Creating a culture of gratitude in healthcare

 

Every week, Dr. Katie Jarvis reached into her mailbox at the small-town hospital where she worked.

She only received two kinds of mail. One was from recruiters trying to entice her to move to a bigger city. They offered lucrative positions and the amenities a metropolitan area could provide.

The other was from her hospital administration. They made rounds every morning, delivering newspapers and checking in on patients. When they heard positive stories, they wrote a brief note sharing the feedback with the providers.

“I kept those cards for the days,” Jarvis says. “You know those days when I had a person, he or she had cancer or had to run a code; we have days where the hours just continue on. Those days, it’s not the money that keeps me going. It’s the impact I make. The notes are reminders of that.”

Today, even after starting her own healthcare technology company, Jarvis occasionally works shifts as a hospitalist. “I can’t give up the notes,” she says.

Science suggests that grateful patients and administrators do more than provide warm fuzzy feelings to providers. Gratitude actually alters their well being and even the care patients receive.

Gratitude reduces burnout

Burnout among doctors and nurses is on the rise. The causes are numerous and include a loss of autonomy and a move away from the high-touch medicine of previous decades toward “treating the data, not the patient.”

One antidote may come in the form of gratitude. A study published in 2019 in the journal BMJ Supportive & Palliative Care found that expressions of gratitude served as a source of support for providers in difficult times, improved mood, and provided encouragement to continue and rewards for their effort. It also increased professional satisfaction.

Nancy Congleton has been a nurse for more than 16 years and says that when a patient is grateful for her care, “it makes everything else irrelevant, such as: exhaustion from being 11 hours into my 12 hour shift; having to skip lunch; not getting to pee, or going from patient to patient without a breath in-between. Simply put, when patients are grateful to nurses, it erases the hardships that go hand and hand with the nursing profession.”

Gratitude balances negativity

Stanford physician Dr. Gregory Hammer has a similar outlook. Three years ago, he was an attending in the intensive care unit at Lucile Packard Children’s Hospital Stanford when an 8-year-old girl arrived by life flight.

She had collapsed on the playground at school with cardiac arrest. When she arrived in the ICU, doctors discovered she had a heart condition that can cause seizures or, in some cases, sudden death. Remarkably, she recovered almost completely and went back to school.

Her family still sends Dr. Hammer a card every year.

“It’s really heartwarming that they are so grateful. It reminds me that I’m doing the right thing,” he says. “Grateful patients have a positive impact on physicians. They provide balance to how we beat ourselves up over every negative outcome.”

Dr. Hammer wrote the book “GAIN without Pain; The Happiness Handbook for Physicians.” He points to the human tendency toward a negativity bias and says that gratitude helps neutralize the discomfort of negative outcomes.

“Our patients can see, they know if we’re burnt out. They know if we’re happy and enjoying our work. They’re as aware of that in us as we are of them,” he says. “When our patients are grateful, it’s very rewarding. Generally, humbling. We see that we can make a difference in the way they think and feel, both their physical health and mental health.”

Express gratitude even when things go wrong

In medicine, as in life, things don’t always go according to plan. Schedules get overcrowded, providers call in sick, and sometimes outcomes are unexpected, even tragic.

Catherine Burger, a nurse for more than 30 years, remembers one patient who experienced unexpected quadriplegia after spinal surgery to correct scoliosis. “I recall this young man gently taking the hand of the surgeon who had performed the surgery that had gone so poorly for him, looking in his eyes and telling the surgeon that he was going to be OK, and he wanted to make sure the surgeon was going to be OK too,” she says.

She said his act of compassion left a lasting impact on her of how meaningful gratitude is especially in the face of negative outcomes.

Gratitude improves patient care

Not only does gratitude have a positive impact on physicians and nurses themselves, but it also impacts the care patients receive.

A study published in the journal Pediatrics in 2019 found that gratitude from patients significantly enhanced medical team performance. The study observed 43 NICU teams who encountered one of the following scenarios: maternal gratitude in which the mother of a preterm infant expressed gratitude to NICU teams; expert gratitude, in which a physician expert expressed gratitude to teams; combined maternal and expert gratitude; and a control group.

Team performance improved among the NICU teams who experienced maternal gratitude, particularly impacting their information sharing abilities.

