Jeremy Cauwels, MD - Sanford Health News

Sanford’s journey to zero preventable harm

Alan Helgeson (moderator):

Hello, and welcome to the “Reimagining Rural Health” podcast series, brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country, from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high quality, low-cost services in rural and underserved populations.

Each episode examines how Sanford Health and other health systems are advancing care for unique communities they serve.

Today’s topic is a conversation on safety and quality measures – at the core, providing patient care. Our guest is Dr. Jeremy Cauwels, Sanford Health chief physician. Our host is Dr. Luis Garcia, president, Sanford Clinic.

Dr. Luis Garcia (host):

Well, safe and quality as a foundation principle in our everyday activities. Jeremy welcome to this podcast. It’s great to have time to speak to you about such an important topic. How are you doing today?

Dr. Jeremy Cauwels (guest):

I’m wonderful. Thanks for having me.

Dr. Luis Garcia:

Well, thank you, Jeremy. I’m just going to get right into the purpose of this topic. We all talk about quality, and we all talk about being a highly reliable organization, but I got to admit that not everybody gets there and it’s always a work in progress. But tell me a little bit about a physician that just joined the organization, sees everywhere, “safe, safe, safe,” and those that have been here for a long time have seen the transition into this safe thing. What is safe?

Dr. Jeremy Cauwels:

Sure. So SAFE is our acronym. It stands for Sanford’s Accountability For Excellence. If you’re looking for a framework for it outside of Sanford, you would look up words like high reliability organizations. What it really means is that SAFE for us is our individual accountability as people for the things that go on in your work every day that you have direct influence over, and that you can allow or encourage to make better depending on your actions.

And so, as we work on SAFE, the basic principles are as basic as tying your shoes. They’re things like making sure you check your work to make sure you did it right. Making sure you’re engaging people appropriately and making sure that as you’re going through, you’re encouraging the people around you to maintain that same level of culture and ability. The goal really is to say, we’re going to treat other people like we want to be treated.

We’re going to do the things that we promise we’re going to do. And what I mean by that is surgeries and treatments, diseases, and that sort of thing. And we’re not going to do those things which would be unexpected. So our goal is to make sure that every person on the teams are actively engaged in preventing things like negative outcomes or bad experiences. And we can do those things in large part due to the diligence and the intelligence of all of the people that we work with on a day-to-day basis.

And so, using those teams, using a few of those simple skills – one of them we use is called STAR. So we stop, think about what we’re doing, make the action we need to, and then review it. So we actually look back at the things we just did to say, what does it take to check up on this and make sure I did the right thing?

Now the good news is that when we do that, I’m inaccurate probably to the order of 1 out of a thousand times or between 1 out of 1,000, 1 out of a hundred. If you put two of us together and we’re checking each other, we get to 1 out of 10,000 times and our error rate drops down to vanishingly low, which is really our goal every time we work together anyway, is that you and I want to complement each other on a way that makes us better.

Dr. Luis Garcia:

Yeah, and thank you for that last comment, Jeremy. Because I was going to ask you why this work? Because if you think about it, we get into health care and whether you’re a physician or a nurse or a health care provider in any sense, you always want the best outcomes. You always want to be that kind person to the people in need to our patients, to our colleagues. And we always try to work in that environment of collegiality, right?

So what was happening that you felt or Sanford felt that we needed to take a look deeper into it? Because inherently you would assume that everybody’s doing a great job in health care, right? Well, was that not happening?

Dr. Jeremy Cauwels:

I think it’s important to recognize the difference between everybody wanting to do a great job and the systems you can put in place to ensure that everybody is doing a great job.

What I can tell you is that at Sanford, every day we do deliver top-notch medical care. And we do a wonderful job of making sure that the people that we see and that we take care of really appreciate the work that we do.

But that being said, I think we all know the old phrase “two heads are better than one.” And what that means is that if I’m actively engaged in making sure that I deliver for the patient that I’m taking care of, and you’re actively engaged for delivering on the patient that you’re taking care of, we can do the job together and magnify that level of intentionality, that level of thoughtful scrutiny that allows us to do a better job with each patient every day because we’re part of a team.

Because every member of the team knows that not only can they intervene, but they should intervene. And that intervention helps all of us deliver care in a way that is less prone to error and more meaningful to the patient because all of us are actively engaged.

Dr. Luis Garcia:

Yeah, thanks Jeremy. And I agree with you. I think that we all should be very proud here in Sanford of the top-notch work that we do. I mean, we’re leading across the nation and it’s all because of all our physicians, nurses, front-line providers. And so our gratitude to them, particularly in the last couple of years that have been very difficult for them.

But you mentioned a team, right? And I want to ask you this question. You have 50,000 employees in Sanford, you know – 8,000 nurses, 3,000 clinicians. How do you go about engaging that amount of people in this kind of work to obtain better outcomes?

Dr. Jeremy Cauwels:

I think first and foremost, it’s about reminding people that they got into health care to make a difference. Whether you’re the one of our folks that cleans our floors, or whether you’re the person that’s actually going to be doing surgery on somebody’s brain. We all got into health care when we could have went and worked somewhere else because we thought that we could truly make a difference in people’s lives.

And I think the most important part about SAFE is that it reminds people of the possibility that when you go to work today, you’re going to intervene in a way that makes somebody’s life either better or longer, or both. And so as we do that, I think it’s extremely important for us to deliver on that promise. And the most important way to deliver on that promise is to make sure that each member of the Sanford family, all 50,000 of them, are empowered to, if they see something, say something. If they need to reach out and say, I have a concern, that we’ve built the culture all around them to address that concern before we move on.

