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?

Without Control–the Patient Dialog

Remember when there were 200 firms in the Fortune 100?

How long ago was that? I think it was around the same time when people still thought you shouldn’t wear white after Labor Day. Time to drop-kick those white pumps to the back of the closet. What made me think of that bit of nonsense was a meeting I had recently with one of the sharpest people I’ve had the pleasure to meet professionally, and a classmate of mine from grad school. She happens to be the founder and president of one of the country’s go-to firms for dealing with business ethics. Having served as a board member for several publicly-traded firms, as well as chairing their audit committees, when the Andersen and Enron scandals hit she went looking for professionals who could help her help her firms. When she couldn’t find the help, she created it.

That conversation got me thinking and made me wonder why there were no longer 200 firms in the Fortune 100. Was it; is it, a matter of business ethics? How often do unethical practices come up when firms interact with their customers? A couple of takeaways from the meeting—for board members to be able to meet their obligation, they ought to do more than reply on the meeting book pulled together by the firm they serve. Simply relying on the book presumes ethical behavior, a presumption not always supported by fact—how much should one believe if the information is being provided by someone who purchased a $900 shower curtain?

What can they do? Due diligence is being reinvented, and the Social Network is leading the charge. One example is to go to Yahoo Chat to see what’s really being said about your organization. Other things I’ve done to obtain facts and opinions, things which particularly gauge how customers and employees feel about the firm include Google Reader, Facebook, Twitter, and YouTube, to name just a few. You don’t need patient focus groups to learn what’s being said, or to learn how good a job your hospital is doing. The patients already have a laser focus. In many instances the group lacking the focus is the healthcare provider.

Firms should focus on maintaining a strong Reputation Bank, one strong enough to be able to handle withdrawals, because you never know when there might be a run on the bank. Might be a good time to look at your own bank deposit slips.  Deposits can be made easily through the social media network.  You can’t stop patients from talking about you but you can shape what they say.

Social media isn’t what it never was.

Social media isn’t what it never was.

The term ‘social media’ is too polite to effectively communicate its importance to what it means for healthcare.  To me, Social Media sounds more like a coffee clutch or a discussion that would take place on Oprah or on The View.

Social media (SM) is often a targeted, violent dialogue fraught with vitriol.  There is nothing convivial or social about it.  It is not undertaken with your organization’s permission or its wellbeing in mind.

It may be easier to understand what it is not than to describe what it is.  SM is not B2B Facebook—it is not throngs of people who want to friend your organization and share nice comments about what it does.  SM usually begins with someone who has a bone to pick with your organization.  Their intent is to fan the flames of their discontent and turn it into a digital conflagration.  It need not be fair or honest.  For the most part SM is propaganda, and its purpose is to sway others to the propagandist’s way of thinking.

If your firm is looking at how to participate in SM, it is best to begin with an understanding of the ground rules—you have some, your opponents do not.  Their approach is like guerilla warfare.  Who knows where they will appear next.  Twitter, Youtube, blogging?

Most organizations who are considering enhancing their SM presence look at it as in IT initiative—enhance the web site, put up a Facebook page, maybe even starting to Twitter.  Just so you know, none of the opposition is throwing social jabs at your IT department.  IT can get you a presence.  What the presence consists of belongs to the likes of marketing, operations, and the executives.

If you have a good PR firm, pull them into the conversation.  It will be like taking your firm to a therapist and starting its own twelve-step program.

We made it to the bigs

Somehow, my social media article made the top story of Chime Healthcare CIO SmartBrief.

Not bad for a metaphorical tomato thrower.

Thanks for playing along.

Social Media–a few thoughts on its power

The web never ceases to amaze me. I’ve gotten to the point if I can’t find something I’m looking for, no matter how obscure, I figure that I did something wrong in how I framed the search.

For example, I was trying to connect to a high school classmate, someone I hadn’t spoken with since before Al Gore invented the internet. This guy got a pair of boxing gloves for his 14th birthday. We each wore one, and jousted only long enough for us each to land a blow on the other’s nose. It hurt—a lot. We gave up boxing. In tenth grade biology, we bet him five dollars that he wouldn’t jump out of the second floor window. The teacher, who knew of the bet, turned her back to write on the blackboard. He jumped. Go straight to the office, do not pass GO, do not collect $200. We used to see how fast his red and white Mach II Mustang would go railing down Route 40. He was the guy you voted best person to keep away from bright shiny objects. The last I heard he went to a teaching college.

Anyway, I Googled him—from the imperative verb Google—I Google, you Google, he, she or it Googles. I can’t tell you his name for reasons that will soon become apparent. Google returns links to things like military intelligence, think tank, counterinsurgency, small wars, and army major. I think I’ve made a spelling mistake and add his middle initial to the search criteria. Up pops a link to CNN’s Larry King. The topic of the show, the hunt for Osama Bin Laden. To quote Lewis Carroll, “things keep getting curiouser and curiouser.”

