Viewing entries tagged
experience

notes on registration

Notes on registration:

Blame it on the availability heuristic, but I feel like every conversation I’ve had in the last 24 hours has been about registration and waiting. You won’t be surprised to learn, I have feelings and opinions about this.

It started with last night’s #PXchat where we chatted about waiting rooms. Think about that term waiting rooms.

Waiting is a basic fundamental of today’s healthcare environment. We generally accept it as a given, at some, probably many, points in a healthcare visit we will wait. We’ll sit and look at our shoes, or phone, or a three month old copy of Road and Track.

Why do we have to wait? It’s rhetorical, I know why we wait. But maybe we really should ask: should we have waits? Starbucks is one of my favorite service industry examples —they use just-in-time fulfillment. We rarely wait more than a minute or two for our triple mocha frappa half caf soy Americanos.

Don’t do it. I know you are reaching for your skeptical hat. But healthcare isn’t a coffee shop, Nick… Don’t put the hat on. Don’t say those words. Just think for a minute, what if there were no waits? Woah!

Then, today a lunch, I had an inspiring chat with a colleague about identity and mindset. She shared an experiment she participated in during graduate school. Would people be more or less confident if they were made conscious of their ethnic identity?

Think about the thing we do after we wait. We go give a complete stranger a list of the little buckets we fit into, parts of our identity. We willfully give up: * Age * Gender * Home address * Ethnic background * Even some socioeconomic info

By sitting, uncomfortably, across from someone and sharing these things, we are also reminded of them. At least subconsciously, they are now at the top of our minds. Do we bring them as badges or baggage into the visit with the doctor? What impact, does that identity recall have?

I’m willing to bet, at least the initial act of registration puts us in a bit of a subservient mindset.

We don’t, in my experience, have the same feelings about hotel check in. Is that because we fill out most of our identifying information online, prior to arrival? (That one isn’t rhetorical - really, is that why?)

This afternoon, I had the chance to visit a really cool space. You know those kinds of places you see in movies or commercials and you think but no one really gets to work in places like that… Well these people do. Think modular walls, mixed soft and hard surfaces, smart screens, cool chairs and funky colors. Cool stuff!

This is what I saw when I walked in Welcome, me

Hello ego!

But it’s actually a lot neater than an ego play. Their welcome area is designed around the psychology of greating the person coming into the space for the first time. It’s insanely welcoming to see yourself on a screen. The entry area is also perched a few steps higher than the work space. So you enter with a commanding view which, in turn, puts you in the position of power, rather than feeling swallowed by a new space. You can surveil everything.

Why not have personalized welcome screens?

It’s as if a million risk manager voices just cried out at once. Stick with me.

If a doctor’s office knows you, really knows you, they’ll know your interests. Surely there’s some field in most current EMRs which would allow someone to capture that I’m into skiing. So when it’s time for my appointment, why not cycle up a clip from a Warren Miller ski film? It would be intermixed with a shot of wild flowers, representing some other patient’s passion. Neither visual gives away our personal information or identity. But both visuals would make us feel personally cared for and welcomed.

Just some notes on registration….

What do you think - what glaring opportunities for improvement do you see? What things should we be thinking about from the staff perspective to improve their work experience?

notes on registration

Notes on registration:

Blame it on the availability heuristic, but I feel like every conversation I’ve had in the last 24 hours has been about registration and waiting. You won’t be surprised to learn, I have feelings and opinions about this.

It started with last night’s #PXchat where we chatted about waiting rooms. Think about that term waiting rooms.

Waiting is a basic fundamental of today’s healthcare environment. We generally accept it as a given, at some, probably many, points in a healthcare visit we will wait. We’ll sit and look at our shoes, or phone, or a three month old copy of Road and Track.

Why do we have to wait? It’s rhetorical, I know why we wait. But maybe we really should ask: should we have waits? Starbucks is one of my favorite service industry examples —they use just-in-time fulfillment. We rarely wait more than a minute or two for our triple mocha frappa half caf soy Americanos.

