Foreword

Combining expertise, experience, and data from millions of people – patients and consumers, along with healthcare employees and executives – the team at NRC Health’s Human Understanding Institute forged a distinct perspective for the year ahead.

Our 2024 Experience Perspective is designed to help leaders turn aspiration into action by prioritizing Human Understanding^® and addressing what matters to the unique humans seeking, delivering, and supporting excellent care in the real world. Section 1 emphasizes that innovation starts with the fundamentals, offering practical strategies for elevating experience; Section 2 takes a deep dive into the anatomy of Detractors, healthcare’s misunderstood stakeholder; and Section 3 shares important trends that reinforce the value of paying close attention to what matters. We will be with you every step of the way.

Introduction

Patients, consumers, and health professionals hope they will be treated as the unique people they are. But hope is one thing; strategy is another. That’s why the 2024 Experience Perspective integrates research with a point of view that can inform and revitalize strategies that relate to and integrate brand, consumer, patient, and employee/workforce experience. Our goal is to help health organizations focus their energy on purposeful action that supports Human Understanding in everything they do.

At the ‘Innovation Starts with the Fundamentals’ workshops we facilitated during the Becker’s Healthcare Annual Meeting and NRC Health Human Understanding Beyond conference in 2023, participants rallied around two very real-world declarations:

In this section, we offer a forward-thinking perspective on each of the fundamentals we identified and pressure-tested in concert with experience leaders across the country:

01

Leading healthcare organizations have started bridging the traditional silos between brand, consumer, patient, and employee/workforce experience. But in terms of structure and function, they tend to treat experience, quality, safety, equity, and brand as separate domains. In some healthcare organizations, operational leaders for a few of these domains report to the same person. In others, domain leaders operate in unconnected silos. Regardless of the organizational structure, progress within and across these domains will stall if efforts are not well coordinated. But Dr. Gregory Makoul, NRC Health’s Chief Transformation Officer, suggests that there’s a bigger point to consider:

At all levels, synchronizing values, strategy, and operations is the key to transcending obstacles to the One Big Dot approach. Michael Giuliano, President of Planetree, has seen what happens when healthcare organizations signal to staff that the domains are mutually exclusive rather than interconnected and when organizational behavior conflicts with professed culture:

It’s worth remembering that the HCAHPS^® (Hospital Consumer Assessment of Healthcare Providers and Systems) survey served as a focusing mechanism that helped spark considerable improvement by positioning patient experience as a key element of overall hospital quality. While this illustrates the connection between important domains, it would be a mistake to focus attention solely on the inpatient setting. In fact, the One Big Dot approach prioritizes Human Understanding in any care setting and across roles (e.g., patients, consumers, employees, providers).

Leaders at OHSU Health Services clearly understand the value of coordinating efforts and adopting a One Big Dot approach across the organization – breaking down barriers that limit progress toward achieving strategic priorities:

The original conceptualization of the Triple Aim, released in 2008, cast the Experience of Care / Better Care in terms drawn from the 2001 Institute of Medicine (IOM) report on Crossing the Quality Chasm: Safe, Effective, Patient-Centered, Timely, Efficient, Equitable. In the ‘triple’ formulation, Experience of Care was tied to two complementary aims: Population Health / Better Health and Per Capita Cost / Lower Cost.

In 2014, the model was expanded to form the Quadruple Aim by adding a focus on addressing clinician burnout (a.k.a. Joy in Work), a logical extension given that employee experience is a major pathway to improving the Experience of Care. And, in 2022, the Quintuple Aim highlighted the imperative of advancing health equity, especially upstream factors such as systemic bias and social drivers of health. While the shapes may change, the core aim of Better Care clearly encompasses experience + quality + safety + equity. One Big Dot.

Research reported in our 2023 Experience Perspective demonstrated that when it comes to quality, patients and consumers emphasize Safety, Effectiveness, and Patient-Centeredness – as did the IOM – but also invoke Communication and Cleanliness. Here, we take a close look at how people think about safety. NRC Health’s leadership on Human Understanding in – and beyond – the care setting dovetails with Planetree’s Person-Centered Care Framework, a model of care that: (1) focuses on the needs of individuals, guided by peoples’ preferences and values and (2) includes supporting structures, policies, and practices that create a culture of quality, compassion, and partnership across the continuum of care. Accordingly, we worked with Planetree’s Michael Giuliano to investigate how people think about safe healthcare.

