Archive for the ‘customer experience’ Category

Thoughtful Thanking Elevates Marketing Efforts

Friday, June 10th, 2011

I was focusing a lot on social media this week when I kept encountering the same frustration by clients and colleagues about thank you’s.  Whenever I hear the same complaint repeated over and over in the same week, it occurs to me that the “Blog Gods” are pushing me to address the complaint.  And being who I am, I must do so head on.

Marketing Is More Than Promotion

The complaint is about tending to the details and thoughtfully expressing appreciation.  Put another way – demonstrating that you care – not letting things “fall through the cracks,” “get lost in the busyness of business” or just thinking it is too much effort to deal with so the detail is skipped.  This may not seem like a marketing issue, but really it is a significant one.  It is one of the elements that can un-do the best service delivery, the smartest pricing and the brainiest promotion strategy.

This marketing issue is about appreciation. Since many of our clients and readers are non-profits, they deal with lots of volunteers – on boards, doing fundraising, and helping move their organization forward.  The last thing you want to do is alienate someone who is helping your organization.  Woe to the organization that frustrates someone who gives of their time and of themselves to help you.

Two Unfortunate Marketing Un-doings

Two examples of poor thanking  execution and sorry to say these are true stories:

1)       For five years, a talented busy professional gave of his time to a small educational organization.  This individual created a novel mentoring program and worked hard to connect kids with families to further their academic success.  This individual went beyond the role of the basic board member and served the board well.  After five years, it was time to step off the board.  How did the organization thank him for his service?  They sent a dismissive email – “oh, yes, thank you “hard-working volunteer” for your help. We will take it from here.”  RESULT:  this volunteer was stunned, spent a weekend talking about it and now the story is circulated around town.  Fortunately, the volunteer does not utilize social networking otherwise his dis-content would be well spread beyond the community.

A well-crafted letter and/or a three minute preamble to a board meeting, celebrating the individual’s impact on the organization, would have moved the volunteer’s feelings in a very different and positive way.  This positive and more thoughtful action would also have celebrated the organization and volunteerism, setting a standard for others to volunteer.  Moving the conversation to the public arena would also gain publicity for the organization.  There is no down-side to a thoughtful thanking.

2)      A small group of business-owners took a half day from work to help another non-profit conduct a telethon fundraiser.  Part of the quid pro quo was that each volunteer would have their name announced and a public thank you over a popular radio station.  Not only did the radio announcer botch the names in his rapid reading, but proper credit was not given.  At one point during the telethon, the volunteers were shushed from being “too loud” while they were taking incoming gift calls.  The volunteers left the organization feeling they would not do any further volunteering for the organization but also somewhat offended and wondered if organizational leadership was slipping.

Whether old volunteers or new, people want to know that you appreciate what they are trying to do for their organization.  If part of the tacit agreement is a name shout-out, then make sure you do this well.  You always want your volunteers to speak well of your organization and to want to return for another volunteering effort.

Don’t let your good marketing efforts be undone through poor management of your employees or your volunteers.  The market will talk to these individuals first because of their presumed knowledge of the organization.  Whether it is your medical practice, your clinic or your hospital, make sure you do everything you can to have all of your emissaries singing your praises.

And like always — marketing is more effective because it is thoughtful and planned!


The Ultimate Patient Experience

Tuesday, March 29th, 2011

My father passed away with metastatic prostate cancer on March 16th.  He was living in my house for the last four months of his life so that we could assist my mother in caring for him.  We were fortunate to have Hospice guiding us along the difficult and foreign path toward death.

He had a series of complications toward the end.  He had a colostomy as well as two nephrostomy tubes.  Most of the work for the colostomy could be done at home but the nephrostomy tubes had to be surgically re-inserted periodically.  On his last visit for the procedure, two weeks before he died, my dad looked at the nurse as she was preparing him and said, “You won’t keep me here, will you?”  Even though it took three of us to get him out of his bed at home and into the car via a wheelchair, my dad did not want to be in the hospital and preferred the physical strain it cost him to return home.

