More is Not Always Better, But More Better Is

One of the many new phrases added to my vocabulary upon moving south is “more better.” Those that know me know that better is just not good enough, so more better is, well, more better!

Unfortunately in healthcare technology, I find that I loathe hearing these two words in the same sentence because there’s that little word “is” between them. People assume more is better –more use of that new EMR, more patients through that portal, more providers e-prescribing, or most common in my current world, more referrals being conducted digitally. It drives me crazy!

More is not always better, but we do have a huge opportunity to do what we are doing way more better.

Why More Does Not Mean Better

The healthcare technology world tends to get distracted by more and forgets to dig a little deeper to get to more better.

I deal with this regularly when people first encounter digital referrals. They’re excited to leave the phone, fax, and email behind. How amazing is it to complete a referral –including an appointment scheduled and confirmed– in 4 minutes or less?

The lure of this utopia is captivating, so who wouldn't want more?

The problem is more referrals doesn’t mean better referrals. More referrals that actually follow through and result in the referral loop being closed is what we need.

A closed referral loop is proven to lower disease complexity, improve clinical outcomes and lower overall cost. It sounds so simple yet in the quest for referral close “loopness” we somehow assume that more referrals should lead to more referrals completed. Sadly that just isn’t the case, but provider organizations (referral senders) have the power to go beyond creating the referral and can help ensure that the referral actually happens.

I can hear your reluctant deep gasp: “Oh great now Dave wants us to do even more!?” Well, yes and no. Instead of thinking more, let’s think more better. The effort is the same but the outcome is greater.

So how do you get “more better” referrals? I’ve got two main ideas.

Communicating Concern

Patients want to feel cared for, but they don’t always trust providers. Many patients I talk with believe that “it's all about the money for these docs, and they are all in cahoots with one another to get more from me.”

“Communicating concern and sincerity will go a very long way toward a more better referral.”

This, of course, is not true. In my 30 years of interacting with providers I have met a few bad actors, but overwhelmingly I have met physicians who truly are committed to the wellbeing of their patients.

Nonetheless, this is the perception of many patients because with healthcare as it is, providers have a hard time keeping up with the load of patients. In the rush, they often forget to pause and look into the eyes of their patients and see their hearts. It doesn’t take long, but it doesn’t happen enough.

But communicating concern and sincerity will go a very long way toward a more better referral.

You can do this by approaching the early engagement with the patient with your emotional intelligence at its best. When you’re listening to your patient’s healthcare issues, use insight to understand the likelihood of them taking your advice and following through with your referral. I’ve found that providers seem to have a sixth sense for knowing when a patient won’t follow through. They feel it in their gut, but they often let it slide because they view the immediate reward as the send, not the follow-through.

To ensure that they’re communicating concern and sincerity, many providers I know ask themselves these four questions when conducting their exams:

  1. What are you picking up during your exam?

  2. Does the patient care about themselves?

  3. Do they trust you?

  4. Are you coming across as sincere and genuinely expressing and explaining your desire for their short and long term wellbeing through this referral or are you robotically going through the motions?

Care About Convenience

Another aspect that might divert your patients is the logistics of getting to the appointment. Think about transportation, social support, or day and time of the appointment.

When providers show they care about convenience for their patients, it helps build trust and will lead to a more better referral.

I saw this recently when evaluating client data in a region. Usually, referrals scheduled with our “send to patient” function led to a lower follow-through rate. The delay in the decision allows for second-guessing and before you know it Tylenol becomes the referral.

But that wasn’t the case in this region. Send to patient referrals had way higher completion rates than referrals completed by the provider at the time of service. How could this be? I needed to dig a little deeper.

First, it's important to understand the difference. The preferred referral is performed at the provider location at the time of service, usually at the end of the exam or during the checkout process. It's so quick that you can’t help but search for the best place, day, and time. Then, voila! Results appear!

But sometimes the patient is unable to commit to the available appointments. Sometimes patients need to get time off from work or get a babysitter prior to committing to a specific day and time.

The send to patient function grabs your recommended provider and proposed day and time and emails it to the patient for them to book or select another appointment at their convenience. They can’t change providers, only the day and time.

So what was so different in this region?

My digging showed that, in this particular region, providers used the send to patient function as a way to show that they cared about the needs of their patients.

“The leading cause of low customer satisfaction is not bad experiences; it’s encountering indifference from providers.”

They would start their conversations with a simple question: “how flexible is your schedule and do you have any limitations such as child care or trouble obtaining time off of work?”

When the patient said yes, the interaction proceeded differently than it did when they said no. The provider showed concern for the patient's convenience and their health. Once the provider found a specialist and an appointment, they clicked “send to patient,” and the patient felt a sense of responsibility to follow through with their considerate provider’s recommendation. Responsibility was “delegated” to that patient, and the patient did not want to let the doctor down because they felt that if the provider was concerned enough about their convenience then he or she most certainly must be concerned about their health as well.

This is an example of the nuance that ensures an impactful care continuum. Research shows that the leading cause of low customer satisfaction is not bad experiences; it’s encountering indifference from providers.

Are you approaching your referral with the end in mind? Are you applying the same sincerity that you present in the exam when you initiate a referral? Are you helping meet the convenience needs of your patients?

It is only when we embrace these human realities that we will get to a place of “more better” referrals and leave behind the idea of “more is better.”


Dave Gregorio is the Chief Customer Officer at Blockit and the author of the Purpose Quotient®, a nationally recognized framework for Organizational Development. A 30 year healthcare industry professional with a passion for people, Dave is the founder of the Heroes to Healthcare mission and CEO of ImPowerQ Associates LLC.

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