Building Relational Slack With Patients

Patient relational slack fosters resilience as well as the ability to innovate.

Reviewed by Monica Vilhauer

Key points

• Great healthcare organizations build a robust stock of relational slack with patients over time.
• Patient relational slack is the incremental patient relational capital owned by the organization.
• Patient relational slack is more valuable than financial slack, since it takes longer to build.

During a recent medical episode, which required visits to various divisions of my local healthcare system, I was once again reminded of how much patient behavior can deviate from a transactional and short-term utility-seeking model. Many patients were apparently fine to wait for better parts of an hour to see their preferred specialist and did not display outward signs of agitation. The literature has documented that a majority of patients are willing to forgive scheduling and other operational errors, and a remarkably small percentage of patients litigate medical errors. More strikingly, most patients are willing to follow recommendations of their clinicians to try new therapies, devices, and medical procedures, with little more than surface-level knowledge of the logic behind these recommendations (1).

These patient behaviors are not simply a result of patient inertia, satisfaction, or even mere patient trust. They result from something even more valuable and rare that some healthcare organizations, including clinicians subsumed within them, have built with their patients: a robust stock of relational slack.

Relational Slack

Economist Birger Wernerfelt noted in his highly-cited paper that “a firm’s resources at a given time could be defined as those (tangible and intangible) assets which are tied semi-permanently to the firm.” Social capital is one such intangible resource that accrues for an organization, such as a hospital system, from several relational sources, including its patients and their caregivers, internal relationships with and among employees, network relationships with partners and service providers, and relationships with donors and foundations.

In the healthcare context, patient relational capital is a facet of organizational social capital that results from accruing patient trust in the organization. Many years following our own research into customer trust and drivers of trustworthiness across more than a dozen industries, I developed an early conceptualization of customer relational slack, which was later formally operationalized in an article I coauthored in the Academy of Management Journal.

Nohria & Gulati defined slack as “the pool of resources in an organization that is in excess of the minimum necessary to produce a given level of organizational output. Patient relational slack, by extension, can be thought of as the patient relational capital over and above the level needed for consummating ongoing exchanges. Another way to think of relational slack is in terms of how much more relational capital one healthcare organization has garnered relative to its competitors. This view is consistent with conceptualizations of brand equity as the incremental value of one organization’s brand over competing brands, for its consumers.

Relational Slack as Opposed to Trust

What is the psychological nature of patient relational slack? Consider personal relationships: When we think of a strong relationship, we implicitly think of one where the bond is deep and resilient — it can take the occasional fraying and stretching and can even be rebuilt when broken. These bonds are built on more than a modicum of trust. They are built on repeated and consistent reinforcement of trustworthiness through engagements that build social ties and lead to both very high trust (extremity), as well as very strongly held trust (strength). Like financial slack, relational slack with patients confers the healthcare organization with a “buffer” or source of internal fortitude, both when faced with challenges and when considering opportunities.

Therefore, building patient trust in a hospital system, medical practice, or a specific physician is important, since trust serves as a baseline for consummating ongoing transactions smoothly. But building relational slack, or a large stock of relational capital, is what allows for resilience, as well as the ability to innovate or take other expansive steps.

Strong and trusted brands are resilient in crises. Patient relational slack can protect the healthcare organization and help it recover from service failures, medical errors, and organizational reputational crises among other negative events. Like financial slack, a stock of relational slack helps sustain the organization at a steady state even as it recovers.

Relational slack also helps the healthcare organization make forays into new markets, expand into new clinical operations, or introduce new models of patient engagement. In all these instances, relational slack serves as a risk-dampening asset for both the organization, and for the patients targeted.

The Value of Relational Slack Versus Financial Slack

Patient relational slack is arguably more valuable for any provider, such as mine, since it takes longer to build across multiple and complex patient encounters. Unlike financial slack, relational slack cannot be quickly acquired via debt or equity-based mechanisms. Further, relational slack is immutably associated with the organization: My relationship with my healthcare provider and the relational capital resulting from my long-term experiences is embedded in the provider’s unique identity and processes, making the relationship difficult for other organizations to easily replicate.

As a result, a healthcare organization might be more protective of its relational slack – rightly so – and not want to take risks that can have a negative effect on its relationships. This potential liability of strong relationships is ever pervasive and will call for pragmatic management of relational capital.

Footnotes:

1. It could be reasonably argued that not all these behaviors are rational or serve the greater “good.”