TEDxMaastricht - Fred Lee - "Patient Satisfaction or Patient Experience ?"

Summary

This transcript explores the shift from service-based industries to an 'experience economy,' emphasizing that emotional experiences can be as impactful as measurable outcomes. Using examples from healthcare and Disney, the speaker highlights how compassion and personal engagement are crucial in creating memorable experiences for patients. They argue that while technical skills are essential, emotional connections and empathy—like those demonstrated by a caring nurse—can significantly improve patient outcomes. The speaker concludes by reflecting on the insights of thought leaders like W. Edwards Deming and Mother Teresa, advocating for compassionate care in healthcare.

Takeaways

• 🤔 Walt Disney seems like the odd one out compared to Deming, Hanel, and Mother Teresa, but innovation connects seemingly unrelated fields.
• 📖 The book 'The Experience Economy' introduced the idea of a fourth sector, beyond commodities, goods, and services, focusing on experiences.
• 🏥 In hospitals, a shift is needed from providing service to creating memorable experiences, similar to how Disney creates emotional experiences for families.
• 🎭 Experiences can be both fun and profound, such as contrasting Tom Hanks in 'Toy Story' with his performance in 'Philadelphia.' It's about emotional impact, not just entertainment.
• 💡 Innovation happens when we make connections others might not see, like applying the 'experience economy' concept to patient care in hospitals.
• ❤️ Compassion in healthcare is like Disney's goal of creating a fun experience; hospitals aim to meet emotional needs during pain and tragedy.
• 📊 W. Edwards Deming emphasized that the most important management figures are often unknown and unmeasurable, such as the impact of patient perceptions.
• 🩺 Personal engagement can change a patient’s experience, as shown by the difference between an ordinary blood draw and one where the caregiver connects personally with the patient.
• 🌟 Emotional care, such as reassuring a patient before a procedure, can reduce anxiety, lower heart rates, and increase pain tolerance.
• 💬 Experiences in healthcare can't be scripted; they must come from genuine compassion, which can even positively affect a patient’s immune system.

Q & A

What is the primary purpose of mentioning Walt Disney in the context of the discussion?

Walt Disney is used as an example to highlight the concept of providing emotional experiences rather than just services. The speaker contrasts Disney’s focus on delivering memorable experiences in entertainment with the need for healthcare to provide compassionate care that meets the emotional needs of patients and their families.

How does the concept of the 'Experience Economy' apply to healthcare?

The 'Experience Economy' suggests that people no longer just seek services but emotional and memorable experiences. In healthcare, this translates to moving beyond service excellence to creating meaningful patient experiences, focusing on compassionate care rather than just clinical efficiency.

Why is the interaction between the patient and 'Sherry' used as an example?

The interaction between the patient and 'Sherry' illustrates the difference between a purely functional service encounter and one that engages the patient emotionally. Sherry's second, more empathetic interaction with the patient demonstrates how small acts of compassion can improve the patient’s overall experience and emotional state.

What is the main criticism of standardized service scripts in healthcare?

The speaker criticizes standardized service scripts for being impersonal and inadequate in creating meaningful, patient-centered experiences. While they may ensure courtesy and clinical efficiency, they often fail to address the emotional needs of patients, which is crucial for holistic care.

How does Deming’s quote 'the most important figures for management are unknown and unknowable' relate to patient care?

Deming’s quote highlights the difficulty in measuring the intangible aspects of patient care, such as the emotional impact of compassionate care. While clinical outcomes can be quantified, the emotional and psychological benefits of compassionate care are harder to measure but are essential for improving the patient experience.

What connection is drawn between innovation and making unusual connections?

The speaker emphasizes that innovation often involves making unexpected or unusual connections between ideas. For instance, applying lessons from the entertainment industry, such as Disney's focus on experiences, to healthcare can lead to innovative approaches in patient care and experience management.

Why does the speaker say that healthcare is not just about entertainment, but still about experiences?

The speaker clarifies that while healthcare is not in the business of entertainment, it is deeply involved in shaping emotional experiences. These experiences may not be fun but are essential in addressing the pain, fear, and anxiety that patients and families go through during medical treatment.

How does the speaker connect compassion to clinical outcomes?

The speaker mentions that compassion can reduce patient stress, which can have a positive effect on the immune system and overall recovery. By providing compassionate care, healthcare providers may indirectly improve clinical outcomes by reducing patient anxiety and creating a more healing environment.

