Reframing Healthcare

A Roadmap for Creating Disruptive Change
By Zeev Neuwirth, MD

Healthcare outcomes in the US are, at best, mediocre compared to other developed nations in the world. But we have the ability — right now — to unleash the tremendous value that’s currently locked up in our healthcare system, and to deliver the type of healthcare we all expect and deserve.

These provocative words are the first you read as you begin this book, and every chapter has ideas worth spreading. I started dog-earing my copy, then adding post-its to the broader ideas, and finally just decided to keep it as a ready reference on my desk. It resonates with us particularly because it details a human-centered design process: not patient-centered, but “consumer-only,” which I’ll explain below.

It’s also written for leaders that belong to three categories:

• Stakeholders in healthcare such as hospital systems, provider groups, insurance companies, employers, etc.;
• Leaders of organizations that are new entrants to healthcare such as retailers, digital tech providers, start-up entrepreneurs, etc.; and
• Leaders of consultancies, patient activist coalitions and professional societies (at Connect_CX, we fit all three of these).

The book is organized as follows:

• An articulation of the problems facing US healthcare, and a baseline understanding of why reframing is so critically important;
• The Reframe Roadmap, a process to reorient thinking, redefine the problem given that new orientation, and redirect strategies, tactics and resources;
• Illustrations of the Marketing Mindset, in three sections;
• Potential game-changing trends in healthcare that can occur within the context of the Marketing Mindset; and
• A focus on Social Determinants of Health, those realities for patients that underlie all of our attempts to design a system that works for them.

If this intro hasn’t yet gotten you searching for the book online or subscribing to Dr. Neuwirth’s podcast, we’d heartily recommend you do both. What follows is an attempt to summarize a book that is rich in content, motivating to anyone with knowledge of our flawed healthcare system and intending to catalyze action.

The Problem

Dr. Neuwirth goes into detail about how the US healthcare system is currently falling short, given current ways of thinking.

We’ve pinned our hopes for transforming healthcare on one silver bullet after another. But these bullets have all been stuck within a particular tradition of thinking about how healthcare works and should work. Our thinking is mired in the confining context of a legacy framework.

• Quality and safety: avoidable deaths make the US healthcare delivery system itself the 3rd or 4th leading cause of death in this country;
• Cost: the US spends more than any other developed country ($10,000 per year per person) on providing healthcare, prompting Warren Buffet to call it “the hungry tapeworm of corporate America”;
• Patient satisfaction and trust: a 2018 Gallup Poll revealed that trust in the medical system has dropped from 74% in 1977 to 36% in 2018; and
• Provider burn out: despite superb training, people are doing their best under unacceptable and unsustainable conditions.

When the business world encounters an intractable management problem, it’s a sign that there isn’t yet a satisfactory theory for what’s causing the problem, and under what circumstances it can be overcome.

– Clayton Christensen, Harvard Business School

The Solution: Reframing Roadmap

A reframe is not about hypothesizing some future potential mega-trend, something that might happen in the future. It’s about discerning what’s already occurred, what’s happening now and what’s clearly emerging as an essential, underlying foundational pattern of reform; it’s a changed way of perceiving problems and goals and acting on that perception.

To illustrate this, Neuwirth uses the story of Dr. Robert Lang, an engineer and physicist specializing in laser optics; but he also had a lifelong passion for origami, and left a successful career to pursue it. He began to create computer algorithms that would solve complex folding problems: where an origami master can fold a single piece of paper 30 times, he found ways to fold it up to 100 times. He reframed a discipline that has been around for centuries by reorienting it as a mathematics and physics challenge.

As a result, he redirected his folding techniques, that have now been used to enhance everything from deploying solar panels and telescopes in space exploration to folding and expanding stents in cardiac surgery. This type of “mental cross-fertilization” is what healthcare needs now, and what’s led to the Reframe Roadmap:

• Reorient: the narrative part of the reframe, where you arrive at a new perspective by looking outside of our industry. As Dr. Lang said, “almost all innovation happens by making connections between fields that other people don’t recognize.”
• Redefine: once you’ve formed a new perspective, you begin to see the challenges you’re facing quite differently; they are literally not the same problems as the ones you had before. This causes you to think differently about tools, approaches, techniques: leading to unexpected solutions.
• Redirect: not to be neglected, this critical third phase is where you take action. While the first two phases are typically the domain of the C-suite and boards, this operational step redirects strategies, tactics and resources and keeps the team from getting stuck in “reframe purgatory,” a twilight zone of pilots and projects that go nowhere.

