The Experience Strategy Podcast: Meaningful Patient Experiences and Digital Health Solutions

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Patients are humans. The digital health landscape is constantly evolving, and there is a lot of opportunity for the US healthcare system to better utilize tools and data to improve the patient experience by viewing them as human beings with individual needs and values. In today’s episode, we’re looking at the intersection of healthcare and experience with Jan Oldenburg of Participatory Health Consulting. Tune in to hear how we can start doing better by patients.

Voiceover: [00:00:00] This is the experience strategy podcast, where we look at the best and the worst customer experiences and ask what were they thinking? And now here are your hosts experience. Nerds, Dave Norton and Aransas. Savis

Aransas: come to the experience strategy podcast. I'm Miranda says.

Dave: And I am Dave Norton.

Aransas: Today. We are joined by Jan Oldenburg.

She's the principal at participatory health consulting. Say that three times fast while there she advises and mentors, prominent healthcare organizations about. Constantly evolving digital health landscape. There's Oldenburg has focused on digital transformation healthcare for over 20 years, working in leadership roles with all sorts of huge companies, including EOI, Aetna, Kaiser.

And today she's joining us to look at the intersection of health and [00:01:00] experience and why it matters so much. We look at our patients as human beings with individual needs and values, individual goals and individual journeys, and the ways in which the social determinants of health influence and impact these patients success and how we can do better by them by seeing them and understanding that.

Jan. Thank you so much for joining us today to start things off. Can you just tell us a little about who you are and what you do?

Jan: Absolutely. Um, and I thank you for having me. I'm very pleased to be here. I have been engaged in the world of healthcare and digital health in particular since actually before the turn of the century, which completely dates me, but it's true.[00:02:00]

Doesn't it

Aransas: 18 hundreds

Jan: precisely. I was a pioneer. Um, but I, I focus on consulting with organizations to help them really think about their roadmap for features and functions. In particular, their digital roadmap for consumers and patients. And then how think about integrating that into the rest of their systems.

So that care seems. Seamless and that the experience, whether you're digital or in-person, doesn't have all these gaps and false starts and hiccups in it. So I focus a lot on removing friction from the experience

Dave: Jan, that, uh, turn of the century comment just kind of freaked me out a little bit because.[00:03:00]

It's scary to think about it. That way, that it has been a long time that these topics have been in the forefront of healthcare. You've been talking about. The need for participatory design, participatory health for a long time. Uh, about as long as I've been working on an experienced strategy, what have you seen?

That's changed. I want

Aransas: to get into that, but just for the listener, can you give us a quick summary of what you mean by participatory?

Dave: Sure let's let's do that. First. I

Jan: view participatory health as health care that respects and engages the individual, the person, the patient as a key player in the system way too often, we think about healthcare as being done to.

Individuals, as opposed to [00:04:00] thinking of them as full partners in the decision, making the strategies and in fact, the outcomes. So participatory health in my view is healthcare that really takes advantage of the individual and respects that person and respects their decision-making and engagement in the process.

I feel so strongly about it, that I've got a book called participatory healthcare focused on how you do that and what it means.

Dave: You certainly do. And it's a great book and I highly recommended it. I remember back in the day that that's exactly how we talked about design thinking was a, we called it participatory design.

That was the original name of design thinking was participatory design. And you're coming from a long tradition and you're one of the founding members of a very long tradition of getting the [00:05:00] consumer voice. Into the process specifically around healthcare and really advocating for paying attention to what the patient is trying to do.

So that's fantastic. It's fantastic to have you here and have you talk about what you've seen over the years?

Jan: Thank you. I, you know, sometimes talk about the innocently receiving five-year time horizon of healthcare. I E that back in literally the late 1990s, when I started doing this work, I talked about.

How in five years, everyone would have access to their healthcare data. And they'd easily be able to be sure that every doctor that they saw had access to the same information about them and that people would be using digital [00:06:00] tools to improve their health and track what worked for them. And as we can see from the fact that that was in 1998 ish, uh, many of those things have taken much longer and every year they're still, uh, almost five years off.

