Why I Started Paying Attention to the Touchpoints

TouchPoints — Episode 1: Why I Started Paying Attention to the Touchpoints

What if "great clinical care" and "a great patient experience" aren't the same thing, and almost nobody is running the second one on purpose?

In this opening episode of TouchPoints, healthcare operations consultant Melissa Gilkes-Smith introduces the worldview behind the show and walks listeners through her proprietary Nine Pillars of Patient Experience framework — the same map she's used for almost 20 years in healthcare operations to diagnose why good practices quietly lose patients they should have kept.

This isn't a podcast about being nicer to patients. It's a podcast about systems.

What you'll learn in this episode:

→ Why "we provide great care, but patients still leave" is never a care problem, it's a pillar failure, and what that actually means

→ The single belief that changed how Melissa thinks about every practice she's ever worked with: a remarkable patient experience doesn't happen by accident, it happens by design

→ The full Nine Pillars framework, walked in three movements:

Before They Arrive — Pillars 1, 2, and 3: how patients form an opinion of you before they ever call (Initial Exposure), what determines whether they can actually say yes to you (Inquiry & Scheduling), and how the communication between scheduling and arrival quietly creates or prevents no-shows (Pre-Visit Communication).

Inside the Visit — Pillars 4, 5, and 6: why the first thirty seconds of a check-in either reinforce a patient's decision or damage it (Arrival & Check-In), why "I felt rushed" is almost never about the doctor (Clinical Encounter), and the most overlooked moment in healthcare, how a visit is closed, and remembered (Checkout & Exit).

After They Leave — Pillars 7, 8, and 9: why most practices disappear after the visit ends and lose patients without ever knowing why (Post-Visit Follow-Up), how perfect clinical care can be undone by a single confusing statement (Billing & Financial Experience), and the most important diagnostic principle in the entire framework, why the long-term patient relationship isn't a touchpoint at all, but the output of everything upstream.

→ The unifying move: the same lens that diagnoses a practice also diagnoses a leader. Every place a manager touches their team is a touchpoint, too, and broken touchpoints upstream cause failures downstream, both in practice and in a person.

The core argument:

Most practices measure patient experience globally and fix problems reactively. They invest everything in clinical teams, technology, and facilities — and then wonder why patients quietly drift away. This episode argues that experience is not a feeling. It's a system. And once you can name the system, you can fix it.

For:

Practice owners, healthcare administrators, executives, practice managers, and anyone who has ever said "we give great care — why are patients still leaving?" If you've felt the gap between the care your practice delivers and the experience patients actually have, this episode names what's happening and gives you a map.