Design is fundamentally about respect. If an experience is well designed, you look at every interaction with your customer: services, clinics, communications, etc.

Understanding the Customer: the Marketing Mindset

The essence of marketing is to be entirely focused on the customer. The core of the discipline is to seek to understand others, and respond to the needs that they have. Here, the essential reframe that Neuwirth is suggesting is that healthcare move from a “patient-centered” approach (where gatekeepers who hold all the knowledge service patients), to one that sees patients as “healthcare customers” and radically improve how customers purchase, utilize, experience and benefit from healthcare.

This is what pushed my buttons about this book: that we think about healthcare provision in an entirely human-centered way, using the basic tenets of the discipline not to sell healthcare, but to deliver healthcare more effectively:

• Identifying your customers;
• Focusing on certain segments of customers you’re best able to serve;
• Understanding their specific needs and journeys
• Creating customized, relevant solutions that meet their needs, and how they define “healthy living”; and
• Engaging them so needs and solutions are connected and sustained.

The book goes on to explain how to redirect these marking principles and apply them to the changing paradigm of healthcare delivery. But to me, the critical part of this section is about taking a “Consumer-Only” approach, as I mentioned above.

As an industry, healthcare is focused largely on its internal stakeholders: providers, administrators, staff and others within the sphere of the organization. But would software engineers be asked if a new software program met their needs first? Would retail managers or developers be asked if a new product or service met their needs?

Of course not. You need to focus on the internal workings of your business, for sure: including treating your teammates and colleagues as VIPs, so they are prepared to deliver a positive experience. But for healthcare consumers, this idea requires a change of focus: what the consumers’ problems are, what “good” would look like from their perspective, and what obstacles and challenges are getting in the way of them achieving the results they see as acceptable.

Neuwirth goes on to describe how healthcare as an industry is gaining competition from previously tangential providers who have always had a “customer-only” focus: Amazon, Google, Apple, Walmart, Walgreens, CVS and so on. While the legacy healthcare system has been distracted, spending time and energy focused on trying to optimize internal processes, these emerging giants will be primarily focused on understanding, serving and meeting healthcare customers’ needs.

Getting it done: Inserting the Reframe Roadmap into the Marketing Mindset

A journey of a thousand miles begins with the first step. So the author ties the two ideas into a seven step model that is described and detailed throughout the remainder of the book, on his Website and in his Podcast, aptly titled “Creating a New Healthcare”:

1. Reorient by discovering and adopting a new perspective
2. Redefine the problem from within that new orientation
3. Rebrand using a new value proposition derived from your reorienting and redefining
4. Redesign from the new perspective/proposition and with the new outcomes in mind
5. Results: identify new outcomes and metrics, switching to demand-side, customer-only value
6. Reorganize based on all of the previous steps, and
7. Redirect strategies, tactics and resources to demonstrate your commitment to the reframe steps that have come before.

The consumer approach is one of identifying a person’s needs on multiple levels –physical, emotional, relational and existential– creating and employing a customized solution, and then engaging that person to create and sustain relevance.

The next three sections go into detail about the steps above, and have served as a reference to us, as designers of healthcare experiences. In December’s blog post, we plan to summarize and explore these in more detail.

But if you’ve read this far, I’m sensing a bit of reader fatigue — and certainly, we can’t do justice to the examples, illustrations, frameworks and details that run through every page of Reframing Healthcare. But we do hope that this summary has inspired you to at least explore Neuwirth’s hypotheses and recommendations.

Our recommendation, of course, is first to buy the book. Second, subscribe to the podcast. And third, take a deep dive into Neuwirth’s Website to better understand the critical need, the steps toward resolving the problems, and how this roadmap can not only change healthcare but also change society as a whole.

Storytelling is a theme that runs through the book. Reorient/redefine and redirect can’t be done without the cultural imperative of storytelling. Once you’ve read the book, seen the problems from a different perspective and determined that the Roadmap is actionable, you can begin to spread the word to your colleagues, teammates and partners; to develop the stories that illustrate the challenges and provide the correct organizational context to change minds, hearts and, most importantly, strategies, budgets and tactics.

“The greatest danger in times of turbulence is not the turbulence; it is to act with yesterday’s logic.” — Peter Drucker

In the book’s conclusion, Neuwirth is looking for someone to pickup the Reframe Roadmap: CEO, Board, provider group, healthcare organizations of all kids. The book, and this blog post, are an invitation to embark upon a new path — to be active participants in an historic moment in the evolution of healthcare.

How will you respond? How will we respond?

Originally posted on connect-cx.com on November 11, 2019