Paul's Blog Archive

Being stranded on the side of the road with an automobile emergency is one of life’s least popular little interruptions...and there’s very little that can change that perception.   However, a friend told me about his recent experience with a flat tire during rush hour that may have changed my mind, a little.  

He used the roadside assistance service linked to his cell phone plan and called for help.  Within the hour, a patient and skilled auto assistant came to his rescue.   In a short time, he was on his way again.   Several very striking things occurred during the hour or so my friend was stranded.  I related his experience to where health care needs to go. 

Within a few minutes of placing the call for help and getting confirmation that help would be sent, he got a return call updating him on the status of the roadside rescue driver.   A few minutes after that, he received another call inquiring about his ongoing safety.  Shortly after the tire was replaced and the roadside technician had left the scene, he received another call asking if he would take an automated survey on the dispatch center service and roadside technician service, with the option of speaking to a real person following completion of the survey if he wanted to provide additional feedback or had any questions.  

While my friend probably should have noted that his tire was worn and done a better job with car maintenance before starting out on the road, the roadside service did its best to get my friend up and running again, while keeping him informed and providing a conduit for additional communications.   The only thing the service didn’t do was put my friend in touch with the closest car mechanic for a more thorough examination of his car.  Maybe that’s a thought I should a pass along to the cell phone company.

In the not too distant future, I believe health care providers and/or insurance companies will need to develop this kind of intensive connection program with patients under their care.   This translates into communications before the inpatient visit and after discharge.  For non-urgent care, early connection with the patient could ensure that he or she gets more comprehensive treatment during the pending patient visit.   For example, while a patient may request an appointment regarding an arthritic shoulder, a quick over-the-phone health quiz might also uncover the need for an annual cholesterol check or colonoscopy, allowing the provider to make those arrangements during the upcoming visit.   In addition, contact after discharge is a key step to reducing hospital readmissions.

Every consumer is basically like my friend with the car….cruising down life’s highway, and perhaps not taking good care of themselves.  When an emergency occurs, they want to call someone who can help solve the immediate problem, but also help manage the situation.   If a cell phone auto rescue plan can provide that attention for $9.99 per month, shouldn’t hospitals and insurance companies look to model this type of customer service?  What are you doing to be only a phone call away?

Imagine a health care system where doctors have a financial incentive to limit unnecessary tests and ensure that patients take better care of themselves.  This system would actually aim to keep patients out of the hospital. 

This is the goal behind Accountable Care Organizations, or ACOs, the latest health care delivery model being touted by D.C. policy wonks and health care gurus.  The current version of the health care reform bill in the U.S. House of Representatives calls for a Medicare pilot project to see if ACOs can lower costs and improve care. 

What exactly is an ACO?  There is no exact answer, but they must include three components: primary care physicians, specialists, and at least one hospital, and the size of the hospital doesn’t matter. These three groups would share responsibility for the quality of care and the cost of care received by the ACO's patients. If the ACO achieves both quality and cost targets, it could receive a bonus; if it fails, its members could face lower Medicare payments. The incentive is to deliver coordinated, efficient care. 

Each ACO would be operated by a group of doctors and hospitals that would be paid by Medicare to care for all the health needs of at least 5,000 elderly or disabled people.

Under the existing fee-for-service system used by Medicare and most private insurers, doctors get paid more by providing more services, and hospitals make more by increasing admissions. With ACOs, doctors and hospitals would get paid based on their ability to hold down overall costs and meet quality standards. In effect, their pay would be based on improving care, not generating more of it.

If the ACOs fail to meet certain quality and cost savings targets, the providers in the ACO would receive lower payments from Medicare.  Conversely, the ACOs would also be rewarded for keeping patients happy and meeting national quality standards, such as making sure men get annual prostate exams and women get their annual mammograms.

In effect, ACOs are an attempt to build relationships between doctors and patients that mimic the closeness that many small town doctors enjoy with their patients.  It’s also an attempt to build integrated health systems like the Mayo Clinic where none exist. But Mayo took several decades to build.  The pilot ACO studies will attempt to see if one can be formed in a year or two.

Creating ACOs requires hospitals and doctors to work closely together and to share financial risk, as well as potential profits.  This means ACOs must break down some pretty serious political and cultural boundaries between hospitals and doctors.  Many doctors prize their independence and don’t want to be bossed around or be treated as employees.

Not all ACOs have to be the same. This could be especially true in rural areas.   The end result, though, is the same: creating an integrated health care organization that is responsible for cost and quality.

