Fighting the Infodemic


Season 1, Episode 4

There’s an epidemic that’s spreading faster than the Delta variant: the Infodemic. Although it doesn’t have physical symptoms, its side effects are bad decisions that amplify the pandemic, like refusing to take vaccines. With so many people, each with their own networks, platforms, and influencers, how can healthcare hope to stamp out the misinformation?

Join Chris Hemphil as they guide us through conversations with some of the leaders who believe that even the toughest problems can be solved by learning to listen better.

3.6 Billion social media users
50% of Adults Did Not Receive Vaccine Info From Their Doctor

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Chris Hemphill

VP, Applied AI & Growth
Actium Health


Sondra Brown

President & Founder


Kristy Roldan

Director of Account Services


Alan Shoebridge

Director of Marketing
Salinas Valley Memorial Healthcare System

Salinas Valley Memorial logo

Dean Browell



Zain Ismail

Section Chief, Planning & Strategy
Henry Ford Health System


Jenn Misora

VP of Client Success Group
Actium Health


Sarah Coles

Head of Influence
Actium Health


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Chris Hemphill (00:02):
Consumer experiences, major disruptors in AI tech are shaping healthcare for years to come. On Hello Healthcare, we dive deep on these issues with leaders who are driving change. I’m Chris Hemphill, VP of applied AI at Actium Health, and we hope that these stories will help you to create or demand better future in healthcare.
Chris Hemphill (00:26):
Hello Healthcare, there’s an epidemic that’s spreading faster than the Delta variant. Although this epidemic doesn’t have physical symptoms, its side effects are bad decisions that amplify the pandemic, like refusing to take vaccines. What is this epidemic, you ask? To answer that, I’m going to blow the dust off of the history books and quote journalist David Rothkopf from 2003, “The information epidemic, or infodemic, has made the public health crisis harder to control and contain.” David coined the term infodemic to characterize the flood of misinformation sputtering around SARS, the global pandemic of the time. What’s the difference between 2003 and now? 3.6 billion. That’s how many people use social media platforms today according to Statista Research. In 2003, Facebook hadn’t even been launched yet and MySpace didn’t even have a million users. So with that many people each with their own networks, platforms, and influencers and influences, how can healthcare hope to stamp out the misinformation?
Sarah Coles (01:33):
I think all of us as marketers can probably attest that COVID-19 kind of hit us like a wrecking ball.
Chris Hemphill (01:40):
That’s Sarah Coles, who is now a VP of healthcare strategy for a marketing AI company called Persado.
Sarah Coles (01:47):
None of us saw it coming, but the good thing is that some really interesting opportunities came out of it. Digital tools have taken off like never before. I don’t think any of us ever expected that telehealth would become such a big thing so fast. And that, and contactless delivery, using digital tools to communicate has just really been an incredible opportunity for all of us as marketers. But even more so the data and data-driven decision making has really come to light. We’ve been using data for a long time in our decision making, but I think through the whole COVID-19 experience, and as we continue to experience it, data is playing a real front and center role in terms of what patients and even what providers we want to reach out to, at what time, and for what reason. I added here the terminology precision marketer, because we are now really precision marketers. We’re no longer just marketers. We’re the conduit between patients and providers.
Chris Hemphill (02:51):
That’s an interesting point that there’s been a ramp-up of certain digital tools and services. Still, healthcare’s ability to fight the infodemic isn’t just a matter of digital engagement. It’s a matter of whether people want and trust the info that they’re getting from healthcare providers. Where does this stand?
Sarah Coles (03:07):
We’ve heard the question that, “Are we over communicating during this time?” Healthcare organizations are really sensitive to what they’re communicating about. But we’re seeing data open and click rates anywhere between 25 and 65% higher than what they were before. So people want to hear from healthcare organizations, they want to consume that content, they want their healthcare organization to be a resource. So communicating often is really a priority now.
Chris Hemphill (03:33):
Sarah said something pretty powerful about whether healthcare is poised to fight the infodemic, specifically the higher engagement with healthcare-related outreach. To see open rates and click rates jump by 25 and 65% is huge. So huge, in fact, that we actually had to investigate. Are people actually interested in hearing more about COVID from their providers? We surveyed 1,192 US healthcare consumers. 66% of them said that they would rather hear from their doctors than from their favorite retail brands.
Chris Hemphill (04:06):
