Feedback from the Gemba: Doctor Ratings

Gemba (loosely translated from Japanese it means “actual place”) is a lean flow term often used to remind people, especially senior managers, that value is created or destroyed at “the Gemba” and that it is important to continually reinforce the primacy of the Gemba and the people who work in the Gemba in the scheme of things.

Customers are part of the Gemba. When we as customers deals with the “frontline” of an organization (a waiter, a hotel check-in clerk, a doctor, a call center operator, a teller etc.) we are engaging with the Gemba. Depending on whether and how the organization empowers and equips its frontline, and the kind of mindset and behaviors reinforced by the culture, the customers of a process can experience delight or frustration at the Gemba.

Professional services providers — think lawyers, doctors, consultants, financial advisors — often add a layer of ego to the mix (as in, “how dare you question my expertise” or perhaps Steve Martin’s character in Theodoric of York, Medieval Barber: “Hey, whose the barber here?”) that can make the experience less than fulfilling.

Nothing, however, helps improve things (or at least give improvement a chance) than a bit of transparency and feedback. We are becoming used to the idea of freely posting reviews of hotels, restaurants and other services, and now healthcare is also coming under the microscope of an empowered customer.

ZocDoc is an example of a site that lets patients post reviews of doctors and hospitals:

With around 60 review sites, America leads the way. But they are also popping up in other countries where patients pay for at least part of their care. Practo, an Indian firm that schedules appointments with doctors, plans to start publishing patients’ reviews later this year. More and more Chinese patients, who generally do not have a regular family doctor, are using a site run by Hao Dai Fu (“good doctor”) to navigate their country’s unstructured health system, says Haijing Hao of the University of Massachusetts. It has profiles of around 300,000 doctors and over 1m reviews.

Increasingly, doctors, hospitals and health systems are seeking to turn the trend to their advantage. Some now offer incentives, such as prize draws, for patients to go online and rate them. A survey by ZocDoc found that 85% of doctors on its site looked at their ratings last year. And a handful of health-care providers have even started to publish reviews themselves. The University of Utah, which runs four hospitals and ten clinics, was one of the first, in 2012. Its doctors’ complaints about independent sites encouraged it to publish patient feedback that was already being collected for internal use. Some of its doctors now have hundreds of reviews.

Preparing staff for the publication of all the comments, good and bad, took a year, says Brian Gresh, who helped create the university’s system. But their worries appear to have been groundless: most reviews are positive, and patient-satisfaction scores improved after the move. Happy patients communicate and co-operate better with their doctors, says Tom Lee, the chief medical officer of Press Ganey, a firm that surveys patients on behalf of health-care providers, including for the University of Utah. Its boss, Pat Ryan, predicts that plenty of other hospitals will follow suit.

Some doctors are still sceptical, fearing, for example, that patients may judge a hospital on its decor rather than its care. But patients are rarely swayed much by such trivia, insists Mr Ryan: “If you have flat-screen televisions and your communication is poor, you will get very bad scores.” Moreover, the feedback reminds doctors that every meeting with a patient matters, so they try harder.

America’s government has started to link health-care payments with patient feedback: Medicare, a federal scheme for over-65s, recently started to give bonuses to hospitals that score well. The Cleveland Clinic, a big hospital, uses these data to improve its care. Britain’s National Health Service has surveyed patients for over a decade (though not on the performance of individual doctors) and published the results online—though some think it could use its findings better.

But many other governments do not even ask patients for their opinions. German doctors and hospitals, for example, have fought efforts to link funding with quality of care, says Maria Nadj-Kittler of the Picker Institute Europe, a research organisation, and are therefore hostile to patient reviews. This is a missed opportunity. Patients who hold their doctors accountable make them better and more efficient. That is good news no matter who pays. (The Economist, July 26th 2014)

Organizations will find that if they do not work to improve what happens down in the Gemba and empower the frontline to improve the processes, increasingly empowered customers, clients and patients will shine a light on the Gemba regardless. When that happens everyone, even Theodoric of York, will need to get used to a bit more feedback.