Guest Column | September 28, 2018

Solving The Patient Loyalty Puzzle

By Brian Wynne, NRC Health

Puzzle Piece

Most health system leaders know not to take patient loyalty for granted. But they might be surprised at just how fickle healthcare consumers can be. The truth is, despite how much progress organizations have made in enhancing the patient experience, patients are only about as loyal to their healthcare providers as they are to their mobile phone plans.[1]

This can be disquieting news for health system leaders, who might hope that personal relationships with patients would prevent them from walking away. But market forces — and evolving consumer preferences — are pushing patients to be much choosier about their clinicians.

Start with financial motivations. The patient’s share of financial responsibility for healthcare bills rose an eye-popping 11 percent last year.[2] As more healthcare spending comes directly from their pockets, patients are more selective about where they spend it. They’ll take their business elsewhere if a provider falls short of expectations — or if they can save as little savings as $500 on their costs[3].

Those expectations, meanwhile, have been rising. The ease and convenience they encounter in other industries have taught patients to hold high standards for service. That’s not unreasonable. But it puts healthcare leaders on the back foot, as they chase the benchmarks set by the likes of Amazon and Netflix.

What Works Elsewhere Doesn’t Work In Healthcare

Taken together, these trends explain why patient loyalty is becoming harder to secure. They don’t, however, explain why health system’s efforts at intervention have not yet succeeded. Research from NRC Health has found that organizations struggle due to three unique features of the healthcare marketplace.


Branding doesn’t have the same potency in healthcare as it does in other industries. While a marquee brand can be alluring to customers looking for dining or entertainment or financial products, it’s unlikely to draw significant interest from a patient. Forty percent of healthcare consumers report that it makes no difference to them whether their hospital is part of a larger, well-recognized system.

This is partly attributable to the convoluted process behind selecting a healthcare provider. While they make their choice, patients must consider the complex interplay of their health needs, their insurance coverage and facility locations and capabilities. These practical concerns take precedence over their perception of a national brand.

Furthermore, the presence of a brand doesn’t always assert itself in the exam room. Patients, for the most part, experience their care at the facility level, often without even being aware if the facility was part of larger network.

By no means does this suggest that health systems should stop putting effort toward branding. But it may mean that branding alone is not the patient loyalty solution that health leaders are looking for.

Low Engagement

NRC Health’s Consumer Loyalty Awards recently recognized hospitals that showed outstanding retention of consumer loyalty. The top performers had some things in common. Among other achievements, they made access to care easy, they were top-of-mind for their patient populations and their patients tended to promote the facilities to their loved ones.

But despite all this, even these elite systems struggled with one factor: consumer engagement. The number, variety and intensity of patient-brand interactions remained low, compared to other industries.

This can be explained by unique patterns of healthcare consumption. Healthcare is innately episodic [4], coming in unpredictable intervals as health needs arise. Between episodes of care, patients may simply not think to interact with their healthcare providers. It’s a case of “out of sight, out of mind.”

Slow Adaptation

Finally, health systems may be struggling to capture patient loyalty simply because of organizational inertia. A report from Kaufman Hall found that 90 percent of hospital executives believe that healthcare consumerism is a high priority — but only 8 percent are aggressively pursuing consumer-centric strategies[5]. These figures prove that prioritizing the needs of consumers is far easier said than done.

Dan Clarin, vice president at Kaufman Hall and one of the report’s authors, said that “Healthcare providers have been slow to adapt because they’ve never had to be consumer focused in the past.” He’s absolutely right. Hospitals previously enjoyed an unassailable market position. Patients had few alternatives for care.

But in the modern era, non-traditional players are making their entry into the fray, which means that patients may not default to hospitals when they need care. As more than 30 percent of Americans do, they might visit a retail clinic instead[6]. Or else they might consult a digital health provider. These new entrants mean that hospitals must work harder to keep their patients’ business.

What Health Systems Should Do

To attract and retain patient loyalty in the face of such challenges, health systems will have to reinvigorate themselves. Luckily, some of the problems facing health organizations already suggest their solutions.

First, knowing that patients experience care most at the facility level implies that it’s critical to perfect that facility-level experience. While patient satisfaction will not guarantee loyalty[7], it’s an essential part of securing it.

Second, health systems can solve the low-engagement issue by pushing their care experience beyond the hospital walls. This gives hospitals more touch-points of interaction with the consumer. Sponsoring health events, partnering with nonprofits in the community, opening grocery stores in food-scarce areas, opening fitness centers and staging educational seminars with hospital staff are all ways to make a hospital brand feel more visible in the patient’s life. These are exactly the tactics deployed by McLeod Regional Medical Center in Florence, South Carolina, whose community-based programming propelled it to the top of NRC Health’s rankings for patient engagement.

But health systems shouldn’t restrict themselves to in-person points of contact. Digital outreach (an arena where health systems have historically lagged[8]) should be a priority, too. Every healthcare organization would do well to improve the design and functionality of their patient portals and focus on building a robust presence on social media.

Finally, healthcare organizations need to proactively fend off the threat posed by retail clinics and other non-traditional providers. This means expanding the hospital’s role in the healthcare system. More and more, consumers want to see their healthcare providers help them get and stay well — not just treat them when they’re sick. Playing a bigger part in consumers’ lifestyles, whether by offering healthy nutrition services or by providing exercise coaching, will show patients that organizations are committed to their well-being.

That sincerity of purpose is a large part of what draws loyalty from patients. Loyalty, after all, is a natural result of meeting and exceeding consumer expectations. Organizations that can make a point of understanding these expectations, and commit themselves to delivering on them, are the ones that will stand the best chance of retaining their customers.

[1] Stephan, J.-P., & MacCracken, L. (2016). Patient Engagement: Think your patients are loyal? Think again. Accenture, 4.

[2] Heath, S. (2018, March 5). High Costs Increase Patient Financial Responsibility by 11%. Retrieved September 18, 2018, from

[3] HealthPocket. (n.d.). Survey: More Than Half of Population Not Wed to a Doctor - Healthpocket. Retrieved from

[4] Sands, D. Z., & Wald, J. S. (2014). Transforming Health Care Delivery Through Consumer Engagement, Health Data Transparency, and Patient-Generated Health Information. Yearbook of Medical Informatics, 9(1), 170–176.

[5] Crnkovich, P., & Clarin, D. (2018). 2018 State of Consumerism in Healthcare Report. Kaufman Hall. Retrieved from

[6] NRC Health. (2017). Want patient loyalty? Give them clarity and transparency (White paper). Retrieved from

[7] NRC Health. (2018). Are These Three Loyalty Myths Holding Your Organization Back?

[8] Ruiz, E. (2016, August 25). Going digital to improve the provider-patient experience. Retrieved September 19, 2018, from