Meeting Patient Expectations Now Determines True Success

Like many healthcare systems, ours is starting to increasingly focus on the patient (or customer) experience. When I went to medical school, I was taught anatomy and physiology, how to read an X-ray, or order a medication. We briefly were taught how to "have the difficult conversation." Our patient experience training involved the adages to shake a patient's hand, sit down to make it appear we spent more time in the room than we actually did, and wait 27.3 seconds before we interrupted the patient's story.

These approaches are not sufficient any longer. After more than a decade of working on quality metrics, we've come to the realization that patients are not wowed by our diabetes outcome measures. Our patients -surprise - already assumed we did a quality job of managing medical problems. In fact, a better patient experience is often the indicator, in a patient's eyes, of the overall quality of care. The unfortunate reality is that your healthcare team can do a perfect job managing diabetes or heart failure or acute bronchitis, but if your approach does not have the key ingredients of empathy, courtesy, and personal warmth, the patient will feel that not only the service but the quality of that service was poor.

In the midst of these considerations, I was watching TV and saw a car advertisement. The ad exemplified the very idea of customer service: what is important to the car company is what is important to the customer. Bottom line. Of course, they mention the important safety and quality goals and some of the desirable frills. However, the commercial began and ended with the promise: It is important to us because it is important to you.

In the last few days, I've heard many patient requests - what is important to them. These include: my clinic staying open until 10 p.m. every night to avoid unnecessary emergency department visits, specialty care provided within our system instead of being referred out, desire for electronic visits, and expectation that care from primary care to surgery to hospitalization to inpatient rehab stay be coordinated. Often, these feel like complaints rather than requests. Then I think about how hard it is to ask primary-care providers to work until 10 p.m. or the limits I have in making specialists manage care a specific way or the barriers to doing what I do in an exam room over the computer.

However, this type of thinking will get us more of what we have: care that may meet guidelines but not patient expectations. Therefore, the challenge is to provide what patients expect in a way that maintains the highest quality of care and exceptional customer/patient experience while assuring that we're not meeting customer experience on the backs and at the expense of the members of the healthcare team.

Like all changes in healthcare and beyond, culture must change first in order to assure success. My medical training culture did not emphasize or highlight this aspect of patient care, but I hope the next generation of physicians is trained differently.