A MANDATE TO PUT THE “CARE” BACK INTO HEALTHCARE
We all hope the healthcare partnership announced in January by Amazon, Berkshire Hathaway, and JP Morgan will improve efficiency and lower costs of healthcare delivery. And we hope the recent Apple announcement that it’s launching its own healthcare centers will meaningfully advance healthcare. But what Americans need now, beyond announcements and press conferences, is for Jeff Bezos, Warren Buffett, Jamie Dimon, and Tim Cook to innovate by putting much greater emphasis on empathy and patient satisfaction.
When Amazon, Berkshire Hathaway, and JP Morgan announced they would launch a healthcare partnership, I was pleased. Then Apple announced that it would launch medical clinics, and I developed renewed hope for the future of healthcare delivery in America. Private sector leaders and initiatives can help revolutionize and disrupt healthcare delivery by creating more competition and setting a new standard of healthcare delivery.
The challenge is, before they can revolutionize healthcare delivery, they fundamentally need to disrupt the underlying culture of healthcare. The primary improvements the leaders of these initiatives have focused on publicly have been technology, transparency, cost, and outcomes. For sure, those are critically important areas of focus. After all, most of us know the basic fact that Americans spend trillions on healthcare with outcomes that are worse than in most developed countries.¹ And we know that fraud, waste, and inefficiency constitute over 30 percent of this. No one can argue that transparency is needed. It’s nothing new or innovative.
The leaders are going for sound bites and easy wins. But it’s vitally important that the new private sector healthcare leaders start emphasizing, even more than technology, transparency, cost, and outcomes, the “care” part of healthcare. This is because only by prioritizing care — the much-forgotten part of the trillion-dollar, compound noun, “healthcare” — can the industry reach better, more satisfying and less expensive outcomes for patients.
With that driving premise, I believe that care, empathy, and patient satisfaction are the most important features of healthcare delivery that require innovation by our new, private sector healthcare leaders, I offer here a short list of recommendations:
Number One: please focus, really focus, on the patient experience.
Patients visiting a healthcare provider are nervous because something may be wrong with them — they should expect empathy and care, and to retain their dignity. We need to demand this. See, it costs the system nothing to treat people with respect, such as physicians and staff members identifying themselves by name, addressing patients by name, directing patients to the right places, and smiling. When I led an ophthalmic implant company, we trained our salesforce to help physicians run clean, efficient medical practices in attractive, comfortable settings with a professional, caring staff, and to manage a patient experience designed to be pleasant and efficient. These efforts set apart the company and generated goodwill for the physician’s practice.
I haven’t run that company for years, but I regularly experience the change in healthcare delivery since those days. I recently saw a frail, old woman enter an endoscopy clinic where I, too, was a patient. I noticed the receptionist behind the sliding glass window made no eye contact, had no name tag, and didn’t introduce himself. He directed her to sit in the dark waiting room littered with old magazines. If her experience continued as mine did at the same clinic (I believe it did), then someone told her to change into a flimsy hospital gown, a nurse started her on an IV, and four hours later the procedure began. In my case, the results of the procedure required me to undergo another procedure and $260,000, two-night hospital stay with a single line item breakout of $60,000 for “medical supplies.”
Replicate that woman’s and my experiences across the country millions of times annually and it adds up to the sad reality that many physicians and nurses are burnt out and cannot fulfill the ‘care’ part of healthcare. Patients are dissatisfied.
Meanwhile, benchmarking against best-in-class operations shows that change is possible! I recently had another appointment at a surgicenter outside of Boston. A receptionist addressed my wife and me by name and escorted us to a kind floor nurse (who had previously phoned me to introduce herself and answer questions). Each practitioner introduced himself or herself, asked if we had questions, and outlined the process. When we left, we received a card listing names and roles of everyone we had met. Also, the venue was attractive, which underscored the importance of physicians’ offices being open and welcoming, making sure the people in charge know how to create this environment. As we left the facility, the staff gave me a card with each of the caregivers name and what he or she did.
Number Two: develop new models for hiring and staffing, please!
