We Don’t Have to Live This Way!

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You got me. I still won’t cop to eating at a Cheesecake Factory, but I am all about the Apple Store.  In fact, I’m a teensy bit over the top about it. Seriously, I beg of you—could we, please, have just a little genius bar with our health care?

I’m no doubt somewhat of a freak (I got up at 2:55 a.m. ET on September 19th to, you know, pre-order the iPhone 6).  A month or so later, I was more than ready to upgrade my aging iPad2, so obviously at the first opportunity I ordered a new iPad Air 2 online from the Apple website.  I requested pick-up at my local Apple Store—because it’s convenient—and, well, I just love going there. A few minutes after I made my online purchase, I received an email informing me that the store staff was ready for me. My new baby was waiting! Serious goose bumps.

I made my way to the mall. It was pretty crowded, as usual. I walked right past The Cheesecake Factory, into the mall, turned left and into the gleaming Apple Store—smiling, not quite skipping, all along. Several staff members greeted me almost the minute I arrived. I explained why I was there. When she understood my reason for coming to the store, the first staff person handed me off to another. I showed him the email on my iPhone. We traded some numbers. He entered those on his iPhone and went back to get my waiting . . . Air 2!!

Within five minutes he arrived with the new purchase. I signed the bill electronically. He asked if I needed any help getting the wee new thing set up. I said, “No, I got this one.”  And with that—I was out of there, back past The Cheesecake Factory and to my car—skipping.  (I’m kidding—about the skipping part.)

It’s true neither I nor any of my devices that day had a reason to visit the actual genius bar—but I think you get my point: Why can’t our health care experiences be as seamless, efficient and humane as a visit to this kind of extraordinary retail store? The staff there is unobtrusively looking out for customers as they enter the store. The first person that saw me triaged my need and handed me over the appropriate level of intervention. I really didn’t need to go further into the store. The staff person readily acknowledged that I was coming to the experience both with my own device and with my own information. We and our devices exchanged information. He quickly figured out what I needed and managed it. He asked me if I was comfortable with DIY care (for the iPad set-up)—and when I was, we parted—another satisfied customer.

Obviously, the full metaphor falls apart some as the acuity of care need escalates—but still, let’s face it, there is plenty of room for health professionals, patients and families to re-imagine the care experience. While they’re at it—they could do a lot worse than looking for models like this store—and the genius bar.

But you ask: Who gets to re-imagine the health care experience?

And to that we say: You do!

Flip the Clinic began with a simple, but I guess radical idea. What might that be?  We think the human beings, both professional and non-professional, who are experiencing what has too often become a demoralizing and dissatisfying health care experience, should have the opportunity to re-think it—re-imagine it—remake it.

To help that happen—the Robert Wood Johnson Foundation is taking Flip the Clinic on the road. In 2015 we will be convening a series of community innovation labs across the country. The diverse set of attendees at each of those meetings—which will include nurses, patients, doctors, designers and others—will work together in hands-on intensive sessions to find discrete ways to re-imagine care.

You probably don’t want to miss that.

If you live in or near San Francisco, Austin, Miami, Durham, Minneapolis or Philadelphia and have a flip idea you’d like to explore—check out the Flip the Clinic site—and sign up.

We’re looking for the best genius bar for health care—or even better whatever your best idea is for making the time health professionals and patients spend together as good as it can be.

Basically, health professionals and patients—it’s your time—it’s absolutely yours—let’s flip the damn thing, ok?

23 replies »

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  2. Steve-it’s interesting. When we started the Flip the Clinic initiative I think many of us thought it would focus on the patient’s experience. In the design discussions with a range of people it became immediately clear that physicians and other professionals are in general very dissatisfied with the current care experience. It’s not just patients. The initiative quickly became about that critical human relationship. That’s both the pain point and the entrepreneurial opportunity. Please check out the project link in the post above. The potential flips there range from ideas to help doctors and health professionals to those focused on helping patients and families. Also-this project isn’t about redefining physician roles-it’s about inviting people who are concerned to think of ways to improve the relationship between health professionals and patients-and specifically to improve the time they spend together to make it better for both sides. Of course, given the status quo-a little customer service in health care might not be such a bad thing… Kind regards.

  3. Why don’t they just call it “good customer service” though?

    Flipping the classroom is about making the student the key actor–the student does the work. In medicine you DON’T want the patient to do the work. Patients should not be coming in for help prescribing themselves medicine and performing surgery. Doctors are specialists, like computer techniciains, who diagnose problems and fix them (with medicine, surgery, etc.) in stark contrast to teachers who are not reparimen. (Teacher specialize in motivation and behavior modification.)

    I understand that a lot of people want to reconceptualize the doctors role as a general purpose health specialist and not a medical technician. Obviously, most of a patient’s health depends on their behavior so if the focus is on helath the physician would focus primarily on behavior modification (drawing on Skinner, etc.)…. but that isn’t what the M.D. gives you training in so it doesn’t make much sense. You wouldn’t expect hospitals to be good at behavior modification and they almost surely aren’t, just like Apple isn’t good at convincing users not to download porn with viruses and to defrag their hard drives.

    I tried to look for examples of sucessful “flipping the clinic” but all I saw was examples of basic customers service: smile, listen to the customers, have a website that functions, make information available (i.e. medical data), etc. Wal-Mart does these things and Wal-Mart didn’t “flip retail!”

