Patients as Partners in Design, Strategy, and Innovation

Podcast Transcript

Adrienne Boissy: Welcome to another episode of Studies In Empathy, a Cleveland Clinic Podcast exploring empathy in patient experience. I'm your host, Adrienne Boissy, Chief Experience Officer here at the Cleveland Clinic in Cleveland, Ohio, and I'm very pleased to have Julie Rish who is at the Cleveland Clinic. Julie, welcome to Studies In Empathy.

Julie Rish: Thank you.

Adrienne Boissy: As many of my guests, you have a gazillion titles. Can you start by telling me a little bit about what you do here at the Cleveland Clinic?

Julie Rish: So, I wear three hats. I'm one part a clinical psychologists, spent my career in health behavior change, specifically obesity. I'm one part director of communication skills in the medical school, so training up thnext generation of medical providers and how they communicate with patients, and then I'm 100% patient experience in leading efforts and applying human-centered design to our work.

Adrienne Boissy: Great. Do you actually divide into three parts?

Julie Rish: Wouldn't that be great?

Adrienne Boissy: You just marry those all together. I want to start a little bit with your journey. You were telling me that you grew up on a farm and yet had a community of doctors. Talk to me a little bit more about what that's about.

Julie Rish: Yeah. So, I think it was an interesting world to grow up.

Adrienne Boissy: Sounds like it.

Julie Rish: So I was a farmer's daughter and a plumber's daughter in a community of largely physicians, or at least well-educated, well-employed people. And so if you tease those apart, I think in one part, living on a farm teaches you a lot about humility in life, life and death, taking care of something other than yourself, keeping them alive.
Also, contributed to mostly being vegetarian and not wanting to eat your pets. But, I think it just taught a lot about humility that now the world is bigger than you are and you've got gotta work really hard to shovel stalls in the middle of winter in Ohio.

Adrienne Boissy: So, it's really funny we're having this conversation today because just this weekend I was having a conversation with my children about their electronic gadgets because they wanted to know if they could get more apps and I couldn't take it anymore. So I said, you know what we're going to do? You're gonna make a bunch of cards for people in the hospital and then we're going to go deliver them, and so-

Julie Rish: That's beautiful.

Adrienne Boissy: ... our Saturday morning was actually spent getting you off your electronics and bringing your cards to patients at the hospital. Because I can't take this. There's something about this. I don't know if it's just child's eyes, they think the world revolves around them, but maybe it's more cultural that we need to infuse actively "It's bigger than you."

Julie Rish: Yes.

Adrienne Boissy: So, it sounds like you've learned that on the get go.

Julie Rish: Yes. Kicked out, get outside and do anything, but don't be inside.

Adrienne Boissy: And hard work, right?

Julie Rish: And hard work.

Adrienne Boissy: You're up at 4:00 AM. That is what I hear goes on at farms, but I...

Julie Rish: Yeah, not quite four AM.

Adrienne Boissy: Okay, but close?

Julie Rish: ... but up early...

Adrienne Boissy: Sorry. Up early.

Julie Rish: ... working really hard. It's funny, this makes me think of a story of my dad. He asked me to go get some kind of tool from the barn and he's, I'm dilly dallying, I'm goofing off, doing my own thing. And he looked at me and said, "Julie, if I could have done it faster than you, I wouldn't have asked you for your help." And it was just this really interesting moment about what does it mean to work hard and what does it mean to actually help someone else. And so just taught me a lot about how hard it is to manage the complexities of life.

Adrienne Boissy: Yeah.

Julie Rish: And then if I think about the plumber piece, that's also interesting. So it was an interesting world to be in the small school, mostly doctors kids and to see how people treated people based on the work they did.

Adrienne Boissy: What they did. Sure.

Julie Rish: And so I think that I've always been slightly neurotic, super interested in communication, very observant. And that always bothered me. Just how people treated and made assumptions based on...

Adrienne Boissy: Give me an example of how that played out.