So turns out people are really invested. It should hopefully follow that people are getting and hearing from healthcare pretty frequently, right? Only 49% of respondents said that they’d received information from their providers about COVID-19. Details from that study are in our show notes. So we know that patients want to hear from healthcare, but largely they aren’t. That begs the question, what would they like to hear about? The survey showed that patients would like health and wellness tips, info on preventive screenings, and available procedures. With all those options, I wonder how to decide on who gets what outreach.
Sarah Coles (04:45):
We are really on the front lines of communicating to the right patients at the right time, using data to segment patient groups so that we’re communicating message to people based on where they are, in terms of, do they need to come in for an urgent appointment type, do they need to rebook an annual wellness visit that can be done virtually, or are we just trying to broadly communicate around safety? So I think segmenting those patient groups upfront is really critical so that the messaging can be target to the patient according to who they are, demographically. It may be appointment type, it may be age, it may be based on ICD-10 codes, but really segmenting the right audience and targeting it with the right message is going to be really critical to ensuring trust over the long run.
Chris Hemphill (05:40):
Segmenting, targeting, getting the right message to the right people, these are all things we like to say, but in fighting the infodemic, where do we start? Sondra Brown, founder and CEO of the market research firm, MDRG, would tell us that we should start with the whole mind, nothing less than that. Their whole mind approach has had some successes in influencing vaccinations. She and Kristy Roldan, their director of account services, sat down with us to discuss their data science meets behavioral economics approach.
Sondra Brown (06:15):
Healthcare is inherently a category that is difficult to objectively evaluate. Going back to that conversation that we had a minute ago about behavioral economics, and to tell us that a lot of those decisions that we make are non-conscious or they’re emotional, or they’re these automatic decisions, or they’re based on things that we’re not evaluating as professionals in the healthcare space, we need to really understand those decisions and how do we connect to consumers so that we can better connect our brand, we can message better, we can deliver products and services in a way that consumers are going to engage with. Engagement is really going to be critical, but it’s not going to be based on these rational decisions. And so if we think about that in the healthcare space, it’s really important that we understand this non-conscious side of the brain, these emotions, these feelings.
Sondra Brown (07:20):
And if we’re going to really connect to consumers and we’re really going to get our brands in front of the consumer, we’re going to have to figure out how do we create that emotional connection in order to connect from a brand experience, but I would also argue in order to provide stellar customer experience. So this phenomenon of really understanding this system 1, this non-conscious, is huge for healthcare. So we really need to speak the language of the consumer, and we need to speak to their heart if we’re going to be able to connect to them and then make a difference in their lives from a healthcare perspective.
Chris Hemphill (07:56):
This is really cool because when you’re speaking with Sondra, she goes deep into what drives unconscious, underlying motivations. She uses terms like system 1 versus system 2, which if you’re not familiar with those terms, an easy way to think of them is fast versus slow. System 1 thinking is the really fast, unconscious thoughts that you have, such as immediately recognizing that a pepperoni is red and that the cheese is golden brown and that the pizza’s tasty. And system 2 thinking is that slow, strategic thinking, “How am I going to buy the pizza, where I’m going to eat it, and what are the implications of if something spills onto my shirt?” So we’ve explored system 1 versus system 2 in relation to pizza, but what about in relation to vaccine hesitancy?
Sondra Brown (08:47):
We have done a lot of work around vaccine adoption, who is hesitant to take the vaccine, what are their motivators, what are the messages that would resonate? And a lot of that work has used a technique called OMET, and it’s the idea that if we want to get people to bypass that rational part of the brain in market research, we need to not start with language-based questions, because inherently, that’s a rational part of the brain. And so what OMET does is it allows you to ask a question, and they answer it by selecting an image, that they cannot make a literal connection to your question.
Sondra Brown (09:38):
And from there, OMET theory, and I won’t get into all of the nuances of that, we don’t really have time to get into that, but the idea is that we then ask them to describe the image and then tie it back to the original question. And the analysis is where the magic happens, where we begin to really understand what are those underlying emotional themes, if you will, that then become sort of the building block for the connect, whether it’s a messaging connection or a brand connection to the consumer.
Chris Hemphill (10:09):
So they use image associations to tease out these unconscious relationships. Very interesting approach. Kristy Roldan, who, as a reminder, is their director of account services, discusses with us how this works in practice.