Don’t do it. I know you are reaching for your skeptical hat. But healthcare isn’t a coffee shop, Nick… Don’t put the hat on. Don’t say those words. Just think for a minute, what if there were no waits? Woah!

Then, today a lunch, I had an inspiring chat with a colleague about identity and mindset. She shared an experiment she participated in during graduate school. Would people be more or less confident if they were made conscious of their ethnic identity?

Think about the thing we do after we wait. We go give a complete stranger a list of the little buckets we fit into, parts of our identity. We willfully give up: * Age * Gender * Home address * Ethnic background * Even some socioeconomic info

By sitting, uncomfortably, across from someone and sharing these things, we are also reminded of them. At least subconsciously, they are now at the top of our minds. Do we bring them as badges or baggage into the visit with the doctor? What impact, does that identity recall have?

I’m willing to bet, at least the initial act of registration puts us in a bit of a subservient mindset.

We don’t, in my experience, have the same feelings about hotel check in. Is that because we fill out most of our identifying information online, prior to arrival? (That one isn’t rhetorical - really, is that why?)

This afternoon, I had the chance to visit a really cool space. You know those kinds of places you see in movies or commercials and you think but no one really gets to work in places like that… Well these people do. Think modular walls, mixed soft and hard surfaces, smart screens, cool chairs and funky colors. Cool stuff!

This is what I saw when I walked in Welcome, me

Hello ego!

But it’s actually a lot neater than an ego play. Their welcome area is designed around the psychology of greating the person coming into the space for the first time. It’s insanely welcoming to see yourself on a screen. The entry area is also perched a few steps higher than the work space. So you enter with a commanding view which, in turn, puts you in the position of power, rather than feeling swallowed by a new space. You can surveil everything.

Why not have personalized welcome screens?

It’s as if a million risk manager voices just cried out at once. Stick with me.

If a doctor’s office knows you, really knows you, they’ll know your interests. Surely there’s some field in most current EMRs which would allow someone to capture that I’m into skiing. So when it’s time for my appointment, why not cycle up a clip from a Warren Miller ski film? It would be intermixed with a shot of wild flowers, representing some other patient’s passion. Neither visual gives away our personal information or identity. But both visuals would make us feel personally cared for and welcomed.

Just some notes on registration….

What do you think - what glaring opportunities for improvement do you see? What things should we be thinking about from the staff perspective to improve their work experience?

Health Affairs is the new shirtless dancing guy

2/13 update: Videos for the panels are now available on the Health Affairs site. Sometimes it’s about the idea, and sometimes it’s about validating existing ideas. Last week, the well-regarded health policy journal Health Affairs hosted a briefing on The New Era of PAtient Engagement. I attended and left feeling satisfied, even excited, and also frustrated and a tad disappointed.

The briefing was a forum for researchers and authors of articles in the February edition to present their work. Many of the topics focused on ways to activate patients or to get patients engaged in their care. Proponents, supported by compelling data, argued activated or engaged patients have better outcomes and reduced costs.

The presentations ranged from reports on data, to emotional appeals. Some, in particular Jessie Gruman, did a nice job of mixing both. Kristin Carman presented an amazing Framework For Understanding The Elements [of shared decision making] pictured here: Framework

I sensed frustration from some attendees. We proved the value of engagement years ago, this isn’t new… and why aren’t there actual patients represented on the panels?. Some even, appropriately, called attention to the fact that Health Affairs requires a subscription to view most of the articles (some where funded by PCORI and made publicly available).

Personally, I was disheartened by some word choices. Implying patients need to be activated suggests patients are passive and something has to be done to them in order for them to care about their health and interactions with healthcare providers. That misses the mark.

