Originally posted on April 19, 2013
By Brian Powers, Amol S. Navathe, and Sachin H. Jain
Over the past decade, patient-centered care has become a mantra for high-quality health care. Policymakers, researchers, physician-leaders, and patients have all cited the need for care to be tailored to patients’ unique needs and preferences. And there is solid evidence that patient-centered care can help improve care quality and reduce costs. However, in the rush to become more patient-centered, the health care system has misplaced its focus.
Current approaches to patient-centered care are based on aggregated preferences rather than individualized needs. Researchers and health systems deploy focus groups and surveys to assess general patient preferences in an effort to determine “what patients want.” But patients are a diverse group with diverse needs. Characterizing general beliefs and preferences alienates those whose needs and preferences do not align with the majority. The result has been a monolithic view of patients and their needs — a framework that prevents the delivery of truly patient-centered care.
All service industries share the challenge of providing tailored, individualized service. In response, leaders in customer service have developed tools and infrastructure to understand and respond to individual needs and preferences. Health care providers should leverage these approaches.
For example, lessons from hospitality industry hold promise in helping physicians understand patient preferences and deliver tailored care. Consider New York City restaurateur Danny Meyer, who has built a restaurant empire on a relentless pursuit of hospitality and personalized service.
People sitting down for a business dinner or anniversary at one of his restaurants might receive reserved, formal service. A group of eager tourists, on the other hand, may hear longer explanations of each dish and its provenance.
This type of service acumen is essential if physicians are going to respond to each patient’s unique needs and provide individualized care. However, medical education currently focuses on teaching standardized approaches to patient interaction. We were taught specific language that patients find helpful and specific actions and reactions such as placing a hand on patients if they begin to cry.
These strategies are well intentioned but stem from a misguided focus on the needs of the average patient. New servers at Meyer’s restaurants do not learn the preferences of the average diner. Instead, they are trained to quickly assess the preferences of the people at each table and tailor service to their unique needs. Medical schools should help students develop these same skills.
Additionally, consumer-marketing tools, such as customer segmentation, can help providers deliver tailored care. Customer segmentation is ubiquitous across service and consumer product industries, but its application to health care has lagged. As health-care-delivery systems expand and more data is stored in electronic databases, there exists the potential to prospectively segment patients according to their needs and preferences.
Recently, researchers have used cluster analysis and data mining of large health databases to group patients according to preferences and measures of experience. Delivery systems could use these data to predict patient needs and expectations. For example, a practice could determine which patients are more likely to prefer being close partners in care decisions, be especially angered by lengthy wait times, or place a premium on warm, trusting relationships with staff.
Despite their broad applicability, these types of strategies and insights from service industries are underutilized by health care systems. One reason is providers have been reluctant to see health care as a service industry. Only by accepting the reality that it is one can providers learn from the successes of others in the field. And there is plenty to learn.
Brian Powers is an M.D. candidate at Harvard Medical School and previously worked at the Institute of Medicine’s Roundtable on Value & Science-Driven Health Care. Amol S. Navathe is a physician at Brigham and Women’s Hospital and is on the faculties of Harvard Medical School and the University of Pennsylvania’s Wharton School. Sachin H. Jain is chief medical Information and Innovation Officer at Merck, a lecturer in health care policy at Harvard Medical School, and an attending physician at the Boston VA Medical Center. He is also a member of Wing of Zock’s external advisory board. Jain and Navathe were members of the Obama administration’s health reform team and are co-editors in chief of Health Care: The Journal of Delivery Science and Innovation.