We used the NRC Health Market Insights national study to rate the importance of three safety dimensions, and we’ve added recent comments from patients to illustrate each:

Preventing physical harm
(examples: preventing infections/injuries from care, diagnostic errors, medication errors, falls)

Preventing emotional harm
(examples: tailoring care to each person with compassion, respect, clear communication, teamwork)

Providing a safe environment
(examples: ensuring cleanliness, security)

The study was conducted between October and December 2023 with 39,669 people who had a healthcare experience within 12 months of their response. While all dimensions were deemed important by a vast majority of respondents, a safe environment – as manifested by cleanliness and security – was considered ‘very important’ by the largest proportion (78.8%). In terms of overall importance, the ratings for preventing emotional harm (96.5%) and providing a safe environment (96.5%) were slightly higher than those for preventing physical harm (95.7%), the vector that tends to be most closely linked with safety.

The point: It is essential that health organizations take a three-dimensional view of safety, with equal attention to physical safety, emotional safety, and a safe environment of care. Indeed, the ‘very important’ responses connote a safety-oriented variant of Maslow’s Hierarchy. In this construction, the most basic need is for a safe care environment, followed closely by physical safety and emotional safety.

All three dimensions are important and ‘zero harm’ should be the goal for each. Think about this as another way to align experience, quality, safety, and equity – our research found that people see cleanliness (safe environment) as an essential element of quality; much of what is traditionally considered ‘quality’ is consistent with preventing physical harm; emotional safety links both experience and equity.

It’s important to note a few patterns that emerged across the three dimensions demographically:

We also asked which aspect of safe hospital care people see as the focus of most health professionals or health organizations. Overall, we found that most people believe there’s a primary focus on preventing physical harm, followed by providing a safe environment and preventing emotional harm. When it comes to the stakeholder groups, respondents see doctors and care teams as having the highest focus on physical safety, which makes sense. Similarly, hospitals and health systems are perceived to have a markedly higher focus on providing a safe environment, which also makes sense. The perception of emotional safety as the main focus is fairly consistent.

When stratifying this analysis by race/ethnicity, physical safety is still in the forefront, but we found that – compared to people identifying as Asian or White – those identifying as Black or Hispanic tend to see health professionals and health organizations as focused relatively less on physical safety and relatively more on emotional safety.

Over the course of 2024, we will be working with our partners to take a deeper dive into this finding, with the goal of elucidating whether it reflects the outcome of more attention to equitable care or signals the need for more attention to preventing harm. We will also work together to illuminate how care teams view and experience physical, emotional, and care-environment safety.

Planetree’s research-based Certification for Excellence in Person-Centered Care is a rigorous program that currently spans 183 healthcare facilities in 13 countries. It includes a Lived Experience Validation to capture the authentic voice of patients, families, staff, and the community regarding experiences in both giving and receiving care. Planetree analyzed high-level trends emerging from the Lived Experience Validation in focus groups and during experience journeys, and the findings align with the Safety Hierarchy and underscore the importance of both Human Understanding and the One Big Dot approach:

Taking a One Big Dot approach can re-energize improvement efforts by fostering alignment across domains (experience, quality, safety, equity, brand) and buy-in across the organization. The fact that domains carry different measures does not mean they should be treated in isolation or as if they are in competition. Moreover, there is tremendous value in learning from how patients and consumers characterize the domains; our research on quality and safety demonstrates that they see the big picture and add dimensionality to it. By transcending silos that artificially separate experience, quality, safety, equity. and brand, CEOs and other senior leaders can make the case that a more holistic view of the work – with attention to all of the detail that goes along with it – is the key to making real progress on an Experience of Care that is more than the sum of its parts.

02

The concept of Human Understanding is both simple and profound: We can change healthcare for the better if we understand and address what matters to the people seeking and delivering care. At a behavioral level, Human Understanding boils down to three behaviors: Connect with me, Listen to me, and Partner with me, all of which are clearly important on both sides of the stethoscope.

