innovation

How neurochemicals can help you lead and be innovative

/ Jonathan Sachs / 4 Comments

Welcome back to Leadership as a Practice. I wanted to first start by sharing that I have missed writing and hearing from you about the content of this blog. I intend to be writing far more consistently and am filled with optimism as we come out from under the worst of the COVID-19 pandemic.

Today, I wanted to share something I learned recently through The Innovative Healthcare Leader program at Stanford University. I found it interesting that the program was a week-long but only discussed design thinking on one day. The rest of the program was devoted to becoming an innovative leader and shifting the mindset of an organization so teams can think creatively as well.

One of my major takeaways came from Professor Baba Shiv, who spoke about a framework he developed called “The X Framework.” A version of the framework is posted online and shown here:

The idea behind the framework is that people have three neurochemicals that change their mood, behavior, and willingness to tolerate risk. Coritsol, the stress neurochemical, gives us a very low risk tolerance and low creativity. The response triggers most people to recoil, shut down, or seek familiarity/status quo. Serotonin is the neurochemical that reflects comfort. Serotonin is the chemical that gets released when you kiss a significant other, for example. Finally dopamine is the neurochemical that activates excitement or creativity.

Much of these neurochemical concepts and how they relate to leadership are covered by authors like Simon Sinek. Shiv’s contribution has to do with the conditions needed for innovation and creativity. In organizations that are high stress, creativity tends to be very low because levels of cortisol are high. When cortisol levels are high, dopamine is blocked from being released. To get to a situation where dopamine can be released, people must have a sufficient amount of serotonin release first.

That is why the concept of psychological safety is so important to both innovation and leadership, more broadly. If you believe, as I do, that the people closest to the work know the work the best and are therefore in the best place to improve it, they will not be able to do so in an environment that consistently increases their cortisol levels.

During his seminar, Shiv argued that one of the primary human motivations is “Social consequence,” which is the need to save face and maintain social standing. For example if a superior calls you out or humiliates you in a meeting with your peers, that would be a negative social consequence and produce a significant cortisol release leading to de-motivation.

According to a recent survey by McKinsey and Company, Psychological safety is, “When employees feel comfortable asking for help, sharing suggestions informally, or challenging the status quo without fear of negative social consequence.” Psychologically safe workplaces exist to keep the team’s serotonin levels high, providing abundance (think free food options at google), recognition, and gratitude. According to Shiv and the McKinsey survey, these organizations also tend to be more innovative and open to taking risks, including adapting to change.

If you are a leader looking to create change and unlock the creativity of your team, look for ways in to keep their levels of stress low and of psychological safety high. Innovation depends on a culture that can support positivity and safe-to-fail experiments.

KEY TAKEAWAY: Do you want to lead an innovative organization? Look for ways to keep your teams stress low and psychological safety high.

Frugal Innovation

/ Jonathan Sachs

The idea of innovation or an innovative company is in vogue. Whether it is the Silicon Valley startup, or the “innovative” CEO, that descriptor has much social currency in today’s world. In business school, one of my favorite classes was the class I took on with Professor Anil Gupta.

Professor Gupta introduced the class to several different constructs for innovation, but the one that spoke to me the most was a concept called Frugal Innovation. Frugal Innovation is the idea that the creation of something new is low cost, low environmental impact, and low resource utilization. Professor Gupta provided examples including Southwest Airlines, GE’s portable ECG machine, and the Aravind Eye Care System.

ideas whiteboard person working

Photo by Startup Stock Photos on Pexels.com

My previous professional experiences probably has something to do with the appeal of Frugal Innovation. As a lobbyist at the federal, state, and local levels of government, I observed several instances of waste. Historically, some government projects have begun with funding and then searched for solutions for the project/problem. Some people call this, “throwing money at the problem,” and I have observed how that strategy rarely ever works.