Healthcare providers hire people with low affinity for service, and they do this all the time. We need the new initiatives to hire people who treat patients sensitively and well. We need the initiatives to put a stop to the bad habit of prioritizing expedience and costs of the hire and begin a new habit: prioritizing recruiting competent people who have an affinity for the role. We need them to recognize that a bad hire costs more than getting it right initially. We need the people managing these initiatives to take time to define and specify the skill sets required for the position. In fact, they should start working with recruiters who have the expertise and contacts to identify and help hire the right people for the right roles.
Take this example of how Starbucks recruits for its Barista position. The company says, “Baristas [should] personally connect with, laugh with and uplift the lives of our customers — even if just for a few moments.” If Starbucks is clear about how the frontline workers should represent the company, these initiatives should do the same. Further, they should hire more people who have worked in high-touch service industries outside of healthcare.
The private sector initiatives should do much more to utilize the skills of high value providers such as Physician’s Assistants (PAs) and Nurse practitioners (NPS). These are medical professionals who practice and prescribe medicine and are trained in team-based care. They greatly improve productivity and throughput and reduce patient wait times. That said, we don’t see PAs (and NPs) in physician practices often enough. Over 115,500 Certified PAs work in the US today, but there are more than a million doctors. The private sector healthcare initiatives need to be a part of changing that ratio.
Number Three: build a culture of empathy!
It’s an indisputable fact that when doctors show empathy for their patients, outcomes improve and errors and malpractice suits decline. We know that training doctors in empathy produces happier doctors who experience less burnout.² And we know that physicians today feel overloaded and overwhelmed because they are required by forces-that-be to focus on throughput more than on care. Sadly, physicians have by and large lost personal contact with patients, which means that the patients in turn become stressed and anxious during visits.
Dr. Helen Riess, director of the Massachusetts General Hospital Empathy and Relational Science Program, told US News & World Report last year, “So many of my patients were dissatisfied by the quality of the office visits with their physicians. They really didn’t feel the care that was supposed to be a part of health care.” Dr. Riess co-founded Empathetics, Inc., which provides empathy training for healthcare professionals. (I’m an investor in and director of the company.) I was talking with Empathetics’ COO recently, and he told me he has spoken with many hospital organizations and understands their troubles and motivations. He said investment in empathy training has evolved from being optional to being a must-have, largely because empathy training reduces staff burnout and turnover and helps hospitals achieve baseline patient satisfaction scores for superior reimbursement from the Center for Medicare and Medicaid Services (CMS).
It’s good that hospitals are investing in empathy training, and I sure hope the new healthcare initiatives will do the same. However, I also hope they’ll make their overarching motive for an investment in empathy not CMS reimbursements and reduced turnover, but rather the holistic, patient-centric strategy of building an organizational culture of empathy. As Starbucks reinvented the coffee experience by trying to become an extension of America’s ‘front porch,’ these new medical organizations need to reinvent healthcare delivery by becoming front lines of empathy.
Number Four: allow physicians to practice medicine.
Physicians aren’t trained to manage people or complex organizations and should only rarely be business leaders. I read a story in an urban newspaper this year about how the then-CEO of a major medical center took a hardline approach after nurses staged a walkout by locking the nurses out of their jobs for four days. The physician-CEO’s tactic damaged the system’s relationship and trust with nurses. The parent company promoted him to chief physician executive of the larger health network where he’ll oversee a strategy aimed at improving the patient experience.
The new healthcare initiatives need to avoid making promotions like this! The former CEO’s medical background doesn’t list experience identifying and solving workforce problems and complex organizational issues. As a longtime life sciences business leader, I can’t foresee how this skilled physician will improve care delivery for the nearly billion-dollar enterprise.
