Time for a Post-Pandemic reset?

II:3 April 4, 2023

Where do we stand with Covid? I guess the US government has determined the crisis is over as of May 11.[1] ?I am not sure how comforting this is but an edict from the government seems fitting given the way things have transpired. Even WHO has pronounced managing the Pandemic a “catastrophic failure.”[2] History will ultimately judge just how far we strayed from what might have been optimal under the circumstances. While it was inevitable that lives would be disrupted, the damage caused by the various “vaccine” and mask mandates seems to be adding up as more is learned. You know things have percolated to a dramatic point when it reaches all the way to an SNL monologue where Woody Harrelson goes anti-vax accusing Pfizer and Moderna of cartel-like collaboration with the Government (and Elon Musk seems to agree[3]). One cannot help but wonder how many lives might have been saved had we immediately focused our attention on the most vulnerable rather than other actions that seem more politically motivated. Perhaps it is more accurate to state that we are still in search of some of the solutions that we hoped would have appeared by now. ?The effects of Covid have been life-changing and will be felt for years to come. A fun story reinforces this point.

This is not the first time the world has been confronted by a widely disseminated disease. Around 1600, the Plague changed the world.?The Bubonic Plague that swept Europe and Asia killed an estimated 200 million people. It was in 1633 that, in the village of Oberammergau, Germany the town fathers decided to do something to celebrate the passing of this catastrophe. The celebration took the form of a play dedicated to the belief that God had answered the prayers of the villagers who were no longer dying from the disease. To honor God, the play was commissioned to commemorate the suffering, death, and resurrection of Jesus Christ—the Passion Play. Overwhelmed with gratitude, the first Passion Play was first performed in 1634 with a commitment to perform it every 10 years thereafter. Until 2020 that is, when it was postponed due to Covid. The 42nd Passion Play had to be rescheduled to 2022. ?

Now that we have seemingly conquered the Covid beast, at least for the moment, some of us might seek a proper way to express our gratitude for the good things that have surfaced. Perhaps we could commemorate the sacrifices of first responders and other caregivers (a day on the calendar?). One of my earlier newsletters spoke to the role we individually might play[4] in our dramatically changing industry. But what about a broader corporate response? Might we celebrate with a leadership reset? If so, what form might this take?

During the visioning phase of strategic planning, strategists love to ask the question, “If there was one thing you could change, what would it be?” Many responses could qualify to be sure. To me, the all-encompassing response is to improve the healthcare experience. Dear reader, please consider this a work in progress, not a finished product. I actively invite your input. With apologies to Joe Pine, Jim Gilmore, and Gary Adamson (mentors in the experience economy[5]), here is my latest attempt at a post-pandemic reset of the healthcare experience.

What lessons have we learned from the pandemic?

The process should start with an acknowledgment of our recent learnings. My list may look a bit different from others reflecting some of my prior newsletters:

·??????Isolation and loneliness abound.

·??????The Public Health infrastructure is broken and in serious need of fixing.

·??????Accelerated impact of Telehealth.

·??????Realization that some current policies are a barrier to improvement.

·??????We are questioning how we spend our time and looking at work and life balance differently.

·??????Science is being corrupted by political influences just like all other dimensions of society; buyer beware.

?If not by now, soon we will have had our fill of lessons learned. Forgive me if you have already reached that point but I feel the need to elaborate on these a bit. Nothing affected me more profoundly during the pandemic than people dying in isolation without their loved ones with them. The vulnerability and loneliness of this moment will stay with me forever.

Whether true or not, the consensus perception seems to be that Public health failed us in so many ways during this time. I can only hope that this serves as a cry for help for those of us so employed. In contrast, telehealth has been a major success. Why is it that it took a crisis to bring out the merits of telehealth? The benefits have been obvious for years, notably for rural and less accessible communities in our many medical desserts. I was taken by the policy model of the previous administration to eliminate two regulatory requirements for each one that was added. So much of what we are regulating in healthcare seems outdated or ill-conceived. Work/life balance remains elusive but some benefits may come from a more hybrid approach, at least for some jobs. I admit to a backlash that I perceive as the need for direct human contact[6] gets replanted in more and more companies. ?

