Having conducted international research audits, interviews and field research with physicians over the past few years, I’ve noticed 5 commonalities of the physicians’ experience that seem to transcend physical and cultural boundaries. Understanding and appreciating these common themes can provide those desiring to do business with physicians with a foundation for further cultivating their knowledge of physicians and for developing a successful relationship with them.

1. Physicians seem to have a perpetual time deficit – while the reasons may differ – in the US a physician may be spending significant time finding a medication that is on his/her patient’s insurance formulary while a Spanish physician may be spending that time understanding local regulations – a common thread across regions is that physicians are being tasked with increasing responsibilities, more patients and yet there are still only 24 hours in the day. Physicians need tools and resources that help them work quickly and efficiently.
2. Medical school is not business school; practice management can be a struggle – for physicians who are intimately involved with the operations of their facility, practice management is a critical responsibility for which many feel unprepared. This is as true in parts of Europe and Asia as it is in the US. Physicians need advice, tools and resources to help them manage this aspect of their careers.
3. Physicians everywhere are worried about bureaucracy and legal troubles – malpractice and following regulations are concerns for all physicians. They constantly need to be on top of regulations, protocols and best practices so as to avoid legal or administrative issues. In an ever-changing medical and healthcare environment this can be a challenge. Physicians often feel very vulnerable with regard to these issues and value advice from trusted peers and experts.
4. Patient adherence remains a top concern – the challenge to get patients to adhere to treatment regimens is universal. Whether it is because the patient feels he or she knows better than the physician, or the patient has a misperception about treatment, or that simple absentmindedness leads to non-compliance, adherence is a major challenge and physicians take it very seriously. There is a multitude of patient education and compliance-related resources available. Physicians want efficient ways to point their patients toward the most effective information and tools.
5. Physicians are people too, and want to feel respected as physicians – physicians get the most satisfaction from their work when they are working with their patients, taking the time to understand their needs, and seeing them succeed through improved health and wellbeing – not when being marketed to or working out from under a pile of paperwork. Physicians have expressed that when they do not feel their patients appreciate their expertise, their time is undervalued, or when they are distracted by interruptions or burdened with administrative tasks, they do not feel respected and do not find their profession satisfying.  

The above form a preliminary understanding of the physician experience across the globe, but keep in mind there are also notable differences between physician experiences in different countries, shaped by local healthcare structure and medical regulation, culture, and the availability of technologies. Even within a single country there can be distinct nuances depending on the type of physician, the working environment such as hospital vs. private practice, and the region. For example physicians in the more rural regions of Italy have expressed feeling isolated as part of their jobs due to limited direct exposure to their peers, a distinct aspect of the rural Italian physician experience that shapes their dependence on online methods of peer communication. So what should companies be thinking about when developing new research initiatives involving physicians so as to ensure new research provides targeted insight and real value? Three things come immediately to mind.

 a)     Optimize what you know – use research dollars and time first to validate and then to probe further: Take advantage of findings like those outlined above and use new research as an opportunity to validate relevant findings in the context of your company’s specific challenge(s) in order to build on what is known. 

b)     Identify what you don’t know – fill in the knowledge gaps:  For example, some companies  have a deep understanding of physician online behaviors (which sites they go to, for which types of information, for how long, etc.) but may not have an equally robust understanding of what  motivates those behaviors, i.e. the “why” behind the physicians’ search for  online information. Many companies lack a thorough understanding of unmet physician needs, the physician’s physical environment, and the impact of influencers such as nurses and other office and hospital staff on physicians’ decisions. The key is to identify unanswered questions and prioritize the areas that will help ensure the success of the physician-vendor interaction.  

c)      Align and make research actionable – research with the company’s and the physician’s businesses in mind:  When forming key questions, think about what will be done with the answers to help better serve the physician. Start by mapping the company’s business goals to the known needs of the physician. With that alignment in place, clearly articulate the desired outcome of the research. Is the goal to identify a new business opportunity? To affirm or rebut existing concepts so changes can be made before proceeding? Thinking about the desired outcome helps ensure that research findings lead directly to specific actions that advance the company’s business goals and align with the physicians’ goals.

