Healthcare Experience Blog

Your Hospital’s Toughest Customer May NOT be a Patient!

With all the attention given to the “patient experience” during the past five years, many hospital managers and staff have rightly turned their attention toward doing a better job of caring for the patient, in all senses of that word.

But a piece of research we recently conducted makes a pretty convincing case that the toughest consumer to satisfy may not be the patient, but the loved one who is there to assist and support the patient.  This loved one can be, and usually is, a close family member such as a spouse or adult child.  But it can also be a personal friend, especially if family members live far away.

Our research, conducted for Amplion Clinical Communications, was designed to determine how many patients and their loved ones have a positive vs. negative experience when it comes to nursing staff responsiveness and communication.

The results were startling to me.

Loved ones, overall, were much more critical of the nursing staff and their ability to respond to patient needs than were the patients themselves.  Loved ones were much more likely to express negative feelings about the patient stay, often using adjectives including “frustrated,” “anxious,” or “angry.”  And relative to patients, loved ones were less enthusiastic when it came to evaluating the overall experience and less likely to recommend the hospital.

Our study included just over 1,000 respondents, all reached via an online survey approach.  The sample was split 50/50 between patients and loved ones, so the results are statistically significant.

And do these results matter?  I’d answer with a resounding “yes” because loved ones are just as likely to tell others about the hospital as patients, perhaps even more likely to do so when the experience didn’t measure up to their expectations.  In effect, they’re raising the bar for “patient experience.”

To see a colorful infographic with highlights from this important study, click here.

What “Patient Experience” Actually Encompasses

If you ask a consumer about their experience with a doctor’s office, a hospital, or an outpatient surgery center, you’ll usually get an earful.

Of course, they may comment on the ease of parking, the length of their wait, and courtesy of the various staff members they encounter; which health providers often categorize as the service elements of an experience.  They may also talk about the level of caring or empathy they felt (“Ms. Roberts really seemed to understand what I was going through!”)  Together, these components have often been viewed as the essence of “patient experience.”

But I believe the consumer’s working definition of “patient experience” is and should be much broader.

Healthcare customers like you and me are also likely to comment in ways that reveal their feelings about the “quality” and “safety” associated with their visit, even if they don’t use those terms as such.  When they see nurses wash their hands before touching them, or when they see techs wearing gloves and removing an instrument from a sealed wrapper, consumers tend to take these as positive quality and safety cues.  When a room is dirty, a piece of equipment doesn’t work properly, or the doctor does not wash his hands, consumers often take note.  Consciously or subconsciously, they wonder about quality and safety.  No one wants to leave the doctor’s office, surgery suite, or diagnostic center less healthy than when they arrived; yet this does happen.

So, moving forward, when we talk about “patient” or “member” experience, I believe we need to think of “experience” as encompassing the related concepts of Quality, Safety, and Service/Caring.

Isn’t that what we do when we evaluate or talk about other types of services in our life, whether getting our car repaired, staying in a hotel, or taking an airline trip?

I’m waiting to see which health system will bring these roles into a more customer-centric alignment by appointing a c-level person to oversee all of three of these functions, which today are mostly divided into three separate silos, with a separate executive for each.

That will be a big step towards being better able to assess and deliver true VALUE, which is where healthcare delivery and financing is headed in the U.S.

Of course, to talk about value, we need to find out how consumers feel about their outcome (Did they get better? Was the procedure successful?).  Plus we need to learn their assessment of the cost, broadly defined to include the actual out-of-pocket cost plus the hassles associated with getting the service and getting it paid for.  Economists have traditionally defined “value” as the benefits delivered versus the costs associated with obtaining those benefits.  This applies in healthcare today.

It’s why buying a $26,000 Subaru Outback represents good value to one consumer, while buying a $75,000 BMW represents good value to another.  It’s also why we may be willing to pay more for our flu shot at the neighborhood urgent care center rather than dealing with the drive and hassles associated with going to our doctor’s office.

As consumers, we do a “value” calculation in our heads, as we anticipate and then make a purchase.  This month, will you buy your toilet paper at Costco, or just make it part of shopping at your neighborhood grocery or drug store?  What about your winter coat: at REI or Walmart?  What about your flu shot?  What about the treatment for a diagnosis of cancer?

In all other spheres of our life, this economic “reckoning” takes into account the expected outcome, experience, and cost…based on what have experienced before, what friends or others tell us, or what we’ve learned through ads or search.


