Category Archives: healthcare

Siemens Healthineers: New Name, New Promise

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When I was a teenager back in 1986, Disney brilliantly dubbed its design and development arm “Imagineering.” With the unique blend of imagination and engineering denoted by the name, the group developed Disney’s theme parks, resorts, and other entertainment venues. Perhaps more than any other entertainment company, Disney has consistently provided imaginative engineering that creates one-of-a-kind experiences for guests. They have delivered on the promise of Imagineering.

Fast forward 30 years, Siemens just this month rolled out its new brand name “Siemens Healthineers” for their healthcare business. They explained it this way: “The new brand underlines Siemens Healthcare’s pioneering spirit and its engineering expertise in the healthcare industry.”

Of course, the greatest power of a brand name is in the promise it makes. Here’s the promise that CEO Bernd Montag made in relation to the new name: “Going forward as Siemens Healthineers, we will leverage this expertise to provide a wider range of customized clinical solutions that support our customers business holistically. We are confident in our capability to become their inspiring partner on our customers’ journey to success.”

Other industry leaders have made similar moves. In 2014, Philips pivoted their focus to become a HealthTech company. The strategy combined their professional healthcare business and consumer business (and still trying to spin off the lighting business) so that “health professionals and consumers will engage on their health journey in a more continuous manner, instead of waiting for acute episodes where disease may hit the patient.” Several years prior, GE launched Healthymagination as their “commitment to invest in innovations that bring better health to more people.”

I think the challenge for Siemens Healthineers will be to focus not on engineering health products but on actually engineering better health, and in a way that is meaningfully different than their competitors.

It’s a subtle but significant difference. Engineering health products is about what they make. Engineering better health is about why. And it is the “why” that can fulfill Montag’s promise to become an “inspiring partner on our customers’ journey to success.”

So it is for all companies: The inspiration is always in your “why.” Which in medtech, ultimately comes down to reducing suffering, improving wellbeing, and saving lives.

Healthcare Trends: What Customers Want – and Don’t Want – From Insurers vs. Providers

There are three significant and interrelated trends we are seeing from our research with health insurers and their members, providers and patients, and payer-provider systems. Taken together, these trends point to specific directions for health plans and healthcare provider organizations to take in order to better engage and satisfy their customers.

Improving Health: 3 Trends in What People Want

  1. More people want personalized health advice on what’s right for them.
  2. They expect doctors to provide them advice on their physical health and medications. But for lifestyle issues like stress management, weight loss, sleep–they seek solutions elsewhere.
  3. For lifestyle changes, they are open to advice from insurers–as long as it’s tied to how to use their health plan to stay healthy.

One key driver of the differences in what people want from their health plan vs. from their providers is mindset. Generally, people take on a “patient” mindset when they are sick and actively needing care from providers. They take on a “consumer” mindset when making lifestyle choices for chronic conditions and when dealing with their insurance company. These different mindsets lead them to want, expect, and accept different things from insurers than from providers. Understanding these two mindsets is critical for insurers and providers to develop the right programs and services people want and will use.

What People Want From Providers: The Patient Mindset

When a person has an acute illness or injury, they are in patient mode. What do patients want, and from whom? Patients want advice from their provider on their condition, symptoms, medication, treatment, and prognosis. Patients believe providers have the training and expertise to help them and should have their best interest in mind. After all, that’s what doctors, nurses, and other providers are meant to do.

Patients do not want advice from their insurance company about what care is appropriate for acute illness or injury. Right or wrong, patients often see insurers as obstacles to optimal care, not enablers. In the heat of the moment, they may lose sight of the fact that their health plan provides them with significant benefits and instead they focus on what they don’t get.

For many health conditions, patients sort of have to trust. As my friend and lifetime health educator, the late Dr. Shimon Camiel, said: “Sure, if I have high blood pressure, I want to be empowered and involved. But if I have an ax in my head, I just want the ER doc to take it out and save my life!”

So in the traditional patient/provider acute care relationship, the “contract” is this: patients trust, providers fix.