Dr. Luis Garcia:

Thank you for that thought, Jeremy. So you talk about the importance of anybody, regardless of your ranking, regardless of your title, to speak for safety and to speak for preventing potential errors. And I think we all have seen the last five years and the journey that Sanford has undertaken with this SAFE approach, and it’s ingrained in our hearts and it’s part of our culture and we’re so proud of it.

Can you share of some of those results? Because there’s that example of, there was a neurosurgeon in the operating room that perhaps listened to a nurse that raised the concern, and because of that we had a great patient outcome. But can you share some of those results that you have seen, “Wow, this is truly making a difference.”

Dr. Jeremy Cauwels:

So what we call those in our world is SAFE stories. They are the stories that tell us just a little bit about what making a difference or what intervening really matters and how it really matters. One of my favorite stories was one of our brain and spine surgeons who was getting ready to do a case. And while he was going through the timeout, talked to the rest of the team in the room, and one of the team members actually raised their hand and said, you know, I’m not sure if this was the spot that we were supposed to be doing this surgery, and I’d like to review it before we move further.

What we call that in Sanford is having a concern and raising a concern. I am happy to say that that concern turned into a short deviation in the timeout where the surgeon and that person in the operating room reviewed the case, realized that they had indeed marked the wrong spot for where they were going to go and proceeded to correct that and do it in a very real way.

Obviously it prevented an error with the patient, prevented something potentially devastating if you’re involved in it from a health care standpoint, because like all of us, nobody wants to be engaged or involved in a mistake. And so if you can find it on the front end and raise that concern beforehand, you can turn the story in a completely different direction.

One of my other favorite stories is actually involving our AirMed pilots and mechanic teams. One of our mechanics recently was working on one of our helicopters and in that helicopter, he was inspecting the very back of the of the helicopter in the tail and found a really small crack in the paint. Now normally a crack in the paint is something you go get it painted over and you don’t worry about it. But this person wanted to look a little closer.

And so, using the skill we call attention to detail, managed to take apart that back portion of the plane, realized that that wasn’t just a crack in the paint, but that crack extended all the way from the tail all the way forward through that entire long tail piece of a helicopter. And we actually had to take the helicopter out of commission and drive that part to the repair facility in Texas and drive it all the way back just to repair it. But that crack wouldn’t have been found had it not been for the attention to detail of that airplane and helicopter mechanic in our air ambulance crew.

Dr. Luis Garcia:

Talking about preventing errors and saving lives in a different way. Right?

Dr. Jeremy Cauwels:

Absolutely.

Dr. Luis Garcia:

I mean, whether you’re in the operating suite or in the front-line or you’re flying helicopters, you are creating a safer place to work and saving lives, right? So that’s a great story.

And you know many other stories, Jeremy. I remember that one story where somebody called in to get an appointment to see their physician and the registrar asked some questions and noted something different with the patient, gave him the appointment. The appointment was for the following week. And further inquiring from the registrar she continued to notice something different. This turns out to be a patient that was actually thinking about committing suicide and needed immediate help. Had it not been for her attention to detail and listening with the intent to help, that patient would not be with us today.

So, once again, it just speaks to the fact that no matter what your ranking is in this organization, no matter what your title is, we all are important, right?

From the environmental services people that help us to all the way to whichever direction you want to take it. We are all important. So thank you for that.

So Jeremy, these are safety stories and I’m sure there’s a plethora of them that you can talk and we could spend here hours. But how do these individual safety stories start translating into trends, cultural trends and outcome trends? And once again, we’ve been five, six years in this journey. Can you speak about some of those trends, those bigger picture findings that you can share with us?

Dr. Jeremy Cauwels:

Certainly. I think one of the things that we talk about on a regular basis is what we call power distance. And power distance really is that space that exists in your head between me as a worker and the person that I have to report something or raise that concern to. And one of the things that’s important about telling these stories and about being receptive when people have a concern, is that that distance can get lowered. And whether that’s because, you know, you’re brand new in the operating room and you’re talking to an orthopedic surgeon who’s been around for 40 years, or whether it’s because you are a new nurse and you’re talking to a nurse that’s been around the floors for 30 years, that power distance isn’t necessarily a physical distance. It doesn’t even have to be a difference in career or degree.

It’s just that ability to make sure that everybody is engaged and everybody is encouraged to speak up when they find something that’s concerning. And so for us, as we talk about that, what we get into is we can actually monitor those safety events. We can monitor and put numbers to how many times out of 10,000 patient days we actually have a serious safety event. And I am very happy to say, as we’ve went down through this journey, we have reduced our number of serious safety events so far by over 50%. And that turns out to be a number that ranks up there in the hundreds of people. And our goal, of course, is to reduce it more than 80%.

Dr. Luis Garcia:

And also that’s in the middle of a pandemic where we were dealing with workforce shortages, where we were dealing with supply chain issues, where there was a lot of instability in the clinical field. And yet our teams, despite all those challenges, happened to reduce that number by a significant amount. Isn’t that impressive?

Dr. Jeremy Cauwels:

It is remarkable. If you look around the country in the same set of circumstances that we were in, what you would find is that many, many hospitals unfortunately didn’t have that same encouragement, didn’t have that same timing to be rolling out high reliability during the pandemic. And they did actually see an increase in hospital acquired conditions and infections while we saw a 60% decrease. So for us, it very much was changing the culture at a time when culture would be the most difficult thing to maintain and the most difficult thing to keep going in a good direction.

Because as you all know, the difficulty with keeping our patients safe while the pandemic was going on, while we were having nursing shortages, while we were all trying to figure out how to wear masks and when to wear masks and when to get our vaccine and all of those things, were the exact things that we leaned into and said, this is how we keep our patients safe and this is how we keep our coworkers safe and we want to make sure we continue to do that.

