In February 2008, the University of Utah Health Care (UUHC) launched a transparency campaign that would have its physician’s post feedback about customer satisfaction online. The initiative was dubbed an Exceptional Patient Experience (EPE). Some stakeholders expressed doubts about its ability to improve the hospital’s approval ratings. It was feared that posting information online was tantamount to exposing themselves to the competition. Nevertheless, the administration went ahead and began posting the results on the UUHC website. The outcome of this initiative was mostly positive. The organization’s attributes nationally rose from the 28th percentile to the current 85th on patient satisfaction. Also, the approval of its physicians on Press Ganey rose considerably.
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The University of Utah Health Care began as a single college hospital in 1965. Today, this healthcare has expanded to comprise four hospitals and ten neighborhood health facilities (University of Utah Health Care, 2014). Healthcare has over 1000 physicians with diverse qualifications, trained at the University of Utah. The physicians handle over 200 medical specialties (University of Utah Health Care, 2014). UUHC stands out because of its patient-centric approach. Here, patients are given priority in the treatment experience with a range of services being put in place to support this approach. One of these services is the famous “Find a Doctor,” which assists patients to locate a physician from nearby regions. Additionally, the hospital combines academic research and patient care for the best outcomes, as well as identifying and combating new disease patterns. UUHC recently began posting patient satisfaction scores online. The results were based on patient reviews of the services they had received from physicians. The move to introduce this service was aimed at fostering transparency, hence increasing patient satisfaction. The chief medical officer at the University, Thomas Miller, explains that the initiative was aimed at helping potential patients to understand the kind of experience they would receive at UUHC based on the reviews of previous patients (University of Utah Health Care, 2014). From a marketing viewpoint, this paper will discuss the development of the Exceptional Patient Experience (EPE) service, its challenges, and its ultimate success. However, it will begin by presenting the changing trend in health care to reveal what triggered the introduction of the EPE service.
Changing Trends in Health Care
Studies indicate that the cost of health care has increased in recent times, resulting in patients paying more for health services. Maruthappu, Ologunde, and Gunarajasingam (2013) observe that the number of Americans with health insurance has reduced significantly since the 2000s. Hence, many Americans are forced to pay out of pocket for health care. On the other hand, public health insurance covers only chronic diseases and vulnerable populations such as children. As a result, more Americans are left to seek health care privately. According to Green (2015), the rising consumerism and out-of-pocket cost trends are prompting customers to think carefully about the kind of care they are about to invest in. In this case, quality becomes of primary concern since patients wish to acquire care that is commensurate with the huge amount of money they are paying. It is in light of this common understanding that UUHC decided to seek alternative ways of improving customer satisfaction. While the decision to post results online may be seen as purely medical, it passes off as a marketing approach for the hospital. Consumerism in healthcare means that the sector has to contend with increasing competition as health care providers strive to outsmart each other. The ultimate beneficiary is the patient since competition is likely to result in increased quality care. Because the cost of health care is usually regulated (fixed), providers are left to compete on the aspect of quality (Brekke, Gravelle, Siciliani, & Straume, 2014).
Policymakers view patient choice as a way of improving healthcare quality. For this reason, policies are shaped to encourage competition. Such policies may include requiring hospitals to disclose sensitive information such as mortality rates, infection levels, and readmission rates (Brekke et al., 2014). Supplied with such information, patients have the freedom to make an informed choice on which hospital will suit them regarding quality. In the past, patients would rely on advice from their family physicians regarding the hospital to attend. However, with the advent of the internet, patients are open to a wide range of information choices. They are now more empowered compared to the past when they had no choice other than acquiescing to physicians (Green, 2015). They can resort to the internet for answers, care procedures, and suggestions. Nevertheless, the internet does not avail of the necessary resources to make patients “equal partners” in health care (Green, 2015). Nevertheless, the introduction of the EPE service was a sure way of winning patients’ approval.
