Overview
Carolinas Healthcare System is a body that comprises numerous healthcare facilities and emergency departments located in the North and South Carolina states. It is a non-profit organization dedicated to affording care to patients, particularly those living in or around Charlotte, North Carolina. Nearly 90 percent of the network’s healthcare facilities are found within a radius of 75 miles from Charlotte. Carolinas Healthcare System (CHS) is legally established under the Hospital Authorities Act of North Carolina. As a public institution, CHS (also known as Charlotte-Mecklenburg Hospital Authority) provides a wide range of healthcare services to patients in the region. All major hospitals within the network are found in the Charlotte area. They include:
- Carolinas Medical Center, which forms CHS’s flagship facility
- Levine Children’s Hospital
- Carolinas Medical Center-Mercy
- Carolinas Healthcare System Pineville
CHS’s main competition is Novant health, a caregiving network that is similar to CHS in size and resources. The presence of healthy competition means that CHS has to remain focused on the identified innovative ways of retaining its patient base while reaching out to uncovered areas. More recently, Carolinas Medical Center (CMC), the network’s center of operations launched a mobile app dubbed MyCarolina Tracker to assist patients in obtaining clinical information. This paper will introduce the concept of online review systems. The goal is to show how the systems can be used in health care to promote the delivery of quality care and hence patient satisfaction within CMC. Healthcare systems that bear integrated online reviews in their service delivery have already reported an increased index in patient satisfaction. One such example is the University of Utah Healthcare (UUHC).
Patient Population
CMC is the chief health care establishment within the CHS network. This hospital, which is located in the Dilworth neighborhood of the Charlotte area, provides numerous health care services, including Pediatrics, Surgery (General and specialized), organ transplant, and behavioral health. CMC serves a large population base with most of it (population) being found within Charlotte municipality. Charlotte alone has a population of 792, 862 people. Thus, given that CHS extends into other areas of North Carolina and South Carolina, the number of people who rely on the network’s services is large.
According to Carolinas Healthcare System (2009), annually, CHS reports over 12 million interactions with patients across its facilities. With over 860 beds, CMC alone is capable of handling more than 1 million patients per year. Of these, a considerable percentage of visits CHS-affiliated facilities in need of surgical operations. The surgeries are performed on people of all ages, including infants. The availability of high-tech equipment makes surgical operations highly efficient and hence the low cases of failure. For this reason, various types of surgeries are conducted throughout the healthcare network, including minimally invasive surgery, hernia operation, vascular surgical procedure, and colorectal operation. Additionally, the hospital runs the most established organ transplant center in North Carolina.
The provision of healthcare in the Charlotte area is dictated by various factors. One such factor is the cost of providing care. Bearing in mind that CMC is a public hospital, it faces the challenge of budgetary constraints. According to Rhyne, Livsey, and Becker (2015), CMC serves a larger proportion of uninsured patients compared to the national averages. This situation places a financial burden on the institution, thus necessitating frequent reimbursement from Mecklenburg County. Secondly, North Carolina has an aging population of 1.4 million, being about 14 percent of the state’s total population. It is projected that the aging population in the state will reach 17 percent by 2020 (Imperatore et al., 2012). As a result, diseases such as diabetes, osteoarthritis, and cardiovascular diseases will increase. This situation may call for the hospital to increase its hospice facilities to accommodate the terminally-ill people. Rhyne et al. (2015) further established that about 43.7 percent of patients’ chronic diseases such as diabetes and obesity were more common among patients of color compared to their white counterparts.
Market Share
CHS is one of the major healthcare networks on the Southeast side of Charlotte. It is recognized nationwide as one of the most comprehensive non-profit healthcare systems. Within Charlotte Municipality, CMC commands a strong market position, with its numerous departments handling a huge number of patients. According to Steingart, Spielman, and Goldstein (2016), the hospital controls 50 percent of the market share in the area. CHS’s major rival within the Charlotte area is Novant Health, which has nearly the same number of healthcare facilities and employee size. Notwithstanding, CMC has gradually attained an increase in market share over recent years regarding both primary patients and those with serious illnesses. In 2014, CHS witnessed a 1.5 percent growth in the market regarding its care business (Steingart et al., 2016). An additional 3 percent increase in inpatient volume was realized as the healthcare network brought more care providers on board to form part of the group. The number of patients seeking different forms of surgery in the various facilities has been on the rise.