As detailed in our 2023 Experience Perspective, we took a disciplined approach to developing the Human Understanding Metric (HU^me) – Did everyone treat you as a unique person? – as a way to gauge the extent to which Human Understanding is happening. When we look across two full years of data collected in our national Market Insights study, we find that only 38% of people who had an experience within 12 months of their response report that everyone treated them with Human Understanding.

In addition to the national data, more than 80 health organizations have implemented the HU^me within their patient experience surveys. Given that these sites have clearly prioritized Human Understanding and responses are captured from ‘active patients’ within just a few days of an encounter, it is not surprising that the results are more positive, ranging from about 56% to 89%. We also find that large, medium, and small organizations (based on the number of responses, the size of the dot) are scoring relatively highly on the HU^me – note the mix of organizations above the inner-quartile range (right-side of the grey box).

We know that Connect-Listen-Partner behaviors are an important pathway to moving the HCAHPS needle. Human Understanding is also the best predictor of likelihood-to-recommend and, thus, Net Promoter Score (NPS). This relationship is clearly demonstrated at Gundersen Health System and M Health Fairview, two of the NRC Health partners that have implemented the HU^me in concert with intentional strategies to engage leaders and teams. Soon after launching the effort, these systems achieved unprecedented increases in NPS over a short time span.

While these results are impressive, they did not miraculously appear upon addition of the HU^me. Both Gundersen and M Health Fairview rallied around the idea and importance of human connection and person-centered care, creating strategic processes to support the Human Understanding movement. See the case study for more detail on how they did it. It’s a great example of going beyond the scores and focusing on the behaviors and outcomes that scores represent.

More broadly, though, we have seen increased Likelihood-to-Recommend (LTR) in most organizations that have implemented the HU^me. Here are the trajectories for five of these. While some saw nearly immediate increases, the jump in LTR is always linked to a concerted internal effort to reinforce Human Understanding. This is a critical point: The measure is great, but the ‘magic’ is a function of embracing Human Understanding in everyday practice.

Bryan Health, a regional health system in Nebraska, is another powerful example of what it means to fully embrace Human Understanding.

Leaders across the organization worked together to develop a new model of personalized care that features the behavioral components of Human Understanding: Connect, Listen, Partner. While using these Human Understanding behaviors as the model’s foundation is important, the disciplined process of infusing them throughout the system is equally impressive and perhaps more impactful. Efforts range from introducing the model and making it part of standard work to using it as the vocabulary for staff recognition, leadership development, job descriptions, and performance appraisals.

There is tremendous power in ‘doing’ Human Understanding. Yet as noted early in this section, HU^me scores from healthcare consumers in the national Market Insights study tend to be lower than those from patients who just had an encounter. This differential reinforces the importance of staying connected beyond a care experience, even a great one: Impressions of Human Understanding, like pretty much any experience, tend to become more diffuse and decay over time.

Indeed, a closer look at the Market Insights data illustrates that the national average – 38% reporting that they were treated as unique people – starts at 48% for people who had an encounter within 1 month of responding, drops to 39% for those with an experience in the prior 1-3 months, and settles in around 33% when based on visits more than 3 months prior. In other words, salience matters.

Health organizations make tangible progress when they prioritize Human Understanding, focusing on what matters and maintaining relationships even when people are not ‘active patients.’ NRC Health bolsters these efforts with proven strategies that range from using MyStory to focus on what matters to individual patients to leveraging Community Insights to connect with groups of people who have offered to share views if asked and drawing from Market Insights to keep branding fresh and relevant. The point is that commitment to Human Understanding does not stop when a healthcare encounter is over. In fact, recognizing that most of patients’ lives happen outside of the care setting is central to advancing Human Understanding.

03

It usually doesn’t take long before accountability comes up in discussions with healthcare leaders, most often in the form of a lament: “We need more accountability” or “We don’t have a sense of shared responsibility.” A sense of personal accountability and mutual responsibility helps sustain workplace cultures that strive for and achieve positive outcomes. Why is this essential ingredient so elusive? One word: Clarity.

