Electronic Health Reporter

Guest post by Avery Earwood, principal healthcare strategist, SAS Center for Health Analytics and Insights.

What do Disney, Apple, Southwest Airlines, Mayo Clinic, USAA, Amazon, Pandora, and Kaiser Permanente have in common? They all sell the same thing.

Whoa! That’s crazy talk. What’s that you say?

Yes, each of these organizations knowingly and deliberately differentiates and competes on customer experience. In fact, each one delivers the best customer experience in its respective industry, as measured by Net Promoter Scores.* Whether delivering immersive entertainment, personalized radio or healthcare, these companies make an emotional connection and engage their customers in extraordinary ways.

Within healthcare the importance of the patient experience cannot be overstated. Our personal health and well-being is synonymous with happiness and is manifest in our personal experience. For many of us, being sick, in pain or in fear for our life (or the life of a loved one) tends to heighten our perceptions and amplify every experience. It’s during such times when a kind word can seem like a grand benevolence, and the slightest oversight feels like a cruel insult. As such, providers should invest as much energy in delivering the best possible customer experience as they do in delivering safe and effective treatment.

Patient satisfaction is not patient experience

The Beryl Institute defines patient experience as “the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care.” Unfortunately, the standard method for measuring patient perceptions about healthcare is a collection of survey questions. Don’t get me wrong; we need a consistent method for assessing patient perceptions to make apples-to-apples comparisons between organizations. The Consumer Assessment of Healthcare Providers and Systems (CAHPS**) survey offers healthcare consumers and financers just that – information by which to make such comparisons. However, the subjective survey data alone is insufficient for providers to fully comprehend and then systematically improve patient experiences.

I won’t belabor the difference between patient satisfaction and patient experience here, but I will draw your attention to Fred Lee’s work on this subject. Lee aptly compares Disney with American hospitals in his best-selling book If Disney Ran Your Hospital: 9 ½ Things You Would Do Differently. I strongly encourage you to invest 17 minutes watching his funny and exceptional TEDx talk on the fundamental difference between patient satisfaction and patient experience.

For providers to gain an accurate and useful understanding of the determinants of patient experience, they must go beyond CAHPS surveys and comprehensively analyze the interactions between care teams and patients. Did the patient’s cognition affect his understanding of the physician’s orders? Did the patient’s activation level affect her desire to leave the hospital too soon, or stay too long? Was the distance from the patient’s home to the specialist’s office factored into the referral? Was the patient’s lack of transportation considered in the discharge plan? And so on.

How well do you know your patients, really?

Those providers who want to deliver a consistently best-in-class patient experience will need to attain a deeper level of understanding, apply better methods of measurement, and acquire more sophisticated analytical tools than random-sample satisfaction surveys can offer. In other industries, we call this depth of understanding “customer intelligence,” as it represents everything we know about the customer. In healthcare, I usually refer to this as a “patient profile,” because the 360-degree view of a patient is vastly more complex than in other industries; it includes multiple dimensions such as risk scores, psychosocial determinants, expressed and predicted preferences, and experiential scores. These patient profiles form the core of our understanding about each patient, and inform personalized care and engagement.

One of the first and most difficult challenges to overcome when building a comprehensive patient profile is acquiring, assessing and attributing the data to each individual patient. This can be more of a policy hurdle than a technology challenge, as the problem of fuzzy-logic matching was solved years ago. The second big challenge is mining vast amounts of unstructured data for useful bits of information. This, too, is made possible with content categorization, sentiment analysis and natural language processing. The third challenge is conducting a thorough network analysis that considers all the connections and factors that shape and influence each patient’s experience.

What are your patients saying about you?

We shouldn’t forget that customer experience is highly contagious. Both positive and negative experiences are spread by word of mouth and can “infect” others much like a virus. Recall the sage advice: “If you want to know what someone really thinks about you, listen to what they say when you’re not around.” No, I’m not advocating for spying on customers or eavesdropping on employees. However, I am suggesting that you actively listen to what patients and employees are saying, tweeting, blogging and putting on YouTube about their experiences with your organization. This kind of social listening is necessary to identify and respond to negative customer experience “outbreaks” before they become epidemics.

Social listening and network analysis enables providers to understand and replicate the positive experiences that delight and engage their patients as outlined in this patient’s open letter to St. Joseph’s Dignity Health. In the video, the middle-aged patient (Trevor) describes his experience with a caregiver who wiped away a tear “just as [his] mom would have done,” and describes the gesture as one that is now part of him and one he’ll never forget. Trevor is not describing his “satisfaction” with the service of the care team – he’s talking about his “experience.” Systematically analyzing each of these tiny moments – glimpses into the essence of patient experiences – will provide the keys to replicate success, influence organizational culture and empower care delivery teams.

The methods by which government agencies choose to measure patient perceptions shouldn’t define patient experience, nor should they limit your ability to study and understand it. Most importantly, please don’t settle for incomplete information to inform your patient experience strategies and initiatives. Insist on, and support, tapping into all available sources, including unstructured text and social networks. Investment in a comprehensive understanding of each patient will enable measurable improvements in quality of care and patient experience that result in better CAHPS scores, higher value-based payments and greater patient loyalty.

*Net Promoter, Net Promoter Score and NPS are trademarks of Satmetrix Systems Inc., Bain & Company Inc. and Fred Reichheld.

**CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).