PEM

Just What is Patient Equity Management?

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My presentation ‘Patient Equity Management” the next step up on Patient Experience Managementow.ly/juObm

 

 

Patient Satisfaction–The Mathematics of Change

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There are three people in the ER. One of them is a physician, one of them is an executive, and one of them is a consultant. They see a machine unplugged that is standing against a wall in the waiting room.

And the executive says, ‘Look, the technology in this hospital is not used.’ And the physician says, ‘No. There are machines in the hospital of which at least one is not used.’

And the consultant stood there in silence guessing neither of them really cared what he thought about the machine.

At least one. A mathematical term meaning one or more.

Some. A non mathematical term.

The term is commonly used in situations where existence can be established but it is not known how to determine the total number of solutions.  In our example, ‘E’ represents the unused machine and ‘C’ represents the unused consultant—the exceptionally bright among us will notice there is no ‘C’.  That is a problem on my end, but I digress.

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How many things can be changed regarding the patient experience that would have a positive impact? At least one.

What would you change if you were not afraid of failing?

 

Why Patient Satisfaction is like Spilt Tea

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At one time the single word Lubyanka was enough to bring normal Russians to their knees in terror.  Lubyanka is known best for being the headquarters of the Soviet secret police.  The basement of Lubyanka housed a prison which contained one hundred and eleven cells, cells used to hold and interrogate political prisoners during Russia’s purge.

Tea was provided to the prisoners twice each day.  A prisoner within each prison cell would place a teapot outside the cell. A prisoner, carrying a pail filled with tea, would pour tea from the pail into the teapot.

Tea spilled on to the floor.  The prisoner would clean the spilt tea with a rag.

Lubyanka’s prison operated for twenty-seven years.  Tea was served to the one hundred and eleven cells and spilled in front of each cell twice a day, seven hundred and thirty times a year.

Two million, one hundred eighty eight thousand spills.  The same number of cleanups.

Someone somewhere made the decision that it was easier or cheaper to spill and sop the water 2,188,000 times than it was to make pails with spouts on them.

What are the pails in your company?  What dumb, wasteful, redundant activities and processes have been left unchanged?

The most obvious one for most companies is call centers.

It is easier to take 2,188,000 calls each year about your bills than it is to fix the bills.  It is easier to take 2,188,000 calls each year about the bills than it is to get rid of the bills.  The same argument applies to a number of other processes.

And do you know where the fallacy in the argument is?  The fallacy comes from the erroneous belief that by having a call center, by answering calls you are actually providing your customers a service.

You are not.  Most times all you are doing is wiping up spilt tea.

Patient Experience Management–What would Oprah do?

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If you watch too much television your brain will fry. Sometimes I feel like mine is in a crepe pan that was left sitting on the stove too long. Two nights ago I’m watching Nova or some comparable show on PBS. The topic of the show was to outline all the events that took place that helped Einstein discover that the energy of an object is equal to its mass times the speed of light squared, better known as E=mc². It was presented to the audience at a level that might best be described as physics for librarians, which was exactly the level at which I needed to hear it. It’s physics at a level that is suitable for conversation at Starbucks or any blog such as this.

So here’s what I think I understood from the show. It tracked the developments of math and physics in the 100 years prior to Einstein’s discovery. The dénouement appeared to occur when Einstein and his fiancée were riding in the bow of the small boat. Apparently, he was leaning over the side of the boat and noticed that the waves generated by the front of the boat moved at the same speed as the boat. He then noted that fact only held true for those persons in the boat, who were in fact, traveling at the same rate of speed. However for those persons watching from the shore, that same wave was not only moving slower than the boat it got further behind over time. Some other things occurred, yada, yada, yada, and there you have it. Clearly, the details are in the yada, yadas.

So here’s what happens when you watch too much television. As I’m running this morning somehow my mind takes pieces from that show and staples them together to yield the following. Let’s go back to the equation E=mc². For purposes of this discussion I’ll redefine the variables, so that:

E = the percentage of Patient Complaints/Inquiries.
m = Patient in-bound calls.
c = number of Patients

If this were true–this is an illustration, not an axiom–the number of complaints to a healthcare provider is equal to the number of in-bound calls times the square of the number of patients. So as the number of calls increases the number of complaints/questions increases and as the number of patients increases the number of complaints increases exponentially. Of course this is made up, but there appears to be a grain of truth to it. I think we can agree that a reasonable goal for a healthcare provider is to decrease the number of complaints and inquiries and to shift a hefty percentage of inquiries to some form of internet self-service vehicle.

I think sometimes the way providers assess the issue of Patient Experience Management  (PEM) is by looking at how much money is spent trying to solve the problem. Some think that if one provider has three times as many people handling calls as another provider that the provider with three times as many people must be more interested in taking care of the their patients, and might even be better at PEM.  I don’t support that belief. I think it can be demonstrated that the provider with the most Patient Service Representatives, and the most toys deployed probably has the most problems with their patients. I don’t think it’s a chicken and egg argument. If expenditures to handle patient complaints and questions increase year after year and resources are deployed continuously to solve the same types of problems, I think it’s a sign that the provider and its patients are growing more and more dysfunctional.

How does this tie to Einstein and his boat? Perhaps the Einsteins are those who work with the provider; those who are moving at the same speed, those in lockstep. From their vantage point, the waves and the boat, like the provider and its patients, are all moving forward at the same speed. Perhaps only the people standing along the shore are able to see what is actually occurring; the waves distance themselves from the boat in much the same way that the patients distance themselves from the provider.

Patient Experience Management–Manufacturing Consent

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Manufacturing Consent

Foxnews reports “Russian police say they have discovered the body of a local politician reported missing last week, in a barrel of cement in a garage near Moscow. Another politician has been accused of ordering the murder, over an $80 million debt.”  So, we’ve got that going for us.

This weekend I caught a bit of NPR’s “Wait, wait don’t tell me.”  One of the guests was Al Gore.  Oscar winner, recipient of the Nobel Peace Prize, a Tony, and an Emmy. The host neglected to point out that Mr. Gore, former vice president of the United States and Internet founder is standing in line to cash a check for one hundred million dollars from Al Qaeda’s (Al Jazeera’s)—you say potato I say potahto.  I know I promised not to cross the line, but that is why you read this and not some missive from the CMS.

What does it mean if when you Google a topic all of the hits to that topic link to you?  It may not mean much if the topic you Googled is “sliding revolving doors.”  But what if the topic has slightly more potiential.

I Googled—v. past tense of Google—the term “Family Experience Management” and every returned URL is to something about which I wrote.  Just so you know, the groundswell begins today.

Perhaps before we get too carried away we should define Family Experience Management (FEM).  FEM is the set of interactions a “family” of a patient has regarding a family member’s interaction with various components of the healthcare system; providers, payors, pharmacies, Medicare.  It is the superset of interactions for patient experience management (PEM).

Most PEM efforts I have studied are like shutting the barn door after the horses get out.  I happen to think there is much greater value in stopping the processes that have led the way to opening the barn door in the first place.

There is reality and there is perception, and with regard to PEM, rarely the two shall meet.  Some things are just true, perception be damned.  That is why what is right should always supplant who is right.  That a majority of people within any given organization have the objectivity of an insider is why the top two prevailing business rules are ‘we can’t do that’ and ‘that will not work.’

A little dissent can be a healthy thing.  Or not. 

One of my favorite axioms is ‘You don’t ask directions from somebody who has never been where you’re going.’

I am a fan of a good adage, so let us try this one on for size.  A hospital executive falls into a hole—the ‘w’ is silent.  Someone from CMS walks by and the man in the hole hollers, “I’ve fallen and I can’t get out.”  The CMS acolyte tosses down a check, and the man replies, “What is this?”

“That’s some of the ARRA Meaningful Use Lottery. We’ve got tons of it that nobody is going to collect.

An hour later a seven sigma guru passes by.  The man in the hole hollers, “I’ve fallen and I can’t get out.”  Seven Sigma man tosses him a set of workflows and a stop watch and departs.

Days later a consultant happens along.  Recognizing the man’s plight the consultant hops into the hole.

“Why did you do that?” Queries the man.  “Now we are both stuck.”

“No worries,” says the consultant.  “I’ve been down here before and I know the way out.”

Sometimes, perhaps way too often, we get trapped by our own thinking.  By the misguided belief that we already know the correct solution, or we know that the one being proposed will never work.  This is like having my son telling me he does not like broccoli even though he has never tried broccoli. 

We get caught up in the notion that we already have a vision of how we want the world to be and we are willing to do anything to make the world conform to our vision.  We limit ourselves to the possible, to what has already been done.  If however, we limit ourselves to the possible, how does progress happen?

