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  • Writer's pictureLisa Williams

Crying in the Clinic

The definition of Agitated Catatonia, a diagnosis I recently received, means that a person decreases reactivity to their environment. It can include hours of meaningless motions and actions and it can be debilitating for the patient and frightening for onlookers. It's mental illness that can be short-lived or ongoing. Exact causes are not understood and it can be linked to both psychiatric and physical illness and it can, in most cases, be successfully treated with rest and therapy.


As a Marketing Executive whose "brand" is optimism, Agitated Catatonia seemed like a stretch diagnosis for me. My moniker is @SEOPollyAnna, a nod to my belief that the job of Business Strategy, Content Strategy, User Experience, MarTech implementations, SEO, Local Search, and other Marketing disciplines should start with the needs of the customer and that focus will organically impact improved metrics across other marketing disciplines over time. This diagnosis was devastating to me personally and an affront to my "brand" of optimism.


Respiratory illness, lack of sleep, recent loss of a job, wonderful life changes (got married a few months ago), stress, and lack of prioritization in work and day-to-day life had me in a programmed state of fight or flight. These and other realities began crashing into each other and I ended up spending two days and one night in the ER to address this mental health crisis. That time, and a couple of weeks prior, was marked with erratic behavior, irritation toward the people I love the most, and a clear indicator that something needed to change.


I've been a Marketer for 28 years and served in healthcare for nine years. Healthcare is (US Economy only) responsible for $4.5 trillion or $13,493 per person (2022 data), the healthcare vertical employs millions and serves hundreds of millions, and is responsible for much frustration for patient and clinician experiences from a combination of complexity, friction, administrative bloat, greed, and lack of data or at least connectivity of that data to drive decisions for iterative improvements.


It's also chock a block full of the best people and contributes to some of our lives most important experiences.


As my friend T Timbreza shared, we should always say Patient Experience, not Patient Satisfaction because no one is "satisfied" about going to the hospital or clinic. Our healthcare experiences can be improved by both deeper understanding of the system, better data readiness (connect it, analyze it, and make decisions about it together as an org or system), and better governance around defining steps from searching, scheduling, way-finding, appointments, and diagnosis to either resolution or ongoing care.


I had spent several days prior to my diagnosis of Agitated Catatonia (most Catatonia is Waxy or Still, meaning the Agitated sort is far less common) crafting a blog post/presentation that outlined potential optimizations for my personal healthcare experiences to date. I hypothesized that my experiences and how I managed my health at home and within the healthcare vertical itself might have similarities to how other humans experience the duality of healthcare: great people and super not great systems.


Spending two days in the ER in a padded room with a threadbare sheet and blanket and little connection to others was both terrifying and illuminating. I remember very little about that two-day experience other than the total lack of comfort, lots of fear, and deep sadness seeing my husband and son so concerned for me and at a loss for how to help. I was also struck in the following days by the care, love, comedy, joy, and connection expressed by my family and friends who are my Care Team in collaboration with wonderful medical experts.


Now that I'm making decisions about what's next for my health and my career, I'm experiencing healthcare journey friction in a very real and visceral way. It's also a gift as a marketer to be able to have a patient/customer experience that I can tie to the work we do.


There is so much good work being done by Clinicians, Operations, Marketing, Tech, et al, to meet these important customer service moments, but there is still so much work to do to improve and get to a full, seamless, accounted-for customer experience and it can't be improved without a leadership investment (top to bottom, vetted and shared across the entire org). Those experiences and the goals around them should be known and understood by all employees, partners, vendors, etc. Our shared goals, metrics, governance, and reporting are collaborated on by many folks respected and heard for their expertise and aligned on those goals.


Healthcare, you're full of amazing people, yet we don't have a stellar example of how this User Experience work is done seamlessly. Getting a system aligned on shared goals that drive people and money resources across the org is the hardest of work. I also know that the smart, brave, resilient, resourceful employees who do the work are tired of doing ALL of those things. What are we each doing separately and what are we all doing collaboratively to improve experiences? Talk about it, report on it up and down and across the org.


Referring back to the investment topic started here, these improved experiences across many people and many skills may need to be managed as a program, not a project. Iterations to experiences big and small could be documented, managed, tracked, discussed, loved and even abhorred across all departments. If the insights from your reporting aren't being heard, shared, talked about quietly, debated loudly, and pondered over at the water cooler your reporting is less-likely to matter and to impact non-clinical patient experiences, or other "experiences":


  • "digital experiences"

  • "web experiences"

  • "user experiences"

  • "customer journeys"

  • "employee experiences"

  • "wayfinding experiences"

  • "contact (any modality including phone call, video, telehealth, email, text, etc.) experiences"

  • "customer relationship management tools"

  • "many, many experiences to have and many ways to describe them, but they all matter"


  • Define why

    • Have we answered why the person is in the hospital, ER, or clinic (planned or unplanned, etc.)?

