The Currency of Time: Driving Patient Loyalty Through Better Experiences

In this episode, Casey Arends, Director Experience Strategy, Fairview, and William England, Ph.D., Strategic Advisor, Research, NRC Health, discuss NRC Health’s “The Currency of Time” report and how health systems can improve patient loyalty by making care both easier to access and more meaningful. 

- Hi, everyone. This is Lucas Voss with Becker's

- Healthcare. Thanks so much for tuning in to

- the Becker's Healthcare podcast series. It's great to

- have you. Today's conversation is built around a

- new insight report from NRC Health called the

- currency

- of time. The premise

- is that patients judge health care through two

- different lenses,

- whether an organization respects their time by making

- care easy to access,

- and the second part, whether the time they

- spend receiving care

- actually

- feels worthwhile.

- And I'm so excited to have two wonderful

- guests to discuss the insights

- of that report to dig in with them.

- William England, strategic advisor research at NRC Health

- and also the author

- of the report. Great to have him. Casey

- Aaron is the director experience strategy at Fairview.

- Welcome to you both. I wanna hop right

- in because, again, we have so much to

- discuss. There's so many great insights

- in this report. And, William, I'll start off

- with you.

- The report, again, looks at the patient experience

- through those two different lenses, time saves and

- time well spent.

- What do those two mean, and why are

- both

- important to patient loyalty today?

- Yeah. Thanks, Lucas, and, happy to be here.

- This is second time, I think, we've met

- on one of these podcasts. Yes. It's great

- to have you. So so happy to be

- back.

- So the idea comes from a book called

- The Experience Economy

- by Joe Pine and James Gilmore.

- And the idea is that,

- increasingly, we've we're solving for and this is

- just writ large, not just in in health

- care, but but in in we're in

- consumerism itself, we're solving for, like, maximum efficiency,

- convenience, and speed.

- And increasingly, folks are especially younger consumers are

- looking for things that are more, like, meaningful

- engagement, personal connection,

- memory making.

- And so the idea sort of comes from

- that book

- and then applied to health care. Essentially,

- the the idea is that that patients have

- sort of two at least two clocks sort

- of in mind or at least the way

- the way concept conceptual frameworks for how they

- think of time. One of them is, you

- know, did I how long did it take

- me to get an appointment? Was scheduling easy?

- How long did I have to wait when

- I got there? Did my test start on

- time? Those kinds of those kinds of issues.

- But then a second conceptualization

- is more like, what did you do with

- my time, when you had it? Did you

- listen to me? Did you explain,

- what was happening? Did I feel reassured?

- Those kinds of things. And so that's that's

- how we're defining time well spent. We have

- a bunch of survey questions

- surrounding each of these sort of frameworks, and

- so we were building statistics and and and

- measurements

- from there. And and to answer the second

- part of your question, why are both important

- to patient loyalty?

- I mean, health care needs both, and and

- I'm excited to to to hear what Casey

- has to say. I think, you know, if

- you have a wonderfully compassionate physician, but it

- takes six months to see them and 10

- phone calls to get, you know, to get

- in front of them, that could be a

- problem, I I would think, for a lot

- of people. But on the other hand, if

- you can get me through the door incredibly

- quickly, but it feels something like a, I

- don't know, a NASCAR pit stop or something,

- that's not a great experience either. And it

- just turns out, though, through the data and

- through the analysis, the patients are often

- much less forgiving when their time is not

- well spent.

- Casey, just as a as a follow-up to

- that,

- again, how did this report and and again,

- this this lens change your own view of

- experience

- and should really should health systems be looking

- at this more like what William just described?

- Well, I think so. And, you know, the

- the fence straddling answer, of course, is that

- they're both important, but I think what this

- helps do is provide some insight into how

- important are they, and it also helps explain

- what's in a team's control and influence. And

- the time well spent metric is clearly more

- within the influence of the clinical care team.

- And, obviously, there's operational and facility considerations to

- how patients experience their time when they're actually

- with us. But foundationally, that's super important. And

- William laid it out clearly, I think, that

- if you hurry up and get more people

- into a poor experience, it's probably not gonna

- produce the long term results that you're looking

- for. So I think it's a great double

- down and reinforcement

- that we've been sharing with our ops leaders

- that you have to make the most of

- the time when the patients are there. You

- have to make sure that the patients are

- heard and that they're confident in the next

- steps. That's foundational and kind of table stakes.