We need to be saved from the shortsighted politicalization of our own intelligence; progresses’ Catch-22.  Once everyone thinks they are thinking out-of-the-box, are they really, or have they simply moved the box.  Sometimes it is best to be the person advocating for coloring outside of the lines.

Patient Experience Management can benefit greatly if only a handful of people began to color outside of the lines.  This link is to a presentation of mine on SlideShare I have given on how to improve patient experience management, something I also call Patient Equity Management. 

You can download it or use a yellow highlighter to help you recall the tasty bits.

I welcome your thoughts, especially learning why you may think I may be all wet.

Thanks Al for making file sharing possible.

 

 

When Patient Experience Management Fails-call the cable guy

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(This missive is somewhat long—this is where my mind goes when I run.)

Ever watch the show “This old House”? Something magical happens to a man when he watches somebody single-handedly rebuild a 6,000 year old home in a 30 minute program. After that no task seems too complex. As a normal male the first rule of thumb is to remember that having a master’s degree from a reputable university qualifies you for about anything short of brain surgery. The true Type A will often carry that step further by reminding himself that given another week or two of study that even neurosurgery would not be that difficult.

I did a project in one of my prior homes. It involved the simple task of rearranging bedroom furniture one Sunday afternoon; 15 minute project, total cost—nothing. After all, how difficult could that be? The truth is the actual moving of furniture involved nothing more than I’d planned. Only when I thought I was done did I notice that the television set was now located a good 20 feet away from the cable television outlet. The obvious solution would be to simply move the furniture back to its original position.

Can’t do that. To move the furniture back to the original position is either admitting defeat, or admitting I wasn’t bright enough to realize that the cable outlet and the television would be on opposite ends of the planet by the time I finished. Besides, my wife had already seen the new arrangement and if I moved it back to its original position I would have to explain why.

So when she enters the room and asks why (and she will ask why—that’s her job) there is now a 25 foot piece of black coaxial cable snaking its way diagonally across her bedroom carpeting I had better be prepared to answer. Sometimes if you’re quick, real quick, you can try and bluff your way around the problem with a technical answer. You can try and explain that all of the static electricity that was created by sliding furniture across the carpet has caused the sonic membrane surrounding the fiber optical transponders in the coax to be 6 ohms off the medium allowable temperature variation for the building codes in your neighborhood. It is called stalling, allowing for a brief period of self-correction.

The truth, having failed me, the only other option left was to try something close to the truth. I’m forced to say I knew the cable would be at opposite ends of the room before I moved the furniture. My plan all along was to call the cable company and ask them to come to the house to install another outlet on the correct wall.

It’s my wife’s job to inquire how much it will cost—she did not fail me.  This is a clear case of me answering her question without bothering to think. It is important to have a clear understanding of the underlying issues before trying to resolve the problem. I mentioned it should cost forty dollars, and we will only need to leave the cable strewn across her bedroom floor for a few days. It’s then her job to say if we put the furniture back where it was we can solve both problems in twenty minutes. Besides, the cable technician left a mess the last time they did some work, and she wasn’t going to spend more money for poor service. Stay with me here, this is how it becomes her fault, and how it relates to the topic of Patient Experience Management (PEM).

Once her issues were out in the open was a simple matter to devise a solution to address them.  The solution needed to be implemented quickly and it needed to be free. My answer came quickly—too quickly. Eighty percent of the problem could be handled by simply running the cable along the floor board, and then under the bed. That only left five feet of cable between me and a happy marriage. Unfortunately, the five feet in question is from the foot of the bed to the television and runs across the major walkway of the room, looking all the while like an undernourished blacksnake.  Did I mention she hates snakes?

Undaunted, I asked for a little assistance to move the bed. This accomplished, I headed for the garage to find exactly the proper tools for the proper job. I returned five minutes later, tools in hand. I was surprised to see the look of dismay on her face. As it turns out, her dismay resulted from the razor blade knife clutched in my hand. After twenty minutes of the best Boolean logic I could muster, I convinced her, or at least myself, that it would be a simple matter to cut a small hole in the carpet and force the cable underneath. After all, the bed would hide the hole.

The only other tool I thought I would require was a roll of duct tape and a 4’11″ broom handle.  Women know we are confused about how to proceed the moment they see men rely on the duct tape gene. Most men, when cornered believe enough duct tape, properly applied, can serve as a panacea for anything up to and including world hunger.

