BUFFALO, New York – We frequently hear about the graying of America. Time, Newsweek, your local paper have all published stories.  This subject HAS been covered by the media.  In healthcare, we know this story all too well. For our industry, the aging population poses formidable challenges. As baby boomers reach retirement/Medicare age, the federal government's financial crisis that we are seeing today will only intensify.  With the certainty of continued cuts in government spending on healthcare, hospitals and physicians will be faced with doing a lot more with a lot less.  OK, so what else is new? 


There is another socio economic trend that is already producing explosive consequences for healthcare providers.  Immigration.   Legal and illegal entrants join our society and our peculiar system of costly health insurance.  Many immigrants, regardless of their status, do not have coverage either because they cannot afford it — which is generally the case — or they do not believe it is their responsibility to buy it.  Either way this means that hospitals and physicians must transfer more of the costs to those of us who can afford to pay:  those with insurance.  Moreover, many illegal immigrants, mainly from Mexico and Central and South America do not speak English.  This language barrier requires culturally savvy marketing gurus, anxious to expand revenue from every possible cultural segment, to adapt to the reculturialization of America. 


This flood of cultural diversity is challenging — some would argue disrupting –our traditional values concerning customer service.


Call virtually any organization — from airlines, mail order pharmacies to credit card companies and computer makers — and you will be told to "Push 1 for English," or there will be an announcement in Spanish telling the caller to push 1 for support in that language.  This phenomenon is not limited to financial institutions, airlines or hospital call centers for physician referrals or patient accounting.


Several months ago, as my U.S.-branded (Chinese built) laptop computer began to spit and sputter, I immediately realized that I would need technical support.   First I had a tough time finding the telephone number.  It seems as though this computer manufacturer would rather you visit their vast archives of articles and technical updates and solve the problem yourself.  Cheaper for them, I guess.  Of course this assumes that you read and write the English language and possess something approaching a PhD in computer "technese" speak.  But wait, you must also possess the basic curiosity or  have the patience of Job, to sift through hundreds — maybe thousands of articles and technical updates — to find the particular problem that is creating all the havoc with your portable brain, aka the laptop.  The only upside to this web-based customer service approach is that you did not have to Press 1 for English. 


Too bad.  It might have been helpful.   However, unless you are clued in to the vagaries of techno speak, curiosity or the patience of Job, the chances of finding the answer in one of these articles — and then knowing that what you think you read was actually the right answer, you will remain lost in product intelligence hell. But I cracked the web site code and found a toll-free service number. 


I dialed.  I listened.  They were trying to sell a new computer, a printer, a… Then I pressed 1 for English.  After a short delay made worse by some really bad music on hold, I got through to a very friendly technical adviser who said his name was Tom.  He sounded as if he spoke "Texan" so my spirits soared.  This may take less time to fix than I thought.  Oh, but not so fast. Tom was not a laptop techno wizard but he politely referred me to the correct service support team that could quickly fix the problem. He told me to hold the line while he transferred the call.  First there was a flood of that really irritating music that repeated itself at least twice before silence arrived.  Then there were clicks, clacks, a ringing echo and then a faint voice — a heavily accented voice — announced that his name was Ricky and that he was here to help me.  This guy clearly was not from my neighborhood.  Ricky seemed sincere.  Ricky truly wanted to help, to please his distressed customer from Texas.  I started explaining the problem and it quickly became apparent that we were not finding the same page with our communication. 


He spoke English but  it was not his native language. Two or three attempts of looking at operating code and making a tweak here or there with my program settings did not solve the problem.  To make matters worse, our telephone connection was very bad.   Substituting two orange juice cans joined with string would have been an improvement. 


Finally I was politely referred to the next level of technical support.  I suspect that by this time Ricky vowed silently to himself that he would never visit Texas because they talk funny. 


More irritating music — at least the connection improved.  Then more clicks and clacks and suddenly another friendly, sincere voice — Asian, I thought, with a hint of a British education — announced that his name was Danny.  He, too, was there to solve my problem.  While his English was more intelligible to me than Ricky's, it was evident that Danny was very far away.  We were communicating but Danny was could not seem to comprehend what Ricky had done. or figure out my laptop's disease.  I guess the case notes had not been posted even though we were in agreement on the case number! Sounded like a hospital-like EHR problem to me.


"Mr. John, sorry but I am going to have to refer you to our top level of support." 


More terrible music — who composed that stuff anyway?  Clicks, clacks…you get the picture.  And then suddenly, as if the heavens opened, a friendly cheerful voice came on the line.  Gosh, it sounded as though we were related, or at the very least we were in the same town. Roger announced that he was going to fix my problem.  He asked three questions.  Now to be fair to my earlier customer service agents, it seemed as though Roger was looking at everyone's earlier case notes concerning my laptop's disease.He chuckled.  It seems as though spoken English was only part of the problem.  "Worry not my friend," he drawled, "This is a simple fix.  I am surprised that you and I are even talking…"  I bit my native tongue.  More than 75 minutes of time had elapsed and normally I do not like people — or mature Presidential candidates — to assume that I am their friend.  But heck, it was getting late and the news that my computer's death could be averted filled me with such joy.  To heck with my idiosyncrasies.  Polite appreciation was the order of the day.  I wanted my laptop — my portable brain — to recover. I did not want to buy a new laptop and go through a new kind of hell:  configuration and the transfer of hundreds of files.


Eureka!  in five minutes we were done.  All was right in my world and with my laptop.  Its demise and replacement were postponed for another day.


Then my curiosity get the best of me.  "Hey Roger, can you tell me where you are located?"


In Austin.  Go figure.


I went around the world telephonically only to find the answer to my sick laptop in my own backyard, so to speak.


Gosh, isn't irony wonderful?


As those of us who labor joyously in the healthcare industry, hopefully we will learn a valuable lesson from our colleagues in the computer and financial services sectors:  Outsourcing service can be an oxymoron.

P.S. I recently did buy another laptop.  This time around I cut out the middleman and bought a laptop made and marketed by the same company. JGS