Examining patient satisfaction incentives through different lenses

My most recent Hospital Impact blog post "The hidden costs of incentivizing patient satisfaction" received a powerful and informative response. Thomas DahlborgToday we continue the conversation with feedback received via theFierceHealthcare - Healthcare Leader Idea Exchange LinkedIn forum.

Tom S., M.D., through the lens of patient satisfaction and process improvement, highlights the folly of incentivizing patient satisfaction, as well as reminds us of the need to identify the root-cause of barriers to our goals:

"Creating a financial incentive for patient satisfaction is like treating hypoglycemia with glucose. It works, but is short-lived and does not address the underlying cause. The goal is to permanently change the culture so that all the staff strive for great service (e.g., turnaround times) and are perceived as empathetic (e.g., address pain, emotional stress, etc). Look for systemic obstacles that prevent success (such as inadequate staffing). Having the right culture results in "performance pride" that always outperforms financial incentives."


Many other experts also hone in on the importance of identifying and addressing barriers to patient satisfaction and outcomes at the root-cause level to truly improve patient satisfaction/experience and outcomes all while decreasing the cost of care (the triple AIM).

From Miles S., through the lens of service quality and patient engagement:

"Patient experience is not about increasing costs per se. It is about doing the fundamentals right and having a caring attitude across the entire hospital value chain. At one of our hospital implementations recently, only 48 percent of nurses in our daily pulse indicated they frequently have time to explain things to patients."

From Olivia B., through the lens of patient and healthcare practitioner engagement:

"Patients want to be engaged in their healthcare but that does not mean they are making unilateral decisions. Often it is the art of conversation that goes away first in care when in fact it should all start there."

From Claire C., patient support assistant, the front-line perspective:

"We need to be mindful that a big part of patient satisfaction is ... understanding ... Why? or Why not? ... That takes time. Take a moment, sit down at the patient's level, do not use medical jargon ... have the patient repeat back to you in his/her own words what the plan of care is. When we take the time to do this patients and healthcare professionals alike develop relationships of trust and understanding, and patients learn that an antibiotic for the common cold can do more harm than good."

These and other comments frequently highlight the lack of time as a significant barrier to optimal care. And yet we as healthcare leaders continue to band-aid a broken system while never truly innovating the model to allow ample time and space for the patient and practitioner to develop an authentic relationship and trust, for the patient to tell their whole story, and to achieve understanding, engagement and activation.

From Dike D., M.D., through the lens of physician engagement and burnout:

"The single largest negative influence on patient satisfaction is the level of stress and burnout in the provider they see on that particular visit (With repeated surveys of physicians showing the average prevalence of burnout on any give office day at one in three). All of this is possible, however all but about 3 percent of organizations have given up on the possibility of creating a physician friendly workplace."

To truly improve patient experience, outcomes and decrease cost of care, as healthcare leaders we must position physicians (and other clinicians) for optimal health (physically, mentally, emotionally and spiritually). I cannot count the number of times I have heard a physician say they have lost their soul for healing or the number of former nurses who have shared they have left the healthcare workforce because of burn out.

Productivity measures continue to do great harm to our physicians, our patients, our communities and runs contrary to the great care, great experience, less cost we say we desire. It is time to truly adapt and create healthy healthcare models.

The whole of this feedback highlights the multilevel, multi-view intellectual capital available to us to improve the broken healthcare system. It also highlights the heart of many who care and desire to make a difference.

The current system does great harm as do many of the current "solutions." We can do far better.

Some questions for consideration ...

  • What are the barriers in your organization to achieving these successes?
  • What are the root-causes of these barriers? How do you know?
  • Who are you engaging?
  • Are you engaging those on the frontlines?
  • Are you engaging patients and families?
  • Are you making progress?
  • Are you innovating?
  • Is the patient-practitioner relationship at the heart of your solution?
  • How are you measuring?

I would love to hear and share your stories.

Thomas H. Dahlborg, M.S.M., is chief financial officer and vice president of strategy for the National Initiative for Children's Healthcare Quality (NICHQ), where he focuses on improving child health and well-being.