“The effect of gratitude comes from the salience and meaning it gives to our work, thus it has a profound effect if it comes from patients or their families,” says study author Dr. Arieh Riskin.

When gratitude is missing

Unfortunately the converse is also true. Rudeness from patients, colleagues, and administration can hamper providers’ outlook and performance.

A study published in 2015 in the journal Pediatrics found rudeness compromised the performance of NICU team members in their ability to diagnose and to treat patients. In this study the rudeness came not from a patient, but from an outside “expert” in a simulated event.

Researchers observed that medical teams routinely experience rudeness in a hospital setting.The result is an immediate and direct effect on cognitive ability, reduced creativity and flexibility, and a decrease in helpfulness.

Dr. Sashini Seeni says it’s easy for patients to forget that doctors are human and the profession requires long hours, dedication, and sacrifice.

“The toughest part of being a doctor is not the treatment, the procedures, or the surgeries,” she says. “It is to deal with their colleagues, superiors and ultimately the patients.”

She describes an unfortunately common scenario in her hospital setting — a doctor is brusquely corrected by a superior for a mistake and receives little support from their colleagues.

“How will this doctor treat the patients if the patients start to complain and being mean?” she asks. She acknowledges that the correct approach is to put on a happy face in spite of the negative environment, but that takes its toll.

Research published in the journal Mayo Clinic Proceedings observed, “Physicians who remain in practice while burned out show higher propensities for making medical errors and diminished quality of medical practice and professionalism. Worse still, patients of depleted physicians are less compliant with physicians’ care plans.”

A simple “thank you” is often enough

Among the doctors and nurses who contributed to this article a theme emerged: providers don’t need elaborate gifts or public displays — a simple “thank you” is often good enough.

They also pointed to some more deliberate gestures that have a meaningful effect, including hand-written notes and telling the provider that you feel better because of their care.

Psychiatrist, Dr. Amy Ricke of Your Doctors Online says a simple heartfelt verbal “thank you” can go a long way in letting a provider know they are appreciated, a thank you card or note even more so.

“I have saved the cards I have received from patients over the years to remind myself of why I chose to be a doctor when I’m feeling less than fulfilled,” she says.

She also encourages patients to complete surveys following their visits. “Unfortunately, often times the only people that respond to those surveys are those who are dissatisfied with their care.  Filling out the survey positively can make a big difference for your physician,” she says.

Cultivating gratitude in health care

Burger also said that organizations can do a lot to cultivate an environment of compassion and positive feelings towards their patients.

“Most importantly, educate all employees — and hold them accountable — in creating caring moments for patients and one another. Patients feel supported in facilities where staff are encouraged to care,” she said

In 2013, Scripps implemented a program called Excel Together in response to employee feedback requesting recognition when they performed excellent work and made a difference, The system-wide program provides a platform for staff to thank colleagues and nominate them for great work. It recognizes employee’s specific achievements that make a difference and support the Scripps culture.

But it doesn’t have to be a big program — even something as simple as scribbled thank you notes shoved into a mailbox can have an immediate and lasting impact. ♥

What millennials actually want in healthcare

 

Millennial Natasha Nuñez doesn’t have a primary care physician and doesn’t plan to.

At one point, the 33-year-old yoga teacher and blogger reached out to the one practice in town that accepts her insurance. “I filled out an application to be a patient with them, and they’ve never gotten back to me,” she says.

She stopped trying. At this point in her life, she doesn’t see the benefits of a traditional primary care doctor. It’s more hassle than it’s worth.

Her sentiment mirrors that of other millennials. A 2019 survey of 2,000 adults between the ages of 23 and 38 found that 24 percent of millennials don’t have a primary care doctor and an equal number have not had a physical exam in more than five years.

A Kaiser Family Foundation study presented even more startling findings: as many as 45 percent of adults between the ages of 18 to 29 don’t have a primary care doctor. In other words, the next generation is unlikely to pick up the slack.

There’s no shortage of commentary on how millennials are changing the healthcare landscape. But most talk about millennials, not with them — echoing the paternalism that this generation often feels from doctors.

We reached out to a few dozen young adults for their take on healthcare, what they’re looking for in a doctor, and how health systems can adapt to meet their needs.

