The Generations

The current healthcare market has four principle consumer groups when looking to create satisfaction and loyalty. These include patients ages 80-100, 55-80, 35-55, and 18-35 with the 18-35 year old group making healthcare decisions for patients younger than 18. Health care is in the business of caring for the generations. Each of these consumer groups have different outlooks on health care and interact with it differently. They each have different characteristics and behaviors related to consumerism that make a flexible approach to managing patient satisfaction important. Healthcare providers that are looking to reach beyond patient satisfaction and achieve loyalty need to understand each of these groups and build their satisfaction activities to be sensitive to all four groups. This differentiation is often what transforms a patient satisfaction system from a simple task of collecting information to one that is about building relationships.

Some of the more important things to know about these generations are:

80 - 100+ Years Old (The Generation of Make-No-Waves)

This is actually the easiest of all generations to please and has been the primary consumer of services until recently. This generation knew the depression and has remained grateful over the years for what they have. This generation also lived as adults through the era when health care was an industry to be respected without question. The educational gap between them and their providers discourages them from challenging the system. They tend to have very strong feelings of loyalty to their providers and struggle with the specialization that has come into the industry because of the inability to build lasting relationships.

This is a generation that is uncomfortable with making waves inside the healthcare experience. They are uncomfortable functioning inside highly formalized patient satisfaction and complaint systems because they are uncertain as to the real consequences of the processes. They do better in sharing opportunities for improved patient relationships in informal information-sharing settings where there is no fanfare. Privacy and low intensity process improvement approaches are important to them.

Traditional formalized written surveys are of questionable value for this generation for a number of reasons. The most important is probably the fact that it is difficult to gauge how truly reflective the information is of real patient perception because this is the generation that does not complain or like to make waves. For example, a patient from this generation may share a concern during a discussion with a care provider but will not reduce this same concern to paper.

55 - 80 Years Old (The Generation of Transition)

This is probably the generation that should cause the most concern for the healthcare industry in today 's market. This generation has a number of characteristics that make much stronger approaches to measuring patient satisfaction important. As they are the largest growing group of consumers for health care, they have a serious potential to tip the scales for consumerism. This generation is also a very skeptical generation and has the potential to cause serious problems for providers who can not read the signs.

This is the first generation to experience the power and benefits of consumerism. They are the post-depression boom generation. While they are not as comfortable as the younger generations in exercising the power to demand more from the industry, they are much more comfortable in identifying dissatisfaction than their parents. While they tend to be reluctant to assert themselves, they encourage others, such as advocacy groups, to intervene on their behalf. They are comfortable with anonymous systems of accountability that allow them to bring their concerns to light.

This is a generation that often feels trapped as they know that they want more but they are uncertain about the safety of demanding it. The danger for healthcare providers rests in the fact that if the patient satisfaction system and sister quality systems are not strong enough to appropriately solicit the right information from these people, providers often don't learn about dissatisfaction while there is an opportunity to more easily fix it and save the patient/provider relationship. This is the generation where dissatisfactions are often learned only after a period of time where chronic dissatisfaction results in a situation that becomes the final straw that breaks the camel 's back. This is also the generation where the community grapevine or an outside investigation is often the healthcare provider's first clue that a patient was dissatisfied.

This generation knew a time when health care seemed to be free. During these times people were much more tolerant of what they perceived as mediocrity - after all it was free. As the dollars spent out of pocket has gone up, so have the expectations and the speed with which frustration occurs. While they may not share them with the provider, they tend to be very free with that information to friends and family. Discussions about their healthcare experiences are an important social discussion. If their stories can help another to make the right choices, they are more than willing to share.

This generation has a greater tendency to harbor cumulative feelings of dissatisfaction related to past experiences for themselves and their parents. As their parents were the generation of "make no waves", this generation is much more likely than any of the generations to have frustrations over care that they perceive was or was not rendered to their parents and to allow those feelings to impact their own patient/provider relationships. This generation is much more comfortable with their children 's advocacy role inside the healthcare environment and their children are much more comfortable in taking on that role. Literature talks about the role that the "boomers" will have on changing health care. One of the reasons this is so true is that they will not be fighting the fight alone. It will be a joint war waged by parents and children to improve healthcare for all. As the next generation is very comfortable with the power and benefits that come with consumerism, they will have no problem in demanding quality for their parents and creating consequences for providers who don 't deliver.

This generation tends to have mixed reactions to the traditional formal paper-based patient satisfaction systems. They tend to do better with a combination of more personalized interactions such as telephone interviews and walk-about interviews combined with paper-oriented activities. The personalized side of the process helps to build trust that it is acceptable to share both the good and the bad. It also fosters more timely awareness of dissatisfaction.

35-55 Years Old (The Generation of Accountability)

This is a very influential generation for the healthcare industry. This group is very open about their expectations and they tend to be very forthcoming with their frustrations and dissatisfaction. This is the generation creating the new rules for transparency, pay-for-performance and accountability.

One of the most important things to understand about this consumer group is that they are the generation of causes and if a healthcare provider does not appropriately and adequately address their concerns, they have no difficulty finding the time in their very busy schedules to dole out consequences. The flip side of this characteristic is that this generation tends to not hold grudges if they feel that their concerns were adequately addressed and the provider is sincere in making sure it will never happen again as this generation understands the principles of quality and quality improvement from their own work lives. The goal is to know when a customer is unhappy and make it right in a way that satisfied the customer.

This generation is very concerned with how quality improvement initiatives ripple out to impact other people as many deal with systems of customer satisfaction in their own workplaces. Their causes are often not directed so much for their benefit as for others who can benefit from their experiences and efforts. This is particularly true if their frustration runs high because a provider does seem to take customer satisfaction seriously. This is the generation that can take a bad experience and turn it into a positive one if they are extremely pleased with the outcome of those activities directed at resolving their issues. For example, if someone from this generation has a patient complaint and a provider can make them very happy in the resolution of it, the tendency is to very positively discuss it in the community. These types of stories can be very powerful in today 's environment where stories about the lack of caring seem to abound. Through their stories they can take a negative and turn it into a marketing positive for a provider - because this is a provider who cares.

This generation does much better with formal, paper-oriented processes as long as they are viewed to be efficient, focused on solutions, and timely. They expect something to happen when they share information. For this generation, a personal touch married to genuine interest in improvement can be very influential. As working generations have to be concerned about service in their own work environments, they appreciate the value of the extra effort that the personal touch can take and understand its business value.

This generation is also very comfortable with change if the goal is to create something better and understands that the best potential for high quality patient care comes from providers that embrace the change. This generation has a higher level of intolerance for providers that don't take their responsibility to stay current seriously.

18-34 Years Old (The Generation of Service)

This is the generation that will follow in their parents foot-steps to continue to force change into the healthcare industry. In addition to their parents high expectations for quality and accountability, timeliness and responsiveness will be what this generation tackles. As the generation of instant gratification, this group will not tolerate the long delays and excuses that are inherent in today's healthcare environment.

Unlike their great-grandparents who have unquestioned loyalty to their providers, this generation will have loyalty to only one thing - the delivery of high quality health care that meets their defined needs. This is the generation that will be very comfortable with the idea that the choices made by the provider will drive their choices and that a provider can easily be nothing more than a temporary stop along the path to finding the perfect provider. To them, providers will be hired and fired just like any other service entity.

As they will probably be forced to pay a larger piece of their healthcare bill, they will expect quality in return for their dollar. Being a very mobile generation with no ties to local providers, they will be willing to travel to get what they want. As the generation of disposability, they will see no reason for providers to survive if that survival is not based on the business of meeting consumer needs.

This generation will share all the same expectations as their parents but will be even more comfortable raising the bar as their tolerance for errors will be even less and they will be much more comfortable with negative consequences for providers who can not deliver. As the knowledge and information generation, they will expect validation for the choices their providers make in their care and an understanding of why.

This is also the generation of "share all and tell all". Unlike their great grandparents who saw health care as a very private matter, this generation puts it all out on the web. Traditional literature taught that one disgruntled person could generally share his or her story with somewhere between 10 and 100 people. For this generation, that number is in the 1000s as they share in their blogs, facebook, twitter pages and website like "Death by Mistakes".

Similar to their parents, this generation of people understands and embraces change. As this generation is extremely comfortable with change for themselves if it means getting what they want or where they want to be, they will have an extremely hard time accepting the healthcare provider that does not demonstrate a willingness and ease with change to create a better patient experience.