracial survivalist training camp; Pennsylvania’s version of Ruby Ridge.

The car next to ours had a bumper sticker printed with the words, “Honk if you are Amish.”  I told my son that I was surprised the Amish would play paintball.  He told me that it was meant to be funny since the Amish did not own cars.  Anyway.

Hundreds of people in the non-erudite crowd were dressed the way I wished I could have dressed when I played army at the age of eight though none of these people had been eight for quite some time.  Those whose arms were exposed displayed militaristic tattoos—while the men were wearing long-sleeved shirts.  Some of the GI Joes were dressed like SWAT, the rest were kitted head to toe in camouflage.  Several wore ghillie suits.  There were head and shoulder-mounted video cameras, and a few of the survivalists had wireless communication devices.  Most wore backpacks and other paraphernalia that would have made SEALs envious.

We passed one group as they were retrieving their rifles from the trunk of their car. Their gear copied the design of Uzis and AK-47s.  I started wondering what someone from a nearby town would have thought had a few of them walked into a liquor store to buy beer, imagining the clerk handing over the tens and twenties and then fleeing out the back door.

Our ammo belts each held over a thousand paint balls.  We gathered our guns and put on our face shields, the visors of which made us look like oversized ants, and headed into the woods to one of the seven hundred acre’s fifty laid out battle areas.  Our group of eighteen was divided half.  Being the only one with the math degree, I explained each team should have about nine players.

Fallujah awaited.

My two sons and I were on the team opposite my wife and daughter.  I smelled payback and before the referee blew his whistle signaling the start of the game I began a flanking maneuver to what would have been the field’s starboard side had we been on a ship.  Passing through a copse of birch, I came upon a pile of logs.  Within five minutes I had taken out three of their nine players.

Did I mention it then started pouring?  Now we were wet WASPs and my son appeared to be doing the backstroke.

One thing I learned quickly is that breathing heavily into your face shield during a downpour makes your vision about as clear as looking through your glass shower door twenty minutes into your shower.  The fog of war?  In the shower not being able to see is merely an inconvenience whereas in the woods people were shooting at and hitting me.

My vision was totally obscured.  I could see shapes and vestiges of light and dark.  Unfortunately I could not see the vestiges that were shooting me.  With a fogged visor, standing alone, and holding my gun I resembled a blindfolded person at a birthday party swinging an object at a moving piñata, only this time I was the piñata.

Did I mention that the paintballs leave the barrel of the gun traveling at one hundred and ninety miles an hour?  Through painful personal research I learned that exposed skin can instantaneously drop the paintball’s speed to zero. 

I think sometimes executives find themselves shrouded by the fog of war, unable to see what is right in front of them.  When was the last time people on the uppermost floors in the hospital sat down with a patient and spoke to them about their impression of the hospital?  It has probably been a while.

If it were possible to rate patient experience and patient satisfaction for your hospital using the prestigious Michelin and consumer-loved Zagat restaurant ratings, how do you think your hospital would score?

Michelin uses secret inspectors to rate restaurants—think CMS, HCAHPs, and patient satisfaction because patients are asked to completed surveys—customers have no say in the ratings.  Restaurants can be awarded one, two, or three stars.  Only about two thousand restaurants in the world have received a Michelin star.

Zagat ratings are formulated by people who ate in the restaurant—think patients and patient satisfaction.  Customers are not asked to rate the establishment; they do so on their own; customer driven.  Think also YouTube, Twitter, Facebook, and blogs.

What would happen to the flow of first-time and returning patients at your hospital if patients had an independent, online, patient-driven rating site?  Now before you bust a blood vessel, I am not suggesting that this approach could be used to rate physicians or treatment.  I do think there may be merit in using it to rate patient touchpoints of nonclinical things.  What sorts of things?  How about things like:

  • The usefulness of the website and the call center
  • Parking
  • Food service
  • Admissions
  • The clarity of the bill
  • Social media aides
  • Appearance
  • Scheduling

One CEO told me that the two things he could do that would have the greatest impact on patient satisfaction were expanding the parking lot and improving the food service.  Might be a good way to add another rating star to the hospital’s website banner.