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Consumer Research:

ake any product off the shelf at the grocery store and you can be assured that extensive consumer research is behind it. Consumer product companies analyze every aspect of the consumer market down to the very shelf on which the product should be displayed. Hospitals, however, have been slow to grasp consumer research. After all, why study the market when people will always to get sick and need their services. But increased competition and more finicky health care consumers are changing that. Hospitals are becoming more efficient in identifying the consumer, but theres still room to grow, says Candace Quinn, CEO and senior strategy consultant of Brand=Experience, a health care marketing consulting firm in McLean, Va. By identifying consumers in the marketplace and learning their perspective about the organization, hospitals can develop effective, targeted messages to the various consumer groups. A targeted mailing can be more effective and cost efficient than a television ad campaign, says Quinn. Just because a competitor is outspending you $2 to $1 on advertising doesnt mean its a more effective way to reach the right audience. For hospitals, its not enough to be top-of-mind among consumers. Trust and loyalty are far more important, she says. Loyalty is likely to translate into future use. Knowing the consumer, therefore, becomes an effective tool in the strategic and financial planning process. Consumer research reaches beyond patient satisfaction to identify what influences patient behavior. Among other things, it can reveal how patients view the quality of services at one hospital over another and patients willingness to recommend a hospital to friends and family. The findings help hospitals determine the aspects of care that have the most influence on patient perception about the quality of the organization. It provides hospitals with actionable data that can focus improvement efforts, help sustain successful programs and identify the needs and desires of the community. Ultimately, it can help hospitals build a loyal patient base that will recommend the organization and provide positive feedback in the community. Its extremely unwise to not understand patients perceptions of your organization, regardless of your market share or financial performance, says Tim Feist, vice president of performance improvement and chief safety officer at Peninsula Regional Medical Center, Salisbury, Md. In addition to patient and employee satisfaction surveys and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, Peninsula conducts consumer research surveys every other year. Doug Wilson, Peninsulas director of planning and business development and government relations, says the process supports the mission, vision and values of the organization. This organization is committed to measuring the patient experience and acting quickly and appropriately to consumer complaints and providing caring, responsive care, Wilson says. At Vanderbilt Medical Center, Nashville, Tenn., a yearly consumer research survey assists with business planning, including the design and marketing of programs and services. Consumer research cannot be an afterthought, says Joel Lee, Vanderbilts associate vice chancellor for medical center communications. The beginning of any project starts with understanding what the consumer wants. Its important for hospitals to recognize that patients perception of quality differs from health care providers perceptions of quality. Health care professionals link quality to treatment outcomes. However, in the minds of patients, quality is about the experience. They expect the clinical outcomes; they want a good experience, says Lori Bruss, executive vice president of The Roberts Group, a health care marketing, advertising and communications firm in Waukesha, Wis. Hospitals need to educate all employees about how their patients perceive quality and put systems in place so patients expectations are not only met, but also exceeded. Its equally important to set realistic expectations for patients about their care.
How We Did It: This gatefold was produced by researching published studies and articles and conducting interviews with hospital and industry executives. Research: Lee Ann Runy, lruny@healthforum.com Design: Chuck Lazar, clazar@healthforum.com

WhoisTodays Health Care Consumer?

The days of the passive health care consumer are over. More than ever, health care consumers seek trustworthy information to make informed decisions about the care they receive. Quality, service, convenience and cost are major determinants in the decision-making process. And the breadth of health carerelated Web sites puts a great deal of this information at patients fingertips. Health care consumers, however, are not one large, homogeneous group. The challenge for hospitals is to identify the consumer segments within their marketplace to help develop new strategies and services to appeal to consumers various needs and desires. Health care consumers fall into six distinct segments and not along demographic lines, according to the 2008 Survey of Health Care Consumers* by Deloitte. These segments vary by the degree to which consumers prefer or use traditional services versus alternative, nonconventional services. Other determinants include the likelihood to rely on physicians to assist with decision-making and the extent to which the consumer uses online tools to obtain health care information.

The Six Health Care Consumer Segments

CONSUMER TYPE

CONTENT & COMPLIANT 29% Medium Traditional

CASUAL & CAUTIOUS 28% Lowest Disengaged, but currently leans toward traditional Leans toward self-reliance Less satisfied

SICK & SAVVY 24% Highest Traditional

OUT & ABOUT 9% Medium Alternative approaches and nonconventional settings Independent; makes own decisions Least satisfied

ONLINE & ONBOARD 8% High Traditional but open to nonconventional settings Leans toward self-reliance Satisfied

SHOP & SAVE 2% Medium Traditional but open to alternative and nonconventional settings

Two Surveys: Different but Equally Important

The Hospital Consumer Assessment of Healthcare Providers and Systems survey and patient perception surveys provide different views of patients experiences. HCAHPS measures patient perception, not consumer perception, says Lori Bruss, executive vice president of The Roberts Group. Hospitals should not rely solely upon HCAHPS data to assess patient perception, she says. The HCAHPS survey looks at how consistently a hospital provides specific services, not how well. Its an important survey, but doesnt provide a full picture, Bruss says. You have to have a combination of both. The chart below looks at the distinctions between the HCAHPS survey and consumer research surveys.

