14 October 2011

Rethink Your ROI

A week or two ago I got into a Twitter debate with Chris Boyer, Director of Digital Marketing & Communications for Inova Health System in Northern VA and member of the Mayo Clinic Social Media Advisory Board, over use of the phrase return on investment (ROI) in relation to healthcare. The debate occurred during the weekly healthcare social media chat (#hcsm) and started like this:

@chrisboyer Want to learn how easy it is to measure #hcsm ROI? I detail how@inovahealth is doing it on this Slideshare preso:http://slidesha.re/pgBNbx

@chrisboyer Oh yes! #hcsm ROI has a direct effect on patients and business. They both work well together.

@chrisboyer It's great to know that others are also doing what's sensible for business - #hcsm ROI. Good stuff!

Really, I was okay up until then, but another TweetChatter chimed in.

@joltdude There really is two ROI's involved with healthcare.. the financial one, and the social/altruistic one. Both are important #hcsm

And Chris Boyer said this:

@chrisboyer Wrong there is only one ROI for #hcsm - the financial one. The social/atruistic results are "success measurements." Semantics.

That's when I got pissed.

@AfternoonNapper Semantics are everything. Docs seeing ROI as only financial guarantees I won't be their repeat customer = lower ROI. #hcsm

@joltdude Semantics of bad bedside manner, and disconnect... Patents go elsewhere.. Hows that grab you? #hcsm

@AfternoonNapper Healthcare's financial ROI isn't that I left w/ a happy feeling. It's that I will have my next surgery at your hospital. #hcsm

@AfternoonNapper Invest in good training, good doctors, etc - I get happy feeling & good surgery. I return and I recommend that others go as well. #hcsm

@AfternoonNapper Altruistic/social measures also directly impact my emotional attitude toward your healthcare entity. Bad attitude=you don't get my $. #hcsm

@chrisboyer C'mon, really? Doctors don't have a right to be successful in their business?

@chrisboyer Everyone still remembers that doctors and hospitals also have to run a business, even while using #hcsm, right? Why is ROI so offensive?

@joltdude Of course they have to run a buisness, but if the pts dont want to go there, due to social metrics, you dont get paid #hcsm

@chrisboyer to @joltdude Your response just doesn't make sense. #hcsm

@AfternoonNapper I've never had a pleasurable business experience w/ a doc/hosp. Healthcare business practices are a near total negative. #hcsm

@joltdude The bean counter just doesnt get it does he?

@joltdude The problem is the fiancial issues ARENT separated from the relational ones. No relation = no profit.... Is that difficult? #hcsm

@AfternoonNapper I will never ever say, "Man, they botched my surgery, but they sure had an effective billing office; I think I'll go back there." #hcsm

@chrisboyer I agree our business needs help. But you don't want them to be in business at all? Socialized medicine? #hcsm

@AfternoonNapper The argument is not at all regarding socialized medicine. It's about defining what matters & that isn't just the red line. #hcsm

@AfternoonNapper Also, to clarify - it's not HCSM ROI. It's ROI in general. I'd be a really lousy stock option. #hcsm

@chrisboyer Wow - everyone is so offended by the concept of #hcsm ROI. That's bizarre. I think it's a great thing.

@MeredithGould It's because people collapsing and confusing the financial issues with relational ones.

@chrisboyer That's it!

@AfternoonNapper Still disagree, but respectfully. #hcsm

@MeredithGould If it were part of your job, as mgr of a hospital dept, you'd give a hoot about the financials. #hcsm

@AfternoonNapper I completely give a hoot, and prefer it not be insinuated otherwise. #hcsm

For the record, there were others involved in the overall #hcsm chat, and there were additional tweets that were not part of this conversation regarding ROI; however, I have done my best to distill the conversation within the conversation down to its relevant tweets. In the end I was angry about two things: that it was seemingly incomprehensible how patients could have an effect on ROI; and the idea that since I'm a patient, I don't care about ROI.