What People Want From Payers: The Consumer Mindset

When a person is dealing with coverage or benefits, they are in consumer mode. They expect to go to their insurance company – not their provider – about coverage decisions, or determining what providers they can see, or where to get their prescription filled. Similarly, they are open to getting advice about how to improve their lifestyle or better manage a chronic condition from their insurance company, as long as the advice is tied to using their benefits better. Consumers are not particularly wanting or expecting health improvement advice from their insurance company if it is not tied to benefits. To consumers, it makes sense and is reasonable that their insurance company will help them do things that both improve health for the individual and save money for the payer. That’s the heart of the win-win.

Consumers do not expect advice from their providers about benefits utilization or coverage. And many don’t turn to providers for help with health habits and lifestyle management unless it is tied to particular conditions like high blood pressure, obesity, or diabetes. Note that when dealing with long-term chronic conditions, people tend to be more in a consumer mindset than a patient mindset– even when interacting with their providers. I’ll cover this complexity in a separate post.

Like sick patients do, consumers sort of have to trust in the system. What is and is not paid for is governed by what their health plan covers, or what they are willing to pay for out of pocket. So the “contract” between consumers and insurers is this: Consumers make good choices, insurers pay for them.

Acting on the Trends for Better Business

Leverage these three trends as a starting point when you think about what your organization can and should offer to your customers. Then do the research to make sure you’re solving meaningful problems that people want your organization to solve.

The result is happier and more engaged patients and consumers and a far better user experience. That translates into brand loyalty and ultimately improved health and reduced costs.

Beyond UX: How To Tap Customer Desire For Better Health IT Solutions

User experience research is really important in healthcare. You need those insights to optimize the user experience and make your technology as good as it can be. But how do you know what desires and expectations users/customers bring into the experience? And how do you go deeper and identify what will bring real value to users/customers?

solutios-userexperience

As you know, user experience research in health IT typically focuses on likes and dislikes and problems and opportunities with the interface, which makes sense. After all, the interface is what users use and what feeds workflows. For some technologies, user experience research also includes how providers, patients, and the device all interact.

To understand value, it’s important to go beyond assessing how users/customers interact with the interface and beyond other aspects of the use case.

Before Use

Let’s start with what is involved with users becoming users; that is, how they get to the interaction and experience. This requires understanding and tapping into their desires and expectations.

Consider: Are users coming to the experience by choice? Are they wanting to accomplish what your technology accomplishes? Are they required to use your solution? What are their expectations? What are their desires? How does using your solution fit into the bigger picture of their workflow and priorities?

These attitudinal precursors to use can dramatically affect the user experience. Decades of research show know how powerfully expectations shape experience. So be sure you know the answers before you test usability and the user experience. Do the research to get answers to these questions. A quick and dirty approach is to talk with users just prior to using your software or technology. Alternatively, you can bring them into a focus group facility, and with appropriate props, have them imagine they’ll be using your technology and find out what’s going through their minds and hearts. Just be sure to ask the right questions and without bias.

Observing Value

Another great complement to user experience research within is in-situ/ethnographic research at clinical practices to understand what will truly bring value to healthcare workflows within a broader context than your technology.

Watch at first. Just watch. Then ask questions to understand. Really focus on understanding problems, not coming up with solutions (yet!).

Ask them what they’re thinking as their waiting for data to be processed or for the next prompt. Identify what matters to them emotionally and pragmatically. Doing so will give you tremendous insight into what they desire and value, which in turn will affect what solutions you make and what user experiences you offer to help them fulfill their desires and get done what they need to get done.

This kind of deep observational research reveals what aspects of their workflow providers and administrators find most frustrating, what wastes the most time, what desires are unfulfilled, and ultimately what interferes with better patient care.

As my friend and mentor Don Norman, a noted author and leading Design Thinker summarizes: Observe/Think/Make. This is the critical “observe” step. If it’s done with an eye toward understanding the broader context within which your technology may be used, it will provide you with far more valuable insights.

Do observational ethnographic research in clinical practices whenever you can. If access is a problem, find other ways to observe workflow. Create mock workstations or procedure rooms and invite administrators and clinicians in. Again, you can use focus groups as a place for crudely emulating workflow. As long as the setup puts users into the right mindspace, it can get you valuable insights.

