I have heard more than one colleague of mine over the years make the comment about a demanding patient, “What do they think this is, a hotel?” While a hospital is clearly not a hotel, it can nonetheless share similar traits. For instance, given the dramatic connection between high patient satisfaction and improved outcomes, a commensurate level of service and commitment to ensuring that patients’ needs are met is important. Unfortunately, it is too often evident that most health professionals (including administrators and staff) do not consider health care a service industry. Instead, it is about a product, and that product is the treatment, the medication, or the diagnostic tests. Surprisingly, most patients share this sentiment. My previous postings have explored the idea that patient satisfaction surveys often rate the individual characteristics of a hospital poorly; somehow though, patients often reverse their thinking and provide global scores that trump the specific categories.
The dichotomy is surprising, but perhaps it shouldn’t be. Most of us have purposely chosen to go to a restaurant despite knowing that the service is not good; most of us have chosen to fly rather than take a train or drive though we are aware of the extra hassle; and most of us have engaged in some behavior that we know is bad for our health but we do it anyway. What is it in us that allows us to perform all these activities even though we know they annoy or frustrate us, or make us unhealthy?
The answer of course is multifaceted; however, one plausible explanation might pivot around a crucial concept: well-being. Humans are rational creatures, we are always calculating, always thinking, and always weighing options and choices. Yes, the waiters might be rude, the wait long, and the service horrible, but have you tried that halibut? There are simply some cases in which the positive, as small as it may be, improves our well-being and allows us to overlook the negatives. We make these conscious decisions every day, and sometimes they are admittedly not even rational. Well-being is a tricky concept, there are many factors that play into it and are constantly at strife within us, and the same winner does not always emerge, even in a similar battle (sometimes that halibut just isn’t worth it!). Importantly, in nearly all cases patients do not choose to be hospitalized or visit physicians; however, satisfaction surveys clearly reveal that they universally put aside their large complaints to focus on their improved health (the halibut over the service). But given the connection with satisfaction and outcomes, shouldn’t they get the service as well? This link is critical in combating the rising cost of health care and improving outcomes.
Understanding well-being and how ethereal it can be is essential for both providers and for businesses. Employee engagement in wellness programs has historically been feeble, and patient satisfaction numbers are on the whole subpar (see Well Being posts). The consequences of these facts are multifold and in many cases deleterious. Without proper engagement, employee absenteeism and presenteeism increase, productivity decreases, and return on investment suffers. For providers, patient adherence to medications drops, follow-up visits dissipate, and general health is not improved, ultimately leading to increased costs. This is not unchartered territory; to the contrary, many studies directly relate patient satisfaction to improved outcomes and employee engagement to a number of enhanced metrics of worker performance.
There are many ways to reverse this trend. Patients and employees should not be forced begrudgingly to make the choice of forgoing their well-being to accept the service/position they are given. One example is health literacy. There have been a number of reports recently about this topic including one this month from the Agency for Healthcare Quality and Research (AHRQ). In its assessment, AHRQ estimates that 77 million Americans (or more than one-third) encounter difficulties with daily health tasks such as understanding medication labels or following immunization schedules. (AHRQ tool) So while the medication might be tremendous, how can it help if the patient cannot understand the directions on how to take it? This example demonstrates how it is in the best interest of all stakeholders to ensure both the service and the product are outstanding.
Some have suggested that social media is a way to address this issue. In fact, more Americans get their health information now from the Internet than from physicians, and an increasingly large percentage utilizes at least one social website such as Twitter, FaceBook, or YouTube. Additionally, major health centers are beginning to introduce this sort of bridge for patients to improve their communication with them. These programs can add a distinct competitive advantage while augmenting patient satisfaction, but only if they are properly incorporated into a strategic framework. Too many companies are already facing a backlash from failed attempts at using social media without fully understanding its use. Without connecting well-being and its implications to a communications framework, messages may not produce desired effects.
In health care specifically, steps are being taken to ensure that physicians and other staff members improve communication with patients. A number of board exams and accreditation requirements have been implemented to accomplish this goal. There has also been a concerted effort to improve patient satisfaction at the broader level. But without understanding the well-being of patients, without grasping what it is they want and need while hospitalized/in the health care system, can these changes have sustainable effects? Health care is both a service and a product industry. I for one look forward to the day when I hear a patient exclaim that yes they feel better, and wow was that service impeccable!
Tags: well-being, wellbeing