If hospitals and doctors are going to live up to this objective, they’re going to have to manage patient health in a more proactive manner.  This means becoming slightly more intrusive.  Imagine a time when the doctor or hospital representative becomes as intrusive as the telemarketer.  The only difference is that the telemarketing call probably raises your blood pressure, whereas the weekly ACO caller is interested in helping you lower it.    How many hospitals are set up to maintain this sort of contact level?  The ones that aren’t may not be ready for the ACO agenda.  Tell me what you are doing to proactively manage your patients’ health.

2010 is here; a new decade with new challenges. During the past decade, all sorts of new technology entered our lives. As your children played with the latest Wii, Xbox or PlayStation, and you downloaded the latest best seller to your Kindle, did you take the time to think about the implication of the latest technologies for your hospital?

How will patients, accustomed to using their phones for instant access to everything, change the customer service demands for healthcare providers? Will they expect to use text messages to get their room cleaned? Will they want a special app for food on demand?

A new report, Trends in Patient Service Strategies: Improving Customer Satisfaction with Technology, explores how healthcare organizations can leverage technology advancements to improve customer service.  While most hospitals already use relationship management systems and web-based scheduling and are dabbling with personal health records, patients are looking for e-mail and chat as well as registration kiosks and patient portals. This report details how technology can support and improve patient satisfaction.

I believe that in this new decade we will increasingly rely on technology to support our customer service initiatives. The emergence of new technology and the increasingly high expectations of patients will make support for technology a strategic necessity. While there may be challenges to adoption, I am convinced that hospitals who leverage technology will increase customer satisfaction.

How are you integrating technology into your customer service strategies? I'm anxious to hear from you. So text me, email me, tweet me or use whatever technology you prefer. I want to hear from you...my phone works pretty well too.

You can follow Paul on Facebook (facebook.com/paulspiegelman) and Twitter (@paulspiegelman).

A sweet grandmother called St. Joseph's Hospital and timidly asked, "Is it possible to speak to someone who can tell me how a patient is doing?"

The operator said, "I'll be glad to help, dear. What's the name and room number of the patient?"

The grandmother said in her weak, tremulous voice, “Norma Findlay, Room 302."

The operator replied, "Let me put you on hold while I check with the nurse's station for that room."

After a few minutes, the operator returned to the phone and said, "I have good news. Her nurse just told me that Norma is doing well. Her blood pressure is fine, her blood work just came back normal, and her physician, Dr. Cohen, has scheduled her to be discharged tomorrow."

The grandmother said, "Thank you. That's wonderful. I was so worried. God bless you for the good news."

The operator replied, "You're more than welcome. Is Norma your daughter?"

The grandmother said, "No, I'm Norma Findlay in Room 302. No one tells me anything."

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Many of us can identify with Norma to some degree. Perhaps we’ve felt out of the loop and uninformed at some point in our own healthcare experiences. Perhaps it was a situation where we didn't feel like our doctor explained a condition in more detail, or when a nurse came to run tests we didn’t fully understand, or when the physician’s office location changed without telling us. 

As healthcare providers, it’s easy to get caught up in the behind-the-scenes work and our many daily tasks. We may not realize how our interactions or inactions might affect the patient experience.

I did spot one good thing in this story though. It sounds like the hospital was doing a good job making information available to family members, giving the organization the benefit of the doubt when it comes to HIPAA violation.

With patient satisfaction so important, stepping back and assessing how well all levels in your organization are doing with respect to communicating to patients is critical. As a healthcare organization committed to delivering the best patient experience, what steps are you taking to ensure that your patients are kept in the loop and do not feel like Norma?

I bet you've used Consumer Reports to help buy a used car, washing machine or hi-def TV.  But did you realize that you can now use Consumer Reports to shop for healthcare?  Hospital ratings data has now gone mainstream, not buried in obscure sites like cms.hhs.gov and leapfroggroup.org that many consumers are still unaware of.  

Consumer Reports is now providing hospital ratings for more than 3,400 U.S. hospitals using HCAHPS data.  Consumers can now find the famous "Recommended" checkmark for a hospital just like they would do for a Toyota.  You can track ratings on eight performance indicators regarding the patient experience, including nurse and physician communication, room cleanliness, discharge information, staff attentiveness, communication about medications, pain control and noise level.

Are we ready for consumers to see our true colors as they would for a car or computer?  Results show that we're not:

- 92% of the hospitals received the lowest ratings for staff communication about medications

- 82% of the hospitals received negative feedback for the way they give out discharge instructions

In short, the kimono is now open.  We are exposed to the consumer community and we should be.  I would appreciate your thoughts about how we make sure that our customers trust us enough to give us the Consumer Reports "Recommended" checkmark.