Exceptional Patient Experience (EPE)
UUHC’s EPE initiative was informed by the belief that adequate information is part of quality health care. Miller contends that health care has been influenced by business, which has rendered information a central element of quality care (Lee et al., 2016). Patients would wish to choose from a range of options based on the available information. Information can also foster trust between the patient and care providers since patients do not feel that some details are being held back from them. However, information asymmetry has remained a fundamental problem in health care. Such asymmetry has created an artificial gap that prevents information flow. In other words, patients are not allowed to contribute to the health care process, which would otherwise lead to improved quality (Green, 2015). The university was determined to understand why feedback on physician performance is usually kept private (Green, 2015). Members felt this information would be more helpful to potential customers if it were released to the public.
UUHC also understood that simply availing data was not the solution to removing the information gap in health care. The department of health frequently provides data on aspects of health care such as cost and safety. While this information is available on various federal health websites, it may not be very helpful to patients. Green (2015) observes that interpreting the “data lumps” provided by the government has proven difficult for patients. Therefore, the data is not as insightful as policymakers had intended. Often, the result involves frustration by patients who then revert to seeking advice on healthcare from friends or even strangers. Certain online tools designed to assist customers to synthesize this data, including Pro Publica’s Surgeon Scorecard, have been criticized for not being effective enough (Friedberg, Pronovost, Shahian, & Zaslavsky, 2010). For instance, RAND coalition advised patients against using Scorecard, branding it untrustworthy and potentially detrimental (Friedberg et al., 2010). therefore, UUHC hoped to overcome the uncertainties of the existing performance report providers such as Scorecard.
The main difference between UUHC’s approach and other evaluation mechanisms is that the former relies on patients to perform the review. Patients comment on the care based on the experience they received, a situation that grants the method of authenticity. Additionally, since the results are left online for everyone to see, negative reviews have minimal chances of being edited out. Brian Gresh, UUHC senior director of interactive marketing, explained that 99 percent of customer feedback is posted online when unedited (University of Utah Health Care, 2014). Editing is only done where the comments contain personal information about the patient because posting such information could be detrimental to the patient (University of Utah Health Care, 2014). This approach is different from other evaluation techniques whose validity and reliability are poor or unverified (Friedberg et al., 2010). UUHC relies on data from over 40, 000 surveys conducted on patients to rate physicians. The rating criterion is a five-star system that resembles other online consumer rating systems such as Yelp and Angie’s list (University of Utah Health Care, 2014).
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Patients are sent an electronic survey through email a few days after their treatment. Apart from being asked to respond to questions, the patients are also asked to provide personal comments about their experience. Next, the feedback is posted online, as well as being used to improve UUHC’s services. In the first year of launching the survey, over 50, 000 patients took part, a plan that encouraged UUHC to adopt the program permanently (University of Utah Health Care, 2014). Other healthcare systems are following UUHC’s footsteps with their online review systems. This move is an indication that the program has been a success. UUHC works in collaboration with Press Ganey, a company that provides research and consulting services to over 50% of hospitals in the country (University of Utah Health Care, 2014).
Impediments to EPE
The implementation of EPE was not without major challenges. Some of the stakeholders feared that the initiative would contribute to overtesting and overtreatment, which would be counterproductive to the treatment process (Lee et al., 2016). Physicians also feared that the initiative would expose them to negative criticism from patients, as well as unreasonable patient demands (Lee et al., 2016). However, Miller has stated that only about 3.7% of the patient feedback is negative (University of Utah Health Care, 2014). Some of UUHC’s physicians are still opposed to the initiative, arguing that it exposes them to unfair criticism.
Impact of the EPE Initiative
According to Rodak (2013), satisfaction with UUHC’s outpatient care in 2011 was in the 38th percentile. However, it had risen to the 75th percentile by mid-2013. Similar results were reported for UUHC’s inpatient care. Lee et al. (2016) observed that improvement at the provider level is the most notable. The 30 surveys conducted in 2014 showed that 453 physicians had ranked above 95% on providing patient satisfaction (Lee et al., 2016).
Why the Program Succeeded
Miller attributes this success rate to various factors (Rodak, 2013). One of these factors is focusing on patient satisfaction. It is common for healthcare givers to perform treatment in a rather mechanical way as part of their duty. Going the extra mile to ensure the patient is satisfied with the treatment may be seen as not forming part of the caregiver’s duty. Prakash (2010) observes that patient satisfaction has evolved to become a common indicator of quality in health care. According to Prakash (2010), this culture emanates from corporate hospitals, which have grown in number to the extent of changing the traditional set up where healthcare was solely from the government. Also, the emerging trend involves healthcare systems hiring HR professionals to train caregivers on the essence of quality care.
