MC Frontalot: When Does a Meeting Need to Be Face to Face?
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"Let's face it, many hospitals are pretty terrible places," says architect Tim Powers, the senior vice president for the health care studio of Astorino, a design and architecture firm based in Pittsburgh. With more than a billion dollars of health care build in their portfolio, Powers is in a position to issue his grim diagnosis. "Hospitals are traditionally bad buildings. They look bad, they function poorly. They smell bad. And people don't want to be there." And as medicine has become more cutting edge, the construction challenge has been to keep up with the new technologies that the public demands. "We're designing for technology that doesn't' exist yet," says Powers. "Generally architects are recognizing this. But we wanted to deliver something that was more than the sum of its parts."
The new Children's Hospital of Pittsburgh, a 1.9-million-square-foot facility and campus, opened its doors on May 2, 2009 and marks Astorino's best thinking to date on patient centered design. Normally the design process involves in-depth interviews with the client--"how many beds, how many surgeries, how many emergency department visits--the deep numerical analysis that tells you how a building will be used," says Powers. "But we knew that we were building a house with a highly specialized group of people."
The used something they call the Fathom Survey, a methodology created by firm designer Christine Astorino, and daughter of the company founder. (Fathom is now a separate subsidiary of the architecture firm.) She conducted a four month study of hospital patients, their family and the staff, to better understand how a patient actually feels during their hospital experience and how to better address their anxiety--and facilitate healing--through design. Think focus grouping with a huge side of cultural anthropology and some good, old-fashioned listening. "Ethnography, sensory exploration, collage work, creative brainstorming, color analysis, one on one interviews with patients, family and staff, and observing people in their environment," says Astorino. "It's all in there."
The final product is an insight journal that is as much a philosopher's notebook as a design guide, (see this pdf for a partial look) was delivered to the team early in the process. It triggered some heavy thinking. "I know it sounds lofty, but it became clear that the primary deep meaning for this building is transformation-- people that come to this building are expecting that their lives are going to be transformed from an unbalanced state to a balanced state," says Powers. "Even when the outcome is death. We wanted to build a building that would support all the emotional processes." More at DiscoverDesignBuild.com.
They sweated the small stuff: the hospital now has individual patient rooms with individual temperature controls, places for both parents to sleep, and beds offering adjustable heights because kids reported feeling more vulnerable when adults loomed over them. Fun artwork and beautiful colors abound. And the transformation theme starts early--the first thing kids see when they arrive is a "transformation corridor," linking the garage to the hospital, with murals on the floor representing the change of the seasons, and butterflies transforming on the walls. (One element that got nixed were shadow boxes that kids could decorate outside of their rooms, sort of like the hospital version of decorating your own locker.)
But some of the bigger adjustments are on the inside. Most of the traditionally patient-oriented areas like lounges and chapels are typically placed near the lobby of a hospital, making them more marketing features than anything else. "Patients felt exposed," says Astorino. "Those are 'wow factor' items that don't help the healing process." Instead, the team created a town square/atrium on the sixth floor, where patients and staff can gather, play, even watch movies from a 40 foot projection screen, rolling up in wheelchairs to the railing if they need to. No one from the public is mixed in. Adjacent to the atrium is a healing garden, a rooftop where both patients and staff can easily "leave the hospital" safely to decompress and reflect.
The response has been overwhelmingly positive, but the team is eager to link design to healing rates and better outcomes--the first round of data is expected in August. They are cautiously optimistic. "One patient's mother told the hospital CEO that she got the best night sleep she'd had in years," says Powers. "That's got to be a good sign."
A lifetime and a career ago, I was a young entrepreneur with a brand new lease on an empty gallery space near the waterfront in Providence, Rhode Island. One of my first great acts was to borrow a neighbor's broom and sweep the sidewalk in front of my door. I don't know where the impulse came from, it was a gesture I must have seen other shopkeepers do growing up in New York City. I remember that feeling--a bit of proprietary pride with a side of great expectation.
What I didn't know was that at about the same time and right around the corner, another young entrepreneur was doing his own version of sidewalk sweeping. The Boston Beer Company, aka Jim Koch, had finally grown big enough to stop brewing beer in the kitchen. Confident in his product and ability to meet a demand that was surely coming, Koch spent the late '80s making his way through the bars and bistros of New England with bottles of Sam Adams, a hopeful heart and a sales pitch for the ages. Whatever it was, it worked. I had my first Sam Adams at the Hot Club in Providence after a long, weary day of work, somewhere around 1990.
Of the two of us, Jim Koch turned out to be the better entrepreneur.
The story of The Boston Beer Company's success is a complex and exciting one, filled with juicy gossip, history, politics and colorful characters that long pre-date Prohibition. I'm angling to get a story about it in the magazine soon. But until then, I'll enjoy the memories of Jim's visit with my finely tuned beer drinking skills, which we share with you in the video below.