The web. Social networking. A great tool if you’re one the outside searching, deadly in the hands of your customers. If your firm is targeted, you are pretty much defenseless. Each customer is capable of creating its own digital perception of your firm. True or false, makes no difference. They’re like little thunderstorms popping up everywhere. Companies scurry around like frightened mice passing out umbrellas and pretending it’s not raining. They’re late, their customers are wet, and they are telling everyone. Very few firms have learned that they can’t put the rain back into the clouds.

Sort of reminds me of the line in the movie Young Frankenstein, “Could be worse, could be raining.” It’s raining, and even the best firms have run out of umbrellas. What is your firm doing about it?

saintPaul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942

Are hospitals making the the same mistake as BP?

“The time has come,” the Walrus said, “To talk of many things: Of shoes and ships and sealing-wax, of cabbages and kings—…

A lot of the strategic issues in healthcare are not easily explained.  One issue can be explained to a fifth-grader.  So, get your crayons out and follow along.

Fifty-some days and counting.  Say it with me—BP.  In many respects healthcare’s approach to social media is analogous to BP’s—the major difference is that neither the payors, pharma, nor the providers has yet to wipe out an entire geography—but the week is not over yet.

BP is offering an MBA in how not to use social media.  Nobody is queuing up on Amazon to buy the book, “BP’s ten pointers on crisis management.”

The funny thing about disasters is being able to schedule them in Outlook.  There are no pop-ups fifteen minutes before the big bang reminding you to get ready—“pipeline blows up in 15 minutes.”

We both know, sooner or later you will have one.  While yours may not crater the shrimping industry, it may be enough to do some serious damage to your business.  Most hospitals have a risk management group.  BP has one.  The mission statement of risk management is to assess and mitigate risks.

BP’s group probably had a plan in place to address a number of risks—risks like OPEC, an expansive war in the middle east, a tanker collision.  Apparently, they overlooked the risk of having a blowout a mile under the ocean.  Who’da thunk it?

If you Google “oil spill” there are fifty million hits.  Add “BP” to the search and the results narrow to a mere forty million.  That toothpaste is never going back in the tube.  People who can’t find the Gulf of Mexico on a map know that BP ruined it.  Thirty years from now people will still know the name of the firm that poisoned the Gulf, destroyed businesses, ruined vacations, made people sick, and cratered home sales along hundreds of miles of shoreline.

No matter what type of disaster BP could have faced, they demonstrated they were not prepared.  Even if it is proven that the disaster was not BP’s fault, it is too late to change their ownership of it.  Nobody is ever going to delete those forty million Google pieces linking BP to failure.  If BP hired a thousand workers whose only job was to try to counter each piece of negative media it would take them decades.

What is the one word to describe BP’s social media strategy?  LATE.

There is no useful social media strategy worth anything that begins after a disaster, none worth anything that begins after a misstep, after a faux pas. defines a faux pas as a social error—a boo-boo.

Unlike Meaningful Use, a good social media strategy can have an almost infinite ROI.  A good social media strategy, in addition to adding revenues and capturing patients, can help assuage the bleeding.  A good social media strategy played out in advance creates allies.

Let us look at this from the perspective of large healthcare providers.  What types of unfavorable events could negatively affect a hospital?

  • A medical disaster
  • Fraud
  • Medical errors
  • Reform
  • Scandal
  • Medical malpractice
  • Natural disasters
  • A data breech

While all negative events are not the same, many aspects of a good social media strategy apply regardless of the type of problem.

There are two major components of a good healthcare social media strategy:

  1. It should be pro-active.  Your social media strategy should be building goodwill each day.  Google the name of your hospital and see how many hits you get.  Next, see how many thousands of those hits are attributable to people outside your organization—too many to count.  You are already late.  People are already posting videos and writing about you.
  2. It should be reactive.  Make sure your “What are we going to do now?” account has a positive balance.  At the very least make sure you can push a button and unleash a plague of social media “I feel your pain” initiatives.

I’d wager a hospital could develop an outstanding social media strategy for less than one-tenth of what it pays in legal fees.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

Are terrorists smarter than us?

Sri Lanka has been in a twenty-six year civil war with the Tamil Tigers. NPR reported the leader of the Tigers was killed. Within a day, the Tamil Tigers’ web site posted a blurb stating that the leader was not killed—a la Monty Python—“I’m not dead yet.”

I’ll be brief. The bad guys. These bad guys live in the jungles, others live in the Afghan mountains. As far as I’ve been able to ascertain, they don’t use Cisco servers, they don’t have a call center. There’s no marketing department, no financial analysts, no freshly minted MBAs walking the hallways telling them what to do.  They have established virtual nations.