Transcript

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I wanted to tell you about a practice I worked with. Good doctors, genuinely good, the kind of clinical care you'd want for your own mother. And patients kept leaving, not in a dramatic way, quietly, one at a time. They'd come in once, get good care, actual, competent, buy the book good care, and then they just wouldn't come back. And nobody could tell you why. The leadership team had a theory. They always do. We need to be nicer, we need to smile more, we need a better patient experience. So they do a training, put up a poster in the break room, maybe hire a consultant to run a workshop, and nothing would change. Because here's the thing I've come to believe. And it's the reason the show exists. When a practice says we provide great care, but patients still leave, they don't have a care problem. They have a pillar failure. And by the end of this episode, you're going to know exactly what that means. Because I'm going to walk you through all nine of them. But first, who am I and why should you spend the next half hour with me? My name is Melissa Jilk Smith, and I've spent almost 20 years inside healthcare operations, not at the edges of it, inside it. I started scheduling patients and supervising patient access. And over the years, I worked my way up to director of operations positions across multiple specialties and then chief operations officer. At one point, I was overseeing 35 clinics across five regions and $35 million in revenue. So when I tell you patients leave practices that give genuinely good care, I'm not telling you something I read. I'm telling you something I watched happen over and over from the inside. And here's the part I couldn't get past. I watched practices invest everything in things they were sure mattered. Their clinical teams, their technology, their facilities, and still lose patience. Not because the care was poor, but because the experience around the care was broken in ways nobody had been made responsible for. A missed call here, a confusing bill there, a patient who walked out feeling unheard, even when the diagnosis was completely right. And the thing that kept me up at night was this. Those problems were fixable. I knew they were, because I'd fixed them. I'd taken a call center's abandoned call rate from 7% down to under 2. I'd grown patient volume by nearly 50% in a single year. None of that was magic. It was design. But almost no practice had someone whose only job was the full patient journey. First impression to long-term relationship. Everybody owned a piece. Nobody owned the whole. I built my company because I couldn't unsee that anymore. And underneath all of it is one belief I've carried into every role I've ever had. Take care of your team and they will take care of your patients. A remarkable patient experience doesn't happen by accident. It happens by design. So here's the core idea, and everything I do comes back to it. Experience is not a feeling. Experience is a system. We talk about it like it's a vibe, like it's the mood in the waiting room. It isn't. It's a chain of specific events, specific moments, and every one of them can be named, measured, and fixed, or ignored until it breaks. They are touch points. Hence the name of the show. Now, for years I've been mapping these touch points. Every place a patient brushes up against a practice, from before they ever called to whether they ever come back. What I ended up with is a framework I call the nine pillars of patient experience. Eight of them are touch points, and the ninth one is the score at the end of the game. And I'm going to walk you through all of them right now, not in a textbook way, in the way I actually use them, which is three movements before they arrive, inside the visit, after they leave. By the time we're done, you'll be able to walk into any practice in the country, yours, your competitors, the one you went to last week as a patient, and see exactly where it's working and exactly where it's breaking. Let's start at the beginning. Long before a patient ever walks through your door, their experience of you has already begun. This is the part most practices ignore, and then wonder why their conversion rates are so low. Pillar one is what a patient believes about you before they've ever contacted you. Your website, your Google reviews, the way your practice shows up in search, what their neighbors said about you at a dinner party three weeks ago, all of it, that's pillar one. Here's where this breaks. You have a practice with great clinical care, but you have a confusing website that hasn't been updated since 2019. A Google rating of 3.6 because you've never asked a happy patient to leave a review. And zero idea that the person who almost called today didn't. If pillar one is broken, nothing downstream of it ever gets to run. You don't lose those patients in your office. You lose them on their phone, in their kitchen, before they've ever even dialed. So pillar two is how easy it is to say yes to you. The patient picked up their phone, the patient went to your scheduling portal, what happens next? Hold times, call abandonment, online scheduling that works or doesn't, whether the human voice on the other end sounds like they want to help or sounds like they want to go home. This is a revenue gatekeeper. I once took a call center's abandoned call rate from 7% down to under 2%. That wasn't a small win. That was hundreds of patients a year who didn't exist in the practices data because they'd hung up before anyone even counted them. If access is broken, nothing else matters. You can have the best clinical care in the city. If patients can't say yes to you, they'll say yes to somebody else. Now let's move on to pillar three. This is everything that happens between scheduling and the patient walking through your door. Appointment reminders, instructions about fasting or medications, digital intake forms, insurance clarity, do they actually know what their visit will cost or are they coming in nervous? This is your pre-visit communication. Here's what it looks like when it breaks. A patient who shows up an hour early because the reminder was confusing, a patient who shows up unprepared because nobody told them not to eat, and a no-show rate that the front desk is blamed for when the real failure happened in pillar three. Confusion here doesn't stay here. It creates delays, cancellations, frustration, and it travels with that patient into every pillar downstream. Now let's move to inside the visit. Now the patient is here