Dan Prince

The New Patient Experience Imperative Report issued recently by HealthLeaders focuses on hospital leadership’s response to patient experience. I found their take on the issue interesting, since we had done a similar study six months earlier.

One chart in the HealthLeaders study was particularly striking to me. When survey participants were asked about their patient experience strategies, 56% said that making physicians, nurses and staff accountable for patient satisfaction was part of their strategy. Yet, only 17% said that tying executive compensation to patient experience measures was part of their strategy.

The initial impression is that executives perceive that improving patient experience is the job of somebody else – the clinical staff mostly.

Our research for The Beryl Institute last April provided a little more insight into who hospital leaders really hold responsible for improving patient experience.

The State of Patient Experience in American Hospitals report we prepared for The Beryl Institute showed that indeed few hospitals – only 14% of those surveyed – hold the CEO or COO responsible for improving patient experience. But they aren’t siloing it as a clinical staff issue either. For example, only 6% give the primary responsibility to the CNO. Forty-two percent of the hospitals surveyed have made a committee responsible and accountable for addressing patient experience.

From “The State of Patient Experience in American Hospitals,” April 13, 2011, The Beryl Institute. The research was conducted by Catalyst Healthcare Research.

Respondents to the Beryl survey were primarily senior leaders, clinical leaders and quality improvement leaders. The heartening findings for me were that people very clearly saw that, whether or not the CEO or COO was directly responsible for improving the patient experience, “strong, visible support from the top” was the number one driver of success, and that getting clinical managers involved and supportive of key changes was the second most important driver.

From “The State of Patient Experience in American Hospitals,” April 13, 2011, The Beryl Institute. The research was conducted by Catalyst Healthcare Research.

Given that ‘cultural resistance’ was cited in our study as the number one obstacle, getting clinical and support staff involved in improvement, with support from the top leaders, was a principle supported by both studies.

This topic and other important patient experience issues will take center stage at The Beryl Institute’s annual Patient Experience Conference. Dates for the 2012 conference have just been announced: April 25-27, 2012, in Fort Worth, Texas, and I’m honored to be speaking. My topic is “What’s Reasonable? Patient and Caregiver Perspective in Provisions of Service.” To register for the conference at Early Bird prices, click here and use promo code RETROEARLY.

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Dan Prince

The Internet is quickly becoming the first touch point in the healthcare consumer’s experience. According to a recent national study we conducted, 56% of Americans turn to the Internet for health and wellness information. So if that’s the case, why are so many health plans missing an important opportunity to build their brands online by creating positive customer experiences?

My theory? It’s symptomatic of a larger problem. Health insurance as an industry had the lowest average score in Forrester’s Customer Experience Index, 2011. Bruce Temkin, who formerly led customer experience research at Forrester, now publishes an index similar to Forrester’s. Health plans’ scores put them one wrung up from the bottom in Temkin’s study, with the average customer experience rating for health plans sitting right on the line between ‘Very Poor’ and ‘Poor.’

Obviously, customer experience encompasses much more than website experience. But a quick trip to the sites of TriCare, the health plan for military personnel and their families that scored highest in Temkin’s study (with an ‘Okay’ rating) and Cigna, one of the lowest-rated health plans in his study, sheds some light on the customers’ point of view.

Before I share my findings with you, I would like to point out that one of my favorite writers on web user experience is Steve Krug, whose best-known book is “Don’t Make Me Think.” His premise is that if people come to your site and have to ask themselves questions like “What can I do here?” and “Where do I start?” you haven’t done your job right. TriCare, whose site has some classic usability flaws, nevertheless does a stellar job of answering the “Where do I start” question. You start by answering three questions.

After you answer them, you land on a fairly straightforward ‘Profile’ page. The fictitious answers I entered brought me to this page with five clear-cut plans.

I clicked on the first plan in the list, TriCare for Life, and came to a short digest description:

Clicking on ‘Learn More’ at the bottom of the page brought me to a longer description – but still not terribly long – with what appeared to be useful links for yet more detail if I were so inclined. Lots of clicking, but overall, it was a pretty intuitive experience.

Contrast this with Cigna’s home page.

The “Where do I start?” question is a lot harder to answer here. My first reaction was “Why did they clutter up the page with all these pictures?” The pictures create a friendly, approachable feeling – which is good in an industry that most customers see as unfriendly and unapproachable. But Cigna makes zeroing in on the little boxes that let you do something, like find out about their health plans, rather difficult.

My eye goes first to the vivid pink box that says “DEEP INSIDE YOU THERE’S A PERSON WHO REFUSES TO BE KEPT DEEP INSIDE YOU.” My reaction is “What in the heck does that have to do with health insurance?” Plus, Cigna has, in drawing my attention to something useless, wasted approximately 2 seconds of my time. Web users keep a tally as they go through your site, and they resent it if you don’t make an effort to get them to their goal efficiently.