Yet as primitive as these groups are, they know the value of rapidly employing social networking to their advantage. What amazes me is not that they do it, but that most people reading this don’t have a proactive policy and the resources required to effectively manage their social media.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer


I remember the first time I entered their home I was taken aback by the clutter. Spent and 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 windows.”

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.”

“Why don’t you shut your windows? It seems like that would solve a lot of your problems.”

She looked 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 Relationship Management (PRM). 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.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 885-6942

My profiles: LinkedInWordPressTwitterMeetupBlog RSS
Contact me: Google Talk/paulroemer Skype/paulroemer Google Wave/paulroemer

If I ask about it they always have an 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, there not bad at all.

This is the mindset that enables the PRM manager (I know you don’t have one—I am being facetious) to be fooled by their 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.

Patient Relationship Management (PRM): Left Brainers, Right Brainers, and No Brainers

Sometimes I feel a little like the ambassador from the planet Common Sense, and unfortunately very few of us speak the same language. Let’s see if we can segment the Patient Relationship Management (PRM) population into left brainers, and right brainers. I am wrestling with an issue that I believe is a no-brainer.

One point, upon which both sides seem to agree, is that without the patients, PRM would be superfluous. The breakdown is that for a hospital to flourish in the long term, hospitals should re-engineer their business processes to facilitate the dissolution or substantive reduction of traditional customer service.  This extends beyond the cordial relationship of a nurse or a doctor and their patients in hospital beds.

In many, if not most instances, the very existence of traditional customer service provides a vehicle which acts as an enabler for failure. It gives hospitals permission to be mediocre in dealing with their interactions with their patients and physicians. In effect, traditional customer service is a tacit admission to the employees and the patients, “We don’t always get it right. We don’t always do our best.

Before deciding not to read further, ask yourself a few questions. The purpose of the questions is to try and articulate a quantifiable business goal for customer service, PRM.

1. Does customer service have planned revenue targets
2. Does it have its own P&L?
3. Does it have a measurable ROI?
4. What is the loaded cost for each patient and doctor interaction?
5. Could the costs of those interactions be eliminated by fixing something in operations?

If the answers to 1-3 are no, the answer to 4 is unknown, and the answer to 5 is yes, your hospital inadvertently made the decision to ignore revenues and to incur expenses that provide no value to your organization. I believe this premise can be proved easily.

The careers of many people are directly tied to the need to have customer service and call centers. Big is good. Bigger is better. Software, hardware, telecommunications, networks—more is better. Calls are the lifeblood of every call center. Without those calls, the call center dies. Calls are good, more calls are better.

When was the last time you were in a meeting when someone said something like, “In the last three years our patient call volume has continued to increase,” or, “Calls have gone up by forty percent.” That part may sound familiar. The phrase nobody has heard is, “We can’t continue to add that many calls.” Tenure and capital. That part of the business is managed with the expectation that the number of calls will continue to grow. And guess what? It does. How prophetic is that? Or is it pathetic? You decide.

Given that, how does the typical healthcare provider manage their customer service investment? Play with the numbers. In many organizations, if customer service management can show that patient satisfaction is holding steady, no matter how bad it is, and they can use the numbers to show that some indicator has moved in a favorable direction, other areas of the business are led to believe that customer service is performing well.

Memo to those executives who are authorizing customer service expenditures—I want to make sure there is no mistaking how I view the issue. If that is what you are hearing from your customer service managers, they either don’t understand their responsibility, or they understand it and they don’t want you to understand it.

To be generous, if patient satisfaction with regard to customer service is below ninety-five percent, your customer service is in serious need of a re-think. Just because patient satisfaction is not tanking faster does not mean customer service is functional.

Most executives know how to get numbers to paint whatever picture they need to paint. Beware the sleight of hand. Any time the customer service manager comes to you and says he is improving operations by reducing the average amount of time someone spends on the phone talking to a patient (average handle time), don’t believe anything else he tells you. Allow me to translate. When the customer service budget is tight (too many interactions and too few people with which to interact) the way to make it fit the budget is to make your people end the call quicker. Shorter calls mean more calls per hour. Note—speed buys you nothing, except for more repeat calls, less resolution, less patient satisfaction. It’s a measure of speed—IT IS NOT A MEASURE OF ACCOMPLISHMNET.

I’d be willing to bet that somewhere between twenty-five and fifty percent of calls from your patients and physicians can be addressed better via a combination of social media and the Internet.

saint Paul M. Roemer
Chief Imaginist, Healthcare IT Strategy

1475 Luna Drive, Downingtown, PA 19335
+1 (484) 85-6942

My profiles: LinkedInWordPressTwitterMeetupBlog RSS