Irfan Khan, MD - Jan 30, 2019

Airbnb, The Fairmont, & JP Morgan 2019: Lessons in Optimizing the Patient Experience in Clinical Trials.

As anyone who has walked the streets of San Francisco in January knows, a map without topography is incomplete in important ways. The map fails because it fails to capture the experience of the journey. And it’s the experience - not the data, not the information, not even the wisdom – that ultimately resonates, that lasts and means most to people.


Flying home from the lack-of-space odyssey that JP Morgan Healthcare conference has become, the experiential was front of mind. That may be a side effect of running a company obsessed with the patient experience in clinical trials, but it may also be because San Francisco provided some vividly distinct lessons in customer success and failure.


If we’re going to improve the experience for people seeking, considering, or participating in clinical trials, we’ve got to give them a map with topography – a map that conveys the experience. And we’ve got to relentlessly focus on building a great experience for them.


 San Francisco_JPMorgan

“Hiding in this picture is the steepest 10 minutes of your business day.”


5 key actions that build a better patient experience:
  1. Emphasize the importance of the patient experience within your organization
  2. Provide decision support in a manner that engages the patient
  3. Communicate empathically and often with patients
  4. Give patients a venue to have their voice heard and listen actively
  5. Follow-up to show patients how their input impacts your organization


The primacy of the experience was demonstrated for me in the standout service of a thoughtful Airbnb host, the surprising failure of a San Francisco hospitality icon, and the beautiful mess that JPM iterates. The ultimate lesson in the experiences shared below is that of empathy as a cornerstone – that great experiences are built from an understanding of, and interest in, the needs of others. And maybe a reminder of the direct and indirect costs of failing to live by that standard when you are in the service industry of trying to help a patient solve a problem. There are lessons here as we struggle to address the two great human challenges in clinical trials, patient engagement and patient retention.


One way I’ve found to make JPM a more interesting and organic experience is to avoid the hotel cartel’s shakedown and scout Airbnb for an authentic place to stay. Everