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Are your patients also your customers?

by Michael J. Tronolone, MD, MMM, FAAAAI

It should come as no surprise to any physician that a physician's perception of quality health care is quite different from that of the average patient. This is in part due to the asymmetry of information between the professional assessing the competence and performance of his peers and a layperson making such an assessment. A layperson seeking the service of a professional such as a physician, lawyer, architect or other, generally relies on a third party assessment such as licensure, credentials, referral, or community reputation as a measure of the professional's quality.

Relying on third party assessments, most patients approach their medical care with the assumption that health care quality is a given. While health care quality may be present, there may be elements in the process of obtaining health care that cause dissatisfaction. Often these dissatisfying elements pertain to service quality. Physicians generally regard medical care quality in terms of timely accurate diagnosis and appropriate treatment. Patients often use measures of service quality as proxies for medical care quality.

Some common aspects of service quality include:
•    convenient locations and hours of operation;
•    ease of obtaining an appointment;
•    length of waiting time in the office;
•    a modern clean office environment, and
•    a courteous respectful staff.

If the public perception is that there are many sources of health care quality, then service quality becomes an important factor in a consumer-s choice of healthcare providers be it hospital or a physician.

Health care consumerism on the rise
There is an unmistakable trend toward increased consumerism in health care. As evidence of this trend one can point to the broad support for a "patients- bill of rights", the diminishing enrollment in traditional HMOs, the growth in health insurance products that feature patient choice, and the rapidly growing consumer driven markets for alternative medicine, cosmetic surgery and refractive surgery. Additionally, it seems safe to assume that in the future one will see increased cost shifting to the consumer as employers move toward a defined contribution formula for funding employee health benefits. This leads one to predict that the future health care consumer will become increasingly intolerant of poor service quality. Fortunately, health care quality and service quality are not mutually exclusive; nor should they be.

How does a physician go about assessing service quality in his or her medical practice? Large organizations often hire consultants that measure and survey patient satisfaction and benchmark the findings against the best performing organizations. Some organizations use a "walk of shame," where senior management must access and experience first hand the services that they sell the public. Smaller practices may survey existing patients for satisfaction or employ suggestion boxes. Some practices react to complaints. Managed care companies often pass along member satisfaction information to participating providers.

The critical questions that need to be asked and answered are:
•    What are the service quality expectations of the patients that one wants to attract and retain in the practice?
•    Is one currently meeting or exceeding these expectations? If not, how can one do better? If so, how can one do even better?

Competition in health care
Many physicians instinctively bristle when medicine is compared to other industries. Most industries compete in one of three different ways: quality, price or customer service. One may have the very best or most innovative goods and services, the lowest price for the same goods and services, or the added value of intimate customer service. Most patients generally believe that medical care quality is present in many settings. Many providers market "high quality" and the public accept this. No one purposely seeks out lower quality in the health care market. There may certainly be a few branded medical institutions of national or international stature that the general population regards as providing the highest possible medical care quality but these are the exceptions, and for these institutions, quality may very well be a true competitive advantage.

Price is a potent competitive advantage in many industries. Physicians have been lured into price competition with the advent of managed care contracting which often promises volume in exchange for discounts. However, when one considers the alternative competitive strategies, which physician would chose as their strategy to be the lowest priced provider?

The third competitive strategy is customer service or customer intimacy. This is a winning strategy for physicians because, by its very nature, customer service is not exclusive to a single provider. Customer service is meeting or exceeding the expectations of your customers. Since the pool of available patients represents a vast spectrum of expectations, there are many market segments to be served. Customer service as a competitive strategy offers an opportunity to define and target specific market segments, that is, those patients that one wants to attract and retain in the practice; and then devise a plan to meet or exceed their expectations. Virtually any practice that diligently pursues this strategy can be successful at it. Contrast this with the fact that there is arguably only one lowest price or one highest quality provider.

Like it or not, today's physician-patient relationship is also wrapped in a service provider-customer relationship and neglecting the latter risks adversely affecting the former. When given a choice, why would one choose high quality medical care with poor service quality when the same high quality medical care can be had with high service quality?