Patient Surveys Guide Competitive Strategies

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Asking customers what they need is one of the best ways of retaining their business, in the experience of Frank J. Lexa, MD, MBA. Lexa is clinical professor of radiology, University of Pennsylvania Medical Center, Philadelphia; professor and Asia regional manager of The Global Consulting Practicum and adjunct professor, department of marketing, The Wharton School, Philadelphia; and adjunct professor of biotechnology, Instituto de Empresa, Madrid, Spain.

Frank J. Lexa, MD, MBA

He presented Service and Quality Methodologies: How to Find Out What Your Patients Really Want at the 23rd Annual Economics of Diagnostic Imaging 2008: National Symposium in Arlington, Va, on October 25. There is, he says, no other $2 trillion industry on earth that exhibits the level of stakeholder dissatisfaction seen for health care today.

Part of the problem, he adds, is that there are so many stakeholders, several with interests and incentives leading them in different directions. The customers of imaging facilities, for example, include nearly everyone, at some point: hospital executives, joint-venture partners, private and public payors, regulators, quality/service aggregators, and referring physicians and their office personnel—in addition to patients and their significant others, friends, and relatives.

A customer, Lexa says, must be defined not only as the entity that decides to purchase medical services, but also as the individuals and organizations responsible for influencing purchasing decisions, designing and entering contracts, regulating businesses, and affecting how brands are perceived by any of the other customers. Quality and service will be seen differently by these groups, as well as by those within them. For this reason, quality and service in health care need not only closer attention, but better definition. Both can begin with an internal survey of patients’ service/quality opinions and concerns.

Why Surveys Are Needed

The forces driving health care providers to scrutinize their quality and service levels, Lexa says, are led by unsustainable economic pressures combined with both local and national increases in the intensity of competition among providers. Other drivers are concern for patient safety, escalating scrutiny of medical practices by both private-sector organizations and government agencies, and the sometimes profound effects of medical errors on individuals. In addition, the reports on quality (including the influential To Err Is Human¹) that have been issued by the Institute of Medicine over the past decade have served to inspire quality initiatives in the public and private sectors.

That book’s 1999 publication, Lexa notes, came a full 30 years after the public’s respect for the medical profession began to decline from its 1969 peak. Today’s physician is far less likely to practice medicine unquestioned, and today’s model of medical-service delivery has changed just as much. By 2010, there may be 29 million health savings accounts in use, as part of what Lexa describes as health care’s retail revolution.

This change will put as much as $600 billion of premiums under consumers’ control, instead of being spent at the discretion of employers or government programs. With individuals making more of the spending decisions, a proliferation of providers stressing convenience can be expected, with MinuteClinic™ and similar in-store, retail health services being examples of this shift.

For this reason, conducting surveys to determine what patients think of a practice, and what they need and expect from it, has become more important than ever. As Lexa points out, the providers and recipients of care see the process quite differently. Of course, the customer is not always right, but knowing which changes the practice should make to improve its competitive abilities depends on understanding the customer’s point of view.

A survey can be among the best ways to elicit that viewpoint. Even when the customers are wrong, surveying them to find out what they want will provide the practice with high-quality market research at a relatively low cost. In addition, the feedback that the survey process provides for the practice’s managers lets them know where employees are doing well and where changes are needed.

Designing the Survey

Lexa reminds practices that it is important to know not only what questions to ask, but why to ask them. Making a survey longer by asking questions that will not lead to any action can