How Providers Can Pivot to Meet Patient Communication Expectations, Reduce Delays in Care

Matt Dickson, senior vice president, product and strategy, and general manager, communications solutions, Stericycle Communication Solutions, highlights findings from a recent Stericycle survey that measured patient engagement preferences, and discusses how providers can adapt to support a better patient experience.

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I am Matt Dixon, senior vice president of product strategy and the general manager of communication solutions for Stericycle. We are the division that focuses on patient engagement within the Stericycle organization.

Can you tell us a bit about the survey your organization conducted? Its design, participants, purpose, etc?

Our survey was really looking at how patients are reacting to health care choices and preferences during the pandemic. We surveyed 535 consumers across 50 states, and this survey was conducted in summer of 2021.

Seventy-one percent of the survey respondents were interviewed via outbound calls, 29% completed an online survey, and we really wanted to make sure we got a representative data set, so we got a really good distribution of age, household income, marital status, geographic regions just to ensure that our responses are reflective of the population at large.

What are the key findings from the survey, and did any in particular stand out to you?

I think one thing that stood out to me, because we have a lot of conservation or media coverage around this, is patient trust. What we found is actually that patient trust in their provider is very high. Ninety-five percent of people reported that they trust the information their provider shares with them on public health issues. Certainly, that's good news. There may be a little bit of disagreement with their physicians on certain areas, particularly around vaccinations, but all in all, really high trust.

The other thing we're seeing, of course, is people are utilizing more in-person care, so 67% had seen a doctor in person in the past 12 months, and 36% actually prefer a physical rating room over a virtual one. You juxtapose that, though, when you ask them their comfort level about accessing in-person care. Only 47% said they're actually comfortable.

I think what we're seeing is that virtual care doesn't fit every paradigm, and people are being required to go in to seek certain care, and they're not entirely comfortable with it, but certainly, are starting to consume more in-person care.

On the flip side of that coin, though, is telehealth usage is still very, very prominent. More than three-quarters of our respondents utilized at least one telehealth appointment in the last year, and really high satisfaction with that as well—85% rate that experience as good or excellent.

When we looked and asked, why are people still using telehealth, they're citing a couple of key factors. Convenience is actually the leading factor. I think at the beginning of this, safety certainly would've been the leading factor, but we're now finding people saying, "Hey, it's just more convenient for me."

Safety was number 2, with 36% of respondents indicating that was their reason, and only 11% indicated cost. While that's certainly a factor, it's dwarfed by the convenience and safety issues that people are most concerned with. Another 8% also reported they get better access to a provider through telemedicine than they can get in person. We've talked about outside of the pandemic for years, saying telehealth can solve for some issues we see with rural patients, and certainly, we are seeing a little bit of that as well.

A couple other, I think, key findings are interesting. The demise of email is greatly exaggerated. Thirty-three percent of our respondents said they're actually most likely to respond to an email from their provider, with only 27% saying text.

Again, there's always a little bit of good bad with that, though, with 39% of our respondents saying they'd actually fully read an email, even though it's the one that they're most likely respond to, and 53% saying they’d just do a quick scan. It’s interesting: they feel more activated by email but less likely to consume all the content.

Satisfaction with provider communication is more polarized than we've seen in previous years, with more people responding that they're unsatisfied and more people responding that they are satisfied. The middle has gone away, so either people are really happy or really unhappy.

Lastly, I'd say globally, especially when you're talking about telehealth and the emergence of technology in health care, one thing that our survey pointed out is that online scheduling needs to get much, much better. Thirty-seven percent of people said they were not satisfied with their online scheduling experience, 40% said it took too long to complete that experience, among those that were dissatisfied, and 33% said appointment availability was their largest dissatisfier with that process.

How do these responses measure up to prepandemic preferences? How do you think consumer behaviors will change going forward?

We'll double click on a few items. On in-person care, 67% vs 34% attended an in-person office visit. This is, again, now vs before. Almost double the number of people have attended an in-person visit over the last year. Thirty-six percent prefer a physical waiting room, and that was up from 19%. Interestingly, again, you would think everybody loves virtual waiting room, who wants to sit there reading a two-year-old magazine? Again, we're seeing as people are getting more comfortable with in-person care, their preferences are shifting very quickly.