Now we've seen improvements in that, over the, the timeframe, but there's something sadly true about the slow pace of innovation and change in the healthcare space. Um, but you asked what has changed. Uh, and I think one of the things that we should really be celebrating is the fact that pretty much everybody can get access to their own healthcare information, uh, through a portal or an app when recently even through an application programming interface that allows them to do something with that day.

They're so inclined or, [00:07:00] uh, provided to an app or tool that will help them do something with it. And that's, that's significant. It's no longer the era of the healthcare professional sort of clutching your record to his or her chest and protecting it from your view. Because you really can't handle seeing the truth about what's going on.

And that change, I think, is a very welcome one and kind of base setting for some of the other things that are available to us today and, and provide potential to. I'd also say, another thing that has really changed is that, uh, increasingly, and it's not there everywhere, but increasingly organizations and particularly individual doctors really understand this dynamic [00:08:00] of they can.

Engage somebody it's always the person's choice, but they can be more engaging in their language, in their approaches, in how they talk about decisions and in how they set up the environment so that someone has an easier entry. Into asking questions or participating in that decision-making and that's an attitude and culture change.

That's in part, a reflection of what's going on in the broader society, but it's really welcome in the healthcare space,

Dave: you know? And isn't that like a great definition of what experience strategy really. The ability to maybe you don't get to control everything about what the patient is doing, but you can set up the environment in such a way that it's more healing.

You can. Make [00:09:00] the time that they spend with you be like time well spent instead of making them feel like they're rushing through a process, all of that kind of stuff that you do that feels soft is really about creating the experience for them and, um, kudos to you for being kind of a pioneer in, in that area.

Jan: Thank you. That's a great way of handling the fact that. Getting old,

it happens. It happens to the best of us, you know? And one of the things I, I think about in the healthcare space in particular, it's, it's fragmented in the. There's no doubt about it. You've got a different often, at least different doctors who are not part of the same system. Your insurance company may allow you to see this person, but not that person.

You may face barriers in getting [00:10:00] what you need or a doctor recommends paid for. You've got somebody dispensing your meds. That is. In most situations connected to your position and may give you different information about it. So when we talk about the experience for people, I've lived, one of the things that's incumbent on, everybody in the system at every part of the system is thinking about how they can make connections to the other components of the healthcare system that ease the friction that make it easier for.

Dave: Sure. Absolutely. And you, you mentioned API APIs as a technology component of that. One of the things, and let's go back to that in a minute, but one of the things that we really wanted to talk to you about today, Jan is related to this, the complexity of healthcare in the United States, the, the healthcare system is very complex [00:11:00] on top of that.

We have. A very complex social environment where there's a lot of things that are going on in the environment that make healthcare and managing healthcare. So, so complicated. Um, the industry has a term for this. They call it social determinants of health. Can you describe for us a little bit, what is social determinants of.

Jan: Yes. Absolutely. I think that the, the general definition of social determinants is that the environment that you live. Your social environment, your physical environment, your biology and genetics, uh, your financial situation, your behaviors, and also what's in the community in terms of access to healthy food access to medical [00:12:00] care.

All of those have a significant impact on your ability as an individual to be healthy, uh, in particular I think, um, there's a saying that's actually true that you zipcode is the thing that can most tell how healthy you're likely to be because the zip code reflects all of those societal component. That affect your health?

That is crime. Isn't. Isn't that scary? Actually,

Dave: it's a little bit scary. Isn't it? Keep going?

Jan: Well, and, and so when we think about that impact, most other countries actually do a much better job of stitching together, the sort of medical and the social components. So we've got a social safety net. That's pretty much disconnected from the healthcare system with different forms, different people, different [00:13:00] processes.

And, uh, as a consequence, we. Tied together and make those connections or haven't traditionally, and that's now starting so that, you know, an example of this. When I worked for Kaiser, uh, they realized that many of the people that they were seeing in certain parts of their service areas lived in food deserts where access to healthy food was not easy.

