Who's Your Customer?

An article in the September/October 2016 issue of the Journal of Healthcare Management titled Who Is a Hospital's "Customer"? [Volume 61, Number 5 pp. 319-334] caught my attention when I was perusing the table of contents. I've often wondered about the perception and reality of "customer service" attributes in the healthcare setting. This article really focused on the hospital setting, but it poses some interesting questions for everyone in healthcare.

Let me preface this by saying, prior to joining healthcare, I worked as a business and IT consultant for a wide variety of firms. One of those was a world-renowned health and wellness spa organization whose reputation for pampering its guests was (and is) legendary. One of the projects I worked on with them was to update and revise their customer service training program. Through that process, I learned a lot about their approach to customer service and what made it stand out from other organizations.

After joining the healthcare field, I wondered about the connection between customer service in a spa environment vs. in a hospital environment. I often wondered what would happen if we treated patients like spa customers? Would we get a better outcome? Would patients be happier and healthier or would that run counter to the efforts of the care providers in an acute care setting? Still later, a parent of mine went through the hospital experience from ED to admit to discharge several times as well as the post-acute-care experience (skilled nursing facility to assisted living), I saw first-hand where we have opportunities to improve and hopefully excel. In this post, I'll focus on the hospital data. I'll follow up with another article on the world outside of hospitals as we explore customer service in healthcare today.

The primary finding of the study referenced in this article is that physicians and nurses don't see patients as customers, they see them as patients. There are some valid reasons for this including the fact that these care providers have expertise the patient does not have and that sometimes what is best for the patient is not what makes them happy. If we contrast that to a pure consumer experience like shopping for clothes, there is no similar situation. If you don't like your customer experience at one clothing store, you can simply leave and go to another one. They are essentially interchangeable. Not so with healthcare. If you're in a hospital and you don't like your customer experience, you're not likely willing or able to simply leave and go to another hospital. So, the "customer" experience in healthcare is not like other customer experiences.

The study noted that elective surgery is the closest thing in a hospital setting to a customer experience. Though it was outside the scope of the article, it can be argued that a visit to a primary care physician office is also more like a true customer experience than a hospital visit. Most people have choices when it comes to selecting a primary care physician and the customer experience likely plays a larger role in that selection and long-term satisfaction than in other care settings.

But let's get back to the hospital. If patients are patients, who are the customers. The article points out several very interesting conflicts in perspectives. For example, patients do not see themselves as customers. Nurses, too, see patients as patients, but they see patients' families as customers. Nurses view physicians and pharmaceutical reps (and other vendors) as customers. Hospital administrators see just about everyone as customers, including patients, physicians, payors and charitable foundations contributors (if not-for-profit).

Since the Centers for Medicare & Medicaid Services (CMS) includes patient experience in calculating a hospital's reimbursement, hospitals need to figure out what that really means. Is it customer service or health care service? Is it making the patient happy or healthy or both? One of the key statements is this: "...customer expectations are an important antecedent to customer satisfaction in a healthcare setting."

There's a lot more in the article and it's well worth reading (subscription required) [here], but the key takeaways are these:

1. Hospitals have many customers, though not all customers see themselves as such.

2. Hospitals need to define all of their customers and the unique attributes of those customers.

3. Hospitals need to understand the expectations of each of those customer segments before they can effectively address them.

4. As healthcare becomes consumerized, the focus on patients as customers will increase.

Finally, as a healthcare IT leader, what can we do to facilitate this conversation and improvement in the patient experience? My recommendations are these:

1. Help the organization understand who the various customers are and help lead discussions about customer expectations. Using technology such as online surveys may facilitate gathering data.

2. Understand how technology may play into the experience (and therefore the satisfaction of) the various identified customers. How does technology improve satisfaction of:

- your physicians

- your nurses

- your support services staff (procedure areas, business office, finance, supply chain, HR, etc.)

- your patients

- your patients' families

3. Avoid the 'technology as cure-all' approach that says that if we throw more technology at a problem, it will magically resolve. Most of the solutions to a better patient experience and higher customer satisfaction (across all customer populations) is process-based. Improving process before implementing technology will always yield a better, more lasting result.

4. To quote Stephen Covey, "seek first to understand." If we don't ask our customers what they expect and what they value, we will never hit the mark. Spending time and resources solving problems that are improperly defined (i.e. our assumptions about what our customer want vs. what they tell us they need) is the definition of waste.

Our job is to understand expectations and either meet or manage them. We can't always make every patient happy at each moment of the day, but we can create a superlative experience in which the patient receives the best possible care and achieves the best possible outcome, in a caring, compassionate and efficient environment.