The increase in market share for CMC has been attributed to various multi-year strategies put in place by the Carolinas Healthcare System. One such move included increasing the network’s access points such as the freestanding emergency departments. The network is also currently investing in urgent care locations to facilitate efficient access to its services. As such, the urgent care locations have tapped into a new population segment, which has caused new patients to be brought onboard. Another factor for the growth in market share relates to a favorable operating environment.
Legislation within the area has favored the expansion of CHS to match the growing population. However, recent changes in legislation may undermine CHS’s growth, particularly in the area of outpatient surgeries. As Steingart et al. (2016) point out, attempts to repeal part of the entire North Carolina Certificate of Need (CON) law, may result in an acute competition. The CON stipulation requires healthcare providers to seek approval from the Department of Health and Human Services before acquiring or replacing healthcare equipment and facilities. Another proposal may see the repeal of sales tax refunds for large non-profit organizations. If repealed, CHS’s annual budget would be inflated because of the need to pay tax.
Certain factors and healthcare facilities set apart CMC from its competitors within the Charlotte Municipality. To begin with, CMC’s Transplant Center handles over 100 referrals every month, being the highest number for any such facility within North Carolina. Additionally, it is the only center that operates an organ-based procurement program, meaning that patients do not have to wait long to receive organ transplants. Also, the hospital engages medical students from the University of North Carolina to alleviate physician shortage. Further, CMC relies on data harnessed through CHS’s Dickson Advanced Analytics Department to improve the quality of patient care. This department, which is among the few in the country, analyzes the available medical data to formulate actionable perspectives on the region’s healthcare. Another distinguishing aspect of the CMC is that despite being a public hospital, it has adopted strategies (for improving care quality) that are similar to those put in place by private hospitals. For instance, multidisciplinary teams have been formed and given leadership roles to facilitate the meeting of goals.
New Initiative (Online Review System)
The changing trends in the world of health care have necessitated creativity in the way healthcare is provided. As Maruthappu, Ologude, and Gunarajasingam (2013) reveal, more Americans are demanding quality healthcare that will match the high cost they pay for services. At the same time, the cost of healthcare is often regulated (fixed), meaning that providers can only compete on the aspect of quality (Brekke, Gravelle, Siciliani, & Straume, 2013). In light of these new changes in the way healthcare is approached, CMC has been determined to improve service delivery to patients. The new focus has been directed toward patient satisfaction.
Patient satisfaction can be attained through various approaches, the most significant being the delivery of high-quality care. Providing patients with sufficient information regarding healthcare is another way of fostering patient satisfaction. As Ziebland and Wyke (2012) observe, the advent of the internet has provided an avenue for patients to access information about treatment, care procedures, and medical reports. As a result, patients are now more empowered compared to the past where they had to acquiesce to physicians. Competition in healthcare means that patients have a range of options to choose from. The infiltration of business culture into healthcare has resulted in increased competition.
Consumerism in healthcare means that the sector has to contend with the increasing competition as healthcare providers strive to outsmart each other. The ultimate beneficiary is the patient since competition is likely to result in increased quality care. Importantly, since patients have a wide range of options to choose from, their primary focus becomes quality. Policymakers in healthcare are also moving toward enacting legislation (the overwhelming support for the repeal of the CON law confirms this position) that open up health care to numerous investors to boost competition. Carolinas Medical Center (CMC) has engaged in efforts to boost patient satisfaction in a bid to increase its market share in the face of mounting competition. One famous approach was embraced when they introduced a mobile app dubbed MyCarolinas Tracker that would provide useful clinical data to patients. Additionally, this app is used to link patients and care providers, popularly known as “Find a Doctor.”
