Sometimes we really believe we know what people want, and our assumptions are wrong. Sometimes they tell us what they want, and we just don’t listen. Both happen in healthcare every day. But when Brian Kelly discovered he had been falling victim to the first trap, he made sure he didn’t fall victim to the second.
“We don’t do very well when it comes to providing urgent care services for women,” Brian told me not long ago. His interest in the topic makes a lot of sense, as he’s the CEO of Women’s Healthcare Associates (WHA), a medical group in Portland, Oregon. But that interest led him down a path he didn’t expect.
A few years back, he and the company’s board of advisers read “The Innovator’s Prescription” by Clayton Christensen, which spawned a task group, which spawned an idea. Given the rise of urgent care clinics, surely women needed one designed to meet their specific health problems. So they took the obvious first step and registered a handful of URLs based on women’s healthcare express. “We really wanted to get out in front of this need we saw,” Brian told me.
Imagine the team’s surprise, then, when at the first focus group they held to talk about the service, the women told those on the other side of the table that they didn’t want it. They didn’t want express, or zoom, or anything else that felt fast and furious. One woman stood up and said, “I want relationships.” The rest nodded along.
To which every patient, physician and practice administrator in America responds: duh! What Brian and his team heard in that room wasn’t unique to their practice, their specialty or their location—for the most part. Patients have been telling us that this is what they want for a long, long time. And yet, as I explored in my book “Back to Balance,” we’re pretty good at driving right by the art of medicine—the important relationship- and trust-building work—on our way to our big goals.
At WHA, the patient relationship and experience has always been a pillar of its approach, its culture and its business strategy—long before it was a triple-aim buzzword. The medical group defined its delivery of that experience with four words: inviting, authentic, knowledgeable and caring.
Consequently, Brian and his team didn’t do what some in healthcare might have done: plow ahead with their plans, sure in their assumptions that urgent care was the best use of their resources, that they knew what patients really needed or really wanted. (“So,” Brian said to me at one point, with a big grin, “you want to buy some URLs?”)
Instead, WHA shifted direction. Within practices, they re-energized their focus on the experience and the relationship with a program called In Her Shoes—as in, what would you want or do or need if you were in her shoes—led by the organization’s chief medical officer. The medical group highlighted moments when somebody was really taking the patient’s perspective into account in staff meetings or clinical discussions.
From a growth strategy perspective, the organization’s leaders made four big decisions.
- First, they listened to patients who needed to be seen quickly when they were sick and added weekend and evening hours.
- Second, they listened to patients’ complaints about the long drive to practices that were usually located near hospitals, and the long waits or last-minute cancellations when doctors were delayed during deliveries. (Babies just hate schedules.) They opened smaller satellite offices in neighborhoods where women work and live, and they now have nine practices around Portland. And they changed how they scheduled physicians so that they were either at a practice or a hospital on a given day, not both.
- Third, they listened to their obstetric patients who didn’t want to give birth in a hospital, and they invested in a new midwife birthing center run by their nurse midwives.
- Fourth, they listened to women who were tired of running around to different specialists and labs, having to deal with referrals and medical records and more appointments—and sometimes not getting the medical care they really needed as a result—and have integrated more services into their group. They offer state-of-the-art mammography in their practices so that women can have the screening done as part of their annual visit. And they have a perinatal medicine practice for women with the highest risk pregnancies.
At WHA, leaders asked, they listened and then they made it possible for women to maintain their relationship with clinicians, regardless of medical needs or desires for different experiences.
“What people are looking for is a connection and trust that we’re going to do whatever we can for them, on a service level and a clinical level,” Brian said.
Of course, each action made good business sense, too. WHA is successful because its leaders listen and then act by balancing the art, science and business of medicine.
If we keep refusing to pay attention when patients, providers and practice staff tell us what they want, we shouldn’t be surprised when they divorce themselves, in one way or another, from the goals we all claim to aspire to—or even from healthcare entirely.
We have a lot to learn from Brian and his team at Women’s Healthcare Associates: Ask people the right questions, genuinely listen to the answers and then take the right, balanced action.
Halee Fischer-Wright, M.D., is the author of “Back to Balance: The Art, Science, and Business of Medicine.” A nationally recognized physician leader, healthcare executive and former business consultant, she is president and CEO of Medical Group Management Association.