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.

Stay up to the minute.

WWBR Week of October 13, 2014

Reference Pricing: A Small Piece of the Health Care Price and Quality Puzzle
Chapin White and Megan Eguchi for The National Institute for Healthcare Reform
“Researchers who examined applying reference pricing to ~530k workers in 19 metropolitan markets in the Midwest in 2011 estimated potential savings of only 5 percent of total healthcare spending. Study authors noted that reference pricing is limited as a cost control tool because shoppable services only account for about a third of total healthcare spending, and it only affects prices at the high end of the spectrum, according to the study. It also potentially leaves patients vulnerable to significant cost sharing, which makes health benefit designs even more complex.” – Matt

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Rafael Grossman blog post
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Abigail Zuger for The New York Times
“The limits to automation are highlighted in this article that describes the mismatch between actual clinical practice and EHR-driven workflow. The comments from physicians also speak loudly about how generating billing codes trumps basic patient care and impedes care coordination. This familiar characterization of EHRs points to the opportunities for change in HIT.” – Brian

Taking Digital Health to the Next Level (PDF link)
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“Commonwealth Fund issues a new report around major barriers to adoption of new digital tools by the delivery system. While this is a good high level read for the uninitiated, it is somewhat lacking in new insights, particularly around operationalizing innovation – workflows, reimbursements, promoting adoption by patients, etc.” – Naveen

The Influential Big Three: Credit Rating Agency Forecasts
Kevin Laidlaw for Lancaster Pollard
“An analysis by Lancaster Pollard noted that 5 financial trends stand out regarding the hospital sector regarding recent reports from the three main credit rating agencies – Fitch Ratings, Standard & Poor’s and Moody’s Investors Services through the early part of 2014. These trends include:

  • Downgrades are outpacing upgrades across the board
  • Revenue growth has hit a record low
  • Expenses are growing faster than revenues
  • Strong liquidity metrics have partly compensated for negative profitability”
  • Mergers and acquisitions are driving up ratings, despite financial pressures in the sector.”


Google Is Testing A ‘Talk With A Doctor’ Feature Within Medical Search Results
Amit Chowdhry for Forbes
“When Google launched its ‘helpouts’ service – a video hangout session built around specific expertise sharing, health oriented use cases were a clear goal. Now, Google has launched an official beta built around providing medical consultations (initially with doctors from Scripps and OneMedical) for people who are searching for specific symptoms. Given their footprint on web and mobile search, this has the ability to be a game changer. Our big question of course is, what happens to the data generated during the course of an online consultation?” – Naveen