While CHS has been consistent in its dedication to providing quality care, a wide gap for improvement remains. One particular initiative that can be of benefit for the healthcare network would be to post medical results online. This approach has been successfully adopted by various healthcare systems, including the University of Utah Healthcare (University of Utah Healthcare, 2014). Dubbed the Exceptional Patient Experience (EPE), this initiative involves posting patient satisfaction scores on online platforms such as Facebook or even the respective hospital’s website. The benefit of such an approach would be enhancing transparency and hence patient satisfaction. Also, such an initiative would boost patients’ trust in healthcare since they have prior information. Hence, they can gauge the kind of care they will receive from it. This information is often more reliable for clients compared to published records because it is based solely on unedited facts from patients. Surprisingly, feedback regarding patient satisfaction is often kept confidential. This plan renders an artificial gap that undermines information flow, which may be counterproductive.
The EPE initiative as a patient satisfaction approach should be anchored on patient critique. In other words, patients should be requested to rate, say on a scale of five, the nature of the care they have received from CMC. Patient feedback can be obtained by sending an electronic survey via email to patients, asking them to provide personal comments regarding their experience at the department. Afterward, the feedback may be posted online on the CHS website (as well as other social media platforms) where current and potential patients can access it. This strategy can grant the method a degree of authenticity, especially if the results are posted online without being edited. Hence, both positive and negative reviews will be available for everyone to see. Editing of feedback should only be done where personal information about patients is at the risk of being published along with the feedback. Of importance too would be to include the name of the physician who attended the patient alongside the feedback. Online review systems are useful because of their ability to be accessed by numerous people at the same time.
Supportive Documentation
A study by Loria (2008) established that 84 percent of patients use online reviews to evaluate doctors. For most patients today, visiting an online review platform is the first step when finding a new physician. This finding illustrates a fundamental change in the way patients access information regarding health care. In the past, patients would seek healthcare information from family and friends, as well as the family doctor (Brekke et al., 2013). However, the availability of reliable and easy-to-understand information on the internet means that patients can find useful healthcare information at the click of a button.
Also, because these online reviews are seen as factual, many patients rarely question their authenticity. For this reason, online reviews will become a matter of necessity for hospitals and other healthcare facilities in the days to come. Already, hospitals that have online review systems are reporting positive rewards in the form of patient satisfaction. Satisfied clients will often return in the future. Alternatively, they may at least recommend a friend to the same facility. For CMC, this outcome would mean increased patient inflow, as well as a reduction in patient turnover. Thus, while the decision to post results online may be seen as purely medical, it passes off as a marketing approach for the hospital.
Consumerism in healthcare means that the sector has to contend with the increasing competition as healthcare providers strive to outsmart each other. Today, many businesses rely on online review systems to improve their products and services to match customer expectations (Duan, Gu, & Whinston, 2008). This practice is also becoming common in the healthcare world as care providers become more concerned with how patients view their services. Already, various care providers have adopted online review systems aimed at improving their online presence, as well as boosting patient interaction.
A famous online review system for healthcare is the ProPublica Surgeon Scorecard, which allows patients to find ratings on surgeons online. The University of Utah Healthcare also has been running a successful online platform that allows its patients to post online any feedback about the care the facility receives from its numerous hospitals (University of Utah Healthcare, 2014). Ordinarily, physicians are not rated by the patients they treat based on the quality of care they provide. As such, a level of accountability is absent on the part of the physicians. Conversely, allowing patients to post online regarding their satisfaction with how a particular physician has handled them can promote physicians’ accountability, hence improving the quality of care.