Dr. Luis Garcia:

And of course, Jeremy, you’re too humble. You always are, and you’re not going to be bragging about the tremendous work that you lead. But I really want you to brag in this conversation about the tremendous work that you do. And I hear that one of our markets right now has gone six months without a surgical site infection and another of our markets had over two years without a CLABSI (central line-associated bloodstream infection). And then you see our hospital start rating continuously go up. I want you to talk about that and what it means for the teams in each one of the markets and your team that is leading all these efforts. These are times where just watching these outcomes is just something to celebrate.

Dr. Jeremy Cauwels:

When we started SAFE, we estimated that our error rate would put us at somewhere around an adverse event more often than every single day in Sanford Health. If you looked at us for a system, I am happy to say that so far we’re pushing to towards two days between an event anywhere in the system. And our goal is obviously to push towards zero. I’ve often said somewhat with a smile that I believe that the best day in Sanford Health is when we can deliver on a day where nobody had a medical error occur at any point during their care.

My honest goal is that we can go a month, that we can go a year, that at some point we get good enough at this, reliable enough at this and that we trust each other enough while we do this, that we can prevent all the errors in health care.

Now you may tell me that’s a pipe dream and I’m OK with that, but it has to be the aspiration of every member of Sanford that only in the paint pool that they took care of that day, they did everything they could to be as close to perfect as a human can and that the person that worked on their left and their right was helping them achieve that level of perfection that allows us to walk home and say, you know what? We did the best we could for every patient we had all day today. And that is truly the goal each time we step in.

Dr. Luis Garcia:

Hey, I’ll buy into that aspiration any day, Jeremy, and kudos once again to you and your team for what you’ve been able to achieve in these last five, six years since SAFE started. So, so let me just ask you something. Why does this continue to be important for us? We onboard 150 clinicians every year and we employ many hundreds more nurses every year. Why does this continue to be important? What would you tell a new clinician that is just joining our forces?

Dr. Jeremy Cauwels:

What I would tell a new clinician is something they already know, even on their best day, they’re not quite perfect. And if they’re not quite perfect, what a better way to come to work than to know the person on your left and the person on your right are there to help you be as close to perfect as you can and that you all have the same goal. And when everybody aligns on that goal that we’re going to deliver absolutely exemplary care, then we can honestly say that if somebody stops me from doing something, they were stopping me from doing something because they had a concern. And that concern was not only for the patient in the bed, but it was for me as a doctor as well. Because I think we all know that we beat ourselves up when we find out something didn’t go as well as it could have.

And it helps prevent those days as well. It helps prevent burnout in our health care teams because we have friends around us that are helping us out. It obviously prevents adverse actions and reactions in our patients, which help us feel better about all the people that are able to leave the hospital under their own power and own care. And it helps our patients directly with the fact that they know they are walking into a transparent organization that’s there to treat them as well as they possibly can and to do it as honestly as we possibly can every single day.

Dr. Luis Garcia:

So, so you mentioned the word burnout in your statements and that is something that directly or indirectly we’ve been feeling in the last couple of years more pronounced than before. Do you feel that this work in any way impacts the level of burnout for our employees?

Dr Jeremy Cauwels:

I think this work impacts the level of burnout directly. I think one of the leading causes of burnout is the feeling that you don’t make a difference. That I don’t need to go to work today or I don’t want to go to work today because my opinion doesn’t matter. And I think the more you can engage people in saying, you know what? Your opinion does matter and every action that you have while you’re inside of our walls is going to help us deliver that perfect patient care. Those people keep coming back to work because they have a mission, they have a longing to keep doing that work well. And I think it gives us the opportunity to do a perfect or nearly perfect job of caring for each patient as we go through. But in order to do that, you have to have people that are engaged and you have to have people that are in it for the right reasons. And the good news is that automatically breeds engaged people who aren’t going to burn out because they knew when they went into work that day, they could make a difference.

Dr. Luis Garcia:

Well, Jeremy, you talk about mission. Our mission is to improve the human condition, right? And we have made it your vision to once again elevate quality and safety as a foundation of our culture. And I think that you have been extremely successful at that. And kudos to you and your team. Aristotle said that quality is not an act; it’s a habit. And I think that you have described throughout this podcast how the excellent outcomes that you have achieved with your leadership have been a matter of habit and a matter of creating a new culture for our organization that would allow us to deliver on that promise, which is excellent self-care. So Jeremy, thank you very much for being here today. Thank you very much for what you do every day and the impact that you have not only in our culture, but in our employees and in turn in our patients. Any closing thoughts Jeremy?

Dr. Jeremy Cauwels:

I would just like to thank you for the time today. Thank you for the ability to get in front of this microphone and talk just a little bit about the care that we deliver every day. And I would like to encourage anybody who’s listening to make sure they understand that this is the way we do things here at Sanford. That our goal is to make sure that every single person has the ability to make an impact on our patients, our residents, and our teams every time they walk in the door.

Dr. Luis Garcia:

Thank you Jeremy. My gratitude. Thank you for being here.

Alan Helgeson:

You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org. For Sanford Health News, I’m Alan Helgeson, and thank you for listening.

Learn more

• Ep. 9: The evolving customer experience in health care
• Sanford USD Medical Center given ‘A’ Leapfrog Safety Grade
• Where to start mental health care? Your doctor’s office
• Ep. 7: Flexible work and well-being in rural health care

Get more episodes in this series

The evolving customer experience in health care

Alan Helgeson:

Hello and welcome to the “Reimagining Rural Health” podcast series, brought to you by Sanford Health. In this series, we explore the challenges facing health care systems across the country, from improving access to equitable care, building a sustainable workforce, and discovering innovative ways to deliver high quality, low-cost services in rural and underserved populations. Each episode examines how Sanford Health and other health systems are advancing care for the unique communities they serve.

