Archives January 20, 2015

Relationships Matter

by Barry P Chaiken, MD

Edward Shin, MD, CEO, Quality Reviews is co-author of this article


Yelp. TripAdvisor. Angie’s List. Healthgrades. No person or organization maintains immunity from scrutiny by consumers. Although reviews can be both uplifting and embarrassing, they surely capture the attention of both the reviewer and the reviewed.

As the Affordable Care Act expands coverage and high deductible health plans capture more money from consumer pockets, increasing numbers of patients focus on the quality of services received from providers. These services extend beyond patient care to encompass patient experience metrics that are easily judged by the average consumer including respectfulness exhibited by caregivers, pleasantness of facilities, and wait times. Patients with sub-par experiences often post negative comments on one or more social media platforms to express their dissatisfaction. These posts then form the building blocks for a provider’s online reputation.

As patients act more like consumers, provider organizations with poor reputations experience decreased utilization of services which hurts revenue and the bottom line. With margins small and competition increasing for patients, few organizations can afford a decline in patient visits. For providers to survive in this new era of healthcare consumerism, they must learn from the experiences of other industries such as retail and hospitality, and apply those basic approaches to managing their relationship with patient-consumers.

Why Relationship Matters

For more than 60 years, employer-based healthcare insurance dominated the payment structure for the delivery of healthcare. With employees shielded from the actual costs of care, demand for services rose faster than inflation causing the cost of care to rise in lock-step. Only after healthcare costs started to impact the competitiveness of American businesses did employers begin to increasingly shift the cost burden of care from employers to employees. Additionally, with pressure imposed by these same employers, insurers became more concerned about costs and began to resist price increases from provider organizations. Healthcare costs became the concern of all sectors of the healthcare marketplace including patients who now were responsible for a painful portion of their healthcare costs.

The shifting cost burden is not the only major factor driving the importance of patient relationships. The disruption of the marketplace caused by the Affordable Care Act brought millions of additional patient-consumers into the marketplace. Provider organizations work to attract as many of these existing and new patient-consumers as possible to fill facilities and generate revenue. Providers now base their survival on making their connection to these patient-consumers “sticky” the same way consumers exhibit loyalty to a particular restaurant, hair salon, or grocery store.

The Old Way

Established efforts to measure patient satisfaction – notice this is not called patient-consumer satisfaction – include the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey and similar efforts provided by organizations such as Press Ganey. According to CMS:

“The HCAHPS survey asks discharged patients 27 questions about their recent hospital stay. The survey contains 18 core questions about critical aspects of patients’ hospital experiences (communication with nurses and doctors, the responsiveness of hospital staff, the cleanliness and quietness of the hospital environment, pain management, communication about medicines, discharge information, overall rating of hospital, and would they recommend the hospital). The survey also includes four items to direct patients to relevant questions, three items to adjust for the mix of patients across hospitals, and two items that support Congressionally-mandated reports.

“The HCAHPS survey is administered to a random sample of adult patients across medical conditions between 48 hours and six weeks after discharge.”

Other survey instruments use similar approaches that utilize paper, phone, and email. Imagine if Yelp required consumers to complete a 27 question questionnaire that was mailed or emailed.

Begun just 10 years ago, Yelp recorded more than 67 million reviews, receives 139 million visitors per month, and obtains more than 35% of its reviews currently from mobile phones. In this age of social media and smartphones, can provider organizations safely ignore the trends of consumerism and continue to embrace paper, phone, and email to build their patient-consumer relationships?

Welcome to PRM

Patient Relationship Management (PRM) represents a healthcare version of customer relationship management (CRM). CRM facilitates the interaction with current and future customers by leveraging information technology. It helps organize, automate and coordinate sales activities, and supports marketing customer service and technical support efforts.

In addition, CRM often uses social media to build customer relationships. For example, many organizations employ Twitter, Facebook, and LinkedIn as a CRM tool to track and communicate with customers, and permit them to share their opinions and experiences with a company, products and services.

As CRM is relatively new to healthcare providers, organizations must be careful in how they design their PRM programs. In addition, they must identify clear goals and objectives for their programs and understand the options available to them to respond to patient feedback.

Healthcare’s reliance on PRM programs that employed HCAHPS type initiatives – paper questionnaires, phone interviews, or email – fails to take advantage of the availability of other means of interacting with patients. In addition, these approaches to reach patients deliver low response levels and suffer from inaccuracy due to the long timeframes from patient interaction and administration of a survey.

In contrast, smartphones offer a powerful tool to interact with patients in a meaningful and timely manner. Using smartphone texting and Internet access capabilities allows organizations to effectively reach patients to gather patient responses. With smartphone use at over 90% in the U.S. it is truly an ubiquitous information technology device.

Linking a care delivery episode to a patient’s perception of delivered services offers a view of how successfully an organization is satisfying the needs of patients. If the goal of a provider organization is to attract and retain patients, obtaining this PRM information allows organizations to continually monitor patient perceptions of care delivery and make adjustments as needed.

Figure 1.

Figure 1 shows how a smartphone can be used to obtain a quick, online survey from a patient assessing the care recently provided to that patient. Using a hospital’s admission-discharge-transfer (ADT) system to identify patients who have just received treatment, software can send a text message to patients that includes a secure link to a short online survey.

Figure 2 presents an example of what a linked survey might look like. To maximize the response rate, survey questions are kept short, less than 10 questions, and responses are on an easy to choose one to five star scale.

Figure 2.

Use of this technology to reach patients in an oncology practice delivered a response rate 5.6 times greater than previously administrated patient surveys at the facility. In addition, the median response time was 54 minutes versus one moth for traditional surveys. Survey costs equaled just 6% of the cost of traditional methods.

Analysis of collected PRM data provides valuable information on what initiatives might provide enhanced patient-customer relationships. Dashboards generated from the data guide managers on the status of operations and potential problem areas.

Solidifying Relationships

As provider organizations adjust to an era where attracting and retaining patient matters, solidifying those relationships requires a strong feedback loop that links care delivered with patient perceived value. Use of paper questionnaires and other traditional survey methods fails to account for the importance of linking care and response in a timely manner. Patient-consumers, trained by other industry CRM efforts to expect a close relationship between a product or service vendor and themselves, are beginning to expect a similar experience with their various healthcare providers. In addition, as more of these patient-consumers pay for their own care, they increasingly scrutinize the care experience they purchase.

For organizations to tract their own performance and adjust nimbly to patient perceptions and needs, they require technology tools to secure actionable, timely information from patient-consumers. Smartphones, and their delivery of applications similar to those shown above, offer provider organizations a valuable technology tool to use in their effort to maintain strong and binding patient-consumer relationships.


  1. HCAHPS Survey –
  2. Customer Relationship Management –
  3. Digital Marketing Ramblings (Yelp) –
  4. Pew Internet: Mobile, 1/2014

Excerpts from “Patients/Consumers: Relationships Matter” published in Patient Safety and Quality Healthcare

Leave a comment

This site uses Akismet to reduce spam. Learn how your comment data is processed.