What’s Behind Your Digital Front Door?

By Robert W. Steele, MD, MBA, EVP/ Chief Strategy and Innovation Officer, Children’s Mercy

The digital front door is sexy. Imagine digital solutions that promise to connect the boundaries between patient experience, clinical care navigation, brand, and market share – the quadfecta, if that’s even a real word. Then, imagine that there are literally dozens of companies that promise solutions that solve many parts of the digital front door, do it in innovative ways, and make your coffee in the morning. Of course, you don’t have to imagine it. Many hospitals and health systems are tackling the digital front door with a fervor rivaling a forty-niner during the gold rush. Indeed, the achievement of frictionless entry into one’s healthcare organization through automatic technological means is not science fiction anymore.

The digital front door is a strategy for engaging patients at every major touchpoint of the patient journey using technology that patients have already adopted for everyday use. Effectively, it’s delivering an experience as simple as searching for health answers online like one does to find the best sushi restaurant, scheduling clinic appointments like one orders coffee on a phone app, and getting timely text messages like one receives when expecting a package delivery. The catch is that all of that is tied to the health system. In doing so, the healthcare organization begins the consumer/patient engagement before they have even been registered in the electronic health record. And if done well, that system achieves competitive advantage by tying easy access to a best-in-class experience.

The digital front door is that first impression that either delivers on the system’s brand promise or diminishes it.

Digital front door solutions include search engine optimization, an interactive provider directory, self-directed triage and scheduling, automatic registration, social determinants screening, disease-specific patient information, non-annoying pushed reminders, and wayfinding both external and internal to the organization. While much of the technology is available, the promise of a seamless digital front door is dependent on the coordination of each of these solutions. To date, there is no single vendor that can simultaneously deliver on all of these solutions and coordinate them with the electronic health record. This has not deterred organizations from engaging in this work, including mine, Children’s Mercy. But what I have found is that solving the challenges of digital front door implementation is only half of the work. When we took a hard look at our operations, we realized that there was a risk of establishing a nice shiny digital front door that led to an old inefficient house.

The first question we had to ask ourselves was where the responsibility and accountability would reside. Is the digital front door a clinical function which should reside in our outpatient operations? Is it actually a part of business development which should be coordinated through our strategy team? Ultimately, this is an important question that one has to answer in the context of health system operations. For Children’s Mercy, we felt that listening to the customer’s voice was located in our marketing and communications department. We effectively positioned the digital front door work as part of our customer relationship management capabilities. The challenge with this strategy is our patient experience team is run through performance improvement, and clinical care navigation is coordinated through our hospital operations and the clinically integrated network. That’s a lot of stakeholders distributed in multiple areas of the system, making success difficult.

While I cannot take credit for the idea, I have tried to instill within the team that 100% of strategy becomes operations at some point. Otherwise, it’s just a big idea. As such, the key to implementing a robust digital front door is buddying up to all those within operations that will impact and be impacted by the chosen solutions. This is often the point at which organizations fail to execute effectively on strategy, and it is largely dependent on their change management prowess. For example, giving the expectation that workflows will undoubtedly change is key, but articulating how these changes will positively drive patient satisfaction and engage the team in coming up with those new workflows helps in accepting those changes. I have found the biggest struggles come from a loss of control for the providers. This is particularly true with regard to scheduling functions. Life has taught me that messing with patient scheduling is a sure-fire way to cause anxiety in healthcare providers instantaneously. And yet, if a frictionless digital front door includes allowing patients to schedule appointments, then providers and their respective teams must embrace the change. Moving to a more patient-centric model can be difficult for those organizations which have historically operated in a more provider-centric one. The digital front door journey is much like the practice of medicine – it is a continuous improvement journey. By establishing a relationship with a future patient or deepening an existing one through efficient digital solutions, providers improve patient experience and health outcomes. Doing so, it can be a powerful tool for attracting patients who become empowered in their own healthcare. 

Ultimately, the digital front door is that first impression that either delivers on the system’s brand promise or diminishes it. Digital solutions can be vetted, coordinated, implemented, and be wildly successful. They can be so successful. In fact, the health system is overwhelmed by the response, or worse, never anticipated how those digital solutions would impact legacy operations. Our digital front door journey at Children’s Mercy is still in its relatively early stages. We are trying to achieve that quadfecta by being deliberate in matching the ease of digitally accessing our system with an equally satisfying care delivery experience.