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The Medical Practice ‘Experience’ Economy and William Deming – Opinion of a Real Patient

The experience economy



I was recently intrigued by a conversation I had with a colleague about her visit to the doctor’s office.  My colleague was upset to say the least, with not only the staff attitude, but how arrogant and in empathetic  her doctor was.

However, she was most disappointed in herself because she invested a lot of time and effort researching and comparing in the hopes of finding the perfect doctor.  I asked her how she found out about the practice, and to my amazement she based it on the number of stars and reviews, and his recent win as a “Best Doctors” in a local publication.

Although my colleague did not have life threatening issue, she did have a concern that was important to her.

Instead of an answer or sympathetic ear, what she got from the experience was, feeling stupid for trusting publications, and 3rd party rating tools which practices have been known to pay for, to drive popularity and reputation.  The following day I decided that I would pull up the doctor and his practice name and see what it was all about.  My colleague had already written a negative review about her experience which I completely agree with her on.  A few days have passed and I thought I would check back to the post and see if there were any responses to my colleagues review.  To my shock, the review my colleague posted disappeared, and all that was left was the positive rating reviews.  It was at that moment that I remembered my career mentor who taught me about Deming and his business management beliefs and values.  The one quote that particularly stuck in my mind was, “The most important figures that one needs for management are unknown or unknowable


As a society we have moved from a service economy to an experience economy.  I recently read this great book called,  ‘The experience economy’ by Joseph Pine and James Gilmore.  Customer satisfaction is simple to measure in a service economy.  Every clinic , business, government agency etc. would typically ask for feedback from the patient or business (of course this would dependent on whether they were even customer focused). This could be in a variety of forms.  Impersonal email blasts, mail by post, social media, survey portal on the web such as survey monkey.  Then the data is complied, and inserted into a PowerPoint presentation, and presented to senior management as, “See how great we are?  Our patients love us”  Typically after that, management would not have any questions to the presenter and go ahead to the more pressing issues, like the numbers that showed a declining profit.

I have always been a measurement and data analysis freak.  I convinced myself and all those that would listen, that without measurement an organization could not survive, and that the numbers had the answer to every question.  As much I love Deming I could never agree with another favorite quote of mine “It is wrong to suppose that if you can’t measure it, you can’t manage it – a costly myth”  But now that I have grown older and wiser and expanded my scope in career experiences, I can accept my defeat and see the true message in Deming’s quote.  Since I am focusing primarily on medical practices and my colleague’s latest incident, I will apply my opinion on the connection between Deming’s quotes and the service and experience economy.


Medical practices that measure themselves strictly from a service economy perspective are managing by numbers and are always looking at how they can show the world how great they are.  They are looking at creative ways to get you to sign up with their practice.  (If you’re lucky they may even throw in a free iPad if you register) During one of my low star rated experiences,  I remember sitting in the waiting room in an office where I overheard staff members asking patients to text, call, and email their votes into the “Best of “ competition so they could show their badge of honor to the world on their propaganda and website.  The more disgusting piece of this was, employees were expected to do the same , and to make sure that they also notified their friends and family.  Keep in mind, most of the people never even set foot in the practice. Of course, the practice convinced itself that this was justifiable due to the wonderful and positive raving reviews by the intake of patient survey ratings.  Which included extremely pertinent  questions like the decor or cleanliness of the office.  Now, if you want my opinion, I really don’t see the value added in this measurement for the patient, or even the practice for that matter!


A more favorable experience with a practice took place just recently.  I sat in a small cramped waiting room while others had to stand because of the limited seating availability.  The decor was pathetic but the staff was smiling and courteous.  The magazines were 4 years outdated with pages falling out,  and you could not get a phone signal if your life depended on it.  The fake palm tree in the corner of the tiny waiting room, had about 1/2 inch of dust on it and the doctor was late every time.  From a customer satisfaction survey perspective, you could almost guarantee that this practice would not be scoring high in the service category.


This is where I had my “AHA’ moment.  If we look at my experiences and relate it to Deming’s quote “The most important figures that one needs for management are unknown or unknowable” the quote now becomes crystallized, at least for me.


Based on my articulation, you can set any criteria (and not including special causes, variations) and patients will always be satisfied.  My thought process is, that if you do everything right clinically, show courtesy to the patient, customer service exists (just to name of few) you will always have satisfied patients.  So technically you are measuring known figures and behaviors.   Now I’m not saying that customer satisfaction surveys are a complete waste of time.  They can definitely offer insights into process deficiencies.  So as my colleague experienced in her situation,  it very well could have been a special cause or variation, or it could have been the practice’s consistent and typical process that became the level of expectation and tolerance by patients. Patients invest a lot of time and effort in browsing through the overwhelming numbers of options in medical care.  As humans we try to short-circuit the process by looking for illustrative indicators such as, the awards, publications, geography, demographic, the  number of ‘gold stars’ beside their name.  So, they hook us in.  We’re sold on their savvy marketing tactics.

The measurement that is not visible to management, is when the loyal or even sometimes new patients leave, never to return.  Like my colleague, I can almost guarantee that the patients are not leaving because of price.  Therefore, beating up your vendors for lower costs will not solve your problems.

In an experience economy, there is no measurable criteria.  It is the unknown and unknowable.  As a patient,  I now recognize that no institution (medical practice or not )can measure what my perception of their organization is.  The organization cannot measure whether I will ever return again.  So, how do you improve something that you can’t measure?

In the end, as much as technology has advanced us, it has also hindered us in many ways.  Before the internet, patients would go meet and interview their potential physicians, and decide if there was a connection.  Relying on third-party tools to rate your experience is impossible.  The unfortunate thing I find is, many people use the term service and experience interchangeably.  To me, they are two very different economies of scale.


Personally, the point of difference is not the decor, the lavish office, the newest technology.  It is the heart of the staff, the environment, the caregivers and my physician.   You see, in an experience economy it is about compassion and emotion.  Although my doctor was late seeing me, he still spent the time needed with me clinically and emotionally.  I didn’t feel as if he was in a rush to get to his next patient.  He smiled when he spoke and that put my anxiety levels to a minimum.  This to me is the true and only measure  in the experience economy.  It’s not about the numbers, or the waiting time, or the decor.  You can’t measure compassion. My medical institution knows, that I will return again to see them in the near future.  Does yours?


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