Great Expectations


Harry Greenspun

Chief Medical Officer, Managing Director, Health Solutions

Korn Ferry

June 26, 2018

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Our family just returned from a spectacular cruise in Alaska, which highlighted the critical role of expectations. Packing for the trip, we had tempered kids’ expectations, especially about the weather, loading our suitcases with jackets, rain gear, hats, and gloves. However, from the moment we arrived in Seattle with a clear view of Mt. Ranier, to when we disembarked a week later, we experienced beautifully clear skies and mild temperatures. Strolling through Skagway, the thermometer approached 80 degrees with bright sunshine. Day after day we remained in delighted disbelief. Even the captain commented on how rare and incredible the conditions had been. Sitting by the pool as we cruised past glaciers, I got an email from a friend who had booked the same itinerary soon after ours. The forecast for his dates called for temps in the 50s and rain. I felt a twinge of guilt knowing he had seen my daily posts and would be hoping for the same.

However, the most fascinating moment occurred during a whale watching excursion in Juneau.  Aboard a small jet boat, we arrived at a viewing spot and were told to call out if we saw something. Within a minute, a humpback whale was spouting and then dove deep with a salute of its massive tail. Others followed while eagles flew overhead. It was amazing. 

Suddenly, our captain told us he had a “surprise” and as we sped to another location. Moments later we were surrounded by orcas – an enormous male, several females, and absolutely adorable juveniles. Our youngest son (the animal fanatic) was ecstatic beyond words. Our guide said that in the years she had been doing these trips, such close encounters were exceedingly rare.

As we returned to the dock, we saw the next group waiting to board. Our captain politely said to us, “Please don’t mention the orcas. If people hear we saw them and they don’t, they will be disappointed, no matter how many humpbacks we see. I didn’t tell you beforehand in case they were gone before we arrived.”  

While we routinely talk about aligned (or misaligned) incentives in healthcare, we rarely talk about expectations. However, their impact on the industry is enormous, often with deleterious and far-reaching consequences. No matter how good the outcome, patients will judge their experience relative to their expectations.  

Sometimes this works to our advantage. As a cardiac anesthesiologist, most of my patients were terrified of undergoing open-heart surgery, so they were relieved and delighted when they awoke uneventfully. Unfortunately, most of the time it works the other way. Poor service, unengaged personnel, long waits, noisy hallways, tedious parking, and countless other factors widen the gap between experience and expectations. However, rushing to meet expectations creates its own problems, contributing to overuse of antibiotics and, even, the opioid epidemic.  

Consumers’ expectations continue to rise across measures of quality, service, safety, and cost.  Understanding and addressing these are critical, so we can either rise to their level or help people set those that are more realistic. The first step is to examine what establishes some of the most basic expectations, particularly around service. Providers often like to compare themselves to others. However, few patients have the opportunity to experience multiple institutions. Instead, they compare their experiences to other aspects of their lives – how they bank, travel, shop, and dine. Other services provide robust websites, self-scheduling, account management, text messaging when your turn has come, and other ways to make their experiences easier and less stressful. A patient sitting endlessly in a waiting room knows that a typical chain restaurant has solved this problem.