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Manav Sevak:
Welcome to the Memora Health Care Delivery podcast. Through conversations with industry leaders and innovators, we uncover ways to simplify how patients and care teams navigate complex care delivery.
Matt Troup:
Hi, everyone! This is Matt from Memora Health, one of the medical directors and co-hosts of the Care Delivery podcast. I’m so excited today to be joined by Dr. Adrienne Boissy. Adrienne, thank you so much for coming on the podcast today. Can you take a minute to introduce yourself to our listeners?
Adrienne Boissy:
Sure! Thanks, Matt. I’m so excited to be here. I’m Adrienne Boissy, Chief Medical Officer at Qualtrics, an experience management software, and I’m a practicing staff neurologist at the Cleveland Clinic taking care of multiple sclerosis patients and former chief experience officer there, also a master’s trained ethicist and washed-up ballerina, if that helps you. And I came to Qualtrics probably, close to two years ago, because I had this massive forever fire in my belly to reduce suffering and create more joy in healthcare.
Matt Troup:
That’s wonderful. I’m excited to touch on so many of these topics today that you just talked about. To start, what inspires you? Tell us a little bit more about your story, and you mentioned about making this pivot recently, just what’s that motivation been like? What’s that really, that fire inside?
Adrienne Boissy:
Well, I think in order to want to ease suffering in the world, you have to have seen it. My personal story is anchored in some degree of dysfunctional family dynamics, which I think many of us have. And this notion of watching, as my own family tried to grapple with topics like alcoholism and mental health disorders and abuse, and try to, I kept asking myself like, why do people behave that way? Why is this happening? And my own coping mechanism was to get out of the house and to do ballet as much as humanly possible, and ultimately, that wound up morphing when I was in college, and I met some patients who had been impacted by neurologic disease, and I was so struck by where the intersection was of their neurologic deficit and who they were as a human and a soul and a daughter and a mom. And so I really started thinking about the humanity of why we do what we do to people, and who, what really makes the human soul this beautiful, magical being, and how can we honor that in healthcare? And I would say that only got amplified as I went through residency and training and didn’t feel like much of a human at times, and yet, was fascinated with the moments after the team left the room, and you’re sitting alone with the patient and building these relationships that for me, last a lifetime in multiple sclerosis. So I think, which leads me into maybe a second part answer to your question, which is I see, all the time I hear stories from my own patients and my own family. I’ve lost three fathers to the same disease. I’ve navigated healthcare every time. I have no idea and no recollection of what happened those prior three times to my family, and from my patients, all the time, you know, can’t get a wheelchair replaced or couldn’t get through to me in the office. And I got to tell you, those small, seemingly small missteps, I think, impact dramatically the memory of a space and a place in terms of how we made people feel. And I want to impact that every touch, every moment, every opportunity that I have to make sure they’re a little lighter, a little sillier, a little more fulfilled no matter what they’re facing as a result of touching me or the organization.
Matt Troup:
I love that. And I heard you speak one time about how empathy is not optional. This is, I love, this is my take, too. I entered into healthcare because, the deep-rooted empathy and wanting to really change and move patients’ lives in a positive direction. How do you feel about it being ingrained within people or the ability to people, for people to learn to be empathetic? And how have you seen that play out in your career, both in a clinical setting and also now in the setting you’re at, at Qualtrics?
Adrienne Boissy:
I think so many of our sentences start with, I went into healthcare because I wanted to care for other people, or wanted to be empathic, or give back, and it’s this beautiful voluntary intention that we have. And what happens, and maybe it happens to you, it certainly happens to me at different points, is we enter a system that doesn’t feel very empathic or humane, and next thing you’re more glorified if you made the discharge happen or completed the paperwork before 24 hours or you billed appropriately. You know, these things that get reinforced when what you want to be doing is showing up and loving on other humans, whether colleagues or patients, so they could be their best selves. So I think that’s one of the things that happens, is that there’s this smack reality of what we wanted to be doing and what we are doing at times, and that disconnect, that sometimes feels like a smack, quite honestly, it hurts a lot of us. And I think that constant rub starts to erode some of our passion and engagement in the space. And if you look at some of the stats, it’s really interesting, right? 90% of us miss emotional cues from our patients. 56% of clinicians think compassion is important. What is happening? We went in as these loving beings, and then you hear stats like that. And the answer is, I think sometimes we have systems that don’t always optimize caring for and loving on the people within them, and that that shows up. When you look at the evidence and literature, it’s clear that empathy, as a skill set, can be taught, but most commonly, what happens is I say to people, okay, give me your best empathic statement. If this was the situation, what would you say? And people would be like, I would say, I understand, or don’t worry about that, or I’m going to fix that. And sure, maybe at some point those are versions of empathy you might want to try, and yet I still sense a significant gap in recognizing empathy is actually not fixing or denying. It’s sitting in that emotional bathtub of yuck with another human being, if even for a few moments, so that they are less alone in it and letting them know that you see them and all that they’re experiencing emotionally, not clinically, emotionally. And that keeps me going too, because I hear us miss, I hear myself miss. I try to be really intentional about the moments that I can listen better or show up differently.
