H

ealth care has long been a laggard in a world racing to embrace customer engagement, empowerment, and feedback. The bold entrance of online consumer companies like Yelp.com and others into the health care sphere has made it clear that public reviews of physicians’ performance are unavoidable and inevitable. Rather than lament this trend, physicians and health care systems should welcome the opinions of our patients, learn from them, and share them with the public.

It’s no secret that the US health care system needs to improve. Consumers — in this case patients and employers — have more collective power to influence change than they realize by choosing how, where, and from whom they get health care. Uber, Nordstrom, and many other companies seek their customers’ opinions and respond to them. Health care needs to follow suit to become the patient-centered service industry that it should be.

The University of Utah, where I work, began collecting patient feedback early on and was the first health system in the US to publicly post patients’ reviews of their providers. It has paid off in many ways. Here are five reasons why patients should take a few minutes to write reviews of their physicians and why physicians and health systems should collect and publicly share those reviews.

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Put the patient front and center

A Harvard Business Review article on customer feedback emphasized that the strongest feedback loops “keep the customer front and center across the entire organization.” In most service industries, this is a no-brainer. In health care, historically, the physician knew best.

My predecessor at the University of Utah, Dr. A. Lorris Betz, tapped “customer feedback” almost a decade ago. In 2008, he launched the university’s Exceptional Patient Experience initiative to make patient feedback a driving force in our health care system. We began collecting information from patients about their experiences with their physicians and used a database of feedback responses to benchmark the scores that doctors received compared to their peers nationwide. We shared with our doctors their patients’ feedback, at first confidentially.

We went public in December 2012 and started posting patients’ reviews online. That signaled their importance in our organization and our larger community. We now get, and post, roughly 100,000 reviews a year that are directed towards our physicians and their teams.

We aren’t alone in doing this. Over the past four years, Piedmont Healthcare, Wake Forest Baptist Health, Northwell Health, Stanford, Cleveland Clinic, University of Pittsburgh, Duke, and more than 50 others have embraced transparency for their patients.

An example of a physician review published online by University of Utah Healthcare. University of Utah

Create a culture of improvement

Five years ago, the Institute of Medicine (now the National Academy of Medicine) released a watershed report called Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. It charged our health care systems to use data better, to partner physicians with patients, and to create cultures of continuous learning and improvement.

Feedback from patients helps drive continuous innovation towards more patient-centered care. In our system, it has improved the handoff of patients from one provider to another, reduced clinic wait times, and even made it easier for patients to get some sleep in the hospital. Patient feedback was the impetus for one of our suburban community clinics to provide on-site childcare during appointments for patients who are looking after young children, and to offer home well-baby visits for newborns by a nurse and a pediatrician at seven and 14 days after birth.

Sharing patient feedback has confirmed to us that, for the most part, our providers are excellent learners. They were initially reluctant to be judged publicly by their patients, yet once they saw the value of direct feedback from a trusted source (their own patients) they embraced the opportunity. For three years in a row, almost half of our providers are in the 90th percentile or above in patient satisfaction and one-quarter are at the 99th percentile.

Make reviews reliable

As I described in a Perspective article last month in the New England Journal of Medicine, anyone can post a comment about a provider on public sites like Yelp, Healthgrades, and Vitals — even a disgruntled neighbor or an upset colleague. That’s not the case for reviews on health system portals. We send review surveys only to patients who have been seen by one of our clinicians. Then we post them unedited (unless, of course, they might compromise patient privacy information or could be considered legally libelous).

In short, health systems, not public websites, offer the most reliable reviews out there. That matters, because better data can help patients make more informed decisions about their care.

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And more

Publishing patients’ reviews of their providers and health system experiences does more than improve the health care experience. It helps build trust between patient communities and their health care systems. It also provides a source of new ideas for both.

For example, we learned that our patients usually wanted to know how much different types of health care would cost. Last year we launched an online pricing transparency tool. In a matter of minutes, individuals can get cost estimates for hundreds of procedures based on their insurance type.

It has also had another welcome consequence: a 180 percent boost in visits to our website.

The relationship between patients and providers has long been one way: providers help patients. What we’ve come to learn is that the relationship is actually a two-way street, and that patients’ comments and reviews can effectively help improve health care in the US.

It’s time to start listening.

Vivian S. Lee, MD, is senior vice president for health sciences at the University of Utah, dean of the University’s School of Medicine, and CEO of University of Utah Health Care.

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  • One problem with asking a patient about their appointment with a physician is asking their opinion the day after their FIRST appointment. Most physicians are very nice and welcoming during your first appointment. Their attitude can change afterwards.

    • I feel the same way. The providers are usually putting on their best bedside manner the first few appointments. Things change. I would rather have a grumpy doctor who knew what he/she was doing rather than a kindhearted patsy sporting a faux wonderful bedside manner who cant tell the difference between a rectum and a retina.

  • If I were a healthcare administrator seeking to subdue medical doctors in my employ, I would definitely expose them to a public popularity contest like “patient feedback”. Good job, provider Lee!

  • I am a retired emergency physician working at writing up medical corruption across America with 90% of physicians involved – two major strategy of theft: A) the HMO doing less so as to profit, and B) the fee for service physician upcoming the work by $63 per patient – to be paid $40 for the cheat. In both cases is domestic terrorism since both lead to mistrust and poor care – more painful to have cancer missed than the sniper’s Jihad bullet. But there is hope when physicians will allow feedback and their work and actually move away from computers back to narrative history taking. I will be looking for the 10% of honest physicians to hold American medicine together as we claw back 1 trillion dollars from MD retirements – money not earned. They will wear green coats = no Oath; the 10% of other MDs will wear the White Coats of Oath driven fidelity to patients and Clean Hands of not taking the endless bribes to do wrong. When we are done, medicine will be better, cleaner, and more humanistic. Hippocrates said within the Oath that the payment is HONOR and a most a medium size house and car. That is how I practiced for 45 years. Now it is time to clean up the medical swamp – the biggest in the world. Those who are first will be last. If you are honest, the sun is rising on a better world.

    Charles Roy Phillips, MD – cphil49401@aol.com

    • In my earlier comment about docs the key word “up-coding” was automatically changed to “upcoming” by automatic spell check and spell change – which makes no sense. Up-coding is the universal MD fraud of calling a Level II visit a Level III visit or III to a IV.

      So many tried to force me to cheat I decided to turn them all in starting this year. Dr. Phillips

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