Seeing the world through the eyes of your customer: Adrian Slywotzky explains what health care can learn from the tech sector

The global rise of tech companies like Amazon, Apple and Google happened because they paid attention to the hassles consumers faced buying books, renting movies or using their cell phones.

They asked, “how can we improve the hassle map of the consumer,” and then set about creating devices and services to accomplish that, author and consultant Adrian Slywotzky told a gathering of health industry leaders Sunday at the American Hospital Association’s 2014 Leadership Summit.

Technology companies have done more than forever alter how we consume information and entertainment. They’ve enabled the tech sector to overcome once powerful and profitable industries, from newspapers to airlines and retail.

“The second most valuable company in retail now is Amazon, which doesn’t operate a single store,” Slywotzky said.

Now tech is turning its attention to health care.

Why? Because it’s a three-trillion-dollar industry, riddled with waste and under pressure to deliver faster, cheaper and higher quality service.

“Health care is a rich environment for hassle maps,” Slywotzky said, referring to all the delaying, frustrating and unnecessary steps patients must endure to book a doctor’s appointment, or pay their hospital bill.

“Patient-centered” or “patient-driven” care, has become the maxim of hospital chiefs.

Slywotzky describes it as “starting with the consumer and working our way back” and says, “It’s the easiest thing in the world to say and hardest thing in the world to do.”

Successful businesses will be those that are able to do it well, and do it in a “Silicon Valley" minute, he said, challenging Leadership Summit attendees to drop by one of the national pharmacy chains that have opened walk-in clinics.

 “See how long you wait, how much it costs you, and ask the nurse practitioner there if she’ll mail you your test results and she’ll say, ‘No, because I’ll give you the results in five minutes,’” Slywotzky said. “Then think about them, not as they are today, but what they will look like three or four years from now.”

Pharmacies may not be able to do everything a family doctor can. “But ask yourself, to what degree are they a threat and to what degree do I want to forge alliances?” advises Slywotzky.

Moving large, highly regulated brick-and-mortar hospital systems tethered to outdated payment models into the digital age can seem an impossible feat.

But innovation is already happening, said Slywotzky, citing the example of a patient at California-based, CareMore.

Ellen, an 82-year-old widow with a history of congestive, steps on the scale in the morning, as she does every morning, to discover she has gained three pounds. Not thinking much of it, she walks into the kitchen to start breakfast, and the phone rings.

It’s a nurse at a CareMore clinic, concerned about her weight gain and suggesting she come to the clinic right away.

“I can’t. My daughter has the car,” says Ellen.

“That’s OK,” replies the nurse. “We’ll send a car to pick you up.”

The nurse is worried because, given Ellen’s health history, sudden weight gain can signal fluid retention in the lungs and put pressure on her already compromised heart.

At CareMore, however, Ellen is put on a treatment plan and within days, the problem is resolved, sparing her a painful and expensive hospitalization.

Citing other patient examples, Slywotzky said, this is how CareMore is achieving unprecedented outcomes.

The health chain, with clinics in Arizona and Nevada, has a hospitalization rate 24 percent below the national average and hospital stays 38 percent shorter than average.

The market leaders of tomorrow are innovating today.

“They’re improving the hassle map of the consumer and they’re doing it at Silicon Valley speed,” Slywotzky said.  “The biggest problem in business is staying with your previously successful business model one year too long.”


Adrian: This helps me see the world through the eyes and emotions of my customer. It shows me how bad things are for them and it immediately starts generating things that I can do, to radically and elegantly improve their hassle map. 

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Interviewer: I am talking with Adrian Slywotzky, an author, consultant at Oliver Wyman and expert in value growth and economic theory. Adrian can you explain hassle maps, their origin and how they apply to health care? 

Adrian: All of us have the disadvantage of being supply side thinkers and when we wake up in the morning we think about my product, my assets, my organization. In a variety industries, technology, but others as well. Certain managers have learned to think in the directly opposite way. They wake up every morning thinking about their customer's problems, their customer's organization and they've gotten disciplined about it and so they've started drawing hassle maps. 