Matt Troup:
Oh yeah, there really is this magic that happens when you can sit down next to a patient or turn the patient off for a minute and just let the exterior world outside of a clinic visit or a clinic office or a hospital room fade away, and you can really engage with that patient. It’s so challenging, though, is that, yes, those expectations that are outside of those walls start to pile up, the patiets keep coming. During COVID, as a frontline worker, that really started to beat down on me just the expectations in both inside the system and outside the system. And we start, I start to feel that as the clinician experience goes down, there’s just less morale and motivation, and then the patient experience probably soon follows after that. How do you start to rebuild that? Does one come before the other? Do you just believe they coexist? Yeah, how do you start to approach the care team experience, clinical experience, as well as the patient experience?
Adrienne Boissy:
Maybe two reflections. One is a personal reflection, and one is an operational reflection that you can remind me about if I forget. The personal reflection is that, I used the word intention before, and I’ll use it again here, I have become intentional about how I show up to my colleagues and my patients. And what I mean by that is, yes, I am, at times, overrun by the system, but when we give the locus of control to the system, what you described is the end result. The locus of control has to sit with us. I’m not defined by the system I am in. I am responsible for the relationship I have, for the words that come out of my mouth, and how I can show up when I touch this person and this person. So I did an exercise where I created my droid pie, I call it, where I really mapped out what a meaningful life an impactful life would look like for me as I moved through the decades, and in that one of them was being more present in some situations and working hard to reduce suffering. And sometimes, that’s sliding the computer to the side and grabbing my patient’s hand. Sometimes it’s slumping in my chair when somebody tells me something horrific, sometimes, it’s remembering the suicide of their son last month, which just happened. Sometimes it’s an unexpected birthday card or a scribble note I put on the after-visit summary, like I try to create my own moments and relationships. That is restorative for me, right? No matter what is happening, I can still do these things, and that actually provides quite a bit of fulfillment for me. When we think operationally, systems, I think one of the most effective things systems could do is get out of people’s way so that they can do that more. If I’m doing pre-OS And prior-OS and reviewing my faxes, I am not present in the way that I want to be. So systems could eliminate the fax machine. They could use AI to understand why the same patient is calling and calling. They could fill in forms that I don’t need to be filling out as a human. They could get out of my way so that I can be the best human I can be. Those would be some things I think about, and I bucket those under operationalizing empathy. If we knew how hard it was, we would work really hard to make it easier and more fulfilling.
Matt Troup:
Yeah, 100%, I think that is the key. It’s trying to remove those obstacles that get in the way. And there’s opportunities now with automation and maybe the, how AI plays into this to try to remove some of that. Certainly, some of the work we’re doing in Memora to try to remove some of those barriers that really get in the way of a patient-clinician experience. And I know one of the things that really motivate you is this people-centered or patient-centered type of model. Where are you seeing that play out in the best ways possible currently in 2023? Where does that playing out best?
Adrienne Boissy:
You mean in terms of companies that I’m seeing it in or in the market as they move organizations?
Matt Troup:
Yeah, the market generally, and any specific examples as well, I’d love to hear about.
