Innovation Starts with the Heart, Not the Head
I recently got a call from a CEO of a health system that encompasses several hospitals, medical practices, and clinics. Lakeland Health employs about 4,000 associates and takes in nearly $500 million per year. Its facilities are spread across the southwest corner of Michigan — where median income is 70% of the national average and the incidence of chronic diseases is substantially higher than the norm. It's a challenging environment in which to be a healthcare provider.
The CEO knew I was a fan of passion-fueled innovation and thought he had a story I'd find inspiring, hence the call. A year earlier he had taken up his new post at Lakeland. Shortly thereafter, he had called a meeting to review patient satisfaction scores. U.S. hospitals have to report this data to the federal government, and if they fall below certain thresholds, they pay a penalty in reduced reimbursement rates. Given that, the CEO was distressed to learn that when it came to patient satisfaction, Lakeland was a laggard — with scores between the 25th and 50th percentile. How could this be?
His senior team told him it wasn't for lack of trying. Lakeland tracked the things that drove patient satisfaction — response times to call lights, pain management, the quality of the food, the effectiveness of patient communication, and so on. By most of these metrics, the care compared well with others in the industry — but this wasn't showing up in the overall satisfaction scores. Part of the problem, the execs suggested, was the hardship and ill-health that surrounded them. Lakeland drew from a shallow hiring pool and had to treat a disproportionate number of seriously ill and often uninsured patients. Many were frequently readmitted when they failed to follow post-care instructions. Having benchmarked other hospitals, Lakeland's leaders knew that more favorably located hospitals typically achieved higher patient scores with similar service levels. Conversely, hospitals in comparable locations delivered scores that more or less matched those at Lakeland.
How, the CEO wondered, could Lakeland reinvent the experience of healthcare for its patients? Lakeland had a team of service leaders who were responsible for benchmarking and applying best practices, and there didn't seem to be a lot more that Lakeland could learn from its peers. Neither could the problem be solved with money. Lakeland didn't have the cash to make big investments in additional staff or new patient amenities.
After a few weeks of reflection and some personal soul-searching, the CEO thought he had a plan. What would happen, he wondered, if Lakeland's associates brought their hearts to work, as well as their professional skills?
With this thought in mind, he asked his team to rent cinemas in three cities and sent around a schedule of more than 20 kick-off events. The theme, plastered on posters at each venue, was "Bring Your Heart To Work." Over the next several weekends, nearly all of Lakeland's staff showed up at one of the events. The CEOs message was simple, unexpected, and daunting: None of us aspire to work in an organization that frequently lets down its customers. We can and must do better than this. So let's set a goal of getting to the 90th percentile in 90 days. We can't scale up much in the way of additional resources, so we're going to have to be resourceful. We're going to raise our scores by touching the hearts of our patients — by making sure they know not only how well we care for them, but how much we care about them. We're going to learn to be more loving. To do that, he said, I want to challenge you to bring your heart to work in new and creative ways.
For a nurse or an x-ray tech with 10 or 20 years of experience, delivering health care is a routine. But for a patient, the experience is anything but. Lakeland's CEO reminded his associates that a hospital visit is one of the most emotionally charged events any human being can ever experience—something that is remembered for years afterward. Borrowing from research done at Florida Hospital, he characterized a hospital visit as a drama in three acts. First, there's admission—typically accompanied by pain, fear and anxiety. Next is in-patient care, which often involves alternating bouts of discomfort and boredom. Third is discharge, when out-going patients often feel unprepared or even abandoned. Using associates to play the role of patients, the CEO demonstrated how each stage of the drama offered opportunities to create loving connections with patients — by demonstrating concern and tenderness, and providing consolation and cheer.
The CEO didn't offer his associates a script or a training program. Instead, he challenged them: "Every time you interact with a patient, tell them who you are, what you're there to do, and then share a heartfelt why. For example, 'I'm Tom, I'm here change your dressings, 'cause we want you home in time for your granddaughter's wedding.'" The heartfelt why needed to be stated in a way that put the patient's hopes and fears at the center of the healthcare drama.
Over the next 90 days, the CEO "rounded" 120 times. He showed up in every department, on every shift, in every facility. "How's it going?" he'd ask. "Have you made any heartfelt connections? If so, tell me about it. If not, let's role-play right now. Let me be the patient."
Initially, many of his associates struggled to come up with a "heart-felt" why. Despite all the caring that goes on in health care, making it personal doesn't always come naturally. It takes practice. "How will we know if we're succeeding?" was the most frequent question directed at the CEO. His answer: "You'll see it in a patient's smile, you'll here it their voice, you'll sense it when they take your hand — and ultimately, you'll feel it in your own heart."
Over the ensuing months two things became apparent. First, success required that everyone, every day, opened their hearts to those they were caring for. One person with a bad attitude could undo the heartfelt efforts of a dozen colleagues. Not surprisingly, front line employees and their managers started to become less tolerant of colleagues with crappy attitudes. In the end, more than a few of the curmudgeons were asked to leave.