What does my customer have to go through to buy my product, use my product, to use my service? What are all the delays, frustrations, unnecessary expenses that they go through? And then they ask the question, this helps me see the world through the eyes and emotions of my customer. It shows me how bad things are for them and it immediately starts generating things that I can do to radically and elegantly improve their hassle map. 

Interviewer: So hi-tech companies have been successful at doing this, right? The Googles, the Apples... 

Adrian: Netflix, Amazon, Google, Apple, Intuit, Bloomberg. It is a way of life with them because think of what it does. You don't start off thinking what am I good at. You start off by asking what's the whole cost of customer problems. 

And then the very next question you ask is, okay, how can I connect the dots from wherever it takes, even if it's outside my own industry to solve the customer's problem for them? And they've been doing that at least for the last ten years. And that's why we as consumers love them for it, and that's why they've generated a trillion dollars of value during that period of time. 

Interviewer: These companies have sort of unleashed sort of disruptive force that has really rocked industries like media and newspapers. But health care you're saying is next, the tech has turned its attention to health care? 

Adrian: So in the first phase, in the first ten years, it was kind of tech versus telco, media, consumer devices. But think about what's happening. Retail, Amazon, second largest in value company, starting to do it in education and financial services, but really starting to focus on health care. Why? Because it is so big and it is so hassle map rich. 

Interviewer: Explain that for me. Help me understand it through the eyes of the patient how it is hassle map rich. 

Adrian: Let me give just one example. If I am a congestive heart failure patient, in most cases when my lungs start filling with fluid, nobody knows that until seven days have gone by. I call the emergency room, I go into the emergency room, I spend a week in the hospital. There is tremendous pain, a tremendous amount of expense. 

There is a company called CareMore in California where if I am their patient I have to have a wireless scale in my home and every morning when I get on that scale it automatically connects to the clinic. If I have put on more than three pounds that means not that I'm getting fat, but there is fluid in my lungs. The nurse calls me that morning, gets me into the clinic, puts me on a regime and in seven days I am free and clear. It costs a few hundred dollars. I am not in great pain. 

And so take that micro example and multiply it by dozens of things. Diabetic wound, a fall that a senior has and if you just trace what happens to the patient, to the consumer and ask the question, could this have been prevented? Can we deal with it in a different way? Companies like CareMore, like Iora, like HealthCare Partners, like Camden Coalition, have been doing that. 

Interviewer: And that is a great inspiration, a great example. But I'm wondering sort of on a larger scale, we're dealing with massive old brick and mortar institutions that are tethered to outdated payment models, under a lot of different government regulations. How can we move that massive shift in the way that you're talking about? 

Adrian: The answer to your question fundamentally is, one procedure at a time, one team at a time. But it's happening in hospitals as well. There are hospital teams who sit down and say, "What happens when we do surgery? When we do joint surgery or cardiac surgery?" And they are finding ways to standardize, to make sure that error prevention through checklists happens and what they find is when you put your mind to it, you can radically improve the process. And some are taking it further. 

At Geisinger in Pennsylvania, you don't get 20 different bills for the entire procedure. You get one bill, one point of accountability and it's a fixed price. Now if it's a fixed price, think about the psychology of the entire team when they know that it is, A, a fixed price and it includes any readmissions within 90 days. How careful you are, how creative you are to make sure that exactly the right thing happens for the patient at every step of the way is phenomenal. 

And so it is a huge thing, but procedure by procedure I think the key to make it happen quickly is to recognize one thing. Whether its CareMore or Geisinger or Iora or HeathCare Partners, in both the hospital and in the care teams, in the last ten years there has been a phenomenal amount of smart innovation. Some of it medical, some of it non-medical, some of it in combination. 

The biggest challenge for the industry is to learn all the smart things that have already been invented. Because if we can focus on learning the smart things that have been invented and adapting them, you can save enormous costs of reinventing the smart moves. 

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By: Kirsten Stewart

Kirsten Stewart is a Senior Writer for University of Utah Health Sciences.