Are you tired of your friends showing off their latest iPhone applications?  Well, there is one iPhone program that will impact all of us in healthcare – Canopy Financial’s new iPhone application for consumer-directed health (CDH) plan enrollees. This new application allows iPhone and iPod Touch users to determine if they can use their spending accounts to pay for a procedure – and, more importantly, determine the typical cost of the procedure based on zip code.

According to Canopy’s CEO, this information will help consumers comparison shop for procedures and even negotiate prices with providers.  Contact information is included! The next target for this consumer-friendly pricing model? The Blackberry. The company’s goal is to eventually have this program available on all mobile phones.

I have long believed that price transparency and even price parity will be coming to healthcare.  And, I feel strongly that healthcare providers must focus on developing a compelling customer-focused value proposition that includes but also transcends price.

With consumers negotiating prices, it is more important than ever to connect with customers before they need a procedure.  Then price will become only a part of the value equation – with service and brand playing a key role.  Pricing is no longer the elephant in the room that no one will discuss.  What are you doing to promote your value to consumers? 

Southwest Airlines is known for its great customer service. In general, the airline industry, like healthcare (unfortunately), is not regarded as the epitome of exceptional service, which is why Southwest stands out. Its unfaltering commitment to service excellence also explains why the airline has been profitable–no matter what the economy–for 35 years.

Cynthia Williams Young, Southwest’s senior director of labor relations, was a keynote presenter at The Beryl Institute’s recent Pursuit of Excellence conference in Dallas. The conference was attended by healthcare marketers from across the country and focused on improving customer service in healthcare. Southwest is a great example of how customer service can permeate an organization’s entire culture, no matter how large, diverse, or geographically-dispersed the workforce.

If the airline industry can do it, so can healthcare. To read seven secrets from Southwest about how to increase your customer service, please click here. 

The economic environment has certainly impacted healthcare, including government cuts, increases in the uninsured population, and job loss. However, in recent news at Grady Memorial Hospital in Atlanta, the economy had nothing to do with their 140 layoffs. Instead, they were due to culture.

Michael Young, the sixth CEO at Grady within the last three years, was hired to turn around an organization that has been heavily criticized for its culture, which was characterized as tolerating inefficiency and hampering patient care. With Young’s record of outstanding leadership, change at Grady is within reach. As the saying goes, “the achievements of an organization are the results of the combined effort of each individual.” As such, every employee at Grady must be onboard and have the same goal in mind of changing perceptions, which will then change reality.

As leaders, do we ask ourselves if we have the right people in the right positions to drive innovation and create a culture of excellence? Are you ready to make the tough decisions?

I’m interested in your thoughts about how culture affects an organization, for the better or worse. Please share any specific examples you have.

My dentist's assistant called me on my birthday. The local book store sent me a note to tell me that my favorite author had published a new book - and sent an order form. Amazon sent me a listing of the latest business books. That made me think - what are hospitals doing to proactively connect with customers in a meaningful way? They may not want to buy our services unless they really need them, but isn't that all the more reason to keep in touch?

Are we reaching out to customers after discharge, just to see how they're doing? Are we following up after a diabetes education class to check if patients want to enroll in a nutrition class? We build tremendous databases of customer/patient information. Who is doing anything with this valuable data?

We all know that resources are stretched thin. But the connections and loyalties that customers establish now will last for years. How are we working to deliver excellent and proactive customer service despite shrinking budgets and staff?

I'm interested in how you are addressing these questions.

Declining reimbursements. Rising supply costs. Tightening credit markets. Hospitals can no longer be considered recession proof. The U.S. Dept. of Labor's Bureau of Labor Statistics reported that as of Nov. 30, 2008, 107 hospitals had reported mass layoffs, defined as 50 or more unemployment claims filed against one company at one time. That is the highest yearly number since 1996 when the bureau began keeping these statistics.

While most of these layoffs impact non-clinical staff, some smaller hospitals have even terminated employed physicians. With layoffs looming, it is even more challenging to focus on customer service along the entire continuum of the patient experience – from the first inquiry, through registration, and post-discharge. In these difficult times, hard choices are being made. The first impulse is to cut everything not tied directly to patient care – however, for patients care is not just visits with doctors, nurses, and other clinical staff. Care and related patient satisfaction is the sum of their entire hospital experience.

I am eager to start a conversation about what you are doing at your hospital to ensure that customer service doesn’t suffer during this economic downturn. Share your thoughts today.