Julie Rish: Yeah. So I think that dismissive nature. So I remember one time watching my father and a friend have this debate. It was over something stupid, like a parking ticket. And every interesting argument that he navigated was just dismissed as if my education and all that I learned when I was in college taught me this. And no appreciation for the fact that his life had different lessons that he had to learn and navigate that makes him equally competent and intelligent. It's just he lived it in a different way. He didn't go to college and have the privilege of that.

Adrienne Boissy: You know, I bartended Boston for 10 years. It's not the same situation? But I remember people would just look at you and make an impression and I remember explaining to one of my patrons that I actually did neurobiological research during the day and they burst out laughing like "There's no way. There's no way that's what you do."
And I thought, this is such an anthropological study of how biased we are at times based on the job they have, the look they have, the intelligence we ascribed to that. It was fascinating. Fascinating. I'd recommend it to anybody.

Julie Rish: You think you quickly make an assumption, right, of where you learn...

Adrienne Boissy: Milliseconds, right?

Julie Rish: ... your life lessons from. And I can very accurately say, I learned so much more from the guys that worked with my dad than I did from...

Adrienne Boissy: All this education, perhaps.

Julie Rish: ... these really super smart, super accomplished, super bright people, and the lessons that I want to take forward in my life about what do we value, what does it mean to be humble and appreciative of the people around us and, and willing to learn from anyone.

Adrienne Boissy: So on that note, unlike many of our other guests who have been working with staff, physicians, you've been working for some time at the other end of the spectrum with medical students and medical student learning. Talk to me a little bit about some of the differences, maybe even in the vein of where you think medical students are coming in today, both in their own head, expectations about the future culturally. What makes them different from many of the staff that we might be training today in patient experience efforts?

Julie Rish: I think what's nice about our medical students is that they are just so eager to learn and they're so open to anything. And I think that that changes with staff, right? There's jading of experience. So I would say that they're thirsting for knowledge of, how do you navigate these complicated conversations and what does empathy look like and how do I elicit someone's perspective and then how do we make certain that we're on the same page in that treatment plan. So I don't know if it's different as much as it is that they're just open to navigating that future with you and...

Adrienne Boissy: Being curious, maybe?

Julie Rish: ... and being curious about what does it look like.

Adrienne Boissy: Yeah. So let's talk about what drew you to psychology.

Julie Rish: Yeah. Interesting. So I grew up on a farm as a plumber's daughter and I was very... I don't know, I was always a neurotic kid, worried about money and sometimes that was very justified that sure, money was tight. And so I always wanted to be a professional something that made a reasonable living. And when I was a kid I wanted to be a vet and then I realized, well, it might be just more interesting to talk to people. So then I thought, "Wow, I'll be a surgeon." I went around with, ironically, a bariatric surgeon who is a family friend. And I just about passed out constantly throughout the day and I thought, well this is just not worth it. I am not doing this.

Adrienne Boissy: Something doesn't seem to be working for you. Sure.

Julie Rish: So I worked for my guidance counselor at school in high school and I thought, "Wow, what a cool job.You just talk to people all day and you help them figure out what's next and what their future looks like and what could their career be." And so it just seemed very interesting and fun and light. And so when I was in college I thought, "Well I'll just study psychology, we'll figure out the med school thing or grad school thing as we go." And it just fit. It kept me curious and interested and I think people are interesting. What makes you tick?

Adrienne Boissy: Oh, they're fascinating. What are you talking about?

Julie Rish: What makes you make that decision? I don't understand.

Adrienne Boissy: I don't think you're supposed to say that. You did what?

Julie Rish: It's honest.

Adrienne Boissy: Well you learned a lot of techniques, right? As to how to draw people out or maybe even reflect their own thinking or decisions back to them. Is that fair? I don't know that much about psychology, so I'm treading gently.

Julie Rish: Very Fair. I think it is about... It's interesting because it relates to my work today, but I think it's about understanding who someone is. What do they value, what motivates them, what do they need, what would be their ideal next step? And it takes you out of it in some ways. You're just the facilitator of helping them experience what life is for them.

