Why Quality Doesn't Matter

Gienna Shaw, for HealthLeaders Media, November 5, 2008

The amount of healthcare quality data out there might be growing, but consumers' interest in it seems to be waning. A Kaiser Family Foundation survey found that folks are looking at information about quality, but fewer of them are actually using the information to make healthcare choices. And when it comes to making choices based on word-of-mouth versus high quality rankings? Well, those results might surprise you, too.

Thirty percent of Americans say they've seen healthcare quality comparisons of insurers, hospitals, or physicians in the past year, according to the survey. But that doesn't mean it had any influence on their choices: only 14% said they saw and used the information. Further, the percentage of people who looked at quality data as well as the number who looked at it and factored it into their decision-making is down from previous years.

The information comes from the 2008 Update on Consumers' Views of Patient Safety and Quality Information. The foundation has been asking American consumers 18 and older about quality information since 1996. This year's study surveyed 1,517 respondents.

The question in question, by the way, was pretty clear. It even gave a hint as to where respondents might have seen comparative quality information, in case it slipped their minds.

"Information comparing different doctors, hospitals, and health insurance plans is available in different places," the question reads. "For example, it might be given out at work, come to your home by mail, appear in a newspaper or magazine, or be found on an Internet Website. In the past 12 months, do you remember seeing any information comparing different doctors, hospitals, or health plans?"

There are so many different opportunities for consumers to encounter quality information—state-sponsored Websites, hospitals' own online information, CMS' recent newspaper ads, sites like Hospital Compare, and rankings in national magazines to name a few. And yet information from those sources reached only three in 10 people in the last year.

It begs the question: Is it a waste of time and money to try to differentiate your organization on quality?

Consider this: The study found that relationships, loyalty, and word of mouth recommendations are more important to respondents than the hospital's quality ranking.

The survey posed a theoretical question: "Suppose you had to choose between two different hospitals. The first one is the hospital you and your family have used for many years without any problems, but the second hospital is rated much higher in quality by the experts. Which hospital would you be more likely to choose?"

A full 59% said they would go to the hospital that's familiar, while only 35% said they'd go to the higher-rated hospital.

In a similar question about choosing between two surgeons (one who has treated a friend or family member and one rated much higher in quality), quality won out, but barely: 44% would choose the familiar surgeon with the lower rankings, while 47% would choose the surgeon with higher rankings. Not exactly a landslide win.

Here's the bottom line: Of course quality matters. And those consumer attitudes about quality data could change tomorrow.

But the numbers suggest that a short-term campaign highlighting quality at your organization isn't going to make much of a difference in your market share or garner a big return on investment.

If you're going to position yourself as the quality choice, it has to be just one part of a long-term strategy.

An organization that makes a commitment to transparency, to publishing quality data even if it is not always flattering, to being open and honest with the community, to always striving to do better is more likely to build a long-term reputation for excellence than one looking for a quick fix by touting a few select scores in an ad or to hanging some "top 100 hospital" banners atop the front doors.

Gienna Shaw is an editor with HealthLeaders magazine. She can be reached at gshaw@healthleadersmedia.com.
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