We recently had the pleasure of interviewing Kip Lee, Managing Director of Innovation and Design for University Hospitals, for our webinar Improve patient experience through healthcare digitalization which you can view here. However, if you’d like to listen while reading the transcript, you can find the audio below!
I’m the Marketing Director here at Purple. I’m delighted to say that we’re joined by two experts from the healthcare industry today. First of all, we’re very lucky to have him, we’ve got Kip Lee, Managing Director of Innovation and Design at University Hospitals. Hi Kip. Thanks for joining.
Hello everyone. Thank you for having me.
And we’re also joined byShaun Bossons, who’s the Chief Revenue Officer here at Purple. Hi Shaun.
Hey, good to see you.
We’re going to be hearing a lot from Kip and Shaun throughout the webinar. And if you do have questions for them during this session, please use the question area on your control panel. I’ll do my best to ask the questions as we go through, but also we’ve got a bit of time at the end to go through any of the questions. So please feel free to ask anything and everything, and we’ll try and make sure that we cover it.
But I want to start by spending a couple of moments to understand why we’ve come together to discuss patient experience. The short and easy answer to that question is because there is ever growing evidence that providing an excellent patient experience has a direct impact on both the financial results of a healthcare system, as well as on clinical outcomes. Deloitte has published papers in recent years that bring to light and show a correlation between an organization’s net margins and their patient experience scores. Those with a “low” score have an average net margin of 1.8%, compared to 4.8% for those with “excellent” scores. So, we can see that there’s a real need from that perspective to work on patient experience.
Then, in the past few months, Gartner has published research on the focus of CIOs in the healthcare industry, which shows that there is a trend of increased investment in technology specifically aimed at improving patient experience with almost half of organizations expected to make investments in the next year.
The final remark that I’d like to make on this is a quote from a colleague of Kip’s, which everyone at Purple really loves, because it beautifully sums up what we’re about. And that is
“If people are lost and anxious before and upon arriving for their appointments, this impacts their experience and quality, which in turn affects the value equation.No, needless suffering, from confusion about where to go”
That really sums up what we’re here to discuss as part of patient experience, and at that point, I’d like to come straight over to you Kip. Thanks again for joining us.
So Gartner is talking about patient experience as if it’s something new. Is it new?
Yeah, great question. It’s certainly good to see Gartner, as well as some of the other big players, identify patient experience as something very important. It’s certainly not new for us as that is a core element of how care is done in healthcare and in hospitals. But it’s always validating to see others, especially from outside of healthcare, as healthcare is becoming more consumer focused.
It’s certainly become a buzzword in the past 2 to 3 years, even more so than before. I think seeing that validation from the outside. It forces us to go beyond our echo chamber. This not only is affirmation from outside of healthcare, but I think it speaks to how consumers or patients as consumers are really thinking more about these dimensions than ever before. Choice is much more prevalent as we talk about the theme of consumerism. So, yeah, it’s both affirming, at the same time, something that we’ve always known.
How do we capitalize on this renewed spotlight and focus, so that’s very interesting. There’s one company that I think it’s also worth mentioning, Forrester has been highlighting some other dimensions of just great customer experience for some time now. I think for over 10 years now, they have had a customer experience index. I don’t think they have a focus on the industry of healthcare. I could be wrong, but when they started off, it was more telecom retail, hospitality. I don’t think I’ve ever seen healthcare, maybe that’s already happened. But what’s great is they highlight three dimensions of great customer care that are very translatable to healthcare. And the three-dimensional are usefulness, usability and the desirability of solutions, and opportunities we have in healthcare and if we’re going to talk about consumerism being such a new thing, maybe an extra layer of that lens applied to patient experience. That part, I think, is fairly new.
Then how might we also consider these three-dimensional. Is the technology or the solutions we use useful, is it usable? And also desirable. It makes me think about Intuit, where they had a great focus, maybe 10 years ago, on what they call designed for delight. That is also a new term.
As we think about patient experience, it’s always been how do we reduce friction and make things seamless, but let’s go beyond that and talk about how we bring delight in an appropriate way. And I think those elements are new, and it’s good to see places like Gartner and Deloitte highlighting these dimensions.
