No more tolerance for mediocrity. The awakening to patient-focused experiences in healthcare “I love starting my experience with a new medical professional by filling out paperwork on a clipboard!” – Said no patient ever. When’s the last time you followed the path of your customer, physically and digitally, to empathize with their experience? When’s the last time you audited your patient journey? When’s the last time you compared the patient experience against best-in-class retail and service experiences such as Tesla, Amazon Go, Glossier, Warby Parker, Casper or Blue Apron? When’s the last time you personally felt unappreciated or frustrated as a customer yourself? As human beings, we crave special experiences. Yet, as customers, we tolerate mediocre experiences. But in a world disrupted by a global pandemic, the one thing that won’t cancel moving forward is tolerance for mediocrity in any form. People have now awakened to the vulnerability of disruption and that no experience should be anything less than convenient, efficient, and intuitive. That is the new bottom line. Everything above that becomes something extraordinary that people will go out of their way to experience. Innovative patient experiences: The new battleground Before COVID-19, or BC, research was already starting to show that investing in customer experience (CX) had the potential to double revenue within 36 months.1 Yet BC, many organizations, underestimated or undervalued it. Some outright ignored it. After disruption, or AD, many organizations started cutting costs, pushing CX further behind in exchange for stabilization and business continuity. This, however, is exactly the wrong move. History has shown that in times of disruption, innovation becomes a catalyst for pushing markets forward.2-4 Make no mistake, CX is the next competitive battleground for businesses to win over customers. The same is true for patient experiences (PX). Innovation in PX will not only help set you apart, but also you’ll push the industry forward by delivering new value and setting new standards for experience along the way. Focusing on patient experiences can lead to innovation, improved care, and better business Those innovative organizations that explore ways to improve experiences and deliver new value will, by default, make customers and patients happier and will help your market grow. To do so, you have to look in and also outside of your industry. Whether it’s customers or patients, it’s really about treating people better rather than assuming they’ll continue to compromise against their own standards of excellence just to do business with us. Customers, patients, people, have choices. Innovative leaders are learning that the best experiences are usually delivered outside of their industry, pushing customer expectations ahead of where everyone is usually looking. Your customers, your patients, are more than ready to experience innovation. According to recent research published by Salesforce,5 Experience, for better or worse, is a critical differentiator. In fact, 86% of buyers are willing to pay more for a great customer experience. The more expensive the item or service, the more they are willing to pay according to PwC.6 A Walker study found that by the end of 2020, customer experience will overtake price and product as the key brand differentiator.7 Customer experience and patient experience are one in the same. So what is patient experience? It is your patient’s perception of how your organization treats them at every step of their journey. How they experience each moment shapes their perceptions and builds memories and long-lasting feelings tied to those experiences. The real patient experience, as it exists right now, is the single source of truth, their truth, which offers human-centered purpose to inspire innovation moving forward. None of this is without reward. Investing in experience is mutually beneficial. Patients and providers prosper. According to Accenture, “A superior customer experience doesn’t just strengthen patient engagement — it also correlates to 50 percent higher hospital margins.8 Today’s patients shop for healthcare services and, like all consumers, they want and will seek out the best possible overall experience when receiving care.”8 Breaking down the patient journey to rebuild a human-centered foundation To deliver an extraordinary patient experience, organizations have to understand the experience their patients have, not just in any one touchpoint, but across the entire patient journey as a whole. The only way to do so, is to actually go through the experience as a patient to identify areas for improvement and also new value creation. Doing so reveals patterns for innovation and transformation that are human-centered and meaningful. So, let’s break down today’s patient journey to identify where we can build upon a renewed human-centered foundation. To do so, we must organize investments in four key areas that will serve as the pillars for the future of PX, starting today. These investments break down as follows: Innovation Data-driven empathy Spatial design, and People and culture The goal of this exercise is to help you find your patient’s truth to enhance their experience, based on data and the journey you audit, what people feel, and what it is they value. This is indeed worth your time. According