New Survey Points Up Perceptual Concerns for Hospital Leaders
Are healthcare consumers nationwide beginning to lose faith in hospitals as organizations? The results of a new nationwide survey are pointing to some concerning trends. The healthcare communications firm Jarrard Phillips Cate & Hancock, a Nashville-based healthcare strategic communications firm that 15 months ago became affiliated with The Chartis Group, the Chicago-based healthcare consulting firm, has just published a survey-based report on the subject.
On Jan. 12, leaders at Jarrard Phillips released the results of the nationwide survey of hospital and health system executives. As the introduction to the report based on the survey notes, “Two years on from the pandemic’s opening salvos, healthcare is witnessing a meaningful gap in public perception regarding the people providing care and the institutions where that care is delivered. People love their doctors and nurses. They even have appreciation for their chosen hospital. But among the public and healthcare workers, there’s perceived tension surrounding the business of care. It’s a growing concern over how hospitals prioritize between money and patients, how they handle access and equity and how they support their staff.”
Indeed, the report notes, “The public trusts healthcare workers. In April 2020, 89 percent of adults had a favorable opinion of both doctors and nurses. Today, that number still hovers around 85 percent. Despite this healthcare heroism, the public has only lackluster approval of hospitals based on their business practices. The Jarrard National Consumer Survey was fielded just as the omicron variant began making headlines. It reveals that even after two years of caring for patients in the most trying circumstances, there’s only weakly held support for hospitals’ approach to the business of healthcare. This soft support leaves patients – and employees - vulnerable to being swayed by critics and competitors, putting hospitals at risk of lower loyalty and open to reputational damage. Though not reflected in the survey, that risk is likely compounded by the stunning virulence of omicron, which is once again straining hospitals, doctors, nurses, communities – and of course patients themselves. The public is tired and angry. Healthcare workers are tired and angry. Acute care facilities are stretched thin. How does this affect perception of the hospital itself as an employer and as a community servant?”
Among the key survey results:
Given the statement, “My preferred hospital is a good community partner providing charity care and working well with others in the community,” only 41 percent strongly agreed, while 22 percent were ambivalent, 8 percent strongly disagreed, and 29 percent were unsure.
Meanwhile, asked whether they were concerned about a range of issues, here were the results among two groups—adults in general, and healthcare workers:
> Shortages of hospital staff like doctors and nurses: 47 percent versus 64 percent
> The cost of hospital care: 44 percent versus 47 percent
> The quality of care at hospitals: 27 percent versus 22 percent
> Hospitals mandating the COVID-19 vaccine: 24 percent versus 21 percent
> Consolidations, mergers, or acquisitions of smaller hospitals by larger hospitals: 11 percent versus 16 percent
Meanwhile, when healthcare workers were asked if their employer does not value mental health, 52 percent of those working in a hospital or in a clinic within a health system said that their current employer does not value their mental health, while 24 percent working in a standalone private practice said so, 15 percent working in a standalone urgent care clinic said so; 12 percent of those working in a long-term care or assisted living facility said so; while 8 percent working in an independent hospital said so.
Examining these findings, the Jarrad leaders state in their report that “Hospitals are emerging from the pandemic with a substantial base of trust and a decent, though likely insufficient, reserve of goodwill on issues of access, equity and quality. And, most importantly, hospitals are home to those who are held in the highest regard: the doctors and nurses caring for patients. The mandate for provider organizations, then, is not to rest but realign. Hospitals must use positive perception to advance their mission while working to move the ambivalent into the ‘proponent’ column through meaningful, visible change. It’s an effort that starts internally with the healthcare workforce and radiates out into the community. Based on the findings throughout this survey,” they write, “healthcare leaders can focus on these core areas to move their organizations forward: Address internal skepticism and focus on your culture. Engage with employees, listen to their concerns and ideas, and evaluate all operations with the wellbeing and sustainability of healthcare workers in mind. Strengthen relationships with healthcare workers and build trust with the public as a critical first step in bringing mission back to the forefront. Take the time to understand how you are perceived in the community. Ensure that what is being said publicly match[1]es how care is being delivered. Give patients an experience that matches the stated commitment to care and show caregivers that their mission is yours, as well. In short: Give patients and staff a reason to stay. Personalize your organization. Stand out from ‘healthcare in general’ by emphasizing what makes your organization unique. Show how your commitment to care elevates the community and the patients you serve. Own the narrative. If you don’t work to explain how your mission is underpinned by a sound business, someone else is likely to focus only on the business and paint hospitals as the villain. Engage with using clear materials to help them navigate their health[1]care journey. And, where your organization has fallen short, own the missteps and lay out specific changes to improve going forward.”
Shortly after the report was released, two Jarrard leaders spoke with Healthcare Innovation Editor-in-Chief Mark Hagland regarding its findings and their implications: CEO David Jarrard and Isaac Squyres, a Jarrard partner and the author of the report and architect of the survey instrument. Below are excerpts from that interview.
Let’s begin at 40,000 feet up. Overall, what were the biggest findings you all gleaned from the survey?