You’ll note I specified the exact length of the broom handle. It’s only after having attempted the project that I’m able to relate the length of the handle. Most men on a project, especially those being watched by their wife, wouldn’t bother to measure a length any more than they would ask directions while driving across Borneo with half a tank of gas.

As it turns out, I should’ve measured both the distance the cable had to travel under the carpet and the length of the broom handle prior to taping the cable to the handle and shoving a 4’11″ broom handle under a five-foot expanse of wall-to-wall carpet. The fact the carpeting was wall-to-wall is key to understanding what lay ahead. Let’s make certain the situation is spelled out clearly; the new carpet in our new home had a hole in it, a broom handle was now nicely buried under the carpet, and my wife was perched on top of the bed like one of Macbeth’s three witches waiting to see what I would do next.

Walking to the wall and grasping the carpet as best I could, I pulled up a good 10 feet of it from the tacking, acting all the while like I would have to have done that even had the handle not been one inch too short. Leaning with my one arm on the newly exposed carpet tacks, I solicited help in excising the handle from beneath the rug. That accomplished, and dying the death of a thousand cuts, I looked for another proper tool to complete the task. Walking through the kitchen to the garage I spent a moment wondering if the proper tool could be found in the kitchen. Naturally, it was—one half of a pair of chopsticks or, as it’s now referred to in technical terms, a broom handle extender.

Five minutes later, the broom handle extender and cable was firmly duct taped to the broom handle and once again shoved under the carpet. They both went in, but no cable came out the other side. So, I pulled the handle back out and surveyed the situation. The situation, as it turns out, was that in my hand was a perfectly good broom handle, a piece of coaxial cable, and no broom handle extender. The extender was now smack dab in the middle of the 5 foot expanse I was trying to cross, the problem being it was on the wrong side of the carpet, the underneath side. It was positioned perfectly. It was too far under to be reached from either end. In other words, the chop stick just became a permanent fixture in our bedroom.

Certainly, one small chopstick hidden beneath four hundred square feet of carpeting was not a big problem to me. It was not a problem unless you happen to be walking barefoot across the carpet and you happen not to be the one who put it there.  It became not unlike the fable The Princes and the Pea, and my princes found it immediately. In the fable, it was the princes could not sleep. In my case, I knew the non-sleeper in the story would be me for as long as the chopstick remained under the carpet.  Keeping my eyes focused firmly on the task at hand, I foolishly believed if I could resolve the cable problem, the matter of the chopstick would resolve itself.

One final trip to the garage led me to return with a second broom handle. The peanut gallery looked on in disbelief in my ability to finish what I had started without having to sell the house at a loss before I was through. The “I told you so’s” were being thought through in most of the major dialects of the Western Hemisphere.

This had ceased to be a project—it was now a quest, no lesser than that of the Holy Grail. A mile of duct tape later, both broom handles were firmly attached to one another. Even if I destroyed every square foot of carpeting in the house, I would not lose this broom handle under the carpet.  A minute later the cable emerged exactly where it should have, on the other side of the room.  I pulled the out broom handle, attached the cable and turned on the television. Everything worked, just as I had known it would.

Standing in front of the television, admiring my work in the new room arrangement, I noticed I was now a good foot taller than when I began the project. Was this an illusion brought about by my success?  As was quickly pointed out by my princess, my enhanced stature was more attributable to the fact that all of the carpet padding that used to lie between the end of the bed and the wall was now nicely compacted into a ball.  The ball of padding was located in the same twilight zone the chopstick found, right in the middle of the walkway. Trying to correct the problem only made it worse. Each time I prodded the ball of padding with the broom handle it grew larger underfoot. Within minutes it looked as though I had managed to suck up every inch of padding from every room in the house and placed it between my wife and a good night’s sleep. Resorting to logic once again, I quickly pointed out that she should walk on it because she would no longer be bothered by feeling the chopstick underfoot.

The next day I was on the phone scheduling an appointment with the carpet installation service. The carpet installer had to pull up most of the carpeting in the bedroom to be able to reach what she had affectionately labeled Chopstick Hill. I watched him work and I learned all about carpet padding and the installation of hardwood floors. He explained it was lucky for me that he came over because our padding was not good quality padding and we would not have known that had he not pulled up the carpet. I asked him why, if we would not have known about the padding, we would want to spend $300 for new padding. Without responding, he just kept slamming his knee in the carpet installer, charging one hundred dollars for his efforts and my education.