Bottom line, going deeper to tap into customer desire and understand what motivates users and what will bring them real value will make your UX work far more gratifying and effective and lead to better Health IT solutions.

Getting Clearer on Patient Engagement: What You Said

In a recent post on patient engagement, I made the point that as a field, we really need to clearly define what patient engagement is and isn’t. After all, how can we improve it, if we’re not clear what “it” is?

Accordingly, I proposed a definition for patient engagement along with a rationale, and invited you to comment and add your definition. Many of you did, providing interesting ideas and much food for thought. Thank you all.

We aggregated what you said (only slightly edited for grammar) and are sharing it here to further the conversation. Let me know what stands out for you, and any new ideas or definitions that come to you.

Joeri GredigWe see patient engagement as the most valuable driver at maximal low costs to achieve faster recovery. Technology developed with focus on patient perceived value will boost caregivers effectiveness.

Leslie Rees: Hard to define with different attitudes of both patient and clinician and often determined by circumstance funding and time.

Marian BondPatient engagement is very different from listening to a patient worry about their health or takes action to improve their condition. Patient engagement is about giving your time to actually hear what is being said and acting as a conduit for that patient to grow in knowledge and spirit. Engagement is the illusion of time for that patient – making them feel like they are the only one in the universe and making them feel fully heard. Care and comfort is a lost art in medicine. It is something that a lot of facilities are trying to teach, but best taught by example.

William Hannon: You can never replace Empathy. Doctors, Nurses, Device Designers, Architects all need to embrace a sense of EMPATHY with the patient. It is a sad state of affairs when a whole new profession UX ‘User Experience appears out of nowhere.

Rafael Goeting: Engagement happens when we give our patients a greater sense of control over treatment, care, and outcome. This type of engagement is not limited to just the patient but also includes their loved ones.

Mahendra Bhandari MD,MBA: Patient engagement is a perpetual support to a patient, outside the period of ‘in person’ contact with the healthcare provider. Wireless medicine and technology is poised to play a major role. This engagement has to continue beyond the treatment of illness to wellness.

Dawn Stewart: In my opinion patient engagement comes in different forms and at different levels. This can consist of a patient taking interest in their condition, seeking out information around treatment and management, understanding their medications…rather than just letting the healthcare professionals treat them. It’s about taking some kind of active role in the disease, condition and therapy.

Sk Ray: I think patient engagement is the tool to share the information which are beneficial for any individual who is suffering due to illness or who is health conscious.

Thomas Calloway MBA: Great topic, Mr. Engelberg. I have always considered “patient engagement” the attitudinal decision that stimulates a commitment to modify deleterious health behavior. If you like, when patient and doctor decide to work together.

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Note that to some of you, patient engagement is about patient attitudes toward their health. For others, it’s about tools, or interaction between providers and patients. A couple of you highlight empathy as the critical ingredient. And several focus on behaviors or actions patients take to improve their health or healthcare.

I’ll keep working on refining the definition of patient engagement so we can move to an industry standard. I welcome your ongoing feedback and input.

Once defined, the next question becomes… how do we measure patient engagement? The fun continues!

Happiness as Competitive Advantage? A Challenge for Health Companies

company_happinessYou may be familiar with the Kingdom of Bhutan’s Gross National Happiness (GNH) index. This small Himalayan nation is the only country in the world that measures and aims for national happiness as its most important objective. The intent is to build an economy and culture based on spiritual values more than on material wealth. It prioritizes GNH over GDP. Bhutan’s commitment inspired the United Nations to pass a resolution that placed “happiness” on the global development agenda.

What does this have to do with you and the success of your company that’s in the business of health?? Potentially, a lot. As you read what follows, consider the notion of balancing both profitability and happiness as guiding values and major indicators of success.

Bhutan’s young King Khesar put it this way in his coronation address: Yet we must always remember that as our country, in these changing times finds immense new challenges and opportunities, whatever work we do, whatever goals we have – and no matter how these may change in this changing world – ultimately without peace, security and happiness we have nothing. That is the essence of the philosophy of Gross National Happiness. Our most important goal is the peace and happiness of our people and the security and sovereignty of the nation.