Value my time

Now solidly in their 20s and 30s, millennials have careers and families. Their lives are busy and they often feel like doctors don’t respect their time.

Kyle Cade Russell*, 24, says he has to wait on hold for 10 minutes to get a hold of his primary care doctor, who is frequently booked six weeks out. That works for annual exams, Russell says, but it isn’t helpful when he’s actually sick and needs medicine, at which point he resorts to an urgent care.

As of 2017, the wait time to schedule an appointment had soared to 24 days in major cities and will likely continue to climb as more medical students, many of whom are young millennials themselves, choose to specialize instead of going into primary care.

Patients feel the physician shortage both before appointments and in the actual waiting room.

Nuñez cited the time commitment of seeing a doctor as one of her chief reasons for forgoing a primary care relationship. The young mom says every time she had scheduled a routine appointment for her or her daughter, it took several hours to be seen.

“That time is simply spent waiting, even at early morning appointments,” she says.

Be present

Russel says when he does get an appointment, it’s too short to be meaningful. “Since the schedules are packed, I rarely get more than 15 minutes in the exam room with my doctor, which isn’t enough to ask any questions about how I’m taking care of myself,” he says.

Engineer Dina Twila Bellamy*, 34, agrees. She moved from a small town to a large urban area in southern California and now bounces from doctor to doctor trying to find one that’s worth sticking with.

“I see my doctor for like five minutes, if that, and they’re always in a rush and just gloss over things to get me out,” she says. “I feel like the quality of my care is pretty bad, and therefore I am not particularly proactive with it.”

Value my insights

While they’re not seeing primary care doctors as much as previous generations, millennials care deeply about their health. And they’re both tech savvy and health literate enough to conduct their own research — including sifting through medical journals.

“I wish doctors understood that I’m going to do my own research, and I’m going to challenge what they say,” says Jordan Bishop, 27, founder of How I Travel. “I’m going to read peer-reviewed journals, I’m going to cross-reference what they say, and if they suggest a treatment that I don’t feel is best, I’m going to raise that with them.”

He says that while he recognizes that his provider is the doctor, “no doctor knows everything, so I want to be a part of the process, too.”

Engage with me

Health systems long for this level of patient engagement, but understandably, not every provider appreciates their medical opinions being challenged.

Artem Cheprasov, health writer at Healthonym says the solution for this is found in physicians first understanding that millennials do more than cursory research on their health.

“When they enter the clinic, they are ready to discuss things with their doctor in depth,” Cheprasov says. “But, for a multitude of reasons, they are often rushed out the door or their comments are dismissed. This doesn’t foster a healthy relationship.”

He says physicians should try to engage on a deeper level — even when it means contradicting what a patient thinks. This isn’t dismissive, it’s engaging.

“Being wrong may make someone feel temporarily stupid, but having been enlightened thereafter, quite empowered,” he says. “This is much better than the alternative: being ignored and left feeling like your thoughts and efforts in your own health don’t even matter.”

Implement technology

“Technology is the key for reaching millennials,” says Bishop. He doesn’t expect providers to be on the cutting edge, but appreciates little things, like automated appointment reminders and a mobile-friendly website.

“If the best doctor in the world has a bad website, I’m not going to become a patient — period. Your website is the first point of interaction with many patients, and those first impressions go a long way,” he says.

Jess Johnson, 34, one of the few millennials surveyed who sees her primary care doctor regularly, appreciates her provider’s forward-thinking approach to technology. She enrolled in its patient portal and values being able to schedule online rather than having to pick up the phone and call someone.

Just text me, already

Do a Google image search for millennials, and the top results are of young adults with phones or tablets in their hands. It’s not just a stereotype — 92 percent of millennials own a smartphone and they’re on it for at least five hours a day. If you want to reach them, text them.

“I coordinate everything through text message — veterinary appointments, hair care, Amazon deliveries, even getting my car serviced — why can’t I text the doctor?” says Satva Puranam* 32. “Just let me know you’re running behind schedule so I don’t have to take three and a half hours for a 20-minute appointment.”

It’s not just routine contact and automated messages they want, either. Liz Jeneault, 28, fitness influencer and VP of marketing at Faveable, sees technology as an opportunity to be more personal with patients.

