What patients really want

Patient expectations are changing as advances in technology and increasing consumerisation transform the way care is delivered, but are healthcare providers responding to genuine shifts in patient behaviour when they design new services and facilities?

Karen Bullivant, Jane Ho and Melissa Hoelting of HKS and CADRE, share the findings of a new major survey

Millennials and boomers are two of the largest age cohorts and healthcare consumers today. A few years ago, HKS/CADRE conducted a national poll in the US to better understand what these two cohorts were looking for in outpatient care. This year, the research was repeated with UK patients. The results showed that although there are distinct differences between the two health systems, patients shared many – though not all – of the same preferences. 

Both countries are facing an urgent need to change healthcare to battle escalating healthcare costs and increasing demand – the US needs to lower overall cost and the UK needs to maintain a service free at the point of care while still providing quality outcomes. With various changes in care models for acute and chronic care, it is more imperative than ever that facilities can respond to varying needs without adding substantial cost. 

A ripple effect of the need for healthcare reform in both countries is felt in the design and construction industry as well, with an increasing focus and shift to more community-based care.  The clinic of the future is still being discussed on a global scale as countries consider where to invest, how to attract patients and staff, and how to build better facilities that can support a rapidly changing and evolving ambulatory care market.

Millennials and Boomers

In 2015, HKS’s research team, through its not-for-profit entity the Center for Advanced Design Research and Evaluation (CADRE), attempted to delve deeper into the market to understand what is driving the latest trends and decisions from patients and clinicians. The research explored patient perceptions through surveys that focused on baby boomers (born between 1946 and 1964) and millennials (born between 1981 and 2000). The resulting report – Clinic 20XX: Designing for an Ever-Changing Present – outlined implications for designing not for a faceless future, but for a dynamic and ever-changing present in the US market. HKS was committed to making this a living report and decided to continue taking the pulse of the industry while extending its patient database, this time in the UK. 

The patient surveys completed in the two studies focused on patients who had visited at least one clinic for the first time within the previous six months. Here are some key insights:

Patients in the UK don’t think of themselves as consumers

Recent market research has indicated that there is a shift among many healthcare providers from targeting ‘patients’ to targeting ‘consumers’. This comes from an increasing need to attract and retain patients and increase patient satisfaction ratings. However, contrary to expectation, when asked to describe themselves, respondents in the UK and the US all overwhelmingly agreed that they see themselves as a patient, not a consumer. This remained true for millennials and boomers, though for younger millennials (born after 1995), there is an upward trend towards viewing themselves as consumers.

Patients everywhere trust people over information  

In an era of information, patients in both countries agreed that they trust people over information. Most people consider their phones as a means of communication and not a lifeline to receive services despite the significant advances in digital technology. This trend remained for baby boomers in both countries. Millennials, however, were virtually split, but leaned towards perceiving their phone as a lifeline. As generations pass, so this trend is likely to escalate, as is being demonstrated by the recent uptake of GP access technology in the UK. 

Patients want a better experience but not always at the cost of service

On one point, patients in the UK and US differed in their preference: experience vs service. Those in the US – especially millennials – felt that experience was more important than just having their health issue addressed. The opposite was true for those in the UK: the majority felt that if their health issue was addressed, the overall experience was less important. Millennials in the UK seemed to be split on this, indicating a potential shift in mindset.

Availability and access are the top priorities in the UK

The top three considerations for what make a clinic appealing for patients in both countries were same-day appointment, less than 30 minutes’ waiting time, and cleanliness and hygiene. In the UK, a same-day appointment was the top priority across both age groups.

Millennials want more amenities

In both the US and the UK, rankings of what made a clinic more appealing were much more streamlined for boomers compared to millennials. With boomers, some things (such as convenient access) trumped other factors, such as having a spa-like experience. Overall, millennials prioritised amenities. Millennials in the UK prioritised efficiency-focused amenities like mobile apps and online registration, while in the US, experiential attributes such as a spa-like experience were highly rated as well. 

Convenience, cleanliness and on-site diagnostics 

Participants in the poll were asked to rate the important factors for their clinic selection on a scale of one to five. For both countries, overall cleanliness and on-site diagnostics were in the top three selection factors based on the averages, for both boomers and millennials. The top selection factor in the US was, unsurprisingly, that the clinic is covered  under the patient’s healthcare plan. Choosing a clinic based on healthcare coverage is less important to patients in the UK, therefore it is not a top selection factor. Patients in the UK placed a higher priority on having on-site diagnostics and being close to their homes.

Participants were also asked to describe in their own words what factors influenced their decision to choose a particular clinic. In a content analysis, the same three things came out top in both the US and the UK: convenience and affordability, reputation and referrals, and their relationship with providers.

Likelihood of returning to a clinic may depend more on pragmatic factors in the UK compared to the US

Not surprisingly, satisfaction with a clinic visit was a predictor of whether patients would return. For participants in the US, satisfaction with follow-up care after the visit and satisfaction with Wi-Fi connection at the clinic facility were shown to be significant predictors of returning to a clinic. For participants in the UK, satisfaction with the registration process and the cleanliness of the facility were shown to be significant predictors.

Connection to doctors is still the most important factor

When asked about communication with healthcare teams, all patients place value in being able to spend time with their doctors. They also feel strongly that they have the most meaningful interaction with their doctors. Providing adequate time for communication between patients and doctors has a strong impact on the patient experience. This was true for both countries.

The lessons learned 

In general, healthcare currently remains a needs-based, not a wants-based industry: patients first, consumers second. Service also plays a crucial role in the overall clinic experience. Healthcare environments continue to work to align experience and efficiency to provide the best service and quality combined with a good overall experience.

20XX-UK: A reminder that being ready for the future requires us to understand the expectations of both current and future generations

Our research has brought to light that when designing or planning a facility, we need to be globally aware and contextually sensitive – considering major differences between healthcare systems and the similarities and differences in patient perspectives.  

As our models of ambulatory care evolve with the changing global population’s needs, I see our role as healthcare strategic planners and architects as key to providing the best positive and uplifting healthcare environments for patients, families and staff. We bring together the best thinking to design ambulatory delivery models and facilities, which integrate to create both pleasing and efficient delivery of care.  

Copies of the full report, Clinic20XX, are available from HKS by emailing Karen Bullivant at [email protected] or [email protected]