How Sutter Health Is Changing Healthcare Through Empathy and Human-Centered Design

Chief Innovation Officer Chris Waugh is using Silicon Valley–approaches to innovate from within the healthcare system. It's working in the most unusual ways. 

Chris Waugh is not your typical healthcare chief innovation officer. When explaining what his team wants to accomplish, his conversation doesn't launch with a discussion about how technology will help Sacramento, California–based Sutter Health improve clinical outcomes or achieve the nonprofit health system's strategic goals. His banter is peppered with words like "empathy," "listening," and explanations about the need for "human-centered design." One of the reasons the healthcare industry struggles, he says, is that it tries to fight emotions with logic.

As health systems compete against Google, Amazon, and other nontraditional players that are introducing new ways of thinking about healthcare and approaching consumers, Waugh is infusing these philosophies into the healthcare system through Sutter Health Design & Innovation. Reporting directly to Sutter Health's President and CEO Sarah Krevans, MBA, MPH, Waugh, who also is a vice president, offers a unique approach to healthcare innovation.

Waugh had no experience working in a hospital or health system before joining Sutter Health five years ago. His 25-member innovation team is composed of system designers, user experience designers, data scientists, and "MBA-style" individuals. "Some of these jobs didn't really exist 10 years ago," he says. "When you put that inside the middle of a large health delivery system, that composition says a little bit about how we approach the work, which is very open with a lot of different talents. Technology is really important, but it's not the hero of the story; it's one of the major levers you get to use when you've figured out what the real problem is."

While the approach to innovation may be novel, Sutter Health's team is transforming the way the 24-hospital nonprofit system delivers care. Tera, a virtual-first approach to primary care, was established by Sutter Health long before a global pandemic forced the rest of the world to adopt this model. By completely reimagining the care process, the Tera team includes a health coach, an LVN, and a physician. The model delivers care at a cost that's 24% less than traditional practices.

Sutter Health also was among the first health systems to test, then launch a ridesharing program with Lyft to transport patients to appointments. Additional initiatives include some you might expect from a healthcare innovation team and some you might not:

• A joint care app
   
• A partnership that is exploring a device to reduce the need for blood draws
   
• Prescription delivery services
   
• An initiative to enhance new life experiences when patients have babies
   
• Honoring end-of-life experiences
   
• A focus on "staff delight," which includes a new program to help employees purchase homes in the pricey San Francisco Bay area to eliminate long commutes to work and to live in the communities they serve
   

Innovation Rooted in Human-Centered Design

Waugh's approach to innovation is rooted in the 11 years he spent at global design company IDEO, where founder David Kelley brought the concept of human-centered design to life through creations like the first Apple mouse.

"The beginning of the story is always the person and what is really going on in their world," he says. Facts indicate that American healthcare costs too much and clinical outcomes vary by ZIP code and skin color, as well as access to and ability to use digital technologies. To change the dynamics, he says, it is essential to dig deeper.

Chris Waugh, chief innovation officer, Sutter Health, (Photo courtesy of Sutter Health)

"A lot of organizations will say they're patient-centered, but what does that really mean?" he says. "You have to spend a disproportionate amount of time with users—people—understanding their life. This includes spending time "listening deeper for some latent and unmet needs that we might not have heard just by looking at the data. That's where empathy is key." When you do that, he says "you realize there are some poor fundamental assumptions about traditional care."

One of those assumptions is that if you give people information, their behavior will change, Waugh says. That approach has not worked. For example, people know they should eat healthier food and exercise, but they remain unengaged in healthy habits. The idea of delivering information and hoping for the best is flawed, he says.

Another flaw: assuming that individuals operate in isolation. "You don't really succeed doing anything by yourself in life," he says. "We are dependent creatures." Understanding how people operate in community, with friends, and with family presents opportunities to involve those entities in a care plan if an individual consents to sharing such information, he says.

Examining what happens after a patient leaves the office—or through virtual interactions in the home—presents additional opportunities to gain insights.

Once the listening process is complete, Waugh says, three words guide the actions of Sutter Health's innovation team: "How might we?" For example, "How might we make it easier for patients to get to appointments?" With that question, myriad solutions emerge.

Only then, technology, creativity, systemic thinking, and design thinking can be employed to devise implementable solutions, which are tested through pilots.

"Did They Cry?" The Role of Emotion in Innovation

"At the highest level, our strategy is rooted in how do we deliver exceptional care?" says Waugh. While the tendency in healthcare is to think that the innovations are going to be related to clinical needs, or about AI, or big data sets, "it's also about basic human needs."

The innovation team once launched a project to capture birth stories, which involved deep interviews with mothers and someone who accompanied the mother to the hospital during the birth experience. Thirty days after delivery, when the mother was as "tired as she's ever been and everybody treats you like you've got this, but you still don't know what you're doing," Sutter Health would deliver a birth story card that summarized the experience in a personal way. The initiative was tremendously successful.

How did Sutter Health know that it worked? If the recipient cried. "That, honestly, was the metric we were measuring," says Waugh. "At the beginning, it was a 90% tear rate. We were trying to design something that's so emotionally resonate that it would make somebody cry in a good way. A clinician might say, 'What in the world does that have to do with clinical outcomes and cost of care, et cetera?' Our response to that: 'It turns out, maybe everything.' Because at the end of that card, you could say something like, 'Don't forget the vaccination schedule. Your next appointment is X.' " Waugh says that the experience could be correlated to better engagement and fewer no shows.

"I get really frustrated with healthcare fighting emotion with logic," says Waugh. "This is very common for a science mind to do this. What often happens in healthcare is we fight emotional things with more information and more logic, like 'Your A1C is out of control. We need to do something about that.' That's the information, but that same parent might've gone home that night, and it was Halloween, and they're trick-or-treating with their kid. And the kid looked at them and said, 'Don't you want any candy?' That's the moment we need to design for—not just beating somebody over the head with more A1C numbers. How do we make sure we're designing for emotional resonance?"

Waugh has one more piece of advice for health systems. "I don't think systems are paying enough attention to the fact that every other aspect of life is also being adjusted and reimagined, and the long-term implications on those things for healthcare."

As an example, he cites the pandemic phenomenon of Zoom towns, where professionals are temporarily and permanently leaving big cities and migrating to smaller communities since they can work remotely.

"What's that mean for healthcare?" Waugh queries. Sutter Health operates a health plan in Northern California "that's really designed for people being in Northern California. Employers are finding that their employee base has just distributed everywhere, and we need to adjust accordingly." To prepare for what's ahead, says Waugh, "It's important for health systems to keep a really close eye on everything that's going on around them, not just what's going on in healthcare."

[Editor's note: This story was updated on December 9, 2020]