What about phyisician activation? we have an opportunity to collaborate on a new model which reduces the power-distance index between providers and patients. We should be helping health systems and providers find ways to reduce the stress and fear for patients who are already engaged.

I appreciate all the concerns, and agree with many of them. But I am, none the less, excited about what Health Affairs has done. It’s important for us to have forward-thinking visionaries who knew were focused patient centered care years ago. It’s important to recognize the importance of what Health Affairs has done.

Five years ago, would a major publication have dedicated an issue to patient engagement? I doubt it. Howard Koh, MD, Assistant Secretary for Health, US Department of Health and Human Services, opened the briefing and called attention to its significance. His presence alone suggests the patient experience and engagement is on the minds of top officials.

I’m reminded of this video of the shirtless dancing guy:

My takeaway from the Health Affairs briefing is the same as the video’s message: it’s not about being the first, it’s about validating those who dare to put forth new ideas. In this case, patient engagement, shared decision making, and participatory medicine are not new. What is new is the attention from major publications, providers, policy makers, administrative leaders and researchers. That’s something worthy of a happy dance.

From Elsewhere: Medicare Discloses Hospitals' Bonuses, Penalties Based On Quality and man does it tell a story

Last week, CMS, the Centers for Medicare and Medicaid Services, announced the names of hospitals who received bonuses for quality. It also listed the names of hospitals which received penalties. Kaiser Health News has done a great job of covering the story.

Here’s what I find to be the single, most telling thing:

Nicholas Genna, CEO of Treasure Valley Hospital in Idaho, recipient of the biggest bonus, credited close attention to patients, including a low nurse-to-patient ratio and handwritten thank-you notes to patients, along with the fact that the doctors own the hospital. “People answer the phone with a smile on their face,” he said.

If that doesn’t validate…nay…quantify the importance of making patient experience the top priority, I don’t know what does.

Compare Mr. Genna’s comments to those from the most penalized hospital:

Thomas Filiak, the chief operating officer at Auburn Community Hospital in New York, which received the largest penalty, said executives have begun a number of initiatives to lower noise near patient hallways, including putting new wheels on squeaky food carts. “They sounded like Mack trucks going through the hallway,” he said.

One speaks to actions and the other to lip service. Sure, squeaky carts are annoying and may lead to a less than favorable result on one particular HCAHPS question. But ask yourself this, for which of these places would you rather work? At which would you rather seek care?

Don’t get me wrong, I’m applauding Mr. Filiak’s efforts and I’m sure the leadership team at Auburn Community is well poised for a fantastic turnaround — I’m looking forward to reading that story in 2013.

What I’m suggesting is that Treasure Valley’s success is clearly the result of a patient-centered culture, and it shows in how patients feel about them and in turn how Medicare is rewarding those kinds of culture.

via Medicare Discloses Hospitals' Bonuses, Penalties Based On Quality - Kaiser Health News.

From Elsewhere: Lean Blog Podcast & Making room for Empathy

One of my favorite phrases is making room for empathy. Room for empathy is about giving staff the time in their workflows to be compassionate and to deliver care which is not only clinically competent but emotionally uplifting as well. But that’s hard to do.

It’s hard because the work of providing care is increasingly complex. We’ve got EMRs with screens of data. We’ve got sign off sheets, time outs, forms, papers, phone calls, results, and, frankly, CYA work. Those things take time. So what get’s cut? Empathy. We cut out the simple things like walking someone to their destination rather than pointing. We cut out sitting with someone who looks concerned (so we look at our shoes or iPhones in the hallway). It’s a problem

There are two main ways to make more room for empathy. First, we could hire more staff. More staff (nurses, care givers, techs, managers, administrators even) mean more bandwidth. Many hands make light work. But we probably aren’t going to get more staff. Reimbursement is dropping, and there is a push to be more efficient. Hospitals are trying to see if they could survive on Medicare reimbursement rates. (Remember, Medicare pays, on average, about 80% of what treatment costs, so we have to cut about 20% of cost out of hospitals).