I was so impressed with his discussion of hardwood floors I almost bought one on the spot to surprise my wife. By now, we both know she wouldn’t have appreciated the surprise. Anybody who did not want to spend forty dollars on the cable repairman would probably have a little more trouble accepting five thousand dollars for a new floor.

However, I walked around with a silent smirk on my face for days knowing had we done it my way from the start, called the cable man, we could’ve saved the hundred dollars and never put a hole in the carpet.

This is what can happen when your patients decide to bypass your customer service because of prior bad experiences they have had trying to solve a problem.  It usually comes down to process, bad process.  Processes are a lot easier to fix than disappointed patients.

 

Who is minding your patients, your equity?

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Did I mention that I like to sing? No? Don’t tell anyone, but I just downloaded some Tom Jones to my MP3 so I can belt out a rendition of Delilah while I’m running—I only do this when I’m certain nobody is around. This doesn’t quite foot with my college collection of albums from Pink Floyd, Genesis, and Queen.

Then there was the time I was on a date at a roller rink. I was probably dressed in a pair of tight fitting bell-bottoms, an equally tight fitting rayon shirt unbuttoned to who knows where—hold the laughter. My almost shoulder length hair half-hid a puka shell necklace.

It may be important to know that although I had ice skated, I had never roller skated. There are a few not so subtle differences between the two.  Most notably, the sadist who designed the roller skate must have thought it amusing to place a large round rubberized wheel on the front of the skate in much the same position as a car bumper. I have no idea what is supposed to do. What it does do is stop you on a dime, especially when you have no intent of stopping.

Let’s see if we can tie some of this together. I’ve never felt that I actually needed to know how to do something in order to develop my own unsubstantiated delusions of adequacy—that probably explains why I’ve been consulting all these years. Anyway, back at the roller rink.

Barry Manilow’s “I Write the Songs” was being piped overhead through speakers the size of a dishwasher. Feeling much too confident for my abilities, I dragged my date to the floor. We stood side by side. I grasped her hands in a crisscrossed fashion like I had seen skaters do on television. After circling the rink for half a lap—watching my feet the entire way—I thought I should further dazzle her by singing. I should point out that it is difficult to sing and simultaneously watch your feet, a fact I didn’t learn until I was airborne. This takes me back to the rubber wheel on the front of the roller skate. We crashed to the floor and quickly took out the next thirty or so couples who were following us. It looked like a conga line run amuck. For the next hour or so it seemed like everyone in the rink pointed at me as though they were trying to warn others to stay away.

I haven’t sung any Manilow since that fabled night. Maybe it has something to do with the fact that times change and tastes change. Now I listen to groups like Dashboard Confessional and Great Lake Swimmers. I still interface with those closeted Manilow fans. Gone are the bell-bottoms and platform shoes, replaced by micro-fiber trousers, Droids, and Cole Hahns. My collar-length hair has a more monastic cut.

I’ve aged, so has my generation.  Aged to the point where they now have the power. Those people own the decision making process in most hospitals.  They may be the people calling the shots in yours. How can you tell if the person wearing the eighties polyester is one of them? Walk past her humming a few bars of Mandy or Copacabana, or something from The Captain and Tennille, and see if she hums back.

Is your Patient Equity Management (PEM) strategy is as dated as the double knits?  Or did I get ahead of myself; does your hospital even have a PEM strategy?  Odds are that there is no PEM strategy, no PEM group or executive.

Hospitals are quite good at managing their assets.  I bet your hospital has someone who can tell you how many chairs, televisions, beds and bed pans you have.  Assets.  We count them because we don’t want to lose them.  That is how businesses are managed.

In today’s dollars over their lifetime the average person in the US will spend more than $600,000 on healthcare.  Patients.  Assets.  They are a big part of your hospital’s equity base.

Who is minding your patients, your equity?  I don’t mean the doctors and nurses.  Who is responsible for making sure discharged patients return to you the next time they need a hospital?  Who manages that relationship for the hundreds of days between hospital visits?  Probably nobody; at least nobody in your organization.  Wanna’ bet somebody in the hospital on the other side of town is studying how to turn that $600,000 patient into one of theirs?

In case you’re wondering, the episode at the skating rink was our last date.