For most hospitals mapping out their post-reform strategies, preparing for the expected surge in newly insured patients is a top institutional priority. Many institutions are carefully scrutinizing which service lines and departments will see a bump in utilization in the coming years, and making staffing and facility decisions accordingly.

But for the safety net hospitals that already treat uninsured and underinsured patients, the expansion of coverage brought on by the Affordable Care Act may have decidedly different implications — it may mean, in fact, more competition for patients that previously had few options for health care.

That's the insight I recently received from Karen Teitelbaum, executive vice president and chief operating officer of Mount Sinai Hospital, a safety net hospital serving the West Side of Chicago. We started off discussing Mount Sinai's efforts to improve the patient experience, in the context of changes to Medicare's value-based purchasing payment system next year that will incorporate patient satisfaction scores into the reimbursement equation for the first time.

But Teitelbaum pointed out that there are even bigger business imperatives for keeping patients satisfied at Mount Sinai — namely, retaining and building a patient base that suddenly will have access to a host of nearby hospitals. Mount Sinai sits only a mile from the Illinois Medical District, a collection of hospitals and other health care providers that includes two academic medical centers.

"People will have a choice once reform is here," Teitelbaum says. "Many of the patients we served when nobody else wanted them will have a choice for the first time."

Sinai leaders make this very point to employees during Sinai Service: Simply the Best, the daylong training course all incoming staff must take when they begin working there. Using techniques first developed by the Broadmoor Hotel in Colorado, Sinai's top executives meet with new hires to drive home the importance of patient service as a critical factor for both business and clinical reasons.  Regardless of their job titles, the new hires work together in teams as they learn Sinai's approach to customer service. Ultimately, the goal is to give all employees the tools to help patients when the need arises.

"Everybody's hearing the same thing," Teitelbaum says. "Whether you're a security guard or a neurosurgeon, you're going through this together."

The three-year-old Sinai Service program is also designed to focus all staff on how patient engagement can make or break the hospital's balance sheets, especially as the hospital's patient base begins to have more choice.

"We link it to a business case," Teitelbuam says. "If just 5 percent of patients who didn't have a great experience went elsewhere … from a business perspective, that would be $3 million right to the bottom line."