Really? Online Reviews Could Help Fix Medicine

Screen Shot 2014-06-04 at 10.36.41 AMA basic principle of health care is that everyone strongly favors transparency – for everyone but themselves.

“Sunshine is the strongest disinfectant” is the oft-used expression that supports putting information out in the open for all to see. That said, every stakeholder in health care gets a bit nervous about exposing their own data.

They are quick to cite the potential downsides – that patients will not be able to understand the limitations of the information, that risk adjustment will be inadequate to explain why their performance looks below average, that they may actually be below average.

No one gets as nervous about public reporting as my health care provider colleagues. We worry that everyone else may game the system, cherry-pick patients, or that we might lose patients if the data look less than perfect. It’s safe to say that number of physicians who hate the idea of public reporting is greater than the number who support it.

All of which makes it that much more fascinating that some provider organizations have recently begun putting all their patient experience data – including every patient comment about every doctor – on their Find-A-Doctor web sites. “Every” actually does mean every – the good, bad, and ugly (after removal of those that might violate patient confidentiality). And they are tied directly to the physician who delivered their care.

Why would they do this? The initial response from some commentators was that they were trying to “out-Yelp Yelp” – that is, control the information that was appearing about them on the Web. In truth, the initial idea was less about controlling information than providing more of it.

Rather than living with on-line comments generated by a small subset of patients motivated by who-knows-what to write in, organizations like the University of Utah decided that they would survey all patients electronically, and post all their comments.

And they would take the chance that more data would provide a better sense of the truth.

The University of Utah health care system was the first in the country to go down this road, and they were rewarded for their creativity and courage with a very pleasant surprise. The result over the last few years has been astounding improvement in their patients’ experience with their physicians.

In 2009, only 4% of their physicians were in the top 10 percentile of Press Ganey’s national database for overall patient ratings. By 2013, it was nearly half – 46%.

University of Utah leaders realized that putting their patient information on the Web wasn’t mere marketing – it was creating a powerful motivation for physicians to give every patient the best, most empathic care. Financial incentives to improve patient experience could never have produced this kind of change.

What mattered was physicians’ awareness that every patient visit is a high stakes encounter – the biggest event of the patient’s day or even month. As one orthopedist put it, “It forces me to be on top of my game for every single patient.”

Which is, of course, a good thing. And it’s the reason why other providers are going down this road. Piedmont Health in Georgia went live last month, and Wake Health in North Carolina went live last week. Other organizations, some very prominent, are actively planning to follow suit – including some outside the U.S.

To their immense credit, the quality leaders at the University of Utah are helping other providers follow their lead. Some of my more suspicious colleagues have asked, “Why are they doing that? Why don’t they try to preserve the advantage that they have built?” The answer seems to be that they believe their mission requires them to do the right thing.

Plus, like all academics, they relish the pride that goes with sharing a patient-centric best practice.

The Utah game plan is simple, graduated, but not glacial in pace. Over four years, they first expanded the amount of data that were being collected. They moved to e-surveying and started sending surveys to every patient after every hospitalization or visit. Armed with more (and more timely) data, they moved to internal transparency, allowing anyone within the Utah system to see anyone else’s data.

After physicians got used to the idea of others seeing their data, and realized the vast majority of comments were actually warm and even effusive, Utah went public in late 2012.

The impact on performance at each step was dramatic, and the secret is now out. Other organizations are aware of what Utah, Piedmont, and Wake Forest are doing, and saying, “We have to do that, too.”

As they do, they will be disseminating priceless marketing information about their care – most patient comments are incredibly warm, grateful, granular, and believable. But, more important, they will be helping their physicians live up to their own aspirations about the kinds of doctors they want to be. And patient care will be better for it.

To join the conversation, register for my June 5 webinar with Cleveland Clinic CEO Dr. Toby Cosgrove “Engaging Doctors in the Health Care Revolution.”

Thomas H. Lee, MD, is the chief medical officer at Press Ganey Associates and the former network president of Partners HealthCare.  This post originally appeared in the HBR Blog Network

4 replies »

  1. Press-Ganey is basically a GIGO system. (Garbage In Garbage Out)

    Many of the categories have too few responses to be statistically significant. Many of the respondents have little or no idea of the quality of the care they receive and are responding based on whether they got the pain meds they wanted, whether the nurse was cute, etc.

    And the system is subject to being gamed. At one hospital I worked at, all the people in my department gave our own department excellent ratings in all categories and all the other departments bad ratings. We were in essence trying to “stuff the ballot box”.

    Not to mention that many hospital administrators wouldn’t recognize quality if it bit them in the a##.

    At least the folks at Press Ganey are making money off of it.

  2. Tom, great idea but Bubba has a point. Some forums have let their comments get out of hand and lose all meaning. The other extreme is that you have to name your name, which will have a chilling effect.

    So you’d have to find a system that doesn’t devolve but that doesn’t identify, perhaps like TripAdvisor. It shouldn’t be that hard to find and implement this, and it is one of the most elegant ideas for improvement I’ve ever seen.

  3. I like the idea in theory BUT I’ve seen enough problems that you’re going to have to convince me that this works

    This is an extension of the Universal Law of Internet Polls; namely using a medium where anonymity is cheap and numbers can easily be gamed is an interesting exercise but hardly scientific

    Participants tend to skew to the outliers – those with strong opinions on either side of the issue, meaning we know what people who don’t like the thing felt and we know what people who liked it felt.

    I took a look at the University of Utah directory that is cited above. I found almost no reviews. That tells me that people aren’t motivated to participate.

    Let’s assume this is a good idea. (And it may well be.) How can we make it work?

  4. Concur whole heartedly with this approach. We need transparency of such data in our healthcare organizations to make the systems work more efficiently and effectively and provide high value, high quality care at a reasonable price. The problem is that it is difficult to get all the data we need because of the lack of interoperability of health information technology systems with differences in system architectures and the “clunkiness” of our electronic health record systems. Patient surveys that are done by local systems are a great way to start, but we need to be able to coordinate those efforts over larger systems and among systems to really improve them. Transparency of data and more granular standards, as well as simplification of systems, are problems that we must address to get where we want to go with more ratonal healthcare reform. See my book, American Healthcare Reform: Fixing the Real Problems.