Patients - Not Your Typical Customer

“We’re shifting to an experience economy, where experiences are becoming the predominant economic offering.”

Nowadays, newlyweds create registry lists with hotels and airlines rather than with retailers such as Bed, Bath, and Beyond, opting to fill their passports rather than their cupboards.(1) Over 15 years ago, Joe Pine, a management advisor to Fortune 500 companies and start-ups, predicted this major shift in consumer attitudes.  In his book, The Experience Economy, Pine explains how customers reward companies who design authentic experiences around their service offerings.  In the TED Talk, What Consumers Want, Pine asks, “What happens when you design a service that is so appropriate for a particular person?...You can’t help but make them go ‘wow’…we’re shifting to an experience economy, where experiences are becoming the predominant economic offering.”(2)

Pine uses a $4 cup of Starbucks coffee as the premier example for this growing trend.  Starbucks is recognized as a leader in the branded experience business.  The company has managed to differentiate itself in an extremely competitive market, an amazing feat considering that they don’t even advertise.  Much of the company’s success can be attributed to the visionary leadership of CEO Howard Schutz, coupled with the branding genius of Stanley Hainsworth.  In an interview with Debbie Millman for her book Brand Thinking and Other Noble Pursuits, Hainsworth explains how he defines brand and the most important aspects to consider when creating a brand.  Hainsworth explains, “Consumers emotionally connect with brands when the brands repeatedly provide something that the consumer wants, desires, or needs…it’s all about having a story to tell. This is what will enable you to create an experience around the brand…Examine every touchpoint and look at how you can tell one clear, consistent story.”(3)

Successful brands such as Starbucks, Nike, Apple, and Disney make you feel like part of an exclusive club, and gaining access is relatively easy.  Ordering a Starbucks coffee may be awkward at first (one small coffee with skim milk, um, I mean one tall espresso, skinny.  Wait, how much!?) but this attention to every detail including language, employee titles and uniforms, product design, packaging, store design, even how the toilet paper is folded in the bathroom, leads to brands with irresistible appeal.

“…It’s very hard for the average patient to judge the quality of the ‘product’ on the basis of direct evidence.”

The branded experience is fully entrenched in our culture and many people wonder why healthcare lags so far behind.  All too often, a patient’s personal experience fails to align with the healthcare experience promised in slick marketing campaigns.  Pine cautions that this is one of the worst mistakes a company can make.  He explains, “…The easiest mistake that companies make is that they advertise things that they are not…the number one thing to do when it comes to being what you say you are, is to provide places for people to experience who you are.”(4)

Books such as If Disney Ran Your Hospital (5) and articles like Why Isn’t Health Care More Like Starbucks? (6); The Doctor’s Office Of The Future: Coffeeshop, Apple Store, and Fitness Center (7); and Is This a Hospital or a Hotel? (8) demonstrate the growing demand for better healthcare experiences and the higher expectations of consumers.

The products, services, and experiences offered by most retailers are easy for consumers to evaluate.  You may not fully understand the underlying technology of an iPhone, but it is the retailer’s responsibility to present options in a clear and convincing way.  Consumers hold the purchasing power and determine if the need or desire for a particular product is worth the price.

Healthcare services on the other hand are very difficult for people to evaluate, and often healthcare providers seem to hold all the power, especially since the patient is in a compromised state due to illness or injury.  As anxious patients try and gauge quality, they often focus on aspects of the experience that they can easily understand such as a compassionate nurse or a clean bathroom.  In the article, Clueing in Customers, service expert, Leonard Berry, advises health organizations to more carefully consider all the environmental clues that factor into a customer experience especially since the product is so difficult to judge.  He explains, 

“…It’s very hard for the average patient to judge the quality of the ‘product’ on the basis of direct evidence.  You can’t try it on, you can’t return it if you don’t like it, and you need an advanced degree to understand it – yet it is vitally important.  And so, when we’re considering a doctor or a medical facility, most of us unconsciously turn detective, looking for competence, caring, and integrity – processing what we can see and understand to decipher what we cannot.”(9)

Often it is the most tangible aspects of the environment such as parking, nursing service, housekeeping, and food service that leave a lasting impression and influence a patron to recommend the facility to family and friends.  In fact, studies suggest that many people choose a hospital based on the amenities provided rather than for its clinical reputation.  A recent article in the New England Journal of Medicine found that “patients themselves said that the nonclinical experience is twice as important as the clinical reputation in making hospital choices.”(10)

Psychologist, Kathy Torpie argues that the recent preoccupation with hospitals investing in hotel-like amenities stems from the misguided assumption that patients should be thought of as traditional customers.  In the article, Customer service vs. Patient care, Torpie writes, “‘Customers’ are generally well people who enjoy elevated status by virtue of their potential to purchase goods or services. Patients, on the other hand, are (by current definition), not well. Their status is greatly reduced by illness or injury that renders them vulnerable, frightened, often in pain, medicated, exhausted and confused. In spite of these limiting factors, patients sometimes have to make important, often complex, decisions in a short time frame.  The ‘goods’ they are purchasing are a return to health and the ‘services’ they seek often require an unspeakable level of trust in their ‘service provider’.”(11) 

