Integrate the Customer Journey to Drive Patient Engagement, ft. Sarah Sanders, Dr. Aaron Neinstein, UCSF

Sarah Sanders (00:00):
With all of the insights that we can glean both from our internal data, and our external data, and experiential behavioral data by just watching what they do with us, you really do have this opportunity to create a scalable, personalized, automatic experience that can actually get people help when and how they need it.

Chris Hemphill (00:31):
What we’re going to be talking about today is breaking down silos between marketing and technical parts of the organization. We’re seeing healthcare really accelerate in breaking down silos. 10 years ago, 15 years ago, we heard about people seeing all these needs and just existing in a world where IT, extremely focused on EMR implementations, marketing focused on outreach, but nobody really speaking the same language. Well, it seems that over time, we’ve in ways listened to a lot of patient expectations. Succumbed to a lot of competitive pressures, too, when it comes to like, it’s important to focus on the experience and we can’t deliver on the type of experience that patients expect unless we are communicating together.

Chris Hemphill (01:24):
I’m joined by Dr. Aaron Neinstein of UCSF.

Dr. Aaron Neinstein (01:29):
Sure. Hi.

Chris Hemphill (01:33):
And Sarah Sanders, who is UCSF’s Chief Marketing and Brand Experience Officer.

Sarah Sanders (01:41):
Yes, hello. Happy to be here.

Chris Hemphill (01:44):
So Aaron, a little bit of different side of the house focusing on digital health and innovation, and Sarah on marketing and the brand experience. But the presentation that they just gave here at the HMPS Conference is on how they started building these cross-functional relationships. How they started co-innovating together with cross-functional teams. What makes me really excited about this, and y’all correct me if I’m wrong, but this is an example. Other organizations, you might be in a scenario where you don’t feel like the technology side of the house or other areas of the house are apt to listening to the types of innovations you want to focus on in marketing. So, we’re going to dig deep into the listening that it takes between these teams, understanding at an operational level. I can say break down the silos and that sounds all well and good. What does it look like? Well, it’s right here.

Chris Hemphill (02:47):
So, just to kick us off. When it comes to building these cross-functional teams, moving out of the siloed environment, I’m just curious about thoughts and motivations. What’s led to this thinking that y’all are driving down now? Did some of my points ring true when we were talking about that?

Sarah Sanders (03:08):
Yeah, absolutely. I think traditionally, marketing has really led the beginning of the patient journey. So in terms of going out and finding patients and bringing them into the organization, the lead gen piece. We’ve done that for 15 years. Used digital to do that. That was really where I think it was introduced a lot. The marketing tech stack was really put into place for that lead generally. But, I think the pandemic changed things. The world has evolved and digital’s everything now. Now, we’re really looking at how to deliver healthcare digitally as the core part of how we practice. I think it’s an opportunity for marketers, because we’ve always gotten so far, but then had to hand it over to the clinical team or the operations team to take that lead or to take that patient and then bring them along in their journey.

Sarah Sanders (04:08):
I think what’s happening now at UCSF is, we’ve created this operating model where we have lots of different disciplines working on customer issues, is that we’re now bringing to bear all the talents of the marketing team, the clinical team, the operations team, our innovation team, data scientists, designers, experienced designers, et cetera, to really come up with solutions that none of us would’ve thought of on our own, and we’re all at the table for the entire journey. So, I think that’s really what the difference is for us. The reason we did it was because we’re creating an entire digital experience, not just these silos of experiences, and I think really seeking to create a better interaction with our customers. We’re an academic medical center. They’re traditionally hard to interact with, where we don’t make it easy because of our multiple missions and the complexity of both our patients and the care that we provide. It’s just ripe for innovation and ripe for evolution, really. So, we’re having a good time.

Chris Hemphill (05:21):
Yeah.

Dr. Aaron Neinstein (05:22):
We are. It was a very natural partnership, I think. As we at UCSF as a complex care organization, as Sarah was talking about, we really were focused on two main parts of our patient journey. People who are new diagnosis of cancer, need a transplant, just diagnosed with multiple sclerosis, some complex medical condition, they’re being referred for care, or they’re seeking a second opinion. What’s the experience of that person who’s dealing with that difficult point in their life and looking for care? Then once people are getting care from us… I’m an endocrinologist, so my background is in diabetes care. How do we keep them engaged throughout their entire care experience so that it’s not just the 20 minutes in the office visit, but that we’re delivering educational content, we’re allowing the patient to connect with us throughout their entire care journey.