  • Define current state

    • What's happening in this moment of being admitted?

  • Define next steps

    • What's likely to happen next? Extra points if your answer is you don't know because you don't. Though what comes next is highly dependent on assessment of your diagnosis, it can be helpful to learn even some basic next steps.

  • Define an action plan

    • Bring together expertise between providers, documentation (including Epic), Healthwise or other medical content and an action plan. It's clear Epic is full of medical language most of us don't understand, that's okay they're working on it . But where are we including clear language? If it's not in Epic or your EHR, or on your website, or linked to good existing content and it's not printed in the documentation then where is the content, focused on health literacy, that will help me align on working with my providers to get to a plan? The plan should include your expertise and my expertise. Also, four days after my release I don't have much more insight in Epic updates to note yet, but it did know pretty quickly that the cost of services was $7650.

  • Write, curate, and share content for the right person, at the right time

    • In this experience, my packet used the words suicidal and homicidal more than 10 times. That's a disrespect considering suicidal thoughts or ideation has never been a problem I've dealt with. It is, however, one that has threatened at least two and maybe more people I love. We cheapen the word and lessen its meaning for clinicians, patients, and caregivers when we are this careless. Be specific. Be accurate.

  • Providing clarity about choice

    • I am the CEO of this body. The plan is my plan and it is made with your clinical expertise and my subject matter expertise on me, myself, and I. Where you have precision in the art and science of medicine, great. Where you don't, be honest. Those decisions (unless legal is part of the calculus of a situation) are ultimately mine. I was lucky (once a correct diagnosis was made with a psychiatrist) to have a wonderful doctor who spoke to me with compassion, understandable explanations, honesty, and hope. I'm also lucky that my husband encouraged me to follow up with said psychiatrist because he felt the provider had been very connected and kind. This particular provider, the psychiatrist and subject matter expert who gave the diagnosis, was not referenced in my take home packet, but his part in my care was incredibly important. The very kind clinic manager who called from the clinic to which I had been "assigned" post-discharge, knew very little about my care and wasn't able to answer some basic questions about next steps. Primarily that was a function of lack of information (a determinant of health) not her competence. Taking a hard look at ALL content shared with patients and making decisions about where that content comes from and how it's linked to, created, consumed, shared, and referenced is Content Strategy. For example, Google has made and continues to make large investments in medical content. Maybe internal (or vendor) content teams don't create condition content, but reference Google's content including videos. Saving content resources for your differentiating content as a healthcare system could lead to a more strategic investment in that content. That may also lead to happier, more productive, more creative, more strategic content creators who are focused on the work of creating new content people need, not more content that has already been created to answer questions about medical conditions and diagnosis.


I thank the good people who cared for me, yet I am wildly frustrated with much of the follow up. Here are five ways my experience could have been markedly better with non-clinical intervention from Operations and/or Marketing:


  1. Provide context

  2. Provide content

  3. Unsilo the touch points (that includes data about the visit, my EHR content and my printed documentation sent home with me doesn't have to be exactly the same, but it should not be in conflict with itself:)

  4. Connect the right people for the care plan

  5. Provide hope with honesty


It is both a blessing and a curse that Marketers experience first-hand the user experiences they need to improve, the cross-functional collaboration and governance that is missing to address that improvement in real-time, and the lack of healthcare data readiness to address these potential leaps in service design and user experience.


The most encouraging experience post-diagnosis (besides my short but very helpful interactions with the psychiatrist and ongoing support from my therapist) has been use of BetterHelp. I challenge anyone who creates "digital front door experiences" to walk through the implementation, adoption, usage, and insights the technology provides. The lack of friction, ease of use, seamless UX/UI, and communications/planning in the app is outstanding. The majority of systems lack exceptional healthcare experiences enabled by the tech. We have a challenging road ahead and lots of opportunities to make an impact. Likely those improvements will come, not from the tech, but from more integration, collaborative thinking, and planning upfront as well as better governance and adoption of MarTech working together to improve the non-clinical parts of the patient journey so we experience less friction and more seamless engagement across touch points that matter.


This challenging and rewarding work is good for the patient and for the system.


COLLABORATION QUESTION:


How are you and your Marketing teams addressing the non-clinical parts of the patient experience?


The title of this post "Crying in the Clinic" is an homage to Michelle Zauner, author of "Crying in HMart", a beautiful memoir about the power of connection, culture, and food in our lives. Thank you to Jess Columbo for the reading rec:)

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