Baby boom dilemma: How to avoid a generation of unhappy patients
Aging boomers will want service, convenience, information
It's been three decades since the Rolling Stones first sang "I can't get no satisfaction." But as the baby boom generation grows older, that could sum up its attitude toward health care providers.
Boomers are harder to please than previous generations in every dimension of patient satisfaction, according to an analysis by Press, Ganey Associates in South Bend, IN, which has an inpatient database of about a million patients. (See chart, p. 39.)
Physicians and medical group administrators are going to have to change some assumptions about patients and how to please them in order to keep the loyalty of baby boomers, says Mary P. Malone, MS, JD, CHE, executive director of Press, Ganey's new division, PG Consulting Services, which helps hospitals and medical groups improve customer service and patient satisfaction.
"They're not shy about switching brands [or doctors], but when they find something that works, they can be extremely loyal," Malone says. "If I want them to be loyal during their high health care years, [I should ask], 'What can I do today to establish that relationship?'"
Malone predicts that successful medical groups will find innovative ways to attract and retain middle-aged patients. "I believe that there will be a time of intense creativity among leading clinics and practitioners," she says.
Just consider how baby boomers changed obstetrics, with the growth of birthing centers, the transformation of labor and delivery rooms, and the popularity of nurse midwives, says Molly Joel Coye, MD, director of the West Coast office of The Lewin Group in San Francisco, a health care consulting firm that specializes in strategic planning and operations.
Expect this technology-savvy generation, with on-line access to medical information, to similarly alter relationships between patients and primary care physicians, she says. Gone is the physician as authority figure. "Baby boomers are going to be more comfortable with physicians who see themselves as equals with patients," she says.
Coye and other experts offer several suggestions of ways health care professionals can anticipate the needs and expectations of these 77 million consumers, who represent 30% of the U.S. population:
1. Convenience.
Do you offer evening or weekend appointments? If not, some patients may drift to practices that do. "Health care has to be available when consumers can get there," says Tom Aug, president of Development Partners, a Cincinnati-based health care consulting firm that specializes in organizational development.
Many in this group will want the option to schedule appointments and arrange for prescription refills over the Internet. After all, they can now buy airline tickets, concert tickets, and a cornucopia of products on-line, as well as shop for a car or preview houses in a real estate listing.
And if your patients express frustration about long waits to see the doctor, the baby boomers among them will have even less patience. Now is the time to work on customer service issues, says Malone. "This is the group that invented everything from McDonald's to drive-through cappuccino stands. They're very convenience-oriented."
2. Personalized service.
The relationship between patients and their trusted physicians is a cherished one. But as pressure increases for greater productivity and efficiency in health care, both sides can feel rushed during an office visit.
Meanwhile, as boomers develop more chronic illnesses such as hypertension, diabetes, and heart disease, the average primary care physician will see patient loads increasing.
At Scripps Clinic in San Diego, the clinic's vice president and medical director, Dan Dworsky, MD, analyzed patient data and realized that, even now, the numbers don't work.
"We figure a hard-working internist could see 4,069 patients a year. The average senior in our group has about 10.5 visits per year. The average commercial [insured patient] has 4.6 visits per year. When we started looking at the size of our physician practices, we realized there were about 1,000 more visits than could possibly be accommodated."
Scripps Clinic is capitated, so simply adding more physicians isn't the answer. Also, Dworsky worried about "burnout" among internists seeing a large load of high-need patients.
The answer: monthly group sessions in which a physician and nurse visit with 20 to 25 seniors and discuss a topic of interest. The group's physician reserves time to talk to the seniors individually and see some patients afterward in his or her office, as needed. This presents a model for handling the needs of older and chronically ill patients as those groups increase in size.
The Scripps program raised patient satisfaction and reduced other demands on the practice, such as calls to the physician for prescription refills or questions. (For more information on the senior program, see related story, p. 40.)
Some medical groups have taken other steps to make sure patients felt more than "the 2 p.m. appointment," Aug says. At one practice he worked with, the receptionist records on a lobby seating chart where patients sit after they check in. They can then be called by name and introduced to staff members - rather than having a medical assistant open the door and shout.
Some physicians dictate a letter for each patient after a visit, summarizing what was discussed, what the recommended treatment is, and when the physician would like the patient to return for follow-up, Aug says. "That's the personalized care people want to see. Patients love it. The physicians who did that scored very high in patient satisfaction."
Some practices recognize patient loyalty by sending an anniversary card to five- or 10-year patients, thanking them for their patronage.
With the use of technology, Aug envisions other personalized touches. For example, physicians could send an important article to diabetic patients via e-mail.
3. Shared health care decisions.
Physicians should identify segments of patients, such as diabetics, and create self-management programs to involve them in their care, advises Coye. Much of the self-management may come from patients themselves as they cull information from the Internet. In some cases, they may discover a medical development that the physician hasn't yet learned about.
"This is going to upend the balance of power and the balance of information between patients and physicians," says Coye. "What patients are going to want is not a dispenser of knowledge but a guide and a coach."
Meanwhile, the movement toward greater patient participation in decision making is gathering steam. For example, the Foundation for Informed Medical Decision Making in Hanover, NH, provides interactive videos that can give patients their own probabilities of good or bad outcomes for a given treatment based on their clinical information. The videos are designed to help patients choose among treatment options for such problems as benign prostatic hyperplasia, prostate cancer, breast cancer, and low back pain. (See editor's note, below, for contact information. For more information on patient involvement in decision making, see Patient Satisfaction & Outcomes Management, February 1997, p. 13, and July 1997, p. 82.)
"[Baby boomers] have learned to participate and work in decisions that influence their lives," says Aug. "They want to have a say, and they want to have options."
Those options increasingly include alternative therapies. Some health plans are marketing to that demand by offering to cover acupuncture, chiropractic services, and other therapies.
4. Quality-based information.
Consumer Reports and similar guides evolved to give baby boomers independent, data-based information on products. Why should health care be any different?
Health Pages magazine, with some limited information about individual physicians and hospitals, is already available in various cities around the country. Some report card projects, such as the Cleveland Health Quality Choice Coalition, includes physician-specific data.
"We make one of the most important decisions of our life - about who our doctor is - with virtually no information about the capabilities of that person or health system," says Aug. "The baby boom generation is more sophisticated in their buying habits, and they're used to having data."
The sheer size of this generation gives them influence. And that means, ultimately, they will get what they want. Medical groups that provide those services will be one ahead of the pack.
[Editor's note: Interactive videos are available on 13 subjects for $49.95 each, plus shipping and handling. For more information on the Shared Decision-Making Program, contact the Foundation for Informed Medical Decision Making, P.O. Box 5457, Hanover, NH 03755-5457. Telephone: (603) 650-1180. Fax: (630) 650-1125. E-mail: 2ShareDecisions@ Dartmouth.edu. World Wide Web: http://www.dartmouth.edu/dms/cecs/fimdm/.]
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