Medium, November 23, 2015

The Romance of: Healthcare

Healthcare can be a matter of life and death, and while one likely considers it to be work of significance, can it possibly also be considered romantic?

Hospitals are at the heart of this very dichotomy. On the one hand, they are utterly practical facilities that are required to consistently perform at the highest level, with robustness and yet the flexibility to adapt to ever-changing circumstances, including extreme crisis situations. There is absolutely no — zero — room for error. Hospitals are designed for perfection; they are the top athletes of human-system performance, the flagships of operational excellence. On the other hand, though, they are metaphysical, symbolic venues: comfort zone and emergency room, living and dying space, meditation center and factory all at the same time.

On the surface, hospitals turn life, the most sacred good, into something profane. For starters, they grant space to clinicians who invade the human body, by cutting into flesh and temporarily making the vulnerable even more so, by dissecting human life as anatomy, a surgical operation that combines the archaic with the sublime. Moreover, it is in hospitals where the sacredness of life meets the most mundane and transactional aspects of survival: latex gloves, neon lights, excretions, odors, human waste. Finally, there is the profanity of bureaucracy, of standardized operational processes that serialize a patient’s fate and reduces his or her individuality to an X-ray or electronic health record, to a mere number in a formal system.

But, despite all this, ultimately, romance creeps back in. Television shows and soap operas hint at the everyday dramas of the human condition that take place within a hospital’s walls. A former colleague of mine, a healthcare architect, told me about a young couple that met at a hospital while both were there for treatment. And she told me about a nurse who had become so attached to her day-to-day workplace, the ICU, that she held her wedding there. One way or the other, hospitals bring out our true colors, who we really are.

Nowhere else are we more human, more intimate, more ourselves

The patient experience is always a journey of transformation guided by symbolic acts of meaning, in other words, by rituals. Since the beginning of humanity, rituals have allowed us to shift between our multiple identities, to leave society and reenter it, and to, literally and metaphorically, heal. One has to understand the underlying rituals, the deeper meaning of the patient experience, in order to design for it and make it more human-centric.

This lens of deeper meaning, of rituals creating and restoring “sacred spaces” at those very moments when we feel the most vulnerable and the most authentic, is a romantic proposition. Hospitals are where we give up control and where our trust in the kindness of strangers is identical to our trust in professionalism. No other professional environment offers so much legitimate space for our most profound emotions: fear, sorrow, and love. Nowhere else are we more human, more intimate, more ourselves. Nowhere else, besides perhaps war, is it more daunting to find beauty in the mundane; nowhere else is it more urgent to understand functional features as a sign of something more meaningful; nowhere else is it more rewarding to “find the big in the small.”

Indeed, the exquisite pain of the romantic can be encountered in everyday healthcare interactions, in small and big moments of gain and loss, life and death. In my book, The Business Romantic, I describe the example of a patient’s experience during a cancer MRI, and how the angle of a tiny mirror that allowed her to see the eyes of her doctor while she was being examined made all the difference.

How do you feel?

With regards to the business side of healthcare, I recently had an interesting discussion with a manager from a big pharmaceutical company. She was generally intrigued by the idea of romance but skeptical as to how it could be implemented in the healthcare sector where brands are typically scientifically designed and cultivated to underscore attributes such as reliability and trustworthiness (as well as their distinction in research and innovation, just consider Mayo Clinic, Kaiser Permanente, or the Cleveland Clinic), and certainly not the kind of erratic, emotionally exuberant persona you might expect from a romantic brand. When transparency as well as regulatory and legal constraints are the norm, then romance appears to be a silly idea. At the same time, these organizations have brands because they stand for something and exude a certain persona and aura. Patients relate to them more strongly than to other, more “neutral” brands.

I had similar conversations with an executive from a healthcare equipment company and a researcher from a leading cancer institute. They all had the same reaction: they were touched by the idea of romance as a humanizing force in the healthcare experience and at the healthcare workplace, but didn’t know how to get started.

John S. Toussaint, the CEO of the Thedacare Center for Healthcare Value, argues in a recent piece for Harvard Business Review, that a purely process- and efficiency-driven approach to healthcare management is an impediment to creating patient value. Citing organizations such as the Palo Alto Medical Foundation, Seattle Children’s Hospital, or Salem Health that are pioneering the new approach he champions, Toussaint demands a shift to a purpose-based model with flatter hierarchies and an adaptive rapid-learning mindset where everyone, including executives, is a “student of work” and always “on the floor,” close to patients and colleagues. Yet the metrics he references for his argument are still the metrics of efficiency-thinking: reduced patient care time, shorter wait time, and so forth.

To me, all these reactions and reflections show that there is a great desire in an efficiency- and bottom-line driven healthcare industry to bring some of the human “care” back — as emotional experiences that, instead of stripping all deeper meaning from the process, embrace it. Healthcare should not neglect feeling like “care.” A truly human-centered approach to healthcare delivery must transcend mere process excellence and embrace a spiritual workplace and patient culture characterized by significance. It must allow for moments of intimacy and delight, and not only be valued by rigorous operational metrics but qualitative metrics that measure the holistic patient experience, how he or she felt.

