Applied Empathy

by Michael Ventura

  Soon enough we were making a name for ourselves, and the studio grew. We took on partners and landed some bigger clients, and I began to realize that if we wanted to differentiate ourselves as an agency, we couldn’t just tell people what they wanted to hear. We would listen, we would connect, and we would always try to see the work through the perspective of the client and the audience it was trying to reach and not just offer one-sided solutions. It didn’t take long before we had built a reputation as a place companies came to when they wanted to learn how to create real engagement with their customers. We were becoming known as a company that could understand audiences authentically.

  The agency was getting bigger than any of us was ready to handle. We were up to around forty people, and we’d added new services such as experiential marketing (back then it was called guerrilla marketing), as well as content creation. I was exhausted, and my body was literally breaking down under the pressure. I started doing whatever I could to cope: drinking, smoking, staying out till all hours, taking whatever upper or downer I needed to avoid thinking about the next day’s mess.

  By 2008, the financial crisis was looming, clients’ purse strings were tightening, and the company was on shaky ground. My partners wanted to go elsewhere, but I still saw potential in what we’d started. But I couldn’t keep up at that pace. Something had to give.

  That’s when I threw out my back. I was changing the water cooler in the studio, and the next thing I knew I was lying on the floor, the water jug glugging its contents all over me. I had herniated three discs in my lumbar spine. I ended up in the hospital, and the doctors said I needed surgery. The surgery wouldn’t fix everything, but it would help the pain. I couldn’t accept that diagnosis. I ambled out and went to an acupuncturist. It was my first visit to an Eastern medicine doctor. One session certainly didn’t cure me, but I felt a little better. I continued seeing the acupuncturist and combined that with other forms of Eastern medicine as a way of repairing my battered body. That introduced me to an entirely new way of understanding and caring for myself. My body, mind, and spirit all needed healing, and I knew this was the start of a long journey.

  I began to delve deeply into the sacred wisdom of indigenous cultures. Mesoamerican shamans, Chinese traditional medicine practitioners, Native American tribal elders, Indian yogis—all of those and more opened their world to me and helped me better connect with myself. My back was soon mended, and my spirit had stumbled onto a new path.

  A NEW PATH

  In 2009, inspired by the ancient wisdom I was learning and a desire to integrate it into my work, I restructured our company, downsizing to a small core team and parting ways with my partners, who were ready to move on. I rebranded the company Sub Rosa. The term is Latin, literally “under the rose”; its colloquial meaning was that of conversations had in confidence.

  The work we do for clients is modern and state of the art, but indigenous wisdom is fundamental to our practice. We don’t incorporate it overtly because we know some folks aren’t going to jibe with what might seem like abstract philosophy—at least at first—but it inspires our thinking and drives the way we approach problems and reach solutions.

  But before we could get to where we are today, we had to discover who we were and what kind of organization we wanted to be. We’d built a good foundation doing work for clients like Kiehl’s and Absolut Vodka, helping them build programs that connected with influential consumers and thought leaders. We’d worked hand in hand with Levi’s to create a campaign that established the brand’s vision for its next chapter and helped it contribute in a meaningful way to local communities it cared for deeply. That was the kind of stuff we loved doing, and our successes helped establish our competency as equal parts strategic thinkers and creative doers.

  We had worked with General Electric on a number of projects, ranging from its Ecomagination program to helping evolve the way the brand participates with influential thought leaders. Our partnership had developed into one of deep mutual respect based on the work we had done together. For that reason, the company came to us when it needed help with a new and complex challenge involving its medical imaging business. We were excited to continue working with the company; what we didn’t know was that the assignment would provide us with an opportunity to define who we are and what we do. Looking back, it was a critical turning point for us.

  It began when General Electric’s chief marketing officer, Beth Comstock, presented us with an extraordinary challenge. “Today,” she said, “GE is lagging in the medical imaging business. We want to be the best.”

  Of course they did. They’re GE. You don’t last long at General Electric if you’re comfortable anywhere but in first place.

  The company wanted someone to help it spur rapid change and innovation throughout its massive medical imaging business, which included CAT and PET scanners, MRIs, ultrasound scanners, and mammography systems. These medical investigative tools provide physicians with vital information about what’s going on inside their patients’ bodies, and they had become an important part of GE’s health care revenue. The company could not afford to slip behind in this area, and their leadership believed we were the right partner to help reinvigorate the business.

  I was proud that our studio of less than twenty people was being tapped for an assignment like this, but before I could even start beaming, Beth threw two conditions at us. “We can give you only five months,” she said, “and you can’t propose any direct product changes because that won’t move our business in the right direction quickly enough.” GE had already been working to develop new imaging technology and improved form factors for its machines, but those changes wouldn’t be implemented for several years. They wanted to spur growth faster than that, and we were the team charged with finding a way to do so.

