The Experience Economy: Evaluating the Experiences YouCreate for Patients, Caregivers, Staff, Payers

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The Experience EconomyEvaluating the experiences you create for patients,

family caregivers, staff and payers.

The human experience

Moments• Our present

attention = 3 seconds

• ~600 million moments in our lifetime

• ~600,000 in a month

Two modes of thinking• Experiencing

• Narrating = memory

Our memories are punctuated by

• Changes

• Significant moments

• Endings

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The human experience story

Physician

Nurses

Therapists

Social Workers

Grief Counselors

Volunteers

Chaplains

Home Health Aides

Today’s realities

Consumerism

Quadruple Aim

Performance Evaluations &Reimbursement 

Recruitment & RetentionEmployee Turnover

Referrals

Competitive Amplitude

Preferred Provider Designation

Frenemies

M & As

PDGM

Compliance

Readmission Rates

Quality

Outcomes

Discretionary spend on experiences vs. things Referrer Turnovers

Census

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Welcome to the experience economy

The experiences you create shape the narrative they’ll remember and rate

Consumerism

Experiences vs. things

Readmissions

PDGM

Employee turnover

Frenemies

Competitive amplitude

Preferred provider

M & As

Compliance

Quadruple aim

Referrer turnovers

Increase referrals

Elevate quality

Improve patient experience ratings & reimbursement

Stabilize recruitment & retention

Drive differentiation

Build relationships

Increase census

5 principles to improve your performance in an experience economy

Anticipate the Irrational

1 2 3 4 5Understand

ExpectationsIdentify

MotivationsCreate Mental

ShortcutsBoost

Memory

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Anticipate the Irrational1

Anticipate the irrational

We have a 1 in 1 chance of dying, and only 1 in 3 have an end-of-life care plan.

We know that compound interest is critical to achieving our dreams of retirement, but 48% of Americans 55+ do not have a retirement account.

We have more health and wellness information than ever and yet the obesity rate continues to climb.

The majority of Americans 55+ would rather age in place, but end up receiving care in the institutional setting they would prefer to avoid.

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Anticipate the irrational

Economic theory rests on human rationality.

Behavioral economics help us understand where we are predictably irrational.

Where we have cognitive biases, or decision making blind spots, why we take mental shortcuts in decision making (heuristics) and how we process and rate our experiences.

This is the human experience to understand, shape and improve.

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Anticipate the irrational – example

A few strong service lines

Smaller

Refer patients far away

Fewer offerings

Higher complication rates

Stealing market share

Higher perceived quality

Increasing preference

Evidence in outcomes

More options

More experts

Innovation

Newest technology

Procedural offerings

Lower price comparisons

Health System A –Rational Choice

Health System B –Emotional Choice

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Anticipate the irrational – example

“Humans rarely choose things in absolute terms. We don’t have an internal value meter that tells us how much things are worth. Rather, we focus on the relative advantage of one thing over another, and estimate value accordingly.”

– Dan Ariely, professor of psychology and behavioral economics at Duke University

Predictably Irrational: The Hidden Forces that Shape Our Decisions

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Anticipate the irrational – application

Rethink managing to a dot. Instead, uncover the hidden forces shaping decisions that may be inhibiting your growth.

Invest in research to reveal the truth, deepen understanding, root out bias and challenge myopia.

Tap into proprietary databases to understand macro and micro trends and influences on consumer, family caregiver, employee and referrer decision making.

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Understand Expectations2

Understand expectations –perceptions of care

 a – c. If coronary angiography shows narrowing of your coronary vessels, what best describes your attitude towards the choice of treatment?

n %

a. I have a fixed opinion about which treatment I prefer. 20 3.7

b. I want to be informed about the treatment options available and then decide together with the responsible cardiologist which treatment I will receive.

355 65.3

c. I want the responsible cardiologist to decide which treatment I will receive. 167 30.7

Surveying coronary angiography patients prior to care, 65.3% of patients expect to be informed and involved in decision making, while 30.7% expect the cardiologist to decide.

Source: Odell A, Bång A, Andréll P, et alPatients expectations and fulfillment of expectations before and after treatment for suspected coronary artery disease. Open Heart 2017;4:e000529. doi: 10.1136/openhrt‐2016‐000529

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Understand expectations –perceptions of care

Coronary angiography patients surveyed before, during and after care

Before Care: High Trust

During Care:Indicators of Misalignment with Expectations

After Care: Rating

2Some questions about information and availabilityBaseline n‐544Q*9a‐c

How have the expectations you had regarding examination, health care and treatment been met?Follow‐up n‐505Q**2a‐c

I trust I will receive all necessary information before any future treatment.

I trust I will receive by (medical staff) in connection with the examination, health care and treatment.

The expectations I had regarding information before the examination and treatment have been met.

The expectations I had regarding the way I would be received (by medical staff) have been met.

I feel well informed.I feel I have been well taken care of.

How do you feel now, six months after your coronary angiography?Follow‐up n‐505Q**3a‐d

Understand expectations

Understanding expectations before, during and after care reveal expectation gaps to prioritize in experience improvement work.