Kip, one thing you and I have chatted about in the past, is how we can learn from those, across verticals, like how we see retail is constantly talking about the customer. We see sports stadiums all about the fan. And we’ve seen a lot of information and learnings from those verticals coming into the healthcare space too.
I think, essentially, just to throw in all these big consulting firms, I think they coined the term liquid expectation. And as people, consumers, but people in general, come across the Googles of the world, or, as you point out, the retail experiences that have done a phenomenal job of really embracing digital and making things easy for people. Now, they come to expect that of their healthcare services, as well. And it’s an opportunity for us to grow and meet those expectations. And, hopefully, in some cases, surpass them as well.
It sounds like it is evolving, how has it changed from five years ago? How has it evolved, in terms of patient experience?
There has been a healthy proliferation of different conferences. There’s been lots of new journals that have popped up, for example, so from an academic, as well as healthcare side, I think there is a recognition that the term patient might not now fully capture the intended audience. And, as I think about ways that we’re trying to grow as well, in Cleveland, through our health system, patient implies someone who is, who might already recognize themselves to be a patient and in need of healthcare.
As we think about things like preventative care and population health, some of these folks might not yet be a patient if we’re really going to think about preventative care, right? It might be otherwise healthy folks, but in the long run, there could be some incremental illnesses that are compounding without folks even knowing about it. So, by expanding how we think about healthcare, from healthcare to health and well-being, which has been a big shift right in the healthcare realm, you have to think about the intended audience and the folks differently.
And, in some cases, the folks we want to help, might not even, number one, realize that they could be patients one day, or they might even be patients, but not part of our system, necessarily.
There’s an article that came out last week saying, should we continue to call patients patients? I think a lot of folks, who bring that kind of consumer mentality are proposing alternate terms, whether it’s consumer. I’m a big fan of the term people, as I’ve already used it. How do we think about people centered care that accounts for all of their holistic well-being and care?
Some might say it’s just semantics. I think there is a healthy debate going on. And I think it could be productive because it forces us, in some ways, not just to pick and choose terms, but to rethink our own mental model of how we think about people. And some of them might have recognizable needs, and in other cases there might be latent needs. And I think some of the best innovations out there are able to address needs that people don’t even know are needed as you think about the apples of the world. So it’s evolving, I think, And I think it could be productive to think about other terms besides patient.
Do you think part of the evolution is taking examples from across verticals, like retail where they look at customer segmentation and customer needs. If you think of a patient, are we doing enough to tailor the experience based on a certain age group or a certain type of appointment? Is that starting to happen?
Yeah, Shaun, I think it’s starting to get more nuanced. I think the traditional way of thinking about segmentation is the obvious things like age group, demographics, ethnicity, all of that is, of course, still relevant. On our team, we like to use personas where it’s actually based on the behaviors, the actual behaviors of people.
And what I mean by that is it helps us to think along different lines of groups of people. So, for example, grandma might use her iPad in the same way as her grandson and from the standpoint of traditional marketing segmentation those are two different groups of people, but from the standpoint of personas, they actually might be the same target audience in terms of the types of needs they have and the technologies they really could benefit from.
So I think there is a revisit of how we think about the people that we’re targeting. I think there’s also another dimension in healthcare as we’re beginning to appreciate the nuances and complexity. For example, we know that in households, women and mothers typically care more about the well-being and the health of their families, and dad might actually be the one who really needs to go to the hospital to be seen for his checkup, but who do you target? It actually might be more strategic to focus on mom and her needs so that she, in turn, can help bring the rest of the family, including dad who needs to really be seen by a doctor. And that kind of richness, complexity and nuance, I think, makes you question, well, who’s, you know, if we go after the patient?
That means you’re going after dad, and he might not resonate, he might not engage. But if you go after mom, who might be healthy, it might be a better way to really address the needs of the family, the community, and so on and so forth.
That’s a really good insight. I know when we talk about public healthcare like in the UK, for example, we have an aging population. And when we have conversations like today, when we’re talking about innovation and technology, we obviously also need to take into account an aging population, it has to be technology that is seamless, frictionless, and easy to use.