Then Cigna compounds my frustration. The pictures aren’t just mood-setting visual clutter. If you click on them, they reveal that they are the gateways to presumably valuable content. For example, the bookshelf image (second row, first picture) is what you click to see “How to choose the right plan” and what plans are available in your state. If I came to the Cigna site with the sole purpose of picking out a plan, how many pictures am I likely to click on, hunting and pecking, until I figure out that it’s behind door number 7! (Of 30. The picture grid is 6 by 5.)

From an aesthetic and production values standpoint, the Cigna website is clearly superior to the TriCare site. But I kept thinking, considering all the money Cigna spent, did they spend any on user testing? If they had set just five users down and watched them interact with that home page, they surely would have seen the error of their ways.

Now, that’s one man’s opinion. The thing about user testing is that you don’t want one man’s opinion – especially one who thinks about things like usability on a regular basis. You want to assemble people who resemble your real users and ask them to do tasks real users would do on your site. Then sit back and watch them try to perform these tasks, preferably recording it so you can share the experience with the team who is creating the site.

The complication and the ‘shell game’ Cigna’s website presents fits all too well with the classic customer image of a health insurance company. Cigna obviously has the budget and the creativity to make the user experience of their website great. But they aren’t going to do it until they really get in touch with their users and create an online experience so intuitive that Cigna visitors don’t have to think!

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Dan Prince

Last week, I commented in this space about how many Americans are using the Internet and yet how few of them are using it to access healthcare information or the healthcare system.

I’ve been exploring this dichotomy, and I found an interesting study from the Pew Internet & American Life Project, The Social Life of Health Information, 2011.  

The Pew report covers findings much like those reported in HealthLeaders’ FACTFILE on Healthcare Online Trends,  which triggered last week’s blog post. But it digs deeper into some of the trends and finds that there are groups that are making significant use of the internet and social media to research, comment on and find support with healthcare issues. Those groups are caregivers and the chronically ill.

Caregivers are defined in the study as people who provide unpaid care for a loved one. 32% of Americans are in this category.

According to the study, only 12% of the people who use social networking sites have used them to gather health information. But if you carve out the caregivers from this total, you’ll find that 20% of them have used social sites for health research. So caregivers are 66% more likely to use social sites this way than non-caregivers are. A significant difference.

The Pew researchers also found that 20% of internet users with chronic conditions use social sites to research health topics and gather health information.

Caregivers are much more likely than other internet users to consult reviews of doctors or hospitals.

Once again, we’re looking at 62-66% gaps between caregivers’ activities vs. non-caregivers.

The gap is larger still if you compare the caregivers’ and non-caregivers’ viewing of online drug reviews. Thirty-eight percent of online caregivers have consulted online drug reviews. Only 18% of internet users who are not caregivers have done so.

The patterns for internet users who have chronic conditions are similar to those who are caregivers.  For example, 31% of the chronically ill have looked at online drug reviews vs. 20% of those who don’t have chronic conditions.

People with chronic conditions are also three times more likely to post a drug review than people who don’t have such conditions – though the absolute numbers are small in either case: 6% of those with chronic conditions have posted reviews compared to 2% of internet users without chronic conditions.

Harbingers of the future of online healthcare?

Obviously caregivers and the chronically ill have reasons to be a little more interested in healthcare, online and off, than the rest of us. But I think these statistics may point to some important trends.

• In the next 10 years, the baby boom generation will start moving out of the caregiver role and into the cared-for role. Their willingness to take to the Internet now with their questions, comments and activities regarding their parents’ care foreshadows the way they will deal with their own conditions and illnesses in the future. As the healthcare system builds more robust and usable online resources for them and as providers find ways to reach out online to offer meaningful and secure consultation, diagnosis and care, the boomers will meet them more than halfway.

• In the next 10 years, we can also expect to see an increase in the number of people with chronic conditions. Already, estimates are that 75% to 80% of healthcare claims relate to treatment and care of chronically ill patients. We can hardly afford to see that number go any higher. Online support and advice from primary care physicians, nurse practitioners, members of care teams and wellness coaches could help keep chronic patients on their meds and their regimens. Facebook may not offer the support group a diabetic patient needs, but a secure online group organized by a local hospital just might.

Hospitals and healthcare companies should be positioning themselves now to meet the needs of the new online healthcare consumer, as those needs emerge. Companies and care organizations who are already online when consumers come looking for them – offering useful functionality, good content and a great user experience – will gain a significant competitive advantage.

My next post will talk about how companies can improve their websites along all those dimensions – functionality, content and user experience – so they’re already ahead as healthcare consumers move online.

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Dan Prince

HealthLeaders FACTFILE on Healthcare Online Trends really caught my attention when it came out last week. Because we at Catalyst Healthcare Research spend so much time thinking about the presentation of data, I was struck by how the charts, admirable as they were, failed to tell the story about the huge gap between Americans’ lives online and their online access to healthcare.

