What Happens To CX If CVS Buys Aetna?

CVS buys AetnaCVS made an offer to buy Aetna for more than $66 billion. While there may be a lot of value in a combined company’s increase in power in drug distribution, what might this healthcare vertical integration mean for customer experience?

My take: CVS and Aetna have totally different relationships with consumers. One lures in consumers for individual retail transactions and an intermittent set of pharmacy interactions, while the other has an annual contractual relationship that often deals with emotional health situations.

As you can see in the chart below from a number of different Temkin Group research reports, consumers have a much more positive relationship with CVS (see Temkin Experience Ratings and Temkin Loyalty Index). As with most health plans. Aetna has a poor Temkin Experience Ratings, doesn’t have many customers recommending it, haven’t earned a high level of forgiveness, aren’t very trusted, and don’t really want to buy anything else from them.

Aetna versus CVS Customer Experience and Loyalty

So what happens to customer relationships if either company takes on attributes of the other?

  • Can Aetna learn and apply lessons from CVS’ retail prowess? Probably not. Stronger retail-like capabilities could help elements of consumers’ relationships with Aetna, but it’s unlikely that there would be much of a change given the radical difference in business models.
  • Can CVS learn and apply lessons from Aetna’s consumer relationship prowess? Probably not. It’s unclear how Aetna can help CVS better treat consumers given its very poor track record.

If this deal goes through, then it looks like consumer experience will lose out in the short-run. Besides the lack of upside in cross-learning, both organizations will likely become more internally-focussed as they work out all of the elements in aligning their operations.

Does mean that this acquisition would be bad for CX? Probably not.

While the short-term impact is not likely positive, there can definitely be improvements in the future. Given the disconnects and inefficiencies across players in the U.S. healthcare system, combinations like this that vertically integrate the market have the potential for improving CX in the long-run. Here are a few of the places where CX may get a boost:

  • More tailored experiences delivered because of better consumer insights coming from applying CVS’ consumer insights capabilities to the combined company’s enlarged consumer dataset.
  • More retail clinical offerings by picking off more straightforward consumer health offerings like vaccines.
  • More creative pharmacy options by co-development of offerings between CVS and Aetna.

The bottom line: CVS + Aetna may provide longer-term CX benefits.

Patients Deserve Better Designed Experiences

I’ve recently spent some time visiting different hospitals, luckily not as a patient. There are a lot of amazing things that happen in hospitals, as the medical field continues to push the envelope on diagnostics and treatments. Many diseases that were once fatal are now being cured or at least managed.

While medicine is getter much better, patient experience remains very problematic.

In some cases, a patient’s medical experience can be like getting a scrumptious steak dinner (great medical treatment) delivered on dirty paper plate (poor experience). In the worst case (continuing this metaphor), the plate has bacteria and causes the patient to get sick. There’s a lot of research to suggest that the a patient’s experience plays an important role in how their body reacts to medical treatment.

I’ve been pleased to see a growing number of hospitals hire Patient Experience Officers. While the existence of that role is not a panacea for change, it at least demonstrate a willingness to make investments in this critical area. The bigger question, however, is how committed are hospitals to making the requires changes?

As I like saying to anyone who will listen, the experience you deliver is a reflection of your culture and operating processes. If you want to create a better patient experience, then you must change many aspects of how your hospital and its leaders operates.

How does a hospital become more patient-centric? By mastering the Four CX Core Competencies:

  • Purposeful Leadership: Operate consistently with a clear set of values.
  • Compelling Brand Values: Deliver on your brand promises to patients.
  • Employee Engagement: Align employees with the goals of the organization.
  • Customer Connectedness: Infuse patient insights into every decision.

Since this is only a post and not a book or report, I will focus the rest of what I write on one of the component strategies of Customer Connectedness called Design for Real People. Too many patient experiences are not designed, or even examined, proactively. They just happen.