Adrienne Boissy: And I would imagine though that people have to process some of the emotion that might get in their way to taking the next step, right? Like if you're scared or afraid or have had trauma, right? And we're talking about that so much these days with social determinants of health, if that's not processed right, everything else is worse.

Julie Rish: Yes. Yeah. And it's complicated. I think I say that and I think to myself, "Wow, that's an oversimplified explanation."

Adrienne Boissy: On my part?

Julie Rish: No, no, on my part, and it's so much more complicated than that because, right, people's emotions and how they navigate, and the time it takes to get someone from point A to point B to C, and then on, I think just some appreciation for the fact that that's such a process.

Adrienne Boissy: Yeah, right. Well, not to mention the time to get a psychology appointment, figuring out whether or not it's covered, paying for parking, right? It's not a small...

Julie Rish: In the 10 sessions you have.

Adrienne Boissy: It's not a small deal for people to take care of their mental health.

Julie Rish: Yes.

Adrienne Boissy: So let's piggyback on that because now you've been doing some interesting work leading our center on human center design to really better understand the journeys that our patients are on both emotionally and operationally. Talk to me about the work you've been doing most recently.

Julie Rish: So I think there's a few parts. I think there's one, how do we just set up a structure around partnering with patients and what does that look like and how do we operationalize that? I think the other part is often time in healthcare it's us designing something for someone else and it's flipping that and saying, no, we really don't understand what we need to design and we need to bring you in to that to be a part of that process.
And that's the part that I get most excited about. It kind of taps into that... This deeply humble and intentionally humble side of me that is curious about what people want and need and desire, and then taking that the next step and bringing them into the work with us with some intentional partnership and then creating experiences that people actually value and they can thrive in.

Adrienne Boissy: Yeah. So you're talking about two different things.

Julie Rish: Yes.

Adrienne Boissy: So I would just want to call that out for our listeners. So one is the idea of how do people who are trying to drive patient experience efforts think about partnering with patients?

Julie Rish: Yes.

Adrienne Boissy: And then the other one, although related, is really about how do we better understand their journey so that we can design care for them or design access for them. Let's actually spend a little bit of time talking about how we partner with patients, right? Because I think historically, you'd get a patient focus group and occasionally you'd ask them a few questions and then you go back and do maybe what you want to do and maybe what they said. That's sort of the classic model for patient feedback or they're run through marketing that we get some feedback from patients. But talk to me about how you've thought about patients as partners in our work, because it's really quite extraordinary, some of the things you've accomplished.

Julie Rish: So I really think it is that part where... It's shifting that model from, we created this shiny object, we put it in front of you and said, "Don't you love it?" You say, "Yes", because we're so far into the design process at that point. We spent so much money that we're not going back in time and changing it. I saw something recently where the longer time goes on, the more we love our own ideas. I thought that was a beautiful analogy.

Adrienne Boissy: Like confirmation bias? Right?

Julie Rish: Exactly, right? We love it. We've invested six months into this idea. And so flipping that a little bit in saying, "Okay, we have this potential opportunity or this problem." So take access for example, rather than us spending a whole lot of energy putting in front of you this really beautifully designed and developed prototype.

Adrienne Boissy: Your final product.

Julie Rish: Your final product, it's really asking someone to join me in the work and saying, "Is this the right problem to solve? Is this the right opportunity? Is this how you would go about it? Is this your interpretation of it?" But it is really very much about being a part of that process from the beginning and the onset of design. And so we've done some really great work I think in just one part, just building a program that our patients and their loved ones desire.

Adrienne Boissy: So describe a little bit how you've thought about partnering with patients and some of the challenges there. Right? Because it sounds like a great idea. I'm sure everybody across the globe is going to want to partner with patients, but it's a little complicated and it does require some infrastructure to actually support patients coming on to help us in this work.

Julie Rish: It's one part designer program that makes sense to our patients.

Adrienne Boissy: Like something they want to be a part of?

Julie Rish: Something they want to be a part of that they can get behind and I think part of that is all the things we talk about like that if they can be really a part of something and see that end results and see it iterate over time, that's meaningful to someone who's volunteering their time with us.