Lastly, regarding lessons learned, I fear that politics has become remarkably invasive in American life. Acknowledging there has always been a dark side to the craft, the current culture seems built around being loud and in your face with half-truths and outright falsehoods. It has become truly debilitating (how many people have simply turned off the evening news?).

The silly invocation of “science” over politics has truly fallen flat and exceeded any snake oil encounters from the past. We must never again revert to the oxymoron of “settled science.”

?????????????????The Unique Opportunity that is Healthcare

Healthcare touches everyone at some time in our lives. Unfortunately, when it does, it is too rarely regarded as a good experience; so there is plenty of room for improvement. There have been efforts in the past to improve the healthcare experience to be sure. But, as pointed out recently by Denise Weismann,[7] HCAHP scores have not improved since 2016. Are you surprised? While I applaud that this is a rare example of a regulation designed to focus on improving the experience, a lot of effort has gone into trying to move the needle in this area and it simply hasn’t happened. I do not wish to be pollyannish, and those familiar with the challenge recognize this is not easily done.

Patients/customers will not have good experiences if employees don’t have good experiences. More recently, appropriate emphasis is being placed on employee well-being. An employee who is worried about being exposed to others with inadequate protection will not be imparting healthy thoughts.

Apple is seeking a frictionless experience for its customers.[8] I understand this on a retail level when someone stops in a store to pick up something they know they need. The lack of friction will certainly be applauded when it comes to the billing process. Both retail and healthcare share a strong aversion to the customer/patient being asked for the same information repeatedly during a single visit. Of key importance, both retail and healthcare thrive on encounters[9]. My experience has been that most people in healthcare want to make a difference. Connecting represents opportunities to influence the customer (patients). Indeed it is these interactions that represent the high-value times when memories can be made. If we can strike the right chord, ask the right question, and somehow connect with the customer, this interaction stands a chance of entering the realm of the remarkable. Of course, there is also the risk that it goes the other way.

Given this perspective what is the job of management? I am proud to be part of a generation of management that I believe has done a stellar job of recognizing the higher-order goal of getting the proper tools and support to our caregivers to permit them to do their jobs well. But the gap in doing so is large, as suggested in a recent poll from LinkedIn:

Work is Being Disrupted Like Never Before

Can we not make the disruption an emersion event? For some leveraging an encounter into a memory comes naturally; but not everyone. We can train for this. Others have, with success. Fred Lee in his now-classic book, If Disney Ran Your Hospital: 91/2 Things You Would Do Differently[10] points out, “For every loyal customer, there is usually a special story.” One of the stories from his book continues to stand out most profoundly for me. To paraphrase (with some liberties):

Judy had a recent diagnosis of breast cancer and ended up having a radical mastectomy. The story is about her night in the hospital after surgery, wondering about how all of this might impact her life and her marriage. Her husband sat with her for a while as one would expect. She was still acting stoically as her husband sat with her. After he left, all the emotions swept over her. It was at this time that a nurse, whom she had not met, entered the room with a tray. She was intensely attuned to the moment. Without a word, the nurse surveyed the situation and turned off the light. She put down the tray and pulled up a chair next to the bed where she quietly held Judy’s hand for a long time. After she was done crying, Judy thanked the nurse, who gave her a sedative as she left the room. The encounter was over. Judy later described the nurse as an angel. What the nurse had done was spontaneous. She entered Judy’s world briefly and had a dramatic impact. The nurse allowed her compassion to take over. She was not hardened by prior experiences or limited by previous trials and tribulations. There were few words, no scripts, and no peer review. She was simply there in the moment. She made a connection and left. Yet, this became an indelible memory, and Judy was compelled to repeat this story many times after she was discharged.

Those who have worked with me before know that I love to tell this story. To this day, I am unable to get through the whole story without getting choked up a bit. It speaks to the essence of healthcare. I am not sure you can train for compassion. You either have it or not. What management can do is make sure that compassionate associates work in an environment that not only gives permission to express their feelings but indeed highlights such opportunities. There are different ways to express oneself. And customers have different needs at different times, not always realizing at the time what these might be. The more we repeat these stories the more people will be inspired to act.