Instead of leaving patient experience to chance (which typically does not work out well), Design For Real People by creating experiences that tap into patients’ emotions and behaviors. How do you do this? Well, we’ve got three approaches:

1) Establish Deep Empathy

Human beings are naturally empathetic, but something happens when we go to work. The dynamics of work and the environment we’re surrounded by can severely dampen the empathy for patients and their families. This is true for doctors, nurses, orderlies, administrators, and even volunteers. Take a look at the video, Five Ways That Organizations Crush Customer Empathy.

  • My advice: You need to amplify empathy on an ongoing basis and look really deeply at the needs of patients and their families whenever you’re designing processes, procedures, services, room layouts, or anything that will impact the experience. Make sure to actively talk about patients emotions and examine their entire journey. Download the free eBook, 25 Tips for Amplifying Empathy, for a bunch of valuable ideas.

2) Create Positive Memories

It turns out that people do not remember experiences the way that they actually occur. Our memory is not an on-demand video recorder, but instead its more like an Instagram account that is capturing some key moments along the way. One of the key studies that identified this phenomena was done by by Daniel Kahneman with colonoscopy patients. His research uncovered what he called the “Peak-End Rule’ which states that what a person remembers about an experience is the average of the peak emotion they felt throughout the experience, and the way that they feel at the experience ends. We’ve extended this rule to also include another key moment, rapid emotional spikes.

  • My advice: While there are many key moments for driving patient memories, the one that jumps to mind is the discharge experience. It’s the last experience that patients and their caregivers have in the hospital and it might be the most haphazard part of the overall experience. Patients don’t know when they are actually going to leave, don’t know what the steps are before they leave, and often given a pile of papers at the last minute. Bring together some previous patients with a few doctors and nurses and co-create a new experience. It can only get better.

3) Facilitate Intuitive Decisions

Human beings have two modes of thinking, rational and intuitive. To lighten our cognitive burden, people make most decisions using intuitive thinking—which is fast, automatic, and emotional—as opposed to rational thinking—which is slow, effortful, and logical. Unfortunately, most organizations exclusively focus on patient’s rational thinking. Since intuitive thinking relies on unconscious heuristics and biases to make decisions efficiently, hospitals must examine how they support these mental shortcuts.

  • My advice: Get familiar with human biases. For instance, did you know that people have a default bias, meaning we will most likely pick the option that requires the least action. When you are creating or evaluating any experience, make sure you are making it easy for patients to intuitively make the right decisions.

I hope that you’re motivated to actively apply customer experience practices to your patient interactions. There are a lot of great tools and practices that will help improve the lives of your patients and caregivers.

The bottom line: Patient experience matters!

This post is part of the Customer Experience Professionals Association’s Blog Carnival “Celebrating Customer Experience.” It is part of a broader celebration of Customer Experience Day. Check out posts from other bloggers at www.cxpa.org/blogs/cxpa-admin/2017/09/27/cxdayblogcarnival

Consumer Emotions To Health Plans Differ Across Age Groups

In a recent post, Temkin Group analyzed 10 emotions that consumers feel after completing a number of different interactions. We decided to dig deeper into one of those interactions, researching a health plan. We analyzed the emotional responses across different ages of consumers after that interaction and found that:

  • Consumers who are 44-years-old or younger tend to feel happy
  • Consumers who are 45-to-64 years old tend to feel frustrated
  • Consumers who are 65-years-old and older tend to feel relieved

As you can see in the chart below:

