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MARKETING STRATEGIES
Amy Chappelow, a charge nurse at J to provide excellent care, to encour- ohnson Memorial Hospital, strives
age her nurses to connect with patients. But
these days she doesn’t just track feedback by
reading dry statistics on patient surveys.
Instead, Chappelow and other clinicians
at the 149-bed nonprofit hospital in Franklin,
Ind., call patients within a couple of days following discharge. After asking a few clinical questions—to clarify discharge orders, for instance—
Chappelow ventures into riskier territory: How
did they perceive their care and what can Johnson Memorial do better? Much of the feedback
is positive, Chappelow says: “I think it makes
them [patients] feel good that we are taking the
time to show our concern.”
The phone calls, now required for roughly 3,000 medical-surgical discharges annually,
are part of Johnson Memorial’s heightened effort
this year to capture patients’ hearts, rather than
just their hospital charges. Along with the discharge calls, clinicians send thank-you cards and
make more frequent patient checks on the floors
to assess the so-called “three Ps”: pain, positioning and potty needs.
The goal: to provide a “wow” hospital experience rather than a merely satisfactory one, says
Louise Neufelder, vice president of patient care
services. “So they want to come back here because
we meet all of their needs.”
Johnson Memorial, which already has
received encouraging survey feedback, joins a
growing cadre of hospitals that believe too much
emphasis on traditional patient satisfaction scores
misses some of the more emotional—and yes,
elusive—facets that shape a patient’s overall experience. Identifying what inspires loyal, even passionate, patients can more effectively boost a hospital’s market share and thus its bottom line,
they say. It’s an evolving concept and not one
that all health care research firms and hospitals
fully embrace or agree about how to quantify.
Still, patient loyalty measures are providing some
additional illumination in today’s competitive
hospital marketplace.
Enthusiasts, like marketing director Janna
Binder, take a far stronger position. Satisfying
patients means nothing more than meeting
expectations, says Binder, of Professional
Research Consultants, a marketing research organization in Omaha, Neb., that includes Johnson
Memorial among its clients.
“The better payoff overall is finding those
patients who think you’re very good and like you
and turning those patients into ones who love
you,” Binder says. “Patients who will drive across
the city to go to you. And if their insurance doesn’t cover you, they will throw a complete hissy
fit with their employers.”
The Loyalty Question
When it comes to measuring and cultivating loyalty, hospitals have lagged behind other industries, such as retail or travel, says Scott Simmons,
a managing partner with the Gallup Healthcare
Group, a consulting arm of the Gallup Organization. The prevailing assumption has been that
insurance drives hospital decisions, he says.
I l l u s t r a t i o n b y C S A / S n a p s t o c k
How ‘Wowed’ Are
Your Patients?
Consumer loyalty—not satisfaction—
is what hospitals really need to measure,
some experts insist
BY CHARLOTTE HUFF
Created from original published content in Hospitals & Health Networks
November 2007 Volume 81 Number 11 ©copyright by Health Forum Inc.
All rights reserved. For electronic use only–not for reprinting purposes.
MARKETING STRATEGIES
“But that’s changing now,” says Simmons,
citing a shift toward consumer-driven health care,
along with the release of quality data by Medicare
and other organizations. “Health care is waking
up to the fact that people do have choice,” he
says. “And in the future, they will have even more
choice.”
Beginning next year, the first HCAHPS
scores, called the Hospital Consumer Assessment of Healthcare Providers and Systems, will
be published online, providing a public window
into how patients perceive doctor communication, hospital staff responsiveness and pain control, among other issues.
As of this fall, one of the proposed questions will ask a patient’s likelihood to recommend, a cornerstone of any loyalty data discussion in the wake of a widely cited 2003 analysis
in the Harvard Business Review.
The study, authored by Frederick Reichheld and based on data from more than 4,000
consumers, used 14 case studies across six industries to determine what questions would best
gauge customer loyalty. The overwhelming
choice: “How likely is it that you would recommend this company to a friend or colleague?”