Most companies in the health industry base major business decisions on financial metrics like ROI to shareholders, quarterly numbers, and EBIDTA. Which makes sense. You need to be successfully financially and deliver a return to investors to be a going concern.

Money matters, no matter how dedicated your company is to improving health and saving lives. “No margin, no mission,” as the late Sister Irene Kraus, former CEO of the $3 billion Daughters of Charity National Health System, is credited as saying.

And, and… maybe happiness can matter just as much as money, and measurably contribute to your company’s financial success.  Especially since you’re in the business of health. Many start with employee happiness and well-being. Kaiser, Genentech, Mayo Clinic are a few of the health companies that have a reputation for really investing in the well-being –  and thereby the happiness – of their employees.  And there’s much further to go.

Let’s do a thought experiment: What would if happiness of your employees was a measure of your organization’s well-being? What about delivering  happiness to your customers?  Can you imagine happiness as part of your brand promise? Part of your unchanging core values? A key differentiator in highly competitive market? A metric you proudly talk about to shareholders and investors?

Be happy??

Med Tech Product Managers: Persuading Your Management To Support Your Innovation

innovationJames is an experienced product manager at a large device company. He has a winning new population health idea supported by a strong business case.

James knows his new initiative will pivot the company well for the future of value-based reimbursement. He also knows that maintaining the status quo will be a death knell as the fee-for-service paradigm gradually disappears.

James has solid ROI projections and trend analytics to back it all up. He also knows his idea fits and delivers on the CEO’s stated vision for the company’s future.  He has pitched the idea up the management chain internally on several occasions.

The problem is James is not getting the support he needs from upper management. He gets heads nodding but no action. No commitment. Overall lukewarm reception.

Why? Because even though what James is proposing is sensible, timely, backed by facts, and aligned with the corporate vision,  it requires going in a direction that is unfamiliar to the company. It is perceived as an unknown. It is therefore seen as risky business.

What should James do? It doesn’t make sense to simply repeat the same arguments and expect a different result. He already made the best case he could. But he knows the window for competitive advantage is slipping away.

James needs other voices to give his bosses enough confidence to say yes and invest in what they know is a good idea and necessary for the company’s long-term viability, despite their concerns. These other voices need to be strong enough to overcome fear of change, fear of moving into an unfamiliar space.

James doesn’t need a large quantity of voices. Survey numbers won’t make his case more persuasive. The status quo thinking he needs to overcome is not rational. He needs to strategically manage relationships with his internal customers. Persuasion at an emotional level if required.

Specifically, James needs smart, influential people that genuinely share his thinking and who his bosses will listen to with open minds. That means select key opinion leaders and perhaps several important customers who will voice their agreement with three things: 1) The underlying premise about healthcare’s inevitable shift toward population health management and value-based reimbursement. 2) The recommendation to take proactive action now in order to be positioned to serve healthcare customers in the impending new business reality without losing viability in the current fee-for-service environment. 3) The reality that not taking action is the riskier choice.

The insights and recommendations need to be delivered carefully and strategically to be heard and take hold. Even if these influential voices are only echoing what James already said, when management hears it from them, it has a different impact.   It shifts the perception of risk away from stepping into new territory, and toward missing the boat by not moving forward with Jame’s idea.

There’s a lot of science and research behind how and why this works from studies of persuasion and decision-making. But bottom line, and like-it-or-not, James needs to marshall additional resources to persuade his upper management to move forward and with sufficient investment. The end result is management’s initial fears of change are allayed, they feel reasonably confident that they are moving forward in the right direction, and most likely, they say yes!

Patient Engagement: What Is It Really?

patient_engagementWhen a patient worries about their health condition, is that engagement? What about when a patient tracks their condition with wearables? Is a provider required for patient engagement to happen? Or is it only engagement when a patient is taking action to improve their condition?

A few years ago, health IT strategist Leonard Kish called patient engagement the “blockbuster drug of the century.” At HIMSS last week, there were numerous presentations on patient engagement and countless vendors offering patient engagement solutions. Yet, there is still no clear agreement as to what exactly patient engagement is, what it does, and how to measure it.