  • 18- to 24-year-olds: The most common emotion of the youngest consumers is happiness, and these young group are the happiest of any age level. They are also the most likely to feel appreciated (along with 35-to-44-year-olds) and angry.
  • 25- to 34-year-olds: This age group is also most likely to feel happy, but are also the group that is most likely to feel excited, worried, and confused.
  • 35- to 44-year-olds: This age group is also most likely to feel happy and is also the most likely (along with the youngsters) to feel appreciated.
  • 45- to 54-year-olds: This age group is by far the most likely to feel frustrated and is the most frustrated of any age group. They are also the most likely to feel disappointed.
  • 55- to 64-year-olds: This age group is most likely to feel frustrated and are also the age group that is least likely to feel happy or appreciated.
  • 65-years-old or older: The most common emotion of the oldest consumers is feeling relieved, and they are the most relieved of any consumers. They are also the most likely to feel confident. In addition, they are the least likely to feel angry, excited, confused, or frustrated.

health plans elicit different emotions across age groups

Why is this important? Our research shows that emotion is the largest driver of customer loyalty. So companies must not only start talking about emotion, but they also need to develop unique approaches for dealing with different emotions across their customer segments.

The bottom line: It’s time to make customer emotion a top priority.

Kaiser Permanente and Humana Earn Top Customer Experience Ratings for Health Plans

Temkin Experience RatingsWe recently released the 2017 Temkin Experience Ratings that ranks the customer experience of 331 companies across 20 industries based on a survey of 10,000 U.S. consumers.

Kaiser Permanente and Humana deliver the best customer experience in the health plan industry, according to the 2017 Temkin Experience Ratings.

For the second year in a row, Kaiser Permanente took the top spot out of the 14 health plans included in this year’s ratings, earning a score of 67% and coming in 206th place overall out of 331 companies across 20 industries. Humana came in a close second with a score of 65% and a rank of 247th overall.

Read More …

Kaiser Permanente and TriCare Earn Top Customer Experience Ratings for Health Plans

Temkin Experience Ratings

We recently released the 2016 Temkin Experience Ratings that ranks the customer experience of 294 companies across 20 industries based on a survey of 10,000 U.S. consumers.

Kaiser Permanente and TriCare deliver the best customer experience of any health plan, according to the 2016 Temkin Experience Ratings, an annual customer experience ranking of companies based on a survey of 10,000 U.S. consumers.

Of the 16 health plans we looked at, Kaiser Permanente earned the highest score with a rating of 57%, placing it 182nd overall out of 294 companies across 20 industries. TriCare came in second in the industry with a rating of 55% and an overall ranking of 199th. Kaiser Permanente and TriCare have been jockeying for the highest health plan score since the Ratings began in 2011. The only other health plans to receive ratings above “very poor” (above 50%) were Aetna, CIGNA, and United Healthcare. Meanwhile, Health Net received the lowest score of any health plan with a rating of 32%, putting it in 293rd place out of 294 companies.

Overall, the health plan industry averaged a 47% rating in the 2016 Temkin Experience Ratings and tied for last place out of 20 industries. The average rating of the industry decreased by seven percentage-points between 2015 and 2016, dropping from 54% to 47%.


Here are some additional findings from the health plan industry: Read More …

Hospital (Almost) Provides Valuable Patient Status

In a recent visit to a hospital, a member of my family spotted this patient status screen. It’s a great concept, keeping family members up to speed on the status of their beloved patient as he or she is in surgery. While it’s a wonderful idea, the design falls flat. Take a look at the confusing status items:

1506_TuftsPatientStatusThis is an example of what I call the Design of Little Things (DoLT). So many organizations invest in good ideas, but fail to do the little things that will create a really positive experience for customers. It’s like running a marathon and then giving up right before the finish line.

In this case, the idea of a real-time status screen is great, but the hospital needs to provide status items that are meaningful for family members in the waiting room. All it would take is one more tweak and this would be a wonderful tool.

The bottom line: Don’t neglect the DoLT


TriCare and Kaiser Permanente Lead Health Plans in Customer Experience

We recently released the 2015 Temkin Experience Ratings which ranks the customer experience of 293 companies across 20 industries based on a survey of 10,000 U.S. consumers.

Overall, health plans averaged a 54% rating and placed 18th out of 20 industries.

