Patient and customer experience often contain unnecessary friction. Two questions can identify the biggest problems.
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Would you rather scan and upload photos of insurance cards your doctor’s office already has on file, or work your way through a phone robot that offers you appointment times in thirty-minute increments when you know you need to skip two weeks ahead? Yesterday I got to do both.
I needed to schedule an appointment with a physician I’ve been going to for years. The practice has my history, my insurance information, all of it. I usually prefer booking any kind of appointment online because I can see the full range of open slots and match them against my calendar. So I logged into the website, selected the appointment type and the doctor, and found a date that worked. Instead of a confirmation, I got a form full of mandatory fields, including scanned images of my insurance cards. I bailed out and called the office.
The phone menu offered “make an appointment,” which I assumed meant a person. It meant a second robot. It asked what kind of appointment I needed, then started proposing times. I had a two-week travel window when I couldn’t be there, and the first suggestion landed inside it. I declined. It offered a slot two days later, also no good. I declined. It came back with a time thirty minutes after that one. Then thirty minutes after that. Several rounds in, I realized the thing intended to march me through every open slot in the two weeks I was unavailable before it reached one I could actually take.
I got out of robot jail by yelling “human.” A friendly scheduler picked up and found me a workable appointment in a minute. Total time wasted before that: about twenty minutes. When I mentioned the robot, she didn’t defend it. She said, “We know, it’s terrible.”
What Patient Experience Data Says
What the office staffer said to me is telling. The people closest to the patients know the process has problems.
My experience isn’t unusual. In a survey of 1,005 patients conducted for the scheduling vendor Notable, 70% said they had tried to book a healthcare appointment online in the past year and were routed to a phone call to finish.
Even more ominous was the stat that said 61% of respondents had skipped going to their doctor in the previous year because “scheduling an appointment was too much of a hassle.”
Why Patient Experience Can Slip After Consolidation
The practice I was booking with was independent until it joined a larger group owned by private equity,. The pitch for that kind of deal is sensible enough. Running a medical practice today is brutal, and most physicians would rather treat patients than administer billing systems and navigate insurance complexities. Consolidation is supposed to buy them scale and expertise. It’s also now the norm rather than the exception: private equity-acquired practice sites grew from 816 in 2012 to 5,779 in 2021, spreading from 119 metro areas to 307.
In theory, a group managing dozens of practices can afford better patient experience than any single office could. In practice, my impression is that the people choosing the technology don’t understand what the patient goes through. They may not test the systems themselves or do a deep dive into patient experience. They buy on vendor promises and look for a combination of efficiency and cost savings.
It’s not unlike the professional manager vs. founder distinction in the corporate realm. Founders are more likely to put customers and employees first. Professional managers tend to prioritize shareholder returns as many corporate boards still believe in shareholder primacy. Except for a few Certified B Corporations, PE firms exist to create financial returns for investors.
Another concern I have is that the metrics that justify a scheduling bot look best when patients give up. Calls deflected from live staff, cost per booked appointment, average human handle time: these metrics all improve when a patient bails out. If the patient actually completes the effortful process, that’s good for the metrics, too.
The problems may be invisible in the practice’s dashboard. Nudge authors Richard Thaler and Cass Sunstein call this kind of unnecessary process burden “sludge.” When I interviewed Sunstein he pointed out that the people hurt most by it are usually the ones with the least capacity to fight through it. In healthcare, those are the patients you’d most want to reach.
Two Questions That Expose Friction In Any Customer Experience
I’ve been making this point for years, and it was central to my book Friction. Every leader should ask their frontline people two questions:
“What do our customers complain about?” Your staff hear it from the customers they try to help every day. My scheduler needed no prompting to tell me the system was terrible.
“How can we make your job easier?” That one sounds backward to managers trying to squeeze more output from a stretched team, but frontline employees know exactly where their own hours are wasted. A bad customer experience usually becomes a bad employee experience, because staff end up spending more time with customers and cleaning up problems the systems created.
Asking isn’t enough. Too many managers hear the complaints and dismiss them as whining, or find a reason not to act. The software change costs too much. The fix is on next year’s roadmap. When people see their insights ignored, they stop offering them. Some of them check out entirely and become part of the disengaged workforce.
My Own Confession
I’ve ignored valuable feedback from customer-facing employees myself. When my company ran a small call center, the reps kept complaining about one function in our software that made a routine task unnecessarily time-consuming. It was frustrating to them and customer interactions took longer, but I knew fixing it meant getting our vendor to change their code. The problem only affected a minority of calls, so I told our reps that was simply how the software worked.
Then I filled in on the phones for half a day and had to perform the task myself. I called the vendor that afternoon and asked them to fix it and send us the bill. In retrospect, it shouldn’t have been necessary for me to experience it first hand. I failed to listen and act.
So here’s your assignment. Pick a process your customers use all the time, whether that’s booking an appointment, filing a claim, or checking out. Do it yourself, start to finish, as a customer would, with no shortcuts and no admin access. Then ask the two questions of the people who handle the fallout. You’ll likely find at least one change that will streamline the experience for your customers..