“Loyalty is everything!”

Loyalty. Such a noble trait that we seek and deeply value in our closest friends, family members and colleagues at work. When used in a business context, it is usually preceded by “customer” and is a primary goal of the marketing strategist.
But it wasn’t a marketing strategist who proclaimed “loyalty is everything” for health care providers earlier this year at the Executive Dialogue sponsored by the Society for Healthcare Strategy and Market Development. Michael Modic, MD, Chief Clinical Transformation Officer for the Cleveland Clinic, passionately left participants with this advice at the close of the two-day program focused on breakthrough ideas to transform health care.
Loyalty is an interesting concept to consider when thinking about the relationship between a patient and his or her health care provider. Traditionally a patient’s faithfulness to a doctor has been characterized largely by blind loyalty: “I do what my doctor tells me to do,” is a common attitude, voiced especially by older patients. But does putting our physician on a pedestal and expecting him or her to cure all of our problems in an almost godlike way truly encourage the kind of relationship that best serves the patient, the provider and the system overall?
The kind of loyalty Dr. Modic commends to support true transformation in health care, I believe, has two distinguishing characteristics. First, it is earned. And with that allegiance from the patient, it must then be mutual.
Earning the loyalty of patients starts with and is advanced by more effective communication with them, not to them. Better dialogue with patients that is characterized by the H-CAHPS survey’s three primary communication tenets – courtesy and respect, listening carefully to what they say and explaining things in a way they can understand – provides the foundation for a strong, effective relationship between caregiver and patient.
The benefits of earning this loyalty in a population-health paradigm are clear and go well beyond the altruistic, feel-good qualities we often associate with loyal.
Loyalty is essential to achieve true continuity of care
Patients demand choice in their health care today. And, if we doubt that is the case, we need only look at what brought the managed care revolution of the mid-1990s tumbling down. For the first time in the history of modern medicine, the cost curve was actually being bent in a significant way. But the overwhelming sense of losing choice and control derailed the promising cost-containment focused strategy. This resentment of lost control also extended to physicians who saw insurance companies suddenly intruding in the time-honored relationship between themselves and their patients. Major employers succumbed to the pressures exerted by their employees, and the most restrictive managed care plans adapted or ceased to exist.
The lesson: loyalty can’t be imposed. Even within individual networks, continuity of care is dependent on patients loyally following a small group of providers that is led by their primary care physician.
Loyalty promotes improved compliance
To consistently achieve better outcomes, patients must feel a sense of loyalty not only to their care providers but also to the care plans they have prescribed for recovery or rehabilitation. The degree of trust and understanding patients experience toward their care team affects their diligence in following often challenging and complicated medication, therapy and lifestyle-altering regimens that will lead to better outcomes and quality-of-life.
Loyalty improves efficiency and can reduce cost
Today, most health care consumers are more acutely concerned about the cost of care because of higher deductibles and co-pays. Focusing on prescribing the best care plan at the lowest cost helps earn patients’ trust and loyalty because they sense that providers are looking out for their best interests holistically, not just clinically.
Finally, while each of these strategies may be focused on earning loyalty of the patient, they work because they embody true loyalty to the patient by the caregiver. Beyond complex organizational and risk-sharing tactics, perhaps this cultivation of mutual loyalty and a shared sense of responsibility between caregiver and patient is the most fundamental element of a successful population health strategy.