TriCare took the top spot with a rating of 67%, placing it 128th overall out of 293 companies across 20 industries. Kaiser Permanente came in second with a rating of 66% and an overall ranking of 136th. TriCare and Kaiser Permanente have been jockeying for the highest score since the Ratings began in 2011, with TriCare earning the top spot in 2011, 2013, and 2015, while Kaiser Permanente came in first in 2012 and 2014.

At the other end of the spectrum, Coventry Health Care was both the lowest-scoring health plan, and the lowest scoring company we evaluated in the entire Ratings. Coventry Health Care scored 39%, making it the lowest-ranked company for the second year in a row.

Here are some other highlights:

  • The average rating for the health plan industry dropped from 56% in 2014 to 54% in 2015—the first time that this industry’s average declined.
  • Of the twelve health plans that we looked at in both 2014 and 2015, Medicaid and TriCare were the only two to increase their scores over the last year. Medicaid’s rating went up by six percentage-points, while TriCare’s increased by five percentage-points.
  • Although it scored below the industry averages for both effort and success, Health Net scored 1.7 points higher than the industry average for emotion, the overall lowest scoring component in the Ratings.
  • The average rating of each of the three components dropped over the past year, but while success and effort each only dropped by one percentage-point, emotion dropped by three percentage-points. This is the first year since the Ratings began that the average score of any of the three components decreased.

Read More …

Lesson From Dana-Farber: Treat The Whole Person

As part of yesterday’s Customer Experience Day celebration, I attended a CXPA local networking event at the Dana-Farber Cancer Institute (DFCI) in Boston. The session kicked off with a panel from the DFCI discussing patient experience.

I’m a big fan of DFCI and have enormous respect for the great work that it does in battling cancer. The panel, which included a cancer survivor turned volunteer, was fantastic. I was inspired by the commitment and compassion they displayed.

One of the points that came up was DFCI’s commitment to treat the whole person. This explains why it provides things such as hand massages during chemotherapy treatment. DFCI doesn’t just treat the disease, it treats the whole person.

I love the concept of the whole person. It’s not just applicable to DFCI or other health care providers, but to every organization. It’s a powerful concept for anyone who cares about customer experience.

Here’s how I think about the whole person:

  • Emotion, not just success. DFCI doesn’t have data showing that hand massages will result in better clinical outcomes. It knows that a patient’s positive medical outcome is important, but it’s not enough. Your customers are the same. You need to understand, care about, and actively design for your customers’ emotional states.
  • Goals, not just interactions. A chemotherapy patient is battling cancer, not just getting treatment. When customers interact with you, it’s often part of a broader goal. A customer who calls to change her address, for instance, probably has a life change going on that dwarfs the need to update your administrative systems. The better you can understand and cater to these larger goals, the more opportunity you will have to build loyalty.
  • Community, not just individuals. One of DFCI’s key elements for helping patients is supporting their caregivers. These people are a critical element of the patient’s medical journey. Your organization needs to understand the role that community plays in your customers’ lives. How can you help your customers achieve their goals by supporting key members in their personal ecosystems?
  • Caring, not just doing. DFCI doesn’t just mandate a set of explicit activities that define how people should focus on the whole person, it consistently reinforces the importance of this focus in achieving DFCI’s mission. It gets employees and volunteers to care about these elements, not just follow a bunch of directions. You need to help employees understand why the whole person is important, and spark their natural capabilities for caring.

I hope that you are inspired to drive your organization towards focusing on the whole person. Here are a few tools that should help:

The bottom line: Start focusing on the whole person!

Kaiser Permanente and Humana Lead Health Plans in 2014 Temkin Experience Ratings

We recently released the 2014 Temkin Experience Ratings that ranks the customer experience of 268 companies across 19 industries based on a survey of 10,000 U.S. consumers.

