Tim Lawless
In 2015, a group of social scientists, designers, technologists, and health experts set out to help Galesburg, Illinois, become a healthier place to live. Over 18 months, they worked with residents to redesign their community and support better health outcomes.
As part of this process, people were asked what was most important to them. Surprisingly, the results didn’t always align with the health industry’s view of itself. The most important thing to people was their family and friends, followed by financial security. Health lagged behind in third place.
The importance of relationships is supported by an 85-year-long study by Harvard, which indicates that close relationships, more than money or fame, are what keep people happy throughout their lives. Those ties protect people from life’s discontents, help to delay mental and physical decline, and are better predictors of long and happy lives than social class, IQ, or even genes. Relationships are powerful—perhaps more so than some treatments, especially in preventative health.
In the last 40 years, as healthcare has become more complicated, industrialized, and consumerized, good relationships between care workers and patients are increasingly harder to establish and maintain. When people talk about a good health experience, they usually talk about a great individual or group of people, but when they talk about a bad health experience, they talk about the system. This article will focus on why the next generation of digital platforms and services must reignite and facilitate the strength of relationships.
Relationship. It’s a loaded word, but in its essence, it’s nothing more than the connection between people over time. While “connections” (or “engagement,” to use marketing speak) are about an action and are usually time-constrained, relationships are about the experience of connecting and “being with” someone over an extended period.
In the marketing world, the word relationship is used in a particular context—relationship marketing. Relationship marketing is a close relative of customer relationship management (CRM) strategy and is an established approach in its own right. Hospitals use it to create a positive and trusted image of their practice, to differentiate themselves from their competitors, and to increase patient loyalty and retention. It’s easy to dismiss relationship marketing as a domain of the marketing department, until it’s connected to the patient experience. This shift began in 2021 when Adrienne Boissy, the first healthcare chief experience officer at the Cleveland Clinic (and the de facto leader of the patient-centered movement for many), joined Qualtrics. Her introduction made patient experience, alongside relationship marketing, via patient (also known as customer) satisfaction. In practice, what Boissy seems to have concluded is that a platform like Qualtrics, which constantly listens to how the patient is feeling, can facilitate personalized care and support, eventually in real time.
As Boissy puts it, “We cannot begin to fix the complex issues of access to care, disparities and purposeful connectivity with patients and caregivers without slowing down to listen with every channel available—a much more meaningful listening strategy for the emotions and values at stake. Only when we understand those can we operationalize empathy and act in ways that will make people feel seen, heard and valued.” Empathy sits at the heart of relationships, and that means listening, and not just during a consultation.
A summary of the literature on how patients describe a good care team shows us that the following four areas are crucial:
As digital experiences augment the historically analog healthcare interactions, we need to consciously work to enable these technologies to demonstrate the above four attributes. Many organizations are looking to nascent technology to experiment in this zone. In fact, ChatGPT-4 has the potential to establish a supportive healthcare relationship. It does surprisingly well as a trusted authority, demonstrating a proactive and positive mindset (albeit lacking authenticity), occasionally showing empathy, and not proactively exploring any meaningful context. While technologies such as ChatGPT-4 will evolve, healthcare professionals can seize the moment to prepare for a new kind of future. As healthcare becomes increasingly driven by data and digital through next-gen platforms beyond electronic health records (EHRs), people will have many more points of potential connection in which to listen and respond. There will be many more contact points, much more data created, and the opportunity to use that data in much more relational ways. People should be mindful about how this data is captured and, most importantly, design a future digital healthcare system that reacts to them.
In the film “As Good as It Gets,” Jack Nicholson, a wealthy, successful, and single author, obsessively desires the attention of a waitress. When she doesn’t show up for work one day, he finds out her son has a life-threatening respiratory health issue. In order to ensure she goes back to work, he sends a private doctor to her apartment. The film depicts a low-income waitress struggling to navigate the healthcare system without insurance, who subsequently becomes the recipient of private healthcare. She is shocked that a physician visits her apartment, that she will receive lab results within a few hours, that he gives her his business card so she could call him anytime, and that, while he can’t promise he can cure her son, he can promise that her son will feel better. Although the film portrays a caricature of the power of money, it clearly shows that the doctor has time to form a relationship with the waitress. She confides in him about her frustrations with the healthcare system, such as rarely seeing the same person and struggling to see a healthcare practitioner. The film plays on people’s real perceptions that a relationship with a physician is the domain of the wealthy—it is a luxury.
This in no way points the finger at the physicians. They are trying their best to provide optimal care within a historically suboptimal system and to create space for the inputs and dialogue that build relationships. In reality, the near disappearance of a focus on relationships is a byproduct of that system which aims to standardize, maximize, and optimize. Outdated fee-for-service models and never-ending administrative tasks with an array of issues make physicians time-poor and overburdened. Without a systemic focus on enabling relationships, the perception is likely to persist, and the vital impact will go undelivered.
But two forces for change are accelerating the need for and ability to prioritize relationships.
The digital transformation of the U.S. healthcare system should mean that better relationships with care teams are attainable to everyone.
The ability for digital experiences to foster strong, lasting relationships will require thoughtful use of data and a sound approach to building care teams with these connection points in mind. There is a unique opportunity ahead to reignite health and care relationships, which means actually designing how digital and nondigital relationships can work.