Today’s topic is a conversation on the evolving consumer experience. Our guest is Ken Hughes, leading consumer and cyber behaviorist. Our co-hosts are Dr. Jeremy Cauwels, Sanford Health chief physician, and Jared Antczak, Sanford Health chief digital officer.

Dr. Jeremy Cauwels (co-host): Hello everyone. My name is Jeremy Cauwels. I’m the chief physician for Sanford Health. I’m here with Jared Antczak, our chief digital officer. And as we are here today, we are just after a wonderful presentation by Ken Hughes who came to talk to our annual meeting. We are asking him just a little bit about the way he sees the world evolving from a digital and customer service standpoint, and would just like to take this time to have an excellent discussion on where things are and where we see things going in the future.

I think the one thing that I would say, Ken, that you talked about fairly early in your talk was that change is the only constant. And I would wonder, as you see change being the only constant moving forward, what does that mean sometimes in health care, and probably more importantly in customers, in general?

Ken Hughes (guest): Thank you, Jeremy, for having me. First of all I think, yeah, I’m fascinated by disruption in general, by societal disruption, anthropological disruption, digital disruption. And we live in such a decade of disruption at the moment. We have all these forces pressing down in every business. And you’re right, it doesn’t matter whether it’s health care, financial services, retail – everything is up for grabs.

Business models of old certainly aren’t fit for purpose in 2030. We’ll look back at this decade and we’ll think, wow, you know how innocent we all were in 2020? So even, you know, post-pandemic, the things that matter to consumers now are different to what they were three years ago. And that will change again the next three years. We have a pace of change that we haven’t probably had before.

Most leaders in organizations led teams and things didn’t change that much, maybe in their career. Whereas today, every six months you have a new 10-year plan.

You know, the idea, I remember at university starting strategic management, we were taught the idea of a short term, a medium term, and long term plan. And you wrote a short term plan for one or two years, a medium term, five years, and no one writes a medium or long term plan anymore in any industry because how could you? How could you know what’s gonna happen in the next five years from a customer expectation point of view, from a technology point of view?

So with metaverse breathing down our necks with the customer wanting things faster, better, more seamless, more frictionless, more transparent every day gen alpha, gen Z all coming up underneath us in terms of their expectations, huge pressure on talent and recruitment. And I mean, the issues are huge. And so what we need to build is teams that, leadership teams that can deal with that kind of disruption, agile teams and that are hungry for it.

Dr. Jeremy Cauwels (co-host): Thank you. Appreciate it. Jared?

Jared Antczak (co-host): So, thoughts, building off of that, you know, concept of disruption, right? I think it’s fairly easy to recognize other industries that have been disrupted or other organizations that have been disrupted. You look at what Netflix did to Blockbuster or what Amazon did to Sears, right? But many in the health care industry would say, but health care is different, right? Health care is about that relationship between patient and provider.

How worried should we be about disruption, and what should we do as a large, complex, multifaceted health care organization to future-proof ourselves to withstand the winds of disruption that might be facing us?

Ken Hughes (guest): Yeah, it’s, it’s a great question and it’s one that is, is asked many times where many industries was asked by Kodak at the time of digital, you know, it’ll never kill film. It was asked of Nokia, you know, we’re the biggest mobile phone brand of the world. No one will ever touch us. That there is a wonderful expression that Einstein had that the only thing more dangerous than ignorance is arrogance.

And arrogance – that arrogance of any industry to say that we’re fine, we’re protected, we have physical assets, we have first mover advantage, we have all the clinical experience, therefore no one’s ever gonna touch us – is the very industry that would be disrupted very quickly. Rug pulled under from you. And there, there’s players who will look particularly in health care at the most profitable sector, maybe at the wellness end, and take the profitable younger consumer from you around the health care wellness piece and leave you with the less profitable, harder work.

So, I know I don’t agree with that at all. I think health care, financial services, these are industries that have this kind of sometimes little arrogance and ego to them around the skills they have. And this idea that outside influence can take those away. They will. Absolutely they will. And we see that again and again. So many examples. So many industries being disruptive from and usually disruption, the point about disruption as a word, is that it is unpredictable. Otherwise we’d call it predictive change and we’d know what was coming.

Disruption will always come from a place you don’t expect from a player you don’t expect, and from technology you didn’t even know existed. And so all we can do in the industry then is to prepare our industry. And we do have first mover advantage, by the way, in health care. And we do have all the clinical experience. So we are way ahead and we have all the data, we have all the patients. And so, but resting on our laurels and thinking, oh, you know, it’ll all come good for us. We’ll be fine doing the same thing that we’ve always been doing will be a very – it’s like seeing the iceberg on the Titanic, and saying, actually, we’ll go through it. Our ship is quite indestructible. We’ll just go through that iceberg, won’t we? Yeah. Dangerous.

Dr. Jeremy Cauwels (co-host): I wonder, you talked a little bit about the etymology of the word patient how it literally comes from the root to suffer or to bear. And slightly later in the talk you talked about predictive health care, where we would be moving with those that I would call the walking well or the more healthy. How do you think we change from the one who has to bear their illness to the digital consumer who’s predicting their illness along with us before it happens and hopefully turning the corner the right direction before they ever land in that hospital?

