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P R A C T A P P L I C A T

Kevin T. Marx, FACHE, vice president, medical group management, Katherine Shaw

Bethea Hospital, Dixon, Illinois

T he topics explored by Abraham and colleagues are of substantial importance intoday's healthcare environment as integrated healthcare delivery systems seek to expand their services to a broader community or increase volume by establishing physician offices or other satellite operations in previously unserved areas. These ven- tures will provide a return to their owners only if patients are motivated to choose

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SELECTING A PROVIDER: WHAT FAGTORS INFLUENCE PATIENTS' DEGISION MAKING?

and patronize the new clinics, practitioners, or facilities. The consumer's choice to use one of these new healthcare outlets is significantly affected by the operator's management of the patient decision factors that were studied by the authors.

Over the past decade, my employer, a rural community hospital, has deployed a two-prong strategy of (1) establishing primary care offices in small towns throughout the service area and (2) expanding the breadth and depth of specialty services avail- able at the main hospital campus. The implementation of this plan has resulted in the creation of numerous new service delivery sites offering physician practices and ancillary services. The comparative success of these individual facilities or practices can be correlated in a large degree to the careful management of the patient-decision variables that prompt an individual consumer to choose one healthcare provider or site over another.

Our experience correlates well with the results of Abraham and colleagues' study in a manner reminiscent of Herzberg's Theory of Motivation, whereby some condi- tions of employment are truly motivators while other aspects merely prevent worker dissatisfaction. In the case of provider selection factors, some of the aspects on which patients base healthcare selection decisions are foundational in that they position the service for success while others truly make a difference by transforming a commodity experience into a truly successful service offering.

Variables such as practice location, appointment availability, and even provider network participation are the required basics for creating a viable medical care prod- uct. However, the reputation of the physician or institution, typically passed on by informal, person-to-person communication, is what turns an adequately performing service into a notable success.

For the word-of-mouth strategy to work, the practitioner or facility must first be adept at providing medical care and customer-focused service. Patient customers must be able to differentiate this practice from others based on the perceived level of caring and concern demonstrated by the staff, the amount of time the practitioner spends with the patient, and the attention paid to other needs, stated or exhibited, during the visit. Once these characteristics are in place, on top of core elements such as location, access, and cost, a provider's high-touch reputation will be communi- cated informally, person to person, more rapidly and reliably than by newspaper ads or Internet quality report cards.

The operator's challenge, first and foremost, is to manage the business to pro- vide the best perceived service possible and then to find ways to encourage informal communication channels to promote the practice. One example of how reputation might be leveraged would be to send thank-you notes to new patients with language indicating that their referral of other patients would be appreciated.

Also, as Abraham and colleagues indicate, untapped opportunity exists in find- ing ways to engage social media in accelerating the word-of-mouth reputation of the practice or site.

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