“Dinner is warm, it’s in the dog.”

Let’s see what we can somehow tie this to patients; I couldn’t resist using the title. The phrase came from my friend’s wife. She’d said it to him after he and I came home late from work one night, he having forgotten his promise to call her if we were to be late. Apparently, she hadn’t forgotten his promise. We walked into the kitchen.  “Dinner’s warm—it’s in the dog.”  She walked out of the kitchen.  I think that’s one of the best lines I’ve ever heard.

Turns out that he and his wife had expectations about how everything would play out.  Turns out their expectations were different.  Satisfaction has more to do with meeting expectations than with actual experiences.  It all comes down to Expectations. In healthcare it comes down to patient expectations.

PEM can be a number of things; Patient Experience Management, Patient Equity Management, and Patient Expectation Management. In this instance, we are discussing the latter. One could argue as to whether the expectations were realistic—and he did argue just that—only to learn that his wife considered the realism of her expectations to be a critical success factor.

Expectations are set, and they will either be met or missed.  The further ones’ experiences are from their expectations the lower is their satisfaction.  I call this the Expectation Gap.

The thing to remember about the Expectation Gap is that in order to measure it you need to know people’s expectations.  And the only way to know their expectations is to ask.  Having people from IT and marketing sitting around defining the expectations of patients and prospective patients is courting disaster.

Each time expectations are missed, the expectation bar is lowered. Soon, the expectation bar is set so low it’s difficult to miss them, but miss them we do. What happens next?  Patients leave. They leave and go somewhere they know will also fail to meet their expectations.

People would rather give their money to someone who may disappoint them than somebody who already disappointed them.