Health systems ramp up consumer research to improve care experience

When leaders at Avera Health in Sioux Falls, S.D., wanted to make improvements to its women's health service line, they turned to a group of 3,500 patients for ideas.

The patients, part of Avera's online consumer panel, are asked to give their thoughts on all sorts of matters going on at the health system. Avera also organized focus groups with about 90 women both virtually through online chat sessions and in person.

Research shows women drive the majority of healthcare decisions for their family, so Avera wanted to target that population to help establish customer loyalty.

From the patients, Avera learned it had relatively outdated facilities. The system is now making some changes, including relocating where pregnant women enter the building after normal business hours to avoid steep ramps and working with the clinical team to simplify health screenings and cancer services.

“If you don't walk the patient journey, you may not have known that,” said Kendra Calhoun, Avera's senior vice president of marketing.

The online panel and focus groups are part of a larger effort by Avera to increase research on its patients to understand them better and improve the patient experience. Experts say Avera isn't alone.

“You need that competitive edge and if you don't know your customers, you aren't going to be able to do a good job getting new ones,” said Stewart Gandolf, CEO of Healthcare Success, a healthcare marketing and advertising agency.

A growing number of health systems are amping up their consumer research investment to enhance patient satisfaction and establish brand loyalty as consumerism takes hold in the industry. But convincing hospital administrators and boards that there is a business case for this work remains a challenge for many organizations, experts say.

Consumer research historically hasn't been taken seriously by hospital leaders, Gandolf said. Administrators and physicians traditionally harbored long-held assumptions about what patients expected from their healthcare experience, so budgets to conduct research have typically been small and marketing leaders often had a hard time making their cases to the C-suite that their findings were valid.

“It used to be people in the marketing department were just sort of there,” Gandolf said. “No one thought of marketing research and they were only vaguely aware it existed.”

As patients wield greater power in their healthcare choices, more health systems are taking consumer research seriously to attract and retain customers. The research is often used to improve patient satisfaction and establish brand advertising.

But the providers making substantial investments in research—usually through their own internal research arms—are still few and far between, said Rob Klein, founder and CEO of healthcare marketing research firm Klein & Partners. Whether or not a system has an internal consumer insights function “is a matter of the attitude of who is in charge. Does the CEO get it?” he said.

Health systems in competitive markets or with a large national reach may be more likely to see the benefits of having a consumer insights function, but Klein argues all hospitals and health systems stand to gain from the research.

“If there was ever a need for data-driven decisions, it's now,” he said. “CEOs are increasingly looking for return on investment so they want metrics, they want decisionmaking based on facts.”

National provider Ascension is one of the few systems that has established its own consumer research arm, having done so nearly four years ago. At the time, Ascension was in the beginning stages of a rebrand to integrate its clinical and operational functions in reaction to industry changes, including the entrance of retail competitors and consumerism.

“The decision was made that we need to be more integrated, have a strong brand and be more consumer-facing,” said Nick Ragone, Ascension's chief marketing and communications officer.

One benefit of having an internal consumer insights department is that the data generated are relevant to the system's work and can be incorporated with Ascension's clinical data, said Chris Manley, the system's senior director of market and communications intelligence. “And the work is continuous.”

A recent project that Manley and his team worked on was assessing online reviews about Ascension's emergency departments to improve patient experience. Manley's team read all the reviews online and assigned each a star rating from 1 to 5, with 5 indicating an excellent experience. Ascension found that about 75% of negative reviews noted long emergency department wait times while positive reviews touted the friendly staff but didn't often mention short wait times.

Taking that data, Ascension is testing new interventions. For instance, the system is working on a protocol to have an ED team member check in with any patient who has been waiting for at least 30 minutes to ask them how they are doing and explain why the wait is long. Another pilot project involves speaking with patients shortly after they have arrived to explain the triage process.

Manley said Ascension's research found patients didn't understand the process and felt anxious about their condition when they had to wait. “If we can do little things for people who are feeling that way, those people are going to have a better experience even when the wait times might not change,” he said.

Calhoun at Avera also touted the benefits of having an internal research arm. “It offers more continuity with our focus and our tactics than if we were piecing it together,” she said.

But even health systems that don't have a consumer insights department can make meaningful inroads in research. Henry Ford Health System has increased its research work over the past few years to improve the patient experience as its footprint grows.

“Our desire to grow and attract patients is a big reason why we have focused on the customer experience because you can't grow if you don't have good customer satisfaction—your reputation will kill you,” said Gwen Gnam, Henry Ford's chief nursing officer and vice president of patient-care services.

After conducting an extensive review of the patient experience literature, Henry Ford decided to implement leadership rounding in 2012.

Nurse managers on each of the units are expected to speak one-on-one with half of the patients on their floors daily. The nurses ask patients at least five questions about their experience, which they log on a tablet. Negatives like cold food or confusion about care are expected to be addressed immediately.

The data logged by the nurses are analyzed regularly to address frequent complaints. One trend Henry Ford spotted initially was confusion around discharge. So the system began new protocols, including speaking with the patient and family members 24 hours before the expected discharge to go over the care plan. Henry Ford has seen a 50% improvement since 2012 in the percentage of people who have answered that they understand the discharge process.

“Patients have a choice of where to go and that has accelerated the need for us to be more convenient and communicate better because we want them coming to us,” said Vanessa Mona, director of care experience at Henry Ford.

University of Missouri Health Care also doesn't have its own consumer insights department but has worked with a company to measure its net promoter scores, which is a relatively new research tactic in healthcare that assesses customer loyalty.

“We can understand how patients are going to behave in the future,” said Kevin Gwin, chief patient experience officer at MU Health Care.

Either over the phone or in an email, patients are asked if they would recommend MU Health to either a family member or a friend. The survey has a 30% response rate in its inpatient setting and a 10% response rate in its ED.

MU Health has used net promoter scores to understand the experiences of patients treated in different sections of the ED. The surveys showed patients in some sections gave negative scores while those in other sections reported positive scores. Focusing on the sections with negative scores, Gwin and his team asked patients what could be improved.

In response, MU Health installed better seating and added privacy curtains. The net provider score for one section of the ED improved from a baseline of -18.8% in November 2016 to September 2017 to 25% in the second quarter of 2018.

“Most systems when seeing a mediocre or low number in their ED don't know where to start,” Gwin said. By using net promoter scores, “it provides these breakthroughs about where to focus solutions.”

The stakes are high for health systems to adopt innovative solutions such as those that address patient needs.

“The retailization of healthcare is here,” Klein said. “Years ago, consumers would compare you to another hospital or doctors. What's changed is consumers are asking why can't you be like an Amazon?”