Customer Friction Factor℠ and Healthcare Providers: My Experience and Recommendations

In a previous post, I detailed my diagnosis with Neuroendocrine Tumor (NET) cancer. I don’t want to repeat any of that post. Instead I’d like to use my medical experiences as at least one set of data points for how healthcare providers could reduce customer friction for their patients.

The following insight is based on roughly two dozen doctor, clinic, emergency room and lab visits from October of 2017 to January of 2018. In late January, I went into the hospital to have my primary NET tumor, located in my small intestine, removed along with my gallbladder, appendix and 20 lymph nodes (seven of which turned out to be cancerous — one as large as a golf ball). I was originally in the hospital for four days. After the surgery, while recovering at home, I had complications (an abscess that blocked my intestines) that landed me back in the hospital for another eight days.

During visits, scans, tests and hospital time, I tried to keep notes on what was as frictionless as possible and what could really use some friction reduction. I have no illusions that all hospitals, doctors, clinics or testing facilities are the same, but I feel that by describing my experiences, perhaps healthcare providers might be able to generalize a bit and improve the overall patient experience. With that in mind, let me get to my observations.

General Provider:

• The provider system I recently used has a patient portal that is used by several different providers and seems to have a moderately good installed base. It was excellent software that kept me up-to-date on my appointments, tests, bills, etc. It even emailed me when a new test result came in or appointment times changed. Additionally, I could read the test results online (with comparable “norms” explained in the results). Seriously, the best patient-oriented provider software I’ve ever used. Recommendation: One enhancement I’d like to see would be access to images via URL links. No images are included in the test results, only the expert reports. Sometimes you want to see your own insides, you know?
• Surveys are, I believe, an important part of a provider getting feedback. However, if you get surveyed after every visit it gets pretty old. Recommendation: Perhaps put in a counter to survey my feedback only every three or five times? I finally got to where I’d just ignore them. Especially if I had two or three visits that week — and a corresponding number of surveys.
• As an aside, having a customer (or patient) repeat information that the provider already has is considered annoying and the single-most hated source of Customer Friction. I do, however, give providers a pass on this as many require lab personnel, nurses, etc. to ask “Name and date of birth?” before providing a test or medications. Not that the medical profession needs my approval, but I heartily endorse this practice as a way to reduce mistakes, and I do not count any communications in this vein to be friction that can be reduced without a reduction in safety.

Emergency Room:

• Most people have horror stories about ER visits. My experience is very different. The one time that I had to go into the ER (abscess causing small bowel obstruction), I had terrific service, turnaround times, nurses and doctors. Now, part of that was because I got to the ER at 3am. But I have to say I had an ER room in four minutes and a doctor in ten. Additionally, everyone communicated very, very well with me and my wife. I literally have no personal notes on improvement from my recent ER experience. Kudos to the provider.

Labs:

• Of all the healthcare provider organizations, I feel that labs are the best-organized and produce the least friction for patients.
• Labs generally ignore appointment times when you show up early and the personnel work hard to get your tests, draws, etc. completed and let you go on your way.
• Lab personnel are very focused and communicate quickly and very well.
• Recommendation: My only possible area of improvement for labs is in signage and directions. Better signs, better placement of those signs (eye level, not waist level) would help. Also, when you’re done with a lab and the technician just says “You’re all set,” but doesn’t point toward the exit or provide some simple direction back to the lobby, this can provide dozens of minutes of fun while you wander around the facility and get into Staff Only access areas. Clear exit directions would help.

Doctor Visits:

• If a doctor asked me for the one thing that every doctor should do to improve the patient experience (none has yet asked me for that info), my reply would be simple: Recommendation: Prepare before seeing the patient. Simply stated, I have found that my opinion of any doctor is directly related to whether he or she has actually read my chart (including my current situation and new complaints), before entering the exam room. It drives me crazy when I realize that the doctor hasn’t done that and expects me to verbally brief them on my history, current events, etc. I will reiterate: The best doctor I know will NEVER enter a patient room without first reading their chart. The worst doctor I know will NEVER read a chart before entering the room to speak to me. If you need further proof, see any Customer Friction Factor assessment that we’ve done. The single-most hated behavior in customer service is making the customer repeat information that the entity already has.
• I know emergencies happen. I completely understand that. But my experience is that doctors regularly run 30 minutes to 45 minutes behind schedule. Recommendation: Perhaps visits are being booked too tight? My personal worst has been a doctor that was 90 minutes late. No real explanation, just an apology. As I’m pretty anal about being on time, I usually am in the clinic at least 30 minutes early, so I help to compound the problem.
• Recommendation: Receptionist / desk personnel should be thoroughly trained. I cannot count the number of times that they missed giving me forms to fill out, were unable to schedule appointments (that being a primary part of their job) and displayed a general lack of follow-up. It seemed like a real problem area for all locations for the healthcare provider I used.

