Patient engagement is a potent therapeutic, but how is engagement related to a core tenet of healthcare’s Triple Aim: Patient experience? For that, let’s take a quick look at user experience (UX) design in software.
Software’s Triple Aim
We’ve all had the experience of getting somewhere in an app or a piece of software and saying, “Now what? Where is that button I know I need to press to get to the place in the system I need to do what I need to do?” That in a nutshell, is an example of the common bad user experience. At the moment the tool is not obvious and not intuitive and without an immediate answer, we will maybe call a friend for an answer, quit using the tool, bang on the keyboard, move on to something else, or all the above. To illustrate: 26% of iOS apps are opened just once and then discarded.
According to EffectiveUI, 70% of software projects fail (probably not far off the rate of patients adhering to their plan of care). The failure comes down to acceptance and adoption. People don’t use the tool because it doesn’t do what they want (outcomes), it costs too much (price), or the user experience is confusing (experience). Software has been working to deliver it’s own triple aim for a long time and out of that has grown the discipline of user experience design.
Learning and Humility
Talk to UX designers and you will often hear one word early in the discussion of UX: humility. One of the core tenets of UX designers is that you have to have the humility to know that you don’t have all the answers, nor do you even know the questions up front. In humility lies the openness to learning, and the goal of UX is to learn as much as possible about what problems the users want to solve. The questions and answers about what the user needs to accomplish must be elicited from the user. So the basic idea is to ask questions, develop, get feedback, make changes and keep going through this cycle until you get it right.
In going through this process, you’ve hopefully gotten to a point where users rarely ask, “Now what?” Through constant, controlled feedback with users, the software that works emerges.
Why go through all this trouble to understand a user’s goals and build a system that can address them?
When the developers and users are in alignment, that is the developer’s job: to make life easier for users.
That is the essence of value creation in software, discovering the job to be done and then helping your users get the job done. UX designers know that when they are successful, they have made their users happy, they’ve minimized costs and they’ve allowed their users to accomplish their goals in the shortest path possible. When the software is successful in enabling the customer’s triple aim of cost, quality (it does what it needs to) and experience, projects are more often successful. Risks to the projects are significantly reduced. Cost and rework are minimized. Users engage with software they like. Everyone wins.
Similarly, if we want engagement, outcomes and lower costs in health care, we have to pay close attention to patient experience, not only for it’s own sake and the sake of shared-savings calculations, but because patient experience leads to better decisions and smarter actions. That, in turn, will also improve outcomes and decrease costs. Experience supports the other two legs of the triple aim.
If we can take anything from user experience design, an indispensable part of software design, it’s that patient experience design could well become part of the core skill set of ACOs and other pay-for-performance reimbursement models. In the real world outside of healthcare, companies that excel at customer experience outperform the S&P by 22.5% while others underperform by 46.3%. Experience design in healthcare will soon become an economic imperative.
Like user experience design, special attention will need to be paid to the context in which health decisions are made and to choice architectures in these different contexts. In healthcare, we have not recently paid much attention to the contexts of health decisions and choice architectures because most of our work has been focused on where people get paid for doing things attached to billing codes, the clinic. But with new reimbursement models, we have to move to decision context far beyond the clinic, to the places where, as Dave Chase from Avado says, “99% of health care decisions are made, (but only 1% of the investment).”
Choice architects and experience designers both look carefully at successfully answering that sticky question, “What do I do next?” and providing the right direction at the right time in the right context.
Whether personal productivity programs like “Getting Things Done” or weight loss programs like Weight Watchers, just as in software experience design, success can be in large part measured by answering the simple question of what to do next in the right context. When a user or a patient can no longer answer that question, we disengage, we move on to something else, we get off track, and we lose sight of where we’re headed. Experience, to a large extent, determines both engagement and success.
We need apps that help people “care about health.” Being on a program with clear choices helps people to stay on track by answering the “what next?” question when they are far from the doctor’s office.
Here’s where mHealth has a distinct role and will become critical. Mobile is, of course, about location, but it’s also about something more than that, it’s about context. When we engage people where they are, we help them make decisions where they are and we track progress where they are in the contexts where they need it. The magic of mobile health (#mhealth) as a discipline will come from the contexts in which mHealth tools can be used. This is exponentially broader than any other sets of tools, but is very,very big when it comes to answering the “What next?” question and supporting patients when and where they need it.
Better Decisions at the Individual and Organizational Level
As Sandy Pentland, a leading data scientist and Director of MIT’s Human Dynamics Laboratory and the MIT Media Lab Entrepreneurship Program, says, big data (particularly from mobile) is about behavior. By engaging via positive experiences in mobile, collecting patient data will someday soon do more than any patient interview, and physicians will have much greater insight into how well patients are doing. Constantly getting feedback will improve the system for each individual and the physician’s organization. This may become the basis of competition and an economic imperative for insurers and payers alike, and they’d do well to hone their skills at patient experience design. ♦