At the Health IT Summit in Toronto, sponsored by the Institute for Health Technology Transformation (iHT2—a sister organization to Healthcare Informatics under the Vendome Group corporate umbrella), Anne Snowdon, R.N., Ph.D., professor of strategy and entrepreneurship and chair of the World Health Innovation Network, in the Odette School of Business at the University of Windsor (Ontario), on Sep. 21 urged healthcare leaders to rethink how they see consumers in North America and beyond.
Speaking on the topic “Consumer Trends Driving Innovation in Healthcare,” Dr. Snowdon told her audience on Wednesday morning at the Omni King Edward Hotel in downtown Toronto, that healthcare leaders from Canada, the United States, and everywhere, need to be rethinking how they perceive healthcare consumers, given rapidly unfolding social and technological change.
The broader context of this situation, Snowdon told her audience, is that the healthcare industry remains enmeshed in a very different mindset from that shared by executives in other industries. In particular, she noted, consumers are calling the shots in so many consumer-facing industries now, in which owning physical assets has melted away as a strategic advantage. “Think about it,” she said: “Uber is the largest taxi company in the world that doesn’t own any vehicles; Airbnb is the largest provider of accommodations, that owns no housing. And Alibaba, the largest seller of consumer goods, owns no stock, while Facebook, the largest provider of digital content, relies on users to provide that content.” The business and operating models in many of those industries are changing very dramatically now, she noted. Even in healthcare, we are seeing the first glimmers of a trend towards consumers driving some dynamics in the industry.
Anne Snowdon, R.N., Ph.D.
For example, she noted, there is an online group for patients with a wide range of diseases called “PatientsLikeMe,” and, she noted, “they’re running their own clinical trials.” (As explained on its website, “PatientsLikeMe is a patient network that improves lives and a real-time research platform that advances medicine. Through the network, patients connect with others who have the same disease or condition and track and share their own experiences. In the process, they generate data about the real-world nature of disease that help researchers, pharmaceutical companies, regulators, providers, and nonprofits develop more effective products, services and care. With more than 350,000 members, PatientsLikeMe is a trusted source for real-world disease information and a clinically robust resource that has published more than 60 peer-reviewed research studies.”) Not surprisingly, Snowdon noted, the opening up of healthcare processes to strong participation could provide “an interesting opportunity, though it could also be your worst nightmare on privacy and security.”
In any case, Snowdon told her audience, “Let’s talk about the consumer shift. When I went to nursing school and then spent a number of years in pediatric clinical care, it was a pretty compelling experience, and it was a very different time. We clinicians were trained to be the experts. We had all the knowledge, and we worked with patients and families,” as the undisputed authorities over their care. “Those days are gone,” she said. “Now, our consumers and patients are coming into clinical settings with ‘Dr. Google,’” she said, referencing the huge amount of online research that patients are engaging in before they interact with clinicians before physician and outpatient visits and inpatient stays.
“But we were never trained as clinicians to do negotiations with patients,” Snowdon continued. “No one ever taught me how to negotiate a contract; but that’s essentially what we’re doing now. The patient is coming in thinking, are you the right clinician for me? If not, I’ll go elsewhere. And 50 percent of our nurses in Canada are 50 years or older. And so they were educated for the pre-Internet world. This is not the healthcare system we thought we were going into as clinicians.”
Yet now, a new world is emerging, and that is one that will become increasingly consumer-driven, Snowdon said. She noted that Canadians are spending 45 hours per month online and 7 days a year on Facebook, while Americans are already spending 165 hours per month online, and 40 minutes a day on Facebook. Meanwhile, 56 percent of Canadians have a smartphone, and 79 percent of those who do, say that they would not leave home without it, while 90 percent of Americans have a smartphone, and 29 percent say that they couldn’t live without their smartphones.
What’s more, Snowdon told her audience, “The divide between the online world and [institution-based] healthcare has been growing. In 2012,” she noted, “44 million unique healthcare apps were downloaded. Searching for health information is now the third most popular online activity for all Internet users 18 and older. And,” she added, “as of 2012, there were over 97,000 health applications—with many more developed since then.”
So, how can healthcare and healthcare IT leaders navigate this quickly changing landscape? Snowdon parsed some of the complexity for provider leaders and for clinicians, especially physicians, around increasing consumerism and consumer health activity. “We need to be thinking about innovation, adoption of new technologies, and of course, you need to be thinking about how to filter what’s good and not,” she told her audience. For example, she said, “My husband is a plastic surgeon, and what he gets in terms of the lists of information his patients are bringing to appointments—it’s a nightmare. He refers to the piles of print-outs that his patients bring to him as ‘Dr. Google.’ And he’s told me that he can barely see two patients a day now for consultations, because of the volume of information his patients are bringing in and wanting to discuss.”
