So much in healthcare requires an individual to navigate complex systems, using unfamiliar tools while dealing with either mundane or stressful issues. How does a person who has a new condition, who may not understand the language of healthcare, and who may not have the resources to find appropriate care, even get started?
Product designers have built entire careers around understanding needs and challenges for consumers of both products and services. If we were to think of a healthcare journey like the provision of a product and a service experience, what might that look like? What if finding a doctor, making an appointment, maintaining your medications, and tracking your medical payments were as easy as ordering shoes on Zappos.com? We caught up with John Edson, founder of the consulting firm John by Design and formerly of McKinsey & Company and Lunar Design, to talk about what the healthcare industry could learn from product designers and why more healthcare organizations need to bring design into the C-suite.
Mark VanderKlipp: When we spoke recently, you were telling me about how you were looking for a new doctor in your medical network because you had moved between counties. Were you able to land with a new primary care doctor?
John Edson: Yes, finally. But it was pretty unsatisfying. I had been with my regional health system for almost three decades, and I figured—out of inertia more than anything—that I ought to give them a chance at my continued patronage.
So I call my old clinic facility and ask them how they go about helping patients like me. I am routed to three different people, and finally they pass me to a recording where I left a message. “Hi, I’ve been a patient for 28 years, and I’m looking for a new doctor in your system. Please help.” No response. After a couple of weeks, I take it on myself to use their website. I find and use their physician referral system.
The next hurdle is that I have to know what kind of doctor I need—”family care, internal medicine or obstetrician?” These words seem elementary to doctors, but I am lost again. I am not looking for a doctor for my family, and I know I don’t need an obstetrician, but what the heck is an internist?
I make my way through the questionnaire and at the end I am given the “choice” of only one doctor. I’m shown his photo and a list of degrees. No ratings, reviews, testimonials, hobbies, personality, efficacy, and so on. This guy could be my front line in diagnosing serious issues, and I have less visibility into this person than I get on eBay when buying used furniture.
This is just one of 100 stories we all complain about. Endless phone trees, mysterious billings, getting lost in medical campuses. In fact, my worst experiences with medical systems make me feel like I’m walking around a medical center blindfolded.
It’s interesting that you mention a collection of touchpoints: first the phone, then three people, a voicemail tree, unfamiliar medical terminology, the website, and finally the campus. In each of these steps, you had to take the initiative and an educated guess about how to navigate toward your goal. This underscores the principle that each of a thousand touchpoints contributes to a single experience. In your example, everything is disjointed, leaving the patient to piece it together. It makes them feel lost.
That’s exactly my point. The important thing in my story is how I as a patient felt through this process—how each of these little steps adds up to my entire perception of the experience, whether good or bad.
We tend to think of relationships with people and institutions in the same way. And if a person we know behaves differently from moment to moment, we don’t know how to be their friend. We feel the same way about our relationships with institutions. It’s just human.
When a patient is made to feel dumb or ignored by a system, they have started down the path of looking for a new relationship. My medical system is a massive regional system that advertises widely, painting themselves as caring and cutting edge. But they regularly miss the little things, and they make me feel like I should have to know more about their systems in order to have the privilege of being seen by them. Their messaging is not coherent with their behavior, so I don’t really trust them.
Given the times we’re in, this is when innovators need to be looking forward to how they are going to move from surviving to thriving. When I look at what patients go through in their medical journeys, there is a ton of opportunity from the standpoint of designing this multifaceted “product” called a healthcare journey.
You wrote the book Design Like Apple about how to design great products, services, and experiences. Given your experience, what advice do you have for healthcare leaders and professionals?
When I take my learnings and think about designing a leading healthcare practice, there are three pillars from which healthcare leaders should start.
First, bring to life a view of your patients. Spend time with a dozen different patients and their families, making sure that they are selected for their diversity: age, condition, geography, gender, socioeconomic status, educational history, etc. Visit their homes, talk with them about their recent visits, follow them on a journey from making their appointment to attending their follow up. This is not survey work; these are live interviews whose point is to understand behaviors and motivations. What are the insights that will inform your decisions about caring for those people in a way that is relevant to them?
Second, build a bold vision of an ideal patient experience: What you want patients to feel when they encounter your practice? You can’t build a better experience from the bottom up, from the different touchpoints (and the departments that control them). Like a product design process, you have to start from the patient’s perspective and build down. So what do you want it to feel like to be your patient? What’s the aspiration? Do you want patients to brag about their experiences to friends?
Think about companies that are set apart in terms of customer experience—companies like Zappos, Progressive, Tesla, Apple or Strava. What would it feel like if patients thought about you like one of these leaders? Yes, you have to do medicine right, but how do you want patients to feel in the delivery of that service? And if you think that this is crass manipulation of patient-customers, you might also build your inspiration around what we are learning that well-being extends well beyond diagnoses and pills and that “wellness” is defined by each individual based on what they feel they need.