The other way we can make room is by eliminating work which does not add value. Productivity gurus say we should work smarter, not harder. I’m increasingly interested in the Lean methodology as a framework for evaluating how we do our work and determining if it adds value, or simply takes up valuable time. So, I’ve been trying to learn more about Lean.

I found Mark Graban’s Lean Blog which led me to his Lean Blog Podcast, a regular, downloadable audio show about Lean. In the most recent episode, Dr. John Toussaint of ThedaCare, discusses the importance Lean methodologies in healthcare.

It’s a fantastic listen and should inspire anyone looking for ways to make room for empathy and return the focus to patient and staff experience.

of red wagon rides and patient centered design

Amplatz tour every room has message panel outside so kids can leave a message for nurses etcIt was a classic childhood scene, a mom pulled her young daughter in a cherry-red wagon. Both had smiles as broad as a their faces would allow. When they made the a turn to the left, a young lady stooped down to the daughter's eye level and said something that put them both in a fit of laughter. There was something really special about how much fun they were having. It's a simple thing really, but aren't wagon rides kind of a childhood rite of passage? That wagon can be anything - a pony, a space ship, a semi truck or just a plane red wagon. The young lady stood up, adjusted her scrubs and went back to the nursing station. Mom and daughter turned the corner for another lap down the hospital floor hallway.

Amplatz tour - every floor designed with a color and theme and on stage off stage spaces

Have you ever stayed in a hip, boutique hotel? You know that cool thing they do with glass walls and bright lights? Well, that's pretty much exactly what I was not expecting when I stepped off the elevator at the University of Minnesota's Amplatz Children's hospital. My friend, J, was giving us a tour. He explained each floor has a story teller character, some animal who's image is repeated as a design theme throughout the floor. The wall was bright orange and yellow glass. If there had been club music I would have assumed we were, in fact, in a W hotel.

"The whole place was designed with onstage and offstage spaces," J explained. An onstage space is patient facing, it is their space where staff are expected to play the role of compassionate caregivers. Fred Lee, author of If Disney Ran Your Hospital, would be proud. Offstage spaces are where staff congregate, or push noisy carts - the kinds of things which wake patients up at night or remind you that you are in a hospital. The idea of onstage and offstage goes deeper than having a separate hallway for food service delivery. Being onstage reminds staff they are, in many ways, a guest in the space. Families, particularly in a children's hospital, settle into their rooms and the surrounding environs. Being onstage means always playing the part of someone who loves children, and serves families, and provides care, and doesn't mind getting a cup of shaved ice for the third time that hour. Need to huff and puff about it? Take it offstage.

Amplatz tour every pt room has video conferencing so kids can talk to family and friends or attend school"You know, it's funny, everyone thinks I've gotten into IT… I haven't, I've gotten into connecting people and making the experience for these kids a little less scary." J played a considerable role in the design of the hospital. One of his many contributions is the design and implementation of a state of the art video conferencing system. The system, available in about half of the rooms, consists of a wall of video monitors, including a 42" screen, and a motion tracking video camera. From a bedside touch panel, kids can dial up family members who may be hours or many miles away. Some kids have even been able to attend school using the video linkups. "It's a way to maintain some sense of normalcy and connection, " J told us. Amplatz is a regional draw, servicing a wide swath of the midwest. Video conferencing can enable the dad who can't take off work to talk to his child several times a day. Doctors can plug in a computer on wheels and do a split screen between the patient, the parent and the medical record, effectively hosting a virtual care conference. How cool is that?

I'm with J, the people aspect is by far cooler than the enabling technology. And the technology is impressive to be sure. The design aesthetic is also - and I say this with no hyperbole - the best design I've ever seen in a care space of any kind. But what really stands out at Amplatz is the atmosphere, the total package. It's not the iPod docks, rainbow walls, x-box enabled video conferencing onstage touch screen dohickies…. it's the utter selflessness that working around sick kids demands. You simply cannot bring your own baggage onto a floor where a family is fighting for what could be their last hours or months together. Kids level the playing field. Check your ego at the door.