“As a new mom, I would have liked for my OBGYN to send me a couple of texts or to follow up with me in the weeks after giving birth,” she says. “I think it’d be nice if doctors would be more personal with their patients and do things like that! I think it makes you feel taken care of, like they are looking out for you.”

Regular check-ins with a doctor via text might also help encourage people to think about and better address anything that might be ailing them, she says.

Likewise, Nuñez says she would love to see a greater integration between doctor’s offices and technology. Her OB uses a secure online messaging system, which she appreciates. And the concierge medical service she is considering allows patients to send information from wearables or medical devices directly to the provider.

“I think patients and doctors would benefit from this in more traditional doctors office settings, too,” she says.

Tell me what this is going to cost

For a generation adept at comparison shopping and sending and receiving money with their mobile phones, purchasing anything without knowing the cost is unfathomable. Waiting for weeks to get a bill in the mail, unacceptable.

“When I get the bill for a 20-minute appointment, I’m always asking what I’m even paying for,” Puranam says.

Similarly, Jeneault says she is proactive and always checks to ensure a doctor is within her network. She also considers what they might charge for services, but says she still prepares for surprises. When her daughter was a newborn, she had a high fever and they visited a small, local emergency room. Doctors offered no treatment. Still, the family received a $1,000 bill.

Jeneault called the hospital to complain. “It ended up working out in the long run because I was sure to explain that I would leave a lengthy review detailing the ridiculous charges for zero service, if they didn’t reduce the bill,” she says. “I suggest people always look at their medical bills in full detail and call if you feel you’re being unfairly charged!”

Not only do millennials want price transparency, they take their views online when they receive inaccurate or excessive medical bills.

Convince me it matters

While millennials care deeply about their health and value prevention, they don’t necessarily see regular visits to a primary care physician as the best way to achieve it.

That’s not necessarily a bad thing, especially considering the growing doctor shortage.

Preventative measures still matter, of course. But, delivering them efficiently outside of the traditional primary care model may prove more effective for both health systems and the growing demographic that makes up both their workforce and their patients. ♥

*names changed where noted to protect patient identities

Aligning health system priorities for innovation

 

Being responsible for innovation—in a famously slow-moving industry—can feel like an oxymoron.

Somehow, it’s your job to simultaneously resolve individual pain points and develop a long-term vision for the way your health system runs. And getting people on board—either for individual solutions or long-term pain points—isn’t always easy.

At WELL, we’ve worked with a wide range of innovation leaders, and we’re used to helping bring people into alignment as they implement our platform. We’ve seen heads of innovation who were great at getting buy-in across their organization. We have also seen the particular areas where they’ve struggled.

Get an overall picture

Rather than trying to learn the ins and outs of each department from the beginning, start with the CEO or head of your health system. What are their large-scale goals for the organization? How are they being measured? These things vary hugely across organizations.

Once you understand those things, it’s easier to ask individual departments and heads how their objectives align with the larger vision. That way, the solutions you develop will be more strategic and targeted toward your health system’s overall goals, rather than being small-scale fixes for isolated problems.

It also means that you’re more likely to get buy-in. Helping colleagues toward their own strategic goals is the best way to get them on board.

Find pain points

That said, a large part of an innovation leader’s role involves listening. “If you walk into a room and say, ‘This is what we’re going to do,’ you have already lost people,” said John Halamka, the executive director of Beth Israel’s Health Technology Exploration Center.

He makes it a point to ask colleagues, “What are your business problems? What are your pain points? What are the things for which, if there were a technological solution, you really would feel better about your workday?”

Put solutions first

While it’s easy to think primarily in terms of solutions to existing problems, it’s not always that simple. According to Michelle Stanbury, vice president of innovation at Houston Methodist, the invention of a new solution sometimes can bring a hidden problem to light.

“You may not understand the pain point until you understand what’s available in the industry,” she said. Houston Methodist’s group of self-titled DIOPs—that’s “digital innovation-obsessed people”—actually begins by keeping a close eye on new technological developments both in healthcare and elsewhere. When they see an exciting new technology, Stanbury said, the next step is to “wonder if we can bring that back into healthcare.”

