Wednesday, February 27, 2008

Wait, Expectations, Satisfaction and Intention to Treat

Is it possible to keep someone waiting in health care so long that they will change their treatment because of bad service? This question goes to the heart of customer satisfaction in health care and it is not an easy answer. The caveat is that every specialty will be slightly different so the validations I provide may not extend to different professions.

While watching 60 Minutes (a TV show out of the US) they did a study on the happiest people on earth. Who, you ask, are the lucky citizens? The answer is of course the citizens of Denmark. When researchers delved further into the source of their happiness what they found was a bit of surprise. It was not that the Danish are blessed with extraordinary love, money or social safety nets – apparently they have low expectations.

Which brings me to the point of this blog; client satisfaction is not derived from extraordinary service (although it helps) it comes from exceeding the expectations of you’re clients. Mathematically, client satisfaction (CSAT) = Outcomes – Expectations.
Now, this all sounds good on paper but how does one judge outcomes and expectations in health care? Researchers have created a measure called the SERVQUAL (Service Quality) scale that has been validated (tested) in healthcare and dentistry. It has five dimensions; Reliability, Responsiveness, Assurance, Empathy and Tangibles. An excellent summary (e.g. readable) can be found in the British Dental Journal, 1999 by PRH Newsome and GH Wright.

In short it discusses whether it is possible for a patient to be dissatisfied. The obvious answer is yes. People want to be engaged in their own care and will pass judgment. It also discusses how clients will judge their health care provider which is not such an easy answer. Because clients generally don’t have the technical knowledge to develop expectations about skills and outcomes they don’t have a significant impact on the CSAT. Rather the tangible aspects of a clinic such as waiting, empathy, cleanliness, accessibility, physical facilities, etc… are what will satisfy you’re clients.

The SERVPERF itself is divided into the five dimensions, each with many questions then repeated for expectations and outcomes. I’ve found this too long to be practical in a busy practice. Because expectations do not add a lot to the reliability of the CSAT in health care they can be omitted with minimal impact. Instead a shortened version can be used (see RATER scale as an example).

Now that I’ve established that customer service can be accurately measured, why should you do it and how does it impact on wait times?

First, imagine you are a surgeon seeing consultations half the day then doing surgery the other half. If you keep the consultations waiting long enough some of them will not book with you because they perceive you as being incompetent. You, as the surgeon, seek to serve the community as well as you can and that means fully booking you’re days. You will have to see a greater number of consultations for each surgery. In other words, for each surgery you do, you will have to see 10% or 20% more consultation because of bad time management. This is a vicious cycle because the more consultations you have to see the more likely you are to run slower. However, there is also a threshold for each type of healthcare. For instance, someone waiting on a consultation for an aortic aneurysm repair is likely to be more forgiving than someone getting their wisdom teeth out. In my next blog I will discuss how to determine that magic threshold and how to monitor it a meaningful way.

Reliability is dependable (1-5)
When you have problems is sympathetic and reassuring (1-5) Provides it services at the time it promises to do so(1-5)
You can trust employees at (1-5)
You feel safe in your transaction with employees (1-5)
The facilities are visually appealing (1-5)
The employees at are well dressed and appear neat (1-5)
Employees of do not know what your needs are (1-5)
Employees of do not give you personal attention (1-5)
You do not receive prompt service from employees (1-5) does not tell you exactly when services will be performed. (1-5)

1 comment:

Jason J. Hales D.D.S., M.S. said...

Very interesting blog. Thanks for introducing yourself. I look forward to your posts.