“IF WE DON’T TAKE CARE OF OUR CUSTOMERS, SOMEONE ELSE WILL”
Great companies know that a single satisfied customer could be more valuable than millions worth of advertising. The practice of issuing reviews and ratings to business entities and public institutions as markers of performance or perceptions of customer experiences is not new. Such report cards serve to motivate poorly performing businesses to do better, thereby improving the needs and overall experience of the customer in the process.
Thanks to a new website, Nigerians can now go online to rate hospitals based on their experiences as patients, or those of their relatives.
“By rating your hospitals you are not only helping other patients to make better choices, your feedback will also help Nigerian healthcare providers improve their services. In the end everyone benefits from the service,”
the website RateNigerianHospitals.com reads.
The website, founded by Joe Chukwu, (a consultant pediatrician in Dublin, Ireland) in July 2013, currently lists 1465 Nigerian hospitals, with more added on a regular basis. Visitors to the site can search for hospitals by name, or by the state in which a hospital is located.
The site attempts to rate hospitals based on 21 customer-centered measures, including accessibility, availability of visitor information, waiting times, staffing, cleanliness, admission and discharge processes, safety and security and a host of other measures. Site visitors can also leave comments based on specific experiences that do not fit any of the listed measures.
The advent of a ratings website for Nigerian hospitals is a very welcome development. More so, in an environment where institutions are not readily held accountable to the people they profess to serve and many enterprises do not give a hoot about how they are perceived in the public domain.
However, to what extent end users will utilize the reviews in informing their healthcare decisions remains to be seen. Health Blog Nigeria raised a few issues with Dr. Chukwu.
Factor of Choice
Publicly disseminated quality report cards are designed to inform consumers’ choice of health providers, thereby helping to mitigate against the provision of low-quality care and improve the functioning of health care markets. The keyword here is “choice”. The customer must have a real choice.
So, what factors really influence the choice of hospitals by most Nigerians? What hospital attributes are really of importance to Nigerians?
In the only study that we found that sought to answer this question, researchers at the University of Ibadan in 1983 interviewed hundreds of patients and found that proximity to the hospital was the leading factor that influenced respondents’ choice of hospitals in Oyo State, trumping other factors like quality of service and hospital costs.
Assuming that this data is representative of patient behavior in present day Nigeria, it may imply that Nigerian hospitals do not differentiate themselves sufficiently for important and relevant hospital attributes to be true choice determinants. In other words, any care is good care!
Dr. Chukwu thinks that in making their choices of what hospitals to patronize, no one single factor predominates. He believes that factors such as social class, personal and family recommendations, family tradition, religious and ethnic considerations, hospital track record, cost, proximity, range of services provided, quality of service and quality of staff, all play a role. He hopes that data gathered from the website over time would shed more light as to what factors or combination of factors influence the choices of patients in Nigeria.
The Hospital Perspective
Do the hospitals really care about whether their patients get consistent and effective experiences across the continuum of care? Do dissatisfied patients have a voice in Nigerian hospitals? How do Nigerian hospitals handle opportunities for improvement when patients are dissatisfied? How many Nigerian hospitals have patient advocates?
As Bob Dylan sang in his 1963 classic, “the answer my friend, is blowing in the wind.”
Assuming that hospitals cared about how well they were rated by patients, such public rating systems would be very open to manipulation, for example by hospitals sponsoring people to leave good ratings for them or bad ratings for their competitors.
Dr. Chukwu acknowledges this fact. With growth and usage of the site, he envisages possible measures, like email verification and IP address restrictions, to limit multiple ratings from single sources, within specified time frames.
He also firmly believes that if the website were able to attract a critical mass of well-meaning users, the effects of any unscrupulous use of the site would be diluted to such an extent that they would not make any difference.
Patient Outcomes versus Customer Experience
Customer experience is just but one piece of a very large equation. Real patient outcome measures may provide better indicators of the quality of care that a hospital delivers. For example, how many people who undergo surgical appendectomies at [insert hospital name] leave the hospital alive? This may be a more relevant metric on which to base your choice of hospital, than for instance the proximity of the hospital.
With the introduction of managed care and HMOs in Nigeria, there has been an attempt to move the bar with quality and outcomes reporting of specific conditions such as diabetes, hypertension, and hospital mortality rates. Nigerian hospitals are actually required to report encounter data to the National Health Insurance Scheme (NHIS) but do not consistently do so because most hospitals do not have information technology systems to capture the required data to make reporting easy. As such, there is presently no reliable publicly available data on patient outcomes in Nigerian hospitals.
Dr. Chukwu is cognisant of this hindrance. As part of future plans for the website, he is working on ways to gather and report patient outcome data, in addition to individual customer reviews. He is also working on plans to initiate awards for the best-rated hospitals and the hospital with the most improved ratings over time.
Acknowledgements: Njide Ndili, CEO, Lionstone Healthcare Partners & Secretary Society for Quality in Health Care in Nigeria (SQHN), for information pertaining to quality metrics for Nigerian hospitals.