Why does it work so well at Amplatz? I'm not entirely sure. There is undoubtedly some combination of culture, training, design and technology which enables the care environment. There is attention to design, particularly around experience. Hospital committees met and drew the initial brush strokes. A parent's council then came in and refined the ideas. The ultimate decisions, however, were made by a council of children patients. It's pretty hard to get the typical non-patient-centric committee compromises when patients get the final review. Clearly, you also have to give staff room too. I don't mean physical room, but rather latitude to be empathetic, personable and compassionate. I didn't get to observe the culture long enough to understand how Amplatz enables culture, although it is clear they do something right for their staff.

Every healthcare provider has a responsibility to be as good as Ampltaz. Here are some of my key takeaways from our short visit:

  • Patient centered design with patient input and review
  • Onstage and offstage spaces
  • Give staff permission to be empathetic (here's an example, at Ampltaz, any patient care conference supersedes staff conferences. If staff are in the conference room for a meeting and a provider wants to discuss care with a family, the staff all leave and reschedule their meeting…wow!)
  • Enable connections, relationships and remove fear - that will drive your IT choices rather than letting them drive you
  • Don't be afraid to have fun - the space was fun. There were games everywhere. Each room had an Xbox! Why do we paint hospitals in muted tones and use dim lighting? No one wants to convalesce in a depressing cave.

The University of Minnesota Amplatz Children's Hospital is a joint venture between UMN and Fairview Health System.

You can follow Amplatz on twitter here.

Amplatz tour - kids reading room (or inside Jeanie's lamp)

Amplatz tour - lobby is bright, modern, cool

Amplatz tour every kid's room has a wii and rainbow will which changes color when you dock an iPhone and play music

Amplatz tour all the art is by patients and is updated whenever a kid paints something new

Amplatz tour kids can control every aspect of the room via touch screen on swing arm over bed

Designing for Experience

The 4AM Wake Up Call. My friend was in the hospital a few weeks ago, nothing serious, a precautionary measure more than anything. I went to visit her and we sat and chatted. I always ask people about their experience. "What's going well, what would you change?" At first, you hear a lot of kudos. "Everyone has been really nice." I don't doubt it. But, you can't improve on compliments. I've found you have to ask people at least three times to get the juicy stuff.

"Well, I don't understand why they keep waking me up at 4 AM to take blood. Is my blood only good at 4 AM," she joked.

I know why they do it.

In The Accidental Mind, David Linden talks about the evolution of the human brain in Gladwell-like simplicity. He says evolution didn't just pop out this perfectly coordinated mass of nerves and synapses. The brain, in fact, is the result of years of renovations, additions and remodels. One part developed to respond to the needs or deficiencies of another. The process of healthcare, unsurprisingly, isn't much different.

Doctors usually want to round on patients first thing in the morning, around 7am. It frees them up for surgical cases or office visits early. When they round, they want to see the latest lab results. Lab tests take a few hours to coordinate and run. Thus the 4 AM blood draw.

It would be easy to point the finger at the doctor and say the patient is being inconvenienced to fit the doctor's schedule. But, much like the human brain, it's not that simple. Could the lab speed things up? How do we even get specimens to the lab, is that an efficient process? Well, that depends on who's eyes you are viewing the process through.

Designing for experience

Designing for experience is about true customer focus. It is deeper than what we traditionally think of as customer service, which describes the way people interact with each other. Designing for experience requires an almost painfully high degree of empathy for the person using your product of service. You have to not only be willing to see it through their eyes, but also feel it the way they might. Getting to that level requires a holistic attention to detail. After all, how much of what we feel is defined solely by our verbal interactions with someone? How much comes from environment, ambiance, touch, visual details, perceptions, waiting times?

