Engaging Patients in a Changing Health Care System

In the Baldrige Health Care Criteria for Performance Excellence, the Customer Focus category (category 3) asks how your organization engages its patients and other customers for long-term marketplace success. The related self-assessment questions cover how your organization listens to the voice of the customer, builds relationships with patients and other customers, and uses patient and other customer information to improve and to identify opportunities for innovation.

As the U.S. health care system undergoes major changes, what are some effective practices for engaging patients in new and challenging contexts? I recently spoke with a Baldrige examiner who responds to that question by drawing on both her professional expertise in business management and her personal experiences as the mother of a patient navigating the health care system for multiple surgeries.

Randi Redmond Oster is now in her second year on the Baldrige Program’s Board of Examiners. For more than a decade, she was an engineer and executive with GE Capital. She specialized in new business development and earned Black Belt Six Sigma certification. Oster later applied her business knowledge and skills in her role as a patient advocate for her son as he underwent numerous surgeries.

During those experiences, Oster saw numerous opportunities for health care providers to better engage patients and their families through information and tools to empower them. Today she works to educate hospitals and others on how to address such opportunities; she also has shared her insights in a book she wrote on empowering health care consumers. When Oster works with health care organizations now, she says she “helps them understand the patient perspective today and ways they can move forward by being responsive to the dynamic change that is happening.”

She pointed out three key developments that have changed the ways that health care organizations must focus on customers today:
 

1. Consumers have higher deductibles. “Because they’re spending more money, they’re asking more questions,” Oster observed.
2. Consumers have access to more data on the performance of health care organizations and employees; for example, the Hospital Compare tool on the Medicare.gov site allows consumers to compare organizations on patient satisfaction measures.
3. Consumers are exposed via news outlets and social media interactions to negative health outcomes via stories about medical procedures. This creates a challenge for the health care community in terms of the satisfaction and engagement of health care consumers. For example, whereas historically wait times were long for patients, health care organizations will risk consumer dissatisfaction for long wait times today.
    

“The shift in health care is accelerating so quickly that [hospitals] are struggling to keep up,” Oster said. The key question for executives of such organizations is, How do you position your organization for innovative changes at an accelerated pace?

Oster sees the Baldrige framework’s category 3 as particularly valuable as health care providers must ensure high levels of patient satisfaction and engagement. After all, funders and customers alike are increasingly using those results to measure such organizations’ performance.

She recounted a turning point in her work with a health care organization that “did not want to lose a patient to a competing hospital and risk not developing a long-term relationship with the customer.” She recalled hospital executives, including the heads of nursing, patient experience, and quality, concluding, “We have to ‘wow’ patients.” “Not only do such organizations have to meet medical needs,” said Oster, “but they also need to figure out what patients need personally.”

The greatest challenge in doing so, she added, lies in the relatively short time a health care provider has to meet the patient’s manifold needs. During a typical 15-minute appointment with a patient, the doctor is in effect a data entry clerk (entering information from the appointment into an electronic health record) and required to listen. “It is hard to ‘wow’ patients if they feel rushed and as if they are merely a number representing data in a system,” she said. Yet changing doctors and their behaviors can be “cumbersome and costly,” said Oster.

She concluded that organizations would do well to empower patients so that “they can maximize those 15 minutes with their doctor.” For example, when her son was hospitalized, Oster kept a “feedback list” and put stars next to names of health care providers she felt did a good job. A few days after her son was discharged from the hospital, she sent a thank-you letter to the CEO of the hospital commending employees on her list. Later, when her son had to be readmitted for complications from surgery, she received words of thanks from nurses and other staff members as they shared that the CEO had read her thank-you letter to all employees. During her son’s second hospitalization, Oster felt she had developed a good relationship with many employees as a result of her feedback.

She has since suggested other hospitals give all patients a similar feedback tool to support the customer relationship. “[Empowering patients] is how they can differentiate their organization from competitors in terms of patient satisfaction and engagement,” she said. She noted that the second set of Baldrige Criteria questions on determining patient satisfaction and engagement (3.1[b]) are about determining satisfaction relative to competitors (3.1[b]2). As the leadership of one hospital realized, “If we don’t do well in satisfying customers, they’ll go somewhere else.” Because of that potential to lose business, innovation in processes to build customer relationships is essential, said Oster.

“My personal mission is to improve the health care system,” she added. “I have a two-tier strategy—bottom-up is to educate people about the system; top-down is to use the Baldrige framework to explain to CEOs how to improve the system by helping them understand the consumer perspective.”