Friday, February 12, 2016

The Place of Passion in the Business of Health Care

I learned early in my business career, after being in medical practice that the way business people and medical people communicate is very different.  Besides having fundamentally different languages, clinical people tend to be more emotional in their approach to communication than people in the business world.  Sometimes clinicians can get a bit too emotional as they take the passion and concern that is needed when helping a sick patient into the business meeting.  On the opposite end of the spectrum are business people who are often in health care due to their profound desire to help others.  They can bring a hard-nosed focus on budget and margin and sometimes appear to be uncaring of the human impact of those numbers despite their commitment to helping.  Both sides have to understand and accommodate the emotional communication style of the other if our current health care world in which business, management and care are all intermingled has any hope to achieve higher quality and lower costs.   
Physicians and nurses know that passion is helpful when speaking with patients.  The patients and their families want to know you care, and that you share their sadness, their anger and their fear as they enter evaluation and therapy for problems large and small.  At the same time, the patient wants to feel that the health professional caring for them is the rock they can lean on and not be overly emotional.  The gifted doctor communicates emotions without inflaming them and is able to walk the difficult line of sharing sadness and happiness while also appearing objective and professional.
In the board room and in business meetings, physician often feel the need to communicate the emotions of the patients to the managers in order to underline the importance of the business decisions on patients’ lives.  In this way, physicians often feel when working with business people and managers that they must play the role of emotional middle-men (and women) communicating the patient feelings and reactions to the business professionals. 

In the business world however, the emotional speaker may be discounted and de-emphasized in the internal negotiating that often reflects productive business decision-making.  That emotionality may be thought of as reflective of less than fully rational deliberations and the one displaying the emotion may therefore be less credible than the one who can make a “business case” in a totally dispassionate way.  There is often a belief in business and management that rational analysis is inherently devoid of emotions. 

In the past few years, research on decision making and emotions have led to what Jennifer Lerner, one of the leading lights in this field (Prof Lerner is an advisor to Accolade), calls a “revolution” with the “potential to create a paradigm shift in decision theories.”  In an article published in the Annual Review of Psychology, she and her colleagues write, “emotions constitute potent, pervasive, predictable, sometimes harmful and sometimes beneficial drivers of decision making.”  While anger and fear tend to be thought of as impairing good decisions, even these types of emotions in the right situations can be useful.  In the preface to his book, “Feeling Smart,” Eyal Winter cites a study that shows when we are moderately angry our ability to distinguish between relevant and irrelevant claims in disputed issues is sharpened. 

At Accolade, in our early formative years, I sometimes took on the role of playing a difficult person calling Accolade with medical problems as part of our certification of new personnel.  During one of these certification calls, I played an unpleasant person, who was angry at everything.  The person I was testing, a talented business health professional was accurate, dispassionate and correct in everything he was saying.  In my role as the patient with the problems, his professional attitude made my character more angry as it made me feel as though he did not understand the urgency of my need.  I stopped my role playing and admonished him to stop being so damn professional!  He had to show emotions and allow himself to be more human to me as the angry person in order to build my trust and allow for positive influence.  At the same time he could not reflect my anger to the point of inflaming an already difficult situation.  He had to understand, acknowledge and direct both his and my (in my actor role) emotions in such a way as to create better paths towards high value solutions.  These same observations hold true for discussions within organizations as well as discussions with patients and other stakeholders. 

The issue of how we reconcile the differences in emotional communication between clinical health professionals and managerial health professionals in order to develop systems that are optimal for patients is critical.  We must, when designing health delivery and care management systems, build them in ways that encourage the understanding of emotions in order to foster better decision making by all involved.  Unless the people on both the clinical and managerial sides of health care can come together and communicate well, the chance of developing better ways to build  structures and processes that encourage doctors, nurses, patients and families to work together for maximum effectiveness and efficiency is significantly hampered. 
In health care especially, the decisions that doctors, patients and families must make when someone is sick are perhaps more fraught with emotions than almost any other decisions.  Our management systems must reflect, acknowledge, and proactively address this reality.  These realities must be understood and used in the same way that objective data, both quantitative and qualitative is understood and used.  Failure to do so, whether in care management decisions or business decisions will result in poor results for the patient and the organization. 

At Accolade, we take an approach which involves acknowledging the emotions, understanding them and then either attempting to encourage them, minimize their impact, or direct them in a more useful way.  Internally, as a company combining smart people from the clinical and business worlds, we constantly work to understand the different emotional communication styles that all of our dedicated professionals bring to the table.  In the same vein, for care delivery systems, equal focus on the providers’ emotions while working with patients is also critical.  As Winter says, “our emotions are more rational than we think” and in health care, we must bring the same rigor to their evaluation, study and to the impact they make on medical decisions as we do for staging and treatment of cancers and other diseases.  We are human.  Emotions are part of the human condition.  Let’s stop making believe they are not important or not relevant to care and to good management and address them constructively.