Not all organizations are as tightly focused on innovation, and it’s common to encounter some resistance from key figures. At WELL, we’ve had a lot of experience working with people in these roles. Below are some key strategies for getting them in your camp.

Chief Financial Officer

“If you go to a chief financial officer and claim a return on investment on an IT project, most savvy chief financial officers will not believe you,” Halamka said.

It’s counterintuitive. After all, CFOs are focused on financial impact, so it makes sense that you’d want to show a direct relationship between a new innovation and a specific, measurable outcome. But it’s also a CFO’s job to be risk-averse, and no solution is guaranteed to produce a solid return on investment.

However, they do understand the importance of benefiting the organization in other ways, so it can be more effective—and more flexible—to make a case based on potential impact. “Focus on other things: the strategic imperative, the impact factor, the safety and quality, and the compliance and regulatory side,” Halamka said.

In particular, he recommended focusing on patient satisfaction, improving physicians’ and staff members’ work lives, and presenting a cutting-edge image to the world. “The health care system wants to be known as tech savvy,” he explained.

Chief Medical Officer

A CMO is most likely dealing with a burned-out physician group. “Physicians want to get back and spend more time with their patients,” Stanbury said. A savvy CMO will be interested in natural-language processing or AI solutions that can help make that happen.

In addition, CMOs care intensely about clinical outcomes, and metrics are important. Before you bring an idea to your health system’s CMO, spend some time reading studies that support your proposed innovations—and if possible, reach out to the experts who wrote those studies. The expertise and data they provide can go a long way.

According to Halamka, never underestimate a CMO’s role as peacekeeper. “A chief medical officer’s role is to align all of these individual, sometimes strongly opinionated, clinicians to a single path forward,” he said. “If you can, as an innovation officer, go to the chief medical officer and say ‘I have a product or an idea that will standardize work and align clinicians to do things one way.’ The chief medical officer will jump for joy.”

But it’s important to be humble—everywhere, but perhaps especially here. Healthcare is a complicated space, and patient outcomes are hard to measure and prove. You may be persuaded by the first set of metrics you present, but a CMO may not. Enlist the help of experts and re-frame your case.

Head of Marketing

“How is the organization perceived?” is the first question on a marketing officer’s mind, whether they’re thinking about acquiring new patients or just the health system’s brand perception more generally.

This can be a great thing. A new technology may not move the dial for a CMO or CIO who’s focused on results. But a marketing officer is likely to love it, provided that it makes your organization look innovative and forward-thinking.

A marketing officer also differs from other leaders in one important way: Everyone else is more invested in the existing structure and patient population. By contrast, marketing wants to reach out into the world, attracting attention and acquiring new patients.

Innovations designed to attract patients—such as a new technology designed to improve communication, or Houston Methodist’s new app intended to give patients easier access to the health system—are likely to go over well. So are smaller-scale implementations that don’t have an easily measurable payout—like introducing a new live chat designed to capture new patients.

Finally, a marketing officer may be particularly interested in integrations that raise the brand profile. Partnering with a major name (such as Uber Health) will help your health organization appeal to a larger community. If you’d rather not take on the considerable work of partnering, look for vendors that have already developed multiple integrated partnerships, which takes the heavy lifting off your shoulders. ♥

Uber and WELL: Improving access to healthcare

 

When we think of access to medical care, we usually think about costs: Does this patient have insurance? Can they afford the bill at the end of the line? What’s the price of that medication?

But sometimes, the hardest part about going to the doctor’s office is just getting there in the first place.

According to the American Hospital Association, an estimated 3.6 million people in the United States miss out on medical care every year because of transportation issues. Likewise, studies have found that transportation problems are responsible for as much as 28 percent of no-shows.

When we talk about transportation, we’re covering a wide berth, from lack of access to a car to long travel times and lack of basic infrastructure. And while providing a ride to a stranded patient won’t address every disparity, it can make a huge difference.

Access through Uber

That’s why WELL has created a way for health systems to send an Uber ride to patients who need one—automatically, with no staff time or input needed. It’s designed to lessen those disparities and get patients in for vital care.

But providing an Uber does more than that. It’s a great way to show patients how important they are—and provide an amazing, concierge-level experience for a minimal cost.