????????????????????????????????????????????????Planning to the Rescue

It isn’t often that planning is cited as a tool, but it is if we know how to use it. Too much in life is left to chance. Why not plan, especially when change is required? Coming out of Covid requires change; we can do much better. And at least some of the change should be specific to the learnings from the pandemic. The value proposition of planning is improved execution. If there was ever a time when the focus was on execution it is now as we emerge from the grips of the pandemic.

Am I the only person who noticed that healthcare became more accessible during the Covid crisis? Why is that and what were the enablers? The why is simple, it got everyone’s attention. Isn’t it remarkable that one of the immediate solutions was to waive various regulations? What does that say about regulations? I am of the firm belief that way too many regulations get in the way of the consumer rather than meeting their intent to protect them, especially in healthcare.

As an example, HIPAA has been seriously overbaked in my judgment. Some people have legitimate privacy concerns. But many if not most of us have no problem with having our health information shared[11]. A perfect example is if we are transported to an emergency room in an unconscious state while away from home. How is anyone to know our prior history? It is almost impossible to retrieve personal health information given the current restrictions. In certain circumstances, the over-emphasis on privacy becomes a deterrent to saving lives! Have you had the same experience I have, where I was told by a caregiver that sharing my information in a certain situation would be a HIPAA violation, at which time I politely informed them that I am the patient and I give permission to do so (to no avail)?

Visioning is one of the most powerful tools in the strategist’s tool chest. While often a misused term, effective visioning should identify specific changes that are to be managed during a given planning horizon. Applying the lessons we have learned gives rise to a few key questions:

·??????What specific capabilities are we going to permanently enable through telehealth?

·??????Can we alter our approach to greeting our “guests” uniquely and consistently in both inpatient and ambulatory settings?

·??????What parts of the care process can/should be made frictionless at both the ingress and egress stages?

·??????Are there ways we can differentiate ourselves in the minds of our customers through our digital footprint (virtual care and digital self-service)?

Impact of New Technologies

As we look back on this time, I believe we will come to realize that we were still in the “caveman stage” of developing new technologies. New tools are becoming available every year (e.g., wearables) that can significantly improve things.?On reflection, there seems to be an inherent conflict between the simple and the complex. The adoption of meaningful changes in healthcare has historically been very tedious, whether technological, clinical, or administrative. Adoption is a critical phase of the change process, with some delays longer than others. Resistance to change (i.e., the status quo) remains a critical obstacle to improvement. As I age, I have observed that sexier “technological” solutions seem to be sought over solutions that may simply involve common sense (not so common). So much of what should be learned reflects culture and attitude instead of some buying some expensive device or implementing a complicated procedure. Sure there is an important role to be played by technological advances, some that WOW. But more can be accomplished quicker simply through changed attitudes and behavior.

This conflict between the simple and the complex can be seen in the recent pharmacological breakthrough of the so-called diet pills that are sweeping the world-- Wegovy and Ozempic. Is this the new Purple Pill?[12] Much is starting to be written about these breakthrough drugs, not just about the active physiological and pharmacological elements but the behavioral implications. Is the pop culture path to a “healthy lifestyle” now embodied in a weekly injection? Yes, semaglutide (the active ingredient in both drugs) represents a novel way for those with type 2 diabetes to control insulin. And I can understand the pressure for wider distribution to control obesity and lose weight[13]. But I admit to some concern that the future of looking fit will be “solved” mostly by taking a shot once a week. Truly, this will result in an even greater divide between the haves and have-nots (at $1,000 cost per month and need to continue use to maintain lower weight).?Once again, a breakthrough causes us to bump into unintended consequences. Some are concerned that this may represent a new set of gateway drugs. Will this new pill cause a further decline in physical activity or reinforce a sedentary life, sustaining our addiction to fast foods over more nutritional meals? Danish drugmaker Novo Nordisk said neither drug is "intended to be used as a lifestyle medication." [14] Left to our own devices, history has proven again and again our ability to corrupt an otherwise improvement to the human condition.????????????????????????????????????