Already, a similar approach exists under the Pay for Performance (P4P) scheme. The P4P allows room for a payment that is commensurate with the care afforded. The plan is seen as an incentive for healthcare providers to prioritize quality while dispensing their services. Similarly, EPE as a platform can motivate physicians to be more dedicated to their work knowing they will be scrutinized in public. It also leads to a reduction in medical injuries that are occasioned by negligent mistakes. Naturally, some CHS physicians will be opposed to this transparency approach, viewing it as exposing them to negative criticism from patients. Surprisingly, the existing evidence shows that negative feedback is uncommon with online review systems (University of Utah Healthcare, 2014; Loria, 2008). This observation may arise because care providers offer their best since they are aware that the patient will be asked to rate the treatment. Consequently, it can be concluded that online review systems are an effective way of attaining patient satisfaction.
In contemporary healthcare practice, patient satisfaction is not often regarded as forming part of the care giver’s duty. The result is that caregivers provide treatment in a rather mechanical manner. They may not bother about how the patient feels about the whole treatment process. As a trickle effect, patients may develop a negative attitude toward the treatment right from the onset. Conversely, giving a say to patients will not only encourage them to develop a positive attitude toward treatment but also be proactive.
In other words, patients who feel that they are part of the treatment process will facilitate their healing by being cooperative. Hence, the transparency approach would allow CHS’s patients to contribute directly to the quality of healthcare, thus further promoting patient satisfaction. According to Tea, Ellison, and Feghali (2008), being a proactive patient can facilitate a quicker recovery. Proactive patients are more optimistic about the future. Hence, they are confident that a certain treatment will be successful. In contrast, where patients are not made to participate in designing the treatment, they may develop a negative attitude. Thus, frustration may arise if they fail to understand the nature of care and/or even why they need a particular treatment in the first place.
Conclusion
The infiltration of business culture into healthcare has led to increased competition in the field. For this reason, healthcare providers are looking for innovative ways of attracting patients. Delivering high-quality care emerges as a primary way of achieving this goal. By facilitating access to medical information by patients, CMC will enhance customer trust of its physicians and the services offered at the hospital. As such, quality improvement can be attained by adopting a more transparent approach by posting customer feedback online. This way, potential customers can access the results and decide whether to visit the hospital. On the other hand, physicians may be challenged to offer their best after knowing that they will be rated.
References
Brekke, K. R., Gravelle, H., Siciliani, L., & Straume, O. R. (2013). Patient choice, mobility, and competition among health care providers. Developments in Health Economics and Public Policy, 12(1), 1-26.
Carolinas Healthcare System. (2009). About Carolinas healthcare system. Web.
Duan, W., Gu, B., & Whinston, A. B. (2008). Do online reviews matter?—An empirical investigation of panel data. Decision Support Systems, 45(4), 1007-1016.
Imperatore, G., Boyle, J. P., Thompson, T. J., Case, D., Dabelea, D., Hamman, R. F., … Rodriguez, B. L. (2012). Projections of type 1 and type 2 diabetes burden in the US population aged < 20 years through 2050. Diabetes Care, 35(12), 2515-2520.
Loria, G. (2008). How patients use online reviews in 2016. Web.
Maruthappu, M., Ologunde, R., & Gunarajasingam, A. (2013). Is health care a right? Health reforms in the USA and their impact upon the concept of care. Annals of Medicine and Surgery, 2(1), 15-17.
Rhyne, J. A., Livsey, K. R., & Becker, A. E. (2015). A model of care for the uninsured population in Southeastern North Carolina. North Carolina Medical Journal, 76(2), 76-82.
Steingart, D., Spielman, B., & Goldstein, L. (2016). Charlotte-Mecklenburg Hospital Authority. Web.
Tea, C., Ellison, M., & Feghali, F. (2008). Proactive patient rounding to increase customer service and satisfaction on an orthopedic unit. Orthopedic Nursing, 27(4), 233-240.
University of Utah Healthcare. (2014). University of Utah Healthcare online physician reviews continue to lead transparency efforts in academic medicine. Public Affairs. Web.
Ziebland, S., & Wyke, S. (2012). Health and illness in a connected world: how might sharing experiences on the internet affect people’s health? The Milbank Quarterly, 90(2), 219-249.