Dr. Aaron Neinstein (06:20):
As we were doing that and as we were starting to develop digital thinking within the organization, the really natural fit is marketing. Because if you look at who for the longest time has been thinking about the customer experience, who has been developing the digital technology stack to develop insights, using terms, “voice of the customer.” Who’s been using CRM technology for the longest? It’s all coming out of the marketing department. So, as we think about-

Chris Hemphill (06:48):
I have to pause you.

Dr. Aaron Neinstein (06:48):
Yeah.

Chris Hemphill (06:49):
I have to pause you to tell you that the way you phrase that is probably making somebody’s heart warm right now. Because-

Sarah Sanders (06:55):
It’s making my heart warm.

Chris Hemphill (06:59):
I’m just going to give a little bit of context. So, all too often that people look at the marketing part of the organization as like, “Oh, construct this billboard, or do this task, make this design pretty.” But just in conversation, Jim Blazer over at Hackensack Meridian, who’s the chief strategy officer. He said, “We want to look at marketers as strategist because of the types of experiences…” Not just the fact that they have a know-how around the CRM systems and the intro of the patient journey, but because that’s what they empathize with and live and breathe every day. So, just want to pause it and just emphasize that.

Dr. Aaron Neinstein (07:39):
Yeah, absolutely. If you think about what marketing professionals are great at, is understanding our patient’s needs and knowing when and how to reach out to them, and building analytics around that to continually improve it. That shouldn’t be applied just to lead generation in the front end of someone’s experience with healthcare. That’s what healthcare needs throughout the healthcare journey. Anybody who’s dealt with a chronic medical condition, taken care of a child or a parent with a chronic medical condition, knows that you need that intelligence that reaches out to you, helps you along your path. If you know that you need to go get some lab test done or go get a CT scan and then check back in with your doctor and then decide what therapy to take, those pathways in those journeys, we can build intelligence around that. That’s what people who are in marketing know how to do. So, I think it opens up a whole new world of opportunity.

Chris Hemphill (08:37):
Yeah. One thing that I want to tease out is a challenge. For marketers to communicate to technologists, they have to understand their perspective and where they’re coming from, too. So I thought it would be a really interesting way to tease it out if I were to ask, by working more closely with marketing, what have you learned? That’ll help people out there identify gaps in, “Hey, here’s where it’s coming from. Here’s some stuff that wasn’t intuitive to Aaron that maybe I should think about when I’m communicating with my own technology teams.”

Dr. Aaron Neinstein (09:14):
Some of the biggest learnings for me is the technologies that are out there in terms of tracking a patient throughout their journey. So, the ability to see what’s happening to someone all throughout every touchpoint that they have with us and track them throughout that process, and use that to learn where they’re experiencing friction. So, is someone coming to our website and they’re leaving? Are they coming to our website and they’re looking to see what our appointment availability is, and then they leave? Or, are they going all the way through to scheduling an appointment? The ability to have robust analytics behind that and really use it to surface those insights that really help you see and feel what a patient is seeing and feeling. I think, to me, that has been one of the biggest learnings.

Chris Hemphill (10:07):
Fantastic. That means marketers, the stuff that you’re living and breathing every day that just might seem like a every everyday nuance, don’t take that knowledge for granted. Right?

Sarah Sanders (10:17):
Yeah, absolutely. I think it’s always been a great partnership with our clinical partners to understand the needs of the patients and consumers, but I think marketers have an insight into, maybe, before they’re even patients. That part of it. Like, what are they searching for? What are their caregivers? What are their needs? I think they think about it maybe a little bit, I wouldn’t say broader, but maybe from a different perspective than maybe has traditionally been done in healthcare. Then when you combine all that together, you have just such a… We call it the 360 view of the patient. I think it’s significant. It’s real, because I think with all of the insights that we can glean both from our internal data, and our external data, and experiential behavioral data by just watching what they do with us, you really do have this opportunity to create a scalable, personalized, automatic experience that can actually get people help when and how they need it based on their own personal needs and preferences.