Kristy Roldan (10:23):
We started this tracker a year ago at this time with the understanding that, “Okay, so everything’s shut down, we can either sit on our hands right now and do nothing, or we can provide a service to our clients and help them understand the consumer landscape,” because all the balls were thrown up in the air. I would argue that consumer behavior has never been in such a state of upheaval than over the past year. So we were tracking people throughout the course of 2020, and even today around a number of areas, travel, the economy, and healthcare specifically. And as the vaccine was coming online, it was becoming more and more topical. And we tried to really narrow down to an audience that would be fruitful for us. So we had this big group of people that were intenders, and we knew that they were going to go out right away and get the vaccine. So not a lot of heavy lifting needs to be done there. We just need to nudge them off the couch, nothing really too major.
Kristy Roldan (11:30):
And then we had this other group that was, “I’m not going to get it. It doesn’t matter what you tell me.” And so, “Okay, we’re going to sit you down for a minute. We’re not going to try and force your hand.” But there’s this middle group, that’s this hesitation group. And that’s who we did the online metaphor analysis with. And they were really interesting because some of the images that they would select were images about people going through a maze or people feeling like their hand was being forced into something. And the larger message there being that they just really felt this level of uncertainty and not knowing. And I don’t think that’s that different than the COVID disease itself, the COVID infection itself. I think that we’ve been learning information like this. And if I think back to last year at this time, we weren’t even wearing masks. That’s how quick this information has been changing and switching gears. So people rightfully so are confused. And this hesitated group was really showing us that through online metaphor elicitation.
Chris Hemphill (12:43):
That’s showing some interesting promise. They’ve found a way to determine who’s merely hesitant rather than completely resistant and then work on that group.
Kristy Roldan (12:52):
And then what we did in the tracker was we converted some of our questions into messaging statements and tried to see what would really move them to take action. And what we found out was some of their barriers, I don’t think that this is surprising at all, but some of their barriers were about short and long-term side effects. They just did didn’t know what to expect. And so knowing that, we put some messages in front of them about vaccines providing a way to get back out into normal life, or vaccines providing a way to get back together with family and friends. And that sort of positive messaging really moved the needle among this group of hesitators. They want to return to something that looks like what they experienced a year and a couple months ago. And that really gets them out of this being jangled up about getting a vaccine and the uncertainty around that.
Kristy Roldan (13:57):
The other thing that’s interesting is if you think about it like a marketing funnel, this hesitator group is really in the middle, so it’s not really time to nudge them off the couch yet. It’s really time to educate them and have informational conversations. It’s not getting to a negative space and it becoming some sort of blame game, is not going to deliver the results that you’re hoping for. Really engaging in meaningful informational conversations is what going to help move these people into action.
Chris Hemphill (14:34):
The marketing funnel metaphor makes sense. Let’s think about it in terms of three stages, vaccine-resistant, vaccine-hesitant, and vaccine-enthusiastic. That way we can personalize the message at each stage, prioritizing the hesitators who are most likely to convert. How do we start actually engaging?
Kristy Roldan (14:54):
It’s very easy to ask people just rationally, like, “Do you plan on getting a vaccine?” If they say, no, the answer is no. I mean, I don’t think that there’s a lot of doubt. But I think that people, if you put together the mix of, “I want to spend time with my family and friends,” or, “I’d to get back to doing things,” or, “I like going to see live concerts,” you name it, those sorts of things, if you mix that sort of element with not no, it doesn’t have to be definitely yes, but just not a no, you can start to form this group that’s, “What is the right levers that we have to push that are going to make you feel good about this?”
Kristy Roldan (15:39):
The other thing that we’ve talked about quite a bit is, in this conversation, these difficult conversations that we have to engage in in order to try and move people to getting a vaccine, some of the information sometimes is just that it’s completely understandable to not know what the vaccine is going to do or to have some reluctancy about that, but we’ve seen what COVID can do, and that’s pretty bad.
Kristy Roldan (16:09):
