New York’s Northwell Health is a few years into the rollout of its digital patient experience, a reinvention of the hospital’s website and patient outreach tools. At the Cleveland Clinic Patient Experience Summit last week, an event co-organized by HIMSS, Northwell Chief Experience Officer Sven Gierlinger and Emily Kagan Trenchard, VP of digital and innovation strategy, laid out some of the lessons they’ve learned in that journey.
“The goal is not to put more screens in front of people and it’s not to dehumanize the healthcare experience,” Gierlinger said. “It’s the opposite. How can we more humanize the experience? And as we thought about the digital strategy, we layered that over our patient experience strategy.”
1. Solve the right problem
Nowadays, the advice to put patients first in designing interventions or to make sure to seek patient input can seem obvious. But Kagan Trenchard and Gierlinger pointed out that a lot of the historical problems have stemmed from taking the opposite of a patient-first approach: a technology-first approach.
They gave two examples: meaningful use, CMS’s EHR incentive program which, despite the name, didn’t include incentives for patients to actually use the technology until phase three; and the mobile health space, which saw developers who aimed at FDA clearance and clinical validity often missing on patient engagement and health outcomes.
“They were all trying to seek this FDA approval,” Kagan Trenchard said. "And this FDA approval was fantastic in a controlled clinical setting, but what happened to these mobile apps when they hit the actual lived experiences of actual people with actual phones in their hands is that most of them failed to actually make meaningful improvements to people’s health. … We were defining the problem wrong and chasing the wrong metrics, and ultimately that led us to then build the wrong kinds of tools to solve these problems.”
2. Go back to the basics
The first step in Northwell’s digital transformation was to conduct interviews with both patients and staff, asking them what they would want in a digital patient experience.
“Nobody said that what they wanted was artificial intelligence robots caring for them,” Kagan Trenchard said. “Nobody said they want more AR/VR headsets. What everybody said was that they wanted was for us to just nail the basics. People were so frustrated about where they had been, that they just said ‘If you can do the basics — get me an appointment, make the billing process not miserable, remember information when I tell it to you — that would be incredible.”
Northwell built their platform to do just that, with verticals focusing on creating patient profiles that following them around the enterprise, making appointment booking easy, offering offline support, and creating a comprehensive multifunctional payments portal.
3. Learn from retail, but don’t blindly emulate it
There’s a tendency in healthcare innovation conversations to compare healthcare to Amazon or Uber or airlines, Kagan Trenchard noted, and it’s an impulse that can be helpful but needs to be tempered.
“Customer journeys are not patient journeys,” she said. “Customer journeys value people for the dollar that they control and the goal is increased consumption. Patient journeys value people because they are people and the goal is decreased consumption of that sick care. Fundamentally, this is a difference.”
Healthcare requires specific considerations around empathy, privacy and empowerment that are different from other industries.
“And this isn’t to say that you can’t borrow some of the really great ways that the retail space has taken stock of the way it interacts with customers, the way it builds engagement,” Kagan Trenchard added. “There’s a ton to learn there. But if you’re going to try to build your strategy, you can’t pluck it off the shelf of retail and expect that you’re done.”
4. Don’t neglect your people
Gierlinger emphasized a point that was made several times during the conference: innovation requires commitment and buy-in from the whole enterprise, especially the frontline staff whose workflow is changing.
“We’ve all heard that culture eats strategy for lunch. But we believe it eats technology for breakfast,” Gierlinger said. “For example, when you start the online scheduling, you can only do that when the physicians give up the autonomy and open their schedules to make sure you can actually schedule into that. If you have to call back 60% of the patients, then why do that? The airlines don’t do that. Have you gotten a call back when you made an airline reservation to verify your flight?”
Failure to build the right culture can make even a solid technology fall flat in execution, Kagan Trenchard added.
“The technology is actually the simplest part of what we have to do because we can build good technology,” she said. “But if you put good technology on bad process it fails.”
5. Be humble; change is hard
“We need to be humble,” Kagan Trenchard said. “We have only had the tools necessary to do digital transformation for a very short period of time. Smartphones are only 10 years old. EHRs have only been in place for about five where we’ve had digital data. The FHIR standard didn’t become the law of the land until very recently so we’ve been able to move data back and forth. This will take experimentation. You will not be able to get this right out of the gate. You’ll probably have to put up 10 products, and seven of them are going to fail, but the ones that work will be phenomenal.”
She advocated three strategies from the business world that can help improve an organization’s chances: agile methodologies, human-centered design and systems thinking.
“I’m sure you all have bureaucracies that want three-month plans with budgets all laid out and this 12- to 18-month implementation time and that’s not a lot of room to move quickly,” she said. “But there’s a lot of tools and techniques that can help you move more rapidly if you look outside of the healthcare industry.”
Focus on Patient Experience
In May, we'll talk to the thought leaders and first-movers reimagining how and where — Hint: outside their perimeter — and report on how they're to activate if not delight the people they treat.