The new healthcare initiatives must make better business moves than this by aligning the organizational structure with the priority of delivering a positive patient experience. The organizational decision-making endemic to the industry needs to change, and the new healthcare initiatives should lead the charge. U.S. News & World Report had an article a few years ago indicating that a meaningful percentage of new hospital CEO hires and executives would come from outside healthcare. Featured in the story was the CEO of a hospital who had a business background and no medical background. The journalist, Christopher Gearon, explained, “[The CEO] is in the vanguard of a trend that appears poised to sweep through the hospital industry. Hospital boards increasingly want that outside perspective, along with some different skill sets–and are willing to hire outside of the industry.”
Number Five: establish real accountability for a positive patient experience
Currently, good clinical results supersede bad patient experiences, and not enough people are held adequately accountable for providing an empathetic patient experience. We need healthcare leaders to consider good results and good experiences to be coequals, and to establish true accountability for this.
Of course, hospitals operate under the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) provision in which patients score their provider through a patient satisfaction survey. And CMS withholds reimbursement for institutions scoring poorly. But, okay, let’s get real — does anyone think there’s much correlation between the survey questions and superior patient experience? I can answer that rhetorical question by saying there wasn’t much correlation for me. Following one unpleasant experience, I received a survey with questions that basically asked whether I was treated like a human being. The survey questions didn’t get to the crux of the issue of putting empathy and care into sustained practice.³
Also, in terms of accountability, many institutions have a patient experience officer who lacks authority to make change. It often seems these institutions hired patient experience officers to help lessen the financial penalties of HCAHPS rather than to improve the patient experience in meaningful ways.
I’m talking about true care and accountability. This might involve, for example, these initiatives ensuring CEOs of facilities, divisions, and organizations who manage by walking around, who notice where problems lie, and who take action to fix the problems. As a young Army officer, I was aide de camp to the Commanding General of Walter Reed Army Hospital, Major General Carl W. Hughes. Each morning we spent at least an hour walking the hospital grounds, patient wards, and administrative offices. We were visible, present, and aware. We chatted with patients and asked questions. General Hughes demonstrated that he cared about patients. He noticed problems and went about urgently fixing them, thus enhancing the patient experience.
Having spent nearly many years attempting to effect change in this most conservative life sciences and healthcare marketplace, I’m disturbed to know that most people believe the above patient-centered healthcare delivery measures are impossible to achieve in their lifetime. Tragically, Americans have been conditioned to accept not only a lack of cost effectiveness, good outcomes, and transparency but also a dire lack of empathy and care.
Bezos, Buffett, Dimon, and Cook are innovators and leaders who can absolutely lead the charge in changing this culture. They should start by publicly prioritizing empathy and care over costs and transparency. Their new initiative must be a changemaker that develops and infuses into the marketplace empathy- and patient-centric strategies. Until their initiative does this . . . until they, as leaders, do this . . . we won’t see true cultural change in healthcare delivery, which ultimately drives better systems, structures, and outcomes, and therefore lower costs. Alas, the frail, old woman I saw in that physician’s office — a woman who has likely paid tens if not hundreds of thousands of dollars into the healthcare system — and all 290 million insured Americans, will need to continue to withstand the poor results, the loss of dignity, the scowls, the uncomfortable waiting areas, and the overworked providers in the wrong roles.
¹ Outcomes for US healthcare are often worse than in many developed countries that spend far less per capita delivering care. The Commonwealth Fund published a report showing US spending to be higher by a wide margin than 12 comparison countries and outcomes to be worse (Exhibits 1 and 9). Second, a 2017 Atlantic magazine article discusses a paper published in the journal Health Affairs, writing, “The U.S. has one of the largest income-based health disparities in the world. Among the poorest third of Americans studied, 38.2 percent report being in ‘fair or poor’ health, compared with 12.3 percent of the richest third. Only Chile and Portugal have a larger income-based gap in the health status of their citizens.”
² Facts and ideas about the beneficial effects of physicians with empathy are widespread. Here’s one article in The Atlantic on the topic.
³ HCAHPS won’t change the culture towards one of empathy. The analogy I make is with manufacturing, where ISO is a global standard for ensuring manufactures follow standard quality procedures. The standard saying about ISO is that it does ensure consistent manufacturing standards, but a company could still manufacture cement lifejackets.