So I think being able to switch gears has also proved to be something among this hesitator group that drives a little bit of motivation there, but definitely getting back to your original question, a mixture of this system 1, this non-conscious, but with screening people out that are definite nos, I think creates this nice hesitator mix that we’re looking to understand what messages motivate them. The voice of the consumer continues to be a vital part. And I think that that has been awoken even further over the course of this pandemic, but keeping eyes squarely focused on the voice of the consumer is going to be an integral part of healthcare conversations going forward.
Chris Hemphill (16:58):
I think we’re making some progress here. Our first question on fighting the infodemic was whether people want to hear from healthcare in the first place. It turned out they’d rather hear from their doctors than brands like Nike and Amazon. Score. This means that people are open to hearing from their providers. It’s better to be in their headspace first and frequent before the likes of, say, Joe Rogan or YouTube’s algorithm.
Chris Hemphill (17:24):
Next, the folks at MDRG broke down how they addressed vaccine hesitancy based on people’s feelings of uncertainty. So there’s now a motive and a framework for addressing the infodemic. Let’s get a bit tactical here and choose a group of consumers to engage. We, of course, want to resonate with all groups, but one group that’s curiously influential is Generation X. We don’t hear about Generation X quite as often as Gen Z, the baby boomers, and the millennials. However, we shouldn’t ignore them.
Chris Hemphill (17:59):
Gen X is often the parents or the children of these other generations. Since their opinions hold so much sway over so many people and families, one would wonder what are their likes and dislikes, how to influence them, and how do they make their decisions. These vary by individual, of course, but to get deeper on these questions, we spoke with Alan Shoebridge and Dean Browell. These are the folks who wrote the book on Gen X, which is called Don’t You Forget About Gen X, One Generation’s Crucial Role in Healthcare. And no more singing from me, folks.
Alan Shoebridge (18:40):
In the healthcare space, there’s opportunities.
Chris Hemphill (18:42):
Along with co-authoring the Gen X book, Alan is director of marketing at Salinas Valley Memorial Hospital.
Alan Shoebridge (18:49):
When you build a relationship with a doctor, after you’ve kind of established, you really have a good chance of keeping it. But there’s also going back to where we started on that skeptical side. So thinking about how you make decisions, Gen X tends to be very skeptical of what their doctors say. So, again, the relationship is going to require getting information, getting facts, and then probably is going to require some level of verification like we’ll see. And this is a good one. So when it comes to my health, I know better than my doctor. And this does tend to skew again with younger generations, and millennials, even, rank a little bit higher than we do here. But when you can actually reach a Gen Xer and start that relationship, just know that it’s going to get tested, that we’re going to want to know from our doctor. As soon as we leave the exam room, we’re going to be on Google, double-checking everything that we heard.
Alan Shoebridge (19:38):
So that is one of the challenges on the relationship side. We’re going to come in armed with probably some information or some questions. So how do you kind of work around that, knowing that those are some of the characteristics of generation, what sort of messaging works? So things that will be effective in your marketing communications are peer endorsement. So if I can see that Dean and Alan were really supportive of a doctor, or they left a rating or whatever, I’m going to value that and be like, “That’s kind of interesting. And I might need to see some more people too, but that’s going to really help me,” just being moderate and I think not making wild claims that we’re just going to shoot down. We’re going to want to poke some holes in it. We’re going to want to know if it holds up.
Alan Shoebridge (20:18):
And also just using logic, I mean, we respond, again, well to facts and value kind of seeing how things are done, how decisions were made, how you got to a place of decision. Transparency, we like to know kind of everything and like to see those reviews, like to read the comments. We’re going to do a lot of research. And the more information you can give us is the best approach.
Chris Hemphill (20:42):
These are some great points to start. As Generation X is growing in influence, but also growing more vulnerable to healthcare and COVID risk, we must understand their communication style. While Generation X wants to hear from you, that doesn’t mean they’re going to take you at your word. They’re going to do their own research, speak with peers, and arrive at their own conclusions. Outside of an infodemic, this could be great, but this carries the risk and questions about who those peers are and what those other research sources could be. Dean Browell, along with co-authoring Don’t You Forget About Gen X, is a social listening pioneer with his company, Feedback. We know that Generation X is going to do their own research and arrive at their own conclusions. Dean shares what healthcare and patient engagement can do to turn this into an advantage.
Dean Browell (21:37):