- Having a strategy for access is just that.

- It needs to be a strategy, something that

- you're aligning your investments to, your capacity to,

- and then it complements

- your ability to provide time well spent.

- And I I wanna

- dive a little bit deeper into an another

- element of this. You you filed the operational

- piece too, but, again, there's also

- something generationally

- here. I know this and and you know

- this and and people from different generations, of

- course,

- really treat health care differently.

- Younger consumers report significantly

- more barriers to accessing care

- than older consumers.

- Casey, where do you see those generational differences

- showing up, and how should health systems respond

- to that specific piece?

- I wish I had an easy button, for

- how to handle that. I you mentioned

- the generational differences. A lot of it probably

- comes down to expectations and what people are

- looking for. And so I think that the

- easy response for health systems is to make

- sure that our digital tools

- that our online experience or our virtual experience

- is as seamless as possible. And for those

- who are looking for that efficiency,

- that kind of DIY

- control over their health care experience,

- have as much of that as possible to

- make sure that we're kind of meeting those

- needs.

- On the other side, we're not going to

- have a different access pathway or different wait

- times for people based on their age, and

- so we need to make sure that we're

- setting expectations appropriately. And I think with our

- younger patients and families, that's a lot of

- our work is to setting those expectations clearly

- and then making sure that we're reinforcing that

- when we do see them, it is the

- right care, that it's okay to wait, and

- that we'll be, you know, taking really good

- care of them once we do have the

- chance to see them. William, did that surprise

- you, that piece, that generational piece?

- Not especially because a lot of our,

- research from the last twelve months has been

- about has had that generational lens.

- And we've and we've just and one of

- the arguments we've made is that one of

- the issues that health care, writ large is

- facing is that most of the most of

- the patients and consumers

- are older folks

- currently,

- but design has to have in mind what's

- coming towards the future. And so that is

- an issue that health care has not faced

- in the history of health care in this

- country, maybe in any country. I don't know.

- I haven't I haven't I haven't done a

- comparative, international analysis. But but the striking finding

- was that fifty nine percent of older consumers

- reported no access barriers compared with thirty seven

- percent of Gen z millennials in this case.

- That's a 22 difference, and that is striking

- on all of our consumer research. Usually, we're

- like, oh, six or seven points. Like, that's

- huge. So this is, you know, three or

- four times what we normally see as a

- difference. And so I don't think I think

- the takeaway is not that young people are

- impatient.

- I think that's too easy even as too

- easy of a story.

- But I think the definition of convenience is

- maybe changing. Like, you know, I can book

- a flight and change a hotel reservation, order

- dinner, move, you know, my Bitcoin around or

- whatever at 10:30 at night. And the the

- environment you know, that's the environment that health

- care is competing against, for for many younger

- consumers' expectations. And I think solving for that

- while still maintaining

- the the good work that a a lot

- of health care, organizations are doing with older

- patients and consumers is is is the is

- the challenge.

- We're so conditioned towards those experiences too as

- consumers

- because we're experiencing

- them in every other sector but health care

- oftentimes,

- right, and shopping, etcetera. I love that you

- highlighted that because it's so crucial to this

- conversation.

- Now we talk about speed a lot, and

- and, again,

- speed is an important factor, but there's also

- a limit to what improving speed alone

- can actually accomplish. Again, we know access and

- efficiency also matter. It's important.

- William, beyond making,

- again, care faster and easier,

- where should health systems focus today

- to strengthen patient loyalty?