The Uber workflow can be launched with a keyword trigger, and is coordinated by a conversational chatbot that can schedule a ride by itself. Here’s how it happens:

1. Keywords Kick It Off

Automatically respond to messages from patients that include words like “car” or “ride” using WELL’s Keyword Actions. Once a patient has scheduled an appointment, our system will look for trigger keywords and ask patients if they need a ride to the clinic.

2. A Chatbot Gets It Going

If your patient needs transportation, a chatbot will coordinate all the details—including getting the right address, calculating travel times, and automatically ordering an Uber. Everything is taken care of behind the scenes through the WELL API.

3. An Open Channel Alerts You

Although the chatbot can handle the whole interaction from beginning to end, your staff will be alerted if the patient needs help. A staff member can hop in to answer any questions, then guide the patient back to the automated conversation. (If all goes smoothly, the automation skips this step.)

4. Your Patients Are Delighted

Stranded patients are unhappy patients. But virtually without effort, you’ve reduced no-shows, shown your patients they matter, and helped to level the field for underserved patients. That’s a lot of goodwill for the price of a ride.♥

Seniors are texting. Everyone else should text back.

 

When Alexis Kuerbis applied for a grant to study older adults and text messaging, she was shocked by reviewers’ reactions.

“Basically, I ran into a bunch of ageist and out-of-date attitudes,” said Kuerbis, a professor of social work at Hunter College. “They were saying ‘Older adults don’t use mobile phones. You’re never going to get them to engage in any technology.’”

But that wasn’t Kuerbis’s experience. At the time, she was participating in a study that involved using text messaging as an intervention for problem drinking, and older adults were among the study participants. “I was seeing people who were older and very tech-savvy, and able to engage in an intense assessment via smartphone,” she said.

What the science says

The scientific literature backed her up. Researchers have successfully used text messaging to engage older adults in everything from appointment reminders to medication management.

According to the Pew Research Center, 80 percent of Americans over age 65 own a cell phone. AARP research found that 86 percent of Americans over age 50 communicate with text messaging. For those ages 50-69, texting has actually surpassed email as their preferred method of communication.

“We think of texting as a millennial thing, but people of all ages engage in it,” said Aaron Hagedorn, a gerontology professor at USC and widely-respected expert on older populations. “Every person is the same, regardless of age: We all want to engage socially.”

“In general, older adults are pretty open to using technology,” said William Chopik, a psychology professor at Michigan State University. In 2016, Chopik studied about 600 older adults with a median age of 68 to find out more about their use of social technologies like SMS messaging, emails, video conferencing, and Facebook.

The seniors in the study didn’t just have positive feelings toward the social technologies used; they were positively impacted by them. “It makes them feel less lonely, and, as a result, makes them happier and healthier,” Chopik explained.

“In every study I’ve ever seen about technology being applied to older adults and seniors for healthcare, across the board, they tend to like it. Separately, they also tend to get excited about it, because it feels fun and new,” said Kuerbis.

An outmoded perception

But we’ve all heard the stereotype: Older people and technology don’t mix. Where does it come from?

For one thing, Kuerbis says, it actually was true a generation ago, when older generations went their entire professional lives without using digital technology. Times have changed. “If you think about it, the generations that have aged in the past 30 years aged at a time when the world was being forced to engage in technology in new ways,” she explained.

Kuerbis’s father, for example, began using computers for work in the 1980s, but his parents never did. “There just isn’t the same level of digital divide.”

In addition, Hagedorn said, non-seniors often think of old age in the most dramatic possible terms: “We tend to think about the most disabled older people, and people tend to think that the design that works for them needs to address the most extreme circumstances in terms of color or size or demands on dexterity.”

But that’s not an accurate picture. For one thing, when we talk about older adults, we’re actually talking about everyone over the age of 50. That’s a huge and highly diverse population—one that covers people at the height of their careers as well as those who have been retired for decades.

And even among true seniors—those 65 and older—technology use comes pretty naturally, Hagedorn said: “I would say that among the population of people 65 and up, 80 percent of them would have no problem using a standard app. Another 10 percent of them could handle it with some assistance from others or on a tablet. The ones who can’t manage it are in a real minority.”

Engaging older adults in texting

“Text messaging is the least invasive and the most accessible [technology] across age groups. It takes the least amount of effort for older adults to use,” Kuerbis explained.