  She also told us the company wanted to keep our scope narrow enough to be successful, so it wanted us to focus specifically on its mammography business and to use what we learned there for the other imaging tools.

  “Okay,” I said to myself. “All we have to do is completely reinvent the mammography experience in the next five months and help drive growth throughout the whole business.”

  It’s a good thing I wasn’t in an MRI machine at that moment, because my brain probably looked as though it were having a ministroke. My palms had started sweating, and a pasty dryness had formed in my mouth. I swallowed hard and said we were ready to take on the job.

  We got back to the studio, and all of us took a moment to catch our breath. I gathered the team to begin figuring out what to do first. It turned out that none of the women on our team had ever had a mammography, meaning that we lacked any firsthand knowledge. In essence, we were being charged with improving something none of us had ever experienced—and for that matter couldn’t actually change (though some of our team members did go for a mammography to understand the experience better). What’s more, even though theoretically all of us could sit in a chair and go through a simulated scan, that wouldn’t help us truly understand what a woman was going through when she was being tested for something as frightening as breast cancer.

  GE’s confidence in us and its belief that we were capable of handling a challenge like this spoke volumes to me. I had no intention of letting the company down. But to do the job right, we would have to refine our process, and that was where our empathic methodology was truly born.

  PUTTING EMPATHY INTO PRACTICE

  We had already been using empathy in our work with clients, but we hadn’t started using the word empathy to describe our methods. You could say we’d been practicing empathy, even if we hadn’t been calling it that. In the end, it became clear to all of us how much empathy played a role in our work improving GE’s mammography business.

  To deliver for our client, we needed to immerse ourselves immediately. We knew right from the get-go that we needed to meet patients directly and connect with their stories. We needed to understand what goes on when you get a mammogram—not just te
chnically but emotionally. And we needed to define what success for GE would look like.

  We started by mapping out the entire process. The first thing we discovered was that GE’s business was focused on selling its machines to hospitals, not interacting with patients. That seemed like a rich opportunity. How could we incorporate what we learned about patients into the way GE managed its relationships with hospitals? We started to realize that if GE provided superior patient experiences through its involvement with hospitals, hospitals would have better patient feedback. Better patient feedback means higher-ranked hospitals. And in the end, if patients and hospitals are happy with the experience of a GE product, they are more inclined to grow their relationship.

  That was a path we wanted to explore. We began to meet with patients, doctors, technicians, and others in the mammography screening process. Listening carefully, it became clear that the only way to get the women to open up and talk about their personal, intimate experiences was to create a warm, safe space for them.

  We saw that a phone call, even an interview in an office setting, wouldn’t provide the necessary level of comfort and safety. That led us to realize how important the setting for our work would be. It wasn’t just about the place where we did our interviewing but also the actual rooms in which mammographies were performed. We realized we needed to create that sort of space—a safe space in which to share conversation and learn firsthand from the people we were engaging in the work. That was when things started to get interesting.

  We went looking for a space that would promote natural, authentic conversation about a sometimes scary, sometimes uncomfortable, always personal subject. Eventually we took over a vacant retail storefront in New York’s SoHo neighborhood, a trendy shopping district that’s also fairly residential. To some, the “obvious” home for the space might have been near a major hospital or in an office building a few floors up from the bustling city streets, but we wanted to be right in the middle of where patients lived and worked. We wanted to be something they could “happen upon” and where they could have a conversation. We wanted to be in their comfort zone and meet the participants in the research halfway.

  Over a few short weeks, we outfitted the space with comfortable seating, a hospitality area where we could host larger groups, and a research library stocked with books and information about mammography and cancer treatments. We built demo waiting and exam rooms to prototype and test new ideas. We now had a living laboratory, where we discovered the value of live experimentation and testing.

  It wasn’t a real, functioning mammography clinic, and the women knew that. That probably wouldn’t have been possible, considering the time we had for the project, nor would it have been practical. Still, portions of the space were designed to evoke the experience of getting an exam, to help participants feel the emotions they might feel when getting an actual mammography. We did that so we could get participants into the right headspace and so we could have meaningful conversations with them.

  At the same time, we struck up a conversation with our friends at the design consultancy IDEO. We knew the team there had also done work in this space and that with a challenge this big and broad, having their medical research background would help us move more efficiently through our research.

  With the space finished, and our partners and schedule all aligned, we opened the doors and began inviting in our first round of visitors: women who regularly had mammograms, breast cancer survivors, doctors, nurses, and product engineers.

  We’d trained the team to be present and to inhabit that space fully, fostering a safe environment for difficult conversations. We had to be sure that anyone we wanted to interview encountered people who were fully engaged and supportive. We knew how important it was to focus on understanding how a woman experiences a mammogram, from the moment she schedules her appointment until she leaves the facility after it’s performed. We invited all types of women into the space. We had women from different socioeconomic groups. We had devoutly religious women sitting alongside atheists. We had senior citizens who had had mammograms before, chatting with women who were about to have their first screening. We did everything we could to open up the conversation and learn as much as the participants would share.

