As healthcare in America moves from a cottage industry to big business and gets progressively consolidated, regulated, and systematized, the industry has found itself at a crossroads with its customers (i.e., patients). Healthcare has technically always been patient-centric of course but like many business it never really focused on those patients – their unique needs and their relationship with them. In other words, healthcare like all business today has become less about the business defining the individual and more about the individual defining the business. A patient-centric and patient-focused model requires healthcare providers to change their businesses to a relationship-based model in which they provide value and grow together with their patients and customers from birth to end of life.
Hospitals and healthcare providers are certainly aware of this need to evolve the way they view, treat, and interact with patients. According to "Top Issues Confronting Hospitals 2015," a report by the American College of Healthcare Executives, one of the biggest issues was raising patient satisfaction, especially among populations represented by the seismic Cultural Demographic Shift. The results of that report were echoed in a 2016 Media HealthLeaders Intelligence Report, "Patient Experience Excellence: Transforming Culture Across the Continuum." Respondents in that survey stated that the top patient-focused area for improvement to “meet patient experience program goals” was patient satisfaction. The number one stumbling block cited by respondents to improving the patient experience and achieving this patient satisfaction was “the difficulty of changing organizational culture.”
That difficulty is unsurprising. After all, healthcare has basically been organized and treated patients the same fee-for-service way since World War II. Today, the idea is that to improve health outcomes, providers and payers need to move away from rewards for volume-driven care and shift to value-driven care, which rewards providers for keeping people healthy while still keeping costs in check. As a result, many organizations have struggled with patient satisfaction as they seek to evolve to embrace these changes. That kind of change requires leadership to see things differently.
This isn’t just about adaptation for the future; it’s about transformation of an industry that literally is at the center of our country’s health.
Transformation on that scale in an industry that has historically moved very slow requires new organizational competencies to help businesses and the industry. That requires leaders to apply what I call “the innovation mentality” – a mindset that embraces evolutionary thinking, strengthens wisdom, emboldens business models, and reinvents the workplace to create and sustain real competitive advantage in the marketplace.
This goes beyond the issue of relationships with patient populations represented by the Cultural Demographic Shift who do not always feel welcomed by the healthcare industry. All patients are people and thus want to feel people are listening and understand their unique needs. Too many of healthcare organizations don’t know how to serve and solve for any populations because they have been and are unequipped to do so and thus fail to deliver real, sustainable value to customers engaging with the healthcare system.The Biggest Issues For The Future Of Healthcare In America And What We Can Learn From Them, Part I
All patients are also customers and they are becoming much smarter in how they shop for healthcare, where they go for treatment, and who and what places provide the best service. This is where individuals are also defining the business of healthcare like never before. Healthcare in the age of the internet and social media has them shopping around for their health needs. As a result, hospitals and doctors that deliver high quality and value are going to be rewarded by the marketplace in the future.
To understand all of this and more and get a sense of these and other big issues facing healthcare in the future, I spoke to four executives about their outlook for the immediate and how their organizations are influencing the evolution of the industry:
This is the first of two articles, covering our discussion on patient satisfaction and overall quality of care, volume-to-value-based business models, reorganization and restructuring of the industry, leadership competency gaps in a patient-centered model, the role of “Big Data,” and why innovation found across other industries has been slow to take off in healthcare.
Zenty reaffirmed the point about comparison-shopping by consumers being a huge change the industry is facing. “As an industry we have been prepared to address people's healthcare needs without significant consideration for the financial requirements that people are going to have to pay for care,” he says. “Now with high deductible health plans, we are seeing more and more patients comparison-shopping than ever before. The estimates are that we get about 4,000 calls a month for people now wanting to know the cost for an MRI or CT scan at each of our hospitals. The age of consumerism is something that we are as providers in the nescient stages of.”
What I found as fascinating from Zenty is there are cost issues at the end of the patient experience with the hospital too that require innovative thinking: “Probably the most forward facing thing we need to do in our industry is to really evaluate how we produce a patient bill. Patient bills for the most part have been designed for a third-party intermediary, namely insurance companies that pay that bill. They are very difficult for patients to decipher on their own. So even something as simple as creating a reader friendly patient bill is going to require us to retool our entire system for sending information.”
