Making the shift to view patients as customers who need to be engaged and satisfied

In an era of changing financial healthcare models, where patients are paying for a larger portion of their care due to high-deductible plans, ensuring patients have a great experience has become increasingly more important for healthcare providers. If patients aren’t happy, they may simply go elsewhere.

Patient experience is one of the most important components of healthcare delivery, according to a recent NEJM Catalyst Insights Council survey on patient experience sponsored by University of Utah Health. “Word of mouth, insurance coverage and online ratings bring people in the door, but patient experience keeps them coming back,” says David Carlson, M.D., Medical Director at Great River Health System in West Burlington, Iowa.

Barriers to truly engaging with patients

To begin with, healthcare providers need to begin recognizing patients as customers. They bring money in the door, whether through their insurance company or from their own pockets, and they often have a choice which physician, hospital, etc. to select. The healthcare industry has become a competitive retail-like environment in this regard.

Here is where many in the industry get held up, however, and rightly so in some respects, where people’s health and lives are at stake.

In a recent NEJM Catalyst survey on patient engagement, Kevin Volpp, M.D., Ph.D., Founders President’s Distinguished Professor of Medicine and Health Care Management at the University of Pennsylvania and the Patient Engagement Theme Leader for NEJM Catalyst, cautions that customer experience in health care is somewhat different than in other industries, explaining that in the latter, “all we care about is what the customer wants, as opposed to health care where we also need to factor in what’s ‘good for a given patient,’ or ‘what’s medically recommended.’”

Part of the challenge involves the unequal clinical knowledge between provider and patient. In consumer-facing industries, the two parties generally have access to the same amount of information regarding the product or service, but not in health care.


That is just one stumbling block on the path to better patient satisfaction. In the NEJM Catalyst Insights Council survey on patient experience, 48% of council members rank not enough time with patients as their number-one barrier to providing an outstanding customer experience. Too many non-value-added tasks required ranked a close second at 47%.

Knowing a patient, understanding his or her history, and providing the best advice is one of the most important parts of any clinician’s practice. But as the survey found, delivering that kind of thoughtful, compassionate and expert care every day is challenging under current constraints where physicians are under pressure to see more patients and work faster, while also creating a better patient experience.

But this isn’t what physicians want. When it comes to having more time with fewer patients, a resounding 72% of clinicians in the survey agreed that it would be worth it even if it meant a reduction in revenue/income. “Most physicians started out with a very humanistic view of medicine, and we were idealistic about the care we wanted to provide,” says Richard Orlandi, M.D., Professor of Otolaryngology – Head and Neck Surgery, and Chief Medical Officer for Ambulatory Health at University of Utah Health. “Now, in this fee-for-service world, we’re on a treadmill, where speed defines our salary, and our salary is how we pay off debts from medical school and support our family. It creates this horrible tension between the care that we want to provide and the time that we’re allotted to provide it.”

Perhaps the first barrier, however, is actually getting physicians and patients on the same page. While in the minds of many clinicians, the amount of time spent with patients directly correlates to how patients perceive their experience, patients often have a different view. In the University of Utah Health Value Survey, only one in four patients chose spending enough time with the provider as most important to them when receiving health care. In focus groups and in survey feedback, patients said they don’t necessarily want to spend more time with their provider — they want to be heard. Nearly 100% of respondents agreed that listening to the patient voice improves care. Yet recent research published in the Journal of General Internal Medicine found that, on average, clinicians listen to patients for 11 seconds before interrupting them. Would a sudden surplus of extra time — say, 30 minutes per appointment instead of 15 — lead to more patient-centered care, where patients partner with their physicians and receive care from more than just a clinical perspective, but also from an emotional, mental, spiritual, social and financial perspective?

The steps to improved patient satisfaction don’t have to be huge

So, how do you go about ensuring that patient engagement and satisfaction are both taken into account by physicians, hospitals and other healthcare providers? The answer might not be as complex as it seems.

  •  Be Courteous: Sometimes, it’s a simple matter of basic courtesies, such as making eye contact, smiling, and calling people by name. Kind gestures can go a long way, particularly for patients who are ailing.
  •  Listen: Truly listen. And understand. Encourage patients to tell their problems, then listen and answer their questions. 
  • Explain: Help patients understand what is happening. Don’t use technical, complicated jargon; instead use clear and simple terms.
  • Don’t Assume: Often care providers get into the rut of assuming the patient knows more about their condition than they actually do. Instead of asking, “Do you have any questions?” ask them diagnosis- or procedure-specific questions to ensure they understand.
  • Be Respectful: Always treat patients with respect. Follow the golden rule and treat patients the way you would want to be treated.
  • Engage Families: Make sure to include patients’ families in the process, keeping them informed and included in the decision making along the way.
  • Be Responsible: Keep appointments, return calls and apologize for delays.
  • Follow up: Put into place a rock solid care plan that includes contacting patients after their visit. Even a simple text message regarding their recent visit can have a huge impact on their perception of the service they received.
  • Respond: As reported by Patient Pop, a 2018 survey  concluded that when a practice addresses a patient’s negative feedback the rate of satisfaction increased 99%.

A recent NEJM Catalyst patient engagement survey showed that the healthcare industry can also learn a lot about patient satisfaction from consumer-friendly industries. In fact, 96% of respondents agreed that there is much to learn from other industries, with 57% saying that an improved customer experience is the top area where they can learn. In the survey, respondents noted that hospitality (55%) and technology (45%) were the consumer-facing industries with the most important lessons for healthcare providers.

So, what can be learned from these other industries? Provide patients with more information than they expect, service them with a smile, and ask if they’re happy. And if they aren’t, do something about it. Happy customers are loyal customers, which has become increasingly important in the retail-style competition among health systems.

Turn wall space in your hospital or office into engaging, interactive displays that are both informative and entertaining. Sponsor events, teams and more within the community. Get your name out there, increasing your brand over your competition. Additionally, consider making your facility a location for hosting community events.

Don’t forget to make use of social media outlets. Communications can be educational or marketing focused as long as they engage patients. Shareable elements are great, so patients can forward on to family and friends and the public at large.

The consumerization of health care continues to reshape the way patients engage with providers and experience care, and to remain successful healthcare providers must embrace these changes.

Ultimately, though, for patient engagement to be truly effective, it must be integrated into the core of care delivery processes. Newer options are out there, including tapping into a patient’s social network and gathering data from remote and wearable devices, however a recent NEJM Catalyst Insights Council Survey on patient engagement showed that most organizations still expect care teams to “do the heavy lifting.” Nearly two-thirds (63%) of Council members list “care teams devoted to complex patients” as their top approach to embedding patient engagement into care delivery. Respondents also noted that care teams are the most effective method of engaging patients, with a combined 91% calling them extremely effective, very effective, or effective. Most notably, more than half the respondents (59%), believe that effective patient engagement has a major impact on quality of care.

Whether its new technology, new marketing strategies, new care-delivery processes or another plan entirely, today’s reality is that patients are consumers and in order to stay competitive, healthcare providers must make changes.