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Dr. Darrell White's Personal Blog

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Archive for August, 2009

Patient-Centered Medicine-The Skyvision Story

It’s become quite fashionable to call oneself “patient-centered”. It’s rather trendy, in fact. Large, quite famous medical institutions now trumpet their new “patient-centered” care initiatives. The hiring of a “patient experience officer” is front page news in Cleveland. The airwaves are choked with advertisements from doctors and hospitals alike, beaming with pride and anxious for you to know that now it’s “all about you, the patient.”

What it really turns out to be is LIPSTICK ON A PIG.

It’s the same hospital with the same staff and the same processes. The same doctors are in the same offices and get paid the same way. A new paint job and new curtains cannot hide the fact that you wait just as long sitting in the same, old chairs in the same old waiting room. No amount of  advertising or re-branding is going to magically change a 1990 Mercury Sable into a brand-new Mercedes 500SL, and if you close your eyes  you still know which one is taking you for a ride.

Since when is “it’s all about the patient” news? Isn’t that the way it’s supposed to be? Do the doctor and the nurse have a job because a patient needs their care, or is the patient there so that the doctor and the nurse can have jobs? How many times have you wondered if that big, beautiful new $100 Million hospital wing is being built to handle all of the patients who must be turned away, or if the hospital will now embark on a campaign to find patients to fill that new, superfluous edifice? Or worse yet, if the $100 Million addition is simply a way to launder all of the “revenue in excess of expenses” generated by the “non-profit” hospital?

Medicine is the ultimate consumer service business. Even more so than any other service business because the people who bring you medical care have been entrusted by a patient to do some version of the next right thing for that patient; they have been trusted to put the care of the patient before their own care and feeding. We do a wonderful job of curing disease in the United States, but we don’t do such a great job of caring for patients, lost as we are in our zeal to care for diseases. Patient-Centered Medicine means looking at the curing of diseases from the patient’s viewpoint rather than the doctors’ or the nurses’ or the hospitals’.

Patient-Centered Medicine is all about the patient’s EXPERIENCE.

Enter Skyvision Centers, a unique take on eyecare built from scratch centered around the patient experience from the ground up. Two eye doctors, an ophthalmologist and an optometrist, left a very successful practice (where very high quality eye disease care is still being offered) to start something new. Something radical. Something truly focused on the patient experience from the very beginning. We had nothing but our names and our reputations. No patient lists. No accounts receivable. Heck, in the beginning we didn’t even have an address! All we had was a blank piece of paper with “Skyvision Centers” written on it, and a picture of a patient in the middle. We built our business around that patient and her experience.

Benchmarks? Sure! We went out and benchmarked Nordstrom’s and the Canyon Ranch Spa and the Ritz Carlton to learn about the best practices in customer service. We studied the mechanics of the Toyota manufacturing methods to learn about flow processes, accuracy, and safety. We built an office that allowed us to maximize our efficiency in a setting that looks and feels more like a boutique hotel or retail setting, with lobbies rather than waiting rooms.

Every staff member went on a customer service “field trip” where we ate lunch at a Holiday Inn and dinner at a Ritz Carlton. We witnessed three of our staff members experience a makeover at the Almay counter at Dillards, and then watched three other staff members ENJOY a makeover at the Bobbi Brown boutique at Nordstrom’s. We checked into a room at the Holiday Inn to have a standard hotel experience, and then checked in and spent a night at the Ritz Carlton. All of us. The non-doctor staff and their spouses stayed on the concierge floor, the docs in regular rooms.

And then we brought it all together and made it Skyvision! Our goal is for each patient who comes through the door to have an experience that is more like the Ritz Carlton than the Holiday Inn. More like Nordstrom’s than Dillard’s. We measure every step of the patient experience and constantly evaluate our customer service just like we evaluate and measure our medical outcomes. We agonize over each sub-par visit or less than stellar service evaluation.

Why? Well, why NOT? Where does it say that providing the best possible medical care with the best possible outcomes has to be coupled with less than the best possible experience? That the most important person in the process is anyone other than the patient? We’ve all seen the check-in process at a Holiday Inn and at a Ritz Carlton. They both work, but they sure feel different, don’t they? Why is it that the majority of check-in processes at medical offices and institutions feels more like a busy airline ticket counter during a storm than the front desk at Canyon Ranch? If the cosmetics cost the same at Dillard’s and Nordstrom’s (you know, like your co-pay for a visit), why is it that you feel so much better after shopping at Nordstrom’s?

We all took a financial bath in the first four years of Skyvision Centers. Hey, starting from scratch is hard! In the end, though, we created what is one of those very rare creatures, a true Patient-Centered Medical practice. It should make you wonder how much better your experience would be if all of those busy practices and all of those hospitals building their new wings took some of the money they are spending telling people that they are “patient-centered” and actually tried to put YOU in the center. We’re pretty much an open book. We’re happy to be the benchmark. Heck, we’ll even go along on their “customer service field trips”! This Patient-Centered Medicine is more fun to provide, too.