The Paradigm Shift Has Begun

While I recognize there is impatience when invoking a “paradigm shift,” the reality is undeniable that focusing on the customer experience in healthcare represents a wholesale change in orientation. Like other aspects of our society, we must acknowledge that healthcare over time has become overrun with a glossary of terms unfamiliar to our customers and a culture built around the concept of “doctor knows best.” It is only through a more intimate understanding of the customer’s healthcare experience in its many facets (it is often complicated) that we can begin to intercede and improve these experiences. (Experience mapping is an unassailable tool in this process.)

It is important to recognize that much of what is required relates to attitude and not the acquisition of high-cost items. That everything is so expensive in healthcare is by itself a major stressor. Yet, there is much change required in how we approach our “guests[15]” and how we train our associates to do so. At a critical time when hospital finances are dire, it is important to focus on low-cost solutions. Some organizations (e.g., in the hospitality industry and retail) devote significant resources to such training and onboarding with success. We can learn from them. This gives rise to the question in healthcare, “Are we training for the right things?”

Does your orientation program, for example, focus on customer relations and the statements (impressions) that we want to leave with our guests from each encounter? Are we measuring the impact of these encounters? What do our guests say is our brand? What caused them to say that? How does this compare to what we want it to be? No doubt a gap exists between the intentional and the actual. We have to find effective ways to close this gap. As organizations are contemplating upskilling programs, perhaps adding a module on customer service would help.

Managing the Experience is not a casual undertaking. I do not mean to imply otherwise. It may sound simple, but few things are as challenging as managing cultural change in an organization. It may be easy to identify how we want every patient to feel after an encounter and to be welcomed into all our different facilities[16] and settings.[17] It is something else again to consistently achieve this with constant employee turnover and a diverse set of patients/customers (not to mention our diverse workforce) who present us with a wide variety of issues and preferences. Yet for the first time perhaps, we truly have the technology to capture key information on individual customers (similar to retail organizations) and to leverage this information without going to great expense to personalize each encounter corresponding to individual concerns and interests.

Healthcare as Theater

Improving the healthcare experience begins with a clear understanding that we are “on-stage” during most of our professional lives.[18] Treating healthcare as performance can lead to breakthrough thinking. Not everyone is warmed by this approach. But isn’t it interesting where a positive encounter is experienced how many patients recognize the care they have received, usually related to the special attention given to them by someone (often a nurse)? I see little difference between this parting ceremony in a hospital (discharge) and the applause at the end of a play or concert, or through a tip offered to a waiter in a restaurant or something nice written on a comment card. These encounters, however brief, reflect the rating given by the customer for the service (entertainment) they have experienced.

We’ve heard the words “patient-centered care” for many years now. Yet are we fully capturing the potential of this orientation?[19] What actor on stage has not coveted the opportunity to engage the audience in a way that will drive them to share it with others? The savvy entertainer and retailers are always in search of novel ways to offer the WOW experience. There is no reason why healthcare cannot participate in this pursuit as well.

Psychologists say that we see ourselves through the lens of our intentions. Yet our actions rarely back this up, at least as seen through the eyes of others. Even this perspective has limitations as people see the world through different lenses, some of which may not resonate with everyone. There is the clinical side (often pretty straightforward), but then there is also the need to customize care (preferences) in ways that we may rarely recognize but that will greatly affect how it is perceived by the patient/customer. It is not a one-size-fits-all proposition. As Covey notes, “Seek first to understand and then be understood.[20] This is the part where the encounter can be made memorable in the moment. Extraordinary experiences create lasting memories. Skilled experience-based practitioners know how to identify such moments and to create memories that have the potential to go viral[21].

Restore Trust in Healthcare

At this time of year as Easter approaches, Christians enter a period of restoration. Perhaps it is also possible to pause and reflect on the dilemma of healthcare that confronts us. The status quo is not sustainable. Yet our lack of clarity in dealing with the pandemic has created doubt in all of us. The trust that has been lost in our healthcare system must be restored. Whether or not we sought such influence, those of us in healthcare have been placed in the role of a soothsayer. That is to say, people have actively sought our advice during this crisis, asking us what they should do. Sometimes our advice has been helpful. Too often it may have been flawed despite our best efforts.