In short, people will make a recommendation, and put their own reputations on the line,
only if they feel intense loyalty, Reichheld wrote.
Word of mouth is powerful, as Mayo Clinic officials can attest. Given the lengthy distances
that patients often travel to get to Mayo, they don’t
necessarily return for more routine care, says
Laurie Wilshusen, a marketing director in Arizona who is responsible for marketing research
and patient satisfaction measurement at the
Mayo Clinic’s three locations—Jacksonville, Fla.,
Rochester, Minn., and Phoenix/Scottsdale, Ariz.
“We do want them to tell their friends and family at home—that when they are really sick, Mayo
is where they want to go. We want to inspire that
kind of loyalty.”
If You Say So
In a late 2006 survey, when asked where they’d
seek care if money and logistics were no obstacle, nearly 12 percent of 1,000 American adults
gave Mayo as their first response. More than
three-fourths—84 percent—reported word of
mouth as the reason, far outpacing other sources
such as media stories (57 percent) and physician
recommendations (44 percent).
Patient loyalty, of course, doesn’t evolve in
a vacuum. To that end, PRC officials studied the
relationship between likelihood to recommend
and other variables, based on 2006 data involving nearly 176,000 patient visits. Of those patients
rating quality of care as excellent, 87 percent also
described their likelihood to recommend as excellent. Among those who described their care as
very good, just 23 percent were similarly likely
to recommend, a dramatic split, Binder says.
“Even very satisfied patients will walk down
the street—they will go to the competitor,” Binder
says. “It’s those ‘wowed’ patients who will keep
returning.”
If hospital leaders lump the “excellent” and
“very good” responses into one category, rather
than breaking them out, Binder says: “It masks
those [patients] who really love you.” Plus, it misses an opportunity for improvement. “The fastest
way, if you want to improve your scores, is to
move those ‘very goods’ to ‘excellents.’ ”
Fred Lee, a national patient relations speaker and consultant, says hospital leaders can gain
the most useful loyalty insights if they incorporate a 10-point scale, as used by Reichheld.
If the survey contains just four gradations
or fewer, hospital administrators risk losing
meaningful distinctions, says Lee, author of If
Disney Ran Your Hospital: 9 1/2 Things You Would
Do Differently.
What’s a Synonym for Compassion?
Another issue, Lee says, is that hospitals don’t
typically ask the types of questions that would
best reveal what he calls “promoters”—the most
loyal patients. He describes one eye-opening
experience, when he sifted through grateful
patient letters sent to an acute care hospital. All
contained surprisingly similar words, he says:
kindness, caring, compassion, comfort, helpful
and so on.
“The synonyms for compassion are not on
our surveys,” Lee says.
“Our current scoring system allows us to
assume we have a lot more [patient] loyalty than
we do,” he says. “We are overflowing that bucket based on how we score things. That makes
people more optimistic than they should be about
the number of promoters they are getting.”
Not everyone is convinced, though, that a
tight focus on “top box” scoring is the best way to
boost patient care.
By adopting that mind-set, hospital administrators will miss the opportunity to better understand and address the needs of less enthusiastic patients, says Melvin Hall, chief executive
I l l u s t r a t i o n b y P a u l G i l l i g a n
The Long Referral Arm
To get a better sense of the potential
extent of patient-to-patient referrals, Mayo
Clinic officials surveyed 1,200 patients
earlier this year. Nearly all, 91 percent,
said they had reported “good things” to
others about their Mayo experience. On
average, those patients each talked to 39
other people.
Source: Mayo Clinic, 2007
Of those who shared positive
feedback, they told an average
of 39 people. Total word-ofmouth reach: 18.5 million
Average
Mayo patients
per year
Percent who
said they shared
“good things”
Total number
of positive
patients
521,000
X 91%
= 474,000
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MARKETING STRATEGIES
officer of Press Ganey in South Bend, Ind.
