Ep. 38 The Real Cost of Patient Dissatisfaction & What to Do About It

by | Mar 9, 2023

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With all the financial demands and technology fatigue, it is so easy to lose sight of the human side of healthcare. But the healthcare world now gravitates toward a patient-centered model as patients behave more like consumers, the market becomes more competitive, and the industry shifts toward value-based care.

One compelling outcome of patient dissatisfaction is the financial impact. For starters, the Medical Economics Journal reports that negative word-of-mouth about a hospital or health system can lead to a loss of up to $400,000 over one patient’s lifetime. Poor performance in patient satisfaction can also predict the chances of a medical malpractice event – something all medical practices want to avoid.

In essence, the shift to a patient-centered approach is an appeal to empathy and fostering trust. “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel,” is a Maya Angelou quote that guest Monty Pate considers to encapsulate the essence of patient sentiment.

We are pleased to welcome Monty Pate back to the podcast!  Monty is an Executive Healthcare Consultant with Medical Advantage who recently led the discussion for our episode on Recruiting Physician Leadership for Health System Success. In this episode hosted by Rebekah Duke, Monty walks us through the ramifications of patient satisfaction, but also long-term and short-term solutions to underperformance this area.

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Full Episode Transcript

Medical Advantage Podcast: Welcome to the Medical Advantage Podcast, where you can hear healthcare professionals, expert consultants, and industry thought leaders discuss the exciting new ideas and technologies that are changing the business of healthcare. Tune in to each episode as we hear from some of the most innovative minds in medicine about the future of healthcare and how your organization can stay profitable, efficient, and on top of industry best practices. 

Rebekah Duke: Welcome everyone to the Medical Advantage Podcast. I’m Rebekah Duke, your host for today’s episode. Today, I’m delighted to welcome back a return guest, Monty Pate, our Executive Healthcare Consultant here at Medical Advantage. In a previous episode, he walked us through physician engagement but today we will discuss the broad impact of patient satisfaction, most notably how it impacts practices financially as well as patient care outcomes. 

But before we get started, we’ll do a quick intro for first-time listeners. This podcast is produced by Medical Advantage. Medical Advantage provides consulting design to help practices improve care quality, reduce healthcare costs and increase revenue. Our broad portfolio of services optimizes operations for medical practices, specialists, groups, and private equity. 

So the prospect of patient satisfaction has gained more and more relevance in recent years. A few of the reasons being the transition toward value-based care, plus the rise of healthcare consumerism. We’re beginning to learn the tangible benefits of the patient-centered model. So what are the mechanisms at play here? How can a medical practice respond to a decline in patient satisfaction? Let’s dive in.  

Monty, welcome.  

Montgomery Pate: Thank you. Glad to be back.  

Rebekah Duke: Thank you. So we hear the term patient satisfaction and we can make a lot of assumptions of what that means, but what does it really mean in the context of healthcare operations? 

Montgomery Pate: Well, sure. The textbook answer, if you will, pertains to whether a patient’s expectations were met during the medical encounter. In my opinion, that’s a pretty dry explanation. From my perspective, from a career in healthcare, I think it goes much deeper than that. I go back to the Maya Angelou quote. We’ve all probably heard it at one time or another. She said, “People will forget what you said. People will forget what you did, but people will never forget how you made them feel.”  

And that encompasses things such as did you feel respected, valued, listened to during your medical encounter? Did you feel a sense of empathy from staff and providers? And did you have a sense of trust in the healthcare team? To me that’s the essence of patient satisfaction.  

Rebekah Duke: Yes, it makes perfect sense to bring empathy back into the equation, Monty. So if I’m an organizational leader, staff member or provider, why should I be concerned about patient satisfaction?  

Montgomery Pate: Well, there are two very important reasons, and I think you touched on them both. 

The first of which is that patient satisfaction has a direct impact on financial success. The second is that there is in fact a direct correlation between patient satisfaction and positive clinical outcome.  

Rebekah Duke: Yes, intuitively, we know that patient satisfaction can have impacts on both financial and care quality, but could you provide some specifics on how this works so that we can get a full picture? 

Montgomery Pate: Certainly we’ll start with the financial aspect and in short, it costs an organization more to acquire a new patient or a new customer than to retain an existing one. And I’ll give you some some points for consideration, let’s look at marketing. Marketing is an expensive endeavor for any business. Healthcare is no exception. You end up investing quite a bit in a web presence, social media, reputation management, television, print, all of those things that you do to attract new patients.  

