A lot of my essays lately have revolved around what makes a trip to the doctor valuable, meaningful, and helpful. At the center of this is the overall goal we are trying to achieve in that encounter. We want to give them what they need at the moment but also give them what they need after the moment to continue their health journey. I wrote an essay about the various words floating around the PX universe and while I am not going to rehash that conversation, I do want to explore a concept implicit in that conversation. Inside we talk a lot about a a patient experience is and this is important. But first, we should consider what a patient thinks of as an ‘experience’ before we consider how a hospital can or should be trying to create one.
I am using the word ‘experience’ not as a broad catch-all for any trip into the outside world, but as Pine and Gilmore use it in their 1999 book, The Experience Economy. As with many things I write about, I will likely struggle looking for the balance between being too detail-oriented and not spending enough time on the details. I am not an economist or a marketing guru, and I am not interested in talking about the book in those terms. I want to examine the book’s main construct as it relates to challenges and debates in healthcare and in patient experience work, both from the patient’s point of view as well as the clinician’s point of view. So, I will not summarize the whole book but simply define some of the terms I will use. As always, I encourage you to call out any errors or omissions in the comment section.
The central point of the book is the evolution of commerce from:
Commodities: Products that are, in a broad sense, interchangeable. Sugar is sugar. Marketing aside, my chemist parents will point out that sucrose is C12H22O11, and it doesn’t matter if it comes from sugar cane or sugar beets or one company or another.
Goods: Products that are, in some way, manufactured. The consumer is buying not just the raw materials, but also paying for the work required to create the item.
Service: Here, an additional element beyond mere construction is added. I often think of this as a human component, but it is some customer-focus regardless of whether actual human contact is involved.
Experience: Beyond service is the value of the event itself. This is a level of uniqueness, a destination, something that brings an added zhush to the good or service. The act of getting the good or service has its own added benefit.
Here is an example that speaks to my essence:
- Commodities: I could buy my own green coffee beans and roast them myself. Grind them and brew a cup of coffee.
- Goods: I could buy packaged ground coffee at the grocery store.
- Service: I could go to a Starbucks.
- Experience: I could go to a Starbucks Reserve, which the website describes as “an immersive, upscale coffee experience featuring rare, small-batch coffee, unique merchandise, and exclusive, high-end food pairings like pistachio raspberry tarts. Locations in NYC and Chicago feature distinct, artistic designs, including copper accents and specialized, high-intensity, handcrafted cocktails, as well as artisanal brewing methods.”
The lines between these levels or steps on the ladder get a bit mushy, as there are gradients between commodities and goods. (I am not sure if ground flour in the grocery store is a commodity or a good, since I did not have to grind the wheat myself but I still have to bake my own cake.) The line between service and experience is also mushy, because an ‘experience’ can often feel difficult to define clearly outside of calling it ‘service on steroids.’ Identifying when a service becomes an experience is likely unique to the customer and not definitionally clear.1 This essay will focus on this differentiation from a customer’s or patient’s perspective. In the next essay, I will explore what this means from a service provider’s or clinician’s perspective.
Do patients want it?
The concept of ‘experience’ assumes a individualized tailoring, attention or uniqueness. This, of course, assumes that the customer desires this level of customization. I must put up some drywall in my basement, so when I go to the hardware store for drywall and screws, I don’t need an ‘experience.’ I don’t need a screw-sommelier discussing the subtle notes and differences between the available drywall screws or a lesson on the structural differences of the eighteen different types of drywall sheets. I might need someone to direct me to the appropriate location in the airport-hangar-sized store, ideally with a smile, but otherwise I don’t need an ‘experience.’ I want to exchange cash for products and get on with my work.
So, the model may work in some marketplaces, but there are plenty of places where we don’t need an ‘experience.’ I admit that for everything, there will always be a group of people—call them hipsters, fanboys, experts, or snobs—that will create differentiation where many people will not. They will demand personalized experiences where many do not. There are independent bookstores with knowledgeable staff who know you and can recommend something just perfect for you or for you high school graduate, and have free coffee, and gift wrapping, and sponsor book clubs, and have reading times. They are wonderful places. They also have a business plan that won’t sell in one year what Amazon sells in one day.
In healthcare, patients want to be treated with respect. They want knowledgeable professionals performing best-practice medicine with no medical errors and with no complications. While they also want information delivered at a level that they can understand, which does require patient-specific communication, I am not sure that patients would define their demands as a desire for a tailored personal experience so much as a request to “just use English, doc.” This certainly sounds more like thoughtful customer service than a larger produced experience.
Will people pay for it?
