I recently returned from the 2019 Health Evolution Summit where Lloyd Dean, CEO of CommonSpirit Health, made an enormously insightful observation about the current state of healthcare: We spend so much time doing, that we haven’t been listening.
Listening matters. When I was in graduate school, two books captured my attention. Published around the same time (1984-1985), one was by a social psychologist in Cambridge, Massachusetts; the other by a team of researchers in Cambridge, England. These books described different ways to both think about and analyze communication between doctors and patients. Thirty-five years later, they remain beacons for me and illuminate our vision for PatientWisdom.
The first is The Discourse of Medicine: The Dialectics of Medical Interviews, by Elliot Mishler. Mishler differentiated between the Voice of the Lifeworld and the Voice of Medicine. The Voice of the Lifeworld is the voice of the patient – it is the foundation for empathy. We have no idea what patients are going through or what they want to achieve unless we listen to that voice. We all know it’s not easy: Everyone is busy and the Voice of Medicine is, well, louder than the Voice of the Lifeworld.
The second book is Meetings Between Experts: An Approach to Sharing Ideas in Medical Consultations by David Tuckett, Mary Boulton, Coral Olson, and Anthony Williams. As I noted in a podcast on Communication Skills Meet Reality, the point is deceptively simple: Clinicians are experts on medicine and clinical care; patients are experts on their lives. And if they’re not taking advantage of each other’s expertise, they are missing a giant opportunity to do the best job possible.
These two types of expertise are very different, representing the Voice of Medicine and the Voice of the Lifeworld. But they are complementary, and both are essential elements in the coproduction of health. For instance, the only way to effectively tailor a plan of care is to understand the patient’s goals of care as well as associated life challenges and support systems. That requires attention to both types of expertise.
At PatientWisdom, we make it easy to listen by amplifying the patient voice and distilling patient expertise. Patients use our site to securely share information about themselves, their health, and their care. We instantly create a one-screen inSIGHT summary that every member of their care team can access via the electronic health record to quickly learn what matters to patients as people – it takes about 15 seconds to review before going in to see a patient.
This approach leads to better communication: 90% of patients report that PatientWisdom improves communication with their providers. And better communication leads to better care: 95% of visits using PatientWisdom were rated as going ‘extremely well’, a marked improvement over the baseline of 81%. There’s another kind of value as well: Using PatientWisdom is associated with a significant drop in new patient no-show rates. A recent patient comment reinforces the power of this approach:
PatientWisdom allowed me to provide feedback to my doctor so that he knows more about the kind of person I am and how I live my life. A lot of the topics I mentioned may never have come up otherwise.
I am convinced that we can literally transform the experience and delivery of care by making it easy to listen to the complementary expertise of the people involved, individually and at scale. This notion isn’t limited to a focus on patients. We have used the ‘Meetings Between Experts’ logic and the same underlying software platform to create digital solutions for health organizations to more productively engage with providers and community members as well.
In the case of ProviderWisdom, we see leaders as experts on running health organizations, while clinicians and staff are experts on their work. By distilling what matters to people on the front line, we help leaders create a more responsive ecosystem that enhances real alignment, addresses burnout, and improves operations by leveraging the ideas of the dedicated team members doing the work. The key here is to close the feedback loop and spark positive action.
Similarly, CommunityWisdom positions the individuals who work at health organizations and community agencies as experts on providing support, while community members have expert perspectives on the needs and assets in their community. Acknowledging and attending to this readily available expertise is a productive way to resist assumptions. We have seen this type of listening lead to strategic investment of resources for developing or partnering with programs that people will actually use.
Facilitating these Meetings Between Experts by giving voice to lived experience is the key to transforming health and care. We all benefit when listening guides doing.