Adrienne Boissy:
A couple of things. If we, whether or not you think, I think it’s important to talk left and right brain, right? Let’s say you don’t buy into experience, you don’t think experience is an important emotional thing. It’s not fulfilling to you like it might be for you and I, then there are still numbers that count. Operational efficiency, quality, and financial data are all well tied to experience efforts, and we could give you multiple examples. If you look at customer-obsessed industries, whether you start with Amazon and move up to L.L.Bean and move over to Delta and then over to Hyatt, these are, right, organizations that double down on creating an unforgettable memory for people, do quite well financially. You might sprinkle Chick-fil-A in there as well. And we know from our own data that organizations that are really mature in connecting PXTEX have two times the revenue growth of an organization. I heard a story recently, I’ll take one from healthcare and one from outside, there was a patient who came to see me once who had called a reputable healthcare organization, had been there previously, and then left and was trying to come back as a new patient. And they got a call back that said, they were, lived in Norse, one of the Idaho or out west. And they got a call back from this organization that said, we don’t have staffing to see you, we can’t accommodate you. So just a no, like we don’t have access, or even though you were a prior patient, so this patient got on a plane and came to see us flying over how many healthcare systems, right, to come see us because we could see them within the next week. And that was a really a remnant effort from our prior leadership where they said, as an organization, we’re going to create same-day easy access. So for access, so operationalizing a solution to create access in the moment for people doesn’t just attract people in your market, it attracts them from across the country. And this true story, another example that I think is really interesting for healthcare came out of our large X4 conference in March with over 10,000 people, and they get the CEO of Delta on the stage, I don’t know if you heard this story, but the CEO of Delta is describing how they have become one of the world’s most admired brands and part of how they, he engineered doing that was years ago, decided he was going to put a stake in the ground about creating connection. And that connection for humans, as you think about the air, you may not naturally make that connection, but one of his premises was that humans always want to be connected, and so he chose Wi-Fi, in-flight Wi-Fi, that rather than be an airline that’s going to charge a bunch of fees for in-flight Wi-Fi, he was going to eliminate those fees, which were making them quite a bit of money, as you can imagine, and they were going to make it super easy for you to connect with those you love or the work you need to do. There’s a theme here of ease, right? … easy for you to do what you want to do. And so, over a course of several years, he operationalized no in-flight Wi-Fi fees. It’s currently rolling out, as your last flight had Wi-Fi. It will soon go away. Charges, it will soon go away. And overnight, they gained a million new loyalty members, right? This is how organizations could make a decision based on their values, right? We are going to create, connect, whatever that promise, value promise is for you. We are going to create connection. We are going to create memorable moments. We are going to personalize your experience. This is a good example of changing an operation or a process to drive real connection and therefore loyalty. I think those are two examples I think of from my own perspective on the world.
Matt Troup:
Those are wonderful examples. I would love to know, do you think that there’s something analogous to the Delta example in healthcare?
Adrienne Boissy:
Do you, Matt? I think when he says, we’re making it really hard sometimes, if we’re being honest with each other, I see patients still get told in any healthcare system, here, call this number. Why do I have, why are we putting more burden on the patient to call when we’re on the phone right now? You could just connect me, or we think the most innovation innovative thing we could do in access is create online appointments. I would submit that’s table stakes. I would submit coming into your home and providing care where you are is much more, is back to the basics, like full circle of coming into your home and providing the care you need or leveraging remote devices to understand your ecosystem and the joys of telehealth and telemedicine, being able to look into your refrigerator and see the rug you trip on and the food that you’re actually eating, personalizing and experience, and I think we can be much more transformative about that.
Matt Troup:
Yeah, and there’s almost been a push recently to de-incentivize some of that, when you think about in-basket burden and now how are we going to create maybe even a barrier to that or charges related to that for patients because it’s untenable for clinicians to manage, but it does represent access for patients, and it really does take, I think technology, in a way, needs to be a new way forward so that we’re not taking these processes that feel burdensome and just incentivizing patients to even use them.
Adrienne Boissy:
Yeah, I think you’re spot on in the sense that one of the opportunities I see isn’t let’s place burden in front of the patient, but let’s leverage the full power of technology that exists today. So look at those MyChart messages to do unstructured data analytics, to understand the emotion, effort, and sentiment to do journey orchestration, so I understand what do you look like across the entire touchpoint with this organization so that I can fix the biggest pain points that you have. That technology exists, something we offer, like it exists right now. And so making a decision that we’re going to invest in meaningful tech stacks that drive out that burden for clinicians, amplify value and personalization for the patient. So I do know, oh, you had a horrible experience at the contact center last time, let me make this touchpoint different and more personal and do a little service recovery. But we could be leveraging that to take the administrative burden off as opposed to putting up a potential barrier for patients. That’s what I’d like to see us do.
Matt Troup:
Yeah. So let’s say we implement all these wonderful technologies, we tech stack of our dreams. How do we best measure that it’s effective? How do you properly measure patient satisfaction? And I would also say, how do you measure that clinicians are satisfied and providing even the empathy that we expect clinicians to provide?
