January 5, 2016
By Upali Nanda, Executive Director for the Center for Advanced Design Research and Evaluation and the Director of Research, HKS, Inc.

Millennials, or Americans born between 1982 and 2000, have replaced baby boomers as the largest population segment in the country at 83 million, according to a June 2015 report from the U.S. Census Bureau. That puts them at center stage when it comes to how the healthcare sector markets its services.

However, not to be forgotten are the 75.4 million boomers, those born between 1946 and 1964, who will soon begin to frequent healthcare facilities more often.  

To determine what both groups are seeking in their healthcare experiences, particularly in the outpatient environment, a research team conducted Clinic 20XX, a nationwide panel poll of a 150 millennials and 150 baby boomers who had visited a clinic for the first time in the last six months, garnering plenty of insight. (Please see image gallery to view charts of the results). 

Making a choice
Top-box scores in response to “What factors made you select this clinic?” were analyzed. Of the 15 options rated, millennials’ top three concerns in selecting a clinic were healthcare coverage, perceived cleanliness, and the distance from their homes, whereas boomers were most interested in healthcare coverage, perceived cleanliness, and the ability to get diagnostics done on-site.

Note: Top-box scores are different from average—they show the percentage of people who rated a factor as the “most important” on a rating scale. Sometimes top-box scores can be more revealing than averages because they give an estimate of the most important considerations for a clearly identified percentage of the population. (Interesting aside: HCAHPs scores are actually based on top-box scores and not averages). 

What’s appealing?
Participants were also asked about what would make a clinic more appealing to them. The top three factors for millennials (based on top-box analysis) were cleanliness and hygiene, same-day appointments, and 30-mintue walk-in appointments. These were followed by 24/7 access and online registration. For boomers, the top three considerations were cleanliness and hygiene, a 30-minute walk-in, and same-day appointments, followed by a quiet environment and a one-hour walk-in.

Interestingly, for millennials, a one-hour wait wasn’t acceptable, ranking 12th out of 15 factors. At the same time, spa-like ambience, which was six out of 15 in the millennial considerations, ranked at the bottom for boomers. 

While the two generations converge on what’s the most important, there are differences beyond those basic concerns that warrant closer attention. Overall, millennials’ preferences for what makes a clinic appealing were highly variable with very little to distinguish between the middle-range and low-range factors, while boomers’ were streamlined with distinct differences between the most and least important factors. However, tech-connectivity amenities, such as online registration, mobile apps for tracking health, and virtual access to physician and staff members, were much more appealing to millennials than boomers. 

This ties into the finding that more than three-quarters of boomers considered their smartphone as only a means of communication and wouldn’t want to access health services through it. This contrasts with the more than one-half of millennials who view their smartphone as a lifeline and would like to access health services through it. While boomers do report using their smartphones as a favorite waiting activity, this may change in coming years, and is worth tracking carefully—especially with the increased use of patient portals by many healthcare systems. 

The virtual visit
Participants were also asked how likely they are to consider a virtual visit instead of an in-person visit to the doctor. Almost one-half of the millennials (49 percent) said they were at least likely to use a virtual clinic, and 27 percent of them were on the fence. Only 24 percent of them reported being unlikely to use virtual clinics. Millennials are digital natives, ready to connect with their care teams remotely and wirelessly. Handheld and remote connectivity won’t be a challenge for them as facility designers push to integrate wireless technology into outpatient clinics. 

Increasingly this connected generation will use their smartphones to make appointments, track their health, and access their care team virtually. Facilities must integrate wireless capabilities to reach out to millennials and keep their records safe and accessible from the cloud. 

However, on the other end of the spectrum, close to one-half of the boomers (44 percent) said they weren’t likely or very unlikely to use a virtual clinic, and one-third of them were on the fence. Only 23 percent reported being likely to use virtual clinics. Boomers are a people-first generation, preferring to meet their physicians face-to-face. Handheld and remote connectivity could be a challenge for them, so considering the people interface of technology will be crucial moving forward. 

Satisfaction and the return visit
The balance of people-focused and technology-focused factors is evident in how both millennials and boomers responded to the survey and the extent to which satisfaction with various facility and service elements predicted likelihood of return. Overall satisfaction with visit, for the two generations combined, was predicted by the rating of wait time and service quality (including rating of care coordination). In other words, across both generations waiting time and service quality determined their satisfaction.

In response to “How do you spend your time while waiting?” millennials reported using their smartphones, people watching, and looking at artwork as their top three waiting activities; boomers chose people watching, reading books and magazines, and using their smartphones. People watching and using smartphones were common activities for the two generations. 

Likelihood of returning to a clinic was predicted by overall satisfaction with visit, follow-up care, and Wi-Fi connection. In other words, patients who were more satisfied overall, received good follow-up care, and had access to Wi-Fi during their visit were more likely to return to a clinic. The emergence of Wi-Fi as a predictor of returning to a facility speaks to the need for tech-connectivity, no matter where we are. In a content analysis of the qualitative responses, the three key themes for millennials were around a positive, friendly staff; quality of care; and cleanliness. Boomers’ responses were similar, noting a professional, knowledgeable staff; a positive, friendly staff; and quality of care. 

Overall boomers were more likely to return to the same clinic, compared to millennials. It follows the notion that the loyalty of millennials is at a premium (in line with other market research on this subject) and must be actively solicited. At the same time, the loyalty of boomers can be counted on and shouldn’t be compromised. 

A balanced approach
As times change, technology evolves, and clinics move to team-based practices, it’s important for facility designers to remember that boomers are clear in their priorities of what’s important and it’s possible that too much emphasis on bells and whistles could dissatisfy this more conventional generation. At the same time, boomers are one of the first generations to truly use technology and are increasingly using smartphones with strong connectivity expectations. In that, they aren’t so different from millennials. 

In order for clinics to attract and retain the largest generations in American history (the millennials), while keeping the loyalty for the most frequent users of health facilities (boomers), designers must focus on technology integration and experience as a whole versus just the brick and mortar of the facility itself.

Simple factors like cleanliness and convenience are fundamental, and building on them to create facilities that respect common human concerns, not fleeting age-based trends, can help us take a balanced approach and go beyond being trendy to being change-ready in clinic design.  

To see the complete report: Clinic 20XX: Designing for an ever-changing present, please visit http://www.cadreresearch.org/projects/clinic-20xx. The Clinic 20XX study was funded by JE Dunn and HKS Architects. It is an open source document that can be accessed at that link.   

This article was published in Healthcare Design in January. Upali Nanda is the executive director for the Center for Advanced Design Research and Evaluation and the director of research at HKS Architects. She can be reached at unanda@cadreresearch.org. Additional authors include the included. Jim Miller is the national healthcare leader for JE Dunn Construction and can be reached at jim.r.miller@jedunn.com. Tom Harvey is the president of CADRE and a senior vice president at HKS. He can be reached at tharvey@hksinc.com. Seka Sekawangi is a design researcher with HKS and CADRE and can be reached at ssekanwagi@hksinc.com.

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