'Loyalty really does fall off a cliff' — Why making things easy for patients may not be enough to keep them

Most patients who leave a health care provider aren't storming out the door. They're drifting, quietly, out of an “uncertain middle” where nothing feels wrong enough to complain about, but nothing feels good enough to guarantee they'll stay.

That's the core finding of the Accenture report, “Turning patient uncertainty into loyalty,” based on a Patient Experience Benchmark Survey of 10,000 U.S. health care consumers that Accenture has run for nearly a decade. Only 65% of patients said they would definitely stay with their current provider. Most of the rest aren't dissatisfied, they're merely “somewhat” satisfied, trusting and likely to stay, a group the report calls the uncertain middle.

Sarah Sinha is a managing director in Accenture's health care practice and leads the company's patient access and experience practice in North America. She has spent more than two decades in the health care provider industry and is the lead author of the new report. She spoke with Medical Economics about the research and what it could mean for physicians' practices.

This transcript has been edited for length and clarity.

In the most recent research, what did you find most surprising?

Sarah Sinha: I think the most surprising thing we found was how fragile loyalty really is. When you look at how patients feel about the experience, the difference between a great and a good health care journey can really influence loyalty. One of the things we saw in the data was that about 65% of patients are loyal to their health care providers. Most of the rest are in a large group of at-risk patients in the middle. They're not outright unhappy. They're in this middle ground of somewhat OK with their experience. They're not going to complain, and their engagement looks okay or even good, but they're not loyal.

We spend a lot of time in the report following this trend, which we see across many of the different metrics: Loyalty really does sort of fall off a cliff when moving to the middle of those engagement scores. When a patient shifts from being very engaged to merely somewhat engaged, that tends to reduce loyalty by more than 50 percentage points across a number of different metrics we look at. That was really the most important, most surprising aspect of the survey to us.

The report outlines four core experience metrics: access, ease of doing business, digital quality and trust. How would you introduce or explain those concepts?

Sarah Sinha: I'll go through each of them. Access really represents how patients get in the front door. It's by far and away the biggest factor in how patients choose their provider, and it covers availability of appointments, but more than that, it includes time and location convenience, and the patient's ability to interact with their provider on the channel they choose, whether that's picking up the phone or using a digital solution. It has routinely, throughout the years we've been doing the survey, been the largest driver of patient experience. And the flip side is what we saw in the survey this year: Only about 40% of patients can find care when they need it, and only about 56% of patients can schedule an appointment in the way that's most convenient for them. So there are a number of challenges with access.

Ease of doing business represents many individual interaction points, but essentially it means: Can patients complete the routine tasks across the journey? When they call, does someone pick up the phone easily? Can they finish what they started on that channel, or a different one? Do they know what the next step in their journey is, and is it easy to get there? Only 44% of patients could get their issue resolved the first time they contacted customer service. Other points of friction include wait times, delayed responses, cancellations and rescheduling.

Digital quality is the third force. This year we were very specific about calling that out, because we found that it's not just having digital capabilities that matters, but how seamlessly they work that really drives engagement. Today, only about 55% of patients find the digital experience very easy. And similar to the other areas, even moving from great to good has an outsized impact: Loyalty drops more than 50 percentage points when digital moves from very easy to just easy.

And lastly, trust is our fourth force, and it's the strongest predictor of loyalty. About 91% of patients who trust their provider say they'll definitely stay, but only 57% of patients trust their providers. Trust is a broad reflection of many aspects of the journey. It's tied to things like how well patients understand their diagnosis and care plan, and to communication, but it's also tied to access and digital engagement. It's the sort of universe of those things where you really can't be great at one and not the others; you have to be good at all of them to have great trust. We also see trust as a predictor of future adoption. That's really important for providers as they evolve and modernize their capabilities, because patients who trust them are much more likely to follow that evolution and adopt digital tools or virtual care. So it's also an indication of whether they're going to stick with a provider in the future.

What's one practical step a practice could take toward first-contact resolution, without adding new technology or staff?

Sarah Sinha: Always simplification and unification of the rules and workflows that navigate patients. In the provider industry, those rules tend to be very complex and very customized, so from provider to provider, or even service type to service type, the rules for how we navigate a patient to the right point of care, the right type of appointment, the right location, can be very different. Standardizing and simplifying those rules and workflows is the best way to enable all of your channels and capabilities to work.

That's the same thing that will drive first-time call resolution, as well as whether a patient can start and finish something they attempted on a digital channel. The provider industry has historically had a lot of gatekeeping over those rules, particularly around patient scheduling. Sometimes you call a call center, and depending on the type of service, the person answering isn't empowered to finish the call, and they have to check with the next level of gatekeeping. The more that workflow can be unified, so it can start and finish in one place, the more those operational challenges get solved without needing additional tools or technology.

What's the best way right now for health care to reconcile patients' desire for both human contact and digital convenience?

Sarah Sinha: You have to have both, and it's important to know when the right time for each is. Most patients don't want one or the other; they want both, and they also want the provider to know when human contact matters more. The lowest-complexity, most routine tasks are the ones that are easiest to put into a digital channel, and those will be widely adopted by the patient base. But when patients have a more complex need, they want to be able to pick up the phone and call.

The other important thing is to connect those channels together, so a patient can move from one into another. If they're on a digital channel and it turns out to be more complex, or they have a question while going through it, they shouldn't have to fully abandon it and start over in a live channel. They should be able to get to a phone call more easily. And on the other hand, if a patient is on the phone and knows they're going to wait several minutes, they should also be able to be directed to a digital portal that lets them complete the task online if they don't want to wait.

How important is portal access right now, especially for smaller practices?

Sarah Sinha: Extremely important. Consumers' expectations are set by other industries that are highly digital; all of the basics, and many more complex tasks, have been digitized for years in other industries. That's setting the bar. Patients will absolutely expect it. They will also understand and expect that some things in health care are of higher complexity, and that they'll want to talk to a human for those. But some of those foundational digital capabilities are really table stakes at this point.