Using culture to offer more customer-centric healthcare

What it means for healthcare companies to serve patients effectively is changing. Here’s how understanding and transforming your culture can help you get there.

During a conversation with a senior manager at a healthcare client, we asked, “What motivates you most in your job?” He told us, “What really excites me is that everybody in my organization, including me, knows that what we do on a day-to-day basis helps people feel better and live longer, healthier lives.”

Time and again we hear this refrain. People who work throughout the healthcare industry get their energy from helping patients. And although the idea of dedication to patient health is nothing new, what it means to really serve patients in the best way possible is changing rapidly and dramatically.

The ideal healthcare model is now consumer focused and delivers efficiency, affordability, and convenience — largely through technological advances. People are increasingly entering the healthcare system before they become ill, which actively delays, and even prevents, the need for acute care. Patients are more in charge of their own healthcare decisions, including decisions on which insurance plans to participate in, where to get care, and what type of care they should get. The consumer is also being defined in broader terms than just the patient — families and communities are becoming stakeholders in the patient journey. In response, payors and providers must increasingly engage with consumers throughout the entire journey.

Traditionally, health-services companies haven’t been known for consumer-centricity. In the 2018 Global Culture Survey conducted by PwC’s Katzenbach Center, less than half of health provider and health insurance respondents selected consumer-centricity as one of their top three strengths. It is then little wonder that consumer-focused disruptors such as Amazon, Apple, and others are entering the healthcare landscape.

In response to these trends, traditional healthcare players are investing heavily in capabilities to enhance the consumer experience, be it with consumer-friendly apps or population health analytics. Organizations are also restructuring, participating in M&A, and partnering with nonhealthcare companies. But these efforts often prove insufficient because they neglect a key piece of the puzzle: culture.

Although formal structures and processes exist on paper, culture determines how things “really get done” within organizations. Companies can rework the org chart, invest in technological capabilities, and trumpet a customer-centric culture on HR posters, but if the culture doesn’t support the efforts and drive them forward, they’ll never take hold.

What is a consumer-centric culture?

It’s useful to think of your company’s culture as its personality, complete with mutually exclusive personality traits. For example, a company can be accepting of risk or risk averse, or somewhere in between, but it can’t inhabit both extremes. Each extreme comes with strengths and challenges. Moving toward the middle mitigates some of the challenges, but it also dilutes the strengths. Although there is no such thing as a perfect set of traits, there are traits that are more correlated with one business strategy than with another.

Working with the results of the 2018 Global Culture Survey, as well as years of experience and research, we’ve identified key culture traits that correlate with consumer-centricity across industries. Cultivating a new culture that supports consumer-centricity requires a balancing act between traits that serve other core purposes and should be kept, and those that need to be evolved to better meet consumer demands. These key traits are discussed below.

Externally focused/customer focused (versus internally focused). It may seem obvious that a customer-centric organization needs to be driven by external forces. But when it comes to health services, especially in provider organizations, internal demands dominate. Such organizations often have a single-minded focus on internal compliance, best-practice benchmarks, and metrics that detracts from consumer-centricity. For example, doctors in group practices and hospitals are required to see many patients a day, fill out reams of paperwork, and achieve target profitability results. It’s difficult to practice with empathy and fully engage with a patient when a consultation is limited to 15 minutes and the physician spends half of that time on documentation.

It’s useful to think of your company’s culture as its personality, complete with mutually exclusive personality traits.

Some health-services players are trying a different approach, identifying ways to be more customer focused without compromising core standards. At Flatiron Health, an electronic health records startup specializing in oncology that has been acquired by Roche, every few months someone living with cancer comes to speak and take questions to remind employees of their mission. These efforts take time and energy, because consumer-centricity requires actively connecting everyday activities to the ultimate mission of the organization. Done right, however, they harness intrinsic sources of motivation among staff to keep the consumer at the forefront of all activities.

Flat and egalitarian (versus hierarchical). Consumer-facing employees need to be empowered to make quick decisions and to manage ambiguous situations in order to meet consumer needs. This means decision rights need to be pushed down in the organization so those closest to the consumer can make the right choices for them. Conversely, a hierarchical culture in which all decisions and actions that deviate from the script need to be escalated to management for approval is one that can’t be sufficiently responsive in dealing with ambiguous consumer situations.