Let’s try to fix that. This first post in the series will focus on what patient engagement is.

We’ll start by defining what a patient is. (Interestingly, the word “patient” originally meant ‘one who suffers’ according to Wikipedia). The most common definition of a patient is simply someone receiving medical care. Note there is a connotation of passiveness in the notion of receiving care. The other relevant point is that receiving care requires interaction with someone who is providing the care. That means patient engagement requires a provider, not just a patient alone. So to be a patient, all someone needs to do is accept care from a provider.

What is engagement? I see engagement in degrees, from caring to understanding to acting. A patient is minimally engaged by virtue of caring about her health. She is more engaged when you actively work to understand her health. And she is deeply engaged when she is taking action – doing things – with the intent of improving her health.

One more component to add: Most patient engagement definitions include: a) participation, use of resources, and interaction with a provider, b) a goal of positive health behaviors, and c) an end result of health management or health improvement.

Put in all together and we have this definition of patient engagement:

Active participation of a person in their health and healthcare, which includes using resources, working with their provider, and taking action to understand, manage and improve their health condition.

How does this definition work for you? Any suggestions for improvement?

Now that we have a good working definition, we can move on to what patient engagement does, and how to measure it. Stay tuned!

Hot at HIMSS 2016: Interoperability, Population Health, Telehealth, Patient Engagement

I just got back from a jam-packed few days in Vegas for HIMSS 2016. Just me and 40,000 of my closest HIT friends.himss16

The mix was 2/3 vendors, 1/3 healthcare systems, I heard. Lots of excitement, lots of energy, lots of promise. Lots of walking.

As I step back, I see four main themes jump out: Interoperability, population health, telehealth, patient engagement. Here’s my quick take on each.

Interoperability: Getting devices to talk to each other, share data, and play nicely together for the higher good- better care, better outcomes. Along with improving mediating outcomes like workflow and reducing errors. Kudos to device and IT companies for sharing and letting go of turf. It’s certainly time.

Population health: All about prediction to figure out whom to provide what services to. Seems to be a modern version of managed care in terms of bottom line purpose, but driven by predictive analytics and with far more tailoring of care. The key piece still under-estimated is how hard it can be to get people to change health behaviors.

Telehealth: Keeps evolving to let more and more care and monitoring happen remotely (or “out-of-person” vs. “in-person”). Now it’s not just connecting provider and patient, it covers connecting providers and providers, providers, payers, and patients, etc. This will challenge our paradigm about what monitoring, diagnosing, and treating can only be done in-person. I think the litmus test for clinical care is empathy – to what extent can a provider truly empathize and thereby deeply understand a patient through mediating technology.

Patient engagement: Though it’s been around since the earliest days of healthcare, it now means all kinds of things and is catalyzing a wide variety of new products and services. Key issues here are about defining what it is and isn’t, developing objective metrics, and making it not a separate “thing,” but an integral and unavoidable part of every healthcare interaction.

Better interoperability behind the scenes, plus telehealth to enhance and extend relationships, combined with population health to focus resources, improves patient engagement to make it all matter.

Let’s Stop Confusing Strategy and Tactics in Healthcare

strategyI can’t tell you how many times we’ve seen very smart healthcare companies – med tech companies, payers, provider organizations, etc., confuse strategy and tactics. And it reduces their effectiveness every time.

Why do strategy and tactics get confused? First, sometimes there is not clarity about what the real objective is and why. This subjects companies to the paradox Lewis Carroll described this way: “If you don’t know where you’re going, any road will get you there.”  Without a clear end point in mind, develop meaningful strategy to get there is very difficult.

Second, there is so much pressure to get new things to market, it makes it hard to carve out time and think strategically. There’s only time to “do” — even if what is being done doesn’t make good sense.

So what’s the difference? Strategy determines how you will achieve your goal. It represents which map you will use to get where you are going. Tactics are the map details and are all about the doing.

Let’s start with a couple military examples: 1) Divide and conquer is a strategy. Sending half the troops in a frontal assault and half on flanking maneuvers are the tactics that executes on the strategy. 2) Go big, go long, or go home, were the three strategies being considered in the Iraq war. How many troops would be where and when were the tactics, and that’s what got all the media coverage.