This gets at the real balancing point of the experience economy. Businesses want to create experiences because the experience can build loyalty and the business can charge for it. By creating a destination, you gain customers who are committed and willing to pay extra for the product or service because it is, in their mind, just better than the rest. Disney, the spiritual forefather of the ‘experience,’ is a perfect example. Disney is thought of, by most people, as just different/better/special. The name itself captures a spark. And you pay more for that spark. A quick internet search shows that a Disney theme park is about 30% more expensive than Universal Studios theme park and 50% more expensive than other Southern California competitors. Disney cruises are two- to three-times more expensive than other major cruise lines. This is not an insult on Disney. It simply points out that crafted curated experiences cost more than services.
Sometimes, creating a brand identity is a shortcut to creating an experience. Jeeps are for adventurers and Harley-Davidsons are for rebels. It is also true that Harleys cost more than comparable motorcycles, but I will leave it to accountants and marketing folks to argue how much of that is because it is a more well-constructed product and how much of that is in the identity or individualization of being a Harley rider. As I talk about individualization and cost, many of you are starting to see where I am headed, as I discuss ‘experience’ with healthcare. Are patients willing to pay more for a healthcare experience than they are for a healthcare service?
What differentiates “service” from “experience” in healthcare
If we define an experience as something just different from its competitors, what in healthcare can claim an identity or difference from the rest of the hospital systems? There are a few with good name recognition. Mayo, Cleveland Clinics, Johns Hopkins come to mind, but is name recognition the same as having an identity, individualization, or providing an experience? The one health system that I can think of that comes closest to this individualized experience is St. Jude’s as their commercials stress the emotional support and medical caring for both patient and family as well as that it is free. I have never been to St. Jude’s in Memphis, though, so maybe I am just captured by their marketing campaign.
Setting aside a broader conversation about these hospitals, and whether they fit the criteria for ‘experience’ or not, I want to explore what impact this has on their potential patients. Let us assume that patients see them as providing more than just healthcare, but also an experience. Does this differentiation really help them in the eyes of the public? A few things to consider here:
Who cares? These hospitals all have brand awareness, but unless you live in Rochester, Jacksonville, Pheonix, Cleveland, or Memphis that brand awareness means nothing. Even if they provide care that no one else does, they don’t provide it anywhere near you. Are people interested in planning destination experiences when they are picking places to get healthcare?
At what cost? Not only is there the associated cost of travel and lodging with going to a destination hospital, but there is also the cost of the hospital itself. Chances are that those hospitals are not in-network for your insurance plan. Plus, that reputation also comes with the reputation for being more expensive. People may modify their belief that Mayo is more expensive with a “…but it is worth it” but there is no doubt that people see them as being more expensive even if they are seen as the best at healthcare. In a marketplace that the public already feels is too expensive, going to the most expensive option seems a stretch.
Is it better? The reality is that while there may be cutting-edge trials going on that you only can get access to if you are there, it is also true that there are cutting-edge trials going on at every University health system in the country. Moreover, if you don’t need cutting-edge trials, are they better at setting a broken leg than the hospital down the street?
This is not to discount or deride these institutions, but to simply call out the reality of healthcare. I won’t turn this into a whole essay on profitability, but hospitals don’t survive by providing big-ticket expensive complex care to a few people. Contrary to public perceptions, those situations are generally not profitable. Hospitals keep the doors open by providing less dramatic care to large groups of people. It is the strep throat, knee replacement, and appendicitis cases that keep the lights on. The reason why hospitals lose their minds at the thought of Amazon or Walmart providing health services is because these companies are targeting the high-profit/low-overhead elements of care and leaving the complex cutting-edge (and not profitable) care to the hospitals.
So, a hospital that truly provides an experience and becomes a destination essentially is perceived as (and often is) more expensive than other options. This might be OK, if you have that nth case rare illness, or you are a European trust-fund baby, or a member of a royal family. But for most people, even those with weird rare diseases, they don’t see these places as real options. They are instead choosing locally between University of, Memorial, or Health System.
None of this means you cannot or should not provide a remarkable care or excellent service. Indeed, that is what patients are looking for. It is just that, as you position this work within your hospital, it is important to realize that your patients are not generally hipsters, fanboys or snobs. They are simply people who want a great experience, but they don’t need a great “experience.” Healthcare as an industry cannot survive if it is relegated to a commodity status.3 Since, though, it often fails at providing decent service, perhaps that should be our primary focus. By dressing important service work in the clothes of providing unique experiences, you may send the wrong message to your patients. You will also send the wrong message to your staff, but that is the subject of the next essay.
1Honesty dictates that it is also made fuzzy because for 25 years people have been trying to turn services into experiences by simply relabeling them.
2I wrote an extended section here about how we confronted that challenge in a previous job, but I cut it for length. I will save it for another day as a case study.
3This also screams for its own essay.
PX Matters with Joseph Snipp 
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