That’s not to say that those older adults use texting in precisely the same way younger populations do. For one thing, Hagedorn said, it’s much better if there’s a human on the other end. Older adults are “very people oriented, not technology oriented,” he explained.

How to reassure them that there’s a real person on the other end? “Ask them to reply back,” Hagedorn suggested. “The engagement of having to reply is a stronger reminder and forms a relationship.”

When it comes to appointment reminders, more is better, Hagedorn said. A one-time reminder will be less effective for a senior population than two or three spread out over a few days.

And Kuerbis’s research shows that older adults have some clear preferences about message content: Single punctuation was better received than multiple punctuation marks; messages without emoticons tested better than messages with a smiley face; and older people preferred “you” statements to “we” statements.

Finally, Hagedorn’s research suggests that trying to replace in-person relationships with technology isn’t likely to work well. When he conducted research that involved providing telehealth counseling to older adults, literally 100% of them said they would have preferred an in-person appointment. By contrast, “young people like telehealth counseling better. They feel more comfortable in their own homes, and they may actually reveal more.”

Instead, technology is more likely to engage seniors “if it strengthens a relationship that’s important to them, particularly if it’s related to an in-person experience”—precisely like a doctor’s appointment.

And despite the stereotypes, “older adults have a lot of concerns about staying connected,” Chopik said. “Technology is one of the ways they can increase their communication with the outside world.” ♥

Women in Healthcare

 

We don’t have enough women in healthcare leadership.

Here’s why we need them…and what we can do about it.

For Teri Fontenot, now the CEO of Woman’s Hospital in Louisiana, a career in healthcare leadership started with serendipity and a great mentor.

“I had no experience with healthcare, and no interest,” she said.

That changed when Fontenot applied for an accounting job at a local hospital, headed by a nun named Sister Anne Marie Twohig.

But Fontenot is in a small minority. A recent Oliver Wyman report found that only 13 percent of healthcare-industry CEOs are women. This is despite the fact that women make 80 percent of healthcare purchase and usage decisions, and compose 65 percent of the total healthcare workforce.


She took me under her wing; she’s the reason I’m in healthcare today…I refer to her as first my mentor and now my saint.”

— Teri Fontenot, CEO
Woman’s Hospital


 

Why the numbers are misleading

The number of women in C-suite positions is about 30 percent higher, overall. But according to Linda Kaboolian, a fellow at Harvard Law School and an instructor of public policy at the university’s T.C. Chan School of Public Health, that doesn’t suggest that those women are necessarily on track to a CEO role.

“Even if they’re in the corporate suite, they’re on the softer side,” she said. “It’s stunting women from moving into CEO positions, because CEOs tend to come from the more technical side of the house.”

Why it’s happening

Women have historically been underrepresented in business leadership, regardless of the industry.

“When people look at leadership, they’re looking at personal characteristics. Even when they’re more competent on objective measures, women are often not seen as leaders,” Kaboolian said. “And when women act in ways that leaders act, they’re often seen as unlikable, not as real leaders.”

But the rest of the business world has moved faster. “There’s a lot more change in corporate America than in hospitals and academic institutions. There are a lot of new startups, there are many more opportunities,” Kaboolian explained.

By contrast, “even though the face of medicine has changed, the metrics and processes by which we choose leadership have not changed,” said Lisa Rotenstein, a resident at Brigham and Women’s Hospital and researcher at Harvard Medical School. “There is a leaky pipeline. At every single rank, women are falling out of that pipeline.”

Why it’s important

OK, so we’d probably be hard-pressed to find someone who didn’t think diverse leadership was inherently a good thing. But it’s not just about what’s morally right.

According to Rachelle Ferrara, senior director of Brasseler Medical and head of the career-development organization Professional Women in Healthcare, diversity is just good business. “More and more companies are starting to realize that when men and women lead together, there’s a higher ratio of return on investment,” she said. (Diversity in the workplace has also been shown to lead to more profitability, greater innovation, and faster problem-solving.)


Diversity is not just for the virtue of diversity; it’s diversity required by the very method of care

— Linda Kaboolian, Fellow
Harvard Law School


Patient-centered care, she explained, requires a strong understanding of the patient in context, which in turn requires diversity of perspective: “The medicalization of issues faced by women and people of color changes when they are treated, and the conditions are researched, by people who are more like the patient load.”

