Understanding how patients arrive at their perspective or evaluation of health care is critical in making sense of the data. What clues or triggers or events lead patients to feel confident, secure, respected, and invested in partnerships with providers and systems?
The answer is just that - Clues! Clues are surrogates for interpreting the level of quality, safety, efficiency, caring, teamwork and partnership they can count on. Clues - some emotional, some logical, some subconsciously experienced – can contribute to a perspective of excellence and confidence in the provider and in the healthcare system.
The more vital, variable, complex, and personal the service, the more alert and clue-sensitive individuals are likely to be (Berry and Seltman, 2008). Those descriptors capture exactly what healthcare means to patients and families. Patients are intensely clue-sensitive and we cannot avoid sending clues! Clues are not about amenities, they are about the human experience of interactions in the complex world of healthcare.
So what are these clues? Originally identified by Carbon and Haeckel (1994), and then elaborated on by Berry and Seltman in 2008, these clues have been succinctly gathered into 3 groupings. We describe the clues, from the patient’s view, as the Work, Look, and Feel of healthcare.
Work – Look – Feel
Does it WORK?
Does the system function reliably and consistently?
How does it LOOK?
What do I see, smell, and hear? What are the intangibles, first impressions, and ongoing signals in the environment?
How do I FEEL?
What is my experience with the people? What is their behavior, how do they work together, what do they say – verbally and non-verbally?
WORK clues describe what healthcare team members do in every encounter. It describes how the systems work or don’t to meet patient needs. Does it work reliably and consistently? These clues are logical and rational – patients come with an expectation of how the system and processes work, and it either works … or it doesn’t! For example, if a procedure is scheduled for 8am, the patient expects that it will happen at 8am; they expect that the health history and list of medications provided previously do not have to be repeated.
LOOK clues. These clues are more emotionally arrived at, and in fact may not even be consciously understood at the time. It is an impression of the setting overall, the intangibles, first impressions, and ongoing signals in the environment. A care setting that is cluttered, dirty, or difficult to navigate provides a message that we cannot organize our environment well and casts doubts about the reliability of care. Confusing signs or online technology that is not easy to understand sends messages that convey that they were developed through the eyes of healthcare team members not patients.
FEEL clues are all about how we do what we do with patients and their families. Similar to the LOOK clue, the FEEL clue is both emotionally and rationally based. For example, the clinic receptionist who fails to welcome a patient and simply points to a sign-in sheet conveys significant clues about respectful treatment. The clinician who jumps immediately into symptoms without first establishing what matters most to the patient, signals a lack of human connection. A provider who sits rather than stands while talking with a patient conveys a different clue about the time available.
Taking time to deeply understand the Work, Look, and Feel clues helps to assure that we will discover insights and innovations that aid design strategies for the strongest patient partnerships. Consciously understanding the patients/families’ experiences that provide clues to them – positive and negative – is time well spent prior to diving into improvement tactics. Deeply understanding the clues is the first step in effective human centered co-design with patients and families. Without that understanding we risk designing ‘for’ patients/families not ‘with’ them.
Purposeful and strategic improvements to rapidly strengthen partnerships are critical to achieving the very best outcomes in all areas: quality, safety, experience, efficiency, with joy and meaning in our professional lives. Wisely spend your time and resources in understanding clues – you won’t regret it!
Carbone, L. and Haeckel, S. Engineering Customer Experiences. Marketing Management, Winter 1994, p 8-19.
Berry, L. and Seltman, K. (2008). Management Lessons from Mayo Clinic. NY: McGraw Hill