- Yeah. I mean, I can tell you that

- that what the data says, and you mentioned

- it and Casey you said it too. But

- just to reiterate, like, if if I can't

- get you through the front door, I don't

- have much of an opportunity to create loyalty

- with you. So that part matters, but we

- did find diminishing returns to efficiency alone. So

- at a certain point, you know, shaving a

- a a few minutes off of a waiting

- time or or, you know, getting you know,

- shaving a couple days off of a a

- of an appointment when process,

- isn't necessarily where the biggest returns to loyalty

- and and, are going to lie. So we

- ask a separate a separate question. You know,

- once we consider

- these different parts of the experience together, what

- actually distinguishes loyalty? And that's where the human

- interaction

- metrics start sort of winning. Confidence and trust,

- clarity, and, understanding, reassurance, communication, those things rise

- to the top of predictors

- of,

- nines and tens or or good scores on

- on on on NPS questions, which I love

- because after crunching all the numbers, you know,

- we find something that's sort of profoundly human

- where, people are willing to forgive to a

- degree some delay

- as long as they know they're in good

- hands afterwards. And I think,

- I think that's an important lesson for for

- people in in in this business.

- Casey, do you feel like organizations understand that

- or have an understanding for why this is

- so important?

- I think we're getting there. And one of

- the challenges that probably not unique to health

- care but is,

- very prolific is the

- silos in which we both provide care and

- then measure those experiences.

- And so,

- it really is challenging for us to connect

- the dots between a scheduling experience

- or a, you know, a call center experience

- and then a point of care experience and

- follow-up.

- And we have such a need to do

- better at

- connecting our data to understand how friction upstream

- in those early experiences

- is flowing into our our point of care

- experiences. So I think we're learning that. We're

- evolving how and where we measure experience to

- get a better understanding of what those pain

- points are. I'm excited about this research because

- I think it helps us have a way

- to kind of weight those different experiences a

- little bit in terms of the importance or

- impact, and is it a recoverable,

- you know, issue that we have, where do

- we point our very limited resources and attention

- units. So evolving our understanding of how important

- that friction is and what effect it has

- on patient loyalty is super important in terms

- of strategy and decision making.

- You described a very important process there, which

- is there's a ton of different touch points.

- And the more touch points we have,

- the more friction it generally creates because there's

- more point of errors that can be involved.

- The process that you've just described of trying

- to you know, going through these multiple stages,

- of their journey.

- Right? How can health systems get better

- at identifying

- and addressing those compounding pain points that that

- chain, so to speak?

- Yeah. I think some of it is improving

- their measurement systems, like getting really adept at

- understanding what are patients looking for out of

- each interaction.

- And I think there's a lot to be

- said in the research that William shared here

- about what really matters to patients. And so

- you think about where you should measure that

- versus where should you measure access. I I

- know that, sometimes people are asking access questions

- on the point of care survey.

- I feel like that's a little bit frustrating

- for the care team. They have limited levers

- to pull to change access or wait times.

- And so if you kind of think about

- the data as a way to say where

- do we need to gather this insight and

- then who's positioned best to do something about

- it, it can kind of ask some interesting

- questions about your measurement strategy of what are

- you actually asking of who and what are

- the patients trying to get out of that

- particular step.

- Obviously, there's a lot of room for opportunity

- and we're no exception to that. Getting better

- at connecting the dots of patient A had

- this experience here and here and here, what

- were the themes, the comments, the

- experience scores across those critical things to the

- outcomes for that patient each of those steps.

- We don't do a good job of tying

- those things together. We kind of view scheduling

- as one experience and paying your bill as

- one experience and the care encounter as a

- separate one. Then we can look at themes

- in aggregate. We're not as good at tracking

- what that looked like for patient a all

- the way through, and that's a growth opportunity

- for us for sure. William, I know that

- the

- the report specifically shows that piece, that friction

- becomes more damaging

- when it follows patients across multiple stages. Right?

- Anything to add here on that specific piece?

- Yeah. Just the the thing that I emphasize

- is that that is the accumulation

- of friction

- matters. I you know, I couldn't get an

- appointment when I wanted, then I had trouble

- finding where to go when I got there.

- Then I waited a long time in the

- waiting room. Then I had to repeat the

- information that I'd already provided prior to the

- visit. And then I left without being sure

- what happens next, and I don't understand my

- medications. And it's like none of those are

- individually catastrophic.

- But piece that together and hang it together

- in the mind of of the person experiencing

- this this care journey.

- And and that's the story that hangs together

- and gets and gets repeated, you know, beyond

- the four walls of the care setting. So

- it's the so

- yeah. It's there's there's a there's a difficulty

- or or there's a hazard of of fragmentation

- across

- teams or across the journey that that I

- think, you know, the patient experiences while maybe

- only the the care providers experience only segments

- of that

- of that,

- process.