Yeah, In terms of aging population, just to build on that, daughters, the female in the family oftentimes has a lot of strings that she can pull to help mom, dad, grandma, grandpa go to the hospital and I think it’s just a richer way to think about the target audience. And, as we think about all the different needs, patient experience, navigation, there are ways I think that we can get smarter as a whole.
Could you give us an example of a bad experience?
Yeah, this is a real one. This is actually what triggered our interest in finding a Wayfinding solution many, many years ago, and this is a personal story.
I had a situation where I was exiting the building having given a presentation on customer-centricity and patient-centric ways of approaching what we do. As I was leaving the main building and walking toward the parking lot, I heard a mother and her daughter stuck on the second floor. And it was past five o’clock, so some of the doors were locked, so they had just crossed into the edge of the building, and they couldn’t go back in the building. They were stuck on the outside exterior, and there were bars. And it was a pathway to go from the second floor to the third floor. But they were really literally stuck, and they were yelling out to me saying, “Hey, can you help us get out of here?”
What happened was according to the static map that they had, which was not that great and that’s what we used to have, it makes no distinction between the second floor and third floor for patients and they needed to be on the third floor to access the walkway from the building to the parking garage. So they couldn’t tell the difference. They were stuck and literally trapped behind bars in one of our building areas.
So I rushed back into the building and figured out a way to let them out. But it goes to show this is the last part of their journey. They don’t think they might have had a good experience with their physician. They’re leaving, they’re trying to go back to the parking garage, and they’re literally stuck in this cell. As we think about the journey, I hope that wasn’t the last thing that they remembered during their visit to our main campus here. That’s one example of how we have unnecessary suffering, the security doors were locked for obvious reasons, after five o’clock. And there was a lot of good intention in creating the maps and the visuals and the printouts, but it was just a bad patient experience tied to poor navigation. If I hadn’t seen them, hopefully, someone else would have and let them out. But, it just goes to show that we can sometimes literally trap people and get in their way, and ruin a potential good experience.
It sounds like it was a bad day for, for the mother and the child. That seems like quite an extreme example. When people have these types of bad experiences, what do you think the impact is on those kinds of individuals?
Typically, we see a lot of frustration, especially at our main campus, because that’s a pretty big campus, at the beginning of the journey. You can walk into many hospitals across the country, and just sit there in the lobby, you can see the frustration, the anxiety of folks as they walk in. And I’ve done my fair share of just sitting there, people walk in and as soon as they walk in there is the look of confusion, the look of frustration and anxiety. We actually built a culture prior to the implementation of our Wayfinding where our physicians and in some cases, senior executives would go out of their way to personally escort someone who obviously looks lost to their destination. And this is all good. And it’s well intentioned. It’s a great opportunity as well. But it’s a workaround. It’s not the way it’s supposed to be, right? So, there’s a lot of that at the front end of the journey.
We believe that, once you lock into meeting the physician provider, we’ve got some great providers in our health system who can engage, communicate, really bring that great healthcare, but that, that’s only, when they come together. We really think about the pre and post before that sacred encounter. And there’s a lot of opportunity there.
That’s the next point I was going to come onto; the impact on the individual themselves.
They were trying to find where they needed to go, but those lost individuals started to impact on other people around them, in terms of the staff, and that impacted on the rest of the experience for all the other patients. Have you looked at the impact of that kind of thing?
Yeah. The staff. Let me speak to the post implementation of our Wayfinding. The staff have also appreciated the app as well. Maybe in some cases, more than the patients. Number one because it helps them feel competent in cases where they still provide that hands-on escort service for patients. But, in many cases, prior to the implementation of our Wayfinding solution, even with that desire to take someone from point A to point B, they themselves would have to ask. I actually don’t know where this is, but let’s find out together. And, there have been numerous cases where our caregivers benefited from knowing where conference room XYZ is.
We have a lot of visits across our campus, there’s a lot of training that takes place, for example. And it’s nice when you can know beforehand where you need to show up and to also help our caregivers.
