Leverage Learning Environments to Create Customer Value

Medical interns at hospital with patientA couple weeks ago a consultant friend of mine, who coincidentally focuses his practice on lean in healthcare, was complaining about issues with his healthcare providers.  It’s a story we hear often – doctors running late, very short and often superficial consultations, a rush to diagnosis, and a bias toward additional services like surgery that they happen to provide – and profit from.  They may be great doctors, but the quality of care, patient experience, and even outcome is not great.

This is also something my wife and I haven’t experienced for several years.

I have a fantastic local primary doctor.  He’s brilliant and could easily have a high end specialty practice that would earn him multiples of what he probably makes now, but he decided early on that he’d like to help as many people as possible by being a general practitioner.  He’s a medical geek at heart, and almost a decade ago when I had an uncertain diagnosis (which thankfully turned out to be a non-issue) he suggested I go up to Stanford to see a specialist to be evaluated by what was then a new technology.  That experience changed how we consume health care, and taught me a lot about how organizations can create value for customers.

The customer experience at Stanford, a world class teaching hospital about a three hour drive north of me, was different from what I’ve experienced at any private specialist.  The facility was clean, quiet, and comfortable, and the appointment started right on time.  At a local private specialist a nurse or MA would take my vital information and then I’d wait for another long period to have a 5 or 10 minute appointment with the doctor.  At Stanford the nurse took the vitals, then a resident came in and spent 10 or 15 minutes with me to go over my situation in considerable detail.  They listened and probed and asked a lot of questions.  Turns out it’s not just because you have to be exceptionally smart to be a resident at Stanford, it’s also because the next step is for them to present my case to the doctor… quickly, concisely, and thoroughly.  The doctor then comes in with the resident and together, in front of me, they review my case.  It was fascinating hearing the doctor/teacher helping the resident analyze the case from multiple angles, considering even fringe possibilities, and come up with potential diagnoses and next steps.  I was included as part of that learning environment.

The doctors at teaching hospitals are on salary, so they aren’t trying to cram as many patients into as little time as possible.  They’re hired to be teachers, so I have found them to have far smaller egos than most private practitioners.  I love watching the residents and students match what they’ve learned in class with the experience of the doctors.  At a hospital like Stanford the experience is both deep and very broad.  Since they are measured on outcomes, there is a desire to understand rather than a bias toward action, such as surgery.  They are also not afraid to say they don’t have all the answers and that we should go to see a different specialist.  A typical consult is close to an hour, not just five or ten minutes.

The one downside of a teaching hospital is some loss of privacy.  One time I was having a rather, uh, personal exam by the doctor while a half dozen med students watched.  This possibility is made clear when I book the appointment, and I figure it’s just a way I can contribute toward improving the capabilities of future doctors.  Still, it can be a bit unsettling.

When my wife began battling severe back pain that had an unusual constellation of symptoms, she went to specialists at UCLA, another world class teaching hospital three hours south of us.  The experience was the same.  Appointments were on time, consultations were sometimes over an hour long, super smart residents and students analyzing the case in collaboration with very experienced doctors, and a focus on correct diagnosis instead of a rush to treatment.  In each case, especially after any treatment, the doctor would give her his card with his direct email and phone number and was truly interested in hearing from her.  Where else can you directly contact world class doctors, and get a detailed response back within hours?  When surgery was necessary, it was in a patient-centric environment, with the loved ones kept comfortable and well-informed, and there was no rush to discharge.

This has changed how we consume healthcare.  If it’s anything beyond the routine we will now drive to Stanford or UCLA.  Interestingly, while our health insurance company would dispute almost every local provider charge, they never dispute charges from those hospitals, even though they are usually two or three times the cost.  They probably figure that it’s hard to dispute the diagnosis and recommendations from a world class facility, or perhaps they believe that the outcome from a more expensive but more thorough diagnosis will be less expensive long term.  That’s probably giving the insurance company too much credit.

Most importantly, there is value being created for me, the customer.  Smart students and residents who have recently learned the latest knowledge, methodically problem-solving with experienced doctors who have probably seen everything, in facilities focused on creating a comfortable environment for customers while utilizing the latest technology.  I have confidence that my situation will be reviewed and diagnosed by the best in the world.  Yes, I feel lucky we can easily access this level of care.  It shouldn’t be luck.  Everyone should be able to.

So think about this from the perspective of the customer of your organization, which is probably outside of healthcare.  How can you better unleash the knowledge and creativity of your people, combine it with the experience and perspective of other leaders, and use rigorous learning, problem-solving, and innovation processes to create value for your customers?  How can you do this so that value is no longer directly associated with just price, but more so to satisfaction, confidence, and quality?  How would that change your competitive landscape?


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