Third, put your understanding and vision to work. Get about the business of redesigning everything about your practice that touches the customer. From their perspective, understand the experience inconsistencies—the patient “pain points”—at every point of the patient experience. Then tackle the biggest opportunities. Where are you letting most of your patients down? How might you tweak the web pages, phone trees, campus signage and so on to support your bold vision?
In your work with executives, how have you seen this kind of design ethos coming to life in an organization?
That’s really the hard part. To activate this kind of vision and process in a healthcare practice, you need what I think of as a patient experience guide. But I think every organization needs someone who is empowered to put the care back into healthcare. That could be a Chief Design Officer or an EVP of patient experience. It’s as important as having a head counsel. This role is responsible for establishing these three pillars.
We are seeing this role show up more and more in companies that are consumer-facing. And that is kind of obvious. Well-designed products and services are winning and even creating more margin in fast moving consumer goods where the competition is high and switching costs are low.
Healthcare has been slower to come to this realization because the industry is by its nature focused more on efficacy followed closely by regulation and risk — and so there are executives in healthcare organizations assigned to look after those things. This is why as patients we get more of the “fine print” than the feeling of care. I think having a designer at the same level as the head counsel could transform patient experience in these organizations.
When you talk with healthcare organizations about this, what do you say? Why does this all matter? We all know that healthcare is complicated, and we don’t have a lot of choice anyway.
Disruptors are entering the field. We also know that young people are less loyal and tolerant of old systems. So that’s why patient experience is going to become increasingly important.
A decade ago a cable TV executive told me about their view of customer experience: “We can’t give customers what they say they want because it doesn’t support our business model.” Today, cable offerings have been reshaped by a multitude of services that are better designed to be relevant and useful to customers. Streaming services that come through the internet have completely replaced live TV in my household, for example. And the funny thing is that the cable TV providers have responded with much better designed services and interfaces because they feel the heat of the competition and the insatiable appetite of choice that people are growing accustomed to. And switching costs have dropped.
Cable TV isn’t medicine, but I can hear medical practices saying the same thing. The argument might go: “Our patients don’t have a lot of choice, delivering medicine is a complex task, people won’t look around for other alternatives. Essentially, they’ll put up with a flawed process as a trade off for the familiar.”
But people are growing accustomed to more tailored and self-selected services, and innovators are entering even complex markets that find a lot of protection in regulation. New entrants like Oscar Health and Forward are using technology to deliver a better patient experience at lower cost, helping consumers navigate both the world of insurance as well as care.
This type of design service seems like a tough sell in an industry that is plagued with structural and financial problems due to COVID and other factors. How would leadership quantify the value of that design process?
There is a growing body of evidence that good design makes for good business.
This idea has been supported by a recent study I was a part of building while at McKinsey & Company. The Business Value of Design looked deeply at 300 companies across medical technology, consumer products, and retail banking on how they performed on more than 100 factors having to do with design mindsets, processes and accountability. The scoring of these factors created a McKinsey Design Index—a grade for any company on how they embrace design. The McKinsey team then mapped the MDI scores of the participating companies against total shareholder return.
The conclusion was dramatic: companies that perform in the top quartile of the MDI grew their value at twice the rate of their competition over a five-year period. No executive team can ignore design any longer.
The study goes deeper too. If you look closely at the data you see that you don’t outperform your competition until you are a top quartile performer on the dimensions in the MDI. The conclusion here is that you can’t dabble in design for the benefit of patient experience. You have to be committed to it.
And we know that focusing on patient experience adds to the bottom line. A new study cites an average revenue increase of $444 per adjusted patient day for health systems with better experience scores. Not to mention the cost implications of keeping patients compared with those who choose to leave based on how they view their experience. The implications are exponential. So this all seems like common sense when you think about it. But what does it mean to be committed? You’ve mentioned the importance of having a designer in a senior role. What else did the study find?
Improving customer experience touchpoints through “design” can often sound like we’re just making things pretty. That can certainly be part of it, but the McKinsey study broke down design into four areas:
- More than a feeling. It’s analytical leadership. Design-led companies that outperform their competition don’t just let design be whimsical. They bring some analysis to it to articulate their goals with the design, to measure outcomes and to hold executives accountable for both.
- More than a department. It’s cross-functional talent. Organizations that embrace design emphasize working collaboratively and creatively with people across departments to solve vexing problems—and together, to put the customer first.
- More than a phase. It’s continuous iteration. The best companies think about their customer interactions as an ever-improving process.
- More than a product. It’s user experience. For health care companies, this is about a mindset that the whole organization is working together to create that comprehensive experience that we’ve been talking about. Every touch point is created with the master vision in mind.
Is there a best way to get started? How should healthcare leaders lean into this new paradigm?
Do a deep dive into one aspect of your patient experience, such as finding a doctor. Spend time with patients watching them look for a doctor and schedule an appointment. The situation can be devised as a test, but the people need to be real patients. Create a small design program to improve that step. Measure the patients’ satisfaction before and after. Then build a story out of that for the entire organization.
Creating these small wins that lead to the proactive design of each patient-facing interaction will help the organization pivot toward crafting improved experiences together.