After years of self-reflection by health care providers on how best to improve patient engagement and experience, many are looking outside their organizations for consumer engagement and experience solutions.
Few in the health care industry question the value of such a strategy. In a recent survey of NEJM Catalyst Insights Council members on consumer engagement, 96% say that the health care industry can learn about engagement from other consumer-facing industries. However, the path forward is not without difficulties given the unique structure of the health care model.
“I think the health care industry still doesn’t fully accept that he who has the checkbook makes the rules,” says Scott Nygaard, MD, MBA, Chief Operating Officer at Lee Health in Southwest Florida. He says that the financial model is evolving, with patients picking up a larger portion of the tab because of high-deductible plans, changing the nature of the physician-patient relationship.
“As cost continues to shift to patients, the demand for accountability and the need to become the discerners of value [also shifts]. Medicine needs to change the paradigm to see the world through the eyes of the patient/consumer who really is the customer. Often we offer what we want, but never ask what do our patients/consumers/customers really want from us.”
Besides the structural challenge of the health care financial model, where a payer other than the patient is frequently also writing checks, there are aspects of the physician-patient relationship that can make borrowing strategies from other industries difficult. Physicians ultimately have a responsibility to guide patient care to produce the best outcomes, even if this care pathway can sometimes be at the expense of patient experience and satisfaction.
“Physicians are obligated to provide patients with what they need, not necessarily what they want,” says Christopher White, MD, M-SCAI, FACC, FAHA, FESC, FACP, Chief of Medical Services at Ochsner Medical Center, Medical Director at John Ochsner Heart & Vascular Institute and System Chairman for Cardiology in Jefferson, Louisiana.
“Explaining an appropriate utilization strategy often requires significant patient education, which requires a time investment and answering questions, which is difficult to do without a face-to-face interaction. Physicians are conflicted by the goal of maximizing patient satisfaction that is balanced with recommending the most appropriate strategy.”
Part of the challenge of optimizing patient engagement and experience is the unequal nature of clinical knowledge between physician and patient. In consumer-facing industries, the two parties involved in a transaction have access to a relatively equal amount of information about the product or service. Not so in health care.
“There is a greater information asymmetry in health care than in other industries due to the sophisticated knowledge base that forms the basis of health care,” says Harvey Himel, MD, MPH, Medical Director of the Wound Center and Assistant Clinical Professor of Surgery at the Icahn School of Medicine at Mount Sinai in New York City.
“This knowledge gap translates into issues of poor health literacy, which impedes patient engagement. Trust in health care personnel is a crucial ingredient in patient engagement that forms the basis of the patient-doctor relationship.”
Perhaps not surprisingly, survey respondents say that the top two barriers to engaging patients as consumers are organizational mindset and patient ability to take responsibility as a consumer.
Nygaard says that the burden of patient engagement primarily falls on physicians, and wonders if one of the reasons why patients may be unable to take responsibility as consumers is due to a lack of relationship-building and patient education efforts by physicians. He asks, “Are we making this a relationship business or are we sacrificing that in the name of expertise? Are providers developing the right skill sets to be successful in an era when relationship skill sets are critical to practicing medicine?”
Insights Council members indicate that hospitality and technology have important lessons for health care, with financial services following behind. White believes that the development of trust between patient and physician is a critical element of the relationship, and draws a parallel with his own financial advisor.
“The advisor has knowledge that I don’t have, and while he has to make money too, I have to trust that he will do the right thing for me. A financial advisor’s role is to educate the consumer, who has less knowledge, and the consumer has to trust that the advisor will do the right thing.”