Adrienne Boissy: But then you have to onboard them. Right?

Julie Rish: Yes. I think the other part is just the actual logistics of bringing someone in, and we have to think about it that we want to bring someone who is safe, both safe health wise to step into our organization, but also for our own caregivers. Making certain that we have the right partnership, it's the right fit, that you're here for the right reasons and that we're going to be able to give you an opportunity that you can find meaning in. Because if we're not doing that, then we can't retain people in the program. But also it doesn't add the same value to either one of us.

Adrienne Boissy: I mean you're spending a lot of time actually now in the most recent iterations. Rather than just bringing a patient on and unleashing them as a volunteer per se. Right? The evolution I think you've created is around tell us what you're interested in, help us understand your priority areas and then trying to create that match.

Julie Rish: Yes.

Adrienne Boissy: Right?

Julie Rish: Best fit.

Adrienne Boissy: For more meaningful connection and work for our patients.

Julie Rish: Yeah.

Adrienne Boissy: And you're also getting them on committees?

Julie Rish: Yes. Yes, and I think we think of it in several different buckets. One, what are the project specific type work. So I am super interested in readmissions. Great. Let's try to find new work in that area. Whether it's a continuous improvement project or a committee that's focused on that, but how do we get you in a specific project around what you're interested in. And then we have just committees that meet and so pushing the agenda around that. What additional committees and you don't need me on that committee from patient experience.
It might be more interesting to have a patient on that committee informing...

Adrienne Boissy: Who better to talk about patient experience than an actual patient.

Julie Rish: Yeah, hospital acquired infection. I don't have as much experience but I have a lot of people who do and could really speak to the value of changing our protocol and practices. And then there's just standing committees that function on the day-to-day. They meet, they share ideas and generate solutions and then we have specific just kind of, "Hey we're doing this project, we have this prototype. Anyone interested in joining us for our two hour feedback session and we'll tell you what comes of it."
So really trying to provide different types of opportunities for people based on what do they have availability to do, but also what are they most interested in doing so that we are finding that best fit.

Adrienne Boissy: Yeah. And there's a pretty active group, I know with our IT group... full? Right?

Julie Rish: Yeah.

Adrienne Boissy: Have you been privy to any of those conversations to hear what some of our patients are saying about use of technology or methods to our technology madness?

Julie Rish: I am. It always surprises me how receptive our patients are to technology, and how opinionated they are about the design of that technology. So how do we continue to simplify that? How do we make it easier to use? How do we create output that's of meaning to the person that's reading it?

Adrienne Boissy: No, I think it's great that they're at the table. I remember years ago when we started the neurology at that time we called it Voice of the Patient Advisory Council and we had a bunch of architects come in. They were going to design a new building and it for neurology and what the architects hadn't appreciated perhaps at the time was many neurologic patients are actually disabled, right. Using walkers, wheelchairs. So not all the doors were automated, and so the patient group challenged all the architects to go spend time in our buildings, looking at the desk heights even. If you're talking down to somebody in a wheelchair, you actually don't want to be talking down to somebody in a wheelchair. But if your seat sits higher than the wheelchair sits, it aggravates, it amplifies that feeling that the disabled patient is less than.

It was fascinating, sort of study in how important it is. That in a more concrete example in our architectural design of our spaces, but making sure that empathy is optimized in our buildings, in our desks, in our design. So I love that. And then of course the architects did, they went out and spent a day in wheelchairs. We got it captured in photographs, and then they had to come back and share with the group everything they had learned. But it really made the patients and families feel heard. It was a spectacular small example of what I think you're describing.

So you also spend a lot of your time in human-centered design. So when the world is all a rage with lean methodology coming to healthcare and making things more efficient in healthcare, what's the value of something like human-centered design and what is it?