What is the significance of 'Gentle Sherry' in the speaker’s narrative?

'Gentle Sherry' symbolizes a healthcare worker who goes beyond mere clinical competence to create a personal connection with the patient. Her gentle approach reduces the patient's anxiety, illustrating how a compassionate attitude can improve the patient's experience, even in routine procedures like drawing blood.

How does the speaker suggest healthcare providers can create memorable patient experiences?

Healthcare providers can create memorable experiences by engaging patients in a personal and compassionate way, focusing on their emotional needs rather than just performing clinical tasks. The speaker suggests that small, thoughtful actions—like showing empathy and being gentle—can transform routine care into a meaningful experience for the patient.

Outlines

00:00

🤔 Connecting Unlikely Innovators

The speaker opens with a 'who' question, examining how various figures like W. Edwards Deming, Walt Disney, Hans Selye (father of psychoneuroimmunology), and Mother Teresa fit into the discussion. While Disney might seem out of place, the speaker explores how innovation is about making unusual connections. They discuss how different sectors—commodities, goods, services, and now, experiences—have evolved, and how the service industry has shifted focus to emotional engagement. Disney’s impact, not just through entertainment but by creating experiences, becomes a central theme for how innovation crosses into healthcare.

05:00

🏥 Service vs. Experience in Healthcare

The second paragraph delves into how the service model in hospitals has limitations when compared to emotional experiences. The speaker reflects on how hospitals initially adopted service standards, but began to see that something deeper, beyond service, was missing at the bedside. The speaker suggests that the emotional and human aspects, such as pain, fear, and anxiety, create a different kind of 'experience' in healthcare, much like a trip to Disneyland without fun would feel incomplete. This notion is tied back to Deming’s idea that not everything valuable can be measured.

10:01

😰 Patient Perception and Clinical Interaction

Here, the focus shifts to the patient experience during a clinical procedure, specifically a blood draw. The speaker uses personal anecdotes to illustrate how patient perceptions are influenced by interactions with healthcare professionals. Silence during procedures can lead patients to focus on everything that could go wrong, increasing anxiety, heart rate, and pain. The speaker humorously describes common fears during a blood draw, emphasizing how even small actions, like a frown from a nurse, can drastically impact the patient's experience.

15:03

💉 The Power of Personal Engagement

In the final paragraph, the speaker contrasts two types of nurses: one who performs her duties robotically and another who engages the patient on a personal level, making the experience more pleasant. They highlight how small acts of personal connection—like a nurse distracting the patient with conversation—can lower anxiety and improve the overall experience. The speaker links this to broader ideas of compassion, referencing Mother Teresa and research suggesting that compassionate care can positively affect a patient's health. The talk concludes by reaffirming that true compassion can't be scripted and must come from the heart.

Keywords

💡Experience Economy

The 'Experience Economy' refers to a concept where businesses provide not just services or goods but also engaging, memorable experiences to customers. In the script, the speaker references a book by two economists who argue that a fourth sector of the economy has emerged, where companies like Disney focus on creating emotional experiences rather than just providing services. This concept is key to the video's theme of rethinking patient care in hospitals as an experience rather than just a service.

💡Service Economy

The 'Service Economy' represents industries where labor is provided to perform tasks people would otherwise do for themselves, such as cleaning or cooking. In the script, the speaker reflects on how hospitals used to focus on service excellence by adopting standardized practices from service industries, but suggests that focusing solely on service is inadequate for industries like healthcare, where emotional needs are also important.

💡Innovation

Innovation in the video refers to making unusual or unexpected connections, such as linking Walt Disney’s entertainment business to healthcare. The speaker illustrates how new ideas can emerge by drawing on different sectors, arguing that hospitals can learn from Disney’s focus on emotional experiences even though they are in different industries. This encourages thinking beyond traditional boundaries.

💡Compassion

Compassion is a core theme in the video, especially in healthcare settings. The speaker highlights that compassion, expressed through small, caring gestures, can have a profound effect on a patient's experience, reducing stress and improving health outcomes. This concept ties into the broader idea that healthcare is not just about technical services but about creating emotionally supportive environments.

💡Emotional Experience

An emotional experience goes beyond receiving services to evoke feelings, memories, or personal engagement. In the script, the speaker contrasts technical service in hospitals with the emotional impact that compassionate care can have. For example, they describe how a nurse engaging a patient in conversation while drawing blood can transform a clinical procedure into a positive experience, lowering anxiety and pain.

