Stop to consider the people you care about most. Some are no doubt only alive today because of advances in science and technology. Putting aside the the fact that many of us have been saved by vaccines, I think of my daughter, who has Type 1 Diabetes, saved by artificial insulin; I think of my father, who recently had an abdominal infection, saved by antibiotics; I think of my friend who nearly died in childbirth because of internal bleeding, saved by surgery. All of them—as well as myself, saved by diagnosis, surgery, and radiation treatment for cancer over 20 years ago—would have been dead 100 years ago.
Today, the average life expectancy in the U.S. has risen to nearly 79 (despite falling behind the rest of the developed world). But even with the additional years of life that so many of us enjoy due to advances in medicine, trust in the healthcare system is in marked decline. In 1966, when life expectancy in the United States was 70 years, nearly three-quarters of Americans said they had great confidence in medical providers, but by 2012 this number had fallen to just one-third of Americans—even though we had gained another eight years of life on average over that time. No doubt this mistrust has little to with medicine itself and everything to do with economic anxiety. Medical debt is the leading cause of bankruptcy for American households. We get far less for our money in the United States for medical treatment compared to other countries, while at the same time being required to navigate a confusing bureaucracy that demands we unravel Kafkaesque intricacies of insurance enrollment, FSAs, HSAs, co-payments, and pre-existing conditions to get the services we need. It’s hard to have confidence in an inefficient system that threatens to leave you destitute if you take advantage of its benefits.
Contrast that to the sharing economy. Every day, we put our trust in connected services that suggest we and our children hop into cars with complete strangers, help us to invite strangers to stay in our homes, guide our love lives, and allow delivery people to open our front doors to drop off packages. Meanwhile, we are seeing ever-decreasing trust in a highly regulated industry populated by people who have dedicated years of their lives to becoming experts, and who regularly save our lives. Why is this? And what can the healthcare industry learn from the sharing economy?
The sharing economy is built upon service and interaction designs that engender interpersonal trust, since those services rely upon users to personally trust their Airbnb hosts (or guests), their Lyft drivers (or riders), their Tinder dates, and so on. We trust others who:
- Are honest and authentic
- Are empathic toward our needs
- Act predictably and logically (which requires, of course, that they know what they’re doing)
The design of these services foster a sort of golden rule: Do unto others as you would have them do unto you–lest you get a bad rating and become shunned by the community.
Beyond digital services, interpersonal trust is the basis of our entire system of automotive transit: We trust that the other people hurtling along at breakneck speeds in two-ton hunks of metal aren’t going to mow us down while we’re walking on the sidewalk, or crash into us while we’re inches away in our own speeding death-machines. Sure, accidents happen, but insofar as the whole system works, it’s because we trust that other drivers are people just like us, with the same needs, and same desire not to get into a wreck. (This is perhaps why people have a higher opinion of their own doctors than the medical industry as a whole, despite doctors’ increasingly compressed time with patients.)
One place the healthcare industry might start when considering how to build or repair trust is to evaluate its products, services, and communications vis-a-vis the principles of interpersonal trust that the sharing economy is built upon. Let’s take a closer look at how:
Honesty and authenticity
The first step here is to clarify an organization’s promise to people: What value do you create in the world for people? Why do they engage with your product or service? It’s crucial that a promise be straightforward, free of puffery, and realistic. It should be a cogent, crisp explanation of how somebody might, themselves, describe the impact you make in their lives. This promise can be inspiring and aspirational, but it also must be something that you can track back to actions.
Consider the mission statements of a few of the leading healthcare companies in the Fortune 500:
UnitedHealth Group: Our mission is to help people live healthier lives and to help make the health system work better for everyone.
CVS Health: We are a pharmacy innovation company with a simple and clear purpose: Helping people on their path to better health.
Anthem: Anthem is working to transform health care with trusted and caring solutions.
Humana: We work to empower our members and help them live healthy, active and rewarding lives.
Pfizer: Our purpose is to innovate to bring therapies to patients that significantly improve their lives.
Mission statements such as these can only positively impact trust if they do two things: direct the creation of products and services that follow through on the mission statement’s promise(s), and (presuming products and services make good on the mission), inform marketing communications so that consumers are aware of and understand the promises. If a mission statement doesn’t help an organization to do either of these things, it’s probably worth revisiting the mission statement itself.