Miller has also identified physician engagement as a factor that led to the high success rate of the program (Rodak, 2013). Physicians at UUHC were challenged to focus on delivering the best care while working as teams to guarantee the best outcomes. Loris Betz, a former senior vice president at UUHC, and an accomplished physician helped to guide the physicians serving as their role models. Miller revealed that the involvement of Mr. Betz in the program led to tremendous results (Rodak, 2013). Additionally, because physicians were aware they would be rated, they strived to provide a quality experience. Online reviews contain the names of physicians who attended to the patient. Prakash (2010) asserts that physicians in the United States are wary of negative reviews since they can lead to potential losses. The loss of one patient due to dissatisfaction can cost a health facility up to $200000. Therefore, the rating of physicians is seen as a motivation for them to always give their best. Nevertheless, not all physicians agree with this approach. UUHC’s success has also been attributed to benchmarking efforts. As the information on other health systems was available through Press Ganey, UUHC’s leaders were able to benchmark their services against those of other health systems (Rodak, 2013). Benchmarking provided UUHC officials with the confidence of being aware they were ahead of other key players, a situation that served as motivation for leaders to double up their efforts. The use of emails was also beneficial since more responses were obtained. This outcome would have been impossible through paper-based surveys (Rodak, 2013). Additionally, email correspondence made it possible to receive feedback quickly, thus enabling leaders to address patients’ concerns almost immediately.
Measures to optimize Results of the Change
The coaching of physicians and staff members at UUHC is a continuous process. Feedback obtained from patients is used to identify areas that require improvement (Rodak, 2013). Additionally, best practices are shared across the system. UUHC determines the satisfaction of patients at the unit level where each unit is equipped with a manager who has been trained on patient satisfaction. For instance, an outpatient clinic consistently recorded low ratings. Through careful observation and analysis, it was discovered that this low satisfaction was caused by delays and long wait times. The solution was to train physicians and staff members on how to decrease waiting times. Additionally, staff members were advised to inform patients beforehand about the duration they would take before being attended. This way, patients would be aware of possible delays. As customers’ expectations were improved, the low dissatisfaction declined. Miller also observes that physicians are encouraged to be friendly to patients, maintain eye contact, and/or avoid distractions such as remaining on phone calls while attending to customers (Rodak, 2013).
Despite the initial pessimism by some stakeholders, EPE has been a success at UUHC. Patient satisfaction has increased tremendously, causing other healthcare systems to follow UHCC’s footsteps. EPE has also led to an improvement in the quality of care at UUHC’s facilities. The culture of consumerism has spread into healthcare, leading to increased expectations from patients. This situation is further compounded by the increasing cost of healthcare. As patients pay more, they also expect higher quality care. EPE ensures that this quality is attained to enhance customer satisfaction.
Brekke, K. R., Gravelle, H., Siciliani, L., & Straume, O. R. (2014). Patient choice, mobility and competition among health care providers. New York, NY: Springer.
Friedberg, M. W., Pronovost, P. J., Shahian, D. M., & Zaslavsky, A. M. (2010). A methodological critique of the ProPublica Surgeon Scorecard | RAND. Web.
Green, M. (2015, November 6). 7 takeaways on University of Utah Health Sciences’ process and decision to go transparent with physician ratings. Web.
Lee, V. S., Miller, T., Daniels, C., Paine, M., Gresh, B., & Betz, A. L. (2016). Creating the exceptional patient experience in one academic health system. Academic Medicine, 91(3), 338-344.
Maruthappu, M., Ologunde, R., & Gunarajasingam, A. (2013). Is health care a right? Health reforms in the USA and their impact upon the concept of care. Annals of Medicine and Surgery, 2(1), 15-17.
Prakash, B. (2010). Patient satisfaction. Journal of Cutaneous and Aesthetic Surgery, 3(3), 151-152.
Rodak, S. (2013). University of Utah Health Care’s 5-pronged approach to patient satisfaction. Web.
University of Utah Health Care. (2014). University of Utah Health Care online physician reviews continue to lead transparency efforts in academic medicine. Web.
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