Press Ganey does include “likelihood to
recommend” on surveys. But Hall believes that
it and other questions branded as “loyalty”
monikers really fall under the same broad
umbrella: Do patients believe they’ve been treated well?
“I think there are those who want to promote loyalty vis-a-vis satisfaction,” he says. “I
think we are delving into really fine semantics
here.”
Turning Patients into Promoters
Can loyalty pay off? Gallup Healthcare officials
believe so. According to an analysis by the Gallup
consulting group published in 2005, involving
patient and physician data from 200 hospitals,
those facilities with the most loyal patients also
had the best earnings per adjusted patient day—
82 percent higher in the top quartile of loyal
patients compared with the bottom quartile.
Data also indicate that loyal customers are
less price-sensitive and more forgiving of a single poor experience once they’ve been emotionally hooked, Simmons says. “Loyalty is more of
an emotional construct,” he says, pointing to the
$4.59 he’d just dropped on coffee during his drive
to the airport. “It measures the emotional, irrational almost idiosyncratic relationship that customers have with products and companies.”
Hospitals, however, shouldn’t adhere too
closely to the retail model if they want to foster
loyalty, Lee says. Retailers often talk about service, which doesn’t apply as well in health care.
“They don’t see sick people,” he says. “So they
don’t have to have any training in empathy or
compassion.”
A better approach, Lee says, is to talk to staff
about improving the patient experience, using
stories rather than statistics to illustrate the point.
Nurses and other clinicians could read letters
from patients—both the gripers and the enthusiasts—at staff meetings and post them on
memo boards, he says.
Compassion also should be mirrored by
top managers, beginning with the hiring process,
Lee says. If the manager is not empathetic, how
could they possibly select similarly minded
employees?
At Medical City Hospital in Dallas, smarter
hiring has been front and center since 2000, as
hospital leaders work to improve employee
engagement—and thus the patient care experience. Literally dozens of people may help care
for a given patient during a hospital stay, says
Virginia Rose, Medical City’s vice president of
strategic development. “But it only takes one person to come in with a bad attitude or lack of competence or not smile to make that experience
bad,” she says.
To better support employees, hospital leaders opened a child care center with extended
hours, she says. They’ve offered more flexible
working options, such as part-time work for older employees.
And they’ve paid more attention to what
employees need to make their job more pleasant and efficient, whether it’s fixing peeling paint,
providing working fax machines or labeling drawers so supplies can be located easily. “Don’t be
afraid to ask that question,” Rose advises other
hospital leaders. “[Employees] won’t ask for the
big capital items. What we’ve found is it’s the
small things that bother people.”
Enjoying the Payoff
Medical City, which worked with Gallup during
the process, quickly noted measurable progress.
In 2000, just 19 percent of employees were
engaged and 30 percent were actively disengaged,
according to a survey of roughly 800 employees.
“These [disengaged] are individuals who are actually working for another hospital, but you don’t
know it,” Rose says. “They literally play for another team.”
By 2007, Medical City’s breakdown looked
far different: 61 percent were engaged and 8 percent were actively disengaged, according to the
latest survey, involving 2,100 employees.
Johnson Memorial officials hope to enjoy
similar momentum if their trends by midyear
continue.
Nearly two-thirds of the hospital’s medicalsurgical patients—64 percent—gave excellent
scores for overall quality of care in the second
quarter of 2007, compared with 43 percent in
the first, according to data provided by Neufelder.
A higher percentage also rated their likelihood
to recommend Johnson Memorial as “excellent,”
58 percent compared with 50 percent in the first
quarter of 2007.—Charlotte Huff is a freelance
writer in Fort Worth, Texas.•
I l l u s t r a t i o n b y C S A / S n a p s t o c k
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One expert suggests
nurses and other
clinicians should
read letters from
patients–BOTH
GRIPERS AND
ENTHUSIASTS–
at staff meetings
and post them on
memo boards.
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