A look at some additional drivers of patient health and well-being.
Most often, researchers of patient well-being explore the interaction between the patient and provider in the exam room to understand barriers to positive health outcomes for patients. Specifically, researchers and practitioners ask questions like: What additional steps could the doctor take in the exam room that would improve patient health outcomes? Did the provider follow the appointment script properly? Which aspects of the patient-provider interaction were most important at driving health and well-being outcomes? Did the provider have a good bedside manner? What was the level of patient-provider homophily? Are patients complying with provider directives for treatment once they get home? Importantly, these questions assume patient well-being is the responsibility of the patient and/or the provider.
Together with Laurel Anderson of Arizona State University, I am conducting research on the effects of health care services on patient well-being. In a study conducted with patient satisfaction data from a large health care organization in the southwest, we have identified the three main drivers of customer satisfaction (as captured by the third-party survey) as: perceptions of provider empathy, level of information provided to the patient, and feelings of control over one’s health. With the health care organization, we are currently conducting experiments to evaluate the effectiveness of the provider communication training module offered at the institution in boosting provider empathy, improving the provision of information to patients, and empowering patients to make important health decisions. Like the aforementioned patient-provider research questions, this project considers the role of provider training in affecting patient satisfaction and well-being outcomes.
Patient-provider interaction questions are extremely important, not only for better understanding patient outcomes, but also for hospital administration. For example, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) patient satisfaction scores drive important federal funding decisions for hospitals. Some institutions have implemented value-based purchasing or pay-for-performance for providers who earn high satisfaction scores, because these providers help drive up federal funding for their hospitals. Instead of tying performance-based pay to satisfaction scores, perhaps it is time to link performance-based pay to patient health and well-being outcomes. Additionally, there may be some key drivers of patient health and well-being (above and beyond mere satisfaction) that are missing when we only consider the data from the patient-provider interaction.
It is important to consider the lives of the patient and provider outside of the exam room.
In addition to the patient-provider satisfaction project, I am also conducting Transformative Service Research with Laurel Anderson to better understand the more macro-level influences of culture, social structures, systems, and communities on patient health and well-being. These projects suggest that we cannot fully understand patient health and well-being outcomes by merely studying the patient-provider interaction. In a series of papers, we are exploring the data from a community action research project on diabetes health disparity in the southwest. Despite plenty of health and social services in place to help reduce the instance of diabetes in the community, the rate of diabetes in the community is not decreasing, and in fact, the rate of diabetes is increasing. We propose three lenses with which to view the problem at hand: service as culture, service as social systems, and service as systems. Each lens illuminates different barriers to the prevention and treatment of diabetes in the community.
For example, when we consider the issue of diabetes health disparity using the lens of services as cultures, results found that the health care culture and the collective culture are very different. For example, the health care culture has different meanings of food (i.e., prescriptions to eat healthy, reduce dietary sugar) than does the collective culture (i.e., food as culture and tradition, something to share with family members throughout generations). These providers and patients are literally and figuratively not always speaking the same language. Additionally, the two cultures have different value priorities. The health care culture values individual health and well-being above all, while the collective culture views family, traditions, community, and collective resources all above individual health. When providers give the typical “diet and exercise” prescription to diabetes patients in the community, the patients just ignore the prescription because it is not in line with their cultural traditions and values. These findings have important implications for cultural literacy training for both patients and providers, implementing cultural change through youth programs (i.e., cultural insiders), and designing minimally disruptive health care service techniques (i.e., co-created treatment plans that highlight the positive beliefs and behaviors already present in the culture).
These projects highlight the importance of culture and community in understanding patient health and well-being outcomes. Importantly, these projects forefront the notion that it is not always the fault of the individual provider or the patient why health outcomes do not improve. In fact, our three-lens model suggests that cultural differences (i.e., prescriptions that are not culturally-relevant), social structures (i.e., lack of access to fresh, inexpensive foods), and systemic issues (i.e., misaligned transportation systems), are all important drivers of patient health and well-being. So, in addition to the important patient-provider interaction, let’s explore external forces that also provider barriers and opportunities for patient health outcomes.
To date, we have presented these research projects at the Association for Consumer Research Conference, American Marketing Association Summer Educators’ Conference, QUIS, and Marketing & Public Policy Conference. We are currently preparing these manuscripts for submission to marketing journals. For more information on my research, please visit: danielemathras.com.
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