What is Value, really?

The term “value” is thrown around a lot in healthcare these days, as organizations adapt their care and business processes to new reimbursement models.   But Value (note the capital ‘V’) is far more than a criteria for maximizing reimbursement and is truly the underpinning of your competitiveness and long-term viability.  Below I will illustrate with a personal example that came to mind this morning and relate it to what your patients truly want.

I am replacing my front doors prior to winter.  On the drive out of my neighborhood I can reach Lowe’s in 1 minute by driving straight and Home Depot by turning left and driving for 1.5 minutes.   For years I’ve had difficulty deciding between the two because I hadn’t perceived much difference.   On this occasion I checked both, but Home Depot got my business because they had an entry door in stock that matches my windows and garage door.

The price of the doors was a great ‘value’ (with a small v) and I was quite happy with my purchase.  Chalk one up for Home Depot.  But today I looked at the old door still in the jam a month after I went to the store with money in hand and caught myself thinking, “I’m never going to buy from Home Depot again…from now on I am going to drive straight ahead to Lowes instead of taking the left.”   I was pretty annoyed.  What could have been so bad as to change my good feeling of buying the door for a good price to near disdain for the company?  Their inability to deliver what I wanted within a reasonable time frame.  They couldn’t provide me with what I Value, with a big V.

Going back to my near daily decision, it seems these days, the prices at both stores are about the same, the friendliness of the staff is about the same, the stock is about the same and the advice I receive from both is equally unreliable, depending on the staff member I am talking to.  Home Depot had both doors in stock 1 month ago and I thought I could have new doors within a week or two.  I was feeling pretty good.

Then they told me I couldn’t buy the doors until I paid $50 for a measurement (I can use a tape measure with the best of them, thank you very much).  Annoyance #1.   After a week waiting to hear from the measuring contractor, I called the store and asked what was up.  The measuring company called me apologetically the next day to schedule, but I had started feeling some doubts at the lack of response.   Annoyance #2.

When the measuring contractor came to my door he was friendly and appeared competent.   As expected the dimensions were exactly what I had come up with 10 days prior when I measured it myself, but I was still willing to cut them a little more slack.  He told me the measurements would be at the store in 2 or 3 days and then I could go in to buy the doors.  2 or 3 more days to wait?  Annoyance #3.

I waited 3 days — all the time thinking, “do they really want my business, because they have a bad way of showing it!” — and drove back to the store to buy the doors, again helped by a friendly, competent staff member.   Then he caught me off guard by handing me a note with the direct number of the installers and the admonition that I call them first thing Monday morning, rather than wait for them to call me, or I would likely wait another week to be put on the schedule.  “Huh?!”

When I called early Monday I was told they couldn’t install my doors for another a month.  That is over 2 months after I first walked into the store.  I am sitting here thinking about all my other options.  I could call the door maker and ask them where else I can buy the door.  I’ve installed several doors and could do it myself if I made the time.  I could call another company.   There are literally a dozen options I could choose, but it’s more than I have time to deal with now and instead I am sitting here annoyed as hell that I have to support their incompetence by buying from them.

I don’t want to belabor this, but I’m sure you get the point.  I was willing to give them the benefit of the doubt up to a certain point, but now my perception of their overall competence is quite negative.   They are unable to provide me with what I really wanted in a reasonable time frame.  That is the big V Value and when they couldn’t fulfill that basic requirement the little v value no longer mattered to me.

Where I buy home repairs is a low stakes choice, but decisions on the care of a loved one are much more important.  You can be sure your patients’ thought processes are much like mine when they reach the point of annoyance with time wasters, incorrect bills, long waits, incorrect advice from staff, etc.  My wife recently had a mammogram at a local hospital.  She had to fill out paperwork requesting the same information 3 times, including medication reconciliation and fall risk at each step, and when she walked into the exam room it turned out they had given her the wrong form for the exam and she had to do it again.  And this was in a Colorado hospital rated in the top 10% of all hospitals in the US.  She said she will never go back to that facility, despite the fact that it is only 10 minutes from our house.

Spending money on “culture change” initiatives without making sure your care and business processes align with what your patients expect is a waste of time.  As I said, the staff at both home repair stores was equally friendly and capable, I felt like they had my best interests in mind — witness the Home Depot clerk who told me how to work around their system — but their inability to deliver on what was really important to me — what I Value — drove me to look elsewhere for service in the future.

It didn’t matter to me how nice or competent the Home Depot clerk was who sold me the door.  I barely remember him.  The Lowes clerk who sold me my refrigerator was incredibly knowledgable too, but Lowes had my refrigerator installed within 2 days of my purchase.  I was pleasantly surprised.  It doesn’t matter that every employee I pass asks if I need help.  I am certain the company has drilled the need for that into everyone.  Lowes has too.  How about letting me buy a door and putting it in within a week or two, even a month.

You must make sure the people in your community have no reason to doubt your competence.   Even better, how about working toward making them pleasantly surprised?  They perceive no difference between your care and business processes.  If either falls short, the are likely to become annoyed and drive to the hospital down the road or the big city for their care.   Getting it right starts with aligning your care and business processes to deliver exactly what your patients expect, all the time, with no errors.   It’s not that hard to get there.  Instead, hospitals all over the country are spending loads of money training staff in how to be friendly and smile for patients, etc, without digging deeply into what their patients really value.  Don’t fall into that trap.

With all that involves, it sounds daunting, but even the longest journey begins with the first step.  Isn’t it time you start?




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