- I wanna wrap us up with sort of

- an an overarching view of all of this.

- Again, improving the way patients experience the time

- touches so many different elements

- in this conversation. Right? We talked about operations,

- digital

- to clinical care, obviously,

- and the patient experience at the end of

- the day.

- I'd like to close this out with this

- question here. Who should ultimately own all of

- this work,

- and how do you keep it from becoming

- fragmented

- across the organization when there's so much to

- think about? Casey, I'll start off with you.

- I think that's foundational by any improvement that

- you're gonna get experience is being really clear

- about who are the ones who are delivering

- the experience

- and making sure that they can see themselves

- in your measurement device, whether that's your key

- driver questions you're asking on a survey or

- your operational metrics for a team. And

- if you don't have that kind of buy

- in from those who are delivering the experience

- and that the data represents their work,

- it doesn't matter how great and well connected

- your data is. They're not gonna take action

- on it and not gonna take it into

- consideration. So I think it's so important that

- we're really clear

- that we set the expectation with our leaders

- and our teams that you're the ones delivering

- this experience, and here's how we're evaluating you

- in a way that is reasonable and fair

- and representative of the work that they're doing.

- Who owns this work? Yeah. Well, yeah. No.

- I'm actually very curious. I have maybe a

- question of my own for Casey and and

- how it works with his organization. But so

- the the way that, you know, we've always

- thought about this

- from from our end,

- which is not the same way that Casey

- thinks about it, I'm sure, is that in

- the what I was mentioning before is that

- there's a continuity in the patient experience. Like,

- sometimes it gets broken up across departments

- for people delivering care. So the access center

- might own one piece or digital teams might

- own, you know, the the back end of

- the app of the, you know, down or

- a clinical team might own another nursing, etcetera,

- discharge teams.

- But the patient doesn't, you know, say, well,

- my access center experience was a seven, but

- my clinical experience was a nine. You know,

- they say, like, this is my experience with

- my with with my with this health system.

- So I I I don't know. I don't

- think we need, like, a c a new

- c suite title, like chief time officer,

- although,

- I'm available for consulting. I think, Casey, if

- you're not gonna

- start a new little side gig. But no.

- But I'm curious, like, the you know, what

- does it require

- from an organizational standpoint, Casey, to to

- hold some,

- yourselves or or organization accountable across those seams

- that are often run by other departments. Is

- that your experience, and and how do you

- account for that? Yeah. I think it's really

- complicated, and I know we're trying to be,

- reasonably succinct here as well. I I will

- just say that from the most basic standpoint,

- having really clear operational owners within each care

- team getting the results of the experiences for

- that area. So, right, the billing call center

- gets their experience data and is accountable for

- that. The clinic team gets their experience data

- and accountable for that. Now when it comes

- to things like how do those teams advocate

- for, how do friction points that patients experience

- on other teams get connected, I think that's

- where the rubber really hits the road from

- an organizational strategy standpoint in, like, system CX

- teams where we can help bring value by

- helping connect the data and tell the story

- and provide

- avenues for people, even if it's not in

- our measurement and data, to be able to

- escalate concerns and have a contact or a

- friend in another department that you can say,

- hey. You know, this patient came, and they

- told us they had a really bad scheduling

- experience. You've got a partner who's able to

- receive that information and take accountability and kind

- of take that data onboard to improve.

- Obviously, we'd like our measurement systems and our,

- kind of strategy of how we think about

- evolving patient care to take both those things

- into account. But in absence of that, I

- think you really have to have that partnership

- across teams.

- Chief time officer, I will add to my

- LinkedIn profile. I think this is a great

- title to have. William, Casey, same for you.

- I feel like you should all have that

- title. It works very well. I wanna thank

- you both so much for taking some time.

- What a great conversation. Thank you for being

- here. It's great to have you. Thanks, Lucas.

- Pleasure. Thank you. And we also want to

- thank our podcast sponsor, NRC Health. You can

- tune in to more podcasts from Becker's Healthcare

- by visiting our podcast page at becchershospitalreview.com.