Fostering Patient Loyalty In Urgent Care Settings

Of all the changes within the health care industry, one thing is unmistakable - the people you treat are not just your patients, they are also your customers (Mayer & Cates, 1998).

Clinically skilled care is a necessary but not sufficient basis for engendering patient satisfaction. In today's consumer-oriented health care environment, clinically skilled care is expected as a given, and therefore won't be the sole reason for patients to return to you in the future. To earn patients' loyalty, care must be delivered with a strong customer service focus. These two qualities - clinical skill and customer service - define high quality health care from the patient's perspective (Kenagy, Berwick, & Shore, 1999).

Increasingly, consumers looking for convenient, immediately accessible, affordable care for their episodic health needs are turning to Urgent Care (UC) centers. Perhaps the greatest asset of UC centers is their ability to provide access to care at times when a primary care physician may not be available, without the high cost and lengthy wait times of a typical emergency department. UC centers typically do not require an appointment, making it easy to see their appeal to today's highly selective health care consumers.

But how satisfied are patients who visit UC centers? And importantly, how can UC centers increase patient satisfaction, and by extension, loyalty? To answer these questions, Press Ganey Associates, a South Bend, IN, corporation that provides satisfaction measurement and improvement services to the health care industry, examined 64,389 patient satisfaction survey responses in 2002. Collectively, the patient responses represented 107 UC centers across the United States. The good news for the UC industry is that the average overall satisfaction rating (a composite measure on a 100-point scale) was 83.0, suggesting fairly high satisfaction levels among UC center patients.

However, when looking more closely at the issue of patient loyalty, there is perhaps less cause for celebration. As Jones and Sasser (1995, p. 91) point out, "the only truly loyal customers are totally satisfied customers." In the context of a patient satisfaction survey, a rating of anything other than the highest rating possible, even if it is a generally positive rating such as "good," indicates the potential for defection to another source of care in the future.

As shown in Figure 1 below, our survey results showed that only 59% of patients indicated that the likelihood of their recommending the UC center to others (a leading indicator of patient loyalty) was "very good," the highest rating on the scale. Thus, a large portion of the UC patient base may be likely to seek care elsewhere in the future if an opportunity they perceive as better should arise.

Effective Strategies

What can UC centers do to improve the experiences of the patients they treat and by extension increase patient loyalty and positive word of mouth? The best approach is to focus on those issues with which patients are currently least satisfied and view as integral to their satisfaction with the care experience.

Our national analysis prioritized each item on the Press Ganey Urgent Care Survey according to the probable impact the item's improvement would have on patient likelihood to recommend the UC center (see Table 1). Focusing quality improvement efforts first on the items at the top of the list will generate the largest gains in terms of positive word of mouth and loyalty.

The #1 priority in our analysis was to find out from the patient "How well you were kept informed about delays." When one considers that much of the appeal of UC centers is their perceived convenience when compared to other health care options, it is not surprising that the issue of delays emerges as a central concern. As shown in Figure 2 (next page), there is a clear relationship between how long a patient spent in the UC center and their stated likelihood to recommend the center.

These data suggest that patients expect UC centers to deliver care promptly, and their loyalty may wane if that expectation is not met. Therefore, streamlining processes so as to effectively manage patient flow is essential. This can be challenging, given the "no appointment necessary" nature of most UC centers.

A key factor in managing visit times and thus increasing patient loyalty is creating an environment that supports expedient care. Having a system in place for tracking length of stay and communicating this to staff is critical. The more challenging task, however, is developing a group consciousness that strives to meet the expectations that have been set. This is a delicate task that requires constant nurturing through hiring practices (finding the right staff), empowerment of staff members, routine discussion of length of stay goals, and acknowledgment of staff successes (see sidebar, next page, "Five Things Managers Can Do").

Example: UC Center in Indiana

The goal at the Immediate Care and Occupational Health Clinic (ICC/OH) of Johnson Memorial Hospital (JMH) in Franklin, IN, is to average 40 minutes from door to discharge, and any deviation from that average is examined and shared with the staff.