Kaiser Permanente earned the top spot with a 68% rating, positioning the company in 109th place overall out of 268 organizations across 19 industries. Humana, meanwhile, earned a rating of 63% and placed 160th overall. While Kaiser Permanente consistently ranks near the top of the list—even taking first place in 2012—this year, Humana ascended from the middle of the pack to the top, improving its rating by an astonishing 12 percentage points.

At the other end of the spectrum, Coventry Health Care (BCBS) plummeted down the ranks after declining 18 percentage points from 2013, leaving it in last place across all 268 companies in the ratings with a score of 41%. Empire (BCBS), Highmark (BCBS), and Medicaid joined Coventry as the lowest-rated companies across any industry.

Download entire dataset for $395

Here are some additional findings from the health plan industry:

Read More …

Applying 6 Laws of Customer Experience to Healthcare.Gov

We have not done our own analysis on the customer experience of Healthcare.gov, but there are widespread accounts of its “user unfriendliness.” The situation is so bad that the White House has hired a new consultant to triage the problems.

6LawsofCXHealthcareGovThis isn’t surprising. It’s not easy to create a great customer experience, while it’s pretty simple to make a poor one. And the government especially is not known as being customer-centric (or citizen-centric). To understand what might have gone wrong, let’s examine Healthcare.gov through the lens of our Six Laws of Customer Experience. These laws define the  realities about how organizations, including governments, treat their customers:

  1. Every interaction creates a personal reaction. Or put another way, an experience that is built for everyone satisfies no one. Every customer experience has three components: functional (can customers do what you want to do?), accessible (is it easy for customers to do what they want to do?), emotional (how does the experience make them feel?). While I’m pretty sure the Healthcare.gov project had functional requirements (which can be very consistent across different customer groups), it probably did not have any accessible or emotional requirements, which demand a deeper understanding of the needs of target customers.
  2. People are instinctively self-centered. Human beings operate from their individual frames of reference, and employees often have a deeper understanding of products, organization, and subject matter than customers do. This means that if employees are not able to look at a product from the point of view of a customer, they will create experiences with overly complex processes, terminology, and user flows. Healthcare.org leaders must acknowledge this bias and work diligently to neutralize its effects.
  3. Customer familiarity breeds alignment. If everyone shared a vivid view of the target customers and had access to customer feedback, then there would be more agreement about what to do for them. Hopefully the Healthcare.gov effort (at least going forward) will use design personas to create a clear and compelling image of target customers. The development of Healthcare.gov would have been better if it had been developed using an iterative design approach that incorporated ongoing feedback from these target users.
  4. Unengaged employees don’t create engaged customers. One of the most important ingredients for good customer experience is a highly engaged workforce. Our research shows that engaged employees are more than twice as likely to stay late at work if something needs to be done, help someone at work even if they’re not asked, and do something that is good for the company even if it’s not expected of them. In addition, they are almost three times as likely to make recommendations about an improvement. I don’t have any insight into the people who were working on the Healthcare.gov site, but I would guess that they were not fully engaged.
  5. Employees do what is measured, incented, and celebrated. You may ask why the people working on Healthcare.gov website did what they did. Well, I like to use this urban quote, “don’t hate the playa, hate the game.” People tend to conform to the environment that they are put into: the metrics that are tracked, the activities that are rewarded, and the actions that are celebrated. It’s likely that there were not a lot of measurements, incentives, or celebrations around good customer experience.
  6. You can’t fake it. As Ralph Waldo Emerson once said: “Who you are speaks so loudly I can’t hear what you’re saying.” While it’s possible to come up with a long list of priorities, there’s no way that many of them will receive much attention. A good rule of thumb: Anything below your 3rd priority is not a priority at all. For a project like Healthcare.com to provide a good experience, it has to be a “true” top priority from the top of the organization. I had not heard any discussion about the experience of Healthcare.gov until there were problems when it went live.

The bottom line: All Healthcare.org leaders should read the Six Laws of Customer Experience.