Additionally, Frugal Innovation solutions are often elegant in their simplicity. The concept includes design thinking as well as LEAN principles to create a solution for a specific market. Innovation happens in the simple delivery of the solution in a way that is both financially and environmentally cost effective.

I graduated from college during the depth of the recession. During both my academic career and in many of my jobs, there often were scarce resources to go around to deliver on the work. In fact, in all of them, the biggest resource I had to do the job was the expense for my time. While producing in a resource-constrained environment is not easy, it has challenged me to be creative in meeting the needs of the customer with the smallest resource investment possible.

I have found that the concepts at the root of Frugal Innovation likedesign thinking, analysis, LEAN, and general creativity, help me to refine my ideas and simplify the solution to be viable and frugal. I have found that I can apply these principles to solutions involving both people and systems. Taking the time to think through the problem and craft a frugal solution is usually “good enough”, if not the ideal solution.

I have also found, ironically, that after I have had some success as a lean department or through Frugal Innovation, other leaders are more likely to want to invest more in the product or service. Demonstrating that you can do things in a frugal way, even just to test and show proof of concept, is a powerful tool.

Innovation doesn’t have to be expensive. In fact, innovation can be most transformative through its simplicity. Additionally, being low impact can also help to broaden innovation to new markets and spread solutions to people across socioeconomic lines. Leaders should keep the principles of Frugal Innovation in their tool-belt especially in entrepreneurial and intrapreneurial projects.

KEY TAKEAWAY: Using Frugal Innovation principles can help leaders develop simple solutions that have a small environmental footprint and make a big impact. 

Competing with health care literacy

/ Jonathan Sachs / 1 Comment

This is the second in a three part series on healthcare literacy. The first was about identifying the competition.

Think about what the average patient knows about a hospital. If all the consumer knows about a hospital is from TV, what are their expectations?

If what Hollywood shows a patient is all he knows, imagine how disappointed he is to sit for hours in an Emergency Department. After a long wait, a patient gets a bed in the department with doctors and mid-level providers who appear to be moving slowly ordering tests and waiting for the results.

The average patient may be thinking, “Isn’t it supposed to be an ‘Emergency’ room? Why is everything so slow? Where is George Clooney?”

The Institute of Medicine defines health care literacy as, “the degree to which individuals have the capacity to process, and understand basic health information and services needed to make appropriate health decisions.” It turns out that most patients, even well-educated ones, can be health care “illiterate”. For some patients, their first experience may also be their first time admitted to a hospital.

The University of North Carolina Chapel Hill has put together this helpful data map to show health literacy estimates based on the 2003 National Assessment of Adult Literacy (NAAL). The US Centers for Disease Control (CDC) has some basic facts and materials available on health care literacy in the United States as well. The data shows that there are many communities in the United States where the population has low health care literacy.

My working theory is that health literacy is one of the health care industry’s biggest competitors. Add in issues with health insurance literacy (which I will discuss more next week) and improving the patient experience is a real challenge. Patient experience is about demonstrating service behaviors like smiling, using a patient’s name, and checking on them to meet their needs, but it is also a lot more than that. Patient experience is also about education. Patients expect clinicians to be excellent teachers while being expert care givers.

Overcoming gaps in health care literacy requires empathy, emotional intelligence, and communication skills. Empathy and emotional intelligence help clinicians learn when a patient or their family does not understand, even though they may not voice their confusion. These concepts are about understanding how families get and share information with each other about the patient. It is about getting one level deeper with the patient and family to build trust.

Communication is another obstacle. Some days, I spend all day in meetings watching people present information. I listen to how clinicians explain things to patients. We have many opportunities for improvement in this area. There are some helpful tools out there to improve communication in health care settings, like Getwellnetwork. Still, technology will not do all this important work for us. Much of delivering care is still direct person-to-person contact.

As an industry, we must get better at practicing these crucial skills. Recently, I learned about a helpful tool called the Hemingway App. The site runs an algorithm, which makes sure writing is understandable to the average person. In fact, I experimented with putting this blog posts through the site.