So they set up farmer's markets in their parking lots so that once a week people could get access. To fruits and vegetables and other kinds of healthy foods that were not available in their general community. I think that's a really great example of thinking about the impact that that social setting can have on the individuals you're caring for and taking [00:14:00] action to remediate it.

Dave: I love that. That's a great example of kind of what's going on. But if you think about the industry as a whole, the complexity of the industry as a whole, you think about the complexity of people's lives, where they live, um, the way that they were raised, what they have access to, what they don't have access to.

All of a sudden experienced design for patients, uh, for people for how are we want to talk about them becomes much more sophisticated, much more complex. I love that at Kaiser example, because it's so straightforward and simple, it probably, they probably got access to food, but it was also probably a really good example to the community of what should be done.

To kind of, to, to help really deliver on healthcare. Have you noticed [00:15:00] any changes that have occurred in the way that we think about social determinants of health during and post COVID as more people are staying home?

Jan: Yeah. Great, great point. Uh, first of all, I think it has pushed the realization that.

Access to broadband capabilities is in fact a social determinant of health. So whether we think about the difficulties that, uh, children from lower income families have had getting, uh, internet access to do homeschooling education is in fact, one of the social determinants of health, because it affects health better.

Um, or financial security as well. Seeing an epidemic of people who lost their [00:16:00] jobs or decided that what they were doing in order to make a living wasn't worth the cost to their health or person, uh, that's forced a sort of reckoning with some of these issues. Um, and also I think the other thing that.

But we've had to take much more into account is the way that social isolation has a significant bearing on your health and your ability to maintain in particular, your mental health, but your mental health related to your physical health. And so, uh, it's had an impact on. Thinking about how we keep people connected, especially the elderly, but everybody's had some of this issue, uh, and you know, being inside your four walls all the time can be great.

And it [00:17:00] also can create mental health problems that you need some external support to get out of.

Dave: I, I, I can totally see that. Yeah.

Aransas: Where are you starting to see some bright points in terms of addressing these issues?

Jan: Yeah. I mean, I think for one thing, the widespread access of a variety, some more effective than others, mind you, of virtual or virtual or digital, or a combination mental health treatment tool.

It is a great signal. I mean, it's made access to counseling and coaching available to people who simply couldn't take time off from work or who couldn't afford the cost of traditional therapy or what they needed it for. Wasn't covered. And [00:18:00] with the. Plethora of availability of phone support, and, uh, tools that you can download and run on a smartphone.

Um, that's brought some of these supportive structures into the realm of possibility for a much wider group of the population. And I think that's a great thing. Another thing that I recently had the, um, the honor, actually, a participating in leap grant that it was funded by ONC and it's based on let's figure out how to move healthcare forward.

And this one was with Missouri and the Missouri health system and they were using it to build. Use API APIs to build linkages between their unemployment support program for a disadvantaged and handicapped people [00:19:00] and the health system so that their department of employment services was working closely with the physicians.

In order to make sure that as they looked for jobs for people that they were respectful, um, the barriers that they might have in terms of ability to do certain jobs or, um, how their health affected the kinds of jobs they could be considered for. I think that's a great example of tightening that net of using our digital tools to build seamless approaches that just make things easier framed of it.

That's so

Aransas: powerful to consider too. If, if that's just the beginning, what happens when our providers begin to communicate with one another and we can begin to get a holistic portrait of somebodies health and wellbeing, which I think our research has shown more and more a. Clear [00:20:00] strong demand from patients to have that, that lens on their own wellbeing.

And I think we've done them a disservice historically, because we've just not kept up with the consumer expectation. Is that what you're seeing as well?

Jan: Absolutely. And in fact, I'll tell you the story that sort of combines these. Um, a couple of years ago, I interviewed a woman who had two children, each of whom had some significant health problems.

And one of the things that she was experiencing in dealing with her health system and the variety of doctors that were caring for all of her children's different needs was the fact that. She was going to schlep her children in for a visit. She couldn't get contiguous appointments. Think about it. Have you ever been in a health system that says, oh, by the way, do you need a mammogram at the same time as [00:21:00] you get this primary care visit, we can schedule that for you at the same time.