If patients don't have an impact on ROI, I don't know what does. How can the consumer of a product not affect that product's bottom line? If we were to all stop drinking Pepsi, would Pepsi not suffer a loss? Granted the company is diversified. Let's say that instead of just stopping drinking Pepsi, we stop drinking all Pepsi products. Then would the company notice? Patients are healthcare consumers. Healthcare providers are selling a product that consumers may either choose to buy, choose not to buy, or choose to buy from an alternative source. The product that healthcare providers are selling is not health. Patients can see a doctor in Maine; patients can see a doctor in Phoenix; patients can see a doctor in Tokyo; patients can see a doctor in Paris. There are lots and lots and lots of doctors. There are so many doctors that if a patient goes to see a doctor and that doctor is unreceptive, does not listen, stares more at the computer than the patient, and provides unsatisfactory care that the patient can go find another doctor. Lest I anger the entire medical profession, doctors are service providers just like our dry cleaners, our mechanics, our piano tuners, our furnace repairmen. If we as consumers receive bad service from the dry cleaner or mechanic or piano tuner or furnace repairman, we find another one. Patients will—and should—do exactly the same with their doctors. No patient who comes into a doctor's office scared and willing to disrobe and bare all truths deserves to be given bad service. Healthcare providers must consider the ROI for the patient who has found the doctor, taken time off from work, sat in a waiting room, seen the doctor for 10 minutes, and been given a solution that may or may not work, thereby potentially resulting in another visit. Doctors indeed can do wonderful and amazing things—for that they deserve respect. But for each doctor who disrespects a patient by failing to provide quality customer service there is another doctor who is willing to provide that service. Patients will find those good doctors. Patients will make those good doctors their doctors and recommend those good doctors to friends and family members. The healthcare organization employing those doctors will see the ROI from growing skills, providing technologically advanced care, and even remodeling that waiting room dramatically increase when there are patients—drawn by quality doctor care—to contribute to the bottom line. And those organizations who fail to provide quality care to patients will see it reflected in their bottom line as well.

As a patient, I care—perhaps more than many healthcare administrators—about ROI because a doctor or hospital's ROI directly impacts my bottom line. If a doctor spends time and money to develop a skill, if a hospital purchases a new piece of equipment, and if the expenses are not recovered in due time, I fully expect to feel the impact on my wallet as a healthcare consumer. In fact, I acknowledge that as a healthcare consumer, I am paying from the start for the new skills, and new machines, and new waiting rooms in any given medical establishment that I patronize. Consequently, in order to lower my personal costs, I need my doctors, hospitals, etc. to get the absolute best ROI possible to avoid passing their debts on to me. I understand that the medical field must progress, and I am okay with contributing to bringing new technologies, more skilled doctors, and overall better service capabilities to my healthcare providers because I will be helped and my community will be helped. However, if we're going to talk about ROI, we must also talk about waste. In the chat above, I reference having never had a good experience with a healthcare business office. I would like to amend that by saying that in the few days since the chat, I've had the pleasure of dealing with the Cleveland Clinic's business office. The employees there are helpful, friendly, and on point. They are everything business office employees should be. And then, they spent $12.32 to accidentally mail me 28 checks that were supposed to go to my insurance company. They wasted the time and supplies it took to create those 28 checks. I imagine they'll spend another $12.32 to mail the checks back out—well, $11.88 because one check actually was supposed to go to me. It was a reimbursement. I imagine they'll pay someone to redo the entire process. I imagine that, at the least, the time, supplies, and money wasted would have paid for someone to have a cholesterol or glucose test, either of which could have life-altering results.

In the end, there must be more investments made for patients not profits.


For clarity's sake:


  1. ROI is almost always associated with tangible financial returns. However, it can also be applied to intangible results. In HR for example, metrics and ROI are often applied to areas such as employee training, behavior modification and recruitment. The returns may not always reflect financial impact, but they can ALWAYS be measured. In the case above, Sarah, you seem to be stating that customer service and quality of patient care directly impact a hospital's ROI. You need to keep in mind that ROI is not the same as revenue. Bad customer service and poor care will most definitely impact the revenue of any business. However, it only impacts the ROI if investments are being made in those areas. If the hospital has invested in new, long-life carpeting and wants to track the ROI to determine if the carpeting was the right choice, chances are slim that they're going to be looking at customer service and care of the patients.
    So yes, revenue & reputation can most certainly be impacted. But ROI depends on the investment.

  2. I think that you are mis-characterizing the conversation I had on Twitter: I was attempting to clarify the term ROI to be used for financial measurement only. As I stated that night (and continually state), ROI is one of many important success measurements that one should use, and often ROI is not the most important success measurement (you couldn't be financially successful if you weren't building relationships with your customers).

    Since you cherry-picked out my tweets to support your position, I hope you at least include this comment with the tweet that I think summed up my position the most: "We all should strive to give the best care, 
have the best relationships and be fiscally sound with health care social media. Simple."


"We are what we think. All that we are arises with our thoughts. With our thoughts, we make the world." — Buddha