I learned of our parallel lives in my old 'hood during this drinking lesson. But I also got a big dose of what makes Jim a great salesman--and it's more than just his love of the product he makes.
I'll let you decide.
Related Stories: | Topics:Innovation, Technology, Leadership, Management, Ethonomics, business, change, jim koch, boston beer company, samuel adams, beer, sales, , Jim Koch, Sam Adams, The Boston Beer Co. Inc., Providence (Rhode Island), Alcoholic Beverage Manufacturing |
Of all the nonsense metrics I like to use to measure brand strength, the most fun is my Facebook status update. By that shaky yardstick, I'd hit a deep wellspring of brand loyalty when I posted that I'd spent the day at Fast Company HQ drinking beer with Jim Koch, the beloved founder of the Boston Beer Company, maker of Boston's finest brew, Samuel Adams.
The flood of Sam Adams drinking stories, jealous outbursts and requests for beer was immediate and enthusiastic. Conclusion: This is a product with unusual consumer engagement profile and a tenacious brand appeal. (The response had nothing to do with the beer-soaked company I keep.)
Koch is no empty keg. He comes from a long line of brewmasters, sports a double Harvard degree and gave up a lucrative career in consulting to do something incredibly risky that he knew would make him happy. Brewing beer. And now, it's made him very, very successful. With Anheuser-Busch's 2008 takeover by Brazilian behemoth InBev, The Boston Beer Company has become the largest American owned brewery in the United States, and at one million barrels per year, the largest craft brewer. In the process, Koch has become a TV icon nearly as cool as the Clydesdales.
In between beer tastings, Koch walked us through the history of the business, as well as his unique take on philanthropy--and the unusual steps he took to keep fellow craft brewers in business during a recent worldwide shortage of hops.
Video by Michael Shick
The great lament of any reporter is what to do with the jewels that routinely get left on the cutting room floor after a really great interview. For me and many of my colleagues at Fast Company, that is often the "how I do what I do" stuff, the extraordinary insights that we get into the nuts and bolts of how great leaders lead, but don't necessarily fit into the story at hand.
That's why I took a bit of a break from feature writing to work on the 30 Second MBA, an ongoing video "curriculum" of really good advice from the trenches, directly from the people who make business happen. It's the best way I know to capture some of those moments that I often get to see, and bring them straight to you--short, sweet, unfiltered, sometimes entertaining, always relevant. Think of it as a collective video blog of good advice from leaders in their natural habitats, offered in byte-sized bits short enough to be easily recalled when you need it. And the kind of stuff that you don't learn in, uh, slow business school.
We've collected a range of questions from our readers, from the philosophical to the very practical, all in the hopes of creating a conversation about the nature of leadership in a modern world. As you can tell, it has a serious DIY vibe to it, and we'll be including a mix of voices--from the C-Suites of Ford, Intel, Accenture and USAA to name a few--to artists, scientists educators, the military and social enterprise leaders from a variety of fields. Expect more than a few of our cover subjects to show up as well. We want this to be a reflection of the sensibilities of our magazine--about innovation, inspiration and possibility--and inclusive of all perspectives. And we hope it will be fun. But mostly, we want it to become the best advice that our readers will ever get.
Got a big leadership question? Ask it here, or email 30second (at) fastcompany.com, and we'll put it into the mix.
Related Stories: | Topics:Innovation, Leadership, Management, Careers, Work/Life, Magazine, 30 second MBA, business school, leadership advice, business, change, Change Agent, creativity, , Fast Company Magazine, Intel Corporation, Accenture Ltd., United Services Automobile Association |
In this modern age, we have become used to thinking about innovation as the domain of the iterative tinkerer, the weapon of choice for wizards who stay up late to make smaller, faster, cooler circuits and systems. But for Tami Minnier, chief quality officer for the University of Pittsburgh Medical Center, life-saving innovation was as easy as picking up the phone. "It was so simple, it's almost embarrassing to say it out loud," she told me. "But I knew it could save lives."
She is talking about Condition Help, a program she helped create that allows a patient or their family to summon a "rapid-response team" of medical personnel, at any time throughout their hospital stay. In most hospitals, these alarms--the 'codes and crashes' that we know from television shows--can only be called in by staff. Crazy, right? "You can sit on your couch at home and call 911 and someone will help you," Minnier says.
But head to the hospital, when you're already in tough shape, and that authority is taken away. For anyone who has sat by a loved one's bedside and couldn't get even the most basic question answered, let alone a serious one, the very notion of being given the power to get medical attention is remarkable. "For people who are at their wit's end, how can it not be the right thing to do?"