Hmm, or, oh, we've referred you to a specialist. Can we combine that with the visit? You've just scheduled to primary care so that you only have to make one trip. It's it's a whole new frontier, honestly, in scheduling. And I, I have to say while I'm not seeing improvements there yet, although I hope they're taking place.

One of the things that, um, somebody like Kathy has said is why should I have. My children, all of it. Why can't care come to me. And I think we're seeing that happen, not just with the prevalence of digital care and virtual care and the ability to do visits from home. Um, but there are also organizations like, uh, ditch dispatch.

Which happens to be run by somebody I used to work with at Aetna who that's [00:22:00] re-inventing house calls as a key component of caring for people in their homes and rethinking what the care model and coordination looks like within the.

Dave: That is so fascinating and there it's amazing how many new things are really happening right now in part, because of the crisis that we've been been through over the last couple of years, I think it's opened a lot of health providers, eyes to the potential of digital solutions.

Really solving, uh, for a lot of problems that they thought were intransigent in some way. Is that the right word in transit? And you say that word? I said it right

Jan: the first one. Yeah. Go Google that.

But Dave, one of the [00:23:00] great things about this, this last two years, and I, I shouldn't sound so enthusiastic about it, but the fact is that we've actually seen that the health system can change quickly when it's under direct. And that itself honestly is hugely important. It gives hope that not everything has to take that infinite five-year period to have a change come into play when necessary systems can organize to make changes.

Dave: Yeah, they certainly can, but not without a lot of pain and suffering. Uh it's it's uh, it's unfortunate, but it's also, it really has been a catalyst for, I think, a very different way of thinking about, um, patient experience and what we want. You started out years ago, talking about participatory health, which meant that the [00:24:00] patient, I think, had a voice, uh, should be listened to, should be understood by the doctor.

And now when we think about participatory health, there's like so much more that we can do from our home. We actually have quite a bit. As a consumer, as a patient, I have so much more control, so much more access, so, and it affects so much more in my life than it ever has before. Uh, it's amazing. I mean, think about all of the things that I can track, uh, for myself share with my doctor, engage, uh, with my healthcare system in a very, very different way, uh, because of technology it's, it's really quite amazing.

Jan: You know, it, it is amazing. And, um, I think there's, there's so much more that we can be doing there in terms of using all of the data I am tracking and all of the data available about [00:25:00] me to make, uh, the approaches to me in terms of how you. Uh, personalized reminders, nudges and incentives. How you provide me with insight about my patterns that I may not be aware of, but they may be sabotaging changes.

I want to make nonetheless and. A wealth of information and data we're tending right now to use it, to affect how we think about population care. Then I think the real magic is going to be when we start really applying it to how we individualized care and personalize it for J. Uh, rather than, you know, Dave is probably motivated by different things than Jan is.

And so let's make sure that when you're nudging each of us about getting our exercise, that you're providing insights that are [00:26:00] actually valuable to Jan or today rather than to some faceless member of the population.

Dave: Totally agree. That's a

Jan: big amen on that. Just

Aransas: know that if you already read background noises, it's me jumping up and down and

Jan: clapping.

Well, and we've thought about, uh, we, we tended to behave as if every 45 year old person with diabetes. Uh, behaves the same and has the same motivations and the same family situation and the same kinds of jobs. And in fact, of course they're as different as everybody in the universe. And if we're going to get good at this, we've got to figure out how to get to the individuals.

Y and, and help that person activate that.

Aransas: I think that's really scary for a [00:27:00] lot of companies though, because they're thinking we got to scale, we got to go faster. We got to take in more people and we need big data to guide us. But what you, and I think we're kind of preaching is, is the opposite of that.

And yet I believe fully that it can be done by enabling. Digital tools. So where are you seeing folks getting too specific wise, effectively at scale?

Jan: Well, in theory, of course it is the, the beauty of, um, big data AI, et cetera, is that you can use big data to get to small individuals, right. To identify patterns, to identify, uh, you know, digital phenotype.