Every day we Americans gain more choices about where to go for healthcare services whether a simple blood test or open heart surgery, AND we bear more of the total cost for these.  So increasingly, and as our proprietary research over the past 10 years indicates, we are acting more like a “typical” consumer in making healthcare choices.

Our 2015 research study on Patient Experience for The Beryl Institute confirms that healthcare leaders believe that a better experience contributes to better outcomes.  And that perceptions about the experience are now a major component in making the decision on where to go for services.

So the next time you query a family member about their recent interaction with a health provider or service, pay close attention.  It’s likely they are already talking in terms of VALUE and EXPERIENCE, where they consider all of these elements—outcome, quality, safety, service/caring, and cost—as part of their total assessment.

Maybe It’s Time to Quit Calling it “Obamacare”

With the Supreme Court ruling 6-3 to uphold a key pillar of the Affordable Care Act, it’s time to accept that this law is the law.  Instead of blaming (or crediting) President Obama with this law and labeling it “Obamacare,” let’s move on.  It’s the ACA, and it’s the official way we’re moving forward.

This law, which was passed by both the Senate and the House, determines how many millions of Americans will obtain some level of health insurance coverage, and its provisions establish the parameters for how much they will pay for this coverage.

You could argue that there’s still plenty of blame to go around for the way the bill was actually written, revised, and never adequately reconciled between the Senate and the House… The bill itself is complex, lengthy, and murky. However flawed, the ACA definitively establishes a framework—now twice upheld by the Supreme Court—that sets the rules and precedent for Payers and Providers.

All parties are starting to figure out how to live with and within the law. Consumers are navigating the ACA website or as is often the case, finding assistance to do so; either way, more Americans are seeking and obtaining coverage. Payers are adjusting their rates as they gain experience about the mix of people who sign up while they continue to analyze what medical services are most in demand.  And providers are now factoring this new reality into their planning and budgeting.

With lots of trade-offs and compromises, the major parties in the healthcare industry ended up supporting the bill; most heaved a sigh of relief that the Supreme Court ruled as it did.

ACA Here to Stay

All in all, we’re moving on—and that’s a good thing.

Now is the time to improve this program to reflect the needs of patients AND highlight the capabilities of America’s robust healthcare system. With patients, providers and suppliers alike asking “what does this mean for me?” we have a few suggestions:

To reduce the level of confusion among the choices, payers could reduce the number of plans they choose to offer.  To help consumers make better choices, providers can continue to offer new buying channels—such  as retail locations and mobile vans—to complement what’s available through their websites and call centers.  And to reach underserved groups, networks can participate even more actively with community-based organizations and events.

It’s been rewarding for us to be involved in conducting research with various types of consumers who are eligible for coverage under the law and to help our clients understand how to better devise and communicate their offerings.  Understandably, many consumers are still confused by the complexity of sorting through the choices, but they are gaining experience and are becoming more informed buyers. At the same time, providers are becoming more nimble at delivering value-based care in the  new environment.

The ACA has been validated.  Let’s honor it: let’s get to work.



Health insurance companies struggle to achieve trust with hospital execs

Trust is a fragile commodity, yet the need for it may never be greater. As the shift from volume to value-based payments accelerates, providers and payers are working more closely together than ever negotiating ACOs, Pay for Quality, and Bundled Payments. Trust underlies these contracts, which is why asking about it is the central theme of our annual survey done collaboration with ReviveHealth.

Using a Trust Index we developed based on relevant academic literature on the topic, hospital executives reported on the amount of behavioral reliability, honesty, and fairness they experience with the nation’s largest health insurance companies.

Now in its 9th year, this research shows that overall the level of trust between payers and providers remains low. Some payers are seen as more trustworthy than others—with Cigna scoring the best marks multiple years in a row and UnitedHealthcare the worst.

But all the major payers included in this year’s study have relatively low scores, and the scores have not materially changed year over year, except in one case, where Anthem saw a big dip.

Those are three major findings from our just-released 2015 National Payor Study, conducted jointly by ReviveHealth and Catalyst Healthcare Research.

The survey was conducted using both online and telephone methods, and included just over 200 participants. Respondents were executives with US hospital and health systems, particularly those who negotiate and handle contracts with payer organizations. The survey conducted in 2014 had a similar sample size.

To view a brief PowerPoint deck showing the results for this year and how they compare to last year’s please click here.

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