Effectively planned and executed physician research that leverages what is already known and focuses on the evolving challenges these professionals face benefits both the company and the physician. Keeping these tips in mind when conducting research drives toward a rich, holistic understanding of the physicians’ experience  and better positions the company to play a meaningful role in that experience.

With so many questions, I think it’s time to start working collaboratively on answers. There are multiple disciplines currently looking at the changing face of the US healthcare system holistically as well as facet-by-facet. As experience designers, I and my colleagues at MISI are actively exploring and documenting what it means and feels like to be a part of this system, and what it should mean and feel like in the future.

FYI…There’s more to this blog post, but if you are interested in learning even more about today’s patient experience and why patient’s fail to follow their doctor’s orders, join MISI on 2/24/2011 in Philadelphia at the Patient Adherence Cocktail Convention hosted by MISI, WoolLabs, and Smart Brief. Visit Wool Labs for more information or to register

Among my many healthcare-related interests is the patient adherence experience. My colleagues and I are finding there is a lot of opportunity across the industry for collaboration on supporting treatment and wellness maintenance regimens.

Drawing on insights gained from several projects involving primary patient research, we are noticing the following themes in the reasons given for why patients fail to fully adhere to the regimens their doctors prescribe.

Lack of understanding of adherence and compliance – patients and caregivers do not always fully understand adherence or compliance, and do not always understand their behavior’s impact on treatment efficacy and overall health.

Lack of incentives and motivation – remaining or becoming healthy should be enough incentive to adhere to treatment and wellness regimens, but patients often require significant evidence or instant results to reinforce changes to their behavior. How many of us have started an exercise regimen just to get frustrated and drop off after a month? Especially for conditions that can be asymptomatic, such as heart disease, or conditions that are not necessarily considered severe, such as acid reflux, seeing the benefits of adherence and maintaining motivation can be a challenge.

Lack of support – once patients receive a prescription or receive instructions on required behaviorial changes, they can feel alone, especially if the regimen is complex. They must take action, often with limited resources or tools and without even someone credible they can trust for guidance, emotional support and information. The effort can feel overwhelming.

Lack of transparency and accountability – patients, first and foremost, are responsible for their behavior, but who else has a stake in their adherence? Who should be monitoring their progress? Their physicians assume responsibility when it’s check-up time, but who should be responsible between visits? And even during a check-up, when it comes to adherence and identifying the challenges and addressing them, the physician most often relies solely on patient self-reporting. Is it reasonable to assume this process can ensure the best outcome?  

Too much assumption – speaking of assuming, it happens a lot on the part of the patient, the physician and the other players in the system. Patients can make many assumptions, such as that a medication is enough without accompanying life changes. Physicians often assume that once they have given treatment instructions to a patient the patient understands, or at least knows where to turn for additional credible information. Hospitals, pharmacies, and insurance companies often assume patients have the necessary knowledge and resources to successfully finance and coordinate care, filter through health and wellness information, and maintain treatment regimens.

These themes may not sound like anything groundbreaking, but they bring to light additional valuable questions.

How do different roles view these barriers to patient adherence?

Is what patients view as being their greatest barrier to adherence the same as what physicians, insurance companies and pharmacists view as being the greatest barrier?

What would it take to tackle each of these barriers?

What are the opportunities across the industry to support patient adherence better?

While there is still a lot to explore, there are certain areas for opportunity that are rising to the top – here are some initial thoughts:

Physicians – as the US healthcare system evolves, physicians will have to define their role as not just a healer or a gatekeeper to treatment, but as a proactive health educator and facilitator, thinking of patients holistically. (See JMH’s post on Personal Healthcare Strategists). In order to accomplish this, physicians will need the support of hospital networks, insurance companies and technology providers.

Insurance Companies – they already have the incentive to keep people healthy, but they are not fully taking advantage of the touch points they have with their customers. Wellness programs need to be better designed to facilitate patient adherence. Incentives, third party partnerships, facilitating information gathering, and the provision of meaningful and easy-to-use tools are areas for opportunity. 