A recent study by Stanford-based health economist Adrienne Sabety demonstrates the value of provider-patient relationships by studying what happens when a provider moves away or retires. She concludes that patients overwhelmingly do not make new primary care physician relationships, suggesting that understanding how relationships form is a fruitful area for future work. The start of these relationships has not been studied enough, but Sabety does cite a number of studies of healthcare relationships that suggest that health relationships result from an experience component, which increases the value of collaboration over time.
Designing experiences isn’t a new discipline, but Sabety’s work points to the need for a new application of the discipline—designing for the beginning, ongoing maintenance, and even the conclusion of healthcare relationships, resulting in better outcomes. This is an emerging space and will require practitioners to bring novel thinking to the design process. No clear point of view on what to do next has crystallized yet—rather, this is a rallying cry for designers to engage with the following three topics to support the reignition of healthcare relationships.
The challenge: Care delivery and patient engagement have become deeply entrenched in old paradigms around time and space. Too often this means missing the mark on appropriately valuing peoples’ time and missing the opportunity to have the right conversations in the right context. This results in experiences that feel rushed and, more importantly, fail to demonstrate empathy—a key attribute of a strong healthcare relationship.
By rethinking time and space as useful raw materials rather than constraints of care, and utilizing their unique properties to design experiences that maximize the impact of digital and analog experiences, we can drive towards improved outcomes at scale. In “The Architecture of Health: Hospital Design and the Construction of Dignity,” authors Michael Murphy and Jeffrey Mansfield speak about the evolution of the structures of care in the physical sense, detailing how much of the design of hospitals focuses on the control and management of waste, water, and air. It is the understanding of these materials and the impact they have on the health and well-being of those being cared for inside the walls of these institutions that propels life-saving innovations. The same innovative thinking can be applied to the materials of time and space. Rich contextual data could be gained by conducting visits in someone’s home rather than in a clinic, in addition to the positive impact such care has on outcomes. Imagine what it would do to the provider-patient relationship if the precious 15 minutes of a routine care appointment were focused on reflection and response rather than collecting discrete data. This is as much about efficiency as it is about effectiveness and will require a sensitivity to the needs of individuals and the affordances of a variety of models of care.
The brief: Design standard operating procedures of routine care for optimal use of time and space, focusing on efficient and effective deployment of human resources and leveraging digital tools and automated processes where they will deliver the greatest amount of impact.
The challenge: People generally want a long-term healthcare partner, especially as their needs increase in complexity or severity. But with the acts of being cared for and about typically restricted to the confines of reimbursable encounters, patients feel forgotten and become dissociated from their health, which can lead to worsening conditions.
When interactions and experiences show a long-term commitment to supporting people, it enhances their ability to engage in their own health management. Woody Allen famously said that 80 percent of success is showing up. This holds true for both relationships and making a good film. There is deep meaning and impact in knowing you’re being looked after in ways as simple as someone sending you a message saying, “thinking of you and hope you’re doing ok” or “read this and thought it might help,” as well as more substantial efforts such as intervening when it’s clear that someone needs help. The BBC TV program “Mortimer & Whitehouse: Gone Fishing” is a strong example of what it looks like to show up and honor the commitment of a relationship. The show features two well-known and beloved comedians, Bob Mortimer and Paul Whitehouse. Both had serious cardiovascular issues, with Mortimer becoming isolated and withdrawn after triple bypass surgery. Whitehouse—in cahoots with Mortimer’s wife—intervenes, showing up at Mortimer’s house one day to take him fishing and change his life. The best relationships regularly demonstrate that kind of commitment and, through transformational use of technology and data, care teams can be empowered to do the same—to take action to care for their patients based on both clinical and contextual knowledge.
The brief: Design workflows and interactions based on need-focused predictive data models, which can leverage contextual information to create personalized experiences, allowing care to be provided at scale during and between clinical encounters while clearly demonstrating a lasting commitment to each patient.
The challenge: A patient may have great healthcare experiences with individual people or institutions, but these experiences can be disconnected, requiring the patient to act as the connector between them. This can be excessively burdensome and complicated and diminish the value of the positive experiences within each entity.
Digital platforms can help people think differently about care team networks. An analogy that springs to mind is how planets orbit around a single star. Think of the patient as the star and the planets as different healthcare teams with different roles, from different organizations and locations. One might be a primary care physician, one a gynecologist, one an oncologist, another a pharmacist. Planets have different orbital shapes and speeds determined by unique characteristics (such as mass and energy) and the gravitational forces from its star, pulling the planet closer or propelling it away. This orbit represents a fluid flow of movement, just like one’s health. The “forces” that exist between different members of one’s “care solar system” determine their proximity and level of engagement, with a patient’s health needs acting as the “gravity.” The beauty of orbits is that even when at their farthest distance from one another, planets and stars are still connected, and the unique properties of each planet maintain the balance within the entire solar system.
The brief: Design a system where all entities of a patient’s healthcare team maintain a connection with the patient and are appropriately connected to one another (i.e., through gravitational interactions). This allows the right individuals to be involved at the right time, communicating effectively about the appropriate topics to create “orbital care relationships.”
We have only just arrived at the foothills of these challenges, equipped for the first time with the tools to make the climb. The advances in data interoperability and experience-led platform architectures enable us to tackle these challenges head-on. But at the start of any feat such as this, three things hold true. First, everyone must be involved in experimentation, which means testing, learning, and sharing. Second, it’s important to form the right team. The team that got to the foothills may not be the one best suited for the climb. Third, we must be deeply committed to creating impact at scale, and we are thankful for daring and visionary clients who are committed to making that happen.
Tim Lawless
Senior Vice President Sales and Leadership
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