Patient Experience (Mis)Management (PEM)

The 2009 HealthLeaders Media Patient Experience Leadership Survey write up by Gienna Shaw states “nearly 90% of top-level healthcare executives said patient experience is either their top priority or among their top five priorities.  However, there’s a gap between what senior executives say about patient experience and what they’re actually doing.”

We should be surprised, but we’re not—at least I’m not; bemused perhaps, but not surprised.  LID—Leadership Innovation Disorder.

Their plans (the healthcare C-suite) for dealing with the area of Patient Experience do not match their priorities.  They are not walking the talk.  Of their other four top priorities, are those plans equally non-existent?  The last time I checked, there are no prizes awarded for simply having a set of priorities without having any plans to address them.  Or, has that changed?  Does the chairman of the board simply state, “Well, at least you got the priorities correct…here’s some more stock options”.

One of the conclusions in the survey is that the “leadership”—and I use that term as a placeholder for those who are supposed to be leading—have not figured out who owns the functional area, Patient Experience. Well, that explains it.  Other reasons to explain away why nobody is doing anything about it include;

• Lack of budgeting priority
• Lack of management alignment
• Lack of game plan or actionable ideas

Questions for the Board and the C-suite.  Let us address each of the three bullet points—the plan for failure.

Lack of budgeting priority.  If fixing Patient Experience is the top priority, why are you funding lesser priorities?  Are you still funding the marketing department?  Of course—apparently there is no such thing as having too many billboards touting the greatness of the urology department.  Hospitals continue to spend money to bring patients in the doors, but no money to keep them from leaving. Doesn’t that seem a little self-defeating?

Lack of management alignment.  Puh-lease.  Leadership is not a democracy.  Here’s how to fix this problem.  The person with the biggest office tells an executive, “You are responsible for Patient Experience.”

Lack of game plan or actionable ideas.  The person with the biggest office tells the executive, “First, I want a report in my hands in thirty days explaining what the best organizations are doing for customer experience both inside and outside of healthcare.  Second, I want a plan in sixty days explaining what we would have to do to deliver that functionality and what it will cost.”  If you don’t have someone capable of leading this type of project, grab somebody who does.

This is not rocket surgery.  There is no need to study how to get started.  There is no need to form a committee or to assign it to a PhD.  All that is required is a decision—you do this by then.

PEM.  Patient Experience Management.  Patient Expectation Management.  Patient Equity Management.  Customers and consumers—patients.

I like Patient Equity Management.  Patient Experience Management, like Customer Relationship Management, is a push.  It’s the hospital trying to manage the patient.  Equity Management is a pull.  The patients, like an MRI, are an asset, an asset whose value over time is difficult to measure.  Nonetheless, an asset to be retained.  I have tried to get my arms around what I call Patient Lifetime Value (PLV), but nobody seems to have a number for it.  The PLV for retaining a patient over the years must be substantially higher than that of capturing a new patient.

Hospitals across the country are losing patients. If an MRI walked out the door, somebody would notice, somebody would try to get it back.  If a patient chooses to go elsewhere the next time they need hospital services, nobody will know—the lifetime value of that asset just went to zero and nobody is the wiser.  If each year 10 percent of the patients decide to leave, you need to replace every one of them just to have the same number of patients next year.

The final part of the survey reports on how the hospital leadership defines patient experience and the initiatives they have underway to improve it.  After reading that part of the survey, my conclusion is the survey’s definition of patient experience and the initiatives hospitals are working on to improve it are symptomatic of why there is a problem.  While some of them are necessary, they are not sufficient.

Some of them may not be necessary, or are at best premature.  For example, Patient Experience Management is not a branding problem.  Rebranding will neither improve the problem nor make it go away.  Working harder at the same bad ideas, at an area where there is no expertise, is not a solution.  It is merely a way of keeping busy, of looking like you are doing something.

Patient Experience Management is a perfect undertaking for the CIO and IT.  In many aspects it is as much a business problem as it is a clinical one.  The business issues are created by ineffective and outdated processes.  Why not take ownership of it?

From the business side of the coin, I view PEM as the processes and business rules that support or hinder every time the patient interacts with the hospital.  This involves social media, the internet, the call center, admissions, and billing.  Most of those processes are the same ones that have been in place for years.  For the most part patients do not want to interact with the hospital other than to get better.  Almost every other interaction has to do with solving a problem that could have been resolved earlier, or meeting an unmet need that could have been met earlier.

Most of these interactions use resources—technology and people.  Most of these interactions do not result in a win for the patient, thereby decreasing their experience and decreasing their expectations.  These unfavorable interactions, if left unchecked, over time will cause patients to go elsewhere.

There is plenty that can be learned from how other industries have attacked these issues.