I’ll tell you one of the benefits that we did not expect when we first implemented our Wayfinding solution, the Purple app is now part of our employee onboarding. So, for folks who come in and it’s their first day of orientation, part of that orientation is actually to use the app to go find the cafeteria, go find where you need to go. And we’ve been able to bake that in. And it’s been great.
Before we move on to some of the good experiences, was there a specific journey that you had in mind when you started to look at a Wayfinding solution?
No, not not a specific route, so to speak. We just thought this is going to be better than what we have. That was really when we first started a few years ago.
If I can comment on a specific journey we have in mind that came out during the Covid 19 pandemic. I think that’s where it became clear that there are specific pathways and journeys that we want to highlight And other journeys once you arrive, that we don’t want to necessarily put on the front stage, because of the safety dimension, and also the security dimension.
So, I think during Covid 19 is when we really realized the potential to use the tool for specific journeys that we want to curate, but it’s allowed us that flexibility. So, it’s been great to see how it can be used for particular journeys.
How has the solution evolved in the time you’ve been working with it?
Incredible progress. When we first started using the product, it was limited to the inside of the building. But it’s tied to both time and space. The way the product now goes more upstream in the journey, downstream as well. And expands beyond the four walls of the hospital to make it even more relevant by starting from home or whatever location someone’s coming from.
Just the advancement and stitching the parking lot experience with the first entry into the building, that’s very exciting.
Why did you decide to move to that blue dot solution?
To go back to the term that we quoted, the liquid expectation. When you talk about Wayfinding navigation today, there is an expectation as consumers of mobile phones, that if you’re going to show me navigation, it’s not a static map and there should be a blue dot somewhere. So that in real time I can know where I am relative to where I want to be, as well as orient myself. I think that’s just the expectation now. I can’t imagine trying to open up an app that claims to be Wayfinding that doesn’t have the blue dot.
It’s one of the reasons why we look to you guys, because the prior solution, we had a navigation solution, it was limited to the kiosks at our main campus. And it did not provide a blue dot. And it’s incredibly frustrating because number one, the environment is complex, and you can only have so many kiosks throughout the facility. So either memorize the map when you’re first engaging with the kiosk and try to hope for the best or hope that you run into another kiosk along the way to make sure that you’re on the right track. But to have your mobile phone do that with the technology and what you guys have been able to harness.
That just seems to make sense.
What other considerations did you have when you were choosing a solution?
Infrastructure was a big consideration. As there are many invasive, and expensive solutions out there that could do the kind of thing we’re talking about, but it’s a unique technology that you guys offer that is minimal in its use of beacons and it truly harnesses the technology that most of us have in our cell phone. That was very attractive, and also an easier sell to our system to say this is beacon light. This doesn’t depend on outfitting our entire two point five million square footage of building with stuff. It primarily relies on your phone, and it’s supplemented and reinforced with this light infrastructure. That was very attractive and helped sway our decision making to go with you guys.
What was the onboarding process like with Purple?
The experience has been great, to date. You bring a very competent and friendly team to our site, and the coordination has been seamless. From a fingerprinting and mapping exercise we were able to work with our team. It wasn’t a big ask, we just needed to find a time where your team can walk around with the mobile phone to map the space. It was fairly straightforward, with no surprises.
I think it’s been a tremendous journey, just learning about this whole space with you. We have a dashboard that we use, that you taught us how to use in less than an hour, where we can go in and look at usage statistics. It’s been great.
And we’ve been grateful that we’re also able to make particular requests. I think we might have been the first among your clients to map out our garage to test it out as we look to benefit from that kind of upstream product feature. And so you haven’t said no to us yet. So I appreciate that partnership.
And I think anything that has benefited other systems, you’ve been very candid with us to say this is something that someone else asked, that you too can benefit from, and that’s been great as well.
How was the product rolled out to patients? Is it integrated into the EHR app, or does it require a separate app download?
Our specific ask was, how do we do this so that we don’t add another app to the app store, and integrate it into our existing official UH Now app? And number one, that was very exciting for the internal team. To bring something as robust as an in-app navigation tool to bolster the official app was met with a lot of excitement.