The other aspect is anytime you bring on a new patient there’s staff and time requirements that are needed to properly onboard that patient. When you bring a new patient into the enterprise, you have to do things such as patient registration, gather demographics, gather insurance information, transfer medical records, and all of those things have an expense associated with it.  

Finally, I would add that anytime a patient changes providers, you put continuity of care at risk and I’ll focus strictly on the the financial aspect of that. Anytime, there’s an interruption, continuity of care, patient changes, providers, you can potentially interrupt therapies, chronic care management, drug regimens, and any of this interruption in preventive or maintenance care can lead to acute episodes which result in the patient going to the emergency department or even resulting in a hospital admission, and that is a much more expensive means of healthcare delivery. The Harvard Business Review in an article in 2014 said that acquiring a new customer is anywhere from 5 to 25 times more expensive than retaining an existing one.  

The other aspect financially, we talked about the expense involved to bring on a new patient, but there’s also lost revenue due to patients who leave your practice. As you mentioned, patients over the last decade have become increasingly consumer oriented. Their expectations now are very high. They expect access, expect seamless care. They’re looking for telehealth and they’re looking for a positive experience with providers and staff. And patients are very willing to shop, compare, and very quickly change providers in order to have those needs met. 

Patients leaving your catchment area for care that meets their expectations, even though it may be further away than your practice. In the business that’s known as out-migration, and that’s one of the many things that keeps practice leaders up at night.  

Also, human nature being what it is, people are very quick to share their experiences with family, their social groups, and put them on social media. And to give you an idea of the severity of the impact, the Medical Economics Journal in 2021 published an article stating that the negative word of mouth about a hospital or health system could result in revenue losses of up to $400,000 over one patient’s lifetime. 

Rebekah Duke: Wow, that’s probably significant. And it’s also important to keep in mind that negative patient sentiment over time can really erode faith in the healthcare system in general.  

Montgomery Pate: No, you’re absolutely right. That’s a great point. And I’ll add one other element in terms of potential exits, and no one likes to talk about this in the medical industry, but that’s malpractice claims and research shows that there is in fact a direct correlation between how a physician is perceived in patient satisfaction and the likelihood that they will be a party to a malpractice claim.  

And even in the best case scenario, let’s say the malpractice , is resolved in a way that the provider is cleared of any offense, the judgements for the defendant. It’s still a great investment of time resources and an absolute distraction from patient care. And not to mention the anxiety that’s created overall in a malpractice situation. So that’s, really the main elements on the expense side.  

Now, you had mentioned clinical outcomes, and you’re absolutely right. There is in fact a direct correlation between patient satisfaction and positive clinical outcomes. And I think this is something that most clinicians do know intuitively, that happy and trusting patients tend to be more compliant, which leads to better results. So as a result, providers must work very hard to establish trust and to build a positive relationship with their patient.  

Rebekah Duke: Yes, trust seems to be the core matter at hand here. So with our healthcare providers, what are some of the keys to establishing that trust?  

Montgomery Pate: Well, I can tell you during my career in healthcare operations, the number one patient complaint that I received was, my doctor does not listen to me. With that in mind, providers need to practice intentional listening, and that means being attentive, making eye contact, ensuring the patient feels heard, and also responding empathetically. 

It’s also very important for providers to communicate in a manner easily comprehended by the patient. So don’t talk above the patient or below the patient. As you’ve heard before, know your audience and that really applies to medical providers as well. And finally, I would say that the provider needs to explain the what, the why and the what’s next regarding the encounter.  

As we become more consumer oriented in healthcare, patients are expecting to know about their treatment plan in far greater detail than previously. The bottom line for all of this, I think you can ask yourself, am I treating this patient in a way that I would want for myself or my loved ones? I think that’s a good question to always keep in the forefront of any patient encounter.  

Rebekah Duke: Exactly. That’s a very helpful perspective, and I understand that providers are continuously challenged with the fact, a laptop seems to dominate that encounter. So it’s a matter of finding balance between inputting to your EHR and engaging with your patients, so,  

Montgomery Pate: Absolutely. Absolutely.  

Rebekah Duke: So patient satisfaction does not just rest on one set of shoulders. What responsibilities do each member of a practice team have?  