Healthcare mission statements suffer a challenge in that insurers, providers, pharmaceutical companies, and pharmacies alike make pretty much the same promise: “helping people on their path to better health,” helping “live healthy, active and rewarding lives,” to “help people live healthier lives,” and so on. The promise of helping people in their quest for health is noble, and may be true, but lacks specificity that people can believe in and see in their lives.
Consider that only 9% of U.S. consumers believe pharmaceutical companies value their health over profits, and only 16% believe insurers do. Much repair is needed to rebuild trust—and one place to start is by clarifying the specific promises being made by healthcare companies, and ensuring they are both truthful and understood.
Being empathic isn’t always easy, as it requires work: people need to put aside their own needs, listen to other people’s feelings and needs, and actively demonstrate that they understand those feelings and needs. It’s a learned skill that takes practice. Organizations must demonstrate empathy in a very different way: by creating products, services, and communications that anticipate and provide solutions to people’s needs.
Every large complex organization faces issues of fragmented, institutional silos that make the creation of empathetic experiences challenging. Design thinking is now a de rigeur approach to help organizations (which cannot, by definition, be empathic) create products and services designed to meet people’s needs, and thereby feel empathetic to people and earn trust. The medical field is no different. The approach has been adopted as a method to help teams understand and empathize with patients, improve interdisciplinary collaboration, and rapidly prototype ideas.
But design thinking has a challenge, which is that it is easy to confuse occasional workshops with long-lasting, sustainable solutions. To make a real impact, design thinking needs to be part of an integrated, iterative, research-led approach, wherein experiences improve over time, informed by data and insights. To succeed, it must be part of a way of working, not an activity.
This mindset of continual improvement and evolution can prove challenging in healthcare, given the (appropriately) stringent controls that the FDA, HHS, and other regulatory agencies place on medical products and services. Consider the crucial yet bizarre role that the antiquated fax machine still plays in the healthcare industry, largely due to issues with data sharing.
To make meaningful use of design thinking and to create product roadmaps that are nimble enough to grow and evolve to meet people’s needs at the pace they expect, the healthcare industry must invest in platforms—such as Apple HealthKit—that are certified for use in the industry. It’s equally important that these platforms be built for innovation and that design teams working on them be empowered.
Predictability and logic
A 2015 study published in the Journal of General Internal Medicine titled “Why do People Avoid Medical Care?” found three main reasons why people avoid medical care: they had an unfavorable opinion of the experience of seeking medical care; they didn’t perceive the need; and lastly—and most significantly—cost (both time and money).
It’s not surprising. Who among us with insurance knows with any great confidence what our copay might be at any given doctor’s visit, or for any given prescription? The last time you visited your doctor, could you have said how long you would wait? Or when you’d be done with your appointment? Can you say, for sure, if your last annual physical was necessary? At what age, and how often, should you get a mammogram or colonoscopy? What percentage of the times you’ve visited your doctor when feeling under the weather, would you have just gotten better without visiting them? How many of the medical procedures you’ve had were actually necessary?
The very mental model; i.e., what one believes is true about the behavior of a system—of how one should engage with healthcare, is broken, making the experience feel unpredictable and illogical. This problem is aggregated by the disorganized patchwork of organizations (providers, insurers, pharmacies, drug makers, regulatory agencies, etc.) that each of us is required to engage with to receive healthcare in the United States.
One potential way to ameliorate this problem is better communication and education. The medical industry has just started to shift to email and SMS push notifications as a way to communicate with patients—but to truly engage with patients, a broader set of modern touchpoints, such as social media, could be considered.
Design can help, but only to an extent
While a radical overhaul of the American medical system might address some of the public’s vexation with medical care, many issues stem from scale and complexity, and will remain so even if substantive reform comes to pass. There are very few analogous service design challenges where the customer base isn’t a specific demographic or segment for whom features and functionality can be prioritized and tailored accordingly, ignoring the needs of other segments; instead, the experience of healthcare must serve everybody in society. To design healthcare systems in which we all can trust, we need to clarify the foundational promise that we make to people, ensure that this promise meets real needs, and craft experiences to keep that promise.