Patient Experience, Social-CRM & Russian Salad Dressing

I was settling in to my first bite of overstuffed pastrami and corned beef sandwich—apologies to the vegetablists.  One of the four octogenarians seated in the booth next to me was speaking loudly to the other three about the catheterization he underwent the prior day.

Thankfully, his friend, who was eating the egg salad special interrupted him and asked, “How long have you known Bernie Westoff?”

“I don’t know Bernie Westoff,” replied the cath patient.

“He is one of your LinkedIn contacts.”

“How do you know that?”

Egg Salad stated, “I looked at your contacts.”

“Who told you you could look at my contacts?”

“You set it up that way.  Everyone can look at them”

This conversation continued for the next several minutes.  I was tempted to pull out my iPad, open the LinkedIn app, and join the fray, but instead I kept my eyes straight ahead and worried about the Russian dressing dripping down my arm.  Crowdsourcing 101.

I think the one application of crowdsourcing most overlooked is one which hardly fits the definition. This type is not premeditated and it does not originate within a company. More often than not, the company is the target of this type of crowdsourcing—Social-CRM.

Most definitions of crowdsourcing involve a call going out to a group of individuals who are then gathered via the call to solve a complex problem—problem solving—much like the Law of Large Numbers.  The crowd is likely to have an upper limit in terms of the number of members. By default, traditional crowdsourcing is fashioned to work from the top down; it is outbound, a push model.

Social-CRM (S-CRM) tends to work from the bottom up. There are no boundaries to the number of members; in fact, there can be thousands of members. Also atypical is the fact with S-CRM no single event or call to action drives the formation of the crowd. The crowd can have as many events as it has members.

The unifying force around S-CRM is each member’s perspective of a given firm or organization. Members are often knitted together by having felt wronged or put-off by an action, product, or service provided or not provided by an organization. Most organizations do not listen to, nor do they have a means by which they can communicate with the S-CRM crowdsource. This in turn causes the membership to grow, and to become even more steadfast in the individual missions of their members.

In traditional crowdsourcing, once the problem solving ends, the crowd no longer has a reason to exist, and it disbands. With S-CRM crowdsourcing, since the problem never seems to go away, neither does the crowd.

Every hospital and payer has one or more S-CRM groups biting at its ankles, hurting its image, hurting the brand, causing customers to flee, and disrupting the business model. Even so, most organizations ignore the S-CRM crowd just like someone ignores their crazy Uncle Pete who disrupts every family gathering.

The fact that your hospital may have a Facebook page and a Twitter account managed by two people who are officed in what used to be a supply closet will not do much to dampen the whinge factor created online by those individuals wondering digitally about why the hospital seems to have so much difficulty even answering its phone to schedule an appointment.

Social-CRM is not a fair fight. Perhaps the best approach is to find out why people are complaining, and then develop a plan to fix those issues that have them screaming the loudest.

 

Why not Improve Satisfaction Instead of Measuring it?

­One of the uncomfortable things about flying is how close you are to the other passengers.  On my return flight from Florida I could see from his teeth that the passenger in the window seat must have had spinach for lunch.  The most troubling part of my observation was that the passenger was in another plane, and neither of our planes was on the ground.

To back track for a second, I observed something else on my drive to the airport.  We are all familiar with the painted white lines that divide the road lanes.  On some roads, raised reflectors have been inserted into the road’s surface in addition to the painted lines.  At night these road nibs reflect your car’s headlights helping you to stay in your lane.

What’s your point?  If asked the color of these nibs we would response that they are white, just like the white strips.  Those who answered white would be half right.  As I looked in my rearview mirror I caught a glimpse of the backside of the nibs, and for some reason I was surprised to see that unlike the front, the backs of the reflectors were red.  It occurred to me that the reason they are red is to warn you that if you see red you are going the wrong way.

It goes to show you that just when you think you have the answer it may be time to look in your rearview mirror; you may be going the wrong way.

That may be where some, if not most, hospitals are with regard to patient satisfaction.  But, don’t feel you have to take it from me.  According to Amednews.com, “The study by Rozenblum and his colleagues said there seems to be more emphasis among health care organizations on measuring patient satisfaction rather than on improving the patient experience.” March 13, 2013.

This bears repeating…there seems to be more of an emphasis among health care organization on measuring patient satisfaction rather than on improving the patient experience.

