Posts tagged “healthcare”

Rethinking Everything About What You Do For Customers

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Rebecca Mead’s New Yorker feature The Sense of an Ending describes some really dramatic (and successful) reframes in care for dementia patients. There’s a number of profound shifts in how the caregivers describe their role and in the kind of experience they seek to deliver for the patient (and their family). The whole article (linked above, but subscribers only) describes those shifts and the cultural and organizational efforts to get there. I’ve included just a portion here

One of the first things Alonzo did, in 1998, was to ask an aide who was born in Vietnam to talk to staff members in her native tongue. “It was the only language I could find that nobody else could speak,” Alonzo recalled. “So we had her tell us very sweetly, in Vietnamese, what she wanted us to do, and we couldn’t understand her.” The staff had to become attuned to the woman’s nonverbal cues.

On another occasion, Alzono underwent a public bed bath, in front of the entire staff, of twenty-seven. She didn’t allow herself to move her limbs, and behaved as if confused. Afterward, she was able to describe the nature of her discomfort, and staff members analyzed their own activity in light of it. “Let me tell you, it sucked – it was incredibly uncomfortable,” she told me. Staff members then spooned food into one another’s mouths and brushed one another’s teeth, in order to be on the receiving end of activities that they performed for their charges every day. “You can find how threatening it is to have something touch your mouth when you have not brought it to your own lips,” she said.

In the most radical experiment, the staff wore adult diapers. “That was kind of life-changing for everybody involved,” Alonzo told me. “We all recognized just how uncomfortable it was to sit in a wet brief. Some of our front-line staff, who really wanted to know how bad that felt, did not change them for a couple of hours.” Previous may residents had been dressed in diapers, as they tend to be in a majority of nursing homes. Not long afterward, aides decided to stop the practice with most residents, instead taking them to the bathroom fifteen or twenty minutes after mealtimes. This made residents happier while making the staff’s jobs easier, because they no longer had to change people who were agitated.

There’s a rich tradition of participating in the experience our customers are having (see this great war story about an adventure in an “old age simulation suit”) and what feels like an increasing mention of empathy. I really like how this story highlights not so much the ergonomic or functional task aspects that are revealed but how this drives to revisiting the fundamental ideas of how the institution conceives of the patient experience it provides. I also like the full-on simplicity of the approach, the people who do this stuff to others now try it themselves and talk about it.

See also Richard Anderson’s blog post from this week about reframes in general and in healthcare specifically.

Elaine’s War Story: I thought my client was going to die

Elaine Ann, the CEO of Kaizor Innovation in Hong Kong tells a story about consciousness – both cultural and physical.

One of my most memorable research experiences was ten years ago in China. My Western client fainted in broad daylight in the middle of our Beijing field trip. We had completed field research work and were touring an exhibition. She just plopped on the floor without any previous sign that she had any health problems.

We called the ambulance and a white van came along. There was nothing on it – no ambulance emergency lights, no oxygen equipment, no CPR equipment, only a stretcher. Not knowing what was wrong with my client’s health, we (me, my colleagues and her co-workers) decided to take her to the hospital anyway.

Upon arriving at the hospital, we had to first pay for the ambulance fees in cash (this is China). Then the client was carried onto a hospital bed. I was caught in between cultures at that point as my client’s Western co-workers were dubious about the medical standards in Chinese hospitals and refused an injection from the doctor; while the Chinese doctor was quite annoyed by the Westerners’ attitude (reading their horrific facial expressions) and challenged them whether or not they really want to be helped after coming to the hospital. Meanwhile, I was trying to translate everything in both English and Mandarin, amidst all the chaos, trying to not offend either party (who couldn’t communicate directly with each other).

Finally, the client’s co-worker decided to take a risk with her boss’s health rather than risk it with the Chinese hospital, so we had to shuttle the client back to the hotel instead. (We then discovered that five-star hotels usually have English speaking travel doctors for emergencies – a handy tip for researchers doing field trips in China). In the hotel elevator, my client fainted a second time and we had to drag her off the elevator, along the corridors and into her room like a dead fish.

My client finally became conscious again and luckily we found out this was caused by a low blood sugar syndrome and happened all the time. All she needed was a candy. We had to decline her request to visit the Great Wall the next day. I really wouldn’t know how to carry her down from the Great Wall if she fainted on top of that, as it’s a defense wall designed to make it difficult for invaders to climb even in ancient times!

Seriously, I would have made the national news if my client died on our China research trip! Phew!

ChittahChattah Quickies

  • [from steve_portigal] Rent a White Guy [The Atlantic] – And so I became a fake businessman in China, an often lucrative gig for underworked expatriates here. One friend, an American who works in film, was paid to represent a Canadian company and give a speech espousing a low-carbon future. Another was flown to Shanghai to act as a seasonal-gifts buyer. Recruiting fake businessmen is one way to create the image—particularly, the image of connection—that Chinese companies crave. My Chinese-language tutor, at first aghast about how much we were getting paid, put it this way: “Having foreigners in nice suits gives the company face.” We were supposedly representing a California-based company that was building a facility in Dongying. Our responsibilities would include making daily trips to the construction site, attending a ribbon-cutting ceremony, and hobnobbing. During the ceremony, one of us would have to give a speech as the company’s director. That duty fell to my friend Ernie. His business cards had already been made. (via @Kottke)
  • [from julienorvaisas] Hey Facebook! Here’s your privacy redesign [Fortune.com] – [The community is now literally begging Facebook to fix this issue. Free design!] We asked several leading user experience designers how they'd overhaul the social network's obtuse privacy settings interface if given the chance. Here, in their own words, are their innovative solutions.
  • [from steve_portigal] For Forgetful, Cash Helps the Medicine Go Down [NYTimes.com] – [The challenge of marketing, design & other forms of corporate persuasion is revealed when you see that people need incentive/motivation to take medication] One-third to one-half of all patients do not take medication as prescribed, and up to one-quarter never fill prescriptions at all, experts say. Such lapses fuel more than $100 billion dollars in health costs annually because those patients often get sicker. Now, a controversial, and seemingly counterintuitive, effort to tackle the problem is gaining ground: paying people money to take medicine or to comply with prescribed treatment. The idea, which is being embraced by doctors, pharmacy companies, insurers and researchers, is that paying modest financial incentives up front can save much larger costs of hospitalization…Although “economically irrational,” Dr. Corrigan said, small sums might work better than bigger ones because otherwise patients might think, “ ‘I’m only doing this for the money,’ and it would undermine treatment.”
  • [from steve_portigal] Creativity thrives in Pixar’s animated workplace [SF Chronicle] – At another company, the employee in Payne's position might be a feared corporate rules-enforcer – the guy who tells you not to put tack holes in the plaster or forbids you from painting over the white walls next to your cubicle. But the architect and 14-year Pixar veteran embraces the madness. Among the more creative additions on the campus: One animator built a bookcase with a secret panel – which opens up into a speakeasy-style sitting area with a card table, bar and security monitor. Other employees work in modified Tuff Sheds, tricked out to look like little houses with front porches and chandeliers. "Sometimes I just have to let go," Payne says with an amused sigh, as he walks into a newer building with a high ceiling – where someone has interrupted the clean sightlines with a wooden loft. A couch and a mini-refrigerator are balanced 10 feet above the floor. [Did a mini-ethnography of Pixar a few years ago and the cultural factors around creativity and community were outstanding]

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