Knowing what I know now about dying — and dying from cancer, I can still say that dying at home, without the fuss of hospital policies/standards/protocols etc. provided a more comfortable and private place for my dad and my family.  For us, the ultimate patient experience was a quiet and private passing.  Hospice nurses and aides took great care to make sure my father was comfortable, clean, with limited pain and in good care.  They took extra steps to help my mother and me know what to expect and what we could do to help my father.  They stepped out when our questioning was done but stood ready to help, steward and comfort us.

According to the Journal of Clinical Oncology as reported by Reuters (September 13, 2010), at-home hospice care saves money, reduces emotional distress for caregivers and leads to a more peaceful end-of-life passing. While most cancer patients indicate they would prefer to die at home, more than 36% will die in an acute care setting.  Over 25% of Medicare expenditures are spent in the final month of life, most often in intensive care even though there is limited evidence of benefit for the patient.

Physicians and healthcare organizations can help patients and their families in this final quest for a positive patient experience by providing more conversation around the planning for the end of life.

Research conducted by the Agency for Healthcare Research and Quality (AHRQ) indicates the following:

  • Less than 50 percent of the severely or terminally ill patients surveyed had an advance directive in their medical record.
  • Only 12 percent of patients with an advance directive had received input from their physician in its development
  • At least 2/3 of physicians surveyed whose patients had an advance directive were not aware that it existed.
  • Care at the end of life sometimes appears to be inconsistent with patient preferences of forgoing life-sustaining treatment.

As health care professionals and as family members, let’s not leave out the important conversation about end-of-life issues.  Talk it over, ask questions, review with each other and make sure that when the time comes, you AND your loved ones understand what is important.  Knowing that my dad died in the manner he hoped makes his absence more tolerable.


Communication Tool to Enhance Patient Satisfaction

Monday, February 21st, 2011

Communication can really break down when a patient or family member is worried or not feeling well.  Add the element of age and hearing loss and that communication pathway is further impaired.  On the provider side, you may be running behind or still thinking about your last patient’s care and deliver instructions too fast for the average 80-year old to find 100% comprehension.

Building infrastructure around the communication process will improve engagement and most likely compliance.  Adding to your communication pipeline might be good medicine as well as good marketing.

Kaiser Permanente has 3.3 million online PHR (personal health record) users.  Recent research has been done by Kaiser to find data to support the theory that greater access leads to greater engagement.  Some of that research will be shared this week at HIMSS but a preview by Valerie Sue at Kaiser, indicates that patients who can use email with clinicians, can check lab test results, schedule appointments, refill prescriptions and review visit information are simply more engaged.  They have an alternative route to communication about their health that goes beyond the fast moving office visit.

PHRs can be a significant tool to empower patients, communicate more meaningfully and help patients take more control of their own health status. Jan Oldberg, practice leader for internet services group at Kaiser, states that there is clear evidence that PHR use in positively correlated to increased patient motivation.  Oldberg also indicates that PHRs have also led to a drop in calls and visits.

Going back to the communication issue in a busy practice.…a PHR can serve as a communication device and help physicians provide their patients with the ability to access accurate and timely information and help their patients keep track of their health issues.  Patients don’t have to rely on remembering everything the physicians said during the office visit.

A Step Toward Coordination

A recent survey conducted by the Markel organization indicates that physicians would also prefer a computerized method of sharing information with each other. In the 2010 survey, only 17% of the physicians queried use a computer-based method for communicating with referring physicians and yet 74% indicated they would prefer a computer-based method when sharing patient information with each other.