Segment size System use Preference regarding care Dependence on providers Satisfaction with providers and plans Compliance with treatment Other factors

HCAHPS

DESCRIPTION
HCAHPS, developed by the Centers for Medicare & Medicaid Services and the Agency for Healthcare Research and Quality, was launched in October 2006. It is a standardized survey and data collection methodology for measuring patients perceptions of hospital care. HCAHPS has three goals: Provide health care consumers with comparative data on patients perception of care; provide incentive to hospitals to improve quality of care through the public reporting of the surveys results; and enhance public accountability in health care by increasing the transparency of the quality of health care provided in return for the public investment. There are 27 questions related to the patients hospital experience. Eighteen questions relate to key aspects of the hospital stay: communication with nurses and doctors, cleanliness and quietness of the hospital, pain management, communication about medicines, discharge information, overall rating of the hospital and likelihood to recommend hospital. The remaining questions are designed to direct patients to appropriate sections of the survey, adjust for the mix of patients across hospitals and support congressionally mandated reports. The survey randomly samples patients of all eligible discharges and of all payer types between 48 hours and six weeks after discharge. Patients may not be surveyed during their hospital stay. HCAHPS may be conducted through one of four modes: mail, telephone, mail with telephone follow-up and Active Interactive Voice Response. The survey takes about seven minutes to complete.

Consumer Research Surveys

Consumer research surveys assess the perception of the hospital in the marketplace. This includes patients perceptions of how well care was delivered at the facility and perceptions of the organization among people who have not been patients at the hospital. Consumer surveys have different goals, depending on the organization conducting or commissioning the survey. They are frequently used to provide insight into patient perception and loyalty to the hospital during the strategic and financial planning process. They also serve as a means to identify what aspects of care most influence the patients perception of the overall quality of care.

Accepts doctor recommendations Most satisfied

Takes charge of own care Satisfied

Leans toward allowing doctor to make decisions Less satisfied

GOALS

Most compliant

Less compliant

Compliant

Least compliant

Compliant

Less compliant

Less likely to seek information and less likely to use valueadded services

Price sensitive; less likely to seek information; less likely to use value-added services

Seeks information and is sensitive to quality

Seeks information; sensitive to quality; uses some valueadded services

Seeks information; uses online tools the most; maximizes use of value-added services

Most likely to travel for care; uses value-added services

CONTENT

*The survey provides a national representative sample of the U.S. consumer market.

Source: 2008 Survey of Health Care Consumers, Deloitte

The content and length of consumer surveys varies depending on the availability of resources and the purpose of the research. Patient loyalty studies allow the hospital to take a deep dive into consumer perception, including the clinical and operational performance, ease of access and willingness to recommend the hospital to family and friends.

Its extremely unwise to not understand patients perceptions of your organization, regardless of your market share or financial performance.

How Do You Meet Consumer Needs?

According to Deloittes 2008 Survey of Health Care Consumers, Meeting consumers evolving needs and preferences now requires more than improving service and convenienceit means shifting to consumer-centric business models and building customer experience capabilities to support the ongoing planning and sustainability of customerfocused initiatives. Below are suggestions that hospitals can adopt to help meet the needs of todays health care consumer: 1. Develop online services and tools to provide consumers with the information they need to make informed health care decisions. 2. Conduct hourly rounds to identify patients needs. 3. Recognize the differing opinions and behaviors of consumers in the marketplace. 4. Set expectations about the hospital visit or patient encounter. 5. Respond to consumers desires for greater personalization and better service. 6. Empower employees to use service recovery when patients expectations are not met. 7. Promote evidence-based medicine through the use of clinical support systems and financial incentives. 8. Encourage consumers to create and maintain personal health records. 9. Educate consumers about the consequences of poor health and bad behaviors and support their participation in wellness and disease management programs. 10. Follow up with patients after their visit via the phone. Allow them the chance to asks questions about their ongoing care and needs.
Sources: Deloitte; H&HN research, 2009

Who Cares What Patients Think?

