In healthcare, experience matters. And I don’t mean years of training or tenure – I mean patient experience. For years we’ve resisted calling healthcare a “service industry,” and felt that “quality” was all that mattered. If by quality we mean clinical effectiveness and outcomes, I’d argue it’s important but not enough. Which is why the Institute of Medicine defines quality as having other domains beside effectiveness: safety, timeliness, efficiency, equity, and patient-centeredness. This last dimension of quality includes incorporating patients and families into the decision-making process and considering their preferences. And patients are pretty clear that one of their preferences is to be treated with courtesy and respect.
There are now numerous sites where people can post ratings and comments about physicians, such as RateMDs.com. The vast majority of comments are not about technical skill or knowledge, they are about listening, wait times, courtesy, bedside manner. These things matter, especially as individuals are paying more of the very high cost of health care out of their own pockets, and demanding value for what they spend. Not only consumers, but professional organizations such as the Robert Wood Johnson Foundation are leading efforts to make the health care experience more patient-friendly.
At Children’s Hospital of Wisconsin, we have long measured patient satisfaction and experience, but haven’t always been as focused on it as we should be. This is changing, and with people at all levels of the organization starting to pay attention to experience, satisfaction is improving. In some of our areas, like imaging, the emergency department, and the Surgicenter, our scores are now well above the national average for pediatric hospitals. But we have a ways to go. Eventually, we need to rethink many of our assumptions about how healthcare is different from other industries. People used to think that cars, computers, and airline travel were different, too – too complex for the average person to evaluate on their own. Yes, computers are complex; it takes as much education and training to build and program computers as it does to become a doctor. But somehow even someone like me who has never taken a computer science class in his life can buy and use one without any specialized help. Of course, when things don’t go right I seek expert assistance, but even there, I shop for that service the same way I do for everything else, judging them not on whether they can fix the problem (I expect that), but on how long it takes, whether they are nice or rude, how well they explain things, and how much it costs.
If you think experience doesn’t matter, watch this video comparing health care to the airline industry. It’s funny and shameful at the same time.