in your building. This is the part practices feel most confident about, and the part where most consequential breakdowns happen because by now the patient is paying attention. Pillar four is your arrival and check-in. It's the first physical confirmation of the decision the patient made on their phone three weeks ago. They walk in, they look around, the front desk either looks up and smiles or doesn't. The waiting area either feels clean and intentional, or it feels like nobody's in charge. This pillar is decided in the first 30 seconds. Front desk indifference, an unexplained wait, a check-in process that asks them for the same information they already gave online, and trust starts leaking out of the visit before they've even seen the provider. You either reinforce the decision to come here, or you immediately damage it. There is no neutral. Then pillar five, this is the clinical encounter. This is the visit itself, the reason they came in the first place. And this is where everybody assumes the system can carry them. Clinical skill is expected. What differentiates is connection, whether the provider actually looked at them instead of their computer, whether they understood the diagnosis when they left, whether somebody walked them through what comes next, or whether they got a printed handout and a vague any questions? The patient side complaint here is always the same. I felt rushed. I didn't feel heard. The doctor was kind, but they didn't really see me. That's a pillar five failure. So pillar six is how the visit ends, the checkout and exit, which is also how the visit is remembered. Did they leave knowing exactly what comes next? Was a follow-up scheduled? Or were they told to call the office? Which is code for good luck, hope you remember. Did anyone walk them through their medication or the next test or what to do if symptoms worsen? Most practices treat checkout like a transaction. It isn't. It's the moment where confusion either compounds or gets resolved. If a patient walks out of your practice, not sure what just happened or what they're supposed to do next, pillar seven and eight are about to get much harder for you. So now the visit's over. The patient is back in their car, back in their life, and here's where most practices quietly disappear and lose them without ever knowing it happened. Pillar seven is your post-visit follow-up and communication. It's what happens after they leave. Results delivery, follow-up calls, care coordination, how long it takes to respond when they message the portal. Here's the failure pattern. The patient gets their blood drawn on a Tuesday, hears nothing on Wednesday, starts to worry on Thursday, calls the office on Friday, gets sent to voicemail, and by Monday, they've already decided they're finding a new practice. And nobody in your office will ever know why. That's why they left. Because they won't tell you. They'll just not come back. So let's go to Pillar 8, Billing and Financial Experience. This is where trust is broken, quietly, permanently, and almost always avoidably. The bill arrives three months later, it's for an amount the patient wasn't expecting. The statement uses billing codes nobody outside a billing department can read. They call the office to ask about it and get transferred three times. The person who finally answers can't explain the charge and tells them to call the insurance company. And here's the cruelest part about pillar eight. You can deliver perfect care through every other pillar and still lose the patient here. The clinical visit was great. The provider was warm. The follow-up was on time. And then the bill arrived and undid all of it. Patients don't separate the care experience from the billing experience. It's all one experience to them. And if pillar eight breaks their trust, the rest of the pillars didn't matter. So now we take all of those pillars, all eight touch points, and we come to the long-term relationship. Pillar nine is different from all of the others. It's not a touch point. There's no moment in the patient's journey called long-term relationship. Pillar nine is what comes out the other end of the first eight. It's whether they come back, whether they refer their sister, whether they leave you a review, whether they stay with you for 10 years, or quietly drift to someone else next time they need care. It's the score at the end of the game. And here's the most important thing I can tell you about it. When pillar nine is weak, when retention is dropping, when referrals have dried up, when reviews are thinning out, the problem is always upstream. It's one or more of the first eight, which means when you can't figure out why patients are leaving, the question is which pillar is bleeding the relationship dry before we ever get there. So that's the map. Nine pillars, eight touch points, and one outcome. And once you have the map, you can stop guessing. You can stop fixing patient experience with a poster in the break room. You can stop investing the wrong pillar and wondering why nothing changes. Now, the exact same lens that diagnoses a practice diagnoses a leader. A manager has touch points too. Every moment they touch their team, how they run a meeting, how they deliver hard news, whether people know what's expected of them, broken touch points upstream cause failures downstream, in a practice and in a person. That's the whole idea behind everything I do. Get focused. Name what's actually true instead of guessing, and then walk through it, one pillar at a time. Here's what's coming. Starting next week, Touchpoints is launching a four-part series. It's called Inside the Nine. Every patient touch point we just walked through is delivered by an employee, and the employee's experience of that touch point determines whether the patient's experience works. Patient experience and employee experience are not two things. They're one operational system viewed from two different angles. And in four episodes, I'm going to prove that to you, pillar by pillar. If today made sense to you, Inside the Nine is going to change how you see your practice. I want you there for it. So do one thing for me. Follow the show, hit the button so next week's episode finds you instead of the other way around. Remember that practice I told you about? The good doctors who kept losing patients they never should have lost? They didn't need to be nicer. They needed to find the pillar that was failing and fix that one thing. That's what we're going to do here. One touch point at a time. I'm glad you're here. I'll see you at the next one.