Pharmaceutical Companies – pharma already diligently produces condition information through unbranded and branded outlets. However, there is an opportunity for pharmaceuticals to partner with physicians by expanding their unbranded information outreach efforts. Patients and caregivers are reluctant to trust pharmaceutical companies when information is provided through their marketing channels; however, they trust information that is thorough, credible and delivered through channels perceived as being unbiased. There is an opportunity for pharma to deliver its research-based evidence transparently through trusted information channels.

Pharmacies – big name pharmacies are quickly evolving from being a place only for medication retrieval to being a resource that focuses on customer service and provides information, as well as select treatment and preventive services, such as flu shots. Among many opportunities for pharmacies is the improvement of their communications and processes with physicians and insurance companies. They have a unique opportunity to step in on the side of making medication adherence easier.   

There are more opportunities to discuss, including opportunities for patient support networks, government sponsored programs, and services provided by commercial third parties ranging from local fitness centers to emerging social media tools. I want to open up the conversation.

What is your role and expertise? What do you think about this topic? About the various opportunities? Join the conversation – leave a comment to this post or, better yet, register for our Cocktail Convention on the topic of Patient Adherence, Thursday, February 24, 2011, in Philadelphia, PA. Come share your thoughts and experiences live and in person. Visit Wool Labs for more information or to register.

All the players in the experience are taking their lumps. Pharmaceutical companies are accused of inserting themselves into a process in which they don’t belong in; Payers are accused of only caring about what will save them the most money; Physicians are scolded for not taking a more proactive role in improving the experience; Pharmacies…well, no one really seems to know exactly what to do with pharmacies these days as they actively search for the right way to redefine their role.  In my experience as both a consumer of healthcare products and services and as an experience design professional who has done a great deal of research on various interactions among these players, the root cause doesn’t fall on any one, rather on all of them collectively.

FYI…There’s more to this blog post, but if you are interested in learning even more about today’s patient experience and why patient’s fail to follow their doctor’s orders, join MISI on 2/24/2011 in Philadelphia at the Patient Adherence Cocktail Convention hosted by MISI, WoolLabs, and Smart Brief. Visit Wool Labs for more information or to register

As I was saying, today’s patient (or healthy person) experience is a complex web of touch points and information sources that don’t have any one connecting point.  There is no central role ensuring that information exchanged in discussions or interactions between the patient or caregiver and any one product/service provider is captured and available to all players in a coordinated “team” strategy that leverages collaboration.  Furthermore, equating “self-managed” healthcare to “patient-centered” healthcare is muddying the waters even more. Care must be centered on the patient without requiring the patient to manage the system of delivery.  

Healthcare is a team experience. As healthy people seeking to stay well or as patients seeking to address our various conditions, we have a vested interest and responsibility for our healthcare.  But that responsibility is shared. We are key stakeholders and decision makers, but we can’t manage our care alone.  And the more complicated our conditions, the more help we need.

This perspective has been brought into sharp relief for me by my personal story and by a recent article in New Yorker magazine.

My Story: The Abridged Version (For the detailed telling, go here.)

I am a pregnant woman who also has a preexisting health condition.  I troubled over whom to call when my preexisting condition flared up – my GI specialist or my OB? I called my OB and her response was eye-opening: “This is the one time in your medical health where you get to have a strategist.  In the same way that I coordinate lab/hospital visits and all of your insurance interactions related to your pregnancy, I also coordinate any specialist visits you may require.  You will always start with me.” What a novel idea.

With my OB as my personal healthcare strategist, these are some of the differences I have experienced…

Role of the Pharmacist was Clearly Defined: The pharmacist immediately acknowledged not only the current reason for the visit, but also the fact that I was pregnant. While she did have an alternative suggestion for me around my medications, she made it clear she would be filling the current prescription and simply writing down the suggestion for me to take back to my doctors for a follow-up discussion if I so choose.  

Complete Access to a Collaborating “Team” of Doctors: For the first time ever, I do believe there is one person who has a complete view of my health.  More importantly, I also believe that there is a “team” of doctors working to ensure my continued good health.  Both doctors work together (without me playing go-between) to collaborate on a course of treatment that helps me get better and keeps my baby’s health needs in mind.  They are also managing the health insurance interactions.

