How Banner Health Ties Executives' Bonus Pay to Its Reputation: 4 Steps

One-hour responses to online comments, calling customers with negative experiences, and shared risk for success are key parts of the formula.

This article appears in the September/October 2019 edition of HealthLeaders magazine. 

For many of today's consumers, the journey to a healthcare facility or a physician begins with a Google search. Securing a spot at the top of that list requires consistently providing an outstanding patient experience, as well as mastering the art and science of reputation management.

By tying executive compensation to patient satisfaction scores and responding to all online comments within an hour, Arizona-based Banner Health has taken this approach to a new level, with an initiative the 28-hospital nonprofit health system says has improved its HCAHPS scores.

As other health systems explore how to move their online needle to attract new patients, Banner Chief Marketing Officer Alexandra Morehouse, MBA,  shares a look inside Banner's strategy.

1. Include Search Optimization in Growth Strategy
 

With previous experience at AAA, American Express, Ancestry, Charles Schwab, and Kaiser Permanente, Morehouse has spent most of her career in industries that have long valued consumer perspectives—a practice the healthcare sector has only recently adopted, she says.

Reputation is what people outside your company think of your brand. Managing those perceptions is intrinsic to brand building, Morehouse says.

Several years ago, Banner made a bold move in this arena. The "overriding goal" was to appear at the top of online search results, Morehouse says.

"Basically, it is the center of our growth strategy," she says. "Because 85% of all healthcare decisions start with an online search, if you're not showing up, you never get an 'at bat;' you actually never get to play."

Describing the move as a "fairly radical innovation," Morehouse says it involved not only technology but customer service and organizational change as well.

2. Put the Right Tools and Technology in Place
 

The process began with acquiring technology to listen to customers' experiences, survey them, and embed star ratings into Banner's online "Find a Doctor" function. That way, consumers can quickly see how patients rate each physician—a move these professionals sometimes resist.

The approach includes online reviews and business listings solutions from Reputation.com, an online reputation management company based in Redwood City, California. Among the key elements:

• The health system mapped out the customer journey, identifying 20 moments that customers find meaningful along this path. Those include when customers find their doctor, book an appointment, spend time in a waiting room, interact with their physician, undergo follow-up, and receive a bill.
   
• Each of the 20 points includes a "listening post," a survey question that asks, "How did we do at that moment of truth?" says Morehouse.
   
• In addition to surveys, "We equally listen to all of the unsolicited reviews," she says. For example, if a patient waits for hours in the emergency department while their child is bleeding, then posts a negative review on Google, that information also feeds into the system.

3. Respond Immediately to All Online Posts
 

Acting quickly on this information is where Banner begins to differentiate itself.

"We figured out that if we manage our ratings and reviews, the Google algorithm takes that into consideration in terms of who goes to the top of the [search] page," says Morehouse.

Information is delivered directly to Banner's call center representatives, who respond to every social media post within an hour, whether it's good, bad, or indifferent.

"If it's negative, we call them," Morehouse says. "People can't believe we're calling."

Calls are initiated by a special unit in the contact center, whose representatives are trained to handle complaints and react with empathy to sometimes contentious customers. If appropriate, they apologize and ask what Banner can do to make things right. The unit conducts about a thousand such calls each month, accessing phone numbers from the records of patients who have consented to such contact. The goal is to resolve issues so that individuals change their negative post or improve low ratings, Morehouse says.

"If they get somebody who genuinely listens to them, solves their problem, and makes it right, most of the time they [modify] those ratings and reviews spontaneously," she says, noting that Banner does not directly ask customers to do so.

"That has an enormous impact on what your reputation is in the public domain because we get 60–70 million hits to [Google] every year," she says.

Google accounts for 52% of consumers' searches for healthcare organizations and providers, according to research conducted by Reputation.com published in its 2019 Healthcare Reputation Report. Google is followed by hospital and health system websites (15%), Apple (12%), Facebook (6%), and Bing (4%). Together, these sites account for 89% of consumer search traffic for healthcare providers. The research indicates only 8% of searches involve Healthgrades, WebMD, Yahoo, Vitals, or Yelp.

4. Tie Satisfaction Scores to Leadership Bonuses
 

Banner has one additional ingredient that sets its program apart. The health system uses customer satisfaction scores to calculate the bonuses earned by vice presidents and above.

"If you want to get somebody's attention, put their pay at stake," says Morehouse, who serves on the compensation committee of Banner's board of directors. Morehouse says she's not aware of any other health system that combines HCAHPS and customer satisfaction scores in its bonus structure. Patric Wiesmann, managing director and general manager of Healthcare & Life Sciences at Reputation.com, says that a number of other hospital systems are exploring this option, but Banner is leading the trend.

A quarter of Banner's bonus is related to customer satisfaction, which is determined by a Net Promoter Score, a concept introduced by Frederick F. Reichheld in the 2003 Harvard Business Review article "One Number You Need to Grow." This score is calculated based on responses to the question: "How likely is it that you would recommend our company/product/service to a friend or colleague?"

Respondents select their answer from a 10-point scale. "If you're a nine or a 10, you're a promoter," Morehouse explains. "If you're a one, two, or three, you're a detractor. Everything in between is a neutral. To arrive at the total, you subtract your negatives from your positives, so it's a pretty high bar."

Banner used 2017 data to establish a baseline. In 2018, leaders set improvement goals for particular areas, such as the emergency department. While the performance of only certain departments was measured during 2018, all bonuses—even leaders with no direct responsibility for that area of business—were impacted.

"If you really want to drive behaviors, you want people to stop thinking [in] silos," she says. "They can only be successful if their neighbor is successful. It's a shared goal. It doesn't matter if it's your department or someone else's; we all own the customer experience."

Adding customer satisfaction to the mix "was a big, big change for our frontlines, for doctors, for nurses—for the entire company," says Morehouse.

Morehouse says that one Banner executive pointed out that the initiative was based on an assumption that a Net Promoter Score increase would also result in an improvement in HCAHPS scores, which are tied to reimbursement. To ensure the connection is valid, Banner analyzes the data annually. She says they have verified a correlation between the upward trend of Net Promoter and HCAHPS scores.

Banner sent out 317,000 surveys last year to measure customer satisfaction. Morehouse declined to disclose the percentage by which HCAHPS and Net Promoter Scores improved, but she said the goal was met and bonuses were paid.