Science-based medicine

Welcome to the 47th edition of my customer strategy newsletter. The five topics this week are:

1. IKEA and customer experience – Ingvar Kamprad RIP
2. The customers (in this case the patients) should not always be given what they want
3. Latest blog posts
4. Notable items from other sites
5. Looking forward

Ingvar Kamprad founded IKEA, lived not far from me for a long time, and pioneered all sorts of interesting things. Following his death, I asked a few people what they thought of IKEA, and what they found memorable. Here is what I retained from that, together with my own views. Yes, it is quite easy to find negative articles about Kamprad’s distant past and some poor experiments with monitoring employees, but I will spare you all of that.

My first encounter with IKEA was shortly after moving to the Netherlands in 1985 to join Digital Equipment Corporation. I moved there from my eighth relocation with the Wrangler jeans company, which was an 18-month stint in Scotland. The clothing industry did not pay very well. While I loved the Scandanavian style I saw in the IKEA store in Arnhem, I had not yet mentally adjusted to having enough money, and bought my furniture from a cheaper Dutch alternative.

IKEA’s first stores outside Sweden were here in Switzerland. While his company was greatly admired in Sweden, Kamprad made himself unpopular by seeming to move to Switzerland to avoid paying Swedish personal income tax. (Wealthy foreigners can negotiate their tax rates when they move here, even with relatively low incomes.)

One of Kamprad’s then innovative great ideas was to outsource manufacturing of his furniture to a low-cost country. In this case, Poland was that country, well before the Berlin wall came down. Making that happen was a major challenge at the time.

He was legendarily frugal. He drove around here in a 20-year-old Volvo.

He set up his stores so that the whole family family could enjoy the trip and stay several hours without getting bored. Store features include cheap food and free play areas for children, along with the considerable labyrinth inside the store itself. Personally, I still like visiting, and feel the model apartments of different specified sizes are a great feature.

Homeless and destitute people often go to the Geneva store early in the morning. For $1.50 anyone can have a croissant, bread, butter, jam/jelly/Nutella and unlimited coffee or tea. Plus the store puts no pressure on people to leave, ideal on cold winter mornings. This is part of a broader phenomenon of trying to do at least some good in the local communities where they are present.

It seems to be an attractive place to work, at least around here. Employees receive a 13th and sometimes a 14th month salary at the end of the year. And there is one day a year where all profits from sales are shared by the employees. IKEA promotes this well, and it always seems to be a busy day.

Customers / patients should not always be given what they want

I feel quite strongly about this subject and will write about it at greater length soon. The current state of customer satisfaction measurement and health fads in medicine is probably killing people. OK, this is just my view, and may be an exaggeration. However, I generally try to base my views on facts.

I write this after listening to a superficially excellent podcast by Jeanne Bliss. She interviewed the Cleveland Clinic Chief Experience Officer, Dr. Adrienne Boissy. You can listen to the podcast here. She described the work Cleveland Clinic has done to implement customer experience measurement and improvement processes.

However… I have to call out two major major (not a typo) issues. One is generic, and applies to all healthcare institutions that survey patients. The second is specific to Cleveland Clinic. (Apparently they have dropped the ‘The’ from their name.)

The first issue is that (in my opinion) measuring patient satisfaction with doctors exclusively at a transactional level is an awful idea. Cleveland Clinic went further and put the doctors’ ratings online. My views on this are based on the third of a three-part Freakonomics podcast series called ‘Bad Medicine’. Stephen Dubner spoke to Marty Makary, a surgical director and health policy scholar at Johns Hopkins. According to Makary:

 “By putting all this attention on customer satisfaction or consumer satisfaction or patient satisfaction, we’re creating a consumerist culture in healthcare. People come in, they want an antibiotic for their kid. They don’t care what your diagnosis or explanation is. They want to walk out with that antibiotic prescription. Or you’re in pain and you want that pain script. If the doctor is under the microscope for their patient-satisfaction scores, you can imagine the perverse incentive here.”

This is supported by a 2012 article in the Journal of the American Medical Association. Of course it is all made worse by people’s tendency to believe their ten-minute Google search is just as robust as a doctor’s ten years of training. I feel that everyone working on patient experience in healthcare needs to remember that the purpose of doctors is to help you, not to please you. 

The second issue is that Cleveland Clinic includes a ‘Wellness Institute‘ that practices ‘integrative medicine’. The principle of integrative medicine is to combine scientifically-proven techniques with others that have no scientific basis at all. You can read this article from the Science-Based Medicine website to get a better understanding of their Wellness Center, and even the personally-held anti-vaccination views of its leader. The issue with ‘Complementary and Alternative Medicine (CAM)’ is that outcomes for serious diseases are worse than for evidence-based medicine. Sometimes much worse. If you scroll about a quarter of the way down this article, you will see a set of graphs that demonstrate that survival rates for people who start off with CAM are far worse than for those who use evidence-based medicine right away. This (according to the biography I read) is what happened to Steve Jobs, who had a rare form of pancreatic cancer that is curable, but he rejected conventional medicine until it was too late to save him.

It should be obvious that I am against CAM, and indeed many nutrition fads that are held to be ‘traditional’. The next time someone tells you that you need to ‘avoid all the chemicals and toxins’ by switching to nutrition or medicine that is hundreds or thousands of years old, ask yourself how long people lived back then. Is that what you want?

As for patient research and doctor ratings, it should be based on outcomes. For example, three or six months after hip replacement surgery, ask the patient ‘How functional is your hip?’ and ‘Are you happy you had the surgery?’. Almost nobody does this. These are far more important questions than whether the receptionist was nice to you, or whether the doctor was in a good mood.

Our latest blog posts

Here are the latest posts. All three listed below are about types of teams you may want to implement if you are designing a new customer experience strategy for your company. Older posts are still available on the blog page.