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Building a high-value healthcare delivery system

Can you think of any other industry that is, or needs to be, more personalized and service-oriented than healthcare?

What is it like to be a patient?  Have you ever been one? 

Patients – the consumers of healthcare – are unlike any other group of customers because of their unique disposition with respect to the service offering. Patients are often vulnerable, confused, uncertain, and face fears about the unknown aspects of their health conditions, diagnoses, treatments and outcomes. Also, unlike a hotel or restaurant patron, or someone shopping online for a good or service, patients are frequently not engaged in willing, productive consumption. To complicate matters, other factors, such as the purchasing role of insurance, the lack of a uniform definition of quality, and the common policy presumption that healthcare is a public good, disguise the true relative worth of healthcare services and frustrate choices among offerings. 

Which of the following would you like in your doctor: excellent quality, superb bedside manner or superior communication? Should you have to choose? Why can’t you have it all, or at least a menu of options from which you can customize your experience? The fact is that customer service innovation in healthcare has not kept pace with other industries, nor has it kept pace with clinical innovation. Consider the history of service innovation among retailers such as Walmart and Amazon, or Apple and Google in their industries, and you will find that there is really no comparison – particularly in the government sector – to healthcare.  In the last century, medical advancements have produced insulin for diabetics, developed x-rays and other advanced imaging, enabled complex surgeries, including organ transplantation, and produced chemotherapy as a means of treating cancer, among other innovations. In the same timeframe, there have been only minimal advancements in measuring and comparing outcomes, and only recently has there been meaningful standardization of clinical records and deployment of tools to enhance patient communication and education. 

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Value is a concept of relative worth – a function of quality over cost.  Value is increased by an improvement in quality, a reduction in cost, or both. In healthcare, quality is a composite of patient outcomes, safety, and experiences. So, an improvement in patient experience leads to an increase in value delivered. Even though we know where patient experience fits in the equation, one of healthcare’s biggest challenges is that there is still no standard definition of patient experience – and, therefore, no standard definition of quality.  With the Affordable Care Act, this is beginning to change. The ACA is, among other things, a culmination of incremental efforts over 25 years to give healthcare consumers a platform to establish relative worth and to create a value-based accountability structure for providers. 

Can you think of any other industry that is, or needs to be, more personalized and service-oriented than healthcare? If you, or a family member or friend, have ever been a patient, you understand the personal nature of the industry and the impact that the experience can have on the value received. We all will be a patient someday!

Why a culture of patient experience matters

Patient experience is not simply about increasing patient satisfaction (i.e. HCAHPS) scores and developing patient engagement tactics (e.g. computer-based visualization tools), nor is it principally about better branding and marketing, or even about improving customer service or meeting expectations. While all of these ultimately lead to improved quality and, thus, higher value, they do not do so in a sustainable way. 

Patient experience is about the blend of values, beliefs, taboos, symbols, rituals and myths all companies develop over time. This is organizational culture, or corporate culture, and it describes and determines the way a company’s owners and employees think, feel and act. The Beryl Institute – a global community of practice dedicated to improving the patient experience through collaboration and shared knowledge – defines patient experience as the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care. While healthcare organizations may not be able to directly control the perceptions of patients and families, the opportunity to influence these perceptions is grounded in their very culture. 

The industry is being transformed from volume and visit driven to relationship and value driven, from autonomy and variability to standardization and customization, from experience-based decisions to evidence-based decisions, and from cost reduction to waste reduction. This industry shift requires the development of a new value-based culture across the organization – a culture of quality – that requires the emphasis of leadership, message credibility, peer involvement and employee ownership (See HBR, April 2014, 23-25). 

Healthcare is changing…and there is no going back!  Hospital and health system leadership are well-advised to go beyond strategy, tools and tactics, and to build patient experience into their organizational culture, rather than continue to let its absence frustrate progress towards performance on value.

Austin B. Kirkland is principal at OUTPERFORM LLC.

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Building a high-value healthcare delivery system
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