I think that this is where that word transparency, I think, is incredibly key, because it is the difference between… And so in another life many, many years ago, I was in higher education. And so higher education is notorious for just get a photo of a blanket, a basketball, four books, and then a just what they would consider a diverse audience of students sitting on it, pretending to study together. And that photo equals diversity. And I think that for me, especially from a Gen X standpoint, but I think this is true for every generation, I really don’t think this is special to Gen X necessarily, but in terms of communicating that message-wise, it’s about allowing people in their own words to talk about why what you’re communicating is important to them.
Dean Browell (22:26):
Do I mean just testimonials? Yes. I mean, testimonials is kind of what I’m getting at, but I think it’s also about the fact that it’s not contrived, but allow if you’re talking about trying to truly let diversity feel and sound authentic is to let it be authentic and let it come with the own words that allow them to express that so it’s not simply a contrived image, or even a contrived message, but allow it to seem as if it comes from a peer, because that that’s much of what you’ll notice that we talked about is really just the, “Look, I know your website’s going to say nice things about you. You created it. I want to know what does someone else say about you, I want to know what was someone else’s total experience like, even if they’re there for a different procedure than I’m going to go for. I just want to know how did they feel about it.”
Dean Browell (23:17):
Now, they may accurately say, “Well, if you’re the one showing me this testimonial, you’ve clearly cleaned this testimonial, right? It’s been scrubbed,” but that will at least be an attempt to acknowledge that you’d much rather hear from a human being and their experiences than from something that feels like ostensibly a stock photo campaign, and how that can come across.
Chris Hemphill (23:39):
If like me, you’re not in Gen X, but Dean and Alan’s points relate to you, that’s not a surprise. These aren’t hard lines in the sand, and Dean goes over that.
Dean Browell (23:50):
The great news is millennials also want authenticity. Now, they may have come to that need and that want from a different angle. We came from a very cynical angle to get to this need of authenticity. So we approached it from a different angle, but we both want the same thing. So the good news is if, let’s say it’s a mover campaign, you’re talking about first-time home buyers, or maybe even second or third-time home buyers who are moving in because of a job into this particular region. Then the good news is you’re probably talking about millennials and Gen Xers. The same messaging should resonate with both if you’re coming at it from, let’s say, their authenticity angle, because those are both traits that they both share. So I think that the good news about this is if you go by life stage, there’s a great chance that you’re going to be able to find some middle ground on some of these.
Dean Browell (24:41):
And I’ve seen this, especially in orthopedics. I think I mentioned earlier too, but I mean, I think that I’ve definitely seen it there where people who are just trying to identify what’s wrong with them, there may be urgent care that they’re considering because they just don’t feel like it’s an ER thing. We’re talking about aches and pains that might be going between a Gen X or even a boomer population. The good news is some of the same things, you could lean on the things where they bridge as opposed to even trying to segment too hard when there may be some overlapping traits that can really help you target really well.
Chris Hemphill (25:13):
So when it comes to working with Generation X and similarly spirited individuals, what’s the key takeaway that we should be applying?
Dean Browell (25:21):
I think it’s listening. I mean, honestly, it’s exactly what Generation X feels like they didn’t get. And honestly, I think this is probably true for any generation, but I think that right now, especially, it’s about listening. I mean, in fact, I’d say most of the studies that I’ve done, even some of the ones that have closed in the last couple of weeks that we’ve been doing, every single one of them included someone, usually millennials, sometimes Generation X, as well as [inaudible 00:25:48], just almost screaming for, “I just wish the doctor would hear me. I wish someone would listen about where I’m at with my problems. I wish I had a way to communicate effectively the pain that I’m in.” And even though it may be talking about some very acute situations with healthcare, I think what we’re going to find, especially with millennials, is, so if Gen X is completely forgotten and we have to wave our hands to get you to pay attention to us, millennials have the opposite problem. They’ve been under a microscope for 30 years now, 40 years, really.
Dean Browell (26:21):
I mean, people were telling them what they were going to be before they even had a dollar to their name. And so I think that for of them, it’s asking them to tell their own story and listening and being very public about it, that you are listening, that you are asking. Maybe it could even be as much as, “We’re going to create this campaign based on what we heard you saying,” or, “We talked to you,” and being really transparent about that. Even though some of those same traits are things that Gen X wants, I feel like millennials, it’s going to be very crucial to allow them to tell their own story because goodness knows it feels like everyone else has been telling them who they are since they’ve been born. Really find out who are you talking to and stop painting with broad brushes. Age is just as important to understand as any other facet of diversity, and it really comes down to respect and listening.