Unlike retail experiences, even those from Apple and Starbucks, healthcare experiences are always memorable.  Across the entire spectrum of care, from the routine blood draw all the way to the life-saving operation, the act of receiving medical care is incredibly personal.  As we cope with our own vulnerability and entrust our health and wellbeing to our care team, we experience a range of emotions.  Under such stressful circumstances, patients have very basic needs.  According to Press Ganey, “patients want to feel as if they are the most important people on the staff’s mind.  They want to be kept informed, talked to (not at) and to be active participants in their own treatment.”(12)

But all too often these fundamental needs are not met and patients are left “waiting for an unknown person, to do an unknown thing, at an unknown time,” says Mary Malone, President of Malone Advisory.  Torpie believes that outstanding healthcare experiences, or therapeutic relationships, result when the emotional needs of the patient have been met.  She explains,  “A therapeutic relationship focuses on care for an individual more than on service to a customer. It requires connection, respect and compassion…The clinical, interpersonal and communication skills necessary to ensure that the patient is safe, comfortable, cared for and included in treatment planning are what generates not only patient satisfaction, but gratitude.”(13)

The best brands tap into our emotions and build a loyal following of customers.  Purchasing their products and services feels good.  Rarely, though, do these experiences make us feel grateful.  But ask anyone who has had a truly outstanding healthcare experience such as a successful surgery, the birth of a baby, and even under less desirable circumstances such as making a loved one comfortable at the end of their life, and people speak passionately about the people who cared for them and how indebted they feel to them.  Healthcare organizations recognized for their compassionate, inclusive, and empowering patient-centered experiences rarely need any marketing campaigns at all.

“If you could stand in someone else’s shoes. Feel what they feel. Would you treat them differently?”

Cleveland Clinic is recognized as a leader in the patient experience movement.  Many institutions look to Cleveland Clinic for inspiration and their annual Patient Experience: Empathy & Innovation Summit grows larger each year.  Since 1975, Dr. Toby Cosgrove has served as Cleveland Clinic’s President and CEO and he has greatly influenced the patient experience movement.  For his annual State of the Clinic address, Cosgrove shared the video Empathy with the Cleveland Clinic staff.  The powerful video reveals the personal thoughts and feelings of people healing and working within the hospital.  The video concludes by asking, “If you could stand in someone else’s shoes.  Hear what they hear.  See what they see.  Feel what they feel.  Would you treat them differently?”(14) Since published in 2013, the video has received over 2.5 million views on YouTube.

In an interview, Cosgrove admits that Cleveland Clinic was once an organization that provided exceptional clinical care, but too often failed to meet patients’ emotional needs.  He discusses candidly how his perspective on patient care has shifted over the course of his career.  He describes a pivotal moment, when as a guest lecturer at Harvard Business School, a student asked him, “Dr. Cosgrove do you teach empathy?”  The question left Cosgrove speechless and caused him to reflect, “…as a resident, we used to lose about 20% of our patients…Death was the enemy, and I spent all of my time concentrating on the technology that would reduce the mortality of cardiac surgery…It used to be that if a patient survived, they were incredibly thankful…Currently, people expect to survive, but they also expect someone who is going to be there with them to help them through a traumatic experience...”(15)

Cosgrove is not the first doctor to be criticized for treating the disease, rather than the person.  Western medicine fights illnesses first with state-of-the-art technology, and this influences medical training, treatment, and the design of hospitals.  In the 1970s, healthcare design was called institutional design, and medical equipment and its required supportive infrastructure greatly influenced the planning and design of healthcare facilities.  Technological and scientific advances had begun to overshadow the most basic needs of patients and many people began to voice their concerns.

A series of negative hospital experiences inspired Angelica Thieriot to imagine a more holistic model of care.  In 1978, she founded the organization Planetree in an effort to humanize the healthcare experience. (16)  Other leaders in the patient-centered care movement included Harvey and Jean Picker.  In 1986, they formed the Picker Institute to advocate for the concerns and comforts of patients. (17)  Today, the Institute for Patient and Family-centered Care continues to carry out the Picker’s vision promoting the core concepts of dignity and respect, information sharing, participation, and collaboration.(18)

In 1985, Dr. Irwin Press and Dr. Rod Ganey developed a survey to measure patient satisfaction as a means to improve performance.  Today, Press-Ganey partners with more than 26,000 health care organizations in their efforts to measure and improve patient satisfaction.(19) 

In 2002, The Centers for Medicare & Medicaid Services (CMS) developed the first national, standardized, and publicly reported patient satisfaction survey.   The resulting HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems or “H-caps”) Survey collects feedback from recently discharged patients about aspects of their hospital experience including: Nurse Communication; Doctor Communication; Responsiveness of Hospital Staff; Pain Management; Communication About Medicines; Discharge Information; Cleanliness and Quietness of Hospital Environment; Overall Rating of Hospital; and Willingness to Recommend Hospital.(20)

Beginning in 2007, CMS reimbursements became contingent on the collection and publicly reporting of HCAHPS data.  The Hospital Compare website allows the public to search for a hospital by name or location and compare satisfaction scores against competitors and the national average.  Recently, CMS has added Star Ratings to the website to help consumers digest survey results more quickly and highlight facilities who demonstrate excellence.(21) This greater transparency and the financial implications have greatly motivated healthcare systems to devote more time and resources to improving the patient experience.