It’s impossible to have a culture of accountability without clarity. As one experience leader put it, “Understanding the relationship between accountability and clarity is critical to elevating the work we do.” There is no reasonable way to hold people accountable for meeting expectations if they don’t know what those expectations are. Questions that facilitate clarity in the experience context include:

Creating a culture of accountability and recognition is one of the bodies of work that form a robust experience strategy. The term ‘bodies of work’ is used intentionally, because a strong strategy is more than a document; it articulates and prioritizes partnerships, workflows, and tactics required to solve problems and reach goals. Here’s a summary of the six bodies of work in the Experience Strategy Framework that Toya Gorley MBA, Improvement Advisor at the Human Understanding Institute, uses in her work with health system leaders:

Research we conducted with experience leaders and CEOs across 138 health organizations in Spring 2023 reinforces the importance of mutual understanding and agreement about priorities and roles. For starters, we asked people in both groups to select the three challenges that experience leaders should own. While the same ‘Top 3’ emerged across groups – and there is no question that all are mission-critical – the relative order is instructive:

While these results should be considered directional rather than definitive, more than half of the participating CEOs emphasized the importance of sustaining experience initiatives, double the proportion that highlighted aligning experience with other organizational priorities. Unless experience is clearly aligned with other priorities in a One Big Dot approach, sustaining experience initiatives will remain a distant and almost unreachable goal.

We also asked experience leaders about perceived role of their CEOs – the extent to which they are ‘proactive’ (passionate, energizing, visible champion), ‘reactive’ (nominal champion who helps if asked), or ‘not active’ (not a champion, given other priorities). The results are telling: There was relative balance between experience leaders reporting that their CEO is proactive or reactive when it comes to championing experience.

The same pattern emerged when we posed this question to more than 150 experience leaders who attended our workshop at NRC Health’s 2023 Human Understanding Beyond conference. However, when we asked what their CEOs would say, there was a major disconnect: Nearly everyone reckoned that CEOs see themselves as proactive. Indeed, while the CEO sample in our survey was small, 100% of those who participated see themselves as proactive. This may be because less-engaged CEOs did not respond, or because there is a disconnect between perception and reality. Either way, clarity about both priorities and roles is paramount.

When it comes to experience, success requires a focus on what matters to the people seeking and delivering care, as well as clarity about roles, priorities, and expectations for purposeful action. While organizations may have some of the bodies of work in place or in progress, all of them are necessary. Striving for clarity within and across these strategic imperatives is the first step toward gaining accountability in turning aspiration into action.

04

The very same behaviors that support Human Understanding with patients and care teams – Connect with me, Listen to me, Partner with me – apply to consumers and community members as well. This lesson is beautifully illustrated by the visionary leadership of Jacqueline Reed, who founded a community-based organization in Chicago 35 years ago. Naming it the Westside Health Authority sent a clear message that people living in the community are authorities on the lives they live and should be involved in decisions that affect their community. Hospitals and health systems would do well to adopt the underlying logic of this model, which can markedly improve the health and well-being of generations.

And some have. Iris Lundy MHL, BSN, RN, Vice President for Health Equity at Sentara Health, helped put her organization at the forefront of positive and productive community engagement because she knows that the first step to listening and partnering is connecting – building trust by making sure that she, her colleagues, and Sentara make the effort to show up as part of the community:

Communities can be defined in multiple and overlapping ways, ranging from geography (see our nSight on Access to Care) to socio-demographics, roles, affiliations, interests, beliefs, and experiences. For instance, there are communities of and within cardiologists, people who recently gave birth, and people caring for an aging parent. A big part of amplifying voices is creating psychological safety for members of any community to express individual differences and differences of opinion. Another big part is the amplification mechanism itself.

There are many ways to gather consumer and community input, from surveys, interviews, and focus groups to Patient & Family Advisory Councils (or Patient and Family Partnership Councils). While valuable, these traditional methods tend to be limited in scope and difficult to manage. NRC Health’s Community Insights tool provides a more contemporary approach that makes it easy for health organizations to run reliable custom studies at scale.

More specifically, we have helped more than 200 health systems amplify the voice of consumers and community members by providing a digital means of building, organizing, and interacting with target groups of highly engaged people who have signaled their interest in identifying problems and solutions. Modes range from well managed surveys and focus groups to video diaries and narratives. Topics cover a broad range of topics: defining health from the consumer perspective, designing new care facilities, redefining the welcome experience, determining information needs and modes, improving the experience for LGBTQ+ patients, and prioritizing telehealth offerings to name a few.