And it was very much welcome because it certainly brings certain gravitas to the home-grown app. And we were able to work and coordinate with Purple to provide us an API, where we benefit from all the features and functions. But it’s literally embedded within our hospital systems app and that was critical for us. Because if we’re preaching about doing digital health and saying, we need to be more seamless and do this for the end users so that you don’t confuse them. That was part of our philosophy and framework. And we were able to accomplish that with the partnership with the Purple team.
So to answer the question, we did not introduce some other app. That is certainly an option that the Purple team provides. But we went the extra mile or the extra kilometer and we embedded the Wayfinding solution seamlessly into our app.
Shaun, you’re out there talking to lots of people in the industry. What are the top five things that you’re hearing in the industry as areas of executive focus?
We’re lucky enough that we get to speak to healthcare systems all around the world and there’s a lot of commonality.
Patient anxiety seems to be key. We’ve mentioned several times today, it’s really top of mind, especially in the world that we’re currently living in, and probably will be living in, in some way, shape, or form, for quite some time. So, how do we reduce patient anxiety based on tailoring our experience to the type of patients
Missed appointments is a massive problem. There was around $150 billion of missed opportunity because of that in the United States alone. And that’s only gotten worse as people have got more fearful. And that’s cancellation of appointments as well.
We touched on this before. Kip was talking about guided navigation, with executives taking that time, and it’s wonderful. It just shows the kind of culture University Hospitals has. But it also shows that it can be quite an interruption in relation to staff that haven’t got the time to do it. And there is increased pressure on employees right now, to deliver against a lot of demand. So, I think we see a lot of healthcare systems say, how can we reduce those interruptions? How can we make sure patients are a bit more self-sufficient wherever possible?
Elective procedures are where a lot of healthcare systems drive revenue. Revenue is still a very important part of this process. And as we go through vaccination, it’s critically important for healthcare systems to still bring patients back for those elective procedures. Where they can drive revenue for them for their own world.
Finally, and obviously this is very specific to the US, HCAHPS. Obviously customer satisfaction is a key driver behind these scores. We want to avoid any form of fines that can occur. We want to make sure we have a strong brand reputation. And so all of these things, especially in the United States, have become the highest focus.
And I would say, over the last 12 months, we’ve had more interest in digital and how digital can help address some of these five areas than we ever have. It’s wonderful to hear the patient is top of mind more than ever, hopefully for all the right reasons. And this is, I think, will continue with those executives.
Kip, if you had 2 or 3 pieces of advice to give to today’s attendees, in relation to what they should be thinking about, what would they be?
Yeah, there is an immediate benefit in terms of patient, visitor guest Wayfinding. And I think that’s obvious in all the dimensions that Shaun pointed out. I can build on two of these.
One is in addition to missed appointments, what we call no no shows instead inside our health system, there’s also the late shows as well, so even if someone shows up, if they don’t have the right tools to know where they need to go, that has an impact on a lot of things. So the no-show component is important. The late show is an interesting one as part of the second box.
HCAHPS are certainly important. I’m not sure what the UK does, but in the United States the HCAHPS scores do impact revenue, as well as experience in engaging that. There’s also something called the CG CAHPS. It’s part of the CAHPS family, where HCAHPS is still a requirement. I don’t think CG CAHPS are yet. But as we think about the transition to ambulatory outpatient care, perhaps one day that will become a requirement, And health systems will give even more attention to the ambulatory care. We’re expanding our Wayfinding, beyond our main campus, to two of our largest health centers. So not quite as large as our medical centers, but because there’s so much foot traffic there, a lot of ambulatory care happens there. We want to get ahead of what might be coming and how we make an impact, also at the outpatient level.
I think what we’re finding is one for the immediate benefits. I guess there’s also the caregiver benefits, as we talked about. I think there’s also some longer term things that interest us. If we tried to sell internally Wayfinding, just along the lines of that patient or visitor Wayfinding dimension, I think it would have been fine. But I think what really got folks excited are the implications and the things you can do once you have a map of the system.