Adrienne Boissy:
Yeah, I’m glad you have a tech stack of your dreams. I think it’s important. I think it’s really important, maybe more than a tech stack of your dreams, you need to have a strategy. What are you actually trying to accomplish? And answer the question How do you want people to feel as a result of touching your organization? What are you after? When we put these values up on our wall or when we create these OKRs, there should be consistency amongst those, right? Year after year, your values shouldn’t change very much. The measurements under it might, but the values should be the anchor. And so I’m often talking to organizations about, great, you say patient experience is a priority. What does success look like to you in that space? And you get a wide swath of answers. People are like maximizing caps, reimbursement is one answer, delivering a contact center of the future is another answer. Scoring 100% of your calls for service excellence is another, and collecting bad debt is another answer. And so, I would just encourage the audience to get real about what is your answer to that question. In my world, I was really working on a model where I see us ask very few questions, maybe five, but across the continuum of care and leaving the rest of it to unstructured data to squeeze out, right? How are we making people feel? Are we communicating effectively? Are we making it easy? Do they feel part of a team or the things I focused on? And those are true for patients, and they’re true for employees because what’s true for both is they’re both human, it’s a really weird concept, and most humans want some of the same things. And I think focusing there is really important before you decide what you’re going to measure or what tech stack, the technology should be enabling those relationships and needs, not defining it.
Matt Troup:
Yeah, that’s wonderful. And as you think about the intersection of technology and healthcare and we bring it kind of full circle back to the empathy component, what is critical for us to think about as we utilize technology in care delivery, but for us still to bring an empathetic human element to it?
Adrienne Boissy:
Yeah, maybe we’ll do Rapid Fire. Number one, I might throw at you that we should be leveraging in the world of employees right now where we’re at a critical crisis, whether it’s temps or staffing or retention of what you have. Number one, I’m going to say tell them how much you appreciate them, and technology can help you do that. If we understood sentiment and we understood unstructured data fully, we could deploy workflows that would automate that sort of joy for employees unexpectedly, which is where some of the magic happens, right? That wasn’t expecting to be told that he was fabulous, but 18 patients told him he was, here, Matt, is your dose of gratitude with confetti attached. That would feel really amazing. It might keep you going just a little bit further. The second, as I mentioned, is get out of the staff’s way. These things we constantly keep talking about prior auth, faxes, appeals, signatures on that, come on, that’s got to go. Number three, people want to know that you know them. And in healthcare, I think it’s really interesting because they want to know how long they’ve been coming to the organization, what happened the last time they were there, who they love. They want you to have that context, and yet in healthcare, we also need to be cautioned about their data, how it’s used, what their permissions are, who is driving value from it, and make sure that they’re at the table defining that. So I see that as a delicate dance that we can only co-design together. And lastly, AI holds a tremendous amount of promise, everybody’s talking about it. And I would just say those, we have to apply some principles of real ethics, right? Don’t hurt people, try to help them, justice and fairness, as well as thinking about how we can make sure that those guiding principles for creating the personalized experience are informed thoughtfully by ethicists and by patients themselves, who will be the end users of that. And our employees, the same thing, right? Lots of rules and regs about how their data is used, and understanding what matters most is part of what that dream tech stack should be able to provide.
Matt Troup:
Wonderful. This has been such an excellent conversation. I so much appreciate your vision and the way you’re promoting just empathy in healthcare. I would love to know, as we wrap up today, what excites you the most about healthcare, where it is right now, and where it’s headed.
Adrienne Boissy:
I think the courage I think there’s real headwinds, right? There’s financial concerns for healthcare organizations we’ve never seen in financial crisis before. As we talked about, some of the employee patients are using alternate models of care. The way we have done it is not the way we have to do it moving forward. And I think what’s required for that, though, is courage on the part of individuals who are saying, I’m not just going to define experience by this. I’m not just going to listen to patients. I’m going to listen to employees, and my community, and patients and put it all together. I’m going to try something new. I’m going to listen holistically. And that in complex organizations often requires a visionary, who’s got some courage. And at the root of that is the fire in the belly that I have, and it sounds like you have. I hope we can create a cadre of people who’ve got that.
Matt Troup:
I would love that, count me in. Adrienne, thank you so much. This was such a great conversation. Everything you say and do is so inspiring to me. So I just want to say thank you so much for joining me today on this podcast, and I hope we get to chat again soon.
Adrienne Boissy:
Well, thanks for having me. Thanks for all you do, Matt. I appreciate it.
Manav Sevak:
Thanks for listening to the Memora Health Care Delivery podcast. For more ideas on simplifying complex care for care teams and patients, visit MemoraHealth.com.
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