Marketing examples: 1) Be first to market is a strategy. Be a fast follower is an alternative strategy. The specific products or services you take to market, the resources you allocate, and the timing are all tactics. 2) First get prospects in the door with a low barrier to entry, then engage them to be customers is a strategy. How you will go about getting them in the door and converting them into customers are the tactics.

 

Don’t be one of the many companies that spend millions of dollars and years of effort on something only because their competitors are doing it. Have a good compelling reason. That way you know where you’re going and why.

Next be clear about what your strategy is, and why. Make sure your strategy is really strategy — and not tactics with the word  strategy attached. Then get into the tactics that execute on the strategy.

Lastly, make sure your team knows the difference between strategy and tactics and why it matters.

Bottom(s) Up! How a Benefits Ladder Can Help You Get Your Marketing Right

Medtech companies, health insurers, and healthcare systems talk a lot about data. My belief is no healthcare executives, providers, or consumers really care about “data.” What they do care about is making good decisions that will measurably improve healthcare and health outcomes, and make or save money. And they see data as a means to those ends, a tool for making those things happen.

So how do you meaningfully connect data with decisions and decisions with outcomes? How do you work in the interim outcomes like improved workflow and increased productivity? How do you know which features and benefits to emphasize and which not to emphasize or even mention? How do you determine what elements to consider including in your value proposition?

One powerful technique we use to identify and prioritize benefits is laddering. We use it in deep dives with clients, and in testing or validating hypotheses during customer research.

Here’s how it works:

At the bottom of the ladder is the essential feature. At the top is the highest level benefit or result.

But first, let’s clarify the difference between features and benefits: Features=description. Benefits=satisfaction. Data is a feature. Good decisions, better workflow, improved quality of care – those are benefits. Those are results that provide satisfaction.

And there are different kinds of benefits (some overlapping): There are core benefits, functional benefits, aesthetic benefits, self-expressive benefits, emotional benefits, and more.

Benefits are what customers care about. But sometimes inside the company, executives, product managers, and marketing managers care more about features. That’s a problem that laddering can help ameliorate.

Here’s what a simple benefits ladder might look like for streaming analytics within health IT, to appeal to healthcare providers.

TOP

  • Improved Outcomes
  • Safer Patients
  • Enhanced Reputation
  • Better Care
  • Faster Decisions
  • Prediction
  • Analytics
  • Data

BOTTOM

Note that the core fundamental feature – data – is on the bottom. Just above that is the next level feature – analytics. Next we move up into benefits, starting with the functional benefit of prediction, which then leads to faster decisions. This set of four captures very concretely what the product is and does. And if we were to unpack these four further, we would get into workflow, efficiency, and productivity.

However as a set, the bottom four rungs on the ladder do not convey aspirations or emotions. And they do not express higher order benefits or results. For that, we need to go higher up the ladder.

A result of faster and therefore better decisions is better care. Which leads to multiple higher order benefits – like enhanced reputation, healthier patients, and better outcomes. And again, unpack these further and you’ll find patient satisfaction, HEDIS scores, etc. Some of these benefits may be produced concurrently, but for simplicity the ladder shows them in linear fashion.

When we go through this process in internal deep dives, we’ll invite clients to attach a heart to the one benefit they believe is the most compelling emotional hook for the product. For providers and streaming analytics… is it faster decisions, enhanced reputation, better outcomes? Is it improved workflow or its outgrowth, saving time?

The ladder they create and the emotional hook they select are well-educated hypotheses. We rely on the voice of the customer for validation or correction.

Bottom line, laddering is a great way to think through what your product or service delivers that matters to customers so you can improve your marketing. Do one for each of your main target audiences. When you do, you’ll notice the bottom rungs of the ladder are the same, it’s typically the higher order benefits that change.

Whether you’re bringing a new product or service to market or need to get better uptake with what you’re already selling, try laddering. It will enable you to transform your thinking, empathize with your customer point of view, inform your value proposition, and set yourself up for marketing success.

What’s your ladder??