David Jarrard: That through the pandemic, hospitals and health systems and nurses and doctors continue to have an extraordinary amount of trust from consumers. However, we’ve seen the beginning of an erosion in that trust; it’s beginning to soften. And we’ve noticed a gap beginning to form between on the one hand, the nurses and doctors, and the business of care, the hospitals and health systems. And that gap is concerning.
What is the cause of that widening gap?
I think there are several reasons. Through the pandemic, hospitals and health systems have come under increasing scrutiny from physicians and nurses, regulators, media, bondholders, about their business practices, through issues such as surprise billing, and whether they’re suing patients or not, have gotten outsized media attention. And that has begun to create a little bit of a split.
What should hospital and health systems leaders be doing about that?
Well, that is a big question. Part of this is to tell your story. Be talking about who you are as a great provider of care, but also to be a great community partner in the provision of that care. How you fulfill your mission and provide charity care and deal with the most vulnerable populations and dealt with health equity—I think healthcare organizations have taken for granted that the halo around doctors and nurses would protect them, but it’s not necessarily true. We’ve got to tell a story so that people appreciate the kind of value that they expect to see from their healthcare systems. Of course, implicit in that is that they do have a good story to tell. You need to make sure that you have a good story to tell. And for some organizations, strained by the pandemic, they haven’t been able to tell their full story.
Do incidents like strikes, and like protests by clinicians over working conditions, affect a patient care organization’s reputation?
There’s no question that some of those actions are straining the trust in hospitals and health systems, including statements by nurses and doctors. And it’s hard for the health systems, who are strained financially. It’s a difficult position for both partners; but you see nurses and doctors leveraging their political strength.
Isaac Squyres: In the data, we see that staffing issues and shortages, that that issue is very much on the minds of the public, up there comparable to cost as a concern. So those issues that administrators are worried about, retention, those staffing issues are very much on the mind of the public in ways that they hadn’t been. So that drives the need and opportunity for leaders to really engage with their physicians, nurses, and employees, both because it’s important operationally, but also because there’s external attention on this, so leaders need to focus on connectedness, culture, and engaging with physicians and nurses.
What is the single most worrisome data point, the single most hope-inducing data point?
Squyres: We asked people if they had a preferred hospital, and about 85 percent have a preferred hospital. And of those people, we asked if they felt their preferred hospital was a good community partner, providing charity care and working with others in the community. And only 41 percent were at the high end of agreement that their preferred hospital was a good community partner. 29 percent were unsure. That was really eye-opening to us, especially given what hospitals have been doing for the past two years. That community partnership data point was telling for us, because community partnership is at the core of what we are as organizations, so that data point was concerning to us.
And what was the most hope-inducing data point?
Jarrard: People weren’t saying their hospital was a bad community partner; you just had a lot of people saying they didn’t know. That’s a negative, because they should know they’re a good community partner; and it’s a challenge, because someone needs to close that perception gap. So there’s an open field that’s open to be won. And so it’s both a challenge and an opportunity.
Squyres: The fact that the public’s trust in doctors and nurses remains really high—it’s much higher than for other types of organizations. That’s really encouraging and an opportunity for hospitals to use trusted voices that can help close that gap around the good-community-partner issue.
Does it help to put identifiable faces of senior executives out there during this pandemic time?
David: It absolutely does. When we talk about hospitals being good community partners, well, you can picture the faces of nurses and doctors, but hospitals are red brick buildings; you can’t necessarily recognize them as human organizations. But there’s this one caveat: healthcare leaders need to stay in their lane. If they veer out of their lane into issues not related to healthcare, that it can become problematic.
What will happen in this new, fraught space, in the next few years?
Squyres: It’s an excellent question, and I think to some extent the gap we’ve identified in the survey—I think that how hospitals and health systems respond to that gap will play an important role in what the next couple of years look like. If hospitals and health systems lean into the moment and acknowledge that they need to work on community relationships, health equity, and billing processes, etc., there’s a chance they can come out of this with a lot of people in that 8-10 category, which then sets them up on the policy front, and they’ll be able to articulate their positions on a host of issues. But if they don’t, there’s risk here, and now is a bit of an inflection point. So we need to do the work to close the gap, now.
Jarrard: And per that, another result related to healthcare workers, related to stress and burnout. And one of our findings was that 1 in 10 healthcare workers are expected to leave the profession. That’s a huge number in and of itself, but not surprising, given the level of stress involved. As we dug down into that number, we found that a number of people want to change their position in healthcare. In particular, half the people we surveyed work in hospitals, in acute-care settings. And a great number of them want to stay in healthcare, but don’t want to be in acute care any longer; they want to be in ambulatory surgery centers, outpatient care, minute clinics.
Squyres: One of the things we find as a truism is that you’ve got to take care of your people and solidify things with your people in order to be successful externally. The survey looks at burnout, and whether or not their employer takes their mental health seriously. So there’s critical work that hospitals and health systems need to do with their workforces, beginning now. Because you can’t necessarily be successful externally unless you take care of your people internally first. So it’s both an internal and an external focus. Those folks working in hospitals talk to their neighbors and friends and recount stories that are meaningful to folks.