Ken Hughes (guest): Yeah, I think that is the future of health care, I’ll be honest. OK, so the two-part question. The first one about the, the origin of the word patient. I hate the word patient. I really do. I think it’s the really wrong word for us to use at all times. If we start to use the word customer, I think we’ll automatically create processes and operations that are more consumer, customer friendly, but calling them patients, they become a part of a cog in a machine, someone wearing a plastic bracelet. I think we need to get away from that word. And it is a very passive role we expect them to play and it’s no longer suitable in our, in our current society. Cuz customers expect collaboration, they expect kind of brand partnerships to community. They want brand tribal belonging.

One story I always love is that, you know, Harley Davidson talks about the hundreds and thousands of sales reps they have on their road every day. Cuz everybody riding a Harley is a sales rep, you know, they believe in their brand, they tattoo the logo on their skin. Do you have a Sanford Health logo on your body somewhere?

Jeremy Cauwels: (Laugh) I do not.

Ken Hughes (guest): But you should. And so the idea is how can we form and foster belonging? And so I don’t think patients today feel a belonging to their health care necessarily. They feel appreciative that’ll happen to them. And so we do need to move away from the word patient, I think, and see it as customer. You know, who is the customer? Who is the consumer? How can we build everything around them?

The second part of the question is, the future of health care, I definitely agree is the walking well, absolutely. We already see it today. People wear trackers and fitness. And so the future is data. The future is keeping me well. And that’s everything from mental health, nutritional health. It’s not just my physical health and my emotional health, even my spiritual health. You know, how, how far you wanna take us up to you. But the idea of having a partner in my life, a brand partner in health care who has my back at all times and doesn’t wait till I get sick, who actually intervenes along the way.

The best example I can give from another industry is the financial services industry where you take out a mortgage and you only hear from them, you know, once a year or maybe once every five years. It’s the most profitable product they have of you. But once they have your money, they don’t really care. So that’s the danger. But let’s not communicate to our customers only when they get sick or only when they need us. Let’s, let’s be there for them at all times in their lives. And they’re gonna go through all their different life stages in their twenties. They’re gonna maybe have family in their thirties, they’re gonna grow older in their forties, fifties, sixties. Now. How, how can we be there for ’em at all times? How can they feel supported by us in a way that, you know, has emotional and resonance with them? You know, that to me is the future of health care.

Jared Antczak (co-host): I’ve heard often that health care is a little bit of a misnomer for what we actually do as an organization and as an industry. We’re really in the business of sick care, we take care of people when they’re sick, not necessarily when they’re healthy. And so that shift from sick care to health care, I think is a little bit of what you’re alluding to with that more customer-centric perspective. Right? Thinking about people or having people think about us too in moments in between visits rather than just when they’re sick or just when they need care as a patient.

Ken Hughes (guest): Yeah, absolutely. I mean, I think that the focus has to be on the person themselves and their journey and what they’re going through. If we wait till they’re sick to make contact with them, then we’re always fixing, it’s like a mechanic fixing the car when it breaks down, as opposed to maybe the car talking all the time as to diagnostically how I’m doing. And so I think, yeah, if we’re looking for customer lifetime value, then we need to step into that space. And even from a profitable point of view, actually for an industry point of view, there’s more people healthy every moment than there are sick, you know, in life. And so why shouldn’t we be talking to them every day about what they need and how our brand can help them and support them?

And that’s the space I think it is – it is a bit of a jump from traditionally health care has been hospitals and clinical care as opposed to wellness. And there is a shift, I know in the, in the wellness industry and the physical wellness industry, like gym membership is around 20% globally, which they love. Cuz that means 80% of people currently don’t have a gym membership. So it allows huge potential and growth for the industry. Same in health care. I think, you know, we’re working with the maybe clinically sick today, but that leaves that are 80, 90% of people every day who are clinically well but, you know, want some kind of health care partner in their life and that should be us.

Jared Antczak (co-host): So I, I’d love to pull on that thread just a little bit and then I’m gonna ask a little bit of a, a challenging question cuz you just said that the very nature of disruption is that it’s unpredictable, right? (Mm-Hmm <affirmative>) But if you had an opportunity to predict and just envision for a moment what the health care consumer customer experience could look like in five years or 10 years, what would you see? How would you see it being different than it is today?

Ken Hughes (guest): If I knew the answer to that, I’d be on a yacht in The Bahamas (laugh) right now doing this podcast. Yeah, I think seeing the future’s really difficult, but I think it would be technologically driven. It’s definitely a guarantee as AI, I mean, I think everyone watching AI this year, particularly with ChatGPT and all the visual stuff, we’re all getting to use it individually for the first time in our lives when think like, ooh, this is kind of cool. And so this year will be the a the step change for AI. Over the next five years we’ll see that play out more and more and more – robotics, the same automation, the same technology. So the loads of converging. So it definitely would be technologically driven. I think people will become more responsible for their own health care themselves. They’ll have access to their own data, which they haven’t had before.

And so we already, we all have friends like this who will track everything about their lives already. And from a health care point of view, they’ve got seven wearables on at all times. You know these people. I think that will become more normal for us all. I think we will and we will happily hand our data over to people to watch that data on our behalf.

And so I think wellness will become technologically driven, but there’s yet for a brand to step into that space with a bit of fun and play. And I think that brand will be quite successful, the brand that kind of makes it a little bit more playful to be healthy. And so I think that there’s space there for, for a first mover to come in and make things different. But I think it will be more personal. I think it will be less clinical and procedure driven. I think health care needs to move in that way. Maybe smaller.

I mean we’ve had, you know, the large hospital kind of model for a long time. I think we probably will start to see maybe a little bit of a fragmentation and, and more customer service aspects in that, and that deliverable in a smaller way. That’s again, it’s a guess.

Dr. Jeremy Cauwels (co-host):

I think one of the things you talked about was also the experiential portion of health care. As we start thinking more about people as customers than patients. You told a couple of stories. I’d love you to go back to the one about the patient checking in for surgery and the details that were brought out during that initial encounter with the nurse that actually made all the difference for him.