As an example, Kaboolian cites the issue of heart disease in women, which still isn’t particularly well understood—largely because it isn’t well studied.

But healthcare organizations that promote more men to leadership positions may be missing out even in more basic ways. As Rotenstein pointed out, female physicians perform better than their male counterparts in some measures. “But let’s say they were equal,” Kaboolian said, “If you were to overly pick from one [category] rather than equally, you’re going to take less competent people just by the law of averages. And very competent women are being passed over.”

What organizations can do

“It really does need to be about healthcare system action,” Rotenstein said. Organizations need to be “actually quantifying, figuring out who is occupying your leadership positions. Even if that data doesn’t look good right now, that’s the first step to rectifying” the imbalance.

Fontenot concurred. “They need to be intentional about it, have a sense of awareness, set goals about what they want their C-suite or board or middle management to look like,” she said.

“Realize who your customers and who your patients are. Nobody wants to be a token woman,” Ferrara said. But in addition, she said, healthcare organizations need to think about how—and who—they’re hiring. Are they focusing on hiring female candidates whom they already see as future leaders?

Uncovering bias

But women don’t just fall out of the healthcare pipeline suddenly, when leadership positions come up for grabs. Their work is being undervalued all along. Women are less likely to be nominated for awards or invited to speak; they also make less than men—even in traditionally female-dominated fields like nursing.

Rotenstein recently uncovered gender disparity in her own residency program. Male physicians’ work was more likely to be publicly announced and acknowledged—despite the fact that female physicians were equally prolific publishers. “You have to think about the sources of potential bias,” Rotenstein said.

For example, when evaluating candidates for an award, people should look at “the criteria for rating a candidate and who is doing the rating. Is the committee doing the rating a diverse committee?”

And finally, according to Kaboolian, healthcare organizations need to consciously rethink their idea of a leader. The question of “whether or not this particular person fits my mental model chan change,” she said. “Those decisions have ripple effects down the line for the next woman poised to put herself forward for a promotion.”

Mentorship matters

All four of the women interviewed for this post said mentorship was vital to success in healthcare leadership. “Almost all leaders are developed by mentors,” Kaboolian said.

“I don’t think I’ve met a leader who hasn’t had someone help them, advise them, coach them,” said Fontenot. “They can share their experiences with you, help you make better decisions. And they can open doors for you.”

But mentorship is a fraught issue. For one thing, Kaboolian said, men in leadership positions are often reluctant to take on female mentees. “They’ll say, ‘If they were men, I’d have no problem about what to do next, but with these women I have no idea what to do.’”

According to Rotenstein, the resulting tendency—to match female leaders to female mentees—is problematic in its own right. “The few female leaders are overburdened with requests for mentorship and sponsorship,” she said. “If we’re going to create a more equal work force, there should be promotion of membership and sponsorship across boundaries.”

What women can do

Women are often “just afraid to say ‘Hey, I want to go to the next level,’” Ferrara said. But knowing how to ask is important: “Do the research and be prepared to know what your options are. Then, when you get there, articulate that you’re a high performer and you want to take on a higher workload.”

And if the organization isn’t great about providing mentorship opportunities, Fontenot said, women need to ask for them. “Most people who would be mentors are not bold about finding people and saying ‘I want to mentor you’…you need to not be shy about it.”

But Rotenstein is concerned that putting the onus only on women isn’t a good way to effect change. “Female physicians and female scientists have been doing things differently for a long, long time,” she said. “There’s only so much that can get us.”

Instead, according to Rotenstein, the focus needs to be on organizations: “For real change to be made, we have to be looking at how our systems deal with these issues. That’s what’s ultimately going to move the needles.”

And the time is now, according to Kaboolian. The changing face of medicine—now in an era of seemingly unending new mergers and partnerships—offers new possibilities for female leadership. “A little bit of turbulence means that old traditional systems are being reformed,” she said. “That provides opportunities for people who haven’t necessarily been on the [leadership] track to find new positions.” ♥

The 2018 class of Harvard’s Emerging Women Executives in Health Care program. Photo courtesy of Harvard’s T.H. Chan School of Public Health.

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