I think the key that health systems need to address is figuring out what makes sense for in-person care or what makes sense for virtual care. Many health care visits, of course, require basic diagnostics, so even your yearly physical, they want to take your blood pressure, they want to get your weight, and these are things that just don't fit very well in a telehealth appointment. I think we're still figuring out what fits where and what works best and what leads the greatest level of satisfaction for the patient.

People are using in-person care when they have to, even if they're not entirely comfortable with it. I think that's important to note, that even though the rate of in-person care has increased greatly over the last year, that comfort level hasn't moved as much. People certainly are going when they need to, which is good news, but we have to, I think, do more to ensure they're more comfortable with that experience.

If we double-click on the other side of that coin, telehealth, people certainly are still utilizing it. Those utilization numbers haven't changed very much over the last year, but the number of frequent fliers is actually down quite a bit. When you look at it, people who are going 3-4 times, and consume 3-4 telehealth appointments, that was down to 32% from 36% in the previous period. But 1-2 appointments is actually up. People are going just here and there, that's up to 39% from 31% the year prior. I think people are just figuring out what works best, in-person vs telehealth, and consuming it appropriately.

We talked a little bit earlier about the polarization of satisfaction around provider communication. The good news is 81% are satisfied, but almost 20% are saying they are not satisfied at all. If we look at that, in our previous period, that split was 73% satisfied, but only 2% said they weren't. Then, if we looked at it for 2020, those were 60% satisfied and only 6% weren't. Satisfaction has gone up but also dissatisfaction has gone up even more. You're looking at 3x the level of dissatisfaction compared to 2020. Interesting trends, I think we're still figuring out how we're reacting to those as an industry, but really a lot more polarization, which I think is interesting to note.

Given these results, do you have advice for providers and health care organizations seeking to improve the consumer experience?

I think one of the things that's jumped out to me is, we've talked about how email is the channel most likely to create activation for people to respond to, but we also talked about how they say they don't read the whole thing. It's important that email must be concise to be most effective. You might want to consider, if you're dealing with a broad array of topics in an email, splitting all those into multiple emails to get people to get out of that scan mode to full read mode, I think is important.

The other thing, with online scheduling, we talked about the level of dissatisfaction with that. One of the leading dissatisfiers was it took too long to actually schedule an appointment online. I think it's important that you make some of these things asynchronous workflow. Have them book the appointment, do intake later, or you're maybe collecting all the insurance information copies of their driver's license, collective medical history at a different time. If you're making them do all those steps in real-time as they’re booking the appointment, you can imagine that becomes a 5-, 10-minute process, 15-minute process. If you're doing medical history, and people are just abandoning it, it's not worth that to them. I think that's very important too.

The other thing is you need to focus a ton on your user interface. A confusing user experience dissuaded 31% of patients from leveraging online scheduling. They told us that: “I wanted to do it, but I got in there and I was just confused how to complete it.”

You want to draw from experiences that are familiar to the consumer and make it akin to, and I hate to say it, but online shopping. Everybody knows how Amazon works. Everyone knows how Walmart works. You really have to do it in a way that they don't feel like they need to be trained and make it very intuitive to them.

When we look at the impact of that, of having that better experience, 55% said an easier booking experience would actually convince them to use online scheduling. If we can make any easier for them, they certainly want to do it, but right now, it's too confusing and time-consuming.

Is there anything else you’d like to add?

When you look at all this in totality, convenience and personalization will be the keys to capturing or retaining patients next year and going forward.

We saw great polarization around provider communication, and to alleviate that, I think what has to happen is we need to get out of this one-size-fits-all approach. We take this middle road approach, which satisfies a good percentage of people, but there's still good percentage that are like, "This is not working for me,” going so far as to saying they're completely dissatisfied. I think we need to take a more personalized approach to communication.

The other thing that is critically important is, access issues are a leading dissatisfier for our survey respondents, with 58% saying they would be unhappy but stay with their doctor if they had to wait more than 7 days for a nonemergency appointment, and 26% saying they would switch. It's going to be more and more important to ensure that patients can get in.

Their patience level is low for getting in and seeing a physician, and I think the leading part of that is we've gone to on-demand consumer economy, so people are bringing expectations from other experiences into health care for the first time. It's really creating this situation where they want it and they want it now, and it should be super easy to do and super convenient, so I think it's going to be important. There's a lot of focus put on those areas over the next year.