The 2011 Markle Survey on Health in a Networked Life also compares physician and patient preference on information dissemination.  Summary findings as reported by the Markle organization indicate:

  • Nearly all physicians indicate that their patients sometimes or most times forget potentially important things they are told.
  • Both physicians and patients indicate important information is sometimes forgotten or lost in their interactions.
  • Nearly half of the public perceives that their ‘main doctor’ is the one who should keep the patient’s most accurate, complete health and medical records.
  • And yet 2 out of 5 physician groups say it is the patient and not the physician who should perform such a role.
  • 15% of the general public believes that no one is performing this role.
  • Both physicians and patients alike believe that patients should be able to obtain and keep a copy of their own personal health information.
  • 93% of the public rarely or never request copies of their health information in an electronic format

The Markle Survey of Health in a Networked Life also has interesting findings on preferences:

  • For physicians, 74% would prefer computer-based means of sharing patient information with each other.
  • 47% of the physicians surveyed also indicate they would prefer to have a computer-based means of sharing records with their patients while only 5% do so today.
  • 70% of the general public favor patients receiving a written or online summary after each medical while only 4% of physician indicate they currently provide patient summaries.

Providing access to a PHR takes the pressure off the office visit communication and provides  tools that can help your patient become more engaged and informed about their own health concerns.  Seems like a no-brainer method to improve upon the patient experience.


The Moment of Truth in Health Care Marketing

Friday, January 28th, 2011

When you are thinking about your marketing strategy and considering how to reach certain outcomes, take a step back and take a hard look at the service delivery itself.  Yes, I have written about this before but I am not sure, we in health care, have fully reached our service potential.  We do a lot of talking about patient-centered care and there is some conversation around family-centered care, but take a good hard look at one service line or even the emergency department and pretend you are the patient.

Partially because of my father’s circumstances (prostate cancer that has metastasized into his bones) and partially because this is how life works, I have spent a considerable amount of time as a family member in several different emergency departments in the last few months.  No amount of marketing, brand promotion or social media forays can make up for those face to face moments with the admissions representative, the triage nurse, the nurse or the physician.  At times like this (and stated before in this blog), the service is the marketing.  And because a visit to the ED or the hospital is a particularly vulnerable time for the patient and his/her family, every extra step makes a difference.

I have mentioned Berkshire Medical Center in Pittsfield, MA before for its amazing balance of high tech with high touch.  Most hospitals strive for this balance but it takes significant work to get the balance past the word-smith and actually identifiable in the exam rooms.  It starts with making the right hiring decisions and then it continues with the nurturing of a caring culture and modeling that culture for employees.

  • Imagine the impression your hospital would make on the arriving emergency patient if a member of the admissions team came out to the car and helped you get your family member into a wheel chair and then shepherded you in and first made the patient comfortable before tending to the business of the admission.
  • What would the patient think if the triage nurse knew that the patient would have to have a CT prep cocktail and also knew the wait to see a physician, even with a suspected bowel obstruction, was two hours, and that nurse sought out a physician so they could start the CT prep cocktail while the patient was still in the waiting room so that the actual time in the exam room could be expedited?
  • Or imagine that in a busy clinic, the nurse comes out, between patients, to explain why there is a slight delay and makes sure that patient is comfortable and understands the process in front of him.
  • Or imagine the surgical resident who comes to the ER because she sees the patient’s name and remembers him from a prior visit and just wants to check on how that patient is doing.
  • Or imagine the charge nurse helping out with a discharge because the patient is agitated and so ready to go home.  Not only does the charge nurse defuse the patient’s anxiety, but she uses charm and warmth, to disarm the entire family while carefully explaining the tedious discharge instructions.  By the time the patient leaves, he feels like he has a new best friend!

None of the above examples can be written in an employment manual. They all actually took place at Berkshire Medical.  It took an extra step for each of these employees to reach out and they did it and probably continue to do it because they care and they feel enabled in their work environment to demonstrate their care and concern.

Each employee in the above examples could have easily made other choices.  This is the moment of truth for any organization.  When the patient comes face to face with an employee, what will be the result?  Inputs cannot be controlled (grumpy and sick patients) but employee responses can be nurtured with the aspiration of positive outcomes.


Healthcare Reform: Impact on Primary Care

Wednesday, January 12th, 2011

It is encouraging to think that Americans are bringing reflection into the mix with the recent events with Rep. Gifford and the other shooting victims. Maybe it is the media that is pushing this national conversation, but any time we can be more reflective and less reactive in our dialogue, we all win, eh?

