Everyone's a Critic

Everyone’s a Critic is a saying that is believed to go back to the 1940’s or 1950’s. It originally referenced those in the media (e.g., newspaper, TV, radio) whose role was to comment about art, music and literature. It morphed into the idea that everyone has an opinion and is willing to share it - even if they are not experts.

While the concept has stood for decades, what makes it different today? First, we have social media. Everyone can post an opinion in real-time. In many cases, postings can remain anonymous. And in some cases, traces of criticism and negatively “vanish” from sight once read. Second, we go well beyond art, music and literature in our reviews these days. We critique everything from restaurants to climate change to a myriad of healthcare topics (e.g., vaccinations, prior authorizations, denials and even CEO shootings).

While our First Amendment guarantees freedom of speech, it's worth noting there are limitations including copyright, violence, untruths meant to harm others (e.g., slander, libel) as well as limits for those that are incarcerated. I personally like having these guardrails. Given we do not live in a completely utopian society, these guardrails are meant to help keep us from crossing certain ethical, legal and moral boundaries. ???

LESSONS FROM A DINER

Let me pose a theoretical question: what if negative critiques could only be provided by those with a certain level of education/training in their field? (those not adequately trained could only provide positive feedback)

For example: there are people who have been trained in the culinary arts that are adept at describing a restaurant’s ambiance and meal in great detail. They can convey flavors, textures and presentation of the plate. They not only have a deep love of food and a refined palate, they possess the writing skills to illuminate whether someone should consider eating at a location or not. Given I have not been trained in the culinary arts, let me follow the theoretical construct above and provide a strictly positive review of a NYC diner I had the pleasure of eating breakfast at the week before Christmas.

The diner I visited has been owned and operated by the same family for over 40 years. The restaurant was tastefully decorated for the holiday season with some greenery and Christmas ornaments that hung from the ceiling (well above the average person’s height so as not to get in the way). Like many American diners, there was a counter as well as several tables and booths. I was immediately offered a seat upon walking in. In fact, everything was nearly immediate. Once seated, I was provided a glass of ice water and asked what else I would like to drink. My coffee was on the table in under a minute and I didn’t have to ask for cream, as it was brought with the coffee. The diner was not huge, but it was able to accommodate a large group that had reservations and were seated during my stay. Despite a very busy morning, my breakfast order was brought to me in less than 5 minutes. (I barely had time to scan a few emails!) My meal arrived hot, portion sizes were generous (I could not finish everything on my plate) and the food was fresh and palatable. The staff were not only efficient, but attentive during my meal – ensuring I had what I needed (most condiments were already on the table) and my coffee cup remained full. The team seemed to work well together, navigating small corridors as they scooted past each other with numerous stacked plates in their arms. They communicated additional customer needs as they passed (it seemed to be everyone’s role to ensure the coffee was flowing). They smiled at each other and with customers. Perhaps it was just the magic of the holiday season, but I was mesmerized by the efficiency, effectiveness and ambiance of the experience.

I think there are several lessons we can learn from that diner. Using my 35+ years of healthcare experience across payer, provider, vendor and consulting landscapes, I started thinking about that wonderful breakfast experience and what the healthcare system would be like if it operated in a similar way. Using the six domains of healthcare quality from the Agency for Healthcare Research and Quality (AHRQ), with a focus on Primary Care, I then tried to apply the diner experience. For instance, let’s look at the first domain below - Equitable. The diner is open 13 hours a day, 7 days a week. Many healthcare offices have 24/7 call coverage, urgent care extended hours and of course the ER fills a 24/7 role for emergent issues; however, the PCP office itself may only be open for appointments from 8 am to 5 pm. That would mean 9 hours of availability (if not closed for lunch) and usually open weekdays only (many PCP offices do not offer weekend appointments). ?

Equitable

·??????? Access to same-day, equitable service (aka care) at least 13 hours/day, 7 days/week (not closed for lunch)

·??????? Scheduling can occur via multiple mediums (e.g., phone, online)

·??????? Care provided onsite or via takeout (think telehealth, drive up immunizations and pharmacy mail order when applied to healthcare)

Timely

·??????? Scheduling and service can occur on the same day (or later, IF customer/patient prefers)

·??????? Check-in time is minimal; directly escorted to service area (think exam “table” in healthcare)

·??????? Service area wait time is minimal

Patient-Centered

·??????? Service provider (PCP) acknowledges me; listens to my needs for the specific encounter

·??????? Communication is clear, in my preferred language and includes take-home document(s) (e.g., receipt, visit summary)

·??????? Appropriate menu choices; just like we don’t expect lasagna when we go for Mexican food, in healthcare, care choices are based on clinical evidence-based guidelines that may include time, size, complexity, duration, etc.

Efficient

·??????? Clear measures of value (outcome/cost)

·??? Appropriately resourced (e.g., staffing aligned to volumes)

·??? Reduce “waste” (e.g., eliminate unnecessary tests/procedures)

Effective

·??????? Readily available (e.g. PCP visits, preventive care like immunizations and cancer screenings)

·??????? Services as expected or better (aka chronic condition treatment follows clinically-based guidelines; healthcare literacy increased throughout process)

·??????? Attentive throughout visit (e.g., lifespan of those living with chronic conditions is increased with equal emphasis on quality of life)

Safe

·??????? No harm was caused during (or directly after) the visit

·??????? Everyone “at the table” was engaged in the communication and coordination of services

·??????? Services were transparent and affordable

KEEPING IT “REAL”

I think we can draw positive and meaningful insights from other industries (like the diner), and I’ll also be the first to point out that healthcare is unique. First, navigating the constantly evolving Code of Federal Regulations, HIPAA, as well as other governing law and regulatory guidelines, can make achieving healthcare outcomes more challenging. Next, achieving the Mission of the Quadruple Aim requires trained clinicians whose education requirements are some of the most rigorous of all professions. The number of years required to garner an undergraduate degree, complete medical school and then navigate a successful internship and residency program can create staffing/access challenges that ripple through the entire healthcare system. Finally, while both industries focus on human-centered experiences that do no harm, helping people feel better is not as easy as a full plate and no easy task in a population that continues to age every year.

Despite the differences, I think it’s still a healthy exercise to get outside of our everyday constraints and view healthcare from a different lens from time to time. As we think about solving patient experience, I think there is a lot to learn from the diner. And having worked in this industry for decades, I know that some of the brightest minds are drawn to this field and together we can eventually achieve the Quadruple Aim. ???

Culture Moments represent the opinions of Rose Bernards and do not represent the view of any organization she has currently or previously worked with. Any healthcare related content should not be taken as medical advice. Content is for informational purposes only and because each person is so unique, please consult your healthcare professional for any medical questions.