And coordinating it. Anyone who has had the experience filling out countless and repetitive forms before treatment – even within the same network or hospital – knows how maddening this is. How is this possible in the digital age? When you have, say, a general practitioner, surgeon, and radiologist you “want those people to be on the same page and coordinated to the benefit of patients.” Stone notes. “Patients have an expectation to be able to get their data and expect their care to be coordinated, regardless of provider.”
So who is responsible for this organization? Traditionally no one, Crawford says. Because prior to demands for patient satisfaction, especially in the age of the Affordable Care Act, there was no incentive to stand up and pay attention to it even more today.
That’s why, according to Barrett, organizations will be required to deliver more coordinated care – care that is more focused on outcomes as opposed to activity in which the incentives are different. This is a big reason healthcare has been so uncoordinated in the past, and Barrett believes this is the most transformational change facing the industry: “This notion of paying for outcomes is what as a consumer or patient you would want. The system has been built the other way for 75-plus years: I’m doing an x-ray, administering a drug or anesthesia, going to a rehab facility – those are individual activities. The outcome we should be looking for is a patient who is now recovered from hip replacement whose functioning at a high level, back to work, and is living life comfortably. This is transformational. I think we are in the middle of that change.”
Following Zenty’s thoughts on the patient bill, Barrett notes that Cardinal Health is looking at the point of discharge as a critical point in changing this: “There are all kinds of inefficiencies in discharge: Lack of information, incomplete records being transmitted, poor coordination from one site of care to another, and lack of communication between those sides. Patients get referred to providers that may not be the optimal site or may not be covered by their insurance. Patients have uncertainty as to their families around the recovery process about what to expect. There is very little transparency around performance in those post-acute facilities. We are very focused on this notion of making this system higher quality, more efficient, safer, and more centered on that patient. As a result, we are about 10% down in readmissions when we can apply all these tools together.” They are also down 10% in costs and more than 90% satisfaction where patients are getting greater intervention at the moment of discharge and more activity post discharge.
“At the end of the day, organizations like City of Hope are here to help patients and families in need,” says Stone. “We do that through our research and we do that through our patient care.”
For Stone it comes down to one word: relationships. “Coordination, leading at scale, leading people of different populations through the Cultural Demographic Shift, leading people of different views... if you are going to serve all these needs you need to connect,” he says “That is a far different world than where healthcare has predominantly been. We need to rely on others so the patients and their families are not left on their own to coordinate care across different specialties and organizations. This places different demands on leaders. A traditional, hierarchical command-and-control approach doesn't work. Before, you could lead just by setting a good example. If you had enough influence and you were respected, people learned and followed by simply watching you. That is still important. But what about the people who work across the state? Or in other states? Leadership by example gets diffused unless it’s coupled with clarity of purpose and mission, the right policies, approach, and hiring methodologies. We have to understand the populations that we serve. Those might be different by location or geography, and we need to have as part of our culture a dedication to serving the people in our community and that means being cognizant of their needs.”
For Crawford, that comes right down to influencing what’s on the literal patient plate: “In the past, people talked about hospital food and how bland it was. But consumers from a culinary perspective are much more astute. They have highly developed palates and different tastes. It's important that we can deliver against flavor profiles and other trends. One of the things we are beginning to do at Aramark is reducing sodium and reducing fat and then using different spices to enhance flavor and give the food a better flavor profile. We are trying to keep up with culinary trends: better taste profiles, better flavor profiles. That way we can deliver on the experiences that our patients expect.”
That extends beyond the hospital as well, Crawford adds. “Sixty to 80% of patients are going to be on a restricted diet just due to some medical issue. It is really important that patients are taught how to eat properly to recover and heal. Aramark has approximately 800 registered dietitians to make an impact not only within each interior setting but also each exterior setting when patients are going home. We want to make sure that they go home with a better perspective on how nutrition can play a part in healing and recovery.”
In the end, something as simple as the food being served in a hospital is being patient and community focused. It is about, Crawford says, “holding yourself accountable in the organization for exceeding your customer’s expectations and doing the right thing.”
It is about introducing a new approach for success – recognizing that the old ways don’t meet today’s unique needs. Without that strategy, change is merely substitution not evolution. Because as we will see in part two: the age-old methodologies do not solve for America’s aging and diverse populations. It’s time for the healthcare industry to evolve with a sense of urgency and in part two, Barrett, Stone, Zenty and Crawford provide their time-sensitive insights to move the industry from substitutional to evolutionary thinking.