And second, though the focus of the CEO's initiative wasn't on call-light response times, pain management, or discharge planning, patient scores on all these conventional metrics started to climb as the heart-to-heart message took hold. The lesson: love someone better, and they'll extend you grace on all the less important things.
Before long, Lakeland was reverberating with stories about heartfelt connections. So how to thank all of those who were bringing their hearts to work? Here, too, the CEO had a plan. Whenever a patient or a colleague reported a small act of heartfelt service, a senior leader would show up within minutes to personally thank the warm-hearted associate. Surrounded by their nearby co-workers, the leader would retell the story, thank the individual, and pin a heart on their badge. Over the course of a few months, more than 6,000 stories were celebrated across Lakeland, and more than 6,000 hearts were affixed to employee IDs.
Listening to all of this, I asked the CEO to share a typical story:
There was a wicked commotion in the hall, and two security officers suddenly found themselves facing a husband in complete emotional melt down. He had come in with his wife who was desperately ill. After the medical work-up, he was told that his wife was dying of cancer and probably won't leave the hospital alive. The news struck like a thunderbolt, and he simply lost it. Having been called to the scene, the security guards were ready to phone the police when an associate nurse comes around the corner. Seeing the distraught husband lashing out at everyone around him, she walked up to him and calmly asked, 'Can I hug you?' When the man nodded yes, she wrapped her arms around him and for the next 20 she held him as he wept into her uniform. Finally calm, he returned to support his wife and the nurse went on with her duties. She was an LPN, who had never been through any course on conflict management, or de-escalation, but she had heard lots of stories about how to connect with another human being.
"Now," the CEO continued, "not every story is that dramatic, but many of them will bring a tear to your eye and all of them will put a smile to your face." Some associates simply found a more thoughtful way to say something to a patient. For example, a receptionist responsible for scheduling follow-up appointments, discovered that she was more likely to get a smile when she switched from saying "the doctor wants you back in two weeks," to, "the doctor would like to invite you back in two weeks." That was a tiny change but it made a positive emotional difference.
But, as the CEO constantly reminded his colleagues, little things could also destroy a patient's emotional equilibrium. He frequently recounted a conversation he'd had with a mother who'd delivered a child at Lakeland several years earlier. The newborn had arrived healthy and happy, but as the mother recounted her birthing experience, her eyes filled with tears. Upon arriving at the hospital, the first person she encountered in the OB unit had failed to look up and greet her with a welcoming smile. When you're an expectant mother, both hopeful and anxious, you need a bit of reassurance—and it hadn't been forthcoming. Years later, that disappointed mom still remembered the cold welcome she'd received.
"So," I asked the CEO, "6,000 stories later, how did this all turn out?" "Well," he replied, "within 90 days we were at the 95th percentile … for the first time ever."
He went on. "Beyond the improved satisfaction score, there was a clinical benefit. We are in the business of saving lives, of enhancing heath, of restoring hope. When we touch the hearts of our patients we create a healing relationship that generates a relaxation response, lowers the blood pressure, improves the happy neurotransmitters, reduces pain, and improves outcomes — for both the patient and the caregiver."
By the way — that CEO was my brother, Dr. Loren Hamel.
For me, the point of his story was simple but profound: empathy is the engine of innovation. That's why I often worry about just how de-humanized our organizations have become. Listen to the speech of a typical CEO, or scroll through an employee-oriented website, and notice the words that keep cropping up—words like execution, solution, advantage, focus, differentiation and superiority. There's nothing wrong with these words, but they're not the ones that inspire human hearts. And that's a problem—because if you want to innovate, you need to be inspired, your colleagues need to be inspired, and ultimately, your customers need to be inspired.
Writing in the early years of the 20th-century, Max Weber, the famous German sociologist, said this about the modern age:
The fate of our times is characterized by rationalization and intellectualization and, above all, the disenchantment of the world. The ultimate and most sublime values have retreated from public life.
A century later, Weber still seems on the mark. We live in a secularized, mechanized and depersonalized world—a fact that strikes me anew each time I find myself scrunched into seat 22B on a dyspeptic airline, or when I've been compelled to navigate through an endless phone tree in a quest for "customer service," or have gotten lost in the maze of a government website that purportedly has a form I need to complete.
It does not have to be this way. These are exactly the sorts of soul-destroying experiences that energize innovators.
In one of his last presentations as Apple's CEO, Steve Jobs said his company lived at the intersection of "technology" and "liberal arts." If he had been the CEO of a different company, Jobs might have talked about the intersection of construction and liberal arts, or airlines and liberal arts, or banking and liberal arts, or energy and liberal arts. To Jobs "liberal arts" was another name for "the humanities" — the encapsulation, in poetry, prose, art and music, of what the ancient Greek philosophers called the just, the beautiful and the good.
The best innovations — both socially and economically — come from the pursuit of ideals that are noble and timeless: joy, wisdom, beauty, truth, equality, community, sustainability and, most of all, love. These are the things we live for, and the innovations that really make a difference are the ones that are life-enhancing. And that's why the heart of innovation is a desire to re-enchant the world.
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