Stack all the reports your organization has purchased concerning patient experience data.  Those reports show your hospital’s scores, how your hospital compares to other hospitals, means, averages, standard deviations, and the square root of the hypotenuse.  Now, next to the stack of reports, stack all of the money your hospital has saved by implementing what it has learned from the reports.

I’m sorry, can you speak up?  Oh, you said you have not saved any money.  Well, let’s try another tactic.  Let’s have dinner for every patient that the experience data helped the hospital retain plus all of the new patients referred based on the things learned from the patient experience data.

J’ai mangé seul.  That is French for ‘I ate alone’.

Patient satisfaction should be exclusive…to everyone

Sometimes it feels like I fell out of the stupid tree and hit every branch on the way down.

Important: Do not remove the wires from your old thermostat until you have marked them with the enclosed labels.

This warning was printed on a bright red background with yellow text and hidden away in the middle of the adult-proof ballistic packaging of the new thermostat.

“Why didn’t you read the directions before you disconnected the old thermostat?” My wife asked as soon as she realized the fan was not working.

“Is there a reason one of the plants in the garden is on fire?”

“You have to power-wash the deck before you put the furniture on it.”  This is the heavy, metal outdoor furniture I am forced to carry indoors once the weather turns cold so that it can hibernate, and return it to the outdoors in spring. 

All my explanations about the fact that the furniture was designed for the outdoors and that it will outlast the next dinosaur ascendency go unheard.  It is this same furniture for which she has militaristically drilled the family, with the rigor of nuclear submarine crew trained to extinguish fires, to race indoors with the cushions whenever rain is expected anywhere within the lower 48 states.  Perhaps she read somewhere that if the cushions get wet they will suffer the fate of the Wicked Witch of the West and melt.

Responses are neither required nor expected of any of the questions or statements tossed at me.  To do so would be akin to arguing in a vacuum—as opposed to with a vacuum.

Pearls of wisdom, in my case, tossed amongst swine.  “Mongo just pawn in the game of life”—Mel Brooks, Blazzing Saddles.

The world has changed.  Customers have changed. All businesses have changed the relationship between themselves and their customers. With few exceptions, healthcare has not changed its approach to patients, and nobody seems to own up as to why.

The way the business model used to work is the business pushes communication from the business to the customer. Businesses evolved to the point where communication between the business and the customer became a push-pull model. The business pushes something to the customer.  Sometimes the customer pulls information, and sometimes the customer pushes information to the business.

Most pushes and pulls function on a one-to-one basis; the business to a single customer (patient), and back. It occurs in secret. Customer A was never aware of the push-pull between the business and Customer B.

Communication is no longer secret. In fact, it is anything but secret, especially among customers.  As the number of customers increases, their communication about a business can go quickly viral—not between patients and the hospital, but among patients. 

Hospitals can do a lot of things but they cannot put the toothpaste back into the tube.

I think patient satisfaction should be exclusive…to everyone, but then I have been accused of trying to believe in as many as six impossible things before breakfast.

Image

How Medical Dummies Can Improve Patient Satisfaction

At some point raising your HCAP score will do no more for your hospital than being able to calculate the next decimal place of pi.  The law of diminishing returns.

The CBS Sunday Morning program ran a piece on medical dummies used to train doctors in a variety of procedures and specialties.  Practicing on a dummy, students could learn how to perform spinal taps, drain knee fluid, administer anesthesia, and deliver a baby. Medical schools are also hiring actors to help doctors improve their bedside manner. 

These medical mannequins cost upwards of three hundred thousand dollars.  They can exhale CO2, have dilated pupils, and swollen tongues.  Hospitals invest millions of dollars to ensure that the treatment their patients receive is the absolute best.  Doctors and nurses spend thousands of hours ensuring that the treatment they provide their patients is the absolute best.

They do not do this just to improve the patient’s experience; they devote their resources and their time to get it right, as right as they can as often as they can. How does that devotion translate to how patients rate their hospital experience?

What do we know?

  • All procedures are as good as the doctors and nurses know how to make them
  • All patients undergo certain procedures
  • Most patients undergo an array of different procedures
  • Almost no patients undergo identical procedures in the identical order
  • Improving the efficacy of a single procedure is good for those patients having that procedure
  • That improved procedure only impacts a small percentage of the total patient population
  • Small improvements of discrete processes will not improve the total patient experience rating for the hospital

What else do we know? (for simplicity let us focus on in-patients)

  • All patients are scheduled, admitted, housed, fed, discharged and billed.
  • Improving any one of these areas will improve the satisfaction of all patients

The big unknown.