to Gartner research, companies that successfully implement customer experience projects begin by focusing on how they collect and analyze customer feedback.9 Customers don’t draw the line between their favorite experiences and healthcare. There’s nothing that says you can only look at healthcare-related examples to guide your work in experience design. To truly break new ground, compare your PX findings to best-in-class experiences outside of healthcare. One idea is to look at breakthrough customer experiences that are changing the game and setting new standards for innovative patient experiences, such as All Birds, Netflix, Ritz-Carlton, JetBlue, Disney, and Ikea. Four pillars of next-generation patient experiences Pillar 1: Innovation Experience innovation is a differentiator and creates new value in the patient journey Innovation is the first pillar because it is how organizations deliver new value in PX. Innovation is, in its essence, the application of better solutions that meet new or unlock unforeseen needs in how patients experience any part of their journey. Often in our work though, we confuse iteration with innovation. If we digitize an existing process, it looks a lot like innovation, because it’s new. For example, if we ask people to complete a digital form using a healthcare-specific customer relationship management (CRM) system and remove the pain points of 1) patients completing paperwork and 2) office staff then having to manually input patient details, we would improve experiences for everyone and also enhance process flow. It’s important. But is that an example of true innovation? While it’s new for us, it’s not new to the customer. To them, it’s an improvement to an existing process, which makes it an example of iteration, not innovation. What’s the difference? Iteration is improving experiences through the iterative improvement of analog and digital processes and other experiential design treatments. Innovation is creating novel, new and unusual, experiences that deliver new and untapped value. Forward Health is an example of total experience innovation.10 What makes Forward so innovative is that it integrates all four pillars of PX, including 1) Innovation, 2) Empathetic and Personal Engagement, 3) Spatial Design, and 4) People and Culture. Forward is an example of modern, “evidence-based” care with the intention of creating a positive experience for patients. Forward focuses on personalization and prevention rather than the majority of reactive models that are so pervasive today. Imagine buying a very expensive, exotic sports car. Upon delivery, you’re asked to race it around a specialized track so that engineers can monitor performance of the vehicle in every capacity, measure your driving skills, and establish a baseline for vehicle diagnostics compared to similar vehicles. Now imagine, from that moment, you learn everything necessary to improve your driving performance specific to the vehicle’s capabilities as well as learning how to maintain the car’s performance over time. Following that event, a sophisticated back-end system continues to track the diagnostics of other vehicles and similar driver performances to then forecast the likelihood of common issues and preventative measures to minimize or eliminate them. More so, the system also proactively tracks your vitals to further improve and personalize performance, prescribe proactive maintenance, and identify potential issues before they become major catastrophes. This is basically Forward. It reimagines the very model of caring for someone’s health. Forward delivers an integrated portfolio of personalized care through the integration of advanced technologies, predictive risk scoring and care, highly trained doctors and staff to deliver proactive and personal experiences, and a completely redesigned physical and digital customer journey. The experience also includes an accompanying app, which goes beyond booking, prescription fills, health advice, etc. It also connects customers to their data and medical records and even tracks their health over time. Because Forward is focused on preventative primary care, the app also connects to Apple Health to share health metrics with your doctor. The app then helps guide customers through their wellness plans in between visits. Even its offices resemble more of a space reserved for cool new startups than a traditional medical office or lab. According to the reviews, people seem to really love the experience–“Hands down, the best healthcare experience I’ve had in my life.”11 As the first pillar in PX, innovation is only limited by imagination and opportunity. With purpose, innovation introduces ways to deliver net new value that you didn’t (or couldn’t) see before. As demonstrated here, innovation isn’t just one thing, it can be everything. It is one moment and every moment. Innovation is the heart of experience design. Pillar 2: Empathy Human empathy and data-driven empathy power personalized engagement and better care It’s easy to confuse sympathy with empathy, but they are very different. And, those differences are important when it comes to care. Sympathy is feeling pity or sorrow for someone’s difficulties. Empathy is the ability to understand and share the feelings of another. This is the heart of “the customer’s experience.” You have to see someone’s perception