Ken Hughes (guest): Yeah, I think I’m fascinated by people. I mean, ultimately I’m a social scientist, right? So I’m fascinated by people, of the human mind, and I’m fascinated by brands who fail to capitalize on the emotional experience and the ability to bond emotionally with someone in health care. We have a really unique proposition where the person presenting to us is in a quite a vulnerable state. They’re usually sick. They’re usually scared. And so we actually have a potential, unlike a retail transaction, which is kind of low in their caring to really make a difference in their lives. So anything we do will be kind of magnified both in a good way or in a bad way. So if they feel unseen, if they feel unheard, they feel invisible, those things are magnified by their vulnerability. Similarly, if we do something positive in experience, that’s also magnified.

So the story you’re referring to is about an older gentleman who checks in, is scared, is heading for surgery. The nurse is helping him settle into the bedroom. And he’s understandably scared. And, so as an intelligent human nurse, she uses the time to get to know him a little bit, to relax him and to start to ask him what his hobbies and what his interests are. And he mentions that he’s big into fishing and she knows nothing about fishing, but she has a short conversation with him about fishing. And the day goes on and the next day as she’s passing, she takes the fishing magazine from the cart going up and down the corridor and drops it into him and says, you know, you might like this. In his patient satisfaction survey that came back, that was the one moment that made a huge difference to him, his entire stay.

And it doesn’t, wasn’t really matter whether the surgery was successful or not, the care he got, it all came down to this one moment that he felt seen, heard and valued. Someone had listened to him. And not only that, but they had been compassionate and acted on that. So compassion is a verb. You have to do something like love is a verb. You dunno what you can say, I love you to your wife and husband, but unless you show it, it’s kind of pointless.

The same thing is true in health care and as we show the compassion. Otherwise, it’s just sympathy. Sympathy is when you care about someone’s suffering. Compassion is when you relieve the suffering. When you action something, that compassionate moment, we need to have that every moment. And so the question you need to ask yourself in health care is, have I created a fishing magazine story for myself today?

Like what have I done today to make a difference in someone’s customer journey that makes them feel special, makes them feel heard, makes them feel that’s about them and not about us, not about profit, not about clinical care, not about procedure, but about actually them. And it can be so simple and sometimes people push back on regulation and they can say, oh, well that’s easy for you to say, we’re so heavily regulated. We’ve got the insurance companies to deal with as well. Yeah. But there is excuses. Nothing is stopping anyone on an individual basis, having a moment of humanity with a patient.

I think the main challenge is pressure of time in that one. So I’m yet to meet a doctor, surgeon, nurse who doesn’t agree with what I’ve just said, but I meet all them all the time who says, yeah, I’d love to do that, but you know, I don’t have two minutes to spend extra with every patient. Cause if I did that, I’d need to spend another hour or two at the hospital today. And already I’m already not seeing my family. So it’s a challenge. It really is.

Dr. Jeremy Cauwels (co-host):

Can I push you directly into another story though? You then told a story about somebody who did have that kind of information at their fingertips where it didn’t take long for people to know what your recent history was and how much difference that made in your personal life as you travel a good bit of your time.

Ken Hughes (guest):

Yeah. So that, that what you’re referring to there is again, building systems that hold data that allow a front-line operator to delve into that system, dip in, it only takes 30 seconds, pull some data and then make someone’s experience a little bit more personal. So I have many, I traveled for full-time for a job. So a lot of time on planes, a lot of time in hotels. And often on a plane, a host will come down to me or host us and we will say, Hey Mr. Hughes, nice to have you back on board. Did you enjoy your trip to Atlanta last week? And why are you heading to Chicago for this weekend? They know all the data on me now. It’s very simple. That’s the system. I mean, I buy the tickets that my name is linked to the tickets.

It’s very simple. They know that Mr. Hughes is in 4A cuz their system shall, they don’t know me personally, but that moment that they take to kneel down, meet you eye to eye and have that little conversation, you feel heard the same as the hotel I stayed at once.

I walked into the hotel and didn’t know the hotel, never stayed there before. But they put my name on the water, they put my name on the local beer in the room, they put my logo into the cheese. You know, everything is just about me and I feel special again. They just stripped all out from my social media. The guest relations manager just spends 10 minutes per guest on a day and he finds the, and it’s only the guest in the suites, you know, he’s not doing it for the hundred, 200 rooms.

He’s, he is cherry picking. But we need to do that. We need to think about how can we build a system that holds very simple data about the customer. Maybe something, stuff that’s personal to them that makes us seem a little bit more clued into their lives as opposed to just talking about the procedure or talking about, I mean, I’ve had my time in hospital myself and I kept a note pad by my desk at all times. Cause it was just fascinating as to be on the other side and to see the pressure of time to see that just being treated like a number, treated like literally a piece of meat in a process of, OK, I’ll fix you, I’ll fix your ankle, I’ll fix your back and I’m moving on. And you never really felt valued to the system. In fact you kind of felt in the way, you were in the way of this doctor or this nurse to get onto the next thing they needed to do. And we need to really dissolve that.

Jared Antczak (co-host):

So building on that concept of, you know, experience and creating a good experience that’s personalized and relevant, you also talked about the need to blend physical and digital, I think you called it ‘phigital,’ right? And the need to consider offline and online, you know, components of what you’re bringing to people. And also how do you make people the center of the universe rather than your services or your procedures or your products as a health system?

You’ve worked with a lot of organizations that have undergone these kinds of transformations in this consumer-centric kind of approach. What are some lessons learned that you’ve seen companies who have been successful at that, and what are some potential pitfalls that you’ve also seen that we should be looking to avoid?

