I have been mulling over my latest Consumer Reports magazine on the topic of healthcare from a variety of angles. It was surprising to see that CR has started its Cover America tour to listen 1 on 1 with people to help diagnose what ails our healthcare system. The challenge in this approach is that most American's have high expectations for healthcare and most do not understand the complexity of the system. I argue that they shouldn't have to understand the complexity. Healthcare is a service business and patients compare the quality of health services to other services they deal with (see Dr. Crounse on Healthcare IT or Not: No excuse for bad service). It is clear CR wants to be an agent for change and it is also clear that most in the healthcare system are woefully unprepared for it. I believe there are at least 5 reasons why. I'll start today with the first reason and continue through the other 4 each day this week.
Why Healthcare is Not Ready for Change
Who is My Customer? This question seems basic enough, but sadly one that most healthcare providers cannot seem to answer. Understanding who the customer/patient is often involves a never ending litany of paper and arcane processes. I use the word customer deliberately. I think we all ought to think of patients as customers. Patients today often pay for healthcare in the form of some contribution to employer paid coverage, health spending or savings accounts, co-pays, and other financing for out of band services.
Where health providers have spent some time on this issue has been in consolidating disparate patient information into a master patient index. While this certainly helps in retrieving patient information, it isn't always all of the information, or even the right information. And it most certainly doesn't help me answer the question--who is my customer/patient.
To better understand the customer/patient, providers are often curious about the impact to their revenue. Who is the insurance provider? What does the coverage look like? Any outstanding collections? This information might be important when a customer is sitting in front of registration or after accounting is trying to submit to insurance and collect for treatment. However, as you move through various stages in a customer/patient encounter, the questions about who is my customer often change. Typically, the next person in the cycle of care only needs to be concerned with the information provided by predecessors. This is analogous to a track and field handoff--"Just hand me the baton so I can run my leg". So often this relevant information exists in multiple silo'ed systems, further complicating their view of the customer. Is the challenge so hard we should just sit back and wait for something miraculous to happen? Well, actually, NO!
A. Inventory your customer information systems. For your organization, determine what is the customer/patient encounter typically like. Map this out from a process perspective and account for the big exceptions. Don't go wild, just focus on 5-8 typical exceptions. Then inventory all of your customer information systems. Where is customer information stored? Don't worry yet about how to get to it, just figure out where it is.
B. Evaluate how customers interact with you. It may seem trivial again, but how do customers find you and interact with you. Do they rely on physician referral? Do they use the phone book? Do they look at your web site (and if so--what do they look at)? Where are they reaching your web site from (your internal marketing, search words, etc.). Do they go to a 3rd party referral service (i.e. through their company, through an association)? Do they trust you? Are they consulting other opinions to determine if they are getting the right treatment (like Doctor Evidence)? You get the point. Get a few diverse people on your team and brainstorm all the ideas. Then test them with a few customers. Invest in some surveys (Microsoft Office SharePoint Server enables you to do some great surveys at a relatively low cost). This is not an easy process, but would be worthwhile if at this point you are committed to change.
C. Knock down the silos--Connect your people. If it seems all of you information is locked into silos, then go find the key and unlock it. Want to know where the key might be. Read about the Connected Health Framework. This is a vendor agnostic framework for connecting all the various stakeholders with relevant information. If you really dive into this framework, you may feel like you have found the key. Try to get through the easier reads, then graduate to the entire 300+ page white paper. It is worth it. Of course from a product standpoint, we have some innovative solutions such as Microsoft Amalga, but I believe products alone don't solve complex problems, so that's why I advocate looking at your architecture first. I could also go on and on about how looking at service orientation and data integration are both worthwhile pursuits, but this is almost like treating before you diagnose. Look at the architecture you have first and foremost. What are the bottlenecks? Where is information stranded? How do you connect people with knowledge so they can act? Knowing this will help you take further steps to becoming more customer centric.
..................Tomorrow I will talk about the next steps you need to explore, and that is understanding who manages the customer/patient relationship? Who should? And what will it mean if you fail to develop some proactive steps for developing a relationship with these customers (yes, I said relationship). If you don't work on it,someone else will. Just look at the site PatientsLikeMe. This is sort of a Facebook for the patient population. Here they can rate their patient experience, share information, make friends, etc. When compared to Best Doctors (another fine site), it is truly a social networking approach that I believe has some merit.