Patient Engagement
All Health Care Interventions Fail (03:51)

When it comes to designing health care interventions, what’s different now versus in the past? What can we learn from interventions that have worked or that have failed so that we can do better in the future?

“All interventions fail, at least in their first iteration,” says Stacey Chang, Executive Director for the Design Institute for Health, “and in health care we tend not to embrace that failure. We’re afraid of that — heads roll when things fail, or initiatives are always too big to fail.” But that attitude is changing, particularly because of Silicon Valley, whose general embrace of failure has brought great success.

“Could we appropriate some of that courage and some of that methodology so that we can fail and learn as well?” asks Chang. Health care is too large and complex for us to assume we can design an intervention perfectly and that it will operate exactly as intended. “We have to learn our way to success,” he says, “and the only way to do that is to design experiments that when they fail are small in effort and intention and aren’t too big to deep-six the broader opportunity.”

Sean Duffy, CEO for Omada Health, describes another element to designing interventions that’s different today: emotion. Patient relations are the ticket of entry, particularly in primary care, and if trust between provider and patient is lacking, it’s tough to deliver care. But, says Duffy, “the world is better able to create high-fidelity emotional relationships on the other end of an Internet connection now.”

People are generally comfortable engaging on social media, so providers could, for example, post videos of themselves and their care team that patients can watch and engage with before the in-person relationship even begins. “I think what we’ll see over the span of the next couple years is that emotional feel, that kind of brand resonance, will be attached to a system,” says Duffy. “A patient will find themselves having a feeling of warmth when they think about Kaiser because of the slew of digital interactions that they have, and that warmth can be created without necessarily having to be in person, which I think allows a) rapid scaling, and then b) measurement to improve.”

Chang agrees, adding that we are beginning to recognize that emotion plays a huge role in health care — it’s not a strictly cerebral endeavor. “One of the reasons Kaiser is so successful is because they created a huge fandom. Their customers love them, and they retain them because they love them,” says Chang. “That gives them the runway to try larger-scale things, to work on returns on investment on heart disease and other things that take 7 or 8 years to manifest.”

From the NEJM Catalyst event Hardwiring Patient Engagement to Deliver Better Health at Kaiser Permanente Southern California, April 13, 2017.

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