Chris Hemphill (27:11):
Respect and listening, sounds like basic concepts. We should have learned this from Sesame Street, but it’s surprising how hard that is in practice. Data collection, focus groups, surveys, these efforts can take months or years and then be plagued by statistical problems. Even worse is when good data and good results get ignored by healthcare leaders.
Jenn Misora (27:36):
If we’re going to take the time to do the research and understand, and I’m not an expert in market research by any means, but I love hearing from people what they’re feeling and thinking.
Chris Hemphill (27:44):
We’re hearing from Jen Misora. Jen leads client success at Actium Health.
Jenn Misora (27:50):
But if we’re not actually going to use that, or we’re going to say, “Well, that’s not my experience, so that can’t possibly be true,” then that’s a huge problem for us because, again, most of us who work in healthcare in a lot of ways have been there for a long time. And the way that we see the healthcare system, and we say, “Well, that’s not true. It’s X, Y, and Z,” well, that’s 20 years of experience speaking to you and telling you that’s how it works. Call a friend, call a parent, call a sibling and say, “How would you handle this situation?” And I almost guarantee it’s not going to be the same way one of us would with our knowledge and experience. So those insights and that qualitative research and listening to people, those ethnographics, studies are so important, but only if people are going to believe that what people say is real.
Chris Hemphill (28:34):
When we can’t listen and learn from our patients, it becomes a serious problem, so serious, actually, that there’s an entire framework designed to listen to patients and designed whole processes around their needs. It’s called human-centered design. Don’t worry, we brought in a human-centered design expert to speak on this. Zain Ismail is section chief of planning and strategy at Henry Ford Health System. He also heads up their COVID-19 vaccination incident command center. And since that’s not enough, he co-hosts the Healthcare Rap podcast.
Zain Ismail (29:09):
So human-centered design, in my view, is a very overarching term that can mean a lot of things to a lot of people. And so let me talk about it abstractly for a minute. So, essentially, what it is, it’s a framework or a model to solve really complicated problems with the community in tow. And so the first thing that is fundamental to human-centered design is that it focuses on optimism. And so people who practice this discipline believe that even the toughest problems can be solved. And so we already come to it from a perspective that we’re about to change the world, which I think is needed in healthcare, right? Because things are so complicated, you can get discouraged really quickly.
Zain Ismail (29:48):
The second thing is centered around community, ultimately meaning that we also believe that the solutions can be ultimately found and harnessed from the people who bear the problem, right? And so hence the need to actually get in there and investigate, because it’s not necessarily going to be us, the healthcare executive, telling our patients, “Here’s your solution.” I mean, obviously, if we’re doing open heart surgery, sure. But in a broader context, we are going to find solutions by actually talking to the community and the people that we serve to understand what their real problem actually is.
Zain Ismail (30:24):
And then finally, the next big piece of human-centered design is really around sort of tinkering and testing. And what I mean by that is it involves a lot of experimentation and exploration, both experimenting around what… or sorry, exploring what the problem actually is and what all the dimensions of that problem are, and then also on the solution side, coming up with one solution. Maybe you’ll find it doesn’t work, so we do it again and again and again until we get to something that you could say has a product market fit.
Chris Hemphill (30:51):
So far, we have some hallmarks of a great framework. Key here is that it’s open to experimentation and tinkering. It’s not something that can just be shoehorned into an organization. Let’s explore a little further on how it works and the types of insight that it drives.
Zain Ismail (31:07):
I work with a team of service designers, and we’ve done some service design work actually in Kenya for a small rural community hospital north of Nairobi. In one model we use, which broadly is [inaudible 00:31:16] centered design is called the NOABS framework, and I’ll explain it in a minute, but the purpose of the project was to work with this rural community hospital as the country, this was in 2018, right… Oh, I can’t with pandemic days anymore. But the purpose of the project was to figure out what this hospital could do to ultimately develop patient and community engagement strategies as the country was rolling out universal health coverage. So all of a sudden, a whole bunch of folks in their community were going to get healthcare insurance. And so therefore what should they do to engage patients? And at least in this context, hospitals compete for business.