The Arizona shootings have led Congress to delay their agenda and to delay the House’s vote to repeal the healthcare reform bill.  While the House’s intent will most likely be symbolic, it seems that there should be more thought into what exactly the reform act does instead of just a visceral reaction.  Hence, my point on reflection.

Key Areas of Impact on Primary Care

The Commonwealth Fund offers a sound briefing on the Affordable Care Act’s impact on primary care. Since primary care serves as the foundation of our healthcare “system,” and is fundamental for efficient delivery, this is an appropriate place to apply focus.  I have supplied the link, in the hope, that you will review the brief directly, but here are some of the key points provided in the briefing:

  • There are provisions in the Act that will temporarily increase payments to primary care providers for both Medicare and Medicaid:  10% bonus for Medicare (2011-2015) and Medicare level rates for Medicaid (2013 and 2014).
  • There are incentives to support innovation in the delivery of care.
  • There are incentives and an emphasis on improving outcomes and enhancing patient care experiences.
  • Recognition and funding exists in the Act to incent more individuals to become primary care providers.

Value of Primary Care

Studies demonstrate that greater access to primary care typically results in better prevention, more adroit management of chronic diseases and even improved mortality rates.  Since our current system of reimbursement for medical providers is fee-for-service, the emphasis (and incentive) is placed on procedures not on coordination of care or management of care or even outcomes.

Nearly half of all healthcare visits are for primary care and yet primary care providers comprise just over a third of our physicians in the United States.  Just as our population is aging and we are increasing access for millions of uninsured individuals, we will be losing nearly one fourth of the primary care providers to retirement.  Currently there are not nearly enough primary care physicians in the pipeline to replace those who are retiring.  Only seven percent of medical students choose to go into primary care.


The Affordable Care Act allows places some emphasis on prevention.  Beginning this year (2011), co-payments, coinsurance and deductibles for approved preventive services are eliminated.  This includes blood pressure screenings and many cancer screenings as well as immunizations.  Seniors will also have a free annual wellness visit and should receive a personalized health prevention plan.

More Providers

If you live in a rural area, you may already be feeling the impact of fewer primary care providers.  The Affordable Care Act provides incentives to battle this serious deficiency through loan forgiveness programs, scholarships and other programs aimed at increasing the supply of primary care providers including nurse practitioners and physician assistants.

Just the Start

The tenets within the Affordable Care Act positively impact primary care, but they do not fix the problem.  There is still much work to be done and the Affordable Care Act is just the start of fixing our healthcare delivery system.


New Year, Same Healthcare Delivery

Wednesday, January 5th, 2011

Thank goodness we have new years to force reflection and to consider our direction.  As you may have noted, I have been anything BUT regular in my blog posts for the past six months.  You may have guessed, it is because of my father’s terminal illness.

Since his health started to take a nose dive in June 2010 and I moved him and my mother to live in my community, I have been forced to see the healthcare industry as a “family member” and have considered our culture’s struggle with morbidity and mortality.

My dad is still with us but the prostate cancer is voraciously taking over.  And even though my dad is 82, he is fighting death.

I don’t know what direction my future posts will take but I just want to offer up some bullet point thoughts for now:

  • I am thankful to Northern Berkshire VNA + Hospice for their continuing care and guidance for my father and our family.  We would be lost without them.  And I am so thankful that my father’s primary care physician recognized the value of hospice sooner rather than later.
  • We have encountered several physicians and nurses who extend their knowledge and care by their grace and kindness.  Berkshire Medical Center has several providers in their medical community that work hard to combine true compassion with competency.  It is these individuals who are the heroes in healthcare delivery.
  • Insurance and payment continue to drive the “system” in interesting ways.
  • Medicare, supplemental insurance, out of network, transferring care into a new state – how complicated does it need to be for our seniors?
  • Our “system” of delivering care is fractured enough that the actual delivery of care becomes problematic and certainly expensive.  Why is the primary care physician essentially out of the information loop during hospitalizations?  Why does one man dying from prostate cancer need a primary care physician, an oncologist, an urologist, a surgeon and an interventional radiologist?
  • Testing, testing and testing?????  And an end of life, how much do we really need to know?
  • Patient-centered care is about the individuals delivering the care, the organizational system structuring the care and the overall corporate culture.  As an industry, we still struggle with the delivery of patient-centered care.  Try being a patient for one day in your organization and see how well you do.