Direct-to-Consumer Health Plans Are More Satisfying

During our recent consumer study, we surveyed almost 700 U.S. consumers who had recently purchased a health plan (including Medicaid and Medicare), 341 through their employer and 335 directly from the health insurer. In my first analysis of the data, I examined satisfaction levels with the new health plan experience.

As you can see in the chart below, consumers that purchase directly from a health plan are more satisfied with every aspect of the experience and they are more satisfied with their health plan. The overall news, however, is not so good. On average, only 35% of U.S. consumers are highly satisfied with their health plan.

1306_HealthPlanExpDTCThe bottom line: DTC leads to higher, but not high satisfaction

TriCare and Kaiser Permanente Lead Health Plans in 2013 Temkin Experience Ratings

We recently released the 2013 Temkin Experience Ratings that ranks the customer experience of 246 companies across 19 industries based on a survey of 10,000 U.S. consumers. Here are highlights from the health insurance industry:

  • The health plan industry has the second-lowest average rating. The average score was 55%, tied with Internet service providers. (The lowest-ranked industry was TV service providers.)
  • The industry has been steadily improving over the last three years, from an average rating of 50.3% in 2011 to 54.8% this year.
  • The highest-ranked health plan, TriCare, is #78 across all industries in the ratings.  The plan’s rating of 71% is six percentage points ahead of the second-highest-ranked health plan, Kaiser Permanente.
  • TriCare earned the top marks for functional and emotional experience while Kaiser Permanente earned the top accessible rating.
  • TriCare earned the largest improvement over 2012, 12 points, followed by Anthem (BSBS) with an eight point gain and Highpoint (BCBS) with a seven point gain.
  • Coventry Health Care has an unusual profile, somewhat below average functional rating with a strong accessible and emotional ratings.
  • Thirteen of the 15 health insurance companies surveyed have scores considered “poor” or “very poor.”
  • Three plans tied for the lowest functional component: CareFirst (BCBS), Health Net, and Empire (BCBS).
  • Medicaid earned the lowest score for the accessible component.
  • CIGNA and CareFirst (BCBS) earned the lowest emotional ratings.
  • The lowest-ranked health plan, #242 Empire (BCBS), was the only plan with a “very poor” rating.
  • Here’s a link to industry results from the 2012 ratings.

Download entire dataset for $395

HealthPlan1 HealthPlan2

Temkin Ratings website

Customer Experience Needs More Practical Wisdom

I recently watched a video of a TED speech by Barry Schwartz, the author of the seminal book The Paradox of Choice. His TED talk was called Our Loss of Wisdom. Wow! It’s a powerful speech.

Schwartz references what Aritstotle called “practical wisdom,” the combination of moral will and moral skill. He uses anecdotes about janitors at a hospital who alter their prescribed work routines in order to cater to the needs of patients and visitors. His key point is that these janitors believe that human interactions involving kindness, care and empathy are an essential part of their job, even though their job descriptions don’t mention anything about how they should treat other people. According to Schwartz:

These janitors have the moral will to do right by other people. And beyond this, they have the moral skill to figure out what “doing right” means…. A wise person knows when and how to make the exception to every rule… A wise person knows how to improvise… Real world problems are often ambiguous and ill-defined and the context is always changing.”

My take: Great customer experience requires employees who exercise their practical wisdom. Unfortunately, as Schwartz discusses, companies tend to create bureaucracies that suppress practical wisdom.

There’s an outstanding article written by Sumantra Ghoshal in 2005 called Bad Management Theories Are Destroying Good Management Practices. Ghoshal describes how management practices operate on the assumption of Homo Economicus, a model of people as rational self-interest maximizers. This economic perspective leads to the belief that employees can’t be trusted to act on behalf of the firm and, therefore, controls must be put in place to align their efforts.

As a result, management interprets success and failure in the light of their controls. If things are working well, then the controls are seen as being successful, so more are added. If things are not working well, then it’s viewed as an insufficiency of the controls, so more are added. In all cases, more and more controls are piled on to employees.