  4. Steve-thanks for the read and the comment. Respectfully disagree with your point though. Flip the Clinic did start by importing some of the classroom flipping ideas into the care experience. (In fact ip the idea came up at a Foundation discussion when Sal Khan visited us. We also have several projects exploring flipping health education both with the Khan Academy and with a collaboration of medical schools). Flip the Clinic has become significantly broader than just the idea of point to online content to help prepare patients before or after a clinic visit. Flip the Clinic is about focusing on the the current dissatisfying care experience-the time that health professionals and patients spend together. The effort is looking for all kinds of ideas to make that time better for both sides of that human relationship. The Apple Store example was merely one idea of how positive a service experience could be if we took the time to structure it with care and empathy for both professional and customer. I also think the Apple Store folks assume that customers will come with a wide range of aptitude for DIY participation-and customize their assistance to meet that expectation and need. Thanks again.

  5. This doesn’t make any sense to me. The Genius Bar is the exact opposite of fa flipped classroom so either it is a horrible model for a flipped clinic or a flipped clinic has little to do with a flipped classroom despite the name.

    In my partially flipped classroom I prepare videos for my students to watch to get content and then push them to think hard about the concept and use techniques to solve problems in the classroom.

    With the Genius Bar the customer is clueless about the nature of the problem, or at least how to fix it, and calls in the cavalry to do the work for them. That is exactly what I avoid in my class–if I do the work they can’t learn (much)! Drivers Ed instructors understood this for a long time, which is why the student drives the car and the instructor doesnt.

    Does anyone want medicine to be like the flipped class where the doctor describes how to do differenti diagnosis, calibrate dosage, and perform an appendectomy and then the patient does the work.

    I understand this could work for learning healthy lifestyle going but that isn’t what medicine does. MDs don’t have comparative advantage in the work that personal trainers, dietitians, and social workers, those professionals do.

  6. “…need to pay heath professionals differently.”

    Code for pay them more.

  7. Peter1-Agree, it does get confusing. I’m not in any way suggesting that we need to pay MDs more or less or whatever. I am suggesting that we do need to pay heath professionals differently. We also need to think differently about the care experience–the time health professionals and patients spend together. There is plenty of room for us to pay differently, design differently–and leave patients and professionals happier. We do need to stop paying for things that don’t work or that we don’t need or that are making us all unhappy and dissatisfied with the care experience. We can do better.

  8. “You get what you pay for–and we want great and rewarding experiences for health professionals and patients, right? Let’s pay for that!”

    Apparently we’re not getting what we pay for in U.S. health care. Double what many other industrialized countries pay but (even according to you) we get less.

    So now you want us to pay even more to get what we should be getting in the first place?

    Your responses are typical MD viewpoint – just pay me more and I’ll do what I should be doing in the first place.

  9. Peter1-It’s funny-one of my personal early threads into this work years ago was all about payment change. You get what you pay for–and we want great and rewarding experiences for health professionals and patients, right? Let’s pay for that! Let’s just figure out how to make those payment schemes work, and we’ll be out of the woods. Payment and extrinsic incentives matter but they’re not everything. There’s way more to co-creating great care experiences than just the right payment. The idea with Flip the Clinic–is to create a space where people can just focus on expanding the possibilities-reimagining and then co-creating great experiences.

    You are right though the wrong payment schemes can really damage healing relationships. Case in point? See status quo…

  10. Hans-appreciate the comment. Honestly, there are times I feel like you’re exactly right-but I for one refuse to be anybody’s powerless pawn. Together I believe health professionals and patients can do fantastic things.

  11. I wonder if the “Genius Bar” health care equivalent will include extra billing a month later by docs because the purchase did not include their full fee, or maybe a “facilities” charge for the building, also not included in the original purchase.

  12. Sounds quaint, but doctors and patients are powerless pawns in a big game played by the government, the healthcare IT entrepreneurs and for-profit insurance companies. The real solution is political. Powerful forces are doing everything they can to keep patients and their doctors from changing their fate. Take your road show to Washington, too!

  13. Dr. Mike-Thank you for this great comment–and for reinforcing the point about the depressing, demoralizing status quo. Bingo. But-wait there’s more! It is your and your patients’ precious time together. You do not have to accept what we’re all resigned to expect. You really don’t. Let’s find a better way.

  14. Lets pretend your insurance company ordered the Ipad for you. And let’s pretend the insurance company doesn’t trust the Genius Bar staff as much as you do. And let’s pretend the Genius Bar staff has to document your encounter with them or else Apple won’t get “reimbursed.” And lets pretend that Bean counters are telling the rest of the staff how to do their job because they are afraid of the insurance company. Now, can’t imagine how those few minor changes would affect the experience at all.

  15. Thanks for the reply.

    Sadly, payment is almost everything. When commercial insurers are paying family docs at 85% of Medicare, it’s hard to think about putting in a genius bar.

  16. Granpappy Yokum–Completely agree–payment matters. We also think there’s room though to start with the design rather than the extrinsic professional incentives. Thanks so much for the comment.

  17. Peter1-thanks so much for the comment. I know we’re both being a little facetious in my post and your comment–but the point is quite serious. It’s also not about the specific service or product–but rather about the way we co-create the interaction between health professional and patient. For many the status quo isn’t working well.

    We’re saying we can make it significantly better–see what Apple did with the boring task of buying a computer. The healing interaction is infinitely more important and intimate-why can’t we find ways to make it rewarding for doctors and nurses and other health professionals as well as patients?

  18. Here’s a Flip the Clinic:

    The simplest iAirPad2 costs $499. Make that the non-negotiable, all payers, cash on the barrel head price for a brief office visit.

    See how easy it is?