The Uber-ization of instance-based patient satisfaction

I was shortly into my Uber ride from my home into Boston before I received an alert on my phone asking me how the ride was going, and whether I would want to tip the driver before I arrived.   

I spent 100 days as a COVID inpatient and it wasn’t until five days after my discharge before a patient satisfaction caller contacted me about experiences that happened almost four months prior. It took them three future tries before I had the energy to walk through dozens of survey questions with them.  

If asked to speak honestly patient experience and quality assurance leaders will tell you that the bane of their existence is getting enough responses by phone or email to patient satisfaction surveys to accurately reflect the quality of care through the patient’s lens.  

Conceptually, patient experience (PX) and quality assurance (QA) understand one of the last things many discharged patients want to do is re-engage with a clinical experience they had been battling to escape from. The other thing they realize is that patients are bombarded by emails and increasingly by phone calls with sketchy caller IDs. I receive dozens a month with a “HEALTHCARE” ID which are immediately sent to voicemail for future deletion. The last thing a former patient wants is an ID or subject line that says “Patient Survey” unless accompanied by a substantial reward for completing the survey.  

But from a more practical level, some of the most profound patient experiences I had were situational and during the earlier days of my stay. These are not prone to retrospection a week after a discharge. But at the moment they were happening they were incredibly profound.  

For example, if I had the ability to do an instantaneous Uber-style patient experience when I was being refused ice chips, despite them being approved on my EMR profile, the provider would get instantaneous feedback about a very special situation. This is compared to the post-discharge retrospective survey which simply asks: Were your clinicians sensitive to your care needs? 

The overarching qualitative answer is yes, perhaps on the whole but there were very important instances of inadequate care that do not fit into an all-encompassing binary survey question.  

Many PX/QA directors are surely aspiring to this moment-based model, but they are cautious for rather frightening reasons. One that I hear frequently is that the inpatient doesn’t want to complain because they fear retribution especially if the stay is long. I think fear of retribution is in and of itself an incredibly important patient experience related to repairing the provider culture.  

On the other hand, the Veterans Administration, the largest healthcare system in the country has moved to a moment-based patient journey that segments experience by stages of care. The reason the VA is obsessed with these experiential stages is related to their need to re-establish trust in that institution after a long period where it was regarded as the last place veterans would want to go for care. The instance-based experience model provides them the opportunity to be laser-focused on micro-improvements as compared to the older retrospective version at some period after release. Plus, the aggregation of these micro-experiences is the real patient experience. The resulting data sets generated would be actionable at the departmental and clinician levels.  

The most interesting thing is that technology need not catch up for moment-based patient experience surveys, it’s already there. Healthcare enterprises need to catch up with readily available technology, much of which patients bring into the care setting themselves or that as a result of telemedicine is already available at the provider setting!  

Those of us who research and write about healthcare technology can poke holes in a dozen aspects of this approach to surveying patients not the least of which would be: cybersecurity, data privacy, compliance, clinical burnout, unions, standards, etc.  

However, in reality, the healthcare consumer could technically provide patient experience feeds to social media accounts outside the guardrails of the healthcare enterprise. Along with cable provider experiences, there is no shortage of hospital horror stories on Facebook and TikTok feeds.  

Finally from personal experience, I would argue that the psychology of getting the “Uber rating” during or immediately after I was in the pulmonary lab for a follow-up is actually reassuring to the “customer” given that the provider “cares at that moment. 

So to go one step further, why not ask if the patient wants to “tip” that department for work well done in that precise instance? This would be a recognition as opposed to a monetary tip.