Ken Hughes (guest): That’s a huge question. Yeah. (Laugh) so much in that to unpack (laugh). OK, well the first thing, let’s take two examples. Let’s take a positive and a negative one. Let’s take the negative one first. McDonald’s currently have huge labor shortages. Massive problem. And so they were forced into doing this. So they had to run digital kiosks. So digital kiosks you see to order at the front of all the restaurants now aren’t there because they think digital is the way to go. Even though digital transformation’s important, it takes you about at least two minutes to place your order via a digital kiosk. It took you about 30 seconds, not 10 seconds to say I have a big mac and fries, please. Large coke done, you know, four seconds. Whereas it takes two minutes. So it’s actually frustrating from a customer experience point of view.

That’s an example of digital not actually adding to the customer experience. Digital actually takes away, it’s slowing it down. It’s more frustrating. It’s, it’s clunkier. Now, do they have a choice? No, unfortunately they didn’t have a choice. Cause they don’t, they don’t have the labor. But it’s, it’s, it’s a good example of not, not doing, not using digital as the answer just because it’s digital doesn’t necessarily make it good.

A positive example of of a company that we’re going through this and it’s less about the digital part, it’s going back to really just humanity. I worked with an insurance company, a global player I won’t mention, but their, their, you, you’ll know, everyone will know them. And the motor claim is quite a charged, going back to the vulnerable part of health care, it’s quite a charged moment, you know, of this. So you, you’ve crashed, you crashed your car, you’re worried, you’re scared, you know, you’re thinking, oh, was it my fault? Was it their fault? Am I gonna get enough money for my car? You know, there’s a lot of stuff going on in that first 30 seconds minute. And so the first thing you do at the roadside is generally you either call the police and the emergency services, but you also call the insurance. So it’s the thing we’re all told to do. Take out your phone, call your insurance company, give them the policy details.

So the old script they used to have from a customer service point of view was they would say, Hey Jeremy, hey Jared, gimme your policy number. And they’d type in the policy number and they’d say, oh yeah, I see you’re insured for this or your cover doesn’t cover that. And they go into a process led conversation. So we changed the script to having done all the research and looked at the thing to make it more human and more, again, built around the customer.

And the net PS, the NPS score, dissatisfaction scores went from what kind of mid-50s, 60s to 85, 90 immediately for this particular customer experience and literally overnight was amazing. So now instead of asking for the policy number, they say, Hey Jared, are you okay? Is there anything we can do to help? Do you want me to call your wife, your daughter, your uncle? Do you want me to call the emergency services? Is there anyone with you? Will we order a taxi? And you keep saying, I’ll give you my policy number and I keep stopping you saying, Don’t worry about the policy number Jared, we’ll get to that in a moment. We’re here to help you for that, but is there anything you need right now? And that first 30 seconds of the call changed everything. Cause you’ve gone from being a transaction, a policy holder, a number to being a person.

And generally people would actually cry. I’ve heard some calls like on the call back, that because they’re so charged and so vulnerable at that moment, the moment humanity was reflected back at them, they would let it all out. And it’s, and so then, then there was all therapy part in the training. And, but you know, so that move when that NPS score just shot straight up, because basically if you treat people like people, like humans, and you reach into and you start using emotion and leverage emotion, you create customer bonds that last forever. And that insurance company, I think it was talking about two years ago, they shared some data with me about retention for those customers. And now if you’ve gone through a claim, the retention potential for you as a customer stretches out 10, 15 years.

Which is really interesting. Cause previously to that, a claim often broke the customer loyalty cuz you didn’t get enough of your car. You didn’t, wasn’t that fast enough. And you were grumpy. So you treat people like people and you make them feel special. And actually you lay down the customer lifetime foundation for life. You know, do I feel special ordering at McDonald’s now? No, I don’t actually. And interestingly, my son who’s 16 no longer shops at McDonald’s because of that. He’s the, that instant Gen Z generation. I want now one click, one swipe. I want things fast. And the idea of having to spend two minutes typing stuff, it’s not his gig. You know? And so, you know, are they damaging their very core proposition of fast food? Yes. They’ve actually stripped out the fast part.

Dr. Jeremy Cauwels (co-host): One of the comments you made while you were giving the talk was the new never normal instead of the new normal. And you’ve just described McDonald’s breaking their own model of fast food, you know, also described treating people from an insurance company like a human being. And so even the insurance company is changing their game to adjust it. As you think about health care, where do you think the biggest interventions or possibly the biggest changes could come from? Just like you said, you walk into the building, you get a plastic band, you walk through the process, you hopefully walk out the other side after a major surgery and the entire thing is a transaction. What is the new never normal for that transaction?

Ken Hughes (guest): Yeah, that’s great. And again, the question itself already is loaded because if we answer it, it’s gonna be different in six months. That’s the point about never normal. That keeps changing, that what people want keeps changing. So we have to understand that the next generation of consumers we’ve built to generate a health care proposition mainly for kind of traditionalist Baby Boomers, maybe Gen X, anyone over 40, you know, the system needs to be always been the same. So we all understand it. Millennials, Gen Z, Gen Alpha underneath us don’t understand it. They don’t see the same thing at all. They want it much faster, much better. And so what is the future? I think the future is definitely a place of collaboration. It’s a collaborative feeling that I get, that I, that together, my clinician team and me are gonna be with me on my health care journey.

