One of the bi-products of our caffeine crazed, media blitzed economy is that we have virtually no attention span. It is as if we have a collective form of ADD. Over time, customers get bored with their vendors, alliance partners and trade associations. Client relationships have a natural tail.

The ability to continuously delight customers is a skill mastered by few. Clients need some type of stimuli that reinforces the value we provide them and it needs to come in different forms at different times. Variety is not just the spice of life; it is the remedy for overcoming the dreaded- inevitable customer fatigue.

Entertainers understand the element of surprise all too well. We all have a lot to learn from that ingenious management mind; Jerry Garcia. In the 60’s, the Grateful Dead had a Board of Directors and a call center. Whenever “the Dead” where touring, “Deadheads” who had gladly forked over their phone numbers would receive outreach about upcoming performances. The Deadheads would do something extraordinary; they would follow the band from city to city. As every show was an ad lib (jam), no two were alike, and no one knew what the Dead were going to play. Most businesses would kill to have the raving fans of the Dead.

The problem of customer fatigue is exacerbated by the fact that challengers are incented to barrage prospects with new offers and discounts in a way that an incumbent is not. In relative terms, the incumbent can easily become complacent and offer clients much of the same. As the old adage goes, “if it isn’t broke…”.

I heard of a guy who gave a business review presentation to a client on an iPad. At the end of the presentation, he said to his client “thank you so much for your business” and handed him the iPad. Giving such generous gifts may not be as accepted as it once was, but imagine the shock value of the meeting. It is one the client will never forget! We need to find ways to maintain our clients’ attention span.

Customer fatigue only magnifies themes we have often shared in this space. The number one rule of customer relationship management is to take better care of the customers you already have than new ones you might attract. Offering our best discounts to new customers flies in the face of this principle. Organizations often position their best people as hunters, and then delegate customer service to others (who may not be empowered to make customer retention decisions). An organization can easily lose sight of its most precious possession, its most profitable customers.

Customers should be treated differently based on their lifetime value, and perhaps even receive different benefits based on their tenure.  One of my clients recently calculated their average client retention cycle (and at what time they lose the average client) and is now taking steps to change their approach over the span of the customer relationship.

Find a way to shake things up and keep customers coming back for more.

A federal judge’s recent ruling that elements of the health care bill are unconstitutional has heightened the health care debate.  Republicans, feeling their oats and perceiving a mandate are threatening to repeal the Patient Protection and Affordable Care Act.

It was only after my friend and colleague Dr. Bala Chandrasekhar explained most of the information in this post to me that I first came to understand the fundamental problem.  Our medical community suffers from perverse incentives. The system does not reward results; it rewards the extension of care.

In the world’s best hospitals, such as the Mayo Clinic, physicians collaborate, in a finite space, where information is shared and decisions are made. In the overwhelming majority of cases, patients are shuttled around, from general practitioners, to specialist, and from one laboratory to the next.  Information about the patient’s medical history is rarely shared, an approach that does not support the best medical outcome for patients.

The advent of electronic medical records and new rules governing payments is the impetus to consolidation in a business so unsophisticated, that many medical files and prescriptions are managed with a piece of paper, pen and fax machine.  The institution of medicine needs to undergo radical change, and the prospects of larger organizations managing our care means that the stakes are getting higher.

Unlike professionally managed businesses, there are massive variations in best practices in medical groups.  Physicians hate oversight, and we pay the price in an estimated 100,000 people a year dying in U.S. hospitals from pure negligence (errors).

It is intuitive to all of us that raising medical care costs are unsustainable, yet the numbers are daunting.  The convergence of an aging populace and exponential health care inflation will double Medicare costs within a decade.  By 2020, Medicare and Medicaid are projected to increase from 21% to over 30% of federal spending (non-interest payments), and that doesn’t include massive spending by state and local governments. Proponents argue that we have the best medical care in the world; but at what cost? A knee replacement that costs upward of $40,000 in the U.S., costs $5,000 in Germany. We all want the best health care, but at some point common sense must prevail.

According to the bipartisan congressional report -Restoring America’s Future, “slowing the growth of health spending is realistic. Other advanced countries have substantially lower health spending as a share of GDP, while still achieving measures of access and quality that often exceed those in the United States. Although a uniquely American approach is required, these comparisons show what is achievable.” Health care reform focuses on capping costs for doctors and reforming various forms of insurance coverage (including universal coverage). It does little to reform the underlying behavioral issues that are driving up health care costs.  The fee for service model is dated and irrelevant.

If these costs are not constrained, our fiscal mess will get much worse, and our businesses and personal wealth will be drained by massive tax increases.  Small business owners, who bear the brunt of a bloated health care bureaucracy in the form of inflated health insurance premiums must advocate for more meaningful reforms.  Our economic future depends on it.