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Patients as Customers: How Can Boards Ensure Patient-Centered Care?

Pulse The rise in health care consumerism is not surprising. It has become the norm in many industries for years – comparing prices and reading reviews before buying a television or booking a vacation is typical for most consumers. While it's not as simple to gather data and make comparisons in health care, the trend has been growing thanks to cost shifts to consumers, increased expectations for on-demand service, growing competition from non-traditional formats, new technologies and a transition toward value-based care.

While patients were once generally passive recipients and followers of doctors' orders and advice, "health care consumerism" reflects the increasing engagement of people in managing and making independent decisions about their health care. Through the establishment of health care purchasing exchanges, patient engagement programs and increased responsibility for a growing share of costs, engaged patients are seeking better care, better outcomes, more personalized treatment, convenience, choice and value for their health care dollar. They are becoming more selective in choosing their health care providers and are paying greater attention to price and quality rankings.

The range of patient choices has expanded as well including retail clinics, pharmacies, national and international medical tourism, and more. Patients (and millennials in particular), want online access to health care information and services. As consumers, patients are often frustrated by a complex system of care that is disjointed, lacks transparency and can be difficult to understand and navigate.

Rising consumerism also means helping patients by giving them the information and tools they need to make informed health care decisions. As they shift from passive patients to engaged health care consumers, people want to know and compare costs, quality and value just as they do when buying a house, a car or making other important purchases. They also are weighing the overall experience they have. In the end, these consumers will decide when, where and with whom they will spend their health care dollars; and their broader experiences as informed consumers in other markets will make the difference in how they make their decisions.

What Customers Want

Health care consumers want the same things from health care organizations that they want from other companies. McKinsey & Company's Consumer Health Insights survey indicates that "providing great customer service, delivering on expectations, making life easier and offering great value" are the qualities that set consumer-focused organizations apart from others.

Different Consumers Have Different Preferences. Defining these qualities and bringing them to life is not an easy task. We all know great customer service when we see it. We all have expectations and know what things make our lives easier. At the same time, everyone defines these qualities differently.

Millennials want strong patient-provider connections with adequate time for verbal discussion. They support telehealth and want providers to have mobile health apps. Baby boomers in their early 60s are experiencing more health concerns and have become comfortable with using technology. They are researching health topics online and use patient portals to communicate with providers. In contrast, patients over 75 years in age want to get their health information directly from their physician, and they rely on their physicians to direct their care. Age is not the only differentiator; geography, education, gender, religion, race and ethnicity are among the many factors that also influence consumer preferences.

It's about the Journey. To further complicate efforts to define what customers want most, McKinsey's research found that what consumers believe makes the most difference to them is not necessarily the same as what truly influences their opinions. Many hospitals and health systems focus their customer service on improving parking, offering high-quality food choices, improving the waiting experience and ensuring online access to information, all of which are important to patients' overall experience and satisfaction. But the more important factors to patient satisfaction are the empathy a patient feels from the nursing staff and being kept informed during and after their treatment. These are the intangible factors that tend to be understated by patients.

Taking consumerism or patient satisfaction beyond HCHAPS or the practices of routine customer service requires understanding, engagement and collaboration. In its CEO Guide to Customer Service, McKinsey & Company consultants note that mastering exceptional customer service is essential to leading in a consumer-driven market. This mastery is dependent on understanding that the customer's perspective is a beginning-to-end experience, or "journey" with an organization. No matter how favorable individual interactions are, the complete experience is not simply the interactions with one or more different "touchpoints" in the hospital or health system (such as reception, admitting or claims). In a recent survey, customers were 73 percent more likely to be satisfied with health insurance and 61 percent more satisfied with hotels when their "journey" worked well, rather than when just the touchpoints did.

Understanding and Offering Patient-Centered Care

 The boards and CEOs of hospitals and health systems are in the best position to consider the consumer's entire journey through the organization, from the time they initiate care until they pay off their account. It is the board's job and responsibility to ensure the organization's viability and success in today's new and different consumer-driven health care market. Trustees can begin this process by considering the following questions and assessing the depth of commitment and understanding the board has about its patient population.

  • Can your organization segment its patient population?
  • Do you know the motivations, attitudes and preferences of each patient segment, or what is most important to each segment?
  • Do you know how well your organization is able to meet the expectations of each of its patient segments?
  • Does your organization conduct consumer focus groups, patient interviews or have a patient advisory committee?
  • Do you have a clear picture of the patient's journey through your hospital or health system?
  • Do you have a clear statement that sets the direction and expectations for the customer experience in your organization?
  • Have you made consumerism and customer experience part of your strategic plan?
  • Does your board include individual(s) from companies known for their customer excellence?
  • Have you explored ideas and concepts that might be adapted from other industries and organizations known for their customer excellence?
  • How highly satisfied are your employees and medical staff? Is this a priority that starts with the board?
  • Does your board ask for employees' opinions about patient experiences and opportunities for improvement?
  • Do you know which services have the greatest financial impact on your organization? How well do they meet customer needs and expectations?
  • What metrics does the board use to measure improvement in patient experiences?

Discussions, deliberations and debate over the answers to these questions will help the board to define how well-prepared it is to succeed in a consumer-driven market, strategic changes the organization should take, and what steps are needed to define the hospital or health system's vision for meeting patient expectations.

Special thanks to The Walker Company for use of: Patients as Customers: How Can Boards Ensure Patient-Centered Care. Additional trustee resources from KHA are available in the Trustee Section of the KHA website. Additional resources from Larry Walker can be found at: www.walkercompany.com.