Next week, I will post on health insurance literacy, a related topic. The health care industry must improve in how it helps people understand their entire care experience, including billing.

KEY TAKEAWAY: Assessing a patient’s health care literacy can help clinicians reach patients. Clinicians can help patients understand their condition through empathy, emotional intelligence, and communication techniques.

Book Review: Be our Guest

/ Jonathan Sachs

Disney is known for excellence in customer experience at their parks, hotels, and on their cruise ships. The company formed The Disney Institute so that other companies could learn from Disney’s approach. While a Disney Institute summit may set you back over $4,000, a lot can still be learned from its considerably more affordable book, Be Our Guest: Perfecting the Art of Customer Service.

beourguestLike Starbucks and The Ritz Carlton, Disney has a well-defined, self-reinforcing, and rigorous system for customer experience. Disney’s “magic” is delivered through its organizational knowledge of guest psychographics combined with demographics (Disney calls it “Guestology”), its simplicity, and the complete integration and alignment of its system. Disney’s core purpose (like a vision statement) is defined as “We create happiness by providing the finest in entertainment for people of all ages everywhere”.

Guestology

Disney invests time, talent, and treasure in its efforts to not only know who are their guests (demographics), but also what their guests expect and want to feel (psychographics). While demographics are important and relatively easy to access through existing systems, psychographics are even more vital to delivering a superior customer experience.

Disney looks at the mental states of its customers by evaluating all of the parts of their experience through 4 dimensions: Needs, wants, stereotypes, and emotions.

Applying this principle to another business, like in an urgent care, for example, this matrix would resemble something like this:

Screen Shot 2019-02-05 at 11.07.44 AM

This analysis is a helpful tool to get a chance to match your service offerings to the perceptions and emotional states of your customers. Disney implements processes to respond to its guests’ emotions throughout their parks and resorts. For example, Disney was the first to entertain guests who are waiting in long lines to help them be less bored and pass the time quicker. Since guest needs, wants, stereotypes, and emotions can change over time, Disney revisits this framework often to match their systems to guest expectations.

The lesson here is that knowing your customer, not just who they are but what they expect and why they expect it, is an essential component of building a superior and lasting customer experience. Another essential component is making sure your system for responding to these factors is actionable by the employees (Disney calls them “cast members”) who are expected to bring it to life. This is accomplished, in part, through simplicity.

Simplicity

Disney’s customer service system has only two components:

  • The Four Quality Standards
    • Safety
    • Courtesy
    • Show
    • Efficiency
  • Three Delivery Systems
    • Cast
    • Setting
    • Process

The four quality standards are listed in order of importance, giving cast members an idea around prioritization. These standards are deployed up and down the organization and are reinforced through constant training and coaching. To build a culture around the two components, Disney uses its own language to refer to customers, employees, and attractions. Further, cast members are given guidelines, not scripts, for them to use to deliver consistent service to guests.

Part of the art of the four quality standards and the three delivery systems are what Disney calls, “Think globally, perform locally”. Doing so allows individual hotels or resorts to integrate their own flavor and uniqueness into Disney’s approach to service delivery. Disney empowers its cast members by soliciting their feedback as well as recognizing and rewarding performance.

Disney’s cast can also then focus on the three delivery systems, including seeing themselves as a part of a larger whole and responsible for themselves as well as the setting and process. That is also where integration and alignment become important.

Integration and Alignment

The Disney Institute defines integration as, “the work of aligning and distributing your service stands over the three delivery systems of cast, setting, and process” (p. 185). Integration is a way to, “build a service organization greater than the sum of its parts” (p. 185).

Disney has built-in accountability to its components of service through its emphasis on integration. It ensures that Disney is staying true to its core purpose by making sure that its cast, setting, and processes are always accounted for in everything they do. It also makes sure that the three delivery systems are developed with the customer needs, wants, stereotypes, and emotions of the guest in mind.