Montgomery Pate: Well, Rebekah, that’s an excellent observation. It does not rest on one set of shoulders. And in fact, patient satisfaction it all starts with that very first contact and in most cases, that’s with scheduling.  

This is the voice of your practice. So when the patient calls in, they should have someone on the other end of the phone that is empathetic, knowledgeable, polite, but also reassuring. Next we’ll go to the front desk and this is literally the face of your practice.  

And I have seen firsthand scenarios where a provider can do all of the right things. They can make the right diagnosis, provide the right prescription, do the right procedure, and have a very successful outcome. But If the office experience is bad, that patient will go somewhere else. 

And some examples of what I would say terrible experiences would be at front desk that’s inattentive or long wait times in the waiting room without any type of explanation or just an an attitude or tone that curt or short with the patients. Or even at times, unfortunately, you may be privy to private discussions going on in the work area. All of that really sets a bad tone and degrades the experience.  

Also, part of the team are your nursing staff, and they have a great impact on this. And when I say nursing, I mean your medical assistants, your LPNs, RNs, your technicians, all of those. And there’s things that they can do or unfortunately sometimes don’t do, that can have an impact on the patient experience. Oftentimes these staff members will not identify themselves, not explain what is going on or why, not communicate in terms of what comes next in the patient journey. And they too can be curt in tone or mannerism.  

And again, we come back to the empathy. Oftentimes during the course of a busy day, it’s easy to not display that empathy that is really needed.  

Next will come to the providers themselves, and I would say with the providers, it all comes down to communication, empathy, and intentional listening as have been described previously. A report in the Medical Group Management Association, listed bedside manner and communication as among the top influencers of both positive and negative physician reviews.  

The final step in the patient journey is the billing experience, and some people may scratch their head and say, well, why would that have an impact on patients? I can tell you that a bill that’s overly complicated, difficult to understand or that is not in line with the expectations that have been previously set by the practice can quickly erode any previously gained trust.  

Rebekah Duke: That makes sense. You know, patients are already very nervous about healthcare costs, so for practices who have taken the time to give surveys, read their online reviews, and from the feedback they figure out that they have plenty of room for improvement, what are some immediate actions that can be taken to address this? 

Montgomery Pate: Certainly. There are some easy no-cost actions that all staff and providers can immediately take. And these are the types of things that leaders should ensure, are continually monitored and reinforced through staff meetings, your morning huddles, one-on-one encounters, the bulletin boards in your break room, and I’ll go through a few of them. 

Again, one of the key words that we hear over and over is empathy, and we need to remember that many, if not most of our patients have a degree of anxiety about the encounter. So keep that in mind and act accordingly. Make eye contact, we’ve all been in a situation where we’ve had someone across the desk speaking to us, yet appearing totally detached. That’s not a good feeling for yourself.  

Busy medical practices have a variety of individuals as part of the patient appointment. Everybody from your front desk, your medical assistants, your technicians, nurses, residents, nurse practitioners, and the doctors. With all those people involved, it’s very easy for a patient to become overwhelmed unless they clearly understand who you are and what you are doing. 

Another key point, listen with intention. Even though you may have that medical chart, that patient record in front of you, do not presume to know the patient’s needs or circumstances. Allow them to speak and finish their thoughts before you interject. I would also say present a pleasant persona.  

And so am I saying that as an employer or provider, if you’ve had a terrible rotten day, that you’re supposed to act happy? Well, in short, yes. But the key word here is pleasant. You are a representative of the practice and you have a great opportunity to calm nerves, provide reassurance and contribute to a positive experience. And for myself personally, I consider it a privilege to work with patients and your demeanor should reflect that. Also, let the patient know what comes next in the appointment journey. Make sure you set those expectations not knowing what comes next only adds to anxiety. 

And finally, thank the patient for their visit. And I’ve had some people question me on that. Why would you say thank you for coming to the doctor’s office? Well, healthcare is a consumer oriented competitive environment, and patients today have a lot of options. So let the patient know that you appreciate them for selecting your clinic for their care.  

Rebekah Duke: Yes. Good old fashioned communication skills. Perfect. So these strategy ideas segue perfectly into long-term discussion. What are some foundational aspects of patient satisfaction framework?  

Montgomery Pate: Sure. You do need to have a robust, sustainable patient experience program as part of your practice or health system, and it should be as important and given as much focus as any other program within your clinic.  