  • Why is nobody focusing on the things that will raise patient satisfaction across the board

The hospital business processes for scheduling, admitting, housekeeping, food service, discharging and billing affect each patient.  Has your hospital ever asked your patients what their expectations are of these processes? I have not come across one that has.  But for those hospitals that do not know what patients expect from these processes, I guarantee you that your patient’s satisfaction barometer is measured against the one other service they purchase that has scheduling, admitting, housekeeping, food service, discharging and billing—staying in a hotel.

But we are not a hotel.  Please, no whinging.  Because patients have spent hundreds of nights in a hotel, their expectations of scheduling, admitting, housekeeping, food service, discharging and billing are predetermined and fixed. Each of these processes, at least when compared to medical procedures are exceedingly simple and the most repeated processes in the hospital.

The chances of your hospital exceeding your patients’ predisposed expectations are slim.  The chances of underperforming are great.  If you have not worked hard at reinventing these processes, your call center, your CRM, and your patient portal in the last two years, your chances of satisfying anyone border on nil. If you are being honest, some of these processes have not changed since the hospital was built.

What do we know about the employees who deliver scheduling, admitting, housekeeping, food service, discharging and billing to your patients?  They are the lowest paid, lowest skilled, least educated, least trained, and lowest tenured people in your organization.

These same people, what they do, and how well they do it contributes greatly to how patients will rate their level of satisfaction with your hospital.  My guess is that what they do and how it is perceived probably accounts for at least fifty percent of how they rate your hospital.

Here is what I propose.  Back to the medical dummies and the actors.  Could they somehow be employed to improve patient satisfaction for scheduling, admitting, housekeeping, food service, discharging and billing?  Imagine having someone in your billing department trying to get a dummy to explain the wherefores of a forty-thousand dollar invoice and you will get a pretty clear picture of how the patient feels when they have a question about their bill.

Remember, a rising tide lifts all boats, and that is a good thing unless you happen to be the person tied to the pier.

Crowdsourcing–The Patient is in charge

You may want to grab a sandwich, this is a long read.

For the longest time it has occurred to me that most companies find themselves in a state of what I like to label Permanent Whitewater. As they careen through the rapids, it is anybody’s guess as to whether they will capsize.  And the philistines they have appointed as commissioners would be more appropriately described as Ommissioners, as they have omitted themselves from understanding the world and leading their charges.

Now, what does that have to do with anything?  Thanks for asking.

For those of you who can find California on the map, you will recall the great turnip boycott of the nineteen seventies—I know they boycotted grapes, but I like grapes and do not like turnip, so I choose to have my own protest.  Anyway, this boycott worked, and as a result, the working conditions for migrant workers improved albeit only modestly.

And here is the kicker.  An entire industry was brought to its knees.  That is not the surprising part.  The surprising part is that all of this change was brought about at a time when there were three television channels and when people actually subscribed to newspapers.

From where I sit, social media can be divided into two camps, those who have not slept since the launch of Google+, and the far larger camp of those who have not lost a minute of sleep.  Businesses, for the most part are well entrenched in the latter group.

Part of the reason why businesses are slow to adopt social media can be attributed to their lack of belief that social media matters or can impact their business one way or the other.  And frankly, I think that has a lot to do with why our economy continues to rejoice in its malaise.

So, how to those of us in the first camp get those in the second camp to see the world our way, how do we get them to jump head-first into social media.  The answer is simple.  We need to create our own turnip debacle.

They say it cannot be done, so let us show them.  The one thing that would get companies to embrace social media quickly and unashamedly would be if there was one less company.

Companies, big ones, fat ones, firms that climb on rocks—feel free to finish the tune without my help have the following issues, they think they:

–       control their market

–       own their customers

–       are managing their customers

Companies are wrong about those three assumptions and the use of social media can and will prove this.  I would ask for a company to volunteer, but that would take too long.

If ABC, CBS, and NBC were able through their coverage of the grape boycott, bring about change to an entire industry, imagine with me what impact a global, committed bunch of savvy social media users could do to a single firm.

Here is what I propose.  Let us pick one firm.  The characteristics of this firm should be that it is well known and not well liked—this way if it self-destructs we can argue that we acted on behalf of a greater good.  It should also be a firm associated with technology, a firm that ought to at least be able to spell social media.  If I were asked which firm I would choose I would pick a firm in some aspect of telecommunications, say a firm like Comcast or Verizon—an easy target, a firm facing a customer experience war armed only with their CRM.

