Patient Engagement

Patient Engagement Survey: Health Care Has a Lot to Learn from Consumer-Friendly Industries

Insights Report · January 10, 2019

Analysis of the NEJM Catalyst Insights Council Survey on Consumer Engagement: What Health Care Can Learn from Other Industries. Qualified executives, clinical leaders, and clinicians may join the Insights Council and share their perspectives on health care delivery transformation.

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Advisor Analysis

By Kevin G. Volpp and Namita Seth Mohta

The consumerization of health care continues to reshape the way that patients engage with providers and experience care. Most providers see this fundamental change in the health care model as a necessary response to changing patient demands, and have embraced the need to learn from other industries. The great majority (96%) of respondents to a recent survey of NEJM Catalyst Insights Council members say that the health care industry has lessons to learn about engagement from other consumer-facing industries.

Health Care Can Learn a Lot from Other Consumer-Facing Industries - Especially About Customer Service - Consumerization of Health Care

From the Patient Engagement Insights Report: Health Care Has a Lot to Learn from Consumer-Friendly Industries. Click To Enlarge.

“It’s not hard to see how the health care delivery system could be much more customer-friendly,” says Kevin Volpp, MD, PhD, Founders President’s Distinguished Professor of Medicine and Health Care Management at the University of Pennsylvania and the Patient Engagement Theme Leader for NEJM Catalyst.

He cautions, however, that customer experience in health care is somewhat different than in other industries, explaining that in the latter, “all we care about is what the customer wants, as opposed to health care where we also need to factor in what’s ‘good for a given patient,’ or ‘what’s medically recommended.’”

Survey respondents — who comprise clinical leaders, clinicians, and health care executives — say an improved customer experience is the top area in which health care can learn from other industries (selected by 57%), followed by customization to individual needs and preferences (35%).

“I do think health care is substantially underdeveloped in both improving the customer experience and customization of individual needs and preferences,” says Volpp. “For decades, doctors have basically told patients what they should do. And part of why we have such low engagement rates is that while there’s some overlap between that and the patient’s own goals, in many cases I suspect doctors don’t really work that hard to figure out what the patient’s goals are.”

Namita Seth Mohta, MD, Clinical Editor at NEJM Catalyst, points out that engagement and customer experience are not the same things, particularly in health care. “We need to differentiate patient experience and satisfaction from patient engagement. An engaged patient is actively involved in the defining of, and realizing, their health-related goals. That is related to but distinct from patient experience and patient satisfaction.”

“Consumer-facing industries usually focus on those two latter elements, but health care has to be a little more nuanced,” Mohta says. “Care providers have to think about engagement, experience, and satisfaction, which are all related but distinct. Patients are more likely to be engaged if they have positive experiences, although not always necessarily.”

Hospitality and Technology Are the Industries That Health Care Looks to Most for Lessons

From the Patient Engagement Insights Report: Health Care Has a Lot to Learn from Consumer-Friendly Industries. Click To Enlarge.

In health care, as in many other industries these days, customer experience is increasingly being improved through the use of customization to meet individual needs and preferences, often mediated by technology.

Volpp describes the link between customization and experience by citing Amazon. “I do think one of the areas in which health care delivery could really improve is if we did a better job of aligning with patient goals. At Amazon, they have this very nice mass-customization model that uses all the data they have about you and people like you to figure out what to offer you. That’s what we could aspire to do in the future in health care — and maybe we could even do it better by integrating this with clinical evidence to determine what people should be offered.”

Survey respondents say the hospitality and technology industries are the top consumer-facing industries with the most important lessons for health care (selected by 55% and 45%, respectively).

“It’s hard to argue with hospitality. It is a benign industry to look toward for lessons without having to defend how broken our current health care system is,” Mohta says. “And technology brings to mind technology-based interactions with providers — asynchronous electronic communication and synchronous virtual visits, as examples of key improvements.”

When it comes to health care organizations actually drawing on other industries for lessons, hospitality (29%) and technology (26%) still rank high. But the leading response is “none” (30%), indicating that while Insights Council members are interested in learning from other industries, only a relatively modest number have actually put that knowledge into practice.

Organizational culture and unaligned incentives contribute to the challenge of changing health care to be more consumer-friendly. Yet this survey shows that health care leaders and practitioners are interested and willing to learn from other industries, which is the right first step.


How is engagement in health care different from engagement in other industries?

“Consumers confuse quality with their satisfaction and patient satisfaction may not reflect best care.”
— Clinician at a small for-profit physician organization in the Midwest

“Actual payment for services is not consistent. Nor is it in any way obvious to patients what the cost or payment is. This only occurs in medicine.”
— Director of service line at a small nonprofit community hospital in the Northeast

“Consumer needs are infinitely variable and need to be tailored to the individual. Improved consumer engagement in healthcare will either require significant process simplification or considerable consumer education.”
— Vice President of a midsized nonprofit physician organization in the South

“We should not look to other consumer-driven industries because we should not act like patients are consumers. We should not take a capitalist approach to medicine — WE SHOULD NOT PROFIT OFF OF THE SICK.”
— Clinician at a small community hospital in the Midwest

“It isn’t. People just think it is.”
— Department chair at a small for-profit hospital in the South

Download the full report for additional verbatim comments from Insights Council members.

Charts and Commentary

by NEJM Catalyst

We surveyed members of the NEJM Catalyst Insights Council — who comprise health care executives, clinical leaders, and clinicians — about what health care can learn from other industries to engage consumers. The survey explores health care’s ability to learn from other industries, the areas in which health care can learn the most, consumer-facing industries with lessons for health care, the consumer-facing industries from which health care organizations have actually drawn lessons, the processes used to gather those lessons, who within health care organizations leads the effort to embed lessons, whether patients should be treated as consumers, and the barriers to engaging patients as consumers. Completed surveys from 766 respondents are included in the analysis.

Insights Council respondents are nearly unanimous in their view that the health care industry can learn about consumer engagement from other industries. However, some have concerns about drawing direct parallels between industries because of the unique nature of the health care industry. In a written comment, a physician from the Midwest cautions that “health care is a need, most other industries reflect a want.” A C-suite executive in the West points out that “health care has to consider [patient] well-being, clinical outcomes, not JUST consumer/patient preference. In other industries, customer preference may take precedence, [but] in health care we need to balance patient preference and clinical judgment.”

Patients Should Be Treated as Consumers

From the Patient Engagement Insights Report: Health Care Has a Lot to Learn from Consumer-Friendly Industries. Click To Enlarge.

Customer experience, the top area in which health care providers can learn the most, may have greater opportunity for improvement than other areas because it is less constrained by clinical requirements, in contrast with more narrowly focused areas such as quality and speed/efficiency.

The survey data reveals some interesting correlations with respondent age. Among respondents 45 and younger, only 39% mention improved customer experience as an area where health care providers can learn the most from other industries, compared to 61% among those over 45. The younger group looks more instead to speed/efficiency (32%) than the older group (19%), and to rapid cycle innovation (25% versus 12%).

Download the full report to see the complete set of charts and commentary, data segmentation, the respondent profile, and survey methodology.

Download Full Report

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