and sense their feelings as a result of your experience. Since experience is so personal, it’s no wonder that emotion contributes most when it comes to customer loyalty, according to Forrester. Empathy is the core of personalized engagement. It’s amazing to me how many executives have never walked in the footsteps of their customers/patients or employees. More so, it’s staggering just how often we look at the existing experiences we deliver and accept that this is just the way it is in healthcare. Some must rise up and listen to and represent the voice of the patient. Someone needs to champion their needs, desires, and aspirations.12 If you’ve ever watched the show Undercover Boss, you recognize a common pattern in every episode. For those who haven’t watched it, the series disguises the top executive to then place them in internal and external facing roles to genuinely experience their business as an insider and outsider. Once top executives walk in the footsteps of their customers and employees, they experience the organization in a profoundly human way. It always leads to sweeping change. Case in point, BrightStar Care founder and CEO Shelly Sun was featured in an episode where she was employed at various caregiving facilities in the company’s network. She wasn’t as polished (or as experienced) as her team. But through her mistakes, she learned that by being more compassionate, patients were more willing to work with her. She was able to see first-hand where patients needed more attention, where her team excelled and where they could improve, how her team felt about the services BrightStar Care offered, and an all-around hands-on perspective she wouldn’t have had otherwise. The experience led to significant improvements in staff engagement and overall patient care. And, that’s what’s supposed to happen. As CEO, Sun would most likely have continued to miss what her company’s employee and customer experience looked like on the front lines. When it comes to empathy, it is supposed to be emotional. But as more and more patients desire digital-first or digital-centered experiences, how can healthcare providers empathize with people on the other side of the screen? The answer is what I call data-driven empathy and it’s the art and science of tracking data, online behaviors, and additional signals, to learn about people’s state of mind, preferences, expectations, and desired outcomes. This is the foundation for delivering relevant, personalized experiences in key moments of truth. For example, Orlando Health uses relevant patient data to provide personalized communication to mothers. New moms, for example, can select preferred information paths to follow such as caring for a newborn. Mothers with older children can follow tracks on best practices for caring for their families. Emails are then personalized to not only communicate updates and relevant information, but also proactively answer questions they may have. Based on user setting and also how patients interact with digital touchpoints, hyper-curated information is then tailored to new mothers to help them prepare for giving birth, caring for their babies and families, and also through personalized emails to address their specific questions. In another example, Your.MD creates personalized health recommendations for each patient using artificial intelligence (AI). As many patients search for symptoms and treatments and also seek qualified caregivers, Your.MD becomes an intelligent hub to guide efficient and informed search and referrals for patients. AI algorithms are trained to search medical literature that covers more than 1,000 common conditions. Patients can then search information and chat with AI bots (virtual agents) to help them connect symptoms with the best caregivers in their area. Hands-on experience combined with patient data allows healthcare providers to learn more about patients, their needs and the context of their situation, their preferences and intentions, and their desired outcomes. With a power duo of human and data-driven empathy, caregivers can learn more about customers to then inspire new and better ways to deliver informed, personalized, and systematic care. Pillar 3: Spatial design (and spatial computing) Reimagine physical and digital spaces to create thoughtful, intuitive, inspired, and connected experiences In pillar three, we examine a rising trend that represents the next frontier, the physical, digital, and augmented orchestration of patient experiences. At first blush, it may seem abstract, like science fiction or both, but it is very much a future that’s taking shape right now. Spatial design is considered a relatively new area of conceptual design. The trends contributing to spatial design, while more recent in study and practice, are in fact years in the making. At its core, spatial design is a collaboration across design disciplines such as architecture, interior design, art, music, materials, and now also spatial computing, which includes mixed reality (augemented reality (AR), virtual reality (VR), and AR/VR). The goal of spatial design is to create integrated, branded, and positive spatial experiences that connect the dots online and offline, improving and introducing new capabilities and experiences. When a patient visits a hospital, that’s just one step of the experience. The entire