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The patient as consumer: a shift in perspective to better measure success

By Steve Jackson, President, NRC Health. This article is also featured on Becker’s Hospital Review.

“What gets measured gets managed.” Peter Drucker’s famous quip has become a business-school mantra. And for better and worse, it certainly applies in healthcare.

Since 1995, when the Center for Medicare and Medicaid Services (CMS) began requiring healthcare organizations to administer Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, hospitals have measured—and managed—their patient experiences impeccably. Patients’ satisfaction with their care episodes has increased by 10% since 2008.

That’s the good news. However, the inverse of Drucker’s dictum is also true: what does not get measured gets missed. All too often, what goes missing in healthcare’s view of its patients is their well time—which, for most, is the majority of their lives. So while organizations have shown a laudable commitment to improving the care encounter, that relentless focus has pushed other interactions to the margins. In a hyper-competitive healthcare landscape with non-traditional, more consumer-centric entrants, that approach is no longer sustainable.

The high cost of a short-term perspective

Much of the problem begins with traditional patient-feedback practices. Broadly speaking, healthcare feedback collection tends to center on discrete episodes of care. These episodes can be many months, or even years, apart. As a result, the collection of patient data is inherently sporadic, siloed, and confined to the short term.

Patient relationships with healthcare brands, however, are long and continuous. Many factors contribute to a patient’s trust in an institution, and not all of them are encapsulated by a given care episode.

The end result is that, while organizations understand very well how patients feel about their care experiences, they don’t necessarily understand the patients themselves. Nearly half of provider organizations, in fact, report an inadequate understanding of a patient’s journey of care.[1]

One major consequence of this short-termism is that health systems’ hold on their customers is more delicate than ever. Hospitals find themselves unable to build enduring relationships with their customers. Seven percent of consumers are willing to switch providers after just one bad care experience;[2] 80% of them will switch providers for “convenience factors” alone.[3]

These factors include the ease of booking an appointment, duration of wait times, and the amount of friction experienced in billing and collection. Many health systems miss opportunities to improve these parallel aspects of their operations, often because they’ve narrowed their efforts to what happens in the exam room. That may explain why many hospitals tend to disappoint on issues of ease, access and convenience.

These shortcomings annoy patients, but they delight one of the conventional hospital’s major competitors: the retail clinic. Non-traditional providers have made an art of satisfying where traditional health systems fall short, mostly by emphasizing convenience and ease: 55.9% of patients, in fact, report that they visit retail clinics because, compared with traditional providers, it’s so much easier to get an appointment there.[4]

Perhaps that’s why retail clinics have seen an astonishing 500% growth rate since 2006.[5] Today, a full 30% of patients have turned to them for care.[6] Their ascendancy shows no signs of slowing, as these upstart organizations continue to innovate and aggressively expand.

What health organizations should do

Those growth rates look ominous, but traditional healthcare leadership is far from helpless. There are a number of strategies they can deploy to bring consumerism back into their culture, and thereby win loyalty from customers and position themselves effectively against the competition.

1) Build loyalty where it starts—in the community.

As mentioned above, much of the patient’s trust is earned through a health brand’s engagement with the broader community. A good place to start is with Community Health Needs Assessments.

In 2010, the Affordable Care Act mandated that nonprofit hospitals create, and publicly post, Community Health Needs Assessments (CHNAs) every three years. Many healthcare organizations view these as an onerous requirement—but they shouldn’t. CHNAs actually present some important opportunities.

The data collected for CHNAs, for instance, expands well beyond simple quantitative measures. As they work to create their CHNAs, hospitals enter into a rare dialogue with their community members, giving them a voice in how the hospital operates.[7] If healthcare organizations manage these conversations with tact and sincerity, they’ll create many meaningful connections with potential patients.

CHNAs can also be used to spur ideas for organizational partnerships.[8] A CHNA can guide hospital leadership to the community’s most urgent public-health challenges, and will reveal which organizations are best equipped to solve them. Partnering with charities that prevent homelessness is one common result of this kind of analysis.

That charitable work hints at another strategy health organizations should pursue: project expertise and compassion from their staff.

Hospitals rightfully take pride in their clinical staff; they’re likely some of the most highly trained workers in any community. Bringing visibility to these staff members will generate significant goodwill for healthcare organizations.

Providing time off for nurses and physicians to participate in volunteer efforts, for example, gives them an opportunity to show their work to outside community members. Clinician ambassador programs can reinforce a health brand’s compassion. And creating educational events can build up a healthcare organization’s authority for specific conditions or lines of service.

Another way to bolster a hospital’s community standing is to build healthy relationships with local journalists.

Executive leadership can be exceedingly useful in this area. By being forthright, respectful ambassadors of their organization’s brand, they can help inform reporters’ perspectives. Candid, open conversations with journalists can contribute to even-handed coverage of a hospital’s initiatives, successes and shortcomings—coverage that, in the long run, will earn good faith from the public.