That do respond similarly, and then tailor your messages around that people have I collected a set of examples, um, about this while I was actually doing some [00:28:00] research for days digital. About, um, tools that are actually working well for people in terms of, uh, both tailoring the messages and providing, cause I think this is key.

Most, most of the reminders that digital tools give you are just upgraded versions of your mother, nagging you to brush your teeth.

And we all responded so well to that. Right? So we resist, in fact, we shut it off. We don't listen. So we've got to get really creative about how we think about that process. And I think one of the keys is give me insight. Along with the nudge. So if you tell me something that I didn't know, or may have only suspected about my behavior at the same time [00:29:00] that you make a suggestion about what I could be doing differently.

Now that's motivating, at least to me. Now, my bet is if they're personalized enough, everybody's interested enough in themselves that that's going to work. Or at least more effectively. Yep.

Aransas: I think you're absolutely

Jan: right. And, and I, I see a few who are starting to do that. Um, People gave the example of some of the ways that the aura ring looks at, for example, your sleep patterns or your exercise and sleep over the past week and make suggestions about how to, uh, run your day as a consequence.

Others, although I didn't experience this, but others have said that they feel as if new does a better job of personalizing those reactions, [00:30:00] uh, for individuals. But I think they're, they're still few and far between, and it's a place that, oh my God, we could be so much better. And the first companies that get this right.

I really going to revolutionize how we think about that intersection between, uh, digital tools and behavior change.

Dave: Yeah. nuMe definitely promises it. Right. I mean, they, that's kind of their whole thing. They promise it. And we have an upcoming article in Harvard business review. Talks a little bit about noon.

So, uh, stay tuned for that sometime in January. I look forward to that. Yeah. Yeah. It should be, it should be really good. Wow. This has been fantastic

Jan: actually, though, I have one more insight to leave you with. And it's about the way that [00:31:00] the physical and digital environments have to cohere. And the way that when you're thinking about people, you've got to think about both the physical environment and their capabilities.

And so it affects things like, jeez, we build a lot of things for smartphones, but some of the populations we're trying to work. They'll have flip phones. So do we have a strategy for using text-based messaging to get to those people? It can be very effective, but the other part is, you know, we've seen, uh, that vaccine mandates are changing people's behaviors in terms of getting them to get their shots.

But I went to the drug store, uh, actually last Friday to get my booster shot. And ahead of mean, line was a young one. We're both waiting for access to the vaccine room and our vaccines. And, uh, she, I asked her what she was there [00:32:00] for. She was there for her first dose of the vaccine. Uh, and I said, something like good for you.

And she said, well, you know, work requires if that's why I'm here. Um, but then she gestured to the door. Other than the little room that they'd set up in my local CVS to provide a space for everybody to get the vaccine. And she said, but man, this is not helping me any. And in an effort to be holiday, how are we in friendly?

Someone had pasted the door with stickers that said, keep us, keep out, be aware, enter if you dare cause.

If you're

Voiceover: worried.

Jan: Bad conjunction of how wean celebrate Tori and the physical environment required to [00:33:00] make somebody feel comfortable getting their first state dose of the vaccine.

Dave: Oh boy,

Jan: context matters.

Aransas: It does well. And you think about how often we do that. And digital environments as well. And we make it so difficult for people to engage and to, um, to really be invested in their own wellbeing.

And the harder we make. The more friction there is the less likely we are to serve these people and help them address their goals, which I'm sure you, you could probably tell us even more about this, but that is the major factor driving up cost. And our health care system is the lack of successful treatment.

And patient engagement is at the core of that. How true is that from what you've seen?

Jan: Oh, I think that's absolutely true. Uh, and you know, one of the things that [00:34:00] is, uh, I I've several personal hobby horses around this topic. So stop me with one of the great examples of this is that. Uh, you know, we put in high deductible plans starting out, I don't know, 20 years ago, or so with the goal of making people have skin in the game, if they were paying a portion of the cost, they'd be more invested in what health care they asked for and what treatments they said yes to.