Cause after all, it’s my health care journey. It’s my health. It’s not your health. And so I think most patients today, and again I’ll steer away from the word news customer feel that it’s not their health care journey. That they are a transaction, a process like an assembly line. You come in, you pop out the other end, hopefully (laugh). And so I think our challenge is to make that yeah, less clinical, less cold, less, you know, even the architecture of hospitals. And we have to challenge everything. Andwe, you know, yes, we have to operate in regulatory state and we have to be hygienic and stuff, but there’s no need for us to be dreary and drab. There’s no fun, there’s no play, there’s no mischief. And these are things the next generation of consumers are looking for authenticity. They’re looking for genuine.

And it’s really interesting. So just go back to fast food, Burger King, McDonald’s, KFC, all these brands, do they offer anything real or genuine? To me, not really. They’re just commodity. Whereas look at street food, street food is booming all over the world because people love the idea that some guy gave up his job in Deloitte Touche, grew a beard and is selling falafels out of a van. You know, they love the realness of that. You know, and people, that’s what people like, they like realness. And so I think sometimes again, doctors, nurses, clinicians are so under pressure. They themselves stop being human. They become machines. So we can lean now into an employee experience conversation because everything I’m saying is also true of the employees who also want to be seen, heard, valued, treated well. They want to be you know, they want to very instantly.

It’s really frustrating for clinicians when the samples that they send away don’t come back the next day. You know, they want instant as well. They want to help people quickly. And so we need to challenge if we’re going to retain the talent and recruit the talent, how do we build a culture around experience for everybody? And it’s what we call total experience, employee experience and customer experience together. Cause if you don’t have happy employees, you won’t have happy customers. And so you kind start there. Richard Branson always said, treat your employees well. They’ll treat the customers well; profits will follow. So he started with the employee, make happy employees who will then make happy customers and then profits will follow after all that. And so, yeah, just, and that’s a fair question. I often get asked, all this stuff sounds great, but it all costs money – where is it coming from? You know, profits are already low. How do we do this?

It’s a challenge. You have to build systems. You have to put, you know, data in place. But that’s the game. The game is preparing for the future. And I think predictive health care is the future. You know, having all the data and knowing how well you are and helping you before you get sick. That’s the future of health care. And that to me, I feel then I feel like I have a partner in my health care as opposed to someone who only wakes up when I have a problem. And when I contact.

Jared Antczak (co-host): So many great stories, concepts, thought provoking ideas. If you had to distill it down to just one major takeaway that you’d like our listeners to walk away from this podcast with, what would be the thing that you want us to anchor on?

Ken Hughes (guest): I’ll tell you a story to finish about a goldfish. So there was this family immigrating from the U.K. to the U.S., mom, dad, kid. They present at the check-in desk. She’s checking them in, looks up and sees a problem. Cause the little boy, the 8 year old boy is holding his bag containing a goldfish, a liquid bag. And the lady’s checking in and thinking, well that’s not gonna work. There’s a hundred more, hundred milliliters of liquid in that bag and fish don’t get to go to America. So she starts to explaining to the family, she said, I’m sorry, I can’t, you can’t go on board with the fish. And the little boy starts roaring crying. Of course he does cuz he’s immigrating. He’s leaving all his friends, his family’s school, his hobbies, and he wants to go. He’s roaring crying in front of her. So she immediately stops and says, oh, I’m sorry.

You don’t understand. What I mean is that you can’t bring the fish on board. You’ve got to give it to me cuz that fish has gotta travel with all the other VIP goldfish that are traveling on the plane today to America. So little boy dries his eyes, hands over his fish, all excited. She gives the lady, gives the parents the boarding cards. They wink and think, thank you so much. They think she’s diffused this really awkward pain point. And they rush the kid through security. What they don’t know is that the lady left there with the fish, takes her phone out, takes some pictures of the fish, sends those pictures to her colleague in Atlanta on WhatsApp, and asks her colleague to leave her workstation, go to the local pet shop where she bought identical looking fish. And 10 hours later, when that little boy lands in Atlanta, she’s standing there at the top of the ramp as he exits the plane and gives him his fish, who he takes proudly to live in America.

It’s a wonderful story that brings the Virgin brand to life in a way that Richard Branson meant. You know, if you see a pain point in any customer experience, if you can help a customer at any point and make them feel special, make them feel seen, heard and valued, do it because they will tell the story for you. That happened 15 years ago. That story’s been told millions of times all over the internet. I tell it all over the world and it’s a story that brings the Virgin brand to life. Neither of the people involved, neither of the two women had to call to Richard Branson and say, do you mind if I take an hour off to buy a fish (laugh)? Because they live inside an organization that says, if you see something that makes a difference, then take it. And that would be my final takeaway to anyone listening.

No matter who you work, no matter what organization you’re in, you can make a difference to people. You can be the person that brings that guy the fishing magazine. You can have the goldfish moment. It’s your job, in fact to, to live a goldfish moment every day. Cause if we don’t, what story does the person have to tell when they go home? Whereas when they do have a story, when they say, you know what happened to me? Yes, I’m better. Yes, they fixed me. But the best part was the goldfish moment or the fishing moment or you know. So we have to look for moments that matter that connect emotionally. Once you connect emotionally, customer lifetime value follows very quickly.

Dr. Jeremy Cauwels (co-host): First of all, Ken, thank you on behalf of Jared and I, on behalf of Sanford Health and on behalf of the idea that if you see something, say something, take an action to help whoever you’re working with and whoever you’re working for that day. It’s been a wonderful time having you here at Sanford, and we very much appreciate your time and obviously all of your contributions.

Ken Hughes (guest): It’s been a pleasure. Thank you.

Alan Helgeson: You’ve been listening to “Reimagining Rural Health,” a podcast series brought to you by Sanford Health. Hear more episodes in this series or other Sanford Health series on Apple, Spotify, and news.sanfordhealth.org. For Sanford Health News, I’m Alan Helgeson and thank you for listening.

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