The first thing you need to do, the starting point, is to assess your current state regarding the patient experience, and a quick web search will tell you that there’s numerous vendors out there who provide survey and reporting tools that provide deep insight into the performance of your providers and staff. Scoring is typically provided by clinic and provider. And benchmarked against the peers within the practices specialty. Patients are also usually given the opportunity to provide comments, and that’s a great opportunity to even dive deeper in terms of the patient experience.  

Next you need to work towards developing a culture that embraces and in fact expects a great patient experience. And I would strongly recommend creating a cross-functional patient experience team that can help cultivate ideas and initiatives geared towards improving patient satisfaction. When you do that, be sure you include representatives from the front lines within the clinic, including admin and clinical staff, as well as your ancillary services and your providers.  

Next, you need to make sure all of your staff and providers understand the why behind the need for a great patient experience. Aside from being just the right thing to do, it’s important that everyone in the organization understands that this is not merely another program coming out of the C-suite. And it becomes easy to ignore initiatives in light of the tremendous workload that staff and providers face. However, you have to make the point that this is a vital component of revenue, success and optimal clinical outcomes. 

Next look for the provider champions. And these are providers who understand the why behind the need for a great patient experience, and also ones who are vocal proponents of the program and are in fact willing to talk with their peers. You need to have those providers share best practices and provide reinforcement. Reinforcement from fellow providers is always essential with any new initiatives.  

Next as the old adage goes, you cannot improve what you don’t measure. So monitor performance results and incorporate those into your practice system, key performance indicators and reporting metrics. And I’ll say here, visibility is key. You do not want to do the reporting and get the data and then put it on a shelf somewhere to collect dust.  

You need to make sure that your senior leadership, practice management, staff and providers are aware of their performance and that those stakeholders own the results. In my own personal experience, I have found that some interesting and actually very positive things begin to happen when you make these scores visible within the organization. I’ll say that providers by nature are high achievers and they become very curious when they see that their peers are scoring higher than they are. You know, you hear comments in the hallway, “Hey, why the heck is my score less than that of my golfing buddy Bill?” So, interest in the concept is now triggered. Then you see providers in clinics organically begin to share best practices and organically begin to celebrate wins for improvement.  

So all of those are good things and all of those are initiated by making that data and those scores visible. So what about your low performers? Well, data is only good if it’s used. So you need to develop and implement action plans that address the low performers. And again, you can utilize input from your patient experience team, your provider champions and best practices from your high performing clinics and providers to develop the approach. You need to create strategies, define your improvement actions, have timelines, identify who the stakeholders are, and continue to monitor results and adjust strategies as needed. 

Be sure you set goals that are attainable. Remember, culture does not transform overnight. So establish realistic goals with defined pathways towards achievement. Again, it bears repeating, celebrate those wins, recognize contributors at all levels in the organization. Providers of course, but also everyone, as you mentioned carries a portion of the responsibility for patient satisfaction: individuals at the front desk, schedulers, medical techs. Wherever you find those wins make ’em visible, acknowledge and celebrate.  

Finally I’ll give a word here about technology. When it comes to the patient experience. Tech, as we know, is an incredible tool that can be leveraged. There’s all types of functionalities that can if used properly, can enhance the patient experience. Things such as online scheduling, online registration, text reminders about appointments, being able to log on and pay your bill online, telehealth. All of that are great but the main caveat is it must be combined with a culture where a great patient experience is the expectation in order to get the maximum return on your investment. 

Rebekah Duke: Definitely agree that you need to find a balance between technology and remembering the human side of care. And this concludes our discussion for today. Thank you so much, Monty, for sharing your insights.  

Montgomery Pate: My pleasure, Rebekah.  

Rebekah Duke: Thank you audience member for joining us today. Should you have any questions about patient engagement solutions, please email us at info@medicaladvantage.com. Catch future episodes by subscribing to our channel wherever you get your podcast, and opting in for notifications. Goodbye for now. 

Medical Advantage Podcast: Thanks for joining us this week on the Medical Advantage Podcast where we discuss the ideas and technologies changing healthcare and what they mean to your organization. For more information, visit us at medicaladvantage.com and make sure to subscribe to the podcast on iTunes, Spotify, or wherever you get your podcast, so you never miss a show. 

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