But guess what, what we found out is that when people are in high deductible plans, they. Just reduce their access to care. They cut up preventive services that might even be free along with expensive treatments. They cut out medications that are actually life preserving along with. And yeah, costs go down, but the long-term [00:35:00] consequences to the health and both those individuals and the population as a whole is actually not very good.

Plus it leads to healthcare is still implicated in something like 66% of bankruptcies. So. Ew. Ew, those strategies push people further down into poverty. And it's another way of thinking about integrating how we think about, uh, access to care is, well, what are the financial barriers and how do we help people overcome them between their insurance and the way our health system handles access to charity care and helps educate people about.

What, uh, tools and capabilities and treatments are going to be most effective for them.

Aransas: Wow. In the end, it all comes down to the human. And I think if we go all the way to the beginning of this [00:36:00] conversation, that that's really, I think the, the mission behind the work that you've been doing is to engage and promote.

The patient and allow them invite them in to being our partners. And, and as an experience strategist, my big takeaway from this conversation is that it's essential to consider the experience of our patients, whether it's their digital experience or their IRL experience with us. Um, and certainly the hybrid experiences as well, but to deeply understand.

Curious about their journeys, their needs, their values, what motivates them so that we can drive cost down for the entire system. And we can drive efficacy up for the patients themselves. Dave, any other takeaways from this that you hope experienced strategists, whether they're UX designers or chief brand [00:37:00] officers, but people who are really responsible at the end of the day for thinking about the experience, what they should take from this conversation.

Dave: I hope that, um, you know, experienced strategists out there are beginning to realize, I'm sure they are that remote care patient. Is a much more, uh, is a much broader, um, area to focus on than just the virtual doctor visit. When you start to think about social determinants of health technology tools, it really expands the impact that you can have on people in their lives, at their own dwelling places.

Right. And so we should be thinking about that a lot more. I think we also need to understand and, uh, work against the knee-jerk reaction that the industry as a whole has to generalized education [00:38:00] and, uh, Jan, the way you described it as reminding them to brush their teeth right over and over again, uh, without any kind of personalization without any kind of individualization.

People need to be embraced at the point that they're at some of that's going to require technology, but some of it is just going to require, um, healthcare companies to think differently about what business they're actually in, how they deliver their experiences, what it is that they're trying to do for their patients and customers.

I think that's

Jan: very important. There's a great example of this. I think in that, uh, you know, it's currently mandated that everybody should be able to see their. And the notes that their doctor has taken about them in a visit. And there's lots of reasons for doing this, right? It helps educate people. It makes them partners in their [00:39:00] care, you know, all of those kinds of things.

And frankly, they catch errors, but there are a lot of doctors who are being most. The idea that somebody might see results, test results, whatever, without having first had a conversation with the physician. And one of the things that makes me sort of crazy about this is that there are some simple solutions and one of them is contextual education.

When I look at a result, show me an explanation of what it means, right. In context while I'm looking at it, don't make me search the internet for an explanation where I might stray off into other territory. Give it to me right there in the context while I'm looking at the actual result. And that's, uh, a, a really effective teaching tool.

Uh, it's also. Really easy to [00:40:00] do with digital tools. And it's something we rarely take advantage of. There are health systems that are doing this, don't get me wrong. Um, but, but not enough and not enough, or thinking about. Those ways of helping to increase people's literacy in the moment and in the moment when they are, uh, afraid and frightened to give them the tools that allow them to Suze themselves.

Aransas: So well said and so inspiring. And as I think back on what you shared has changed in the past, you know, since the turn of the century, uh, where we still have gaps, it is reassuring to consider the progress we've made and. Frankly, it's reassuring to see how clearly the roadmap is being built for us to move forward, providing greater access and meaning in our care.

Thank you so much, Jan, [00:41:00] for your time today, for those of you listening. I know you want more from Jan. I know I want more from Jan. So follow her on Twitter at Jan Oldenburg. She has a lot of great stuff to share there. And then. Seizes to inspire. Jan, thank you so much for being here. And we look forward to having you back on the show.

Another time to those of you listening. Thank you as well. Join us next week for a deeper dive into how we can use both digital and human support to improve other elements of care.

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