Health care in the U.S. continues its radical transformation with the rollout and rapid adoption of high-deductible insurance plans. More than even value-based purchasing, this has the potential to reshape the health care landscape because it has awakened the health care consumer. In its 2014 Employer Health Benefits Survey, The Kaiser Family Foundation reported that 41 percent of all firms (32 percent of large employers, 61 percent of small firms) have rolled out high-deductible insurance plans.
With the patient now responsible for large deductibles at insurance company negotiated rates, households are forced to become smarter consumers of health care services. New businesses and services have been introduced to meet market needs. Witness the rapid expansion of urgent care facilities, the availability of vaccinations at pharmacies, and most recently, staffed clinics within retailers. These all serve one purpose: providing consumers more expedient, cost-effective access to care on their terms.
This ever-increasing trend in consumer activism necessitates that health care providers start to view their patients as health care consumers. In a January 2015 article titled “Improve patient satisfaction from the eyes of the consumer,” this author advocated that providers improve patient satisfaction in order to build their brands. With a stronger brand, they can better compete, and be among the winners as the industry consolidates. Overwhelming feedback to the article questioned the appropriateness and relevancy of patient satisfaction as a stated goal. Instead, reviewers advocated that patient outcome should be the sole focus. Notably, the article’s premise: “How will hospitals compete given the structural changes facing their industry?” was not addressed.
Why did this happen? Simply, the phrase “patient satisfaction” has become polarizing. CMS measures hospital patient satisfaction and ties reimbursements through standardized patient surveys called HCAHPS. Many clinicians believe that the HCAHPS survey is misguided, inaccurate, and leads to excessive costs in an effort to please the patient. And as one nurse said, “And you can’t make everyone happy!”
An expert on patient experience development and cultural transformation, Jake Poore of Integrated Loyalty Systems, says: “Many providers today feel like they are set up to fail. With the pressures of new requirements, tools and processes for documentation (EMRs) and having to see 10 to 30 percent more patients than last year just to make the same productivity or revenue, they feel like they are literally running ‘on the daily gerbil wheel.’ When you add the fact that most patient clinic appointments are in 15-minute windows, you have a perfect storm: The last thing on a provider’s mind is patient satisfaction or survey results.”
What is the root cause? Poore suggests a misalignment of priorities between what health care organizations measure, reward and hold accountable and the priorities patients expect from their caregivers. When Poore and his team ask health care leaders, providers, and staff to identify the top 4 most important operational priorities and prioritize them in order, they say: #1. productivity, #2. competency, #3. safety, and #4. courtesy.
On the other hand, when you ask patients (which Poore and his team have done with nearly all of their clients around the country) what they want most from the front desk to their physicians and nurses, patients rate their priorities as: #1. courtesy/compassion, #2. competency, #3. productivity, and #4. is safety. In explaining the patient priority order, Poore says that it rarely even occurs to patients that a hospital or the caregiver is not safe. As one patient said it, “safety only becomes my concern when safety has been jeopardized.” Overwhelmingly, what patients say they want first is a care team member (clinical and non) who is “warm, welcoming and listens” and talks with them, not to them: “… as an individual, with dignity and respect. As patients, we assume you are smart and an expert of your trade, but we want you to start the conversation on the human side first, do your exam second.”
As consumers, we purchase products and services we like. We are most loyal to brands where we have an emotional connection and where the people behind those brands seem to share our priorities and values. But when managing our own health care, we have traditionally been the patient. The patient has now become the consumer who expects the health care provider to treat them as such. But how should providers adapt to this new paradigm? They need to focus on their client, the patient, and improve the patient experience. More than ever before, health care consumers have many choices for their care. Providing a poor patient experience will damage an institution or provider’s brand, resulting in lost loyalty, lost patients, and, above all, lost revenue. By improving the patient experience, providers will not only enhance their patients’ well-being, they are better equipped to prevail in the new health care marketplace.
Jim Lahren is a health care consultant.