Sarah Sanders (11:31):
That’s what I aspire to. I think that’s the coolest potential outcome of the work that we do. Healthcare is so hard. It’s such an emotional journey, so hard to navigate. If we can just make it easier on people, particularly in the complex arena that we deal in. I went into marketing because my mother’s a nurse and grew up going to… She’s a nurse practitioner and worked with her in her practice on occasion, and just admired her dedication to the patients. But, I knew I was too squirmy for any of the direct clinical care. But, I always felt like healthcare marketing was different from other kind of marketing. You’re definitely having an impact on patients. We’re educators, we have a higher calling than you might think about when you traditionally think of marketing and growth strategies and things like that. I think we’re just trying to help people get where they need to go and do it with the most possible fulfillment in that experience. So, yeah.

Chris Hemphill (12:51):
That’s an excellent way to look at it because you looked at your mother as a caregiver and you thought about where your role in that delivery process is. Actually, a slightly controversial conversation we’ve been having is that… We can debate about this, but I would argue that because of the involvement in educating people about what services are available, and especially when you get into using that 360 experience, using data that you have to identify where certain needs are. That puts marketing in the care delivery process in a certain way.

Sarah Sanders (13:28):
Mm-hmm.

Chris Hemphill (13:28):
Well, I thought I was… I was ready. I had my boxing gloves ready, but the head was going this direction.

Sarah Sanders (13:34):
Yeah.

Chris Hemphill (13:36):
Yeah. I see that as directly the opportunity, right? Again, so let’s think of somebody who’s gone through their cancer journey and it’s an endless array of chemotherapy treatments and infusions, of lab tests, of pet scans. People end up needing to be their own care navigator and their own advocate. As doctors we’re terrified, also, that people are going to fall through the cracks. That just because you order the pet scan to be done in three months and six months, we rarely have the systems that really help the person get there and make sure that those tests happen at the right times. So, I view it as a huge opportunity to make sure that people don’t fall through the cracks and to know that, yes, you should have a pet scan at three months in six months. Then, your infusions are at one, two, and four months and to make sure we help you schedule those, come to those, get educated before and after. Make sure that you’re connected with your doctor and your care team at the appropriate time. I think that’s a huge opportunity.

Sarah Sanders (14:45):
I think it’s a relief on the provider side. Like, how do you think about a provider and the heavy weight that they carry? You know what I mean? How do we make their day easier so they can really add what they need to for the thing that they can only do with their patients. So, I think it’s not just about the patient experience. It’s our providers, especially after the last couple, are burnt out. They are overburdened. It’s hard to be a physician or a nurse in this day and age. Again, that’s another part of just that trying to help. I think we can help the providers just make their days a little easier if we can help educate their patients in a way that’s streamlined and supportive of the customized advice that they get through their physician. I think that helps both sides of the equation. It’s designing a better system so that everybody feels supported and educated.

Chris Hemphill (15:52):
Yeah. On both sides of this conversation I have to say, I’m personally just impressed by the empathy for each other’s roles and the understanding of where each other fits in the whole care journey. For the people that are out there in their organizations, for the people that want that 360 experience, but feel like they’re going at it alone. Like if you’re on the marketing side, but there’s not that communication, not like you’re still in that siloed environment. I’m wondering if we can get into maybe an example or just specific of what the cross-functional world looks like. What does these cross-functional teams and relationships look like? Just as examples that we can call up our bosses and say, “Hey, there’s a better way,” And that they’ll send this segment of the YouTube video or something.

Sarah Sanders (16:42):
Yeah, well maybe we could get an example. But I think to start out with, I think what makes our organization special is that this was from the top. This was a commitment of our leadership, a commitment of resources, and a commitment to create, or at least try, a different way. You know what I mean? I’ve been on the marketing side when you’re trying to do that, and you just hit one barrier after another. Nobody sees it as being the place of a marketer to get further down that journey. So, I think it does start at the top. It takes a commitment from the organization. I think in our instance, I think it was about hoping to create an experience that leapfrogged others in our industry and competition. Really, for the purpose of some people do this for growth. Some people do it for a population health strategy. They put all this infrastructure into place.