Julie Rish: It's a methodology like continuous improvement or Agile, and it's a methodology for problem solving. I would just argue that it's more about problem re-imagining and identifying opportunities. And it's really great in spaces where you're not exactly certain that that's the right problem or that's the right focus, or should we be going down this road? And what's really beautiful about it is it's designing around those closest to the work, so the people that are gonna touch that most often, and what do they need? What motivates them? How did they behave with that?
So it's a specific methodology that's about taking, what is it that matters most to all the stakeholders that are interfacing with that and then designing your solutions around just that.

Adrienne Boissy: Human-centered design is this methodology, right? Where you're empathizing with patients, you're going to Gemba, so to speak, you're spending time with them. And then there's three or four other steps where you eventually dream about what it could be based, not just on how people feel, but how they behave. Right? And then you try to implement. And then you rapidly cycle it through. Is that a good capture?

Julie Rish: Yes.

Adrienne Boissy: And then you iterate. So kind of that agile quick method. But it has very defined steps and it's very popular. Right? There's a nice statistic about companies that use human-centered design are Much more financially successful than companies that don't, because their products make so much sense to the end user.

Julie Rish: Companies that have an organizational commitment to design thinking outperform their competitors substantially. It's like 211%.

Adrienne Boissy: That's pretty amazing.

Julie Rish: It's pretty amazing.

Adrienne Boissy: And so why does it feels so new for healthcare do you think? We just didn't think like that before or we just did stuff and rolled it out? Or you think as patients get more empowered and we want them as partners, it's a opportunity to use a different methodology?

Julie Rish: I mean there's a part of me that thinks that part of it is that we assume that we have always done it without a method to doing that. Of course, I listen to my patients. Of course I care about the end user. And I think there's something very different about that culture of "I care about you" and then actually applying some methodology to that to really make certain we understand exactly, Why did someone behave in this way and what led to that, or what were the feelings related to that?

I think for healthcare it's been around in healthcare. I also think that we like quick and fast and "Lets just act." This is a methodology that takes time up front. In order to empathize and understand someone, you're going to have to spend a little bit of time and energy upfront, doing that in-depth interviews in people's homes and analyzing them and writing all of this up. That takes a lot of time and commitment and so I think that's a harder sell than that very quick, "Here's the process, this is broken, let's apply this method. Oh we have a fix, let's go with it." With human-centered design, the fix might be pretty disruptive and it might be, "Why are we doing this in the first place?"

Adrienne Boissy: This way, yeah.

Julie Rish: Maybe we need a whole new way of looking at this and that might be a harder sell.

Adrienne Boissy: Yeah, so give me some good examples. You've worked on some interesting projects here. I know both with the problem list itself as well as in collaboration with financial services. Pick one of those projects to tell me a little bit about.

Julie Rish: I'll tell you about the bill because that's kind of an interesting pain point for healthcare. So we did a project where we wanted to better understand just really our patients' response to medical billing. And we had this really interesting question. So there was a huge patient population that would go through four cycles of the medical bill and then it would go on to collections and then they would pay either part or all of that bill. And that was really perplexing. Like that's interesting. Why didn't you just pay us in the four cycles that proceeded that collections payment? Or what about our payment plans do we need to rethink? Because clearly they're not working. So we wanted to better understand that behavior, what's contributing to that behavior?

And it was really an interesting project where we did again in-depth interviews with patients. We went to their homes, we asked them to show us, tell us how do you categorize your bills, where do you store them, how do you file them? How do you know what's due? And people had just absolutely gorgeous ledgers, beautifully handwritten ledgers and beautifully organized and in this desire to pay us the challenges that either they couldn't pay us in the amount that they wanted, or they didn't understand that we were actually asking for a payment and that insurance had paid what they could or would and that it was just really overall quite complicated. It wasn't an easy bill to understand. So we learned a lot in that process.

But I think one of the things that really stood out to me is this concept of trust being really quite fragile. And in the same sentence multiple times, we heard the statement that, "I trust you with my life. I'd never seen anyone other than you, and I'm quite certain you're taking advantage of me financially." It's sad and kind of awful. And it was really about the design of that bill in the back end of it, that it was so confusing that it almost felt to patients that, "Maybe you just make it confusing so that I don't understand and I don't ask you those questions."

