Signals From Beyond our Biology and Bias in Healthcare Engagement– The Umwelt

richard schwartz

“ Once in a while you get shown the light
In the strangest of places if you look at it right.” ~The Grateful Dead, Scarlet Begonias

As a trend-spotter, my productive time is spent looking at what is happening in and out of the industries on which I focus. My clients and partners who use my reports and perspectives don’t just expect a write-up showing a handful of trends, The What. The context and actions found in The So What and The Now What are where the relevance and opportunities lie. It is kind of like the difference between the geological society letting us know a massive storm is coming. While important, the real substance is in the preparedness for it, the support during it, and the outcomes after it.

Make Me Dangerous

The best request I’ve had in recent months came from a client sitting in a café in Germany. With complete and unshakable seriousness, they said, “I need you to take these trends and insights and do two things for me . . . make me dangerous and keep me out of danger.”

I love well-crafted words and this for me was very clear. But this could not simply be What, So What and Now What. Healthcare is increasingly horizontal, new entrants are creating new paradigms threats and opportunities, and we have increasingly powerful technological tools — yet to be well-harnessed. This request needed insights and direction involving myriad variables including the clear and the translucent. It had to connect the expected and the unexpected.

I returned to my hotel, tired from a long day and noticed the placard on the towels. You know the one — a picture of a lush waterfall and a recycle symbol. Regardless of the language, it is clear it means to re-use your towel. This one was in German, and while my comprehension of the language is decent, there was a word I did not know, “Umwelt”.

So, I did what most curious people do — I Googled it and that was the rest of my night.

The Umwelt

Umwelt loosely translates to “environment”, but the true meaning has no English counterpart. In short, it means the environmental realities as dictated by our biology as individuals and/or a species — ‘the world as it is experienced by a particular organism’. The simple example is that the sounds a bat hears and the smells my three hound dogs detect are in the environment I live in — my Umwelt. While they are very real, present and potentially influential, my biological limitations prevent me from perceiving them.

In the early 1900s, German biologist, Jakob von Uexküll established crucial thinking on the Umwelten in the information processing of a given organism. His work is the foundation of Semiotics (the study of signal intake, processing, and actions) and is still cited as pivotal in the advancement of, AI, computer science, robotics, and IoT.

I was rapt.

I got tangled in the correlation to business and my client’s pressing request to make them dangerous and keep them out of danger.

The business challenges and opportunities we have all exist in their own Umwelt, that world we do not see because of our biology and our biases. How dangerous might we be, if we could see beyond our natural and self-imposed limitations? How much danger might we avoid with more keen environmental perceptions than our competitors?

The Problems We Are About to Have May Be Our Best Opportunities

How many companies and industries have missed environmental signals only to find themselves ensnared in a tangle of reality that simply crushes the life out of them? Blockbuster, Kodak, Retail, Taxis, Newspapers are quickly conjured up as victims of biases and biological limitation to perceive the clear signals that could have kept them out of danger. Even GE, delisted after 110 years, sits on the edge and must look beyond what they understand and want to be true and embrace realities in a world either ignored and imperceptible.

Why did they miss these signals? It is simple, bias and biology prohibited them from seeing the hungry drooling wolf on the ridge. And do not think for a moment that wolf that eviscerated ravished Blockbuster was Netflix. Tenacious ideals ate Blockbuster. Romantic notions from the gravitational pull exposed the limited selection of boxed films, tubs of microwave popcorn, and an overall crappy human experience.

In the end, firms that ignore signals, passively or actively, forget that they are in the service of satisfying the customer’s end goal. Their big transformational thought was a pivot to selling 1/4 inch holes instead of 1/4 inch drill bits. Well, no one wants to buy a 1/4 hole either. Do they?

Organizations who ingest and respond to signals recognize what people want and then shorten the time and distance between the two in a great experience. Those that hold on to the past — they get better and better at what matters less and less.

The Health Umwelt — Three Thoughts to Explore Beyond Your Biology and Bias

  1. Imagine A World Without You

Microsoft’s Corporate Vice President of Healthcare, Peter Lee recently shared a thought he and his team explore to better contextualize the value and necessity of their role. Inside our limited environments, we perceive every idea we put forward in a pitch or a proposal as valuable. Naturally, as the merchant of the idea, we are central. Lee’s approach is somewhat of a reductive introspection or a bullshit detector — depending on how you look at it. They ask,

If Microsoft were to disappear tomorrow, in what ways would the healthcare industry be harmed?