Sarah Sanders (17:53):
UCSF, I’m just giving a plug. I’ve only been there six months, but I’m already enamored. It really is a place where people want to do the right thing, and so customer experience is the reason we’re doing this. We want to create a better experience for a customer, and we have a ways to go, so there’s opportunity there. I think it’s so important that you get leadership buy-in and I don’t know how you do it without that. I think you do have to get in there and probably find a supporter, somebody who maybe individually… Find a physician who believes that this is the right way to go and maybe pilot and experiment and show a model that works. I guess that would be the advice I would take for somebody who doesn’t have the kind of infrastructure already in place.

Dr. Aaron Neinstein (18:49):
Yeah. So, agree completely with everything Sarah said. Two examples that come to mind where we’ve really felt the power of the cross-functional model. So, one is Sarah and I are part of a customer team that’s really looking holistically at our customer experience for UCSF, and membership of that team includes design and Sarah for marketing. We have our patient experience director. We have one of our chief operating officers, so an operations individual there. We have a data and engineering representative on that team. I think one of the insights we’re starting to see is, as we try to develop voice of the customer data from around the institution, that has traditionally lived in siloed areas. The experienced team gets our Press Ganey surveys and our HCAP surveys and marketing has been responsible for our star ratings and our patient reviews on the web. Being together on this team, we are starting to look at, how do we actually bring all of that data together to serve the needs that we have as an institution and move those data out of their historical silos. That’s one place I feel like we are really starting to see the potential value.

Dr. Aaron Neinstein (20:08):
Another example that comes to mind is the work that teams have done around the head and neck surgery campaign. As Sarah was talking about, we did stand up new patient self-scheduling. So, self-initiated from the web. These are not referred individuals to our head and neck cancer practice. We built a cross-functional team around that. So similar makeup, marketing, operations, engineering, design, product management, data science, and that team was looking at the experience for somebody shopping for care or seeking care from the web. They were able to build not just the scheduling part, but because it was a cross-functional team, they also built the analytics underlying everything. They instrumented the entire process from web all the way through to scheduling, and they built the campaigns using Salesforce and Marketing Cloud. We now are able to, from end to end, go all the way from advertising and campaign, to scheduling and to the appointment, and actually measure the whole thing.

Dr. Aaron Neinstein (21:18):
What is also really exciting and powerful about the model is, it wasn’t just a team coming together to do that as a project, but that team is staying focused on that area of what we’re calling the prospect patient experience. So, that team will continue to make that model better and to improve that process and the patient journey over time. They don’t just disappear and go back to some other day job. We know that experience is important for UCSF in perpetuity, and so we will continue to have that team improve it iteratively through the learnings that they gather.

Chris Hemphill (21:55):
Wow. When you’re naming all these different people that are coming together, different organizations, context, background languages. We could of course have a video where we pretend that everything goes smoothly every day and all that. But really, one thing that just opens up is, well, what about disagreements and dissonance from folks all coming together under this. Could you talk about just some things that you’ve seen and how that’s overcome? How you iron through these types of scenarios?

Sarah Sanders (22:30):
Yeah. We could talk. You could go first.

Dr. Aaron Neinstein (22:33):
I can start. I think one area where we probably could have done a better job, also, is in role clarity at the beginning of forming these cross-functional teams. Because, what has happened historically is decision making and project work happens to the org chart. So, people are familiar with their own teams. It’s the people they work with all the time. When you pull people out of that context, as you’re alluding to Chris, and you take someone from the design team and you take someone from data science team and you take someone from marketing, and you put them together in a team and say, “Now you’re focused on the experience of a prospective patient. Who’s looking for care at UCSF.” They’re not used to working together. They don’t necessarily know what each other’s expertise are, what they do. So spending time actually clarifying, this is the role of a product manager. This is the role of a designer. This is the role of marketing. This is the role of data science. I think we could have done a better job at that internally.

Dr. Aaron Neinstein (23:31):
This was our first version of putting forward cross-functional teams and we’re going to iterate and improve our model. I think that’s one area. I think another is the decision making process. Again, same thing. People are used to decision making happening through the org chart hierarchy. We’re trying to move more decision making authority into those teams and allowing them to make more decisions and that requires a lot, as Sarah was talking about. Leadership buy-in to nudge teams to be the ones to make those decisions and empower them to make those decisions. When they start looking around at, “Oh, I’m the one who gets to make that decision,” encouraging them to do it.