  Over the first few weeks, we started to feel genuinely connected to our guests. They were coming back day after day, and they chatted with us and opened up about some of the most challenging aspects of their lives. As trust grew among all of us, we saw opportunities to push further, letting go of assumptions and asking probing, often more ambitious and deeper questions.

  We wanted to know what it was like for patients in the days leading up to their screening. What were they thinking about when they went to bed at night? What were they concerned about? A group of women agreed to video journal their experiences in the days leading up to their mammography. They spoke to the camera in a way they couldn’t speak to anyone else. They were raw and honest and open about their fears. Some had family histories of breast cancer and were worried about what they might find. A few had already found lumps in their breasts and were concerned that these could be cancerous.

  We quickly learned how little attention had been paid to patients’ experiences. And the more we connected empathically with the women’s stories, the more we began to see the challenges they faced on their journey.

  A mammogram is a commonly used method of detecting a cancerous growth in a woman’s breast. Generally speaking, doctors recommend that most women over the age of forty get screened every twelve months. Breast cancer moves quickly, and early detection matters greatly for a woman’s chance of survival. But statistics told us that not all women have a mammogram as regularly as they should, and it was important for us to discover why.

  Early on, we found out that the number one thing women hate about a mammogram is the pain of the procedure. This wasn’t terribly surprising, since during a conventional mammogram, two flat panels compress the breast tissue as flat as possible so that the machine can perform with the highest level of effectiveness. It’s only for a few moments, but it’s not fun. As a result, nine months later, when it’s time to reschedule, some women delay. Nine months slip to twelve, twelve become fifteen . . . and fifteen might be too long. That pattern, we came to find, was all too common.

  The pain was a direct result of the form and function of the machine itself—and we had already been told that we couldn’t change the machine. But the pain of the procedure was a big problem and one that needed our attention. Our only recourse was to discover what other parts of the experience we could fix as a way of addressing the issue of pain from a new angle.

  At the same time, we were having conversations about the other elements of the exam experience. One thing we heard frequently was that women hated the hospital gowns: the cheap material, the opening in the back. They were immodest. They didn’t feel nice. The list went on and on. Tellingly, one woman referred to them as “the ones they give sick people.” Those conversations revealed that there were plenty of opportunities to improve the overall experience—not only the gowns but also the language that caused patients to see a mammogram as a “dreadful” experience, rather than a helpful “health maintenance” procedure akin to an annual physical. That informed recommendations we would ultimately make regarding the literature given to patients in advance of the screening, as well as training for hospital staff in order to speak differently about the procedure.

  At that point, we realized that many of the elements we were discussing didn’t stem from GE and its business directly, but in order to solve this problem, we needed to look at those elements and see how they could become part of GE’s business.

  We continued our research into the environmental and service design elements of the patient experience, and we soon discovered that the patients hated the waiting rooms. Out-of-date magazines, ugly art, receptionists who treated patients like cattle instead of active participants in their own health. To say the rooms had been designed without
any consideration of how patients would react to them would imply that they had been designed at all. The rooms we saw in our field research felt more like leftover spaces into which someone had put some badly upholstered chairs and a pump bottle of Purell. We could easily make changes there.

  Keeping the importance of early detection in our minds, we knew we couldn’t let minor things such as ugly gowns and crappy reading material continue to influence the overall experience and perhaps keep women from getting screened regularly. We also found that women avoid getting screened for reasons that are more serious than the gowns and waiting rooms. We heard things such as “My insurance doesn’t cover it” or “I can’t find time in my day.” But some responses were emotionally deeper than others—statements such as “I have three family members who died of breast cancer. I hate seeing that exam on my calendar. It feels like an appointment with death.” It became increasingly clear that many women were traumatized well before the exam even started.

  If we were going to recommend changes to the gowns, improvements to the waiting areas or the scheduling process, and refinements to the language used by technicians, nurses, and doctors, it would require commitment, not just from GE but from hospitals and their staffs. To create that commitment, we would need to prove that making changes to those things could affect the overall experience. Even after all we had learned, we decided we were still too narrowly focused. Talking to doctors, patients, engineers, and caregivers was a start, but we needed to seek broader insights and find ways of improving the other parts of a mammography experience. We’d spoken to the usual suspects. It was time to bring in some unusual ones.

  We invited in two brands that were already expert at creating warm environments and inviting products for women: Victoria’s Secret and Kiehl’s. We asked them to help us think through the reimagining of the waiting rooms, changing rooms, and mammography gowns. As we designed new and improved prototypes and made other changes to the nonclinical aspects of the mammography experience, we tested them in our space, asking visitors to go through mock exams and tell us how the changes affected their experience.