But until they do, until all of those folks advertising their all-new, all-you, “Patient-Centered Medicine” spend some time looking at the experience of receiving medical care from the viewpoint of the patient, all of us who are those patients had better pucker up.

The pig just got her make-over.


There’s been lots of news recently about how we communicate with one another, or how technology is affecting how and where and from whom we obtain information. The headlines are almost universally negative. Have you noticed that, too? My good friend Brian Tucker at Crains Cleveland Business bemoans the fact that digital sources, specifically sources that conform to the readers’ interests, are burying traditional published media. Three social networking sites were collateral damage in a cyber-attack aimed at an economist from Ukraine; a 24 hour blackout of Twitter seems to have rendered 10 million people mute. A woman was so depressed without her Blackberry during a month-long “vacation” from her device that the reunion was deemed worthy of a front page article in USA Today. The Western world is wireless and webbed, and we’re all reaching out and being reached here, there, and everywhere.

The White family is due for cell phone upgrades this Fall and my wife and kids are all excited about the prospect of new and better technology. They are really enjoying the prospect of prospecting for that newest, latest, bestest phone. Me? Not so much. It seems as though all of the new stuff on the new phones will simply allow me to be available to more people more of the time; if I am ABLE to text and tweet and Facebook there’s a greater likelihood that someone will EXPECT me to do so RIGHT NOW. I’m pretty sure that’s not such a great thing.

The most powerful product in the social history of man might be the cell phone. Think about it. Totally connected at all times, with ever-expanding connectivity tools. The cell phone has brought about a true paradigm shift in First World human communication. It is the ultimate expression of the ability to reach farther and farther to contact and connect. The “Social Media Revolution” didn’t really explode until Facebook, Twitter and the rest of the revolutionary venues were tied to a cell phone.

And therein lies the problem. It is that most remote connection that has overwhelmed connecting.

For those of you over that age of 35 or so, remember what the phone was like in your youth? It didn’t ring too very much, did it? And each ring was important because… well… it was. No trivial phone calls from relatives or marketing calls or pollsters calling to query about the mundane. If you were home and the phone rang you jumped for it, an instinct that became a part of the Western social DNA.

How about the caller? What was their experience like? No call-waiting to ensure that each call would be answered. No answering machines or voicemail. No “for English press 1.” You got busy signals! If the phone kept ringing you didn’t have to wonder if someone saw your number on caller ID and said “no way”– you knew they weren’t home (or they were on the can–no one had phones in the bathroom then!)

Now? Well, There Ain’t No Such Thing As A Free Lunch. That unlimited ability to connect at any time has become an OBLIGATION to be connected. Right NOW. Always. Cell phone as priority 1. You’ve seen it; heck, you’ve DONE it. You’re having a conversation with someone, right there in front of you, someone you can literally reach out and touch–you know, with your hand. Their cell phone rings or buzzes or sings and without any conscious thought out comes the phone and they answer it. Or they tap out a text. Right in front of you, mid-sentence. Heck, in the middle of a hug you can feel them reaching for it. Even call-waiting…as much as my Dad bemoans the loss of the courtesies of a bygone era he still clicks me out, puts me on hold, because “someone’s on the other line!” And I am supposed to get excited about a new phone that will make all of this EASIER?!

I propose that there is a Fourth Law of Thermodynamics: SPACE is conserved, just like energy. The space that has been removed between each end of a cellphone/technology-driven connection is not destroyed, it is simply placed between the two physical bodies in the interrupted personal connection. Whether it’s a call, a text, or a tweet, the cellphone is the elephant in the room, the elephant right between two people who are close enough to one another to shake hands.

Connected? Sure we are. But we were pretty connected in days gone by, just in a different way. We lived with our parents. Our grandparents lived upstairs. Our aunts and our uncles lived with our cousins around the corner or on the other end of town. The coolest connection was two cans attached by a string stretched between your bedroom window and your best friend’s window next door. The elephant in the room was some family story that everyone already knew that was so trivial that even USA Today would bury it on page 12.

So, what to do? How do we utilize all of this new stuff in order to INCREASE our contacts and connections without increasing the distance between us when we are together in the same room? I think  I will become an elephant tamer. I’ll start with my own elephant because I am just as guilty as most others, and I think I might start by buying a smaller elephant, a new cellphone that does mostly nothing but make phone calls. I’ll help those in my charge (the White progeny) by pointing out the choices that they are making, the message they are sending when they choose the elephant over that someone right there. I’ll continue to make people uncomfortable in my office when they answer the elephant during an exam (people actually do that–answer the phone when I’m in the middle of examining them!). Heck, I’ll probably tease them when they twitch, that visible effort necessary to stop themselves from answering that silly ringtone they bought for 5 bucks–I think of that as petting your elephant when you can’t talk to it.

Heck, I might even start leaving MY elephant at home. Hmm…just thinking about that makes me  feel a little lighter.

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