When will we start being more human?
Time to stop monkeying around
I was recently chatting with a colleague who recounted the following story about an experiment that was done with set of monkeys:
Four monkeys were put in a large cage. A bunch of bananas hung from the top. But if any of the monkeys tried to get the bananas, ALL of the monkeys were sprayed with a blast of cold water from a firehose mechanism. Soon the monkeys learnt not to go for the bananas. Not only did they not go for the bananas, if any monkey appeared to be going for the bananas, the others pulled it down.
After a few days the researchers took away the apparatus to spray the monkeys. But the monkeys continued to avoid the bananas.
The researchers then replaced one of the original four monkeys with a new one. The new monkey saw the bananas and went for them. What did you think the other monkeys did? Pulled that monkey down and prevented it from getting the bananas.
One by one, each of the four original monkeys were replaced. In each case, the new monkey tried to go for the bananas and was prevented from doing so by the other three monkeys. Finally, none of the original monkeys were in the cage, but still no one ever went for the bananas; and if one tried to, the others would stop it.
“It’s just how things are done…”
Regardless of the verity of my colleague’s story, it made me reflect upon some recent frustrations and how myths, stories and learned behavior shape us and our institutions.
“It’s just the way things are done.” “I’m sorry, but those are the rules.” “I would like to, but I didn’t make the rules, I just follow them.” How many times do we come across these statements? Too often, in my opinion. Yes, sometimes there are reasons for the rules, but most times it seems easier to hide behind the rules, processes and precedence than to truly understand a need or look for a creative solution.
Why does this persist? It’s a systemic issue, a self-reinforcing problem of power and apathy. Managers seek power from the system to fill the void caused by lack of empowerment. Employees turn increasingly apathetic after constantly being beat down. Complicate it with the toxic litigious environment (or simply the belief that it exists) that has permeated life in the U.S. The result: like the monkeys, we tend to perpetuate systems long after the impetus has changed.
I encountered this recently at the doctor’s office where we’d gone for a healthy-kid check-up (shots and a weight check). One of our kids had broken out in a mild rash the previous week, but it didn’t look too bad and wasn’t bothering him, so we figured we’d watch it a bit more closely and ask the doctor about it at the scheduled appointment. When we turned up at the appointed time, we first had to wait for 20 minutes before we were seen. Mind you, this was first thing in the morning and there was only one other family in the waiting room. There was no bustling, or even sign of life, anywhere in the clinic and really no time to have a backlog, given that it was still early in the day. But we’ve been trained to except delays at medical offices — because the system has been structured around the needs of practitioners and documentation, not patients. Fine. Irritation levels heightened, but tolerable.
As the kids were getting prepped for the shots I asked the nurse if, when she was done, she could take a quick look at the rash. She immediately said, “Oh no, this is just a visit for the shots and weight check. You need to make another appointment for that.” I persisted. Bad move. All the expected responses emerged: “That’s the system…,” “this is a different type of appointment…,” etc. My irritation levels were now high. Another nurse came to placate me. Finally with the threat of leaving and never coming back, a doctor was found who could take a quick look. After a two-minute observation and conversation, the doctor confirmed what we had suspected: nothing to worry about. As the second nurse, who had been a nurse for over two decades and used to be an “advice nurse,” made a new reservation in the system for us (because that was only way to proceed), she explained that in this facility and with the current system, she was not allowed to do what she was trained to do. I have to point out that throughout this interaction neither of the two nurses even glanced at our son’s rash. They went into an automatic mode of what can’t be done and why, without even looking at our son to consider the request or employ their expertise.
I recognize that my criticism of the nurses in the context of the current healthcare system may be unfair. Healthcare practitioners function within an extremely litigious culture and have responded with process, rules, and systems to protect themselves. It’s a CYA-first system. It’s understandable. But is it sustainable? How long can (increasingly) high-cost and bad service survive? With the advent of ‘Obama-care’ urgent care centers and ‘minute-clinics’ are booming. A service orientation will go a long way in non-critical (read, most prevalent) cases.
But, does it have to be that way?
This example highlights the incredible opportunity for any new entrant to very quickly differentiate itself from the pack. Empower the employees to listen and address your customer’s needs, reduce barriers to getting shit done, and see how fast the word spreads. You don’t need to market anything — your customers will do it for you. A breath of fresh air in these stultifying times goes a long way.
For my own care, I am a member of a healthcare clinic start-up called One Medical, whose goal is exactly that: hyper-focus on convenience and improved service. Their offices don’t look like medical complexes. More like a modern office. You can book your appointments, upload your medical records, manage them, and do much more through their website or a smartphone app. Like the rest of the companies of the 21st century. But, starkly unlike most incumbent healthcare systems. Appointments are never delayed more than 10 minutes and customer service comes first.
That same week that we took the kids to get their shots, I was at a One Medical center. But the interaction started a few days prior to that when I called to make an appointment. I called, rather than booking online because I was looking for specific expertise. High-cholesterol and diabetes run in our family, and I wanted someone who could look at all of my medical charts — blood tests, VO2 metabolism tests, genetic sequencing profile (I’m on a bit of a quantified self quest currently), etc. — and provide holistic guidance around care: nutrition, exercise and (maybe) drugs. The person who answered the call listened to my request and context and worked me through the options. I wasn’t stuck in an Integrated Voice Response system for 10 minutes, and she didn’t transfer me to three other people. She had knowledge of their capabilities, and equally important, paid keen attention to my needs. Within a few minutes we had collectively worked our way to two options, and I picked a Physician’s Assistant based on her background (focus on cardiac conditions), availability (within two days) and location (a few blocks from work).
And the appointment went just as smoothly. Not only was I in and out exactly on time, we went through all of my tests, and I had all of my questions answered plus an action plan: try a change in dietary habits, log my food intake, measure my blood sugar levels regularly (feeding my need for more data), see a nutritionist and make an appointment to re-do my blood tests in three months. Oh, and we also scanned and uploaded all the test results I had brought with me and updated my health insurance information. All in the allotted time.
There is a nominal membership fee to join One Medical, but for me it is well worth it. One Medical has actually switched my perspective from ‘avoid healthcare facilities unless in dire need’ to ‘maybe I can actually focus on prevention.” Not only did they gain a customer, they increased the services rendered. It has actually grown the market rather than just taken a share of it. And, in the long-term in will likely cost me, and my insurance company, less given my focus on health and prevention.
The underlying problem isn’t endemic to the healthcare system. Take the convenience and service orientation of Uber and Lyft compared to the typical taxi companies. Or consider the customer service focus of Zappos or Amazon. These and many other start-ups have won customers, taken share from incumbents, and grown the market, primarily by addressing customer needs that had been ignored by the incumbent providers. By being human. By recognizing individual needs and being willing to break norm and revisit assumptions. By going for the bananas.
It’s time to revisit our assumptions
Laws, rules, systems and processes (for the most part) were developed to protect us. Sometimes from ourselves. But they require periodic revisiting. Times change. The original context and assumptions may no longer apply. If you don’t revisit them, someone else will. Hiding behind rules and regulations is a defensive move at best.
The nurses at the clinic could have heard our request and taken a look at our son’s rash. They could then have triaged us to either see a doctor (because they weren’t trained or confident of their opinion) or caveated their opinion and given us the choice on whether we would like to see a doctor to get another opinion. Even if it were an erroneous opinion, not all errors lead to litigation; only the egregious ones. Hiding behind that excuse is systemic and systematic laziness.
It’s time to be more human. It’s time to empower our employees and revisit our assumptions. We, who we serve, and the world will be a better place if we do so. And, we’ll get the bananas.