Take the industry’s approach to prior authorizations. Before patients can get an expensive procedure, they must get approval from their insurance company (or risk having to pay for the entire procedure out of pocket). Prior authorizations can be acquired quickly in some cases, or be bypassed entirely. But in more complicated cases, the request may be sent to payors’ medical directors or third-party vendors for a review that can take days, or even weeks, to process. The more hierarchical the reviewing entity, the higher the likelihood that a request will need to be further escalated, and the longer the process takes. But at a place where people at lower levels of the organization are more empowered to make decisions — such as an authorization review nurse — routine procedures may be able to be quickly approved.

Focused on broader performance measures (versus solely on financial metrics). Through our work with health-services clients, we’ve demonstrated repeatedly that effective customer engagement is associated with clear financial value. One regional healthcare payor estimated it would save between US$560 million and $800 million by improving its consumer engagement. But this value would be generated as an outcome of numerous interactions along the consumer journey, making it difficult to isolate or attribute to any one factor or initiative. Whereas increasing patient volume or the speed of claims processing directly affects financial metrics, the financial impact of consumer engagement efforts is less immediately observable. This means that in companies that prioritize financial metrics over all other indicators of performance, championing consumer-centricity becomes a challenge. The complexity of the health-services space and the high cost of healthcare mean that all players face margin pressure. That makes it tempting to build a culture around financial metrics — to encourage decision making that is based on immediate bottom-line impact.

But companies that excel at consumer-centricity tend to do the opposite. Take United Services Automobile Association (USAA) as a cross-industry example. USAA has a reputation within the financial-services industry for strong consumer-centricity serving its target constituents. Unlike many other call centers, USAA employees don’t rush through calls with customers and are not evaluated on how fast they handle the inquiries. “Member satisfaction trumps every single [other] metric,” says Bruce Temkin, managing partner of the Temkin Group, who is known as “The Godfather of CX.” USAA is also willing to invest in projects that may benefit its members even if they will not have a short-term financial payoff (e.g., helping members who live from paycheck to paycheck save more).

Even with the margin pressure facing today’s health-services players, it is necessary to look beyond black and white financial metrics to factor in the value of broader performance metrics. Value-based accountable care organizations, for example, often don’t turn a profit in their first few years. But investors know that providing consistent quality care and engaging consumers in their healthcare journey will benefit patients’ health, decrease the number of doctor visits and medical treatments, and increase consumer satisfaction — all of which will ultimately translate into financial success.

Improvisational and comfortable with risk (versus process focused). Agility — the ability to move quickly and be adaptable — has become a buzzword. In today’s health-services industry, where the ways in which people interact with data and make demands on organizations are rapidly changing, agility is needed to deliver both performance and strong consumer-centricity. The ability to be agile, however, requires a willingness to improvise, which is challenging in the highly regulated health-services industry. Although every organization needs rules and processes, true agility requires an ability, at both the individual and organizational level, to look beyond processes to quickly find solutions, especially when it comes to ambiguous interactions.

A claims adjudicator at a payor may deny a claim because of a misspelling of a patient’s name. This can happen even though the misspelling is obviously a mistake. The patient calls to clarify the error but is told that the claims adjudicator’s hands are tied. The problem here is not the rule; a rule that says the name on a claim must match that in the policy makes perfect sense. The problem is a culture that allows no room for discretion — i.e., a culture that is not agile.

Oscar Health Insurance is trying to do things differently. It has developed a network that aims to be functionally stable while constantly in flux. Doctor information is updated daily, and member requests that fall outside Oscar’s model (e.g., needing a women’s health physical therapist) can be dealt with. Oscar’s network-building teams are comfortable not knowing all the answers, improvising as they go along.

Agility and improvisation, however, cannot happen without a degree of risk tolerance. An employee may be willing to go off-script to help a consumer, but only if he or she isn’t afraid of being disciplined or even fired for it.

To be sure, the health-services industry is not a naturally consumer-centric one. In attempting to build a more consumer-centric culture, we run up against the fact that healthcare must fundamentally ensure patient safety and drive high-quality outcomes. Because of this, it may be easy to dismiss these findings about the importance of being externally focused, encouraging egalitarianism, accepting risk, and focusing on a broad set of performance metrics.