journey before, during, and after a visit, every touchpoint, digitally and physically, everything someone sees, hears, smells, and tastes, is a new canvas for the orchestration (and modernization) of patient experiences. Nothing is left without reimagination by those who champion an advanced, connected, and productive future. According to Deloitte Digital, for instance, around one-third of first-time hospital visitors get lost or confused.13 Other reports also find that upwards of 40-to-50 percent of first-time visitors lose their way.14 Even staff report being confused about critical locations, with 25 percent also getting lost. Imagine holding up a phone and seeing an arrow guiding a path. As you walk, the phone would also display information about where you are in the hospital. Gatwick Airport implemented an AR wayfinding system to help passengers reach their destination quickly and efficiently.15 Now, Rochester Institute for Technology is working with Rochester Regional Hospital to create prototypes to demonstrate the potential of augmented wayfinding systems for hospital visitors and staff.16 Enhancing patient experiences doesn’t just have to rely on advanced digital technologies (automating clipboards anyone!?). Even in micro patient journeys, there are touchpoints and processes ready to be reimagined specifically for important patient personas. For example, pediatric patients who need MRIs as part of their diagnosis or monitoring, experience great anxiety throughout the process. Because their nerves can get the better of them, children tend to move during the scan. This can lead to emotional distress, costly delays, and also expensive retakes in MRI scanning as younger patients tend to move or fidget during the exam process. Sedation is one option. But, anesthetics add costs and risks that aren’t ideal in most circumstances. One solution was to reimagine the MRI (and also CT scan) experience through the eyes of a child. This allows for children to feel more comfortable and in control of their experience while helping staff minimize the number of takes. Now, imagine today’s experience at every step. Picture the dated process of referrals and appointment scheduling, the sterile and discouraging design of most medical offices, the transactional acts of checking in, the drab design of waiting rooms that do nothing to soothe fear, then finally the unveiling of a massive, disheartening (and scary) metallic cylinder that, during operation, makes noises that rival horror soundtracks, and the insensitivity of a “move em in and move em out” processing cycle. None of this describes a solution to understand or address the omnipresent suspense and terror running through the core of a child’s very being. To help children stay calm, empathetic medical professionals set out to make the experience more approachable and less scary. One way to do so was to reimagine space and the entire physical and digital environment leading up to and through MRIs and CT scans. Many human-centered experiments emerged, with each looking at the problem and opportunity through the eyes of a child. As a result, new touchpoints were created and existing, unmovable touchpoints, such as the scanners and the rooms they’re housed in, were humanized. In some cases, new processes introduced storytelling.17 One case used Lego characters and Lego building exercises to prepare children and young adults for their exams/scans. Toys were also introduced to humanize the process. This allowed children to simulate the process by putting their favorite doll in a pretend scanner to ease them into the process. These approaches helped to make the experience more controllable and comforting in their eyes. In other cases, like that of Siemens U.K., mobile and digital apps were created to simulate the experience and help patients prepare for everything from check-in to the waiting room to the exam room. Patients could conduct their own scans of virtual items, complete with realistic sounds. Some apps, for instance, one developed by King’s College Hospital in London, U.K., were also developed for VR headsets to make the experience more immersive. Philips Healthcare introduced the concept of ambient experiences AX, which incorporates architecture, design, lighting, digital, and sound to create a more relaxed environment for scans. These purpose-built spatial design applications included: A free custom mobile application designed for children ages 4 to 10 and their parents to help prepare for the exam A specialized radiography team trained to work with children A specially designed children’s lounge featuring a toy scanner that kids could play with before their exam A specially designed examination room themed around images and sounds from the app. Other installations transformed MRI and CT scan rooms into themed experiences to help children feel like they’ve traveled into another world or adventure. Spatial design is all encompassing when it comes to designing physical and digital spaces. And it represents the next frontier of patient experience. We hardly touched upon the potential here. From Forward to Philips, however, you can start to see just how far spatial design can go in creating and delivering connected, modern, and human experiences online and offline. Make no mistake. When experience innovation wins, the patient (and the