Hospital Stays:

• In any profession, you have personnel that treasure what they do and work tirelessly to perform the best service for their customers / patients. And in any profession, you have people that will do the absolute minimum to service their customers / patients. That’s no different in healthcare, but the problem is good and bad nurses are so very OBVIOUS. I’ve had nurses that just bent over backwards to ensure I was okay. And I had nurses that camped at the nursing station and were visibly annoyed that they had to come in and get my IV machine working again. Additionally, on an average hospital day, I’d see a nurse for probably 2 hours out of every 24 (consolidating all the five- and ten-minute visits during the day into one chunk of time). I probably saw a doctor for 10 minutes total daily. Nurses will make or break a patient’s opinion of your service. In my experience, 90% of my nurses were absolutely terrific. But I also worry that they are so busy. I believe from what I’ve seen that nurse time is scheduled too tight, too. And yes, I understand that it’s a cost issue. Recommendation: Ask patients for their feedback on nurses and technicians by using personnel photos. That way, names aren’t confused and you’ll get specific feedback on which personnel are providing the best care.
• Why, if you are an architect of a hospital, would you select the world’s loudest doorknobs? I could literally hear the next room’s door being opened from the doorknob sound alone. Now if I was running an illicit poker game with the orderlies, I’d love the extra warning. But many times I was trying to sleep, and I was confused as to why these doorknobs were selected. Recommendation: For hospitals, soundproofing isn’t enough. Look at all environmental noises.
• For food service, may I suggest that ala carte ordering is great from a patient’s perspective? But if it takes an hour to be delivered, that’s a huge downside. And in my experience, my hospital took four days to get my diet right (defined as in sync with what my doctor wanted it to be), and only corrected it in the last hour before I was discharged. This left a bad taste in my mouth (pun intended). It got so bad that my should-be-sainted-soon wife actually snuck into the Nutrition Center and snagged an apple sauce for me when I just couldn’t bear the empty stomach any more. When you are causing a woman like my wife to sneak around you might want to improve your process. Recommendation: Review and revise your diet and food delivery processes to ensure quick and faultless delivery.
• Recommendation: Equipment should be in good working order or promptly replaced. I had an IV machine that would occlude (See how I’m using doctor words now? Long hospital stays do have some perks … ) every 30 or 45 minutes. I named my IV machine “Mr. Wheezy.” After about two days of near-constant alarms, I wanted to toss it out the window. It drove me nuts. My wife actually got to be an expert in coaching it back into functioning, only because we got tired of calling the nurses twice an hour.
• The hospital was constructing a new wing across the street. That’s good if you’re a hospital administrator. It’s bad if you’re a patient and the construction crew begins their day at 6:05am with hammering pilings into the ground. See above for environmental noises.
• Nighttime visits from technicians and nurses separated the great teams from the not-so-great teams. I’m not exaggerating when I say that some nights I was disturbed no less than 10 times. The great teams would bundle their interruptions together (e.g., have the nurse come in with medicine at the same time as the tech would do vital signs and a blood draw). Those thoughtful teams took the nighttime interruptions down to 3 or 4 from 10. I loved them for it. Recommendation: Train your nursing and tech teams to batch together nighttime procedures to reduce patient sleep interruptions.
• While I’m on nighttime interruptions, I had one technician come into my room at 1 am, talking loudly on his cellphone. After about 5 or 7 minutes he hung up and explained he was here for a blood draw. I’m thinking no one told him that this was inconsiderate behavior. Recommendation: Train personnel on nighttime and cell phone courtesies.

Patient care friction is no less important than any other kind of friction. It’s the difference between former patients raving about the care you provide — or ranting about it.

To learn more about the NTT DATA Customer Friction Factor Assessment for Healthcare, check out this whitepaper.