Who Is a Hospital's "Customer"?

INTRODUCTIONOver the past several years, the Centers for Medicare & Medicaid Services (CMS) has begun incorporating the patient experience in calculating a hospital's reimbursement for services rendered (Florence, Atherly, & Thorpe, 2006; Huntington, Covington, Center, Covington, & Manchikanti, 2011). This customer satisfaction element forces hospitals to focus on nonclinical aspects of hospitalization, including customer service techniques common to other service industries, to improve the overall patient experience (Ford & Fottler, 2000; Fottler, Ford, Roberts, Ford, & Spears, 2000; Mazurenko, Zemke, Lefforge, Shoemaker, & Menachemi, 2014). For example, some hospitals offer amenities such as room service, personal concierges, and wellness centers, but these efforts often yield mixed results (Ford & Fottler, 2000; Ramachandran & Cram, 2005). One underlying reason for the lack of success is organizations' failure to identify who the customer is and what is important to that customer.Customer is defined as "someone who buys goods or services from a business" (Merriam-Webster's Online Dictionary, n.d.). To date, no uniformly agreed on definition of healthcare customer has emerged, but the previous definition could apply to a patient. Popular insurance plan options, such as high-deductible plans and health savings accounts, have led to rapid growth in consumer-driven healthcare, where consumer is generally accepted to mean customer. With the advent of these and other products in the healthcare marketplace, individuals are motivated to shop for providers on the basis of price and quality information that is publicly available, which may be influencing the shift in labeling from patient to customer (Powell & Laufer, 2010).Importantly the use of the term customer has long depended on the person or organization using the term (Bastian, 1998). For instance, healthcare administrators might refer to customers rather than patients when negotiating privileges with physician groups (Boote, Telford, & Cooper, 2002). Administrators might refer to insurance providers as customers, as insurers often influence where patients seek treatment (Telford, Beverley, Cooper, & Boote, 2002).The purpose of this case study was to identify a hospital's customers, as viewed by both patients and healthcare team members, and to identify variables that lead to customer satisfaction. The study was conducted at one acute care, for-profit hospital located in the southwestern United States. The study's findings may be of interest to hospital administrators who wish to incorporate customer service techniques to build customer relationships. It also offers a method to identify potential customer segments and the attributes those segments deem important to making the decision to do business with the hospital. Ultimately this case study provides a framework in which to identify a hospital's customers and the best ways to attract and retain them.BACKGROUND?Ils a Patient a Customer?Webster's Online Dictionary (n.d.) defines patient in the verb form as "bearing pains or trials calmly or without complaint" and in noun form as "a person who receives medical care or treatment." In healthcare, this term often carries connotations of passivity and deference to physicians (Deber, Kraetschmer, Urowitz, & Sharpe, 2005). As a result, a patient is viewed as an individual who grants authority to the physician, whereby the physician is presumed to be the sole decision maker regarding the services provided.Conversely, customer is defined as "someone who buys goods or services from a business" (Webster's Online Dictionary, n.d ), implying that medical services are commodities to be managed in the market. When an individual is a customer, he or she purchases services and is fully responsible for checking the quality of the goods before the purchase is made (Brookes & Stodin, 1995). …