Patient experience measures provide an insight into the quality of medical care as experienced by the patients.

Research shows that fulfillments of expectations are associated with improvement in quality of life.

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Understand expectations

Let’s talk about beer. The MIT Brew.

An insightful concoction from the Columbia Business School and MIT Sloan School of Management

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Understand expectations – example

Finding: What and when you communicate can impact expectations and subsequent ratings.

2Study: Determine whether people’s expectations influence their views of subsequent experiences and what they report about their experience.

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Understand expectations – mapping2

Phases of patient and family caregiver journeyMapping emotional touchpoints

Understand expectations

Map their journey

Assess expectations at key touchpoints for patients, family caregivers, staff, payers

Deepen your understanding of others’ expectation to improve your experience outcome

Understand how they frame the situation

Remember that perception is their reality

Determine what is their norm

Translate to their language of understanding

Assess the expectations your brand evokes and how the experience reinforces or unravels them

Start your experience improvement plan (see handout)

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Identify Motivations3

Identify motivations – the power of a question

Why did you choose your profession?

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What does success look like to you?

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Identify motivations – the power of a question3

Motivator: EmpathyAnswers inspired improvement from department with lowest patient satisfaction scores

Motivator: Understanding andAcceptance Answers inspired referrals to profitable service line

Motivator: Providing ComfortAnswers educated, reassured patient choice

Identify motivations

When you connect with personal motivators and identify shared values, outcomes/performance indicators improve; action is possible, change becomes surmountable.

You guide individuals through change – in their health, their lives, their careers.

In your human centric organization Trust is your currency You share human truths

To belong To matter To be validated To avoid embarrassment To express individuality, uniqueness To feel successful, achievement, conquer adversity

Personalize the experiences you create to each individual (see your handout)

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Create Mental Shortcuts4

Create mental shortcuts

The power of ONE idea with distinction and inherent value Unlock hearts and minds

Emotionally connect

Mark the mental GPS coordinate To locate existing and future information, perceptions, experiences

To speed the decision making journey

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Create mental shortcuts

Rebrand for Growth

• Increased hospice ADC by 60% within one year

• Tripled palliative care ADC in three years

• Increased conversion from palliative care to hospice by 11%

• Added two new service lines

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Create mental shortcuts

Think What does your brand stand for? What is your promise? What is your distinction?

Consider the Scarcity Heuristic What if your brand were to cease to exist?

Reflect How does your culture, operations and communications amplify

or contradict your promise?

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Boost Memory5

Boost memory – with a colonoscopy?

Study: Patients rated pain intensity every 60 seconds during a colonoscopy procedure.

Finding: The ending of the experience influenced the memory and rating for the experience.

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Boost memory – the peak-end heuristic

“The peak-end rule is a psychological heuristic in which people judge an experience largely based on how they felt at its peak (i.e. its most intense point) and at its end, rather than based on the total sum or average of every moment of the experience.”

– Daniel Kahneman, Nobel Laureate, Professor of Psychology, Emeritus, Princeton

While we prefer to think we are recalling facts about an experience, our recollection of events is typically incomplete and heavily dependent upon the feelings we were having during the experience.

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Boost memory – the peak-end heuristic

This psychological heuristic explains why we can actually be irrational in our recollection and memory of events. It also suggests that our memories consist of a series of highlights rather than a thorough record of facts and events.

We maximize our brain power and conserve cognitive energy – avoiding memories that are irrelevant and not needed.

Research indicates that the length of time of an experience has little effect on the real memory (i.e. Duration Neglect).

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Boost memory

Let’s take a fresh look at your journey mapping.

Assess touchpoints Elevation: moments of happiness that transcend the normal course of events through

pleasant sensory experiences and surprise.

Pride: moments that capture us at our best; whether it be moments of achievement or moments of courage.

Insight: eureka moments; they change our understanding of ourselves, of the world and give us a moment of sobering clarity.

Connection: social moments of shared experience, special events.

(Source: Karen Doll, consulting psychologist, Minneapolis, MN)

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Boost memory – application

Johns Hopkins study Spoken instructions – 14% patient recall

Visuals supported by spoken instructions – 85% recall

Example: ER Pain Scale

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Boost memory

Remember the two modes of thinking: experiencing and narrating.

ExperiencingOur moment to moment awareness and being present. This mode of thinking is intuitive, quick and unconscious. Each moment lasts 3 seconds.

NarratingOur collection and integration of our experiences into a story. We review our experiences and create narratives that we experience as our memory. Our narrating mode does a lot of editing and interpretation. During this process, changes in our stories can occur.

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Boost memory

Where are your HHCAHPS or CAHPS scores the lowest?

Boost your results with repetitive visuals and narration Mitigate the months – overcome the time lapse between an experience

and when it is rated

Create familiarity for the unknown

Process chart combined with narration

Use patient language to normalize the experience for the patient and family caregiver

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RECAP:

Anticipate the Irrational

Understand Expectations

Identify Motivations

Create Mental Shortcuts

Boost Memory

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5 principles to improve your performance in an experience economy

Mardy MakiChief StrategistTranscend Strategy Groupmmaki@r-p.com

Thank you!