For a number of years now, many experts have predicted a significant shift in how consumers get information about local health care providers. That could yet happen as Americans assume more of their own health care costs and as the Internet and other resources offer more robust and reliable comparisons of quality and patient perceptions. But so far, when people want information about health care and those who deliver it in their communities, a large percentage continue to rely on family and friends and their personal experiencesand that underscores the need for hospitals to better understand who their consumers are and how they perceive excellent care. Most-cited sources of local health care information

ADMINISTRATION

Consumer loyalty surveys can be conducted alongside HCAHPS or separately. By conducting the surveys jointly, hospitals get ongoing data for process improvement and public reporting requirements. When done separately, hospitals can opt for ongoing, yearly or every-other-year surveys, depending on the organizations resources and goals. The more frequent the consumer/loyalty survey, the better able organizations will be to quickly respond to consumers concerns and needs. The mode of the survey also varies based on the hospitals goals and resources and may include mail, phone, Internet and mail with telephone follow-up. Participants do not have to be recent or current patients of the hospital. The goal of loyalty surveys is to get a sense of the consumers perspective of the organization, including likeliness to choose or recommend the facility. A broad representation of the community is recommended. Loyalty surveys seek to understand how well services are provided to patients and how the organization is perceived in the marketplace. Sample questions include: If a friend or family member needed health care services in the future, is the likelihood of your recommending X hospital excellent, very good, good, fair or poor. And when thinking about your overall experiences with X hospital, would you say the hospital typically exceeds your expectations, meets your expectations, falls below your expectations or dont know? Patient loyalty surveys can be costly, but provide an important look into the perceptions of current and potential patients. Because of the multitude of survey options, benchmarking with other facilities can be limited unless using an outside research service.
Sources: CMS and H&HN research, 2009

ELIGIBLE PATIENTS

Patients participating in the HCAHPS survey must be: 18 years or older at the time of admission; have at least one overnight, inpatient stay; and have a nonpsychiatric DRG/principal diagnosis at discharge.

Internet 8.6% Friends/ relatives 34.5%

SAMPLE QUESTIONS

Other 25.8%

Family doc 21.1%

Insurance......................6.7% Experience....................6.4% Work ............................5.5% Hospital mail................3.4% Newspapers ................2.7% TV ................................1.0% Radio ............................0.1%

The survey assesses the consistency with which the hospital met the patients expectations. Sample questions include: During this hospital stay did the nurses treat you with courtesy and respect? During this hospital stay how often was your pain well controlled? Most questions ask patients to respond on a scale of 1 to 4, representing never, sometimes, usually or always.

PROS/CONS

HCAHPS is a first step toward providing publicly reported patient perception data. It addresses service consistency and basic elements of service experience. The scope of the survey is limited. It does not provide clinical quality information or a deep dive into patient loyalty.

Source: PRC National Consumer Perception Report: Uncovering 25 Years of the Healthcare Market, 1984- 2009

What is information about your market without quality? Just information.

Thirty years of researching healthcare consumers, patients, physicians and employees has proven that consumer research is not one-size-ts-all. What is true in Philadelphia is not true in Chicago. Consumers in Missoula are not necessarily the same as consumers in Wichita. And, what is true for one hospital in Miami is not necessarily true for its competitor across town.

Decisions...
The PRC Consumer Perception Study details consumers opinions of your services, communications and programs relative to your competitors, identies your market share for very specic services, pinpoints market opportunities and evaluates your marketing and advertising efforts. You need a survey that provides quality information specic to your market and organization, not generalized data gathered in a survey designed for a broader audience. Syndicated research gathered annually from the same people is just information not the quality information you need. With PRC, you will have the quality information needed to track the effectiveness of your campaigns, utilization and perceptions of your services, what drives hospital selection in your market, as well as consumers loyalty to you and your competitors.

based on Pinpoint Accuracy.

Much has changed since PRCs rst National Consumer Perception Report 25 years ago.
Our country has experienced ve presidents, each with his own healthcare agenda. Americans also witnessed scientists make monumental discoveries and advances; where would we be today without these advances? PRC has been present for this great journey, sharing our philosophy and quality information along the way with healthcare organizations. It has been our privilege to share our knowledge and expertise with more than 1,800 hospitals and health systems across the country, helping them understand the best way to impact their market and their consumers. Let PRC help you understand your changing market, too.

Awareness of Area Hospital Providing the Best Specialty Care

1984 Cardiology Obstetrics Oncology Orthopedics Outpatient Surgery 47.1% 50.8% 45.6% 39.4% 45.7% 2009 62.9% 54.8% 51.7% 49.5% 53.7%

Primary Source of Local Healthcare Information

1984 Friends and Relatives Primary Physician Internet Newspapers Hospital Mailings Television Radio 27.0% 45.8% 0.0% 10.9% 3.2% 2.2% 0.6% 2009 33.6% 21.1% 8.6% 2.7% 3.4% 1.0% 0.1%

How has your market, consumers needs, and their perceptions changed?
If you would like to receive a complimentary copy of the PRC National Consumer Perception Report: Uncovering 25 Years of the Healthcare Market, please send your contact information to: NationalConsumerReport@PRConline.com

Professional Research Consultants, Inc.

11326 P Street, Omaha, NE 68137 www.PRConline.com 800-428-7455