hospital) wins. Pillar 4: Culture Building a culture of innovation empowers teams to deliver industry leading patient experiences Did you know that classic change projects have a failure rate of around 70%? Most change initiatives fail because, beyond a roadmap, leadership usually doesn’t account for the human side of transformation. In my research around experience, innovation, and digital transformation over the years, the one constant between them is that corporate culture is either the number one catalyst to change or its greatest inhibitor.18 As such, culture must be a clear and present priority as part of any experience design and innovation initiative. Culture is the designable collection of ideas, the psychology of your organization. It is the norms, practices, and rituals that drive behavior. It is the collection of beliefs, mindsets, and potentially hundreds of ideas that inform experiences and outcomes. Most importantly, culture is what drives employee behavior and it is absolutely visible and tangible by patients. High-purpose cultures are functional, clearly articulated, employee-enhancing work environments. Healthcare systems definitely have a high-purpose – patient lives – and while profitability and operations are part of any business, the price of human life, and the value caregivers deliver, serve as the guiding principles of patient experience. To design experiences means that you first have to design a culture that brings together employees around a common vision and purpose. Everything starts by asking and answering a few important questions: What do patient experiences look like in the future? What does success look like? How does work change and how are employees rewarded for going in this new direction? One of the most thoughtful and experienced groups in this space is Gapingvoid Culture Design Group based in Miami, FL.19 They have led culture design initiatives for the likes of Zappos, Roche, Microsoft, MIT Sloan, and the U.S. Airforce. Gapingvoid believes that to make change successful, culture design needs people to be emotionally connected to the change you are seeking. Transformation is then made possible based upon how you connect employees and their emotional connection to future, mutually-beneficial outcomes. To create a high purpose culture and move the organization toward an innovative patient-centered vision requires executives to visualize and socialize what change looks like. That, according to Gapingvoid, is defined as the “future motivating state.”19 This future motivating state then has to be articulated through the communication of both the new vision and how employees align around it moving forward. Gapingvoid refers to this as “articulated beliefs,” a collection of beliefs, mindsets, values, mental models, and other factors that, when taken together, inform how people should work. In one underperforming cancer center, Gapingvoid learned that the reported experiences patients had were consistently low. If you’re a cancer patient, the last thing you need is anything but a helpful, compassionate, and productive patient experience. In its initial audit, Gapingvoid found that the caregiver dynamic was one that focused on health outcomes, but not on how the team works together, and accordingly, how they show up for patients. This led to inconsistent and ultimately negative patient experiences. To rectify this, managers would typically audit employee sentiments and behaviors. Then a new employee engagement and comms program would follow to communicate new solutions and goals. Often, systems would also be redesigned and people trained against them to improve performance. But this doesn’t get to the real root cause, which is really about people and culture, to enable them to show up as their best selves, together. Gapingvoid found that executives needed an understanding of caregiver mindsets and norms, principles, and world views that employees showed up with to work each day. Telling questions included: How were they interacting with one another? What did they believe in? What were their frustrations? How do they work as a group? More importantly, who did they aspire to become? What was it that would unify them, to bring out their best selves, to be more adaptable, resilient, and agile, and to be more effective together? Following this discovery work, Gapingvoid led a culture design initiative to develop a new future motivating state, a new belief system, mindsets, and norms that would guide employees to show up differently, for patients and for each other, every day. Leadership then articulated this new vision and belief system, developed unifying language, and socialized it across the organization. Furthermore, the rollout of the new culture employed semiotics (this is a huge part of the transformation), which include meaningful artifacts for every channel facing employees and patients, to visualize these new beliefs in creative and inspiring ways. This not only helped the team do great work together, it also invited patients to become part of the movement too. Within ninety days, Gapingvoid contributed to improvements such that medical practices overall reported 85 percent “very good” responses with 9 out of 11 clinics above the target. Outpatient Oncology overall reported 84 percent “very good” responses with 2 out of 5 service lines above the target.