In 2001 Susan and I were living in Paris. No, there are no buts, it was that cool. One weekend in July started like so many others. We descended into the local metro station, Odeon, out of the sun and into the belly of Paris. After an hour of riding, including a transfer to a regional train, we began the ascent back towards the surface. The first thing we saw was a giant, antiqued sign proclaiming our location to be Main Street U.S.A. It was utterly surreal. On one corner was a 1950s themed ice-cream parlor. Across the street was a video arcade. There was even a mini Statue of Liberty. Somewhere in the distance Its a Small World After All was floating through the air.

At that moment, we weren't in a field outside of Paris, we weren't even in France. We were in Disney's world. We were 12 years old, wide eyed and ready to run through the park at 100 miles per hour. They had gotten every detail right. The writing on the street signs, the food vendors, even the rides. It was a classic Disney experience.

Disney is a master of designing for experience at its resorts. That's not a young French girl playing Snow White. It is Snow White. That's not a facade in front of a concrete building, it is an honest old-time ice-cream pallor. It has to be, because if we saw behind the curtain, if the magic were revealed, then our brains would instantly unplug from the illusion and we'd feel like we were, in fact, in a field outside Paris, or marsh outside Orlando.

The challenge with designing for experience in healthcare, and probably most businesses, is the historical precedent of designing by censuses and compromise. Politics have become part of our corporate culture. If we do X, does it upset the person in charge of Y? If so, what is the compromise? And there's the rub. When we compromise to satisfy internal politics or business pressures, more often than not, we are making an even bigger compromise for the patient. It's how we get the 4 AM blood draw.

The PocketPC and importance of the foot fetish

In 2002, I had a PocketPC device. Its marketeers clearly took liberties with the size of the average pocket, but nonetheless it was a fairly compact thing for the time. It had a stylus-based touch screen, miserable handwriting recognition and very limited Windows PocketPC software. But, I like to live on the cutting edge with gadgets, so I picked one up.

What I really wanted was to watch movies and TV shows while at the gym. The problem was that it used some obscure file encoding. Not only that, the videos had to be perfectly formatted for the screen size. I found that if I ran a video through two different programs on my desktop PC, I could manipulate the file enough that it would usually play on the PocketPC.

I was the only one at the gym watching their own personal video screen.

I'll never forget the reaction of a friend who saw me on the elliptical one day: "you really are a huge nerd aren't you?" It was a friendly jab. At least I think it was. Fast forward to today, almost every runner on a treadmill has an iPod, iPhone or small personal device. This morning I saw one musclebound guy in a weight belt and tank top entering reps onto his iPad which he carried with as much pride as his protein shake. I dare you to call him a nerd.

What once was once a niche use case, is now the norm.

This summer, at Stanford's Medicine 2.0 conference, the precursor to the recently announced Medicine X series, Dennis Boyle from IDEO spoke about design thinking. He flashed up a slide of a stocking clad leg disappearing into a bright red high heel shoe. "If you want to make the best shoes, ask someone with a foot fetish to review them, they know more about shoes than you do," Boyle told the audience. What a line!

The past few years have given rise to a new term, e-Patients. These paradigm changers are empowered, engaged, informed, and most of all, desiring to participate in their care and planning as an equal peer. An e-Patient can be someone who googled symptoms before going to the doctor, or someone who studies their lab results with the veracity of a Rhodes Scholar.

The Pew Internet and American Life Project reports, "one in five Americans have gone online to find people with similar health concerns."

Still, not everyone one is convinced. One doctor privately quipped to me, "thats just what we need, more people using Dr. Google."

I understand his reaction. The perception is e-Patients come with inaccurate information, too many questions, or have unrealistic expectations of a doctor's availability. That misses the mark. The value of e-Patients, in addition to arugably reducing the burden on providers, is as the extreme use case. What if they are high-contact and high-need? Embrace it. They are the early PocketPC users who can tell you why using two programs to put videos on a device is seriously flawed. They are the ones with a foot fetish who can tell you why that color red isn't ideal.