The insight came, as these things often do, after a terrible tragedy. The tragedy belonged to Sorrel King, a grieving mom turned patient safety advocate. In 2001, Josie King was an 18-month-old toddler recovering in the hospital after she was burned in a home bathtub accident. She died suddenly after a series of preventable medication and treatment errors. Her mother now tells the wrenching story on her Web site and to audiences throughout the country. Her simple point: She knew something was going seriously, albeit slowly, wrong with her daughter, and if she'd been able to get someone's attention, Josie would be alive today. Minnier heard King speak at a medical conference in 2004, talking about rapid-response teams organized around patient needs. It got her attention. "I knew it was the right thing for us to do."
Patient-centered care is the new 'new thing' for in health. For all its positive vibe, it's tougher than it sounds. "Health care has historically been an individual profession, not a team sport," says Minnier. "We have empowered the physician to be the smart person, the one who has all the knowledge. Frankly, the more you feel you have to deliver everything, the more self-centered you become."
She cites the explosion of technology as another barrier. "We rely on technology and machines more and more," she says. "The simple act of listening and diagnosing a patient, of using intuition to piece together their condition, we do that less and less." Putting the patient at the center of their own care means taking their feedback seriously--even when they are frightened, confused, or simply overwhelmed. But it's also giving them effective tools to be more in charge of their own health. Letting them hit a panic button and dispatch teams of doctors? Visions of litigious hypochondriacs danced in the heads of UPMC leadership. "There were some concerns that the system would be abused," she admits.
The program allows patients to use the same emergency line that nurses and doctors do. (Just pick up the phone and hit 111.) Immediately, a team is paged and dispatched to the scene in minutes, for anything from a full cardiac arrest to any spiraling health condition. No screaming in vain for a duty nurse, no paging invisible doctors, no fretting while a patient struggles. "It's a fresh set of eyes and ears and completely unbiased," says Minnier. Patients are taught how to use the system when they're admitted and are reminded by stickers on the phone and posters everywhere. "We have pictures of Josie King on some of the materials to help us tell the story," says Minnier. "None of this is rocket science."
But the results have been remarkable. "We now know that 69% of the patients who have used that line would have been harmed if they hadn't called," she said. And they've made significant strides in pain management, the most common patient complaint in hospitals, and the most measured component of patient satisfaction in the data collected by Medicare.
Condition Help was introduced in 2005; it is now being used in all 20 hospitals in the UPMC system and inspiring similar programs around the country. And as hospitals are increasingly being asked to measure things like patient satisfaction and pain management, programs like this are becoming important ways that health systems can differentiate and market themselves.
For Minnier, that only goes so far. "I spend a lot of time asking how we can change the work process to make things safer and less painful for the patient," she says. "Even if I couldn't measure it, it's the right thing to do."
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The President has set out a broad agenda for health care reform, with "patient-centered" medicine as a major touchstone. His visit to the Cleveland Clinic today is a smart choice.
I recently spent more than two days with Delos "Toby" Cosgrove (pictured below), M.D., CEO and President of Cleveland Clinic, and his staff. When Cosgrove became the CEO in the fall of 2004, the hospital had long solidified its reputation for technical excellence, particularly in innovations around heart surgery. But Cosgrove was facing his new job with a new set of challenges, not the least of which was a growing competitiveness within a health-care system that was increasingly focused on wellness and new metrics around quality of care.
And Cleveland Clinic was getting poor reports from patients on the quality of their experience. "It occurred to that that I'd never cared for a healthy person before," says the one-time cardiac surgeon who saw his patients when they were laying unconscious on his operating table.
A series of epiphanies followed, setting the Cleveland Clinic on its own remarkable reform process. How Dr. Cosgrove and his team guided the Clinic into the era of patient centered medicine is the subject of an upcoming Fast Company feature story.
But the empathy piece is worth talking about now.
A recent study by the University of Chicago reveals that 75% of patients don't know their doctor's name or what their doctor does all day, at least as it relates to them. And the doctors who do show up often make you wish they hadn't. A widely followed bit of research on physician empathy from the Jefferson Medical College has begun the daunting task of measuring just how badly doctors can be at connecting with their patients. The news is both grim and oddly predictable. They're not very good at all. "Female doctors have much higher empathy scores. Docs in psychiatry, pediatrics, family, and ER medicine tend to be more empathetic," says Dr. Bridget Duffy, an internist and medical empathy and patient experience expert.
Duffy has worked with the Cleveland Clinic, among other facilities, to reorient their systems to be more patient centered. "Cardiovascular surgeons have the least." (Heart docs are joined at the bottom of the list by anesthesiologists, orthopedic surgeons, and neurosurgeons.)
