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Improving patient experience: Lessons from an envelope company

Posted Jul 25 2013 10:35am

by Anthony Cirillo

Physicians are suffering from a bad rap these days. Recently a FierceHealthcare article reported a study by Danielle Ofri, M.D., Ph.D., an associate professor of medicine at NYU School of Medicine, which found "empathy and moral reasoning begin to erode during the third year of medical school, with students daily witnessing both patients and doctors experience fear, anger, grief and humiliation."

At the same time, JAMA took on the topic of physician communication. In one study, Amina White, M.D., and Marion Danis, M.D., of the National Institutes of Health in Bethesda, Md., wrote "the presence of a computer in the examination room and the pressure to document the visit in the electronic health record (EHR) are often perceived as adversely affecting the patient-physician interaction."

They suggested using the EHR as a relational tool for improving individual and population-based health outcomes.

In a JAMA editorial, Abigail Zuger, M.D., of St. Luke's-Roosevelt Hospital Center in New York, commented about "changes in physicians' speaking and writing habits that will be necessary to accommodate new models of practice."

She wrote:

"The physician will be fluent in standard clinical language, including the delicate phrases of care and compassion.

The physician will be adept at translating medical jargon into comprehensible lay terms, knowing how to defuse words, such as obese or psychotic, that might cause alarm or hurt feelings.

The physician will also keep up with popular culture, tracking popular direct-to-patient communications and incorporating them into the clinical dialogue.

The physician will have virtuoso data entry and retrieval skills, with an ability to talk, think, listen, and type at the same time rivaling that of court reporters, simultaneous interpreters, and journalists on deadline."

Wow. So we will graduate jaded students who can walk and chew gum at the same time making the five precious minutes we have with them efficient, empathy be damned.

I am not sure how much empathy anyone can command in the brief interludes that define the doctor-patient visit. I do think it can develop over time, especially in the practice setting.

We can start with Sheile Brune's Life History Project, a program that records and creates the personal story of patients that can then be referenced during care episodes.

Here's some unlikely inspiration. Well-known speaker and author Harvey MacKay actually was first a CEO of a company with one of the most boring products imaginable--envelopes. But he made a fortune in the envelope business that parlayed the rest. How? By knowing his customers.

He armed his sales force with something called the MacKay 66-- 66 questions that his sales force was tasked to find out about customers over time. That is key. You obviously can't go to a current customer and barrage them with 66 questions. Some of Harvey's questions were answered just through observation.

Well what did that approach do? It caused a real relationship to develop between the sales person and the prospect. It led to genuine friendships to the point that the sales person was less sales person and more trusted advisor.

Here's a sampling. Obviously the questions providers would ask, observe or note would differ and a lot would be prohibited, but you'll get the idea.

  • Is client prospect politically active? Party? How important is politics to him/her?
  • Are they active in the community? How?
  • What is their religion? Do they actively practice?
  • What sensitive issues should not be discussed with the person?
  • Does customer drink? Smoke?

Interesting, right? What if in that EHR we captured more life story? It doesn't have to be the MacKay 66. But over time, as the physician and patient interact more frequently, the physician could become more naturally empathetic and interested.

My physician experience, which I wrote about last month , benefits from my physician remembering my interests and my work. I am in pretty good health so while my doctor visits are thorough, we also spend a fair amount of time talking about the healthcare system because it is a mutual interest.

I suggest empathy can be subtly infused by having it sneak up on practitioners disguised in information collected over time about a person and emphasis on person, not patient. It is what I counsel marketers to do when targeting audiences. Not so different when you consider that the experience of care is the marketing.

Anthony Cirillo, FACHE, ABC, is president of Fast Forward Consulting , which specializes in experience management and strategic marketing for healthcare facilities. He also is the expert guide in Assisted Living for .

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