💡Patient Perceptions

Patient perceptions refer to how patients interpret and emotionally respond to the care they receive. The speaker illustrates how a patient’s perception of care can influence their physical and emotional state, using the example of a blood draw where patient anxiety is reduced through a nurse’s calm, reassuring demeanor. This shows the importance of creating positive perceptions through personalized care.

💡Clinical Measurement

Clinical measurement involves using quantitative data to assess and improve healthcare outcomes, such as blood pressure or heart rate. The speaker cites W. Edwards Deming’s famous quote, 'If you can’t measure it, you can’t improve it,' but also mentions that Deming acknowledged some of the most important factors, like the emotional impact on patients, are 'unknown and unknowable,' emphasizing the limits of measurement in healthcare.

💡W. Edwards Deming

W. Edwards Deming was a renowned quality management expert, famous for his work on improving processes through measurement and continuous improvement (PDCA cycle and Six Sigma). The speaker references Deming to show that while measurement is crucial for improving healthcare, Deming also recognized that some aspects of care, particularly the emotional and compassionate side, cannot be easily quantified but are still essential.

💡Mother Teresa

Mother Teresa, known for her compassion and humanitarian work, is cited in the video to emphasize the power of small acts of love and care. The speaker uses her quote, 'We can do no great thing, only small things with great love,' to underline the importance of compassionate, personal interactions in healthcare, where even small gestures can have a profound impact on a patient’s well-being.

💡Patient Satisfaction

Patient satisfaction is traditionally measured to assess the quality of healthcare services. However, the speaker critiques this approach, arguing that merely focusing on service satisfaction overlooks the deeper, emotional experiences that make a lasting difference. The video suggests that real improvement in patient care comes from engaging patients on an emotional level, rather than just checking off standardized service tasks.

Highlights

Walt Disney initially appears to be an odd fit in a discussion about clinical measurement, but innovation is about making unusual connections.

Innovation is about making connections that are not logical for most people, but can lead to breakthroughs.

The 'Experience Economy' introduced a new sector of the economy, which focuses on emotional experiences rather than just services.

Hospitals once focused on service excellence, but patient experience has become more critical in recent years.

Experiences are distinct from services, and in healthcare, patient experience can involve pain, anxiety, and fear rather than entertainment.

W. Edwards Deming said, 'The most important figures for management are unknown and unknowable,' challenging the idea that everything can be measured.

A personal experience, such as Tom Hanks' roles in 'Toy Story' and 'Philadelphia,' demonstrates the diverse nature of human experience, from joy to tragedy.

Patient satisfaction and perceptions can have a profound impact on healing, even if changes seem insignificant at first.

Hospitals are in the business of meeting emotional needs during times of pain and fear, similar to how Disney meets emotional needs through entertainment.

Clinically perfect service does not necessarily translate to a great patient experience—human connection and compassion are essential.

Deming emphasized that while some outcomes cannot be easily measured, their impact on patients' perceptions and experiences can be significant.

Anxiety and fear before medical procedures can affect patients' heart rates, blood pressure, and pain thresholds.

Small acts of compassion, like engaging patients in conversation during procedures, can significantly reduce anxiety and improve their experience.

Experiences occur when individuals are engaged in a personal and memorable way, which cannot be achieved through scripts or standardization alone.

Mother Teresa said, 'We can do no great things, only small things with great love,' which applies directly to compassionate patient care.

