Throughout my life, when I would weigh decisions, my mother’s voice in my head would remind me that when you pick up one end of the stick, you pick up the other. She meant that actions have consequences, both good and bad, both expected and unexpected. So, when I wrote about the impact of the Experience Economy in the last essay, I was not suggesting that we not care about patients and their time in our care. I was simply reminding readers that actions have consequences. By branding an effort in a certain way, you will awaken preconceptions and establish new conceptions, some good, some bad and mostly unintended in the minds of your patients.
This is true not just with your patients or the communities you serve. It is also true with your staff. Your staff, both clinical and non-clinical, have preconceptions about the health system they work for. These may be based upon past behaviors, current messaging or organizational mythology.1 These can be accurate, a bit distorted, or flat-out misunderstood. So, when considering how to communicate and roll-out a new service initiative, words matter with staff as much as they do with patients.
When considering how to communicate something, it is critical to consider where your audience is. A successful teacher or presenter has a sense of what preconceived notions their audience has on the topic they are presenting on. When I was young and dumb, I used to think that because I was passionate about a topic, the audience certainly was as well. It only took a couple 8am classes with a room full of Freshmen to learn that this was not the case. I quickly learned that regardless of whether I wanted to lean into them, or turn them on their head, I first needed to appreciate the class’s initial expectations on the topic. This made the learning curve for dealing with emergency department doctors at 0500 much easier to climb.
I used to be amazed at how shocked some people are that certain individuals are drawn to certain jobs. Now I am just annoyed. Setting aside the veracity of these claims, 2 people seem surprised, even outraged. at the perceived liberal bent in academia or the perceived conservative bent in business, not acknowledging that individuals don’t choose careers randomly. There are personality traits, preferences, or goals that drive people to certain lines of work. Why are they surprised that people with certain personality types or worldviews would be drawn to certain jobs?
To that end, what sorts of people go into clinical healthcare? Again, while one can go too far into broad stereotypes, my experience is that doctors, nurses and technicians share some dominant personality traits. They tend to be no-nonsense, outcomes-focused, and put a premium on rational decision-making. They don’t tolerate embroidery well; doctors have a reputation for interrupting patients. A study in 2018 showed that doctors could not let a patient talk for more than ELEVEN SECONDS before interrupting them. Many suffer from an irony deficiency. [Insert rim-shot here.] The administrative side is often dominated by businesspeople. Another black-and-white crowd, who are focused on the quantifiable. They may appreciate and echo the hospital’s commitment to quality care and serving the community but will often also remind audiences that there is no mission without margin. This is not an insult. This isn’t about throwing shade; it is about knowing who you are trying to communicate with. These two groups respond well to standardization and process orientation.
The great cosmic joke is that there is one group at the hospitals that don’t function that way. The PX crew tend to NOT fit in this mold. (OK, two groups, if you also include Post Acute Care, and the PAC folks have the best pot-lucks.) Whether the PX folks came from the administrative side, the clinical side or the outside, they tend to march to a more nuanced and freeform drummer. They feel and are inspired by the touching heartwarming stories. The anecdotes and patient comments carry great meaning for them. These folks respond well to emotional appeals and the HOW and not just the WHAT.
And when the PX team seeks to train, workshop, or simply connect with the clinicians or administration on experience work, it is like oil trying to dance with water. The audience may enjoy the presentation and understand the reasons for the work, but crossing the chasm to day-to-day impact on operations often falls flat. [I would make an Evil Knievel joke here, but I have already done enough damage to my social relevance in these essays by my ancient cultural references.]
Again, I paint here with a very broad brush, but based upon my experiences, there are some very clear reasons why the experience message gets lost, misunderstood or just dismissed by the clinicians and the administration.
Preconceptions
None of this work is new. Versions of this message have floated around healthcare for a couple of decades. Because these folks have heard this message in various forms before, most in the audience will push this message to one of its extremes.
One group will see this message as very broad and unrelated to the work they do. The audience is familiar with If Disney Ran Your Hospital. They have heard the message about pulling service advice from Ritz-Carlton or Starbucks. While they may enjoy the stories or even find some elements inspirational, they still see the gap between what these companies do and what they do every day as expansive. Even aside from feelings of terminal uniqueness, these examples feel untethered to the world they function in every day. They hear “Disney” and they check out, since the monsters in a hospital (cancer, sepsis, ALS) are real, not animatronic, and not all the rides end with everyone happy and safe.
The other group slides to the other extreme. This group will focus on the key behaviors and self-define them as super-specific and even silly, useless, and inane. This is often voiced with the dismissive claim that experience is simply putting mints on pillows. Here, the extreme highlights little things (at least within the context of a hospital’s core work) and calls them silly and ineffectual. I had a surgeon once say, “a mint on the pillow won’t fix an operation performed on the wrong leg.”
Not in my job description
While this is often summarized as “I am here to save their ass, not kiss their ass” in the clinical world, my experience is that the administrative side expresses this more frequently. Because while old salty surgeons and nurses may not care about this stuff, 3 most of the younger clinicians received a healthy dose of customer service in their training. I have been lucky to work with several hospitals and their residency programs and have found that most doctors care about their Google ratings and the patient comments. They just don’t know how to affect them.