For example, FACTFILE shows this distinction between “Internet Access By Age” and “Obtaining Lab and Test Results [Online]”

At a glance, the gap doesn’t look like a big deal. “Okay,” you could conclude – without really looking at the numbers – “lots of people have access to the internet, but a fair number of them don’t access lab test results online.”

We redrew the charts to make the scale the same on both, and the message changes. Lots of people have access to the internet, and almost nobody is getting their lab results online.

The study looked at not only how many Americans get lab results online but how many learn about physicians online, communicate with providers online, make appointments online, pay medical bills online and more. For each of these activities, the numbers of people performing them is miniscule, compared to the numbers of people who have access to the Internet.

I don’t want to diminish the value of the data that HealthLeaders, partnering with Thomson Reuters, provided. But the gap between what Americans could be doing online to communicate about and manage their healthcare – and what they are doing is even starker than HealthLeaders’ charts make it appear.

I’ll be looking into this gap, the factors that make it so hard to close and where progress is being made in the next few weeks and months. Stay tuned.

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Dan Prince

Fear, like any strong emotion, shuts down the verbal parts of our brain as it stimulates other functions like heart rate and body temperature. That’s one of the interesting things Colleen Sweeney points out in her patient fear presentations. Fearful people have a hard time expressing themselves. It’s classic psychology, borne out in Colleen’s research for Memorial Hospital and Health System in South Bend, Indiana. Colleen is Director of Ambassador and Customer Services there. She has made two presentations on patient fear for The Beryl Institute this year.

People’s inability to talk about fear when they’re in the grips of it, is compounded by a reluctance to talk about fear. Our culture equates fear with weakness. We put medical practitioners on a pedestal, and we don’t want to appear weak in front of people we look up to. We fear that even talking about our fears will expose our ‘stupidity’ to these very smart people.

We don’t know the names for all the things we fear in the hospital. The bacteria. The diseases. The procedures. The drugs. Or we can’t pronounce them. I may not express my fear when I’m scheduled for the procedure my uncle was undergoing when he died – because I’m not sure I’ll say it right.

Colleen says her biggest challenge is hiring people who “care enough to ask the question: What do you fear?” Asking the question – then listening intently and sincerely – can open the door to real communication.

Give patients a comfortable outlet

Given how hard it is to talk about fear with a healthcare professional, my first thought as I heard Colleen address this was to give patients a chance to open up and talk to someone they are comfortable with, as an intermediate step. Then let the healthcare professionals ‘listen in.’

A few months ago, I wrote about St. Louis Children’s Hospital’s patient video project, focusing on eight-year-old Benjamin Robinson who, with a little help from his parents, videotaped his interactions with hospital staff. Benjamin spent a lot of time at St. Louis Children’s during his 52 weeks of chemo after he had a brain tumor removed.

Benjamin’s video was meant to inform and reassure young patients and their families. But it seems to me a similar technique could have great power with a hospital staff audience. Here are a couple of simple approaches.

• Give the video camera to a member of a patient’s family and ask them to talk to the patient about their fears when the staff is out of the room. Be prepared for some editing; it may take a while to warm up, even when the people conversing are family.

• Identify the members of the hospital staff who are best at drawing out patients and learning what their fears are. Again, with the help of the patients’ family, capture on video what those particular staff members say or do.

I wouldn’t put a professional videographer in the room. That extra presence would make the conversation even harder to have. And professional quality is not the point.

Let staff see those who handle patient fear the best – in action

Colleen Sweeney talked about Chris, who, until recently, was a CNA at Memorial. He worked the night shift, and he invariably asked patients, ‘How can I really care for you this evening.’ Colleen told the touching story about the injured truck driver whose real fear was for his dog Roxie, left in the truck when he was taken to the hospital. Chris drove an hour and a half to pick Roxie up and take her home, photographed her every day the driver was in the hospital and managed to bring her up to the hospital room on the day the driver was discharged.

Every hospital has a few Chrises. Consider videotaping their interactions with patients as they ask questions about their fears. Capture what the staffer says to allay those fears. Colleen found that many nurses, doctors and PCAs don’t ask patients about their fears because they don’t know how to reassure them, how to find something to say that won’t make their fears worse. Give staffers a chance to watch the people who are good at it, absorb and discuss what they are doing, and then encourage them to put it into action.

Obviously, you will tell the patients, families and staff what this project is, why they are being asked to participate, who is going to see the videos and in what kind of setting. Releases and permissions will be required. Patient privacy is always paramount, and nothing is more private than patient fears.

Clips could be extracted from the videos and used in many ways: Group meetings, a special section of the hospital intranet, or released to staff over time as a “What Patients Fear and Why We Have to Know” (Colleen’s presentation title) series.

With the proper permissions, some of the clips might even be turned into a video for patients. Hearing other people express their fears and seeing firsthand how unthreatening a conversation with medical professionals can be, may go a long way in helping patients conquer their anxieties about expressing their true feelings.

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