What Healthcare And Airlines Have In Common

Roy Smythe–(Forbes)–Health care providers have learned several lessons from the airline industry such as crew resource management, and checklists. That being said, one area in which we do not often seek guidance from those who fly the friendly skies is customer satisfaction. Why not? In the 2014 American Consumer Satisfaction Index (ACSI), airlines were ranked only slightly higher than the following perennial crowd pleasers: subscription television providers and local and federal governments.

Unfortunately, despite the fact that the health care industry is not actively seeking the advice of these colleagues, they do share eerily comparable approaches. A new realization of these similarities came to me a few years back, while watching a documentary on the Boeing 787 Dreamliner­. Following a discussion about the new carbon fiber fuselage and other improvements, the scene shifted to the cabin where Blake Emery, Boeing BA +1.12%’s Chief Differentiation Officer, was leading a reporter on a tour. I listened as he discussed the “end-to-end” flying experience.

He talked about how people were often anxious and rushed in transit to the airport, and how parking was frequently a hassle at best. He then discussed the other impediments involved in making it from the airport front door to your seat on the plane (confusing signage, security lines, etc.). Lastly, he admitted that once you arrived, the cabin environment was typically anything but inviting.

My mind raced… this was the health care experience, just in a different setting. Over the next few days, I kept thinking about the concept, and came up with many more parallels. As it turns out, the experience of flying and seeing a health care provider are incredibly (and regrettably) similar – environmentally, and existentially.

Airport gates are virtually identical to clinic and hospital waiting rooms – with chairs created by a famous French designer (the Marquis de Sade) and situated to maximize capacity and minimize privacy. The gate desk mirrors the clinic desk in appearance and function – a person gives you a number and asks you to “sit and wait,” and then informs you that “the flight/doctor is running late,” or “sorry, I can’t change your reservation/appointment.” This person controls your access to the “expert behind the door” – the pilot or the doctor.

Once past the desk, you are likely to be even more apprehensive – after all, you have now lost all control over your immediate future, and have placed yourself completely in the hands of the “expert.” And… you may well sit on the tarmac/in the empty exam room for a while before takeoff.

I contacted Blake Emery, and arranged a visit. He was kind enough to both show me a mockup of the Dreamliner cabin, and compare notes.

“We had to make a decision whether to maximally engage the flyer in the experience of flying, or to maximally distract them,” he said. “Do you figure out a way to recapture the enjoyment of flying, or put some sort of virtual reality hood on everyone’s head as soon as they board the plane?”

He described how they had used a combination of two techniques – “Idealized Design” as well as a method for understanding the “Cultural Archetype” that consumers have for flying. I was familiar with Russell Ackoff’s Idealized Design concept, but not the latter.

He explained, “We worked with Clotaire Rapaille – the founder of a technique of extracting the formative impact that products or experiences have had on people, often at a young age. Rapaille calls these “cultural archetypes,” or “hidden codes.”

Some archetypal experiences are good, and some are not. The thing is that if the common archetype is negative for your product or service, you need to somehow offset that… if it’s positive, you need to capitalize on it.”

He then went on to explain how Rapaille’s process worked – one that admittedly has its critics, despite the fact that he has worked with a large number of Fortune 500 companies, and continues to be in high demand.

“So,” I asked, “what was the hidden code for flying?”

“Have you ever taken a child to the airport, or up in a plane?” he asked.

“Yes, several times,” I replied, “and I have the scars to prove it.”

He laughed, “Then you likely understand when I tell you that the cultural archetype that Rapaille uncovered for flying – the formative experience that most have when exposed to it for the first time, is actually JOY (Rapaille always prints his “code” words in caps). We decided, after a fair bit of deliberation, to try to capitalize on that – to engage the customer in the experience rather than distract them. We wanted to re-capture that childlike emotion of wonder and joy.”

So, the 787 Dreamliner and its new cabin components are now well known – stabilizing technology for less turbulence, higher oxygen content, larger windows to bring in the blue sky from without and blue ambient lighting to mimic the sensation of “being in the sky” within. Also some additional elements were put in place to counter the sense of loss of “control,” such as the ability to adjust several shading levels for the windows.

Interestingly, Rapaille has studied some aspects of health care, and his cultural archetypes for those are not necessarily surprising – for hospitals, the code word was IMPERSONAL FACTORY. However, he has not studied health care as an “enterprise.”

Since having these conversations with Emery, and reading Rapaille’s books, however, I have an educated guess. The hidden code that I would like to suggest that we consider, one that we are absolutely not capitalizing upon, is CARING HOME.

I have asked several people to relate to me their earliest memory of health care. Most say that they remember getting a painful shot, or gagging on a wooden tongue depressor. However, these actually are not their first true health care delivery experiences. For the vast majority of us, our first health care experience was at home. We had a fever, a cold, or an upset stomach – none of which were serious enough to seek out the doctor – but capable of engendering fear, and insecurity.

Care was not delivered by someone in a white coat, but from a loving parent, and we were treated in an environment that felt safe to us, and where we were certain we were going to “get better.” Most of us received extra attention… perhaps along with some warm soup, or a soothing drink delivered to our bedside. The strongest medicine of all was a parent’s love – soothing words, a reassuring smile, and a tender touch.

Is it possible to re-create a physical and emotional environment that looks and feels more like a “caring home” in hospitals and clinics?

How about passing out some pillows and blankets for those uncomfortable waiting room areas (while you’re at it, how about the airlines do that too? You can’t even get them on the plane now)? How about cups of warm soup in the winter, and lemonade in the summer? Why don’t we soften the environment and create spaces that feel more like home, and less like the airport? Why can’t we find and train more volunteers to sit in waiting areas, engage people in conversation, hold a few hands, and attempt to boost both spirit and confidence?

Most of us have been conditioned to both fear and loathe medical care (as we do flying) – anticipating psychic or physical pain, or in the case of surgical and other interventions – perhaps even death. However, the truth is that the vast majority who come and go in health care settings actually do “get better,” just like Mom told us.

I am challenging health care providers to actively work at creating emotional and physical environments that feel more like a CARING HOME, and less like an IMPERSONAL FACTORY. Let’s buy fewer flat screen televisions for waiting rooms, and actually engage patients and their family members in the positive experience of health care.

Dr. Roy Smythe is a Forbes contributor and the Chief Medical Officer for Valence Health, a Chicago-based health care consulting, services and operating company that seeks to facilitate the ability of providers of care to manage medical and financial risk.