In the overlapping Umwelt in healthcare, every vital player is focusing on outcomes and experiences. Your addition to any solution here may be vital, but other’s may not see or understand it due to their gated view from their own cocoon. By removing yourself and being honestly introspective about what becomes lost or suboptimal, you have a better understanding of your real value and how to help others understand it. You may discover you are the lynchpin other do not see or a commodity everyone else sees through. Either way, you have work to do and a clearer direction of what that work is.

2. Deference to HIPPOS

Let’s face it, the individual beliefs and biases that enable HIPPO (Highest Paid Person’s Opinion) decision-making have been present within patient and practitioner engagements for a long time from manufacturers, systems and payers. Today’s leaders are weaponizing data to inform, validate, and adapt decisions. Insights we get beyond the predispositions of individuals or ‘the way we’ve always done things’ enable exploration of influencing factors that were likely ignored, unspoken, or not considered in the first place. Even as leaders adopt machine learning to support decisions, there can be an inherent bias in the algorithms themselves. Egos ignore critical data and create algorithmic echo chambers.

Not considering aspects like Social Determinants of Health (SDOH), creates vague and vacuous segments of many that tell us cohorts of people all behave in the same way. We have to look at the factors that influence behaviors and decisions on the fringes of the curve instead of homogenized opinions. These signals often are most valuable when gathered from the source — the end user.

When Dell began planning for the launch of their specialty clinics in 2015, they leveraged their embedded Design Institute for Health to look at the optimal service model and physical layout to optimize everyone's experience in the clinics as well as outcomes.

Dell Medical School was founded on principals that challenge norms. They consumed and responded to signals in the Umwelt of patients, practitioners, families and — in the end, made a bold and seemingly radical decision . . . no waiting rooms. Instead of the patient moving through a series of waiting rooms for doctors, labs, and paperwork, they realized there were value and efficiency in placing the patient in a central space of their own and everyone coming to them. It is a fascinating use of real-world signals to challenge the way things have always been done.

Likewise, NHS recently took on a massive effort to prepare their workforce in order to best realize the value of digital health. Key to this effort was signals gathered from constituents through perspectives and actions. Their final report, The Topol review, led by cardiologist, geneticist, and digital medicine researcher Dr. Eric Topol, is worth reading and clear evidence of using signals to direct plans and actions.

In both cases, HIPPOs played a much smaller role than signals that might have gone unnoticed or ignored altogether.

3. The Signals You Look at Are the Answers You Get

Healthcare entities look at signals around diagnosis, prescribing, search, social, site visits and behaviors, media consumption, benefits, access, and a host of others to help inform and validate tactics. With the elevation of digital from the help desk to the corner desk and the influx of Chief Digital Officers, signals being are increasingly looked at from behavior perspectives and from the digital exhaust we generate with each interaction. Both Sanofi and Lilly have partnered with San Francisco based Evidation Health. Evidation collects and analyzes signals generated from behaviors outside of the doctor’s office or hospital that relate to an individual’s health and impact their outcomes. Evidation’s data platform can ingest individually-permissioned real-time data from more than 100 sources ranging from Apple Health to Fitbit, Epic, and Blue Button. The processing and decisions designed from these signals take engagements from being labeled patient-centric (seemingly designed for the patients based on interactions and observations) to enabling patient-mediated solutions (specifically designed because of actual behaviors and real-world insights generated by segments of one.) Evidation’s CEO, Deborah Kilpatrick, sees the data bridging a “divide between the patients experiencing outcomes and the providers of healthcare solutions trying to improve them”. In the emerging era, “patients themselves, and their data will directly bridge this divide.” If a practitioner only has the thirteen-minute office visit and some lab work to make decisions and a plan, we may be hoping for the best. Armed with insights from all the time the patient is not with them enables doctors to watch over the 5,000 hours they are not with them.

Make me Valuable

Today, I look carefully at the Umwelt in the perspectives and recommendations I provide. I had fallen for the catchy the phrase — “make me dangerous,” but my explorations beyond my biology and bias have created a pivot from danger to value. The actual danger is in doing things that do not actually generate value and staying out of harm’s way means you might be hiding from the skinned knees from which you need to learn. We won’t create value for patients by resting in our echo chambers, the world is moving too fast, availing to many opportunities, and it is not waiting for you.

“The pace of change has never been this fast, yet it will never be this slow again.” - Justin Trudeau — Davos 2018

If we are to truly realize better experiences and outcomes and democratize the signals generated by people in the umwelt, we must have consent and our goal must be to “Make it Valuable and Keep it Generating Value”.

Richard Schwartz is the co-founder and Chief Connectivity Officer at Rapt Health. Rapt is a partnership-focused consultancy specializing in connecting people, companies, technologies, and ideas to create exponential, outcomes-focused health solutions.

richard schwartz

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