Patient Experience and Satisfaction Aren’t the Same as Engagement

Healthcare’s inexorable march toward value-based care has brought with it a focus on what’s best for the patient. Instead of routinely pushing people from one billable appointment to another, providers of all types are, to varying degrees, beginning to understand that more care doesn’t necessarily equal better care.

This shift in policy and philosophy is certainly welcome, and long overdue, but healthcare organizations (HCOs) must be sure to push their good intentions in the right direction.

hospital waiting roomTake, for instance, the hospital waiting room. The longtime dumping ground of year-old magazines, well-worn chairs, and grainy television sets has been transformed into a bright, comfortable, and almost welcoming place. Swanky waiting rooms have spread throughout the hospital, too; patients can sit in comfort as they await exams or consultations in various internal departments.

You’d have a hard time finding anyone who prefers the older, dingier waiting rooms. But the esoteric improvements mask a more fundamental issue: HCOs are focusing too much attention on patient experience and satisfaction, trying to compete with hotels, and not enough on honest-to-goodness engagement. Instead of spending so much time, money, and resources on making waiting comfortable, hospitals should address why patients are waiting.

The rationale for this misplaced focus isn’t hard to find. In a world of quality metrics, HCAHPS scores, and innumerable “top hospital” rankings, the need and desire to improve experience and satisfaction is certainly understandable. However, a good waiting experience isn’t the same as a good care experience – or, for that matter, a good understanding of how to make the right decisions to improve health and well-being and spend less time waiting to receive care in the first place.

Nice waiting rooms are, well, nice, but they remain a holdover of the fee-for-service world. Think about your auto mechanic. The free Wi-Fi, fresh coffee, and clean bathrooms aren’t there to entice you to leave; they entice you to come back (and spend money) the next time your engine starts making funny noises. If anything, a posh waiting room is a form of revenue cycle management (RCM), since it’s all about bringing repeat customers through the door.

Waiting rooms don’t improve engagement. That’s why Geisinger Health System CEO Dr. David Feinberg wants to “eliminate the waiting room and everything it represents,” namely a way to build up inventory for doctors at the expense of the patient. The larger issue is that value-based, coordinated care will only succeed when patients are truly engaged in their care. Admittedly, this is a struggle.

As it is, HCOs have enough trouble improving the patient experience, according to a recent Kaufman Hall survey. They know they need to do something, but they say they lack the “strategic insight” to figure out what it is, not to mention the capability to implement such a strategy. This survey did not ask if they had had the capability to upgrade their waiting rooms, but I’m willing to bet they did.

Engagement itself is another giant step forward. It’s hard to fund (big-money donors prefer to see their names on a building instead of, say, an app or program) and even harder to implement (the n=1 strategy of precision medicine means that interventions must be specifically tailored to vastly different patient population segments). Plus, engagement technology must link to a larger value-based technology strategy, which itself requires a shift away from the point solutions so prevalent in healthcare and toward solutions that meet specific clinical or operational requirements within healthcare’s new value chain. Most HCOs lack “strategic insight” into what this entails, too.

Whatever the future holds for value-based care, insurance reform, electronic health records, the private practice, the standalone hospital, or the industry as we know it today, the chief goal of practicing healthcare will remain constant: Keeping patients as healthy as possible for as long as possible so they get as much out of their lives as possible. To that end, HCOs would be wise to not keep patients waiting.

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3 comments on “Patient Experience and Satisfaction Aren’t the Same as Engagement
  1. Brian Eastwood says:

    Intermountain Healthcare recently published a blog post suggesting that the patient *experience* is really the sum of the parts of various types of patient *engagement* — one of which is the technology component escribed in this post. It’s a different take on this topic, and one worth reading.

  2. Ramesh Jain says:

    I loved: “Keeping patients as healthy as possible for as long as possible so they get as much out of their lives as possible”. But what are people doing for this.

    • Brian Eastwood says:

      Ramesh, you raise an interesting question, and it’s not one with an easy answer. At its core, though, I think it’s all about two things. The first is improving care coordination, so that the various physicians, nurses, and specialists who see a particular patient are all on the same page and can provide a cohesive care plan, as opposed to the fragmented care plans that end up providing patients with disjointed or even contradictory information. The second is engaging with and educating patients to the point that they become activated and then empowered participants, meaning that they are much responsible and active participants in the care process as opposed to passive recipients of care. Many types of technology solutions can augment these processes — virtual visits, patient portals, condition management apps, remote monitoring devices, nutrition / weight management programs, and so on — but at its core I think it’s a matter of listening to patients, understanding what they need as well as what they value, and working alongside them to develop a care plan that takes into account their needs and values while also addressing their underlying medical diagnoses. It’s a tall order, I know, but I believe that there are plenty of men and women in healthcare who want to make it happen.

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