Better hospital ratings: Good news, bad news

Satisfaction still trails 1994 scores

Patients are happier with their hospital experiences today than they were two years ago, but that’s nothing to brag about, according to recent figures from the Milwaukee-based American Society for Quality. In the annual American Customer Satisfaction Index (ACSI), data from first-quarter 1998 figures, hospitals garner 72 points, compared to 76 for motion pictures and 71 for hotels and motels. The three industries comprise the ACSI’s service sector.

(The hospital satisfaction ratings are illustrated in the graph "Hospitals: ACSI ratings from 1994 to 1998, p. 6.)

Consumers haven’t singled out hospitals for lackluster performance, however. Overall service sector ratings are sliding downward as this decade moves to a close, a mistake for which the society’s past president Jack West scolds the industries.

"Company executives — and employees — cannot lose sight of the fact that their job security and the financial future of their enterprises depend on customers," he says. "These creeping reductions in customer satisfaction across service industries ought to be addressed firmly and immediately."

The ACSI is the nation’s uniform, national, cross-industry index measure linking customer satisfaction to financial performance. It is produced through a partnership of the American Society for Quality, the University of Michigan Business School, and the accounting firm Arthur Andersen, LLP.

Unmet expectations

As consumers become more sophisticated about health care, they want more from their encounters with providers and hospitals. High expectations are fueled by media scrutiny of unrest within the industry.

For example, the ACSI report mentions reverberations from nursing unions and consumer advocacy groups’ exposure of proposed and actual reductions in professional staff.

(A look at the graph "Hospitals: Customer expectations, perceived quality, and perceived value from 1994 to 1998," above, shows that perceived quality still trails 12 points behind expectations and perceived value.)

Customer loyalty a delicate matter

While a hotel might write off a night’s stay or a theater might issue a free pass to win back an upset patron’s loyalty, a hospital can’t give back the extra hour a consumer waits for lab test results or pain meds. And irate consumers do serious damage to a hospital’s reputation.

Because hospitals have limited means to woo back alienated customers, it pays to identify and deliver services in forms that consumers perceive as quality. For example, the ACSI findings cite customization of services as a factor in favorable perceptions. Customization includes convenient hours of operation and individual attention from hospital staff. (For four-year ratings, see the graph "Hospitals: Customer loyalty from 1994 to 1998," above.)

Stay tuned to the customers

Just because the whole service sector is getting a bad rap from consumers, your facility need not follow suit. If you listen to your public, advises Susan Edgman-Levitan, president of the Picker Institute in Boston, they can clue you on how to build loyalty and satisfaction. She shares these three tips from Picker’s widely-renowned customer satisfaction research:

o Run planned improvements past your patients before implementation. "When hospitals plan changes in response to problems patients identify, 99% of the time the interventions are off-base. Sometimes, I think if we could quantify the money we waste providing inappropriate solutions to people’s problems, we would probably have all the money we need."

o A correlation exists between patients’ perceptions and the technical side of quality. "We’ve noticed in our work [at Picker] that when measures of morbidity and mortality are above the norms, patient satisfaction scores tend to slide also."

o Patients talk about bad experiences more than they talk about good ones. "When people have a bad experience with care, they are likely to tell between 10 and 20 people."