2) Measure what matters.

Good data is the foundation for strong health-system management. Compromised data quality, insufficient sample sizes or irrelevant statistical “noise” can undermine the efforts of even the most earnest healthcare leaders. They simply won’t know where to direct their attention.

Start with strong data collection. As explored above, many health systems rely on CAHPS or other mail-in surveys to learn what patients think about their care experiences. The problem is, most customers prefer not to offer their feedback by mail. As a result, these surveys usually see depressed response rates, hovering around just 29% per year—a number made even more troubling when you consider that only a sample of the patient poplutation receives these surveys in the first place. These low numbers then contribute to statistical uncertainty, which might make clinicians view the feedback as unreliable.

Updating survey modalities is a relatively simple step that healthcare organizations can take to resolve the issue. Modern, digital-facing real-time feedback platforms reflect what patients want to see. When well deployed, they multiply quarterly response rates by four.[9]

However, a surfeit of data won’t do much good without robust analysis. Fortunately, AI-powered tools can automate much of the analytic legwork. Natural language processing, for instance, is a subset of linguistic analysis that assays patient comments for meaningful sentiment trends. The technology has advanced to the degree that it can distinguish nuanced layers of opinion in feedback.[10] This enables healthcare systems to process enormous volumes of open-ended comments and field specific areas of concern for patients.

Taken together, these best practices in data collection and analysis give leaders the best possible means to understand their customers’ thoughts and determine next-best actions. Organizations should adopt them as soon as possible.

3) Make consumerism the priority.

Finally, for these changes to succeed, leadership must recognize that they are not ordinary initiatives. It won’t be as simple as adding a few items to a to-do list. Rather, organizations will need to take an integrative perspective, creating a unified, holistic and longitudinal vision of their customers and their needs.

The relentless pursuit of clinical excellence, while a worthy goal, may have obscured this vision for many healthcare leaders. It has forced consumerism, and its attendant demands, to the bottom of institutional priorities. Future patient loyalty will hinge on whether or not organizations succeed in bringing it to the foreground.

That means a cultural shift as much as an operational one. Organizations need to embrace the fact that in this industry, as in so many others, the most consumer-centric organizations are the ones that will continue to thrive—and that this consumer-centricity begins with a clear-eyed understanding of what consumers want.

[1] Becker’s Editors. “Patients and Providers Don’t See Eye-to-Eye on Patient Experience: 6 Survey Findings.” Becker’s Hospital Review. February 25, 2016. Accessed June 2, 2018, at https://www.beckershospitalreview.com/quality/patients-and-providers-don-t-see-eye-to-eye-on-patient-experience-6-survey-findings.html.

[2] NRC Health. “Healthcare CMOs: What Can You Do About These Common Problems?” Accessed May 30, 2018, at https://nrchealth.com/healthcare-cmos-can-common-problems/.

[3] NRC Health. “Effortless Care Experiences” https://nrchealth.com/wp-content/uploads/2018/06/Effortless-Healthcare-White-Paper.pdf.

[4] Kaplan, Gary, Marianne Hamilton Lopez, J. Michael McGinnis, Committee on Optimizing Scheduling in Health Care and Institute of Medicine. “Issues in Access, Scheduling and Wait Times.” National Academies Press (US). 2015. Accessed June 2, 2018, at https://www.ncbi.nlm.nih.gov/books/NBK316141/.

[5] Burkle, C. M. “The Advance of the Retail Health Clinic Market: The Liability Risk Physicians May Potentially Face When Supervising or Collaborating with Other Professionals.” Mayo Clinic Proceedings, 86(11), 1086–1091. 2011. Accessed at https://doi.org/10.4065/mcp.2011.0291.

[6] NRC Health. “2016 US Healthcare Statistics Data By State and Demographics.” Accessed May 30, 2018, at https://nrchealth.com/2016-us-health-care-statistics-data-state-demographics/.

[7] Stein, Lauren. “Using Community Health Needs Assessments to Promote Health Equity.” Harder+Company Community Research. 2016. Accessed June 4, 2018, at https://harderco.com/using-community-health-needs-assessments-promote-health-equity/.

[8] Heath, Sara. “How to Create, Conduct Community Health Needs Assessments.” PatientEngagementHIT. 2017. Accessed June 4, 2018, at https://patientengagementhit.com/news/how-to-create-and-conduct-community-health-needs-assessments.

[9] NRC Health. “What Can You Learn When You Go beyond HCAHPS?” 2017. Accessed at https://nrchealth.com/can-learn-go-beyond-hcahps/.

[10] Doing-Harris, Kristina, Danielle L. Mowery, Chrissy Daniels, Wendy W. Chapman and Mike Conway. “Understanding Patient Satisfaction with Received Healthcare Services: A Natural Language Processing Approach.” AMIA Annual Symposium Proceedings 2016: 524–533.