The view that safety within health services is directly at odds with consumer-centricity is an oversimplification. The industry is not one homogeneous block, and not all health-services players or professionals have the same direct connection to patient safety. A customer service rep who ventures off-script in a conversation with a member presents a different level of risk than a surgeon who skips a checklist before starting a procedure. Instead of thinking broadly about empowerment in health services, we need to think more granularly. A nuanced understanding of where risks are and are not acceptable is needed, as is a thorough understanding of the consumer journey and where employee empowerment is most needed. Deliberate choices need to be made about the interactions that are most crucial in the consumer journey, and where it’s most necessary to get consumer-centricity right.

How it’s done

It is important not to try to “have it all.” Just as a company’s strategy can’t be to serve as a low-cost provider and premium provider, trade-offs are involved in becoming more consumer-centric. Prioritization and focus are critical to consumer-centricity. Rather than launching large-scale change programs that attempt to fundamentally reshape an organization, it’s important to identify and execute on the basics — to focus on a narrow set of priorities and to do that well.

From a culture perspective, these changes usually start with identifying a critical few behaviors that aid consumer-centricity, and then translating them into specific action items for different parts of the organization. For instance, many organizations struggle because their culture lacks employee empowerment and accountability. This could cause a patient with an atypical question to be bounced from department to department, or a technician who sees an error on a scrip to assume that it’s not his or her place to question the doctors. A critical behavior in this case should be related to taking ownership over delivery of results rather than just completion of tasks. This behavior encourages agility and improvisation, as well as external customer focus. For customer service representatives, this could mean listening closely in order to fully understand a caller’s situation and then proposing a novel solution or anticipating a future need. For a head nurse, this could mean talking during meetings about lives comforted and pain relieved rather than bed turnover times.

 
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A lack of communication and collaboration is another common pain point that inhibits consumer-centricity. To address this issue, a hospital that we worked with chose as one of its critical behaviors “take a moment to explain your rationale.” Again, this applied differently to surgeons and to hospital administrators. Surgeons would not pause in the middle of a tense operation to explain what they were going to do next, but hospital administrators would be expected to explain a staffing decision.

Successful behavior evolution also requires an organizational ecosystem that is coherent. This means that formal enablers (e.g., decision rights, rewards, and incentives) and informal enablers (e.g., norms, informal relationships) need to be aligned with the behavior traits the organization is trying to drive. Thus, if your goal is to drive consumer-centricity but you evaluate your call center reps solely on the number of calls they answer, you need to reevaluate these incentives.

Technology and digital tools can be an important enabler of the right critical behaviors. For example, although we can conceptually talk about risk and the level of discretion/empowerment various players along the consumer journey should have, technology can quantify this risk and help determine where the guardrails should be set. Similarly, utilizing data to quantify the value associated with specific consumer experience levers enables an organization to adopt a broader set of performance measures beyond direct financial metrics. All of this allows an organization to move closer to the ideal consumer-centric culture. The important point here is that IT-related initiatives should complement culture-related efforts. Coherence is key.

Room to evolve

A hospital is not a retail store or hotel. Health services as an industry may never achieve the kind of consumer-centricity that treats customer whims as sacred and immediate gratification as the holy grail — and it shouldn’t aim to. But there is room for health-services organizations to evolve their culture to support and accelerate efforts to be increasingly consumer-centric.

In a consumer-centric health-services ecosystem, senior doctors should still cite their experience and qualifications to push back on patient demands that will compromise the quality of care (e.g., recommending a safer procedure versus a quicker one); a nurse doing her rounds should, however, feel empowered to share a healthy snack from the break room with a hungry patient.

The ideal organization is intuitively responsive to consumer needs, and is one in which employees navigate ambiguous situations and make the right, consumer-centric choices most of the time.

Author Profiles:

  • Jaime Estupiñán is a New York–based principal with PwC US, where he advises health clients on market-driven strategies and agile organization transformations. He is also a member of the global leadership team at the Katzenbach Center, PwC’s global institute on organizational culture and leadership.
  • Alice Zhou advises clients on culture and organization. A director based in Philadelphia, she is part of the Katzenbach Center.
  • Jessica Geiger is a senior associate based in New York. As part of the Katzenbach Center she advises healthcare companies on organizational strategy and culture.
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