Patient Loyalty through the Hospital Emergency Department

According to healthcare expert Nicholas Webb, health systems are now joining the “89 percent of companies that expect to compete mostly on the basis of customer experience.”

“Ours is quickly becoming an experience economy,” observes Joseph Fifer, President and CEO of the Healthcare Financial Management Association.

The new-to-healthcare concept of the “experience economy” provides a useful framework for thinking about patient commitment. This framework explains consumer choices not as cold, objective calculations but rather as decision-making processes involving emotion, memory, and trust. And while Fifer is referring mainly to patients’ financial experience in a healthcare setting, providers should remember that patients’ experiences affect their trust and their engagement, which in turn impact health outcomes.

The Top 5 Loyalty Drivers You Can Influence:

1. Previous experience: By suggesting you can influence “previous experience,” we don’t mean you can change the past. But you can avoid one of the most common sources of frustration for returning customers (and patients): being treated as if you’ve never been there before. If a patient has had a previous experience in the ED, they should feel you recognize that.
2. Best doctors and nurses: Provider performance doesn’t happen in a vacuum. The ED’s culture, its relationship with key partners in the hospital, and access to actionable, data-based guidance for performance improvement all contribute to making a good provider one of “the best.”
3. Compassionate care: Compassion should of course be practiced by all ED clinicians and staff, but it must be supported by the health system more broadly. It is easier to treat patients well when professional satisfaction is high (or, as we sometimes put it, “happy doctors make for happy patients”).
4. Reputation: When patients affirm your health system’s values by repeatedly choosing your providers, you’ve contributed to a reputation—and built a relationship —you can be proud of.
5. Family/friend recommendation: Reviews and other vehicles of comparison are becoming the norm across healthcare, as they have long been in other industries. Health systems should follow those other industries in recognizing that a recommendation from a trusted source is loyalty’s proof and gold standard.

Mastering the Drivers of Loyalty: Amazon vs. Healthcare

Many people seem to think health systems should be looking to the digital tools and customer service practices of massive retailers like Amazon. The comparison has merits and (obvious) limitations. While making the experience of care a positive one—not least when that “customer” is afraid, or ill, or overwhelmed—is undoubtedly harder in a healthcare setting than in the typical retail scenario, some of the aspects of an excellent retail experience do carry over.

In terms of healthcare, those elements might include:

• Understanding what the patient’s needs are.
• Not pushing patients to look at products or services that don’t apply to their lives.
• Configuring systems and training people so that patients aren’t asked for ID more than once or asked to spell their names again.

It may seem superfluous to figure out a simpler registration workflow when the stakes of other processes are so much higher. Yet this attention to the details of the visit—from the patient’s perspective—can increase patient trust, and confirm that they’ve come to the right place for care.

Anticipating Patient Needs

Of all the loyalty-oriented changes possible, this area is perhaps the most essential. This kind of anticipation can be clinical and non-clinical, but is always predicated on seeing things from the patient’s perspective. Crucially, then, it converts that empathy into action.

In the ED, this type of anticipation can take several forms:

• Lab tests are ordered for a patient before they even see a physician. The department is so focused on the patient’s needs that they’ve thought ahead about the presenting set of symptoms and have followed clinical protocols to decide on and organize staff around the next steps for the patient—all of which helps minimize the patient’s wait time.
• Anticipation also applies to patient questions around billing, or the availability of payment plans. Offering the chance to talk to an expert in those areas can help address a patient’s financial concerns rather than leaving the patient to worry over them silently.
• Proactive pain management is of the utmost importance in emergent situations; anticipating this need should already be a top priority for emergency physicians and staff.

As these examples suggest, the people patients will recognize as anticipating their needs (or not) are likely to be front-line clinicians, reception employees, and billing staff. Yet these people cannot on their own reorient work processes (like testing protocols) or set pain management policy.

Even if the push for patient commitment begins in the ED, it must be supported and reinforced across the health system. In our “Utilizing Data” section, we discuss how health systems can support front-line providers and staff who seek to anticipate patient needs—and describe what a data-driven continuous circle might look like in the ED.

Reaching Beyond the Four Walls

Going beyond your physical facilities is a key principle to creating loyalty. Instead of restricting care and communication to a patient’s hospital visit, that patient should understand that they have a partner they can rely on at any time. That means having access to health information and medical history records 24/7 via a robust patient portal, but it also means communication driven by the providers themselves, especially when patients feel vulnerable or passive. Having an ED physician call a patient the day after discharge is unheard of today. For that very reason, that outreach or something similar would likely feel monumental to a patient. That gap between expectation and what’s delivered feeds back into the earlier discussion of the “experience economy.” ED physicians stand to build immense trust by exceeding the current expectations that they are always on to the next patient and are too busy to follow up.

Patients today often feel bewildered by the new healthcare options that have cropped up in the past few years. The principle to keep in mind is that they’re looking for guidance, so the health system can earn trust by acting as an expert guide.

If you feel a sharp pain in your stomach, should you go to the ED? An urgent care center? Walgreens? Health systems can best help patients not by sending every person with a stomachache to the hospital, but rather by advising them to access the cheapest, quickest, and most appropriate care site. In other words, health systems should help patients navigate our fragmented healthcare system in the way that best fits the patient’s needs and means.

Here are examples that would bear out this principle and make manifest the role of hospital-as-guide:

Utilizing Data

So far we’ve mainly focused on two domains of change for health systems interested in moving from satisfying their patients to acquiring loyalty from their patients: anticipating needs and thinking beyond the patient’s physical visit to the health system. A third domain is utilizing data, meaning how a health system can aggregate and interpret information in order to inform behavior.

The behavior piece is critical: too often, health systems collect data only as a response to compliance requirements or other external demands. This information—whether it’s extraneous questions for the EMR, redundant insurance queries, or irrelevant satisfaction questions —is seen as an answer to someone else’s question rather than a dynamic and accessible resource for clinicians and staff. Without a sense of its utility, data collection (and data entry) can seem burdensome, sometimes even pointless.

Changing focus from satisfaction to loyalty requires a revised perspective on data use as well.

Data is often the missing link between a health system that’s interested in patient commitment and a health system that earns it. For instance, a patient might rate a clinical unit highly on a satisfaction survey but still leave the hospital feeling frustrated because the billing staff doesn’t have updated information about her account. Health systems that are serious about loyalty will invest in getting all staff the information they need to provide individualized, informed attention—no matter their department.

The Metrics of Loyalty

We know how you measure patient satisfaction, but what are the right metrics for patient loyalty?

To make the switch from the left column to the right means reminding everyone in the organization, from physicians to customer service representatives, that while they may only see the patient for a small fraction of time, the sum of the patient’s experience includes all those fractions. In other words, it’s not just one friendly scheduler or the work of one skilled surgeon that defines the patient’s experience: it’s the overall culture of the organization—the ability to anticipate the needs of patients, think outside of the box, and incorporate actionable insights through data.