Proactive Team Ownership of My Wellbeing:  My doctors are checking-in to see how things are going with the medications, my pharmacy is making some good recommendations for additional steps I can take that support my doctor’s treatment;  my insurance company is providing additional live resources for me to leverage as I go through my pregnancy.

No one person’s experience can be generalized across the healthcare experience spectrum. But my experience does reinforce a recurring theme in healthcare: The need for better and more open collaboration and communication among all of the players involved in managing any patient’s health.  A good patient experience isn’t about a solitary owner; it is about a good point person who is knowledgeable in all touch points and objective enough about the emotional part of health management to take the lead, grab the pen, and “own” the coordination, leading all players toward the same mutually agreed upon desired outcome.  In other words, a personal “healthcare strategist.”

The New Yorker Article
While formulating this position, I came upon a fascinating article by surgeon and journalist Atul Gawande in New Yorker magazine called The Hot Spotters.  The article is about how some pioneering doctors are rethinking how those who use the healthcare system the most are treated.  One of his subjects is Jeffrey Brenner, a physician in Camden, New Jersey, who decided to combat excessive medical costs by treating the “super-utilizers.” (In Camden, one per cent of patients are responsible for thirty per cent of medical costs.)

Brenner formulated his own team concept. It includes a nurse practitioner and a social worker. They make regular home visits and phone calls to check in about new and existing complaints, unfilled prescriptions, and other complications that could land these patients back in the hospital. They help apply for disability insurance and fill out paperwork for state-run housing where their medication can be overseen. They encourage these super-utilizers to improve their lives with steps like quitting smoking, cooking more, and joining Alcoholics Anonymous. And the results are striking, both in cost reduction and in better outcomes for the patient.

This is exciting stuff and something I and others at MISI XD are paying close attention to. This team concept with a lead “strategist” is very compelling on many levels. The reason this strategist cannot be the patient is that with rare exception we are the least knowledgeable about how the healthcare system really works and what options are available to us, and because we are too emotionally involved with the experience of our health.  The role must be filled by someone who understands the entire healthcare system and is tasked with achieving the best outcome for the as dictated by the patient.

In my experience, with few exceptions coordinated team care seems to be limited to 1) the very wealthy; 2) people in crisis; 3) pregnant women.  The $64B question is, “How do we institutionalize the team healthcare concept for everyone?”

To learn more about today’s patient experience and why patient’s fail to follow their doctor’s orders, join MISI on 2/24/2011 in Philadelphia at the Patient Adherence Cocktail Convention hosted by MISI, WoolLabs, and Smart Brief.  For more information and to register, go to: http://www.woollabs.com/conference0211/

Astra Zeneca presents its Accoladez awards every year to brand teams and partners who produce work that provides the biggest breakthrough in how to communicate about a brand or to address a difficult brand challenge. It recognizes a key finding in market research as well as a unique methodology used to uncover a transformational insight regarding customer behavior.  Accoladez is highly coveted among the Brand teams and the competition is quite fierce.

Our Experience Design group recently won finalist status in the category of Commercial Insight for the Physician Experience Research Study we completed in early 2009.  Our work was recognized because it provided the basis and firsthand validation of what Primary Care and GI Specialists were looking for from the Digital channel, both from a preference and behavioral standpoint.

The study sought to understand how physicians use the digital space in the context of treating their patients. It included detailed 1:1 interviews with over 50 physicians in two cities – the highlight of the research was the “day in the life” diaries we asked physicians to complete to track their digital activities. The goal was to get at what physicians’ digital behaviors REALLY are versus what they claim they are in self-reported surveys or large-scale reports. We wanted to answer the “how” and “why” of physician behavior, not solely the “what.” The insights we gathered helped AZ stakeholders both in digital and traditional channels prioritize communications and tactics.

We think this recognition speaks volumes about the value of having a non-agency with no agenda to push for any particular marketing communications tactics doing this type of research. It frees the partnering vendor to call it as they see it and focus on creating value for the client.