UC Davis has made great use of Community Insights to inform and co-design new initiatives. Within two years of implementation, they have gained direct access to about 40,000 people who have volunteered to help the organization learn and improve. Here are some of the priorities they were able to tackle by nurturing the broader community and strategically seeking input by defining micro-communities and selecting participants based on the issue at hand:

Unless organizations work with consumers and communities to identify needs, they risk wasting resources solving the wrong problems and/or creating new ones. It’s equally important to bring end-users into the process of co-designing solutions, whether refining or replacing current ways of operating. Consider this example:

Without genuine attention to usefulness and usability from the end-user perspective, shiny new objects are likely to collect dust. Of course, this line of reasoning extends beyond the technology itself – surrounding processes must be constructed with sensitivity to the needs and experience of end-users as well.

Community Insights is a useful starting point for embarking on human-centered design, “a process that starts with the people you’re designing for and ends with new solutions that are tailor-made to suit their needs.” But doing it right requires being open to learning what and how people are thinking about a problem, not taking a shortcut by creating a solution and asking if people like it, or would like it better in a different color. With experience and expertise in human-centered design, the Human Understanding Institute and its network of experts can help our partners think and work differently, co-designing services and solutions that meet the needs of consumers and communities.

More than two decades ago, the Net Promoter Score (NPS) was introduced as a consumer-loyalty metric linked to the likelihood that someone would recommend a company’s products or services. Typically, NPS is determined by asking customers something like: “On a scale of 0 to 10, how likely are you to recommend our company/people/products/services to a friend or family member?” Based on the 0-10 score a person gives, respondents are grouped into one of three categories:

The NPS metric is calculated simply by subtracting the percentage of Detractors from the percentage of Promoters – and research has shown that high NPS scores are strongly correlated with reutilization, future purchases, and other behaviors that demonstrate loyalty and contribute to growth. Conversely, organizations with large proportions of Detractors tend to have lower revenue and declining brand reputation over time.

In recent years, many healthcare organizations have adopted NPS as a key metric to track patient experience and gauge loyalty. However, much of the focus has been on understanding and creating promoters (asking, e.g., what leads someone to give a high likelihood-to-recommend score?). Further, there is a common (mis)perception that because Passive respondents are closer on the NPS scale to Promoters than are Detractors, it should be easier to convert them to Promoters ‘next time.’ Our research proves the opposite to be true. Organizations would do just as well to focus on understanding patients who have had deeply negative experiences because healthcare Detractors are in fact forgiving and are just as likely (possibly more so) to be future Promoters when compared to Passive respondents. Because this finding may seem counterintuitive, we took a closer look at one of healthcare’s most misunderstood stakeholders: Detractors.

Last March, we wrote about building trust and loyalty and found that – at the market level – consumers trust doctors and nurses more than hospitals and health systems, about 1.6 times more. Interestingly, this finding is reflected when looking at the experience data we collect at medical practices, where we see that the proportion of Detractors is 1.6 times higher for facilities than providers. In other words, patients are significantly more likely to report a bad experience when asked about a facility compared to a provider. A key question for organizations to ponder then is what (or who) should be the target(s) of increasing loyalty? It may be easier to build loyalty to people, but care teams frequently change, so it is equally important to build allegiance to the organization.

Digging in further, Detractors tend to be younger than Passives and quite a bit younger than Promoters, especially in the context of likelihood to recommend a facility, where the average Promoter is 6 years older than the average Detractor. This age gap may be a result of less-frequent contact with health systems, the types of services used, possibly even generational differences in expectations of care.

Looking at the full age distributions of Promoters vs Detractors, the asymmetry between the two groups comes into sharp relief: Patients under 55 make up a much larger proportion of Detractors. So at least one way to build loyalty is to better understand and address what matters to younger patients.

With respect to sex, we see a higher proportion of Detractors than Promoters in the group of younger males, but the largest segment of Detractors skews toward younger females. This may have to do with maternity care and subsequent childcare (e.g., bad experiences are amplified by the expectations and very real needs of young mothers). While loyalty is built one person at a time, this data suggests that there is ample opportunity to make inroads with patients under 55 and younger women in particular – especially given that we estimate the lifetime value of a loyal 26-year-old patient at over $1.2 million.