It is often the administrative side that gives the most push-back. Some of them don’t see themselves as ‘patient-facing’ or don’t see how this is relevant given that they have their own financial and efficiency metrics they must meet. I remember getting push-back from people in billing once when I asked them to start every call with a “Thank you for calling Hospital X, I am Joe in financial services, how can I help you today?” because it was going to torpedo their average call-length stats.4
Expensive. This preconception can come up in two different ways. The first is “who is going to pay for all those mints on the pillow and all that free coffee?” This is not surprising, as costs are important, but I also find the question telling. When talking with a clinic manager about providing free coffee and water to patients his first question was “Where is the money coming from?” I mentioned that since this was his first question (and not “How will this help scores?” or “How do we manage folks who cannot have coffee before their appointment?”), it told me a lot about where his head was at. I didn’t blame him, as it was simply another example of how attention is currency and illustrated what happens when senior leaders continually pound the fiscal responsibility drum, drowning out all other conversation. Since he received far more emails about his clinic’s balance sheet than his clinic’s patient satisfaction scores, it was not surprising that this was the first place his mind went.
The other place where this preconception pops up is in the cost of the training itself. Even if a workshop, training session, video tutorial, or lunch-and-learn session is done by in-house staff and doesn’t cost anything, the time for the audience is a cost concern. I cannot count the number of times that I have received emails from leaders complaining that they don’t want to pay traveling nurses or agency staff to participate in training on the hospital’s core service work. I ask them if 30% of their staff come from a staffing company, are they comfortable with 30% of their patients not getting consistent excellent care? I think that the “train the trainer” models (where you train the directors, managers and supervisors and they train the frontline staff) can be effective, but I also think it is primarily popular in organizations because it is cheaper than bringing everyone into one room to hear one message.
Vague. If the target audience is using decision trees or triggering events to act, a message that focuses on the HOW and not the WHAT will sound vague. They know what to do when blood potassium levels fall below 3.5 mEq/L, or when a bill extends past 60-days overdue. These are clear triggers that call for specific actions. But when the triggers are “patient seems anxious” or “patient isn’t sure the suggested appointment time will work with their schedule” these folks can struggle with when to act. Then, when your solutions don’t strike them as clear and codified, they can struggle with what they need to do. This often means that they will interpret what you say as, “Our strategy is to be nicer” and they will dismiss it as stupid or unhelpful.
Who cares? Not only do staff often think this is not in their job description but they also think that patients don’t care about this either. “They don’t care about the experience; they care about getting their broken leg set.” “They don’t need a ‘billing experience,’ they just want pay what they owe.” When your audience define patients as simply wanting quality best-practice medicine or the earliest appointment time, they will dismiss all this work as trying to give the patients hugs and cookies instead of trying to get a patient through the process as quickly and painlessly as possible. Like other things here, this says more about the employee than it does about the patient. If you think that all your patients are pissed-off drug-seekers, then they are not likely to be motivated, touched, or swayed by a remarkable experience. If you think all your delinquent accounts simply don’t want to pay for the care they were provided, you think that giving them attention and compassion is the same as giving into their demands.
This all sounds a bit depressing for a Friday, but none of this means that service work, providing remarkable experiences for patients and employees, is pointless. It simply means that if you want to connect with your audience, you need to understand their mindset so you can either lean into their preconceptions or turn them on their heads. When you talk in a language they understand, most of your audience will be eager. But, when you ignore where they are coming from and simply assume that what you are selling is worth buying, then you will get a lot of smiles and nodding heads but no real connection. If you talk about ‘experience’ without doing the groundwork, a large portion of the audience has already relegated what you say to the pile of foo-foo garbage. The stories and anecdotes that you love and think speak to purpose can get smiles and nods from your audience, but no real recognition.
How do you reach these folks and get them to care about the message? I will save the long version for another day, but the moment, play into their mindset. If they are no-nonsense, outcomes-focused rational decision-makers who don’t tolerate embroidery, then you must deliver on that. If you use their language, they are more likely to understand your vision. Save the experience journey mapping for another time.
1I remember being at a hospital during the holiday season and hearing staff complain about how the hospital used to give out turkeys and hams but doesn’t anymore. I asked administration about this and discovered that this was true. Fifty years ago. There were literally no employees currently on staff who worked at the hospital during the free ham and turkey giveaway. And yet, it is amazing how the legacy of hurt feelings can transcend all time and space.
2Speaking as a professor and owner of a few small businesses (and not extrapolating beyond my own experience), the correlation between political perspective and academia or business is not as robust as some portray it to be. But that would be a subject for another essay, perhaps on a different website.
3 When confronted with the notion of patient-centered decision making, I had an ED doctor say, “So, we should take a vote on whether to set the patient’s broken leg?”
4 I told them that this was some Olympic-gold-metal deflection and that I would have been aggravated, if I wasn’t so impressed at the complete lack of self-awareness that they demonstrated. Yeah, sometimes, I have bad days when I am not 100% committed to solutions and instead want to metaphorically punch people in the nose.
PX Matters with Joseph Snipp 
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