Of course, not all doctors are unresponsive or imperious jerks, and there are plenty of others who would love a chance to show off their bedside manners, if only they had the time to perform their healing arts.
Now, they're going to have to.
In the last few years, Medicare has started requiring associated hospitals to collect feedback from patients about how their visits went, everything from how communicative their doctors and nurses were and how their pain was managed, to how clean and quiet the facilities are. The kinds of things that empathetic caregivers tend notice and do well.
There's a lot at stake--certain reimbursements are linked to these scores--and hospitals have already begun to use high marks as a marketing tool. And some, like the Cleveland Clinic, have gone to extraordinary lengths to value patient input, even including patient feedback in physician performance reviews. But the other bottom line is better health. "Physicians that have the higher empathy scores have better health outcomes for their patients and fewer adverse events," Duffy says.
But can bedside manner be taught?
Medical schools and hospitals may want to take some tips from the business world. DDI, a leading international consulting firm, believes that empathy has a similar importance in the workplace--and has had good results in opening even the hardest hearts in the C-suite.
"There is a clear relationship between empathy on the part of a leader and their perceived effectiveness," said Doug Reynolds, an unflappable PhD who conducts behavioral and psychological assessments for DDI that help corporate clients screen for leadership qualities in job candidates. (Which can be exactly as scary as it sounds.)
The data DDI has collected from years of assessments shows that empathy helps a leader do everything they need to do better, and demonstrably improves everything from company performance to employee tenure. It all boils down to trust. "Empathy is a component of essential leadership tasks like coaching, gaining commitment from peers," he says. And it can be taught.
Mostly.
Reynolds says that empathy has two parts, one of which is behavorial. That's the part that can be taught: Leaders can be encouraged to stop barking orders, listen for 'empathy cues,' ask better questions, and mirror back what someone has said to let them know that they've been heard. "We can give you a positive model for what it means to listen to a subordinate and respond empathetically to them with feedback," he says. This training, which is specific to individuals and industries, seems to work. "We saw a 32% improvement in the number of observers who reported that their leaders listened and responded with empathy "often" or "almost always" after training," he says.
What cannot be taught, however, is that deep magic, when a person is actually feeling the other person's emotions, the truest definition of an empath. "That's a personality trait," Reynolds says.
My conversations with Cosgrove, Duffy, and others at the Cleveland Clinic have left me optimistic. "I was a huge part of the problem," smiles Dr. Cosgrove. "I call myself a recovering heart surgeon." The early days of heart surgery, when a patient was as likely to die as live, hardened his shell.
The combination of the poor report card, the changing nature of medicine, and his new perspective as an administrator focused Cosgrove on an uneasy reality. Miracles in the operating room simply weren't enough. "My God, I missed it," he admits. "In my journey, I got so consumed with making people live, I forgot all the rest of it." And listening to the patient, something the Cleveland Clinic is learning to do and replicate, is the ultimate empathy cue.
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"We've gotten good at market transitions over the years," says Sue Bostrom, Cisco's CMO. "Market transition" may be a charming euphemism for meltdown, but Cisco's real transition has been to use technology to connect with prospects. Bostrom, a twelve-year veteran, made a bet two years ago that the web could provide the information customers need about Cisco products, but also research for their own business needs. "People are coming to the internet to search, coming to find experts and expertise," she says. "We needed to embrace that." That embrace has turbocharged Cisco.com from an expert resource for about 15 million visitors a month into a lead-generation engine of real power.
In the past nine months, Cisco's site has rolled out a "virtual account manager," an online system that does all the things that expensive salespeople do--chat up prospects, make them comfortable, and build relationships. "The key is personalization," says Mike Metz, Bostrom's senior director of Web marketing and strategy. "We pay close attention to what people do when they come to Cisco.com, from how they got there to what they click on." Usability testing has increased the amount of targeted information they’re able to deliver. Now nearly 40% of visitors get helpful information based on their searches. "If we figure out that you live in Chicago, are interested in health-care information, and need to learn about wireless, we can direct you to a healthcare and wireless seminar near you."
When a prospect is ready to make a decision, the site cinches the deal. Let's say you're an IT manager from upstate New York, shopping for a phone system for four offices. A phone call, or click-to-chat feature, connects you to a person who knows your history as well as the details of the specific product you need. You can then be connected on the spot to an authorized Cisco reseller in your area to schedule an in-person consult. "It can all happen in real time," Metz says. Cisco has introduced the virtual manager in 35 countries and 14 languages. "We're converting about 15% of those prospects," he says, resulting in hundreds of millions of dollars in revenue. "There aren't enough salespeople in the world for what we need to do."
To read about how Corning, IBM, Intel, and Schwab are weathering the current economic storm, read “Through the Fire” from our June issue.
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