So the first element in all this is the fact that clinicians, especially physicians, are being challenged directly as authority figures by their patients, who are bringing outside information into their face-to-face encounters. The second element, related to the first, is the demand on the part of consumers for their healthcare providers to provide them with highly usable information and data, in a timely way. “Our society is increasingly relying on transparent, real-time information at a glance, from everywhere,” she emphasized. Implicitly, then, clinicians and patient care organizations are going to be competing with the array of different types of data and information that healthcare consumers/patients can obtain online from unofficial sources.
The third element in all this, Snowdon said, is that different groups of healthcare consumers are already behaving differently. We’ve been talking about ‘the patient’ or ‘the consumer,’” she said, “but I’d encourage you to think about consumers as being very different groups of people with different value propositions.” She posited a simple delineation of two different groups: consumers her parents’ ages, and consumers her children’s ages. “My parents are patient, are used to waiting, they value stable relationships with their clinicians and others, and they are very loyal to brands. They see health as a service; and they defer to the expertise of the provider. Meanwhile, my children [who are young adults] are super-impatient—they won’t wait for anything!—they are super-connected” to sources of information from a variety of sources; “and they have loyalty to value, not to a brand. What’s more, they see health as a right; they do personal research involving data; and they’re willing to negotiate relationships”—meaning that they demand certain things from their care providers, and if they don’t get those, and can’t persuade their providers to provide them, they will readily leave those providers.
Meanwhile, speaking of what has often been called the “Sandwich Generation,” Snowdon referenced Baby Boomer-aged women. “These women, who are 47, 48 years old,” she said, “make the majority of health decisions for their families. They’re caring for aging parents for more years now than the number of years that they have had their children at home. In fact, there are 7 million women in Canada who provide care for both children and aging parents. These middle-aged Baby Boomer women value agelessness, autonomy, and personalization.”
But regardless of age, healthcare consumers are generally becoming more demanding, and they are using social media to get their way. For example, Snowdon noted, “Friends of mine had a bad experience at a hospital somewhere in Canada, and they decided to tweet about it. Within an hour of their tweeting about that hospital, the CEO of that hospital was at their family member’s bedside.”
The key point in all this, Snowdon said, is that healthcare leaders need to understand that the world that healthcare consumers are demanding is not the world that patient care leaders would create; in fact, she said, it’s clear that, left alone, the leaders of patient care organizations would simply perpetuate the status quo. “As Henry Ford said, if I’d asked people what they wanted, they would have asked for faster horses!”
So, Snowdon said, “Now is the time for provider leaders to make very big shifts in how they operate, and in how they interact with healthcare consumers. The reality is that consumer confidence in healthcare institutions is dropping. Partly, that’s because we in healthcare have been socialized as providers to tell consumers what to do.” Instead, the reality, she says, is that healthcare consumers are increasingly telling providers what to do, and that consumers will make market-shifting choices based on how well providers respond to their demands. So, she said, “We need the consumers directly connected to us as we prepare for the future.” In that context, she stated, “Future healthcare is going to be personalized and directly connected, with self-management as the dominant model, because of the dramatic growth in chronic illness. It will be driven by consumers’ ideas of what value is; and it will need to be collaborative, involving community-based collaborative care [and care management] teams. And it will be outcomes-driven.”
Asked by Healthcare Informatics what the chief takeaway for healthcare IT leaders in particular should be in all this, Dr. Snowdon said of CIOs, CMIOs, and other healthcare IT leaders, “They’ve got to speak the language of every stakeholder group, and they’ve got to be able to map out the value proposition for each stakeholder group. What is each stakeholder group interested in? For example, doctors want their work lives improved through increased time efficiency. If you give them some time back in their workday, they’ll love you. The same is true for nurses. Meanwhile, CEOs want to know not only how any change will affect the bottom line; they also are very focused on the image of their organization. And of course, consumers want increased convenience and better service.”
What is extremely important, she said, is that “You’ve got to strategically map out each value proposition. And you’ve got to understand that there are subgroups; for example, older consumers and younger consumers are totally different. I have to say,” she added, “as a practicing nurse, I was always a bit wary of IT people, because it seemed that everything they were doing would only add to my time burden. So if IT leaders can change that proposition, that will really impress clinicians and win them over,” as they help to build the IT and technological foundations for the future of healthcare.