Should patient satisfaction be treated as an end or a means to an end?
Imagine you are juggler. You are holding four balls in the air at the same time. For many financial executives, the four balls are the following:
- Patient satisfaction
- Employee satisfaction
- Quality/safety
- Financial viability
You are attuned to the negative consequences if a ball drops. Dropped balls in health care may result in ethical lapses, reputational damage, excess mortality, adverse outcomes, rising costs, corrosive inefficiency, and dissatisfied patients and employees. How can you juggle all of these balls at the same time?
First, you must value all of them. A failure to value any ball such as employee satisfaction may result in a dropped ball. Second, you must keep your eye on all balls. Third, you must recognize that you are the key to keeping all the balls in play. Fourth, you must focus not on a single ball, but all balls. It is true that some balls may be valued more than other balls. Again, all balls must be in play at the same time.
The focus here will be on patient satisfaction and financial viability. It is well understood that the patient satisfaction ball largely as come onto the scene ince payment as become increasingly tied to patient outcomes. This does not mean that healthcare organizations were not stressing patient satisfaction, but the focus has become sharper as revenue is tied to risk. Given the relationship between patient satisfaction and payment, financial leaders are challenged to keep both balls in play.
Understanding the Patient Satisfaction Ball
Patient satisfaction is a key to achieving and sustaining a competitive advantage for many healthcare organizations. Health plans, self-funded employers, patients, family members, referral sources, and employees are attracted to organizations with top performance on patient satisfaction. The reputation of your organization can be amplified or dampened based in part on your patient satisfaction scores.
As a financial leader, it is essential that you determine the costs of providing an infrastructure attuned to enhancing patient satisfaction. Some of these costs include the following:
- Information resources
- Education and training resources
- People resources (e.g., staffing ratios)
- Environment-of-care resources
- Advertising resources
- Measurement, tracking, and feedback resources
A related cost is the design of variable/incentive compensation for executives, managers, and providers to perform at a very high level with respect to patient satisfaction. Savvy financial leaders know that costs represent part of the financial viability model.
Understanding the Financial Viability Ball
The financial viability ball focuses on the development of processes, policies, procedures, and priorities such that revenue exceeds expenses. When determining the financial viability of raising patient satisfaction, the costs are relatively easy to quantify. What about quantifying the benefits of achieving competitive patient satisfaction scores and ratings? This is a bit more challenging, but below are some ways to quantify the benefits:
- Health plan network integrity
- Health plan competitive pricing
- Referral retention and growth
- Patient retention and growth
- Employee retention and growth
It must be acknowledged that the financial modeling required to quantify these benefits is no easy task, yet it can and has been done.
Juggling the Two
To drive home the point that both balls must be at play at the same time, picture two different choices made by financial leaders.
Scenario No. 1: Patient satisfaction represents a cost center. This scenario assumes that all costs associated with patient satisfaction are expenses. At a time when expenses need to be trimmed, the costs associated with patient satisfaction may be on the chopping block. This point of view is reinforced by the notion that to raise patient satisfaction you simply need to hire the right people. If you hire the right people, patient satisfaction is nearly automatic.
Scenario No. 2: Patient satisfaction represents a profit center. This scenario assumes that investments need to be made to enjoy returns from investments. This is true for capital expenditures and other expenditures such as hiring a surgical team. This approach allocates financial capital but expects a rate of return that is greater than the financial capital allocated.
Which of these two views is more closely related to your own view as a financial leader? What about the view of your top management team or board members, your fiercest competitors, or benchmarked organizations that have national reputations for achieving high patient satisfaction?
Dropping the Ball and Ethical Consequences
Returning to the reality for many organizations that payment tied to patient satisfaction scores raised the profile of patient satisfaction, a key question is the following: Should patient satisfaction be treated as an end or a means to an end?
Considering Patient Satisfaction as an End
As an end, patient satisfaction has inherent value. In other words, the achievement of patient satisfaction is the focus. This perspective values the perceptions and experiences of individual patients and groups of patients. In this view, a single experience of patient dissatisfaction would warrant exploration even if the patient represented less than .0001 percent of all patients seen. If payment was no longer tied to patient satisfaction ratings, then healthcare leaders would continue to make patient satisfaction an organizational priority.
Considering Patient Satisfaction As a Means to an End
As a means to an end, patient satisfaction has extrinsic value. The goal is to achieve a specific patient satisfaction rating, to enjoy a financial incentive, or to dodge a financial disincentive. The majority of these patient satisfaction initiatives are based upon aggregate data not individual patient data. As such, if a single patient experiences dissatisfaction, then the organization can afford to deny, ignore, or minimize the experience of this patient who may represent less than .0001 percent of all patients. If payment were no longer tied to patient satisfaction ratings, then some healthcare leaders would lower patient satisfaction on the list of organizational priorities, and some may even drop it all together.
Reflect on whether you as a financial leader and members of your C-suite and the board are behaving in ways, making decisions in ways, and allocating resources in ways that are closer to either the patient satisfaction as an end or patient satisfaction as a means to an end. Focus not on your intent, but on what’s happening. There is often a great distance between intent and behavior. Most ethicists would argue that fellow humans should not be treated as a means to an end.
Managing a Challenging Job
As a juggler, you have a challenging job. To do your job well, which requires a focus on effectiveness, efficiency, and ethicality, you must acknowledge that you are called upon to juggle many balls and always be sensitive to moral and ethical lapses. What matters in your organization when you are juggling the patient satisfaction and financial viability balls?
William Marty Martin is a professor and director of Health Sector Management and Entrepreneurship, DePaul University, Chicago.