Sarah Sanders (24:16):
Yeah. I think it’s also… I play the role of both a functional leader and then a leader within our digital patient experience, which is our cross-functional team environment. It’s been really helpful because I guess I get the perspective of being a functional leader because not all of our functional leaders are in our cross-functional teams. That’s hard for somebody to get their head around, I think, to see what’s normal course of business, keep going on what your functional accountabilities are, and what’s the kind of work that gets done in this cross-functional innovation environment. I think we still have folks, because we’re early on in this, really struggle with… These aren’t competitive with each other, they’re actually complimentary, and we’re not replacing any foundational systems. We’re hoping to accelerate the foundational systems and then experiment with patient journeys and experiences within the context of those systems.

Sarah Sanders (25:26):
It makes it complicated sometimes, but I think that’s some of the dissonance. I think we’re still getting over getting people to understand what the roles are and really what they aren’t, so it’s a work in process. We’ll continue to communicate. You just have to really communicate. I think that’s the core of it. Tell your narrative, tell your stories, tell your successes, but a lot of communication.

Dr. Aaron Neinstein (25:55):
I think building trust on the team, also. I noticed like even at our customer team that Sarah and I have been part of for maybe about six months now, I think early on, we weren’t quite sure what each other’s boundaries were. Again, you’re bringing together people who come from all these different contexts. I think we were sort of like nervous to step on each other’s toes. I think we’ve built up trust over time, and so the ability to just be candid with each other and say like, “Okay, do you have that or do I have that? Or, is this something you want to take on? Is that something you want me to take on?” I think just building trust in that cross-functional environment becomes so valuable.

Dr. Aaron Neinstein (26:37):
I think it takes time, and you have to really be committed to the process because I think there’ve probably been a million times along the way where we could have said, “This is a lot of effort. There’s a lot of time we’re putting into this. Maybe it’s not worth it.” But, I think we all see the bigger opportunity and the vision and so we’re committed to really working through all those challenges.

Chris Hemphill (26:59):
Well, I’m really thankful that you came and laid out what this cross-functional relationship looks like and were very specific in the types of roles that come together and the types of problems and challenges that people face. Knowing that that top down effort is required, hopefully the examples that you share will get leaders to think from that perspective. And, if someone isn’t from that top of line angle at the manager director level, et cetera, but want to get the attention, hopefully by sharing your examples, that can start getting people to start thinking in that direction.

Sarah Sanders (27:40):
Great.

Dr. Aaron Neinstein (27:41):
We hope so. We hope our stories help.

Sarah Sanders (27:42):
Yeah, we do.

Chris Hemphill (27:44):
All right. Well, again, appreciate you very much. Real quick, just the best way for people to be able to get in touch with you if they want to learn more about these stories, like social media or whatever.

Sarah Sanders (27:57):
Oh, sure. Well, we have very easy emails. It’s Sarah with an H Sanders, S-A-N-D-E-R-S-U-C-S-F.edu.

Dr. Aaron Neinstein (28:08):
Same, it’s aaron.neinstein@ucsf.edu. Also on Twitter, @aaronneinstein is another good way to catch me.

Chris Hemphill (28:17):
Great. We’ll just leave those details in the show notes.

Sarah Sanders (28:20):
Okay.

Chris Hemphill (28:20):
Great. All right. Well, thank you for spending time with us and everyone watching or listening, we really appreciate you and your interest on this topic as well. We want to see those silos broken down. We want to see organizations working together and making a commitment to the patient. Now, one thing that I want to emphasize is that we’re talking as a health system leaders in this topic, but we don’t want the patient voice to be left out either. So, we actually did interviews with patients about the experiences that they had, and these are patients who are also leaders. So, you get really interesting, really deep thinking about the positives and the negatives of the types of care journeys that they’re involved in. So, those videos are in the show notes as well, or you can click the links on the screen. So again, thank you very much and until we see you next time, hello.

Sarah Sanders (29:21):
Hello.

Chris Hemphill (29:24):
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