They are the ones who can tell you why a 4 AM blood draw is not a good idea.

Facing the future

Designing for experience in healthcare requires a wholesale change to the way we plan for and implement services. Rather than design by committee, teams need to focus on putting themselves in the patient's perspective. If you want the ideal inpatient blood draw, sleep in a hospital room, and have someone wake you up at 4 AM two days in a row. By the third day, you'll have some creative ideas for solving the problem.

Boyle suggested being pushed around your hospital in a wheelchair, not once, but hundreds of times. See if from the eye level of someone sitting down. You'll notice how most nursing stations have counter tops higher than the eye level of someone in a chair. A hospital CEO once remarked to me, "you know it doesn't really matter what art we put on the walls, all of our patients are laying down and only see our drop tile celling, and man is it ugly."

Designing for experience also requires a high degree of empathy for the customer. It means you have to open yourself to feeling what they feel. Imagine being scared or confused or sedated. Empathy means thinking about what you would want in the same position. Have you sat waiting for 45 minutes in a doctor's waiting room? Do you like it? Then why do we think our patients will. There are solutions to these problems, but they require us to design for the patient experience, not the personal or political needs of the organization.

If you think designing for end user experience comes at a high cost or the sacrifice of revenues, just look at Apple's current market valuation. It can be done.

Designing for experience also means embracing the fringe use cases. Look towards our most frequent users, our e-Patients or our squeakiest wheels. What can they tell us about what works and what doesn't? What feels like fringe today will probably be the mainstream of tomorrow. Do we want to be ahead of it, or behind it?

Experience is a differentiator. In describing my experience at Thomas Keller's restaurants in this post, I said I expected the food to be amazing; it's was a given. What makes the meals memorable are the experiences. It is the same thing which sets Disney's parks apart from Six Flags. The Disney visit is a complete experience. It is the same thing which has made the Ritz-Carlton a world famous brand. We make choices based on emotion first, and reason second. Emotional connections are made with experiences. We expect excellent clinical care whenever we walk into a hospital. (If it's not excellent, we have bigger problems.) Experience makes the competitive difference.

If we want a healthcare system which works, is high quality and patient focused, we have to start designing for experience.

Its not what you do, its why you do it

My new friend Ashleigh, a branding/experience/design guru, recently shared a concept with me. She told me about the golden circle theory from Simon Sinek. He says: "people don't buy what you do, they buy why you do it." Sinek cites Apple as a prime example of the golden circle way of thinking. I'm pretty fond of the little California design company as well. If you've run out of Ambian and read this blog as a substitute before, then you'll know I frequently draw on Apple as a source for inspiration in healthcare innovation.

This isn't a tech blog so I'm not really interested in how many thunderwire ports the new iWidget has and why google's robophone is superior because it has 1.21 gigawatts of magic dust inside. Sinek takes the same approach, focusing on the culture of Apple (and others like the Wright brothers and Martin Luther King, Jr). Sinek says most of us, and most companies, think from the outside in. We think about what we do, then how we do it and finally, maybe we get to why we do it. In the video, Sinek argues innovators like Apple reverse the process, they think about why they do what they do and move outward towards what it is that they do.

Sinek says Apple first says 'we exist to think different, to make things better, we are a design company who happens to make easy to use computers.' As consumers we identify first with their core beliefs and secondly with their products. We think 'I like to think outside of the box too!' Apple could innovate, design and produce running shoes and they would probably be equally regarded as innovators in that space. It is not what they do, but how they do it. (I'm practicing, Sinek repeats that line over and over, its and effective technique.) He counters with Dell's attempt at making an MP3 player to compete with the iPod. Consumers reacted by asking ' why would I buy an MP3 player from a computer company?'