Zain Ismail (31:52):
And so we worked with that team in Kenya, remotely, which was a lot of fun. And what we started to do was leading them through a human-centered design process, we created an interview framework for the them, a set of questions. And we started to work with them to actually interview members of their community to understand how they procure care, how they perceive care. We asked them questions about finance. We asked them questions about their family, how far they travel, all the things that you would expect. And then we organized all that qualitative information.
Zain Ismail (32:21):
We recorded the audio, and then our team back here in North America went through it and started to organize things in what we call a NOABS framework, which essentially stands for, so the N means needs. And so when someone’s speaking or when someone’s talking about their experience, we call it, this is a need. The next one is O, so objective, so any goals or anything that explicitly tangible in nature that they wanted to achieve. And then A stands for activities, and so activities that a person is doing. B is for breakdown, so anything that through the experience that failed or through their life transition that failed. And then S is for solutions, which ultimately means potentially solutions that they created or that they found.
Zain Ismail (33:05):
So what we did is we took all this audio and started to document what we were hearing and then organized it in this way. And that helped us analyze it to then go back to Imara Mediplus, who was the client, and say, “Here’s some potential recommendations.” So that’s just one of many ways to organize qualitative information and actually extract meaning from it.
Chris Hemphill (33:22):
Now you’ve heard it. This is how they built a system around respecting and listening to patient needs. What are some of the results that this method yielded?
Zain Ismail (33:31):
Really interesting insight is we started to ask, and by we, I mean the local team started to ask the community about their perceptions of this hospital as it related to them being a high-cost provider or a low-cost provider. And so this was really interesting, and it blew my mind, especially coming from the North American context, which you also can’t forget in this whole process is, think about your privilege and where you’re coming from versus the investigation you’re doing. And so this hospital is actually very North American in the sense it’s very clean, very well-branded, very well-constructed, but it’s actually a low-cost provider in the community.
Zain Ismail (34:11):
When we did the research, we discovered that people weren’t coming to the hospital because they kept their cleanliness standards so high and their branding standards so high, they just assumed it was high-cost, like the actual high-cost providers in the community. And so to me, that was really interesting. And so we ended up working, or trying to come up with the solutions for the client to say, “Hey, you should keep a high cleanliness standard. This is healthcare. You should keep a high brand and experience and look standard, this is healthcare, but how might we come up with solutions that can communicate to the community that despite those things, you’re actually a low-cost provider and they can get great quality care here?” And so that was a really interesting insight that you would never know unless you talked to people. And then of course, coming from the North American perspective, we were completely blindsided by that when we discovered it in the research.
Chris Hemphill (35:01):
What it sounds like here is that when we listen to patients in a systematic way, we’re going to uncover things that we weren’t expecting. Prime example here are that the hospital had invested heavily in promoting their cleanliness standards. However, they found that people’s perceptions were that the care there would be too expensive. So this process uncovered something completely unexpected from their patient population. Should health systems ignore findings like this because they’re so far from their existing strategies? You can probably guess my answer on this, but let’s hear it from Zain.
Zain Ismail (35:36):
I think the first thing in my mind, you need to commit that insights you gather through a qualitative analysis, which human-centered design is, are valid. And so there almost needs to be a cultural shift in your organization and strategy that what we glean from interviews, surveys, primary research is as valid as what we glean from finance or some data numeric number that we get from some analyst in the background. And so that’s a big thing that I see a huge gap in healthcare is we accept the analysts’ charts and their pie charts, and God only knows what they do, but when someone comes in with insights or a recording of a patient and how they feel about care, we have a tendency to dismiss it, even though, in my opinion, that’s the richer insight.
Zain Ismail (36:22):