There is a seemingly ubiquitous line of reasoning related to NPS improvement: Passive respondents should be easier to convert to Promoters, since a 7 or 8 is closer to 9 or 10 than the 0 to 6 scores left by Detractors. Intuitively (and mathematically) it’s not an unreasonable assumption. However, it is not supported by the data. We drew a random sample of nearly 1.3 million medical practice patients who completed surveys after two different encounters in 2023. It turns out that from one experience to the next, 17.0% of Detractors became Promoters compared to just 14.5% of Passives making that switch.

Note that the vast majority of Promoters stayed Promoters (82%) – for clarity, neither that group of patients nor that pathway are shown in the diagram below.

Analyzing the trajectory of Detractor-to-Promoter switches offers insight into what went wrong to create Detractors in the first place, then what went comparatively right the ‘next time,’ when these same respondents gave a 9 or 10. Looking at the percentage of top-box scores from one experience to the next, the big three shifts in Detractor-to-Promoter care experiences are:

As shown below, initial Detractor experiences (red) may have a lasting impact on future visits: Despite dramatic score increases from one experience to the next, there are significant gaps between a subsequent Promoter experience (green) and the overall average for the full NRC Health sample (gray). While it is possible to move Detractors to Promoters, it might require more than one positive experience to fully recover from that initial experience.

Still, it’s clear that listening, giving patients enough information about their treatment, and building trust are key to moving Detractors to Promoters. We explored these potential relationships more rigorously to see if there is a basis for the belief that these behaviors (or lack thereof) may be causally connected to the creation of a Detractor. And indeed there is.

Trust and Human Understanding are related but distinct and powerful vectors when it comes to care. Our research across organizations using the Human Understanding Metric shows that HU^me and Trust are the #1 and #2 drivers of likelihood-to-recommend, and thus, NPS. Looking broadly across all NRC customers (not just those who incorporate the HU^me), we used logistic regression to evaluate a random sample of patients (n = 402,657) from more than 20 urban/rural health systems across the nation over the last 12 months. Controlling for demographic factors such as age, sex, language, and marital status we modeled what motivates patients to give a 0-6 when reporting their likelihood to recommend an organizations’ providers/facilities. Here is what we found.

All things being equal, if you want to create a Detractor:

Our previous research has also shown that patients who report their providers listened carefully to them are more than 240% more likely to say they trust their providers with their care compared to those who felt their providers didn’t listen. So clearly the pathway to building Trust is through better listening. In sum, if you want to avoid creating Detractors, adopt the Human Understanding behaviors – Connect with me, Listen to me, Partner with me – and focus on Human Understanding to build trust and strengthen it at every touchpoint.

A final point worth mentioning about Detractors vs Promoters is that a linguistic analysis revealed that the word choices each group uses in their verbatim comments are (unsurprisingly) very different, but instructive nevertheless. Below is a scattertext plot showing the frequency of two-word phrases (bi-grams) distilled from a random sample of more than 1 million patient comments. Promoters’ bi-gram frequency ranks are plotted along the vertical axis, while Detractor frequency ranks along the horizontal. The color and size of each dot represents the average likelihood-to-recommend and subjectivity scores associated with the comments in which each bi-gram appeared (smaller dots represent less subjective, more fact-laden comments; red dots represent more negative phrases).

Some key phrases most frequently used by Promoters:

Contrast those to some of the phrases mostly used by Detractors, and we find patients indexing a much different care experience:

These comments demonstrate that patients who are treated as unique people (i.e., the care team takes the time to make them feel comfortable and really listen, answer questions, and explain things) are more likely to be Promoters. Patient comments also broaden the Detractor path previously uncovered by the quantitative findings and show that it includes limiting access to care, shrugging about wait times, rushing patients through their care experiences, and forgoing follow-up.

Detractors differ from Promoters, but not just because they had a deeply negative experience. They are also more often younger and female. And from all we’ve learned, what Detractors missed was a care team that paid attention to their journey from start to finish and:

The good news is that healthcare Detractors are forgiving, which reinforces the importance of understanding what makes them tick and making every effort to mind the gaps in care, especially when things go very wrong.