I come from hospitality originally. I remember my days at Marriott, when we were building the website. The digital apps, maps are such a fundamental part of that experience, because you can start to do other things with them. It’s almost like Google or Apple Maps API are table stakes. And then the stuff you can do on top of that, whether it’s things you can do while you’re at one of our facilities, or getting more detailed in terms of destinations. If you can track people, what else can you track, or find, or search for? So lots of other future use case implications, but it all requires a baseline mapping function.
So the prospect of things that we can do, overlay on top of the existing map and the mapping that we’ve done, it’s also very exciting. And I encourage other health systems to think about those things as we are, as well.
What types of data can have a better impact on experience?
It’s been helpful as we’ve been able to look at our data to date, and either validate or debunk some of our hypotheses. As we think about the different welcoming stations throughout our hospital, our preliminary hypothesis was that these are the entry points.
This is where we can double down on having more information, people, volunteers, and we were surprised by some of the insights based on the heat maps. We were able to see when people were firing up their Wayfinding. It was not in the locations that we thought they were going to be, and that has helped to reposition some of our existing resources and strategies around how to greet people. So that’s a very direct implication of using the data to date.
Thinking about the future I’m incredibly excited about some of the correlations that we can hopefully begin to make. So for example, the missed appointments or the late shows. Are there some correlations that we can make? And also go after some of the hard metrics that health systems are always interested in missed appointments, that’s a big one.
How can we or how might we show that based on the intervention of having Wayfinding, not just at that facility but more upstream. If anxiety is what deters people from even showing up in the first place. Can we actually make that attribution and find a way to tell that story in a truly compelling way? I think a mix of both quantitative and qualitative will be really compelling.
We’ve also got a fair amount of qualitative, because that’s also data, of watching people and seeing the ease by which they are either getting to their location using the app. I will say, we still have a healthy amount of our caregivers, providing that high touch escort for guests who are lost. But we’ve now enabled them. And so it’s just as exciting to hear about our caregivers. It’s instead of the lost leading the lost. Now, you can empower and make sure that our caregivers know where they can go to find where they need to go, or where they can direct folks. So I think, finding those connections, I think there’s a lot that we can do with the existing technology that we’ve been able to benefit from. And now making the connections, too.
Are there any other benefits you’ve found from Wayfinding?
Yeah, I think tying it with other solutions that we have in healthcare, especially being part of the innovation side of our healthcare system, it’s easy for folks to get excited about the next shiny object or technology. And we’re beginning to now, instead of looking out, because that’s how we started. When we first started our team, looking out, what else was out there? What’s something that we can bring into the system? This is one technology that I think we need to really harness even more so than we have to date, by looking for ways that it can connect with other technologies that we use. To truly make the patient experience seamless. I think we’ve got a lot of fragmented technologies in healthcare, so the example of integrating your Purple Wayfinding solution inside of our app, that was one example. It takes a lot of work, but endless benefits to the end user. How do we then stitch some of the other things that we’re doing?
We have, like many health systems, a virtual waiting room, because of Covid, where instead of showing up directly inside of the clinic, at the hospital. How can we direct people in advance to stay in their car or stay somewhere else to maintain social distance? And then using text messaging or SMS or the notification technology to let them know when it’s appropriate to come in to be seen by the physician.
There’s a way to. Integrate location based services, whether it’s knowing where that person is while they’re waiting to be seen or letting them know. We’re sending you notifications in advance. How can we let you know? The day before or 30 minutes before your arrival? Where do you need to show up? Can that also influence the likelihood of showing up?
So there’s some interesting data that could be collected there, But also, reduce that anxiety if I know where I need to go. How many of us before we need to go somewhere, look up where we need to go? That is not something that’s readily available for a lot of these healthcare experiences. You have to look up a separate email that you received from a couple of days ago. And, if I can’t find that, I don’t know where I need to go. Whereas if I’m getting these notifications, shouldn’t it be attached to that reminder? So, there are endless possibilities to integrate existing technologies.
That just makes a lot of sense. And we can start from just stuff that we have on the table, and I am incredibly excited to see how we can use your technology as a hub for some of the solutions that we can generate.