Wednesday, May 26, 2010

Physician Ratings vs. Healthcare Narratives

An interesting study came out last week which aligns with some of my thinking and thoughts on individual physician ratings:
• The overall activity of ratings is pretty low (e.g. there are not many ratings being posted by patients). I think a major part of that is because consumers are not really confident in how to rate doctors since (1) there is a fair amount of subjectivity which makes it hard to put into a "standardized rating" and (2) they don't do it often. In other words, consumers might feel they can be experts on restaurants and movies since they have a lot of experience at those venues AND there are often obvious metrics. Meanwhile, most people just see a doctor 2-3 times in a year (and then it's just for 15 minutes), they usually just see 1-2 doctors (so not a lot of comparisons), AND the experience each time might be different depending on a variety of factors (e.g. how sick they are, the type of syndrome they have, how they respond to the therapy, etc.). In other words, most patient's actual experience with the doctors is often short and incomplete (at least with respect to fully rating them).
• Most of the ratings are positive… which makes sense since that is often human nature. But at least this dispels the myth that only "haters" would post! However, it should be pointed out that it often only takes 1 bad review to sour most people, unless there are over 5-10 good ones also present. A small amount of reviews can be easily biased by one bad one.

The LA times even did an article about this study: Physician rating websites mainly sing doctors' praises, study finds. It is a good story, although I think they used this study to too quickly dismiss these sites. Rather, I would use this study to explain that:
1. Physician rating sites are still in their early phases and the jury is still out on how important they will be.
2. For a true objective rating of doctors, we ideally need much greater numbers of consumers doing these ratings, and ideally in a more consistent manner (e.g. randomly poll patients, otherwise you will mostly get the most extreme examples on either end to post a review).
3. There needs to be a way for physicians to respond, particularly to negative posts (although without violating patient confidentiality). For example, I am impressed that now does allow for that function.

With that said, I think there is also a very important role for more "narrative" reviews of healthcare as well. However, that is likely to be best done at the systemic level (e.g. total healthcare experience across an enterprise), rather than geared towards a single physician. For example, I recently heard about a website called Patient Opinion . This is a non-profit organization in the United Kingdom founded by Paul Hodgkin, a GP who wanted to make the wisdom and insights of patients, available to the NHS (National Health Service). He states "the old ways of doing this – inviting a patient to sit on a working party or carrying out a survey – did not work very well", so he devised Patient Opinion as a way for thousands of patients to both share their own experience and gain support from others. The results are story after story about the good and bad in the system. And hospitals and other entities actually read and respond to these stories. They have found that these stories have more power and information than any objective rating scale could ever provide - and that they are often able to fix systemic problems based upon these narratives. Wow - that's a very powerful thought...

Thursday, May 13, 2010

Storytelling and Innovation

I am fortunate to be part of the Innovation Learning Network (ILN) which "brings together the most innovative healthcare organizations in the country to share the joys and pains of innovation. Its purpose is to foster discussion on the methods of Design Thinking and application of innovation / diffusion, ignite the transfer of ideas, and provide opportunities for inter-organizational collaboration." Some other members include Kaiser, Partners Healthcare, the VA system, UPMC and the Ascension Health System.

We meet twice a year for "in person" meetings where we learn formal innovation techniques, brainstorm on how they can be applied at our institutions, and share stories of successes (and failures - since the nature of innovation requires some failures!). Our most recent meeting was last week and was in Chicago - it was primarily hosted by a fantastic innovation and design consultancy called gravitytank (and the Szollosi Healthcare Innovation Program helped to co-host since it was in our home town!). As usual, my friend and fellow blogger Dr. Ted Eytan has already written this up a bit - check his ILN report out and you might also be able to see a picture of me about to be adorned with a leopard robe...

The theme for this meeting was "Storytelling" - particularly around how can stories help one develop or spread innovative ideas. I took away a couple of major learning's:

Stories are a very powerful communication tool - humans are innately and culturally programmed to hear and understand stories. It is much easier and better to explain a problem or solution in the context of a story than as a bunch of numbers and statistics. What would you rather hear as a prelude to a decision to open up a new medical office in a certain area of town: "Bob and Jane were 25 years old when they met at Margie's Candy store, fell in love, bought a house in the new section of Lakeview, and then had a son named Bobby Jr. and later a daughter named Scarlett", or "The average age of marriage in Lakeview is 27 and the majority of couples have two children". Think about how much of the story of Bob and Jane you already filled in with your own mental images (the look and smell of the candy store, the kids playing in the house…) and how much you are already interested in their lives vs. how little you care about the stats.

There is an art and a science to creating stories. First, define your Hero, the Villain, the Weapon (the tool which the hero uses to defeat the villain), and the Treasure that is received. Consider adding in a Mentor, a Companion (an important partner), some sidekicks (humorous extra characters). Next, set up your plot to mirror some of the typical archetype stories that people are used to hearing… almost all stories have a Hero overcoming a Villain to get to the treasure, but more specific stories each have their own subtleties, such as "Rags to Riches" (think Aladdin), "Overcoming the Monster" (think Jaws) and "A Quest" (think Indiana Jones). Finally, always make sure to humanize any data and keep things interesting by doing things like proposing puzzles, using props and interacting with your audience.

Storyboarding is an excellent tool for brainstorming. Draw picture panels of the current state, put them up for everyone to see, and then step back and think about how else it could be done. Draw new panels and put them up, mix and match.. and create a whole new story. We broke into groups and looked at the problem of getting thru the airport - some groups looked at this from the eyes of a single mother with two children, others from the eyes of a busy consultant, others from the eyes of an aging couple. Within 30 minutes, the amount of great ideas was staggering - from "Family tickets" (one ticket for the adult and kids) to "amusement-like rides" through security, to pat downs with cooking-like gloves which smelled of warm cookies (hey - no holds barred on innovating!).

There are a ton of books on how to more effectively use stories; one of my favorites is Squirrel, Inc. Others include Made to Stick and The Seven Basic Plots: Why We Tell Stories.