The business of Healthcare is really, really good... for all of those in the business of healthcare. For those of us who are depending on healthcare to stay healthy and alive... eeeh, its not as good.
It's easy for us to see the Healthcare Industry as group of caring, smart, innovative, life saving individuals, companies and org's. After all, there are many amazing people within healthcare who truly love their work and care about helping people. But the 'good ones' are handcuffed by a broken healthcare system and the rest find ways to make a comfortable living within the cracks.
Power, Control & Value — Patient's Get None
As an industry, healthcare is incredibly inefficient and ineffective. The problem is, we don't realize just how messed up things are until we need healthcare. But at the point that we need it, we are vulnerable and often times desperate which means we have no control, no leverage, and usually no guide to help us know where we stand or where to start.
The good news... this is a perceived lack of control and power. But this powerless perception of reality allows healthcare to maintain nearly all of the control, albeit perceived control. This control enables the 'system', removing any urgency to improve. In fact, the industry continue to thrive without focus on adding value to their customers (Yep that's us, the patients).
Why Be #1 When #36 Is Just As Lucrative
As Americans, we would love to believe that the US Healthcare Industry is the best in the world. But this is false. Pretty much the only thing we rank #1 in, is cost. The US ranks #43 globally in life expectancy, which is just slightly above Kuwait. Not to mention, we are apparently dying quicker by the year. Shouldn't life expectancy be a direct reflection of an effective healthcare system? Maybe? Possibly? Obviously. But the US is ranked #36 in the world in 'healthcare effectiveness', a metric used globally to evaluate how well healthcare systems are performing (based on; cost, outcomes, timeliness, and accessibility).
So how can the most expensive healthcare system in the world be so bad at the execution?
How? Because they make most all decisions with the mindset of 'we need what they have'. The 'good ones' don't always think or act in this way but in large, the industry sets all of the rules of engagement. They dictate prices, they claim most of the power, they use fear to modify behavior and expertise to intimidate. They instruct rather than listen and they 'clearly' don't prioritize 'transparency'. Pun intended.
The scary part is, they do it all so effectively because they don't care enough to add value to our 'customer' experience.
*(in this case value = peace of mind, reasonable prices, consideration, care, high quality products, effective/efficient services, or even a f-ing call back... etc.)
It's just easier to view the customers (us, the patients) as vulnerable and desperate and to see themselves as the superheroes.
But this is good business and it surely isn't good for our health.
Healthcare Ignores Us
No other industry on the planet could survive with this mindset. The great and even good companies from all other industries would be lost without having a near obsession with adding value for their customers. Think about it, the most successful companies are always working to do one thing better than their competitors, for their customers... adding more value. Hell, even Walmart cares more than healthcare. Good companies work incredibly hard to listen to and understand the most intimate wants and needs of customers. They invest resources to improve their product or service offering. They work nonstop to build connections with customers and a positive reputation for their brands. They try to exceed our expectations in every way.
Why? Because they need what we have ($).
But healthcare doesn't even pretend to do the same with their customers.
Why? Because we need what they have (or so they think, for now).
If Healthcare Ran Uber
To put the above in perspective, let's imagine if the popular ride sharing service, Uber, was run by healthcare (healthcare company).
Here's how that experience may feel:
You and a few co-workers go out for some drinks one evening after work. At the end of the outing, you wisely decide that driving yourself home isn't an option. You've never used a ride sharing service before but think, tonight is a great time to start.
So you open your phone to download a ride share app and you find 'Shitty Uber'. You notice the free version of the app is only available on Blackberry's and desktops. But getting a DUI is super costly, so you just pay the $59.99 fee and start your download.
The Shitty Uber app is a huge file and taking forever to download. The 5.75GB of free space required for the app isn't free on your phone. Ugh! So you delete Angry Birds, 4 audio books (that you know you'll never listen to) and 26 videos of your kids birthday party.
Finally! It downloads!
You open Shitty Uber and try to figure out its shitty interface. After 10 mins you finally learn how to enter your destination.
A driver named John pops up. The app say that John is 1 mile away. You try to confirm John as your rid but you get an error message saying 'Driver not in your network - this driver requires the Platinum Unicorn Rainbow Package".
Then a popup, see list of 'excluded serivces'. You tap, no thank you.
Still desperate to avoid a DUI, you search again.
