The Elephant and the Blind Men: Understanding Patient Satisfaction

The elephant & blind menNo doubt you’ve heard the tale of the Elephant and the Blind Men.

The age-old story seems simplistic. But, stick with me on this…there’s a timely lesson here—and a lively discussion—that’s vital to how we think about patient satisfaction. And ultimately, how patients select “the right hospital.”

It seems that several sightless individuals each gave a different description of the unfamiliar animal: “The elephant is a pillar,” said the man who touched the creature’s leg. But for the man who touched the tail, it is like a rope. And so on…six different—but incomplete—descriptions of an elephant.

The parable illustrates the concept of multiplicity of viewpoints—the notion that truth and reality are perceived differently from diverse points of view, and that no single point of view is the complete truth.

And so it is with the evolving definition of “patient experience.” Exactly what is it? Who defines it? Who is responsible? How is patient satisfaction properly delivered, measured and rewarded?

Clearly, it depends on whom you ask.

Consider, for example, one doctor’s viewpoint in The Atlantic by Richard Gunderman, MD, PhD, and professor of radiology, pediatrics, medical education, philosophy, liberal arts, and philanthropy, and vice-chair of the Radiology Department, at Indiana University.

Titled Finding the Right Hospital, Dr. Gunderman’s essay considers “What’s good for patient satisfaction may not be good for medicine. Awash in marketing, the key questions to consider when choosing a hospital.” [The Atlantic; May 28, 2013]

“Hospital marketing has reached a frenzy.”

“It is nearly impossible to drive around metropolitan areas in the U.S. without being barraged by billboards trumpeting hospitals’ cutting-edge technology, luxurious facilities, or the lives of patients they have saved,” Dr. Gunderman writes. And in this bewildering atmosphere, how should we—patients, prospective patients, friends, family—determine which hospital is the right choice?

His insightful comments include considering a hospital’s success rate, or a selection influenced by hospital amenities or even the food service.

And then there are “patient satisfaction ratings.” Dr. Gunderman observes, “it can be difficult for patients, most of whom have no background in healthcare, to distinguish between hospital staffs that are merely adequate and those that truly excel. In the case of surgical technique, for example, patients are generally unconscious, and when it comes to serious illnesses such as cancer and stroke, most of us happily have little or no prior experience with which to compare.”

You will want to read the full text, but The Atlantic article observes, “The best time to identify a preferred hospital is generally before the acute need arises. Here are the two key questions to consider: Do the people who work there, particularly nurses and physicians, seem generally happy and proud of the work they do? And, if health professionals were going to be hospitalized, which institution would they choose, and why?

“Ultimately, while hospitals work hard to establish their brands and convince patients that they offer superior service, we are cared for not by hospitals but by the people within. The hospital is but a tool, like a stethoscope or a CT scanner, in the hands of the health professionals who are the real source of excellence in care.”

But can the typical patient make an informed hospital selection?

There is no easy answer for the question of how patients should choose the best healthcare providers, including physicians and hospitals, or what role patient experience and related ratings should play in how providers are graded, judged and compensated.

It’s incredibly difficult for most patients to judge the clinical quality of care they receive—unless it’s obviously bad care. It’s also hard for patients to get an unbiased, accurate indication of where a majority of doctors would send their own family for medical care.

Often doctors don’t want to be put in the position of recommending against a hospital. This is particularly true in the current environment of health system consolidation and vertical integration of comprehensive health services for a large population of patients.

So the average patient, even armed with reams of information from the Internet or other sources, generally has to rely on a “gut feel” regarding their providers and the related institutions where the providers affiliate (or are employed).  The average patient’s gut feel will be based on whether they believe they are being listened to, being heard (not necessarily the same thing), and that the provider empathizes with the patient’s physical and emotional pain, fear and frustration.

Positive patient experience is not about whether a doctor is jovial and jokes with a patient—it’s about whether “I feel my doctor or other healthcare provider truly cares about my problem.”  You can’t prove that you care by saying “I care.” You prove it by how you make the other person feel.

Some patients will perceive a healthcare provider’s abrupt, rushed “bedside manner” as an indicator of bad care, even if the clinical quality of care is excellent. It’s also tough for rushed and stressed providers in today’s healthcare climate in the US to maintain a positive and empathetic attitude with every patient. The situation is aggravated by an increasing number of patients, many of whom are evermore demanding.

Some doctors may want to dismiss this issue of patient experience and patient satisfaction as irrelevant to optimal clinical care, but it’s not.  In fact, it is often quite the opposite.  Patients are more likely to comply with recommended treatment, medications and other health remedies when they believe that their provider truly listens, understands, acknowledges and cares about the patient as a human being.

We acknowledge that healthcare providers are often put in the category of “problem solvers,” and that they deal daily with people in physical and emotional distress.  It must be challenging to avoid the natural human tendency to protect oneself from getting too emotionally involved with each patient’s cause of distress.

In fact, emotion can often get in the way of optimal patient care, especially in an emergency. Providers are trained or at least conditioned to keep an emotional distance.

Does empathy make a difference to outcome?

An interesting study would be to assess if a provider’s perceived empathy for the patient can be tracked to a better clinical outcome than when the patient perceives that the provider doesn’t really care or listen.

Even with the same diagnosis and recommended treatment protocol, I would not be surprised if better patient outcomes could be equated with greater perceived provider empathy. In fact, several research reports clearly point in that direction: Patient Experience Drives Selection, Adherence, Compliance, Outcomes.

The most interesting response to The Atlantic article (posted below the online article) was posed as an analogy comparing hospitalization to automobile repair. In both situations, the customer/ patient generally presents in distress, and has little or no idea of the cause or the solution to their problem. And after the service they don’t know if the provider was competent unless the job was botched and incompetent service is obvious.

Another side of this analogy—one that the commenter did not mention—is that in both instances, you leave with a repair that does not necessarily improve your situation, but only stabilizes the previous status quo. (Except, of course, that customer is that much poorer for the cost of the repair to return to the prior status quo.)

The one glaring flaw in this analogy is that the worst-case scenario for the auto repair customer is the need to buy a replacement car.  The hospital “customer” (patient) can’t buy a new body or new lease on life.

Ultimately, Patient Experience—and the process of selection in finding the right hospital—is not a simple or singular perspective. Each viewpoint is true…although none is complete.

Some versions of the Elephant and the Blind Men parable conclude with the various individuals listening to each other. They collaborate to “see” the entire animal. The objectives of the nation’s healthcare delivery system are best served, understood and achieved with insight from multiple perspectives. It’s a tougher and more complex course, but ultimately it’s a better outcome.

For additional reading: Healing is Not Enough: Cleveland Clinic Lessons in Patient-Centered Empathy.

Lonnie Hirsch


About Lonnie Hirsch

Co-Founder of Healthcare Success Strategies, Lonnie has consulted for over 2,000 health care clients during his 20-year career. Lonnie writes for many healthcare publications, and also has spoken at hundreds of venues nationally. His topics include patient experience, customer service, marketing, branding and business development.

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