Since 2011, the Beryl Institute has published a biennial report on the state of the patient experience.  The 2015 installment shares results from an on-line survey consisting of approximately 60 questions designed to gain a better understanding of what health care organizations are doing to “improve the Patient or Resident Experience across the continuum of care.”(22)   Over 1500 individuals responded to the survey, representing 48 states and 20 countries.  The study found that although structures for addressing patient experience are now common, many health organizations have yet to clearly define it.  For example, while 83% of U.S. hospitals have a formal structure for addressing patient experience, only 47% have a formal definition and 58% have a formal mandate or mission.  The study found that 63% of U.S. Hospitals employ senior patient experience leaders, such as a Chief Experience Officer (CXO), but only 38% of leaders spend 100% of their time in that role.  This means that “just shy of 4 in 10 U.S. healthcare organizations have leaders with full-time commitment to the patient experience.”  The study found a significant increase in the use of patient and family advisory committees, and respondents identified leadership and culture change as critical components to improving the patient experience.  U.S. Hospitals identified the following primary areas for investment to advance patient experience over the next three years: Staff training and developments (59%); Broader culture change efforts (44%); Patient/Family engagement via advisory council (37%); Measurement to support performance improvement (33%); Patient portals/access to records (32%); and Facility upgrades (32%).

References

  1. Rosenbloom, S. (2016, Apr. 5).  Trips Not Toasters: Wedding Registries for Travel Lovers. The New York Times. Retrieved from http://nyti.ms/25IJqGD
  2. Pine, J. (2004, Feb.). What consumers want. TED. Retrieved from https://www.ted.com/talks/joseph_pine_on_what_consumers_want?language=en
  3. Millman, D. (2011, Sep. 27). How Starbucks Transformed Coffee From A Commodity Into A $4 Splurge. Fast Company. Retrieved from http://www.fastcompany.com/1777409/how-starbucks-transformed-coffee-commodity-4-splurge
  4. Pine, J. (2004, Feb.) 
  5. Lee, F. (2004). If Disney Ran Your Hospital: 9 1/2 Things You Would Do Differently. Bozeman: Second River Healthcare.
  6. Volandes, A. (2015, Feb. 12). Why Isn’t Health Care More Like Starbucks? Forbes. Retrieved from http://www.forbes.com/sites/matthewherper/2015/02/12/the-un-starbucks-success-to-american-health-care/#3b9d35db6498
  7. Bader, S. (2013, Dec. 11). The Doctor’s Office Of The Future: Coffeeshop, Apple Store, And Fitness Center. Fast Company. Retrieved from http://www.fastcoexist.com/3023255/futurist-forum/the-doctors-office-of-the-future-coffeeshop-apple-store-and-fitness-center
  8. Rosenthal, E. (2013, Sept. 21). Is This a Hospital or a Hotel? The New York Times. Retrieved from http://www.nytimes.com/2013/09/22/sunday-review/is-this-a-hospital-or-a-hotel.html?_r=0
  9. Berry, L., & Bendapudi, N. (2003). Clueing in customers. Harvard Business Review, 81(2), 100-106.
  10. Goldman, D.P., Romley, J.A. & Vaiana, M. (2010). The Emerging Importance of Patient Amenities in Hospital Care, The New England Journal of Medicine, 363:2185-2187. doi: 10.1056/NEJMp1009501
  11. Torpie, K. (2014). Customer service vs. Patient care. Patient Experience Journal: Vol. 1: Iss. 2, Article 3.  Available at: http://pxjournal.org/journal/vol1/iss2/3
  12. Torpie, K. (2014)
  13. Torpie, K. (2014)
  14. Cleveland Clinic. Empathy: The Human Connection to Patient Care. Retrieved from https://youtu.be/cDDWvj_q-o8
  15. Cleveland Clinic. Cleveland Clinic Culture.  Retrieved from https://youtu.be/NYnu0-PKjlM
  16. Planetree. Reputation. Retrieved from http://planetree.org/reputation/
  17. Picker Institute. Principles of Patient-centered Care. Retrieved from http://cgp.pickerinstitute.org/?page_id=1319
  18. Institute for Patient- and Family-centered Care.  Retrieved from http://www.ipfcc.org/faq.html
  19. Press Ganey. Retrieved from http://www.pressganey.com/about
  20. Centers for Medicare & Medicaid Services. HCAHPS: Patients’ Perspectives of Care Survey. Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-instruments/HospitalQualityInits/HospitalHCAHPS.html
  21. Centers for Medicare & Medicaid Services. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Star Ratings. Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/Downloads/HCAHPSstarratingmethodology.pdf
  22. Wolf, J.A. (2015). State of Patient Experience 2015: A Global Perspective on the Patient Experience Movement. The Beryl Institute. Retrieved from http://www.theberylinstitute.org/?page=PXBENCHMARKING2015