To make Disney’s guest experience consistent and reliable, the leadership is committed to this model and includes new initiatives through the lens of integration to provide context for staff at all times. At other companies, initiatives often appear disparate and unrelated due to the lack of context. By using an integrated model like Disney’s, companies can usually avoid this type of cognitive dissonance.

Conclusion

Healthcare organizations can learn a lot from Disney and many have worked with the Disney Institute or read books like If Disney Ran Your Hospital. In order to successfully follow the ways of Disney, the leadership of the organization needs to agree to an aligned model that they will always use as context.

KEY TAKEAWAY: Learning about your customers, developing a simple system for delivering to their expectations, and creating integration and alignment around those elements is how Disney creates its “Magic”. Doing it in your organization requires the same level of intentionality and discipline.

Be our Guest is available for purchase on Amazon for $24.99 (does not include Prime discount)

Design Thinking in Health Care

/ Jonathan Sachs / 1 Comment

man wearing black and white stripe shirt looking at white printer papers on the wall

Photo by Startup Stock Photos on Pexels.com

Background:

Design thinking describes the empathetic development process for a new product or service. Design thinking is user-focused and includes important time for observing how people interact in the environment where the product or service will be launched.

To understand design thinking and the empathic process used to develop new products, there are a few really good resources on the internet. The most well known pioneer in design thinking is David Kelley, who was a close friend of Apple founder Steve Jobs and developed the first computer mouse. Kelley founded a company called IDEO, which takes on clients who want to develop a better product or service.

Kelley has been featured on national broadcasts regarding IDEO and design thinking. In this interview with Charlie Rose, he explains how it works and talks about his relationship with Steve Jobs:

IDEO was featured on 60-minutes for their work helping to redesign the grocery cart using design thinking. The video is a good high-level overview of the process. How it works:

There are many more resources on the internet for design thinking. IDEO has an online University where they offer courses on design thinking that start from $199 (I have not taken their courses, so I cannot say whether or not I would recommend them). Stanford University has the Hasso Plattner Institute of Design, or the “d school”, which is the most prominent academic program focused on design thinking in the United States. They have many resources too for the public to understand design thinking, such as this helpful overview.

Applications in Healthcare:

In healthcare, design thinking can be used in ways ranging from how the patient and their families experience care at the hospital, outpatient office, etc to how the physical building is laid out and designed, to how the equipment is laid out and designed for clinicians. In essence, the possibilities are endless.

As an administrator, the main thing that design thinking is helping me focus on is the patient experience.

Take for example Doug Dietz. Dietz builds imaging equipment for GE and realized that children who had to be tested on his machines were so scared that 80% of pediatric patients had to be sedated to administer the test. To fix this problem, he launched the “Adventure Series” at GE (pictured below), and made the machines look more kid-friendly. As a result of this new design, fewer children are sedated and tests are done correctly the first time, which adds capacity for other patients to use the testing machines.

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An Example from the GE “Adventure Series” – photo courtesy GE Healthcare on Flickr

I recently read an article about healthcare disruption in the American College of Healthcare Executives magazine. My favorite quote from the article was from Ian Morrison, PhD, author, consultant and healthcare futurist. He said,

“A lot of outsiders to healthcare view the field as ripe for disruption because it is profoundly dysfunctional. Most entrepreneurs who get into healthcare do it because they or a family member have had a bad experience and were so frustrated that they thought they could start a company and do it better”

Dr. Morrison is right and his statement describes the empathetic nature of design thinking. We can and should do a better job of making the dysfunctional system less-so for our patients by empathizing with them and their experiences in the hospital. Only through empathy are we truly delivering able to help sick patients get better. Those elements need to baked-in to what we do every day.

KEY TAKE-AWAY: Empathy is at the heart of design thinking. Applications for design thinking are everywhere, especially in healthcare. By observing and understanding how people interact with your product and service, the better you can make it.