Transcripts

I want to start with a who question this

is the who

section who does not seem to belong in

this

group W Edwards Deming the the father of

quality measurement pdca 6

Sigma what about Walt Disney father of

animation and theme

parks what about

hanel the father of psychon

neuroimmunology or Mother Teresa icon of

compassion well if you look at this

group most people would say the odd one

in the group is Walt

Disney these three at least have had

some things to say about clinical

measurement about the immune system and

prevention and of course about healing

when we cannot

cure it's hard to see Walt Disney

fitting into the kind of things we've

talked about

today and there was a time when I would

have said impossible not logical

improbable but you see Innovation is

making connections that are un un usual

connections for most

people two economists wrote a book

called The Experience economy in this

book they said that instead of three

sectors of the economy like we are used

to Commodities goods and

services there's actually four

sectors now of course when I was in the

hospital business in the 1980s we saw

ourselves a new frontier was service

excellence and we were going to learn

from all the service Industries how to

have great service and the way we went

about it of course was to take all of

their scripts and standardize them for

our staff and tell them this is what you

say introduce yourself smile tell the

patient why you're here and what you're

going to do and when you leave the room

you say is there anything else I can do

for you just like a

waitress that was my

thinking but then I read this

book and there was a shift that took

place

because this book said that there's a

whole another sector completely

different than

service and it's when you buy

essentially an emotional experience

nobody comes out of a

movie and talks about the service they

got nobody comes out of Disneyland and

talks about the service they got they

talk about the experience they had and

after today I would say to you nobody

will come out of here talking about the

service service they got but most of us

will talk about the experience we had

that's completely different service is

labor done for me I would otherwise do

for myself clean my own house um uh

paint the house change the oil in my car

cook me some

food but an experience is quite

different and of course in this book

which really grabbed me was Walt Disney

the quintessential example of the

service economy according to the two

economists well I got to thinking about

it and I got to thinking now we're not

in the entertainment business so that

doesn't quite

fit but then it began to dawn on me that

not all all uh

experiences are

fun theater is about not only the things

that make us laugh and have fun what

else is theater about if it's about the

entire Human Experience then it also has

tragedy Tom Hanks as Woody in the movie

Toy Story was certainly

entertaining but Tom Hanks dying of AIDS

in what

movie

Philadelphia that was not

entertaining this e-word is not

entertainment it is experience could I

say that I had a profound

experience watching Tom Tom Hanks with

AIDS yes it's an experience could I also

say I had a great experience watching

Tom Hans or listening to his voice in

the little character Woody in Toy

Story vastly different

experiences but I believe that like

Simon syic said today that in the

80s we were like

this and then we began to diverge into

the service

economy and we thought patient

satisfaction and patient satisfaction

scores and all of those things would

lead us to the same things that service

does in the service

industry and I began to see something is

vastly missing from the service industry

when it comes to the bedside of a

patient and I decided that the

Breakthrough that we talked about

earlier although small some people will

say oh the difference is insignificant

but wait a minute I thought today we

just said that when your routine changes

even

slightly it can have a profound impact

on your thinking on your behaving and

when your thinking and behavior changes

you get a different

world so let's look at this are we in

the same sector as Disney only offering

a different

experience well Disney is in the

business of meeting the emotional needs

of a family to have fun together well

that's not

us but we in

hospitals are

in the rule the job of meeting the

people's needs who are a family

especially who are going through pain

anxiety fear and even tragedy to

together so we could say that a hospital

without compassion that meets the needs

of

those in

pain would be like a trip to Disney that

was no

fun Deming said something that most

people who quote Deming never quote when

most people quote Deming they say if you

can't measure it you can't improve it

and yet Deming also said the most

important figures for

management are unknown and

unknowable and he goes on to give the

example of how do you measure the

multiplying

effect of going from good to great in a

patient's perceptions how do you measure

that multiplying effect of that and yet

that could be the single greatest thing

we could focus on next to SA

safety let's take an

illustration we'll go about this in two

different ways we'll start in the

service

industry I'm in the hospital bed smiling

face comes in the room and says good

morning Mr Lee my name is Sherry I'm

here to draw your blood today we'll

probably be drawing your blood every day

to check on your progress and I say well

good morning Sherry but you see now

she's finished with her script and she

has nothing left to say until she says

is there anything else you need at the

end and so for the next s minutes we

have complete

silence does that begin to feel

awkward well silence is not only awkward

but just before an invasive procedure

and I have deliberately taken the least

invasive least painful least anxiety

producing experience patients could

possibly have and still call it invasive

to make my

point in silence where does the

patient's mind go just before a

procedure that's

invasive to everything that can go wrong

you can't help it if you

try well how many things can go wrong

with a blood draw you say well not that

much well you're all Professionals in

healthc care you can discount this but

when I was 9 years old my mother told me