An un-named Wall Street analyst quipped General Motors is a "hospital that makes cars on the side." While that quote is clearly drawing attention to the employee benefit structure GM has cited as a source of financial hardship, it is nonetheless poignant. Could anyone say the same thing about a hospital or other provider - that they are something else first and care givers on the side?

I optimistically think most hospitals and providers really are in the business of caring for patients. Find me a provider who doesn't list patient services as the largest source of revenue. A senior hospital executive once told me he liked working in healthcare because you can run a cafeteria one day, be an architect the next and work with doctors on the third day. While I think that kind of diversity excites a lot of people (myself included), those are all things we do, not reasons to do them. I believe most hospitals and providers really have the core beliefe they exist to care for people, to make them well and bring them comfort. So why are we so bad at expressing that as an industry?

I've written about "healthcare highway" before. A stretch of road which had billboards for every major provider in the area. Dan Dunlop regularly posts examples of hospital ads on his great blog. All of these, the print ads, healthcare highway, all talk about what the providers do. Some have the best cyberknife for brain tumor treatment. Others boast their rankings and awards. Others are the fastest. Almost none talk about why they do what they do. There is biology at work too; we can understand the sign that says "top 50 hospital", but we don't have an emotional reaction.

The message to consumers, Sinek says, is filtered through our biology. We are programed to understand the complex ideas and statistics these "what we do" ads throw at us. However, none of them go past our brain's basic stage of reading the words and understanding them. When companies and individuals talk about why they do something we register it differently. It is what we call a "gut reaction." We resonate with beliefs because, for many of us, we believe the same thing.

As always, I'm not sure what the solution is. There are plenty of ads for providers which talk about how much they care. I'm not sure that is the same thing in Sinek's world as talking about what they believe, what drives them to care. Sinek does give credence to the importance of the message in who you hire and how they ultimately help drive those beliefs. That resonates with me.

What do you think? Do you have any examples of healthcare providers who speak and work from the outside in? Are there hospitals who first say "we exist to change the patient experience, and we happen to heal people in the process?" Is the opposite happening? Are consumer's looking at ads featuring healthcare technology and asking 'why would I get care from a technology company?'

Code Lavender - making the patient experience a strategic goal

"Most patients want the high tech and a great quality outcome, but they can't judge the quality of the [treatment] they can judge the quality of the experience..." - Bridget Duffy, MD This inspiring video came to my attention by way of Dr. Howard Luks. Every time I watch it - I have done so several times - I become more inspired. Dr. Bridget Duffy, the Chief Patient Experience Officer for the Cleveland Clinic (how great is that title!) presented this talk at the Gel Conference. Dr. Duffy makes the case for elevating the patient experience to the same level of importance as clinical outcomes.

There are two concepts in particular that resonate with me from this talk. The first occurs around 21:45 when Dr. Duffy talks about "Code Lavender". In her words, TV medical dramas have made us all familiar with a Code Blue, a patient in cardiac and/or respiratory arrest. A Code Lavender is when someone is emotional arrest - a patient, visitor, doctor, nurse, anyone in the hospital. Calling a code Lavender means that "everyone in the hospital stops and sends healing intention or prayer..." It is a powerful concept.

The second point that I find especially apt is an overall theme of the talk: creating a meaningful, positive, healing patient experience is the most important strategic goal a provider can have. "If you focus on that, [hand washing, clinical outcomes, quality, performance improvement] will come."

At the end of her talk, Dr. Duffy slips in a key part of this plan, "listening to their needs." I recently had cause to say to someone "I'm working with a patient to resolve a concern they have, this is the best part of my job, social media is just a way to get there." Using these real time tools to connect with patients and improve their experience is truly what #HCSM is about to me. I am fortunate to work for an organization that has made experience a strategic goal. I get to see every day the impact it has.

Bridget Duffy at Gel Health 2009 from Gel Conference on Vimeo.