Okay, this isn’t meant to be a rant, especially because my father has enjoyed exceptional care in North Carolina and now in Massachusetts.    We do need to think long and hard about healthcare delivery. We who dwell in this industry are the individuals who can work to change things. We do need to consider the demographic pressure as the baby boomers age – both in terms of costs and appropriate care.  We do need to consider the lack of primary care that is already impacting rural regions. And we do need to understand that all individuals can impact their own healthcare – simply by the food we eat (plant based, anyone?) and the exercise we have. As the new batch of Republicans vow to dismantle last year’s healthcare reform, should we take the time to communicate to our local politicians about what we know?


Make Yourself Rich

Friday, November 5th, 2010

I am in the process of moving my parents from North Carolina to Massachusetts.  My father has prostate cancer that has diffused into his bones. With no family members in North Carolina, it made sense to help them make this move.  Eventually we all have to face the journey of a loved one’s end stage care and while some situations might be more complicated, the process is not easy.  Our society doesn’t do a good job of talking about death and dying.  And I am finding out that our healthcare providers and payers handle these issues with amazing variance.

While physician offices are usually quite busy, I applaud the primary care provider and the oncologist’s staff who have gone out of their way to be helpful and have given me advice beyond just the job function.  The office staff, even the busy receptionist, have taken the time to be supportive and provide kind words.  These people make a huge difference in the patient experience, or in my case, the family member experience.  While we do expect that a hospice worker will provide that level of warmth, I am pleased and surprised to receive it from staff who have mounds of work on their desks and are not specializing in end of life issues.

I wish I could say the same is true for the healthcare payer.  I have spent well a couple of hours with four different employees trying to find out if we can keep my father’s care from having a hiccup.  He is moving mid-month and that seemingly is a problem.  I can’t seem to get an exception or a person with authority who can handle this request.  I do get transferred – cold and warm transfers – but I will continue to work on this issue.  But wouldn’t you think a customer service department would be more inclined to be helpful and thoughtful when discussing end-of-life care?

If you are a healthcare worker, provider, payer, staff, or otherwise, know that when you take those extra few minutes to help someone – and probably not someone like me but more likely a person who hasn’t worked in healthcare for years and is feeling a little lost and vulnerable – or listen to them or suggest an option, you are making a big difference.  You are sharing your humanity. In these times, the more of us who can step out of the daily routines and the propelling pace that hurdles us through our days, to show that we care, the richer we will be.


Moving Toward an Accountable Care Organization (ACO): The Healthcare World is Changing, Are You?

Wednesday, September 8th, 2010

Yesterday, CIGNA announced the launch of an accountable care organization (ACO) pilot with the Piedmont Physicians Group in Atlanta, Georgia.  The essential intention behind this pilot is to demonstrate how primary care physicians can be rewarded for improving outcomes while also having lower medical costs.

The pilot program will monitor and coordinate ALL aspects of patient care. Patients will not have to do or change anything in this pilot.  All of the adjustments will be done internally.  Patients will most likely experience immediate benefits in the management of chronic conditions, such as diabetes.

The CIGNA/ Piedmont pilot uses a registered nurse as the clinical care coordinator.  This role is specifically oriented to assist patients as they navigate through the healthcare system to manage their health issues.  The care coordinator adds an additional layer of interface that will use data and clinical programs to help support the individual’s needs.  The focus will be on improved outcomes.

In essence, this program, and others like it, are going back to basics on one level and moving forward on another.  The focus will be on prevention – keep an individual well but once the individual needs to access care, the pilot will work to coordinate that care, guiding the patient through the process with knowledge and informing data.