they could put a bubble up your arm go

right to your heart and kill you

did you ever hear that it could kill you

with a

bubble yeah what else could go wrong did

you know they could blow out your vein

yeah think about that next time they

could blow out your

vein Bleed Out Underneath big big bruise

on there hurts to bend your arm for a

week I know because it happened to my

son you know what they say when they

blow out your vein

oops there's a reassuring word oops and

then they say give me your other

arm I want to say bring me another

FLOTUS well if I'm having all these

thoughts oh by the way how many sticks

there's one that you worry about ow ow

ow ow

ow yeah if I'm having these kind of

thoughts what happens to my heart rate

goes up what happens to my blood

pressure goes up when your heart rate

and blood pressure goes up what happens

to your pain

threshold goes down everything hurts

more than it should so when she puts

that little in that little bicycle inner

tube or whatever it is around my arm and

tights a knot in there she catches some

of my skin and it hurts and I look down

there and I think you know what if you

can't see the skin in the knot how will

you ever find my f

we're talking patient

perceptions I look at her face when

she's looking for a vein it has a frown

on it what does a frown tell you when

somebody's looking for

something well that means they can't

find

it so imagine my surprise when she pulls

up the needle and she starts this thing

and I want to say oh hold it hold it I

could get you a vein let me pump pump

this out for you you know there

quick of course I don't do that it's not

very

manly this is more of the manly pose

help yourself there's my

arm I'm brave I can take anything put

two or three bubbles up there I'll show

you I can take

it blow it out you try that on me I can

take anything 17 Sticks no

problem of course I'm like this and my

pain threat hold his way down here and

when she puts the needle in E how big a

needle is

that

look she got it first sck how lucky was

that now if you draw blood do you want

to be thought of as lucky or

good patient

perceptions nothing about her made me

think that if that she would ever get

that vein except by pure lck of course

I'm

glad she stands up in her SCP STP kicks

in and she says now then Mr Lee is there

anything else I can do for

you and I say no thank you

Sherry do you really have to put me

through this again

tomorrow I'm afraid M you do Mr Lee and

she's out the door and down the

hall in any way you can measure what she

did it was perfect perfect clinically

perfect for service perfect perfect for

Courtesy but was she

great you can't improve on it and you

can't ask the patient how to improve it

cu the patient doesn't

know good morning mustle my name is

Sherry I'm here to draw your blood

today and I say well good morning Sherry

she says by the way do you live around

here or are you from out of town I said

well no I live around here I raised two

kids here you see she sense that I was a

little

tense and she decides to distract me I

don't know what she might say but I tell

her about my two kids a little bit son's

a Macintosh computer technician my

daughter's an artist and while I'm

telling her this she's already put a

tourniquet around my arm and pinched

some of my skin but did I notice not

much I'm trying to tell about my kids

she starts feeling for a vein and I get

focused real

fast my heart rate starts to do this and

I think oh oh here it comes and she

looks up she says by the way you have a

nice vein here Mr Lee I should have no

trouble with this

one what did that do to my heart rate

what did it do to my pain threshold and

then she goes on and said by the way

beginners can be a little rough but I

have done this for 10

years when they're trying to find

somebody that can get a vein they

usually call the lab and say is gentle

Sherry down

there and I say are they they call you

Gentle

Sherry now you see once in while

somebody will go when I say that which

of course means too much Disney for this

group we're not going to call each other

Tinkerbell or gentle Sherry I don't

think so too much Disney or too American

for us but I got that from clinical

trials Gallop reports them in the book

First Break All the Rules they would go

to a hospital ask for the best nurses

they were doing a placebo experiment

with a shot and they would ask for

average nurses best nurses of those

nurses they get lots of compliments from

patients average nurses get no

compliments and no

complaints they each give a subject they

all are randomized so this double blind

study we they ask the subject after each

shot the different subjects and the

different nurses did we get a pain

rating by saying on a scale of 1 to 10

how much did that

hurt after they take away the double

blind they suddenly discover

that your best nurses have lower pain

ratings than your average nurses and you

say well how can that

be there it is on the

videotape the best nurses tend to say

This Might Sting a little bit Mr Lee but

I'll be as gentle as I

can what does the word gentle do to a

person's anxiety a little bit of fear if

I can say this for a blood draw how much

more important would this be for every

other procedure that we

do but it are the passionate

compassionate caring people that do this

because it has to be done from the heart

you can't fake it these authors say that

experiences occur whenever an individual

has been engaged in a

personal or memorable way the difference

between these two sheries is that one

engaged me in a personal memorable way

and when she got up and said is there

anything else I can do for you I will

say not right now but if I have to have

my blood drawn tomorrow will you please

be the one who comes back don't be

sending rough Rudy up

here I want gentle Sherry

again and Deming says that

difference between being perfectly

satisfied and wanting the person back

again cannot be measured scripted

reduced variation or

standardized it comes only from the

heart it can be physical

emotional hrelia pointed out that

compassion can actually affect the

immune system if you believe compassion

can reduce stress in a

patient Mother Teresa said we

cannot we can do no great thing we can

only do great small things with great

love thank you very much