So much in society is in flux today, and healthcare is suffering along with other venerable institutions[22]. Not all sources are credible. It is more important than ever to carefully curate what we are willing to accept as evolving knowledge and to share this with others when warranted. Did you happen to see the recent delayed studies from Cochran Review regarding the ineffectiveness of masking?[23] Different pundits still offered different interpretations such that the original authors had to issue a follow-up statement to more accurately summarize their findings: It would be accurate to say that the review examined whether interventions to promote mask wearing [sic] help to slow the spread of respiratory viruses, and that the results were inconclusive.?Not sure the additional statement was any more comforting. Or how about the comparison of cities with more restrictive lockdowns that did no better than others when it came to the spread of disease?[24] There is a growing argument against vaccinating children for Covid in the absence of more determinative clinical data. No less than Dr. Deborah Birx (former coordinator of Covid-19 response) has concluded that our efforts to manage this pandemic “have failed” and she fears we are no better prepared for the next one. This is no time to be influenced by the expedient or to allow burnout to warp what our eyes witness. The simple reality is that the vaccines and lockdowns did not hold up to the promises and, further, seem to have caused serious collateral damage (yet to be fully measured).

Improving the healthcare experience can only occur to the extent we are first able to restore trust with our customers. This process begins by recognizing vulnerability. Clearly, healthcare has been vulnerable to the vagaries of the Covid crisis. I don’t expect this to change quickly. Seeking new knowledge based on solid research will help us climb out of the void. Getting politics out of the conversation can also help. A sincere look in the metaphorical mirror may allow us to regain our perspective and reignite the empathy that drove many of us to get into healthcare in the first place. There is much work to be done. As we push the reset button as healthcare leaders, may the challenges we face propel us to do better with humility, recognizing that many forces are competing for our attention at the same time that people in our communities are struggling.?

_______________________

[1] The date the “pandemic emergency” is officially ending.

[2] The draft “pandemic treaty” begins by saying it is being drawn up "in recognition of the catastrophic failure of the international community in showing solidarity and equity in response to the coronavirus disease (COVID-19) pandemic".

[3] Host Woody Harrelson likens Pfizer and Moderna to DRUG CARTELS | Daily Mail Online

[4] What Role Will You Play? | LinkedIn

[5] See The Experience Economy…

[6] See my previous newsletter Bring Back the Water Cooler | LinkedIn

[7] Denise Wiseman, PhD, MBA, CPXP | LinkedIn

[8] Frictionless Healthcare? Amazon Wants To Try (forbes.com)

[9] I am fond of referring to “foot traffic” as something that should be encouraged as healthcare organizations expand their ambulatory footprint (hopefully in retail zones).

[10] James A Hamilton 2005 Book of the Year, (Bozeman, MT: Second River Healthcare Press, 2004).

[11] Perfect example of the tyranny of the minority.

[12] For those old enough to remember the Purple Pill that patients actively asked for. Truly, I believe that direct-to-consumer advertising by pharmas is one of the great mistakes of all time in healthcare policy that have greatly added to the cost of care and preventable overdoses and addictions.

[13] when 73% of US adults had estimated BMIs in the overweight or obese range (2017-2018 according to CDC)

[14] Wegovy, Ozempic: The barriers to accessing these weight loss drugs | Fox Business

[15] A critical concept in the experience economy

[16] Variety of facilities abounds in healthcare with few prototypes that dominate

[17] Preparing for surgery is not the same as an annual physical or lab test.

[18] Shakespeare notes that “All the world’s a stage.”

[19] I draw on my experience of having visited over 1,000 hospitals in the US. I was met by a “greeter” at the front door of only two hospitals in all my travels. We have a long way to go!

[20] Steven R. Covey, The 7 Habits of Highly Effective People, (Simon & Schuster: 1998, 2004, 2020)

[21] The wonderful insight about memorable experiences is that the customer is compelled to share them with others; it is not optional it is an instinctive reaction. Memorabilia can play a big role in commemorating an experience.

[22] "jeff goldsmith" | Search | LinkedIn

[23] Evidence-based medicine publisher held up mask meta-study because it lacked 'right answer': author (smartnews.com)

[24] See for example, Jenny Rough and Andy Markowitz, List of Coronavirus-Related Restrictions in Every State Most states have dropped COVID-related restrictions; several put limits on vaccine mandates, AARP, Updated February 13, 2023