Now, the idea of our little social project will be to provide a heads-up to all of the other companies about the start date of the importance of social media.  Let’s tentatively agree on starting on the first of November unless there is a game on television I want to watch.

The goal of the project is to demonstrate that the bourgeois, the working class, with its harmless set of social media tools, can create affect enough of a disruption to an organization to make that organization sit up and take notice, or to make it disappear.

I am sure you remember the YouTube video of the Comcast technician that fell asleep on a customer’s couch.  It went viral, but Comcast did not, and that was simply a single posting by a single customer.  What would happen if the social media mavens decided to use the tools at their disposal and concentrate their efforts at or against a single firm?

Crowdsourcing 101.

I think the end result of such an effort would have a significant impact.  The impact could easily bring about more fundamental change about how firms use social media than was brought about by the grape boycott.

Sometimes something has to be sacrificed on behalf of the greater good.  Although a rising tide lifts all boats, it can ruin your day if your firm is the one chained to the pier.

What are your ideas?

When Patient Satisfaction is Personal

To paraphrase Oscar Wilde, ‘Consulting is the most unusual of the perversions’. 

Some say potato, some say po-tah-to; Dan Quayle, not often mistaken for one of Werner Von Braun’s rocket scientists, spells both versions with an ‘e’.

Customer/patient, patient/customer, impatient/customer—let’s just call him Ernest.  The importance of being Ernest.

The patient’s experience is not some abstract concept to be debated among the ‘six sigmaists’. Take today for example.  My father is lying on the floor with a heart rate of 147. He has had one heart attack.  At seven AM the ambulance takes him to the hospital, a hospital without a cath lab.  His enzyme markers are elevated, and they have to transfer him to a hospital that has the ability to treat him.  At 1 PM he starts to dress himself—he hasn’t seen a sole in five hours, he is leaving—like father like son.

It seems the hospital forgot to write a transfer order or to even check on him.

I hope they do not ask him to complete a patient satisfaction survey.

If you happen to read this he and I would both appreciate your prayers.

Is Patient Experience Management abi-normal?

I remember the first time I entered their home I was taken aback by the clutter.  Wet leaves and small branches were strewn across the floors and furniture. Black, Hefty trash bags stood against the walls filled with last year’s leaves. Dozens of bright orange buckets from Home Depot sat beneath the windows. The house always felt cold, very cold. After a while I learned to act normally around the clutter.

There came a time however when I simply had to ask, “Why all the buckets? What’s the deal with the leaves?”

“We try hard to keep the place neat,” she replied.

“Where does it all come from?” I asked.

“The open windows, the stuff blows right in.”

I looked at her somewhat askance. “I’m not sure I follow,” I replied as I began to feel uneasy.

“It’s not like we like living this way; the water, the cold, the mess. It costs a fortune to heat this place.  And, the constant bother of emptying the buckets, and the sweeping of the leaves.”

Trying to assume the role of thought leader I asked, “Why don’t you shut your windows? It seems like that would solve a lot of your problems.”

She looked at me like I had just tossed her cat in a blender.

When you see something abnormal often enough it becomes normal. Sort of like in the movie The Stepford Wives.  Sort of like Patient Experience Management (PEM). The normal has been subsumed by the abnormal, and in doing so is slowing devouring the resources of the hospital.

Are you kidding me? I wish. It’s much easier to see this as a consultant than it is if you are drinking the Kool Aid daily. When I talk to people about a statistic that indicates that 500 people called yesterday about their bill, and everyone looks calm and collected, it makes me feel like I must be the only one in the room who doesn’t get it—again with The Stepford Wives.

If I ask about the high call volume they always have an answer, the same answer.  “Billing calls are usually around 500 a day.”  They say that with a straight face as though they are waiting to see if I will drink the Kool Aid. It’s gotten to the point where no matter how bad things get, as long as they are consistently bad, they are not bad at all.

This is the mindset that enables the patient experience executive (I know you probably don’t have one—I am being facetious) to be fooled by his or her own metrics. When is someone going to understand that repeatedly having thousands of people calling to tell your organization you have a problem, means you have a problem?

It would probably take less than a week to pop something on your web site, and post a YouTube video explaining how to read the bill.  Next week, do the same thing and help patients understand how to file claims and disputes—granted, you may need more than a week for this one.