Un-quantified selves

A few weeks ago, I spoke at the BBVA Ideagoras conference for healthcare marketers in Madrid and heard the IBM CTO in Spain, Elisa Martín Garijo, present the abilities of Watson, IBM’s cognitive computing solution (which is named after IBM founder Watson, but not, as you might have suspected, after Sherlock Holmes’ Dr. Watson, the intuitive, emotional, and erratic counterpoint to his analytical, emotionally detached boss). No doubt, Watson’s computing power is impressive, and IBM’s claim that it will revolutionize healthcare is not too far-fetched. Watson will automate many routine medical tasks, especially preventive ones in order to free up personal doctor-patient time for risk groups or acute health issues.

However, during the Q&A a doctor in the audience raised his hand and protested, mildly and politely, against the Watson vision: “Healing requires more than just the right information. It needs empathy and listening. Often the patient knows more about their illness than we do. It’s a dialogue, really, not just problem-solving.” Furthermore, the man admitted his fear of a future when humans no longer care — only machines. Martín Garijo was sympathetic and in her response highlighted again the many benefits of Watson’s application in healthcare. But even if rational arguments are sound, emotions override them at any time. In order to market cognitive computing and alleviate fears, IBM and other advocates of AI-driven healthcare must use more of their common sense and intuition.

At the same conference in Madrid I met Anne Seubert, a fellow speaker, who has been a diabetes patient since she was a young girl. For her insulin injection routines, Anne depends on a monitoring device that tracks her food consumption, as well as her physical activity, 24/7. As she told the audience, “I have to manage my life every single second. I never have peace of mind. I cannot ever lose control. Every meal is a numbers game. I must check my insulin levels before and after I do sports. I must check my sleeping hours, my stress levels. Even when I can have sex or fall in love is dictated by the numbers.” Anne calls herself a “natural born quantifier.”

Indeed, she lives a life of numbers, and she finds it ironic that so many people now seem to voluntarily want to quantify their lives through self-tracking devices. While everyone else around her appears to be eager to join the Quantified Self bandwagon, all she wants is to get off it and live an un-quantified life, a life beyond the metrics. For her, living a life dictated by the regime of data has always felt like a handicap that infringes on her very human agency. To revolt against this regime and find “romance between the numbers,” she began to very deliberately design her “romantified self.” For example, she launched a blog called Kekstester (“Cookie Tester”), an homage to cookies in all shapes and forms, and a riff on the profession of ‘cookie tester.’ The cookie tester became Anne’s romantic alter ego, a small act of defiance that allowed her to reclaim her own narrative and bring some unpredictability and sensuality back into her life. The blog rose to Internet fame in her native Germany and even established her, the diabetes patient, as a “cookie critic.” “A cookie is the shortest connection between two people,” she smiled. “Pure love.”

Stories, just to be heard

Anne’s story is also a tale of the power of storytelling, one of the eldest and most enduring human technologies. Increasingly, healthcare practitioners recognize its value, too. Stories create intimacy and build empathy. Columbia University has pioneered a graduate program in “Narrative Medicine,” inspired by the belief that “effective practice of healthcare requires the ability to recognize, absorb, interpret, and act on the stories and plights of others.”

This growing field provides a platform for the stories of illness as a way to heal. According to the school’s web site, Narrative Medicine addresses “the need of patients and caregivers to voice their experience, to be heard and to be valued, and it acknowledges the power of narrative to change the way care is given and received.” Originally centered on patient and caregiver stories, the school has expanded the Narrative Medicine program into the realm of literature as well as visual and performing arts, adding museum-based courses, drawing classes, and dance courses.

The flame

Despite all this, it is often hard for healthcare workers to sustain their empathy, their intrinsic motivation to feel with and help others. They are often at risk of “compassion fatigue.” Even worse, research suggests that physicians, in particular, are more likely to burn out than any other category of workers in the US. Buddhist meditation techniques or other mindfulness practices are an effective antidote, according to Robert Mc Clure, a scholar at the Berkeley Center for the Greater Good.

In the end, healthcare is like any other business. It is hard to keep the flame alight. The romance fades when things become transactional, standardized, and depersonalized, when they are purely driven by a striving for efficiency gains and the bottom line.

Efficiency means resourcefulness, it’s an act of responsibility and care. And yet, while it helps us better manage existing resources, it doesn’t help us renew them. Mindfulness and soul must remain at the heart of every process. Romance must not be a luxury, but a fundamental part of the patient experience, especially during a time and in a location where sacred and profane spaces merge to become one single container of acute meaning.

An excess of attention, a hand on the shoulder, a deep gaze into another’s eyes, moments of silence and calm, a staff that matches “patient acuity” with their own presence in the moment, the permission to provide rather than deliver, to look after rather than monitor — all these rituals and features help us heal, be well, and feel better. They bring the romance back to care, and with it a large part of our humanity.

In the end, when nothing else matters, only romance remains: when we look back at our lives, lucky are those of us who can see more than there was and for whom life has been more than just the sum of its parts. In healthcare and beyond, designing more romantic experiences means designing more humane experiences.