Trend 01

A human-centered design approach to understanding issues and solving problems starts with listening to the people affected by them. Forward-leaning health systems are turning to crowdsourcing solutions like NRC Health’s Community Insights to amplify the voices of patient communities and consumer groups as well as those of their own employees and providers. Beyond revealing essential insights, this practice can facilitate co-design and increase connection, engagement, and loyalty in the process. Topic-wise, the major focus in 2023 was on defining journeys and gaps in experience writ large as a precursor to taking action. In addition to the focal points summarized in this table, we conducted studies on consumer personas, loyalty, employee feedback, advertising evaluation, and educational content.

Trend 02

The hot topics for crowdsourcing and co-design are even more relevant in markets that are seeing an influx of retail clinics, which have multiplied in recent years as consumers indicate increasing openness to the concept. While uptake moderated a bit in 2023, growth will continue as high-profile retailers make investments and inroads (e.g., Amazon Clinic now supports video visits nationwide). Health systems need to be aware of these new access points in their communities and choose a path forward. Whether the ideal strategy is competition, collaboration, or co-opetition, retail care has to factor into the strategic vision for many health organizations.

Trend 03

Even as new entrants in the market expand healthcare choices, consumer preference for health systems has rebounded after a pandemic-associated dip. The dissonance of the pandemic made it easy to push healthcare needs to the back of the mind, but as the fog clears, consumers are reconnecting their future needs to healthcare brands that can fulfill them.

The uptick in preference, coupled with an increase in Net Promotor Score (NPS) at the facility level, are positive signs, but a third of consumers do not espouse any preference for a health system. While there is room to grow brand preference, meaningful growth will require a different approach – one that recognizes and respects the fact that more than 98% of most people’s waking hours are spent outside of the care setting. To build brand preference, health systems must make themselves relevant in the context of everyday life, taking a page from the retail and tech entrants. Moreover, to convert preference into presence and ultimately into loyalty, healthcare organizations should understand and address needs including access, care, follow-up, and payment.

Trend 04

As preferences tick upward, professed loyalty continues to rise. NRC Health’s Market Insights study scans for what drives loyalty to a healthcare brand. The top 3 factors might not be a surprise: insurance coverage, previous experience – the key to building trust over time – and convenient location are all drivers of loyalty for half of consumers. But doctor recommendations have been steadily rising to the key-driver echelon. This makes sense because – as noted in our nSight on Turbulence, Trust, and Loyalty – while trust in organizations has increased over the past decade, consumers still place more trust in doctors and nurses than in healthcare facilities. The #1 predictor of loyalty at the provider level? Human Understanding.

Trend 05

As the pandemic recedes, the question of how to establish preference and build loyalty remains, especially as navigating healthcare markets becomes increasingly complex. Two trends worth keeping in mind fall squarely in the digital space: (1) the proportion of consumers who say they are likely to use a mobile device to access healthcare information has increased dramatically over the years; and (2) the percentage of people who report that they visit hospital websites is on the rise.

The implication is clear: An inviting digital front door – with useful content and a smooth user experience for those who enter – is a potential differentiator. In fact, when we look at what consumers say separates one hospital or health system from another, two factors with the most upward momentum are online scheduling and an easy-to-understand bill-paying process. And our data shows that ‘find a doctor’ and ‘find a specialty or service line’ are two of the main uses for health-organization websites. All together, these findings paint a compelling picture: an increasing number of consumers will demand a strong digital presence that makes their entire journey easier. Human-centered design can improve both the process and outcome of interactions within both physical and digital spaces.

In 2023, we released nSights on topics ranging from moving the HCAHPS needle to mental/behavioral health to billing and payment to AI in healthcare. The 2024 Experience Perspective covers even more ground, but sends a clear message: Elevating experience requires thinking differently and taking decisive action. The idea that innovation starts with the fundamentals is a great place to start: Taking a One Big Dot approach changes the frame with meaning and purpose. Advancing Human Understanding with a connect-listen-partner focus has clear benefits. Getting strategic about accountability is the key to productive follow-through, and amplifying consumer and community voices gets us closer to meeting the needs of those we serve. Better understanding Detractors – minding the gap – should help us miss the mark less often and change the trajectory when we do. And the trends we’ve highlighted all reinforce the need to pay close attention to what matters so we can anticipate and meet real-world needs. Human Understanding is the line of continuity that runs through every aspect of experience for all involved. Because healthcare is human care.