A second driver named Tammy pops up. Tammy is in your network. Confirmed! Finally!
Tammy arrives to pick you up but the car is already full of people. Annoyed, you think, "I was in the right spot and on time, wtf... or is this what they mean by co-pay"
But you've come this far and though the process has sobered you up, you still need the ride.
You squeeze in the back and Tammy drives off.
To reduce your anxiety of being packed into the back of Fiat, you grab a Golf Digest Magazine from 2013 that Tammy has so thoughtfully left out for her riders.
“Triple booking seems to work in healthcare. If Doctors can get away with it, why can't we".
Rube Lyft, CEO of Shitty Uber
You are on your way!
But a few mins into the ride you realize Tammy is driving in the opposite direction from where you live.
You say, "hey Tammy, where are you going?"
Tammy snaps, "just trust me, I'm the expert here."
You inform Tammy that this is your first time using Shitty Uber and reassure her that you aren't trying to be rude. You are just looking for a little peace of mind. You just have a feeling that 'something isn't right'.
You try another tact and ask "is this the best route to take?"
From the backseat you hear her mumble to herself "Ugh riders... what's with all of the questions."
Tammy is clearly becoming more annoyed with your presence. But to justify her decision and route, she spits out a bunch of auto-navigation terms. Most you've clearly never heard.
Another hour passes, Tammy is finally nearing your destination. She is close to your neighborhood but she turns early and drops you off a couple streets away. But you are close to home now and you don't ever want to get back in that car so you just embrace the walk.
As you get out of the car, you ask, "what do I owe you?"
Tammy ignores you. You notice she is writing in a notebook. "What are you writing Tammy", you ask.
She says "oh just my notes about our time together today."
You ask "can I see?"
She says "no, these are my notes... just my thoughts on how I believe you are feeling."
You think, ok... well that seems kinda backwards. But you are so ready to be home you just let it go.
Again you ask, "what do I owe you for the ride, Tammy?"
She rolls her eyes and responds, "oh you don't pay anything now, I'll send you a bill in about a month."
You think, wait, what?
A month has gone by since your shitty, Shitty Uber ride. Flipping through the mail one morning, you see an envelope with red stamp saying "Statement Inside". You see that it's from Shitty Uber and open it on your way to work.
You nearly drive off of the road... you think '$2k for the shittiest ride of my life. Might as well have risked getting a DUI'.
"How I am I going to afford this?"
You feel ripped off! You're mad. You call Shitty Uber. They transfer you to Tammy's extension. Ring, ring, ring...
"Tammy's office, how can I help you?"
"Hi, can I speak with Tammy about my bill?"
"My name is Tina, I'm Tammy's daughter, I deal with all of the billing issues - what's up?"
You state your case but she replies, "I'm sorry but that is what the service costs. You only have our Copper Whoopsy Daisy Package."
In response you say, "But, I can't afford that."
Your blood starts to boil. Tina's rude, yet patrionizingly calm voice is making you even more angry. It's hopeless. She's not going to change anything.
So you ask, "Is there a quick and easy way to rate my experience so I can let future riders know just how unfair this is?"
Tina says "oh yes, absolutely, go to www.shittyuber.com. Go to the forms tab and download the form labeled 'outdated feedback form'. You' ll need to print it, fill it out and mail it the PO Box listed at the bottom, use reference #9dX10O35@."
"It will take 2-3weeks but once its been reviewed, we will post it on the most impossible page to find on our website"
Feeling completely defeated, you say "I wish I never need that ride."
Tina ignores the comment, wrapping up with one last gut punch... "Thanks for choosing Shitty Uber, we look forward to 'taking you for a ride' again really soon."
What's The Point?
Yes, this is an overly dramatic story to prove a point. But is it?
See, Uber's success in the transportation industry is a direct reflection of their unwavering dedication to providing the most seamless, simple, and consistent ride service. They aim to add value at to ever part our riding experience. Uber works hard to be a more affordable and more convenient solution for our transportation needs.
Most healthcare companies, however, don't care enough to listen to or even to respect their customers. The people on the ground, mainly the nurses, are the only ones who truly get it. But they aren't the ones making the big decisions. The executives making the decisions are far too disconnected to really make the right one for the average person. Because when the system works for them and the money keeps flowing... why would they dedicate resources to creating a simpler, more fair, error free service that adds value for everyone?