Patient Perception is Reality.

By William P. Summers
Director & VP
(Note: This is a personal opinion article by Mr. Summers)

Patient perception of the quality of care could be the ultimate critical long-term measure of whether a health care practice will thrive, die, or simply survive.  In situations where patients have a selection of providers to choose from (and the resources to make the choice); they will choose the provider that they perceive brings the most value.

To be specific, they will choose the provider that they feel is most “in-tune” with their needs, has their best interests at heart, and who they believe will provide the best level of health care.  Health care providers should put themselves in the shoes of patients and families.  They are the customers. 

If you were faced with a potentially life threatening illness wouldn’t you ask yourself, “Where (at what specific provider) do I stand the best chance to get better?”

The purpose of this article is to provide health care professionals some insight regarding how one “patient” perceives quality of care.  This article is more about subjective personal experience as opposed to rankings from national publications such as U.S. News & World Report.

Does subjective personal experience matter?  It does in a world where we have the freedom and resources to make a decision along with the online tools to quickly gather the personal experiences recorded by others before us!

There is a restaurant near the town where my family lives that I’ve had dinner at twice.  The first meal was un-memorable and the second meal was just plain bad.  Needless to say, no matter what ranking they might get in the local paper, I won’t be going back.  (And all my friends and family know I won’t be going back.)

Perhaps you are thinking quality of health care and quality of restaurant meals may not be the best basis of comparison.  It may not be… However, the point of this article is about the importance of customer (patient) perception and how it may affect the organization.  In the case of the restaurant, not only did they lose my business; they lost my wife’s business, potentially some of my friends’ business, and quite possibly the business of tourists who might happen to ask me for a recommendation.  (Since my wife and I own a small retail store, you’d be surprised at how many visitors ask us our opinions.)  The point is that word travels fast.

Whether your organization is a non-profit hospital, a privately held medical practice, veterinary clinic, etc.; your organization is a business.  Businesses depend on customers to survive.  All businesses need to focus on providing the maximum value to their customers.  In the case of health care providers, the internal questions that need to be asked might be; “What can my organization do better to give the patient and her family more confidence in us?  How can we ensure that our patients view us as providers of excellent health care?  How do our patients perceive us?”

In other words, if your organization is serious about its business; your organization is working hard to ensure that patient (customer) perception of your organization is excellent.

Significant personal experience (as a patient, visitor, and family member) has shaped how I formulate my perceptions of health care quality and value.  I consider at least the following:

  1. What is the reputation of the organization?
  2. What kind of impression do people get when they visit your facility?
  3. What is the personal “patient experience” like at your organization?

Reputation is important to the extent that it sets the expectation of the patient experience.  A bad reputation is difficult, costly and takes a lot of combined effort to reverse.

I know the CEO of a hospital in the rural southeastern USA.  The doctors on staff at this particular hospital have been known to refer patients outside of the hospital network because of the lack of faith they have in their colleagues. 

The CEO is very astute from a marketing and public relations perspective and believes that this habit of referring patients out-of-network is damaging not only the immediate revenue streams of the hospital today, but the reputation of the hospital long-term.   A bad reputation affects not just the sub-standard physicians that aren’t receiving the in-network referrals; it adversely affects every employee at the hospital (including the doctors who are making the referrals out-of-network).  Since this hospital is in a rural area, it also negatively affects the entire community.

The CEO is in the process of re-structuring the internal physician peer review board.  He is adamant that any sub-standard physician needs to be dismissed from the organization because, according to him, “An organization is only as strong as its weakest link.” 

This hospital is faced with the daunting task of changing the culture of an entire organization.  Not only is the task difficult, it might end up being very expensive as it certainly requires a significant time investment and could result in employment and/or contract terminations along with all of the associated headaches that come with restructuring.

From a business perspective, it is necessary and worth it long term to lead this hospital through a cultural and organizational “shake-up.”  Within a tight-knit community, you can rest assured that word travels fast when a family member, friend, or neighbor has to drive an hour away to another community hospital just to see a specialist even though one might be already available close by. 

The out-of-network referral often breeds suspicion and fear as the questions go from, “What’s wrong with that doctor?” to “What’s wrong with our hospital?” to the statements; “There must be something wrong there,” and, “I’m not going to the local hospital if I can help it.”

No matter the size of your market or the amount of competitors close by, the lesson is to not let your reputation become tainted in the first place.  Executive management could have and should have spotted the out-of-network referral trend described above a long time ago.  They didn’t – or they simply chose to ignore the situation.  This hospital is now faced with an uphill public relations fight.  (Does your executive management regularly review the referrals made by staff physicians?  What is your organization’s referral policy?)

Reputations set the expectations of the patients and their families.  An absence of a reputation is better than a bad reputation because an organization is starting with clean slate and has the opportunity to build a great reputation.  The best case scenario is certainly already enjoying an excellent reputation.  Once the positive reputation is established, it becomes a matter of staying on top of one’s game to maintain the excellent reputation.  To do this, an organization must continue to deliver and even follow the Japanese “Kaizen” principle of continuous improvement.

How could an excellent reputation positively affect our business?

Recently a good family friend stayed with us in our home as a guest due to the fact that he had sought out “the 5th best cardiologist” in the USA to examine his heart and provide advice.  This doctor happened to be local to us in the Charleston, SC area.  The doctor’s diagnosis called for a cardiac ablation procedure.

Largely due to the reputation of the doctor, our friend was at ease with the diagnosis and immediately scheduled the procedure without considering a second opinion or second guessing the doctor. Read more...