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Dissecting Patient Loyalty

by Rick Blizzard

Gallup defines patient loyalty as a patient's likelihood to return to a healthcare facility -- a straightforward concept, but one that's seen differently by different people. Faced with unmanageable volumes, some emergency department managers may even view high likelihood to return as a bad thing. But the bottom line is that like any other business, hospitals need repeat customers to be successful.

Through our research in many hospitals, Gallup has arrived at a simple attitudinal relationship to help explain patient loyalty:

Satisfaction (a combination of process and people) + Quality = Patient Loyalty

If a hospital wants to improve patient loyalty, which aspects of service should it focus on? Analysis of Gallup's 2003 healthcare database has uncovered the specific patient perceptions with the strongest relationship to their sense of loyalty.

Satisfaction Items Affecting Loyalty

The graph illustrates the five patient satisfaction items with the highest correlation to patient loyalty within each of four service areas: inpatient, emergency department, outpatient surgery, and outpatient test and treatment. (Note: Six items are listed for the emergency department because there was a two-way tie for fifth place.) Gallup does not ask all the same questions in every service area, but the results still show some overall trends.

When it comes to loyalty, it's no surprise that the emergency department is different from the other three areas. In the emergency department, where patients are faced with unplanned, urgent medical needs, "process" items (those relating to hospital operations such as registration speed, speed of service, etc.) rather than human interactions, drive loyalty to a greater degree than they do in other service areas. However, "people" items (those relating to human interaction) are still important.

In the inpatient and outpatient environments, where speed is less crucial, "people" items take over as the primary determinants of loyalty. Staff members must be caring, show concern for their patients, and communicate effectively.

Outpatient test and treatment is the only area in which ratings of "patient kept informed about delays" falls in the top five correlations, probably because of the "in-and-out" nature of many outpatient services.

Most Important Satisfaction Item

Again, Gallup asks different satisfaction questions in different service areas, but one item -- "concern shown by staff" -- is asked in all four areas and also appears in the "top five" correlations for every area. No matter what kind of medical treatment they are receiving, sick or injured patients are experiencing some amount of stress. Even patients who are undergoing a simple procedure like an X-ray want the comfort of a caring staff member who will answer questions and make sure they feel comfortable. It may seem trite to talk about "bedside manner," but it's a simple fact that ensuring staff members show they care about their patients is a good starting point for hospitals seeking to increase patient loyalty.

Perceived Quality

We'd be remiss to discuss key drivers of patient loyalty without noting the other side of the equation: impressions of quality. Great people and efficient processes make for high satisfaction levels, but true loyalty also requires that patients feel, either through direct experience or second-hand information, that using a particular hospital is at least as likely to result in positive medical outcomes than the other options that may be available to them.

Bottom Line

Along with perceptions of quality, patient satisfaction is essential to fostering loyalty. Satisfaction can be broken into two areas. Efficient processes are what set people up for success. Staff members cannot perform successfully when processes are broken -- particularly with regard to emergency facilities, where speed is imperative. But people factors -- namely, patient relationships with staff members -- are vital to building satisfaction with a patient care experience, and subsequently patient loyalty, even in the emergency department.

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