CIGNA will continue to pay the primary care physicians for the medical services they provide but they will also pay a care coordination fee along with a possible reward in a pay for performance structure.  In some ways, this is similar to concierge practices where the physician continues to provide medical services for reimbursement from third party payers but also collects an annual fee for additional services – services not unlike care coordination and an emphasis on prevention.  The responsibility for that additional fee becomes the payer’s in exchange for improved outcomes.  Sounds like a win-win situation.

Providers need to make way for new incentive programs like this one.  Whether a hospital or a physician organization, preparation for change needs to happen now.  There is substantial information flowing about electronic health records (EHRs), utilization of outcomes data and comparative effectiveness research findings and the ability to provide care coordination.  It is likely that these three tenants will form the basis of a provider’s ability to become an ACO.

The handwriting on the wall indicates that providers will be paid for keeping patients healthy.  Providers should reconsider the value of their outreach programs that seek to motivate physical activity, healthier diets and smoking cessation.  Some early research (Trust for American’s Health, 2008) suggests that funds spent on prevention outreach lead to significant savings in healthcare costs.  This kind of outreach is already in place in many organizations.  If not, the easiest step is to focus on wellness events and early detection programs and begin planning for the other steps (EHR implementation, using comparative effectiveness research findings and coordination of care).  The world is changing and providers need to change along with these new (or renewed) constructs.


Guest Post – Making or Breaking Your Customer Experience

Tuesday, February 16th, 2010

Intuitively, we all know that we need happy employees to deliver great customer service.  That intuition is also backed by extensive research that also validates this conclusion.  But, do you really know and understand what it takes to create that happy employee?

The American Society for Hospital and Human Resources Administrators recently released a study of the workforce trends for the year 2015.  Entitled, “Strategy Trumps Shortage”, they came to the following conclusions:

  • Work processes will need to be redesigned
  • Retention of existing staff is critical, even those able to retire
  • Companies must do the right things to attract the new generation of worker

While on the surface, these conclusions don’t seem to be much different from what we have heard in the past, when you put them into the context of the current generational shift going on in the work force, they are actually quite relevant.

Let’s start with work processes…By 2015, the majority of our workforce will be made up of Generation Y and Millennials.  These generations thrive on independence, rapid feedback and a desire for balance between their work and personal lives.  They are much more likely to judge their organizational experience on individual relationships…not on the overall organization.  Therefore, they will chose to work for places where they can exercise their creativity within a flexible work environment.  Are you designed to meet their needs as an employer, or does a top down, hierarchical environment best describe you?

Thinking about retention of staff, one of the greatest expenses a company incurs is in losing a staff member.  The hard costs of a turnover include the money spent to fill the gap until a person is hired (overtime, temporary staff), training time for the new person, loss of productivity during the training period and others.  While some turnover is good, it’s key to understand who you are losing.  If it’s your good people, something in your environment needs to change.  Your good people can always find a job, and they are the ones providing the great experiences for your customers.  You cannot afford to lose them.  Find out what motivates your top performers to stay.

What about attracting the new generation of worker?  As noted above, the newest generations look for a workplace that will allow them the freedom to not only do their jobs, but to also design how they would like to do those jobs.  While there are certain requirements and rigor to each job, it’s important to look at where you can be flexible.  While tradition is important, doing things the same old way just won’t endure.

To meet these challenges, the study noted that there are certain leadership approaches that will be necessary to create environments so that employees will be energized and focused on providing your customers with great experience.  Some of those traits include:  an appetite for change, the desire to engage the workforce, the thirst for innovation and an approach that welcomes new generations to the workplace.  Do your leaders possess these traits?

To best serve your customers, you must best serve your employees first.  Make it a focus for 2010 and you will see great results!

OUR GUEST BLOGGER:  Catherine Baumgardner has extensive experience in leading operations of clinical services for a regional health system, and in consulting with clients to develop and implement strategies that will deliver desired results. Her outstanding skills in customer service culture development and implementation have made her a favorite choice with her clients.  If you are looking for someone with a strategic awareness to customer experience and operational excellence, Catherine is a good person to contact.  She recently started her own consulting firm, Catherine Baumgardner and Associates and we are pleased to have Catherine as our first guest blogger!