Welcome to Yelp for hospitals. What should we do next?

Performance in the practice of medicine has always drawn scrutiny and evaluation. Lives are at stake and years of education, practice and certification are required, simply to have the chance to be a physician or nurse. But today we’re witnessing an unprecedented rise of ranking, rating, and scorekeeping of performance in our hospitals. And there’s growing evidence that more patients are making their hospital choices based on these ratings and the reputation they bring.

Welcome to Yelp for hospitals.

Macro forces like triple aim and the ACA provide the tailwind for this new reality by making quality and outcomes larger factors for reimbursement. Along with them, individual performance of providers is increasingly a core pillar of how hospital financial success is defined. At the same time, patient satisfaction monitoring puts the patient in control of the scorecard.

“Our people are our best asset” is a cliché because it’s true. Today, your people don’t simply deliver clinical care, their performance in everything – medicine, customer service, patient safety, and hassle-free visits – defines the reputation of the hospital.

Any hospital that doesn’t have a strategy for improving the performance of their people and enhancing the hospital reputation will soon be left behind in the marketplace.

Why reputation is so important

We now have direct evidence that reputation drives choice and market share.

It’s not simply a soft consideration that gives way to other forcing factors. Austin Frakt wrote recently in the New York Times: “There’s an exceedingly simple way to get better health care: Choose a better hospital. A recent study shows that many patients have already done so, driving up the market shares of higher-quality hospitals.” He cites analysis published by the National Economic Bureau of Research that revealed patients traveled further to receive care at hospitals that had higher positive patient outcome track records.

How precisely are patients finding the higher performing hospitals? We don’t have much hard evidence, but we know there is way more information out there for patients to access. Google makes it easy to get a snapshot look at what people have said or written about a hospital. In fact, a 2012 Google study of hospital related searches found that reputation ranked highest in priority for consumers. It ranked ahead of plan acceptance, the recommendation of a physician, latest technology and even the recommendation of a friend or family member. There’s a fundamental shift in how patients choose where to get their care when reputation is their leading concern.

This shift will continue, meaning the stakes are getting higher and the spotlight growing brighter. This summer the CMS Hospital Compare program further fueled the shift in how patients choose hospitals with the release of a star rating for over 4,500 hospitals. Despite major concerns about the methodology, including difficult to adjust for local social determinants of health such as low incomes, higher co-morbidities and lifestyle habits, the rating system appears here to stay. Hospital Compare, and its ranking systems, are core to the CMS commitment to transparency.

When you add Hospital Compare ratings to other measures from US News & World Report, Health Grades, Consumer Reports and Leapfrog among others, the degree of subjectivity to what constitutes “high quality” has gone way up. We’re now effectively grading quality on a human scale. The ratings and reviews simply add more weight to the value of reputation in the marketplace.

Drivers of reputation

A hospital’s community reputation is built one patient at a time. It’s a function of what caregivers say, what they do, and how patients feel about it. It’s subjective and personal. In our transformation work with over 180 health care organizations worldwide, we’ve learned there are three key components to how quality and reputation are defined: experience, communication, and safety (which are primarily driven by patient-centered, waste-free processes). Patients ask and answer three fundamental questions about their care: Did they treat me like I mattered? Did they take the time to communicate effectively? Did they avoid hurting me in the process of making me well?

When the answers to all three questions are “Yes!” the story of their care at your hospital gets told in both the local and online communities. To be sure, great technology and world-class facilities are wonderful assets. But it’s how the institution functions and what being a patient there feels like that sparks the verbal and digital word-of-mouth that drives reputation.

Want to create that viral word-of-mouth? Fundamentally transform your culture of safety and process-driven patient experience. For example, in 2010, Ohio State’s Wexner Medical Center sought to make patient safety and waste-free, patient-centered processes two cornerstones of the institution. Wexner achieved a remarkable 26% reduction in adverse events and 40% reduction in patient safety indicators. They estimate a savings of nearly $30 million dollars in related costs. This improvement has earned Wexner numerous awards, ratings and recognitions and a status as a role model for patient safety. It’s a big part of their current reputation.

Strategy for driving reputation

Chasing 5-stars and “best of” designations is not a winning strategy. It’s likely to lead to short-term thinking and give staff goals they cannot directly impact. Instead, great ratings and rankings need to be an outcome of a hospital culture obsessed with reliably and repeatedly doing the important things exceptionally well. Hospitals win at the reputation game when they create among their physicians and staff an army of every-day problem solvers in each service line that understand “how things happen” (Did you keep me safe? Did you treat me like I mattered?) is as important as “what happens” (Did you make me well?.)

The winning strategy in the reputation war is a laser focus on the triple aim patient experience pillars of safety, efficiency, and satisfaction. For each, identifying lead indicators on your dashboard is critical. Factors like rework, wait times, equipment readiness and availability, and caregiver communication are often early signs whether or not a patient will be a net promoter of the hospital. These are metrics that a trained and empowered staff can impact with everyday problem solving, TeamSTEPPS training, and visual management boards for progress tracking.

Most importantly, leadership must be clear that market reputation driven by high performance is the foundation for growth and sustainability in the new normal of health care. In short, what got us here, won’t get us to there where we need to be to survive and thrive. We are what we do every day, and what we do every day without fail in safety, efficiency, and satisfaction will drive our reputation. The winning strategy is to become so good in those domains that it becomes impossible for rankings, ratings and search results not to say so.

Mark Migliori is a plastic surgeon.

Image credit: Shutterstock.com

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