Adrienne Boissy: And I want to highlight a couple things about the bill, because it's growing dialog in patient experience. One is, we've been in an organization that centralized the bill first years and years ago, credit really to our colleagues in finance, right? So rather than getting a different bill from every single hospital, you're getting one bill from the Cleveland Clinic. So that was a step forward. And then we've regularly gone... It's very interesting, right? We've regularly gone and done market research with patients about the bill to constantly iterate and iterate and iterate and iterate and keep making improvements.
And yet people still have this dilemma that they're not paying it, with multiple chances and then they pay it at a point much later. And I do think a lot of that was about trust, right? People would say in some of the videos I remember you made, people would try, we actually sat and listened as people tried to contact the finance center and listen to the messages and waited on hold with them, or they showed us all their paperwork and it was like a sea of papers laying in front of them about the bill. Which in part is why we've made making that financial journey simplified, clear crossed estimates, real time insurance verification, pay from wherever you are, a part of our future strategy, inpatient experience, because it's such a pain point for patients.

Julie Rish: I think I was gonna just add, I think that can sometimes be the challenge with just a focus group. We could iterate until the end of time on a statement and you could change this color or change this wording or change this font. But to get at why people are behaving the way they are and what are the actual things they need on that bill to trust us, is very different.

Adrienne Boissy: It's a great point.

Julie Rish: And it's the future that we need to be in and it's more efficient. Let's spend a lot of energy here and get down the core principles of what needs to be in that journey with us. And then we can iterate on the little things as we want to down the road.

Adrienne Boissy: No, it was great project, and we learned a ton. You introduced me recently to speculative design. Talk to me about that because we are always hear human-centered design, it seems more popular these days, but speculative design I had never heard about and I was really excited.

Julie Rish: Yeah, absolutely. So it's this emerging field, and it's interesting because it's... People have different opinions of the field and it's a little bit provocative, but it's this concept really quite simply of how do we think about our future? So not two years out or five years out, which is where we tend to spend our energy. but what does our future look like in 15 years or in 25 years? And to be intentional about spending energy about designing prototypes and experiences for 15 years from now, and then allowing that to inform what we do today and our strategy.
And I think that that piece to it is so important because the future's coming and we can either let it happen around us, or we can be very intentional to be designing a strategy that anticipates what's coming next, not just reacting to what's put in front of us.

So I think it's a really important area for us to begin to focus on, to spend that time thinking about our future and what matters to us as an organization. And then what the implications are. So a great example that we talked a lot about is artificial intelligence. In the short run, we tend to overestimate the impact of technology. In the long run, we underestimate the impact. So when artificial intelligence was first mentioned, we probably were quite disappointed that it didn't solve all our problems today.

Adrienne Boissy: I think people still are kind of disappointed.

Julie Rish: Are quite disappointed, but if we think about over time there's going to be a rapid evolution of what that can do for us. And when we start to think about the future, then we start to kind of back up and say, "Wow, what implications does autonomy have?" Or, "What partnerships make sense in that future", and, "Who will people trust", and "What collaborations do we need to have in place", and "What do we want that future to look like, who's liable for that future?"

So I think it's a really important area that we haven't necessarily spent a lot of time thinking about and it gets me excited because I really am a planner. I like to think about what's next. And I think that allows us to really streamline our energy in a direction that we want to go in.

Adrienne Boissy: Well, I think too, it's... I hear sometimes fear on the part of some designers or even some hospital systems about planning for a future you don't know yet. And yet that's exactly what's required right now. It is hanging so fast. We have to be comfortable with that discomfort and yet still be able to design ahead, and speculative design struck me as an interesting exploration of that in a formatted way, right? It's not just loosey goosey, let's imagine what it could be. It actually has some structure to how you can begin to plan for something you've never even imagined before.

Julie Rish: No, I love the example of, a lot of it relies on building prototypes to get people to respond to. So concept cards is a great example. One example that I really liked is that concept of, "Let's build a breathing machine that shows you or allows you to breathe in and inhale the pollutants that might exist….