So the first thing is you must commit that qualitative insights and the human-centered design process is a legitimate process for strategic planning, so that’s one. The second thing, and sort of diving deeper into this, is put rigor around the process. And so human-centered design, though it can be practiced by anyone as a layman, again, the concepts aren’t terribly difficult to wrap your mind around. And a lot of them align to things we already know in healthcare, like Lean Six Sigma, process improvement. A lot of things aren’t terribly new. They just come around in circle.
Zain Ismail (36:55):
That being said, though, you can actually hire or onboard onto your team, and maybe you already have them within your organization, true qualitative researchers who do this for a living, design researchers, folks like that. And so even look at your FTE count and what roles you’re bringing into your strategy team and say, “Hey, if we’re really committed to this, committed to this input, we probably need to hire someone that’s expert in this field so that they can bring those insights in a way that’s meaningful and understandable to the organization.” And so those would be two big things I would say that is key that everyone needs to get a hold of right away if they plan on going down this path.
Chris Hemphill (37:34):
I might sound like a curmudgeon here, but curmudgeons can be a good thing. It’s possible that our studies and surveys might give us bad information. It calls into question in human-centered design, is there a wrong way to listen to patients?
Zain Ismail (37:49):
The first one is having wrong expectation about the process. And so one thing I’ll say is that human-centered design done well is not linear. And so in healthcare, we love linear processes, we love care plans, we love the standard of care. It’s if this, then that. Human-centered design is more like an exploration where we’re going on a journey towards, we think this, but if we have to take a turn to the left or the right, we’re going to do it. It’s not really about going to a specific destination that we’ve identified at the beginning. It’s more about generally going in direction, maybe across the ocean, and maybe we’ll land in America, maybe we’ll land in Cuba, wherever we find based on the insights. And so getting your expectation right at the beginning, or not getting it is a huge pitfall that I’ve seen happen that usually causes projects to go haywire.
Zain Ismail (38:38):
The other big thing too is being too prescriptive in your investigations when you’re doing research, asking terrible questions that are leading, that don’t really get at an insight, they validate your bias or what you’re trying to push, which is only going to waste your time. You won’t ultimately develop a product or service or a high-quality engagement or marketing engagement. And then probably the biggest thing people need to watch out for is as you’re doing your research, that you make sure you’re not only testing for usability, and so for example, if we’re doing a focus group on, “Does this app work?” And I see that happen all the time where people say, “Do you like the color? Is it functionally working? Is it easy to click through?”
Zain Ismail (39:23):
Well, that’s one piece, but the bigger piece to test for is motivation. Will people actually use it? I’ve seen fantastically designed software and products, even services, but nobody uses them because we’ve not designed first to test for motivation, then test for usability, whatever the product or service is. So those are the three things I’d watch out for, being too prescriptive, test for motivation and usability, and set your expectations.
Zain Ismail (39:48):
Through innovation methods and human-designed methods, we can build systems for health and wellness that are community and citizen-centric and that are built on evidence and not ego. And by evidence, I don’t just mean your financial evidence, your typical strategic planning, Sg2 data, but I mean the evidence that comes from our patients and health plan members. We can do it, and we will get there. And all of us listening, it’s our opportunity to integrate these things to actually build the systems that people want.
Chris Hemphill (40:15):
Out of everything we’ve discussed today to combat the infodemic, the common thread is listening. True, there are resistors out there, but people want to hear from their healthcare providers. Additionally, healthcare needs to be able to listen and act when patients speak or make their pains heard. We’re in a tough time, widespread misinformation about this claims minds first and then lives. For those of us in healthcare communications, seeing this misinformation spread is devastating, and it’s even more so when the anger and vitriol over vaccines comes our way. Still, let’s not forget what Zain said earlier.
Zain Ismail (40:58):
The first thing that is fundamental to human-centered design is that it focuses on optimism. And so people who practice this discipline believe that even the toughest problems can be solved.
Chris Hemphill (41:11):
Thank you again for tuning in to Hello Healthcare. If you like what you heard, please spread the word. Tell your friends and colleagues to subscribe on Apple, Spotify, or wherever they get their podcasts. This conversation is brought to you by Actium Health. And to get the latest on what these healthcare leaders are saying, subscribe to our newsletter on or join us for our weekly broadcast on YouTube and LinkedIn. Thanks. And when we see you next time, hello.

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