In this environment, employees lack the empowerment to exercise practical wisdom.

As it turns out, companies can unleash practical wisdom by focusing on the four customer experience core competencies:

  • Purposeful Leadership: Provides employees with a higher calling and permission for improvising.
  • Compelling Brand Values: Provides employees with an understanding of the true goals of the organization and a framework for improvising.
  • Employee Engagement: Provides employees with a reason to care about the company and its customers.
  • Customer Connectedness: Provides insights into what customers really need and fuels empathy.

The bottom line: Organizations need to cultivate more practical wisdom

Want Patients To Follow Medical Advice? Satisfy Them First

In our recent consumer benchmark study, we asked a number of questions about patient experience. It turns out that 79% of recent patients trust health advice from doctors, but only one-third will follow advice from health plans and pharmaceutical companies.

But that’s not the total story…

We also asked patients how satisfied they were with interactions during their recent medical visits. When we examine their likelihood to follow medical advice it turns out that there’s a large gap between satisfied and dissatisfied consumers. As it turns out, about half of consumers that are satisfied with their recent interactions with pharma companies and health plans are likely to follow medical advice from those firms.

This is in’t particularly good news for health plans, since  they were the lowest scoring companies in the 2012 Temkin Experience Ratings. But it is another reason why customer experience is critical for health plans. If those firms want to improve their economics by having members make more healthy decisions, then they are more likely to be successful and influence consumers if they improve how they treat them.

The bottom line: You need to earn the right to offer health advice

Great Patient Experience Is Free

I’m a big fan of Dr. Atul Gawande. No, I haven’t signed up for his Facebook page (I doubt he has one), but I really like his perspective on healthcare. He’s  a surgeon at Brigham and Women’s Hospital in Boston, but Wikipedia describes him as an expert on reducing error, improving safety, and increasing efficiency in surgery.

He’s an excellent writer. His book “The Checklist Manifesto” was the inspiration for my post “The Customer Experience Checklist Manifesto.” If you’re working on patient experience or healthcare reform, then you should get to know his work.

I just read a fantastic article that he wrote in The New Yorker “Big Med: Restaurant chains have managed to combine quality control, cost control, and innovation. Can health care?” Gawande uses a recent experience at Cheesecake Factory, a restaurant chain that consistently delivers a wide variety of freshly prepared menu items to eighty million people per year, to draw a comparison with the current U.S. healthcare system. Here’s an excerpt:

In medicine, too, we are trying to deliver a range of services to millions of people at a reasonable cost and with a consistent level of quality. Unlike the Cheesecake Factory, we haven’t figured out how. Our costs are soaring, the service is typically mediocre, and the quality is unreliable. Every clinician has his or her own way of doing things, and the rates of failure and complication (not to mention the costs) for a given service routinely vary by a factor of two or three, even within the same hospital.”

My take: Our U.S. healthcare system is broken. Without a clear focus on operational efficiency, repeatability, or accountability for results, the only thing that is guaranteed is escalating costs. But it doesn’t have to be this way. Look at how Aravind Eye Care revolutionized eye surgery in India. Gawande’s article also includes innovative practices such as Brigham and Women’s Hospital’s work to standardize the entire protocol for knee replacements and Steward Health Care System’s remote “command center” for its intensive care unit.

What does all of this have to do with patient experience? Everything. There’s no worse patient experience than an unsuccessful medical procedure, a procedure that you can’t afford, conflicting medical advice, or going though an unnecessary procedure. Unfortunately, our current healthcare system is set up to breed these types of experiences.

I recently republished my manifesto: Great Customer Experience Is Free. It seems to me that I could have also said that Great Patient Experience Is Free. Gawande shows that there’s enormous opportunity for both better outcomes and lower costs.

The bottom line: It’s time for a truly patient-centric healthcare system