Adrienne Boissy: Oh yeah, this was a fascinating...

Julie Rish: It's fascinating, right?

Adrienne Boissy: So tell them about it. This was fascinating and brilliant.

Julie Rish: So, yeah, so in the UAE, and I can't think of the designer right now, but they were doing this work on pollution and what the future is going to look like with pollutants if they continue in the path that they're on. And they had this great exhibit and they built these different prototypes and they built a prototype that emitted the pollution that you would anticipate in 15 years, and then they asked those leaders to breathe it in and that was a differentiated experience. Correct? You can read the stats.

Adrienne Boissy: It was like this metallic, polluted air, but it...

Julie Rish: Toxic.

Adrienne Boissy: ... but it wafted at them and the leaders, I think the story is the leaders the next day enacted, right? Real change.

Julie Rish: Billion dollar plus in commitment to how do we think about that and in change that trajectory. But it is that difference between you could read the paragraph and the stats for days and days and days and not actually be personally impacted.

Adrienne Boissy: Impacted.

Julie Rish: But you have to... The act of breathing that in...

Adrienne Boissy: Changed everything.

Julie Rish: ... Changes your perspective on what that could look like and, do I want my kids living in that world? Hopefully not.

Adrienne Boissy: It is a really interesting way of bringing empathy to the forefront, but through a different tactic. Right?

Julie Rish: Exactly.

Adrienne Boissy: You can't just say, "I'm sure you don't want your children to do..." People are like, "Well, of course I don't", but what does that mean? But then the experience of actually doing it. I agree, it was a stunning story.

Julie Rish: A great example, and it's that application that I think is so powerful. So if we create different types of prototypes, even with the experiences that we want to create and then allow people to kind of step back and step in to what that experience could look like, it's a different type of experience than just kind of dreaming or envisioning what the future could look like. It makes it very tangible and real.

Adrienne Boissy: You have to sit in it and feel it and what it evokes in you.

Julie Rish: Exactly.

Adrienne Boissy: I would be remiss if I didn't give you an opportunity to describe pain points that you continue to come across for our patients and most recently in some other work that you're doing. What do you think sort of the leading edge of patient experience in the next five years is? Problems we have to solve that you're continually seeing in your work?

Julie Rish: I think in the interviews that I do, there's always this thread around trust. So I'm particularly interested in how do we foster trust and the different experiences our patients have with us? Because sometimes they send a segment those into different buckets. But if I think about the actual things to solve, access obviously has to be solved, right? It's confusing for our patients. It's hard to get to us. It's not intuitive, it's not easy and there's delays in that. So I think just from moment of symptom, to here they are with us. I think we have to be able to solve that and hopefully technology is going to be a supporter of that in that we should be designing what that technology looks like.
I also think this concept of how we walk with people through their journey of health, it's different and much more personal than I think healthcare has been. So I think creating a way to walk beside you in health and in wellness is critical for our future. I think there's pain points all in-between. So access, discharge, delays, all the things that we talked about...

Adrienne Boissy: You don't have to name them all.

Julie Rish: ... creating meaningful moments with humans. Because it's interesting even in the access work that we did, some of the pain points our caregivers felt were the moments that they weren't actually connecting with a patient or they didn't feel like they could give the answer to the patient that they wanted to give, or that they were going around these circular systems of trying to get answers, and it was painful to them as well as our patients. So I think finding ways to make that more seamless for both and allowing people to connect as humans is so important.

Adrienne Boissy: Well, I want to thank you for joining us today and sharing so much about your own personal journey. The commitment you had, I think even growing up, right? And the value of work ethic and humility as someone who works beside you every day, I appreciate in you all the time. So thank you.

Julie Rish: Thank you.
This concludes Studies in Empathy Podcast. You can find additional podcast episodes on our website, my.clevelandclinic.org/podcasts. Subscribe to Studies in Empathy Podcast on iTunes, Google Play, SoundCloud, Stitcher, or wherever you get your podcasts. Thank you for listening. Please join us again soon.