I have been following for a time the debate in the US about Medicare’s Project in order that patients can rate a hospitals quality by a star rating system, like the one used by Trip Advisor. From a European perspective this might be perceived as something American and somehow distant. For Americans it has become reality, but even for Europeans my feeling it is that this measure is a step more towards the transformation of patients into consumers, which is typical for private healthcare providers, but not only.
As this blog’s readers know I work for a private fertility clinic and I am proud of it. Yet neither the clinic nor myself share the vision of the patient as a customer. We attended the recent IMTJ congress on health tourism in Madrid. Speakers kept on insisting that patients are becoming consumers and that this was a global tendency. Even my clinic’s marketing director was enthusiastic about the idea and we had to cool her enthusiasm down.
Who is promoting consumerism among patients? For instance IMTJ itself that has a concept of medical tourism like a 5 star hotel with an OP room because it sells touristic services around a treatment. And these services are sold with marketing strategies that are symbolically related to vacation: comfort, service, a time that is free of worries and experiences that are opposed to day to day life, whether relaxing or exciting.
The big healthcare corporations try to transform medicine into a commodity, the patient into a consumer and the physician-patient-relationship into a customer-provider relationship. Not by chance these corporations are owned mostly by finance capital. We already saw in another post how there are two kinds of capitalism in healthcare: financial capitalism and traditional capitalism (family or not family businesses).
Financial capitalism prioritizes financial results above any other questions. This is why it spends huge sums in marketing with the goal of seducing the patients or compensating a poorer care.
En el primero los resultados se anteponen al paciente y por eso gastan grandes cantidades en marketing, con el fin de seducir a los pacientes. En el segundo el resultado también importa, pero la relación con el paciente es cercana, está gestionada por el médico y no por los expertos del marketing experiencial.
Customer experience is not the same as patient experience
Of course it is very legitimate to use tourism services in order to make the patient feel better when he is abroad or in order to make your hospital more attractive. Yet this does not transform a patient into a customer. Somebody who comes for instance for a knee operation can be a customer during the trip and the accommodation part of the treatment. Then he would be the king, according to the marketing guys. But once he crosses to the therapeutic space he is no longer the king: he is the centre but not the king. The difference is huge: the king commands because he pays. The patient is the centre whether he pays or not. We do not talk about a business, we talk about a life.
Customer experience is built in order to produce satisfaction and make the customer come back and recommend a product or service. It aims to satisfy his needs, generally leisure and pleasant needs in the case of tourism. Patient experience is aimed to heal. We are not in front of pleasant feelings, but mainly in front of death, uncertainty, fear and pain.
Patient is the centre, but not King
According to the Cleveland Clinic, possibly the reference hospital in patient experience, to be in the centre is not about to be satisfied, but about making the correct things for a patient. We want the patient to recover the best and quickest way possible, from a perspective that takes into account all dimensions: biological, psychological, social, cultural and spiritual. If with this work we manage that he recommends our hospital or comes back if he needs … this is the consequence of a good job, not the result of an emotional marketing strategy.
Capitalism in healthcare and the corrosion of character
Possibly this reflection on patient consumerism comes because a British patient that called recently to the clinic and was angry with her physician. The patient 47 years old, is single and wishes to become a mother. She is angry because the clinic does not give her a date for an embryo transfer, since her endometrium is not thick enough. Yet, during the mock cycle the endometrium responded perfectly, but then it did not do so.
I will reconstruct the conversation according to the information given to me by the physician:
– Patient: “why has my endometrium not reached again its initial thickness?”
– Physician: “we followed the protocol, but apparently the endometrium has not responded to medication. We can try a different dose.”
– Patient: “I am already 47 years old and I do not have time to try different things. I had my pregnancy programmed for June”
– Physician: “medicine is unfortunately not an exact science. We base on scientific evidence, but evidence talks about probabilities. Sadly you are among those 12% of people where medication does not produce the desired effect. I feel very frustrated too and I can only tell you that we need to try different dosages or may be ad an additional drug until your endometrium responds.”
– Patient: “I do not have time for adjustments and regular ultrasound checks: I have a lot of work and I have to train hard”.
As can be seen, the patient demands two things that are important to her. On one side, to achieve a pregnancy when and how she wishes. On the other side, she wants to have the control over time and bend a higher goal –to have a baby- to her ordinary work and sport habits.
Here we find two classical elements of capitalism. The first one comes from marketing in its version of customer experience, where the client king commands: “I paid for a service and you have to deliver it as I wish”. But a body is not a machine and a fertility treatment is not a customer-provider service.
The second element is efficiency. This patient sets her production goals over he reproduction goals. She might be not that different to the majority of Western women …that are young! To postpone maternity has become the norm. But the patient, as she stresses out, is 47 years old. Her baby is so important to her that she is even ready to have it without a couple. Yet she is not able to get out of her mental scheme of efficiency and productivity and thus she prioritizes her higher goal bellow her lower goal.
Other patients try to bargain their treatment, True that a fertility treatment is expensive and that many people get indebted because of a treatment. But the point is not the money, but the way the relate money to the treatment, which follow also a capitalist customer-provider scheme, we do not follow at IVF-SPAIN: customer loyalty by discounts, offers and promotions, bargaining by threatening to go to competition etc. At the end of the day, we are talking about money amounts that are often lower than a car, a material object that loses value. If one compares a car purchase with all what a child means in the life of his parents there is something wrong when some people put a treatment in the same category as a car purchase.
Patients trapped in time-productivity-efficiency schemes, parents commodifying their children… we are meeting clear examples of what Richard Sennett calls “the corrosion of character”. Senett describes how in financial capitalism or flexible capitalism insecurity and uncertainty about the makes the individuals integrate into their character in way they are unaware of the values corporations demand like productivity or efficiency. Sennett wrote his book before the digital era; if we are sincere with ourselves we will discover that Sennett’s thesis applies also to ourselves: who has not answered to mails late in the night and how many people can allow themselves to separate their working time from their persona time?
What to do
We see that the tendency towards patient consumerism is not only fostered by the marketing of big biomedical companies, but that many times patients themselves are behaving already as consumers; not because they pay for private healthcare, but because they establish customer-provider relationships with medical institutions and healthcare professionals. We saw already in the case of Osteoporosis that at least in Europe treating patients as customers does not always work well.
From the perspective of private healthcare I believe it is very important to keep medical and human values high without letting tendencies of financial capital infect us. It is key in that sense:
- Have a medical management
- Foster a patient centred organization
- Impulse humanization
- Focus on patient experience and not on patient satisfaction (only)
- Hire a patient experience officer
Private healthcare can be a business and at the same time be true to strong values that can differentiate it from financial corporations. In order to meet both goals it is possible –from a purely business point of view- to keep in mind following aspects:
- Commercial strategies that are patient centred, not consumer centred
- A balanced marketing budget: we want to gain patients, not to compensate failures owed to a focus on financial indicators
- High margins are OK, but do not subordinate all to financial metrics
- Healthcare professionals are the patient experiences: dignified work conditions and advanced HR policies
- Reinvest in R&D and innovation and engage patients in innovation policies.
In out next post we will see the positive consequences of a good human resource and talent management on patient experience. Until then I wish you a happy summer.