What do we really want from our health care?

A recent survey conducted by the Advisory Board Company, a health care consultant group, asked 4,000 people to prioritize the factors that would matter most if they had to get care for a simple illness like the flu. Somewhat surprisingly, most respondents didn't mention many of the things that clinicians (or health policy experts for that matter) care most about. Let's review a few of them.

Clinicians care about quality. As a result, we're bombarded with messages about which hospital is better than another. Lately, Center City Philadelphia seems full of workers from a certain health system wearing t-shirts touting their latest ranking in the US News and World Report—walking billboards. However, according to the survey, people actually value facilities with cutting-edge technology over high scores on quality measures.

Perhaps, people feel that technology is a clearer signal of quality than another score on a confusing index. I remember two colleagues discussing the merits of the expensive laser one of them just bought for his office. The other asked what he could do with the laser that couldn't be handled just as effectively with more conventional techniques. He admitted that he didn't really use it much but said, "it brings in patients."

People seem more concerned about convenience than about the credentials of the providers they see or being able to see the same ones each time. The respondents wanted clinics that are open 24 hours, have onsite labs and a guarantee they will be seen in 30 minutes. Seeing a doctor (as opposed to a nurse or physician assistant) or seeing the same provider for follow-up wasn't nearly as important. While having a clinic close to home was very important, communicating symptoms by email ranked high as well.

Not surprisingly, what was valued varied by the age of the respondent. Younger people wanted free visits and convenience while older folks cared more about reputation and credentials.

Of course, any survey of this nature must be taken with a grain of salt. Until you or a loved one is really sick, it can be hard to know what to expect or even what really matters to you.

Your health outcomes depend as much on the coordination of your care team as on the individual team members. Many problems in health care quality arise from communication failures and what's called "patient handoffs." One provider doesn't have the same information or doesn't know what the other did or is planning to do because no one is talking to anyone else. It's like building a house without a general contractor—things don't come out well when the sheetrock gets put up before the plumbing.

Rob Lieberthal and Dominique M. Comer, colleagues at the Jefferson College of Population Health, have discovered that there is little correlation between patient satisfaction and actual health outcomes. In fact, they found you are more likely to have a better outcome in a hospital that has a large volume of patients but lacks for comfort. We could call this the "cupholder syndrome" - we judge the quality of the mini-van not by important factors like crash survivability but by some ultimately less important cosmetic factor. It's easier to count cupholders than to interpret crash statistics.

If we really took these survey results to heart, what would the typical medical clinic look like? Maybe, the model would look like an all-night gas station/convenience store with low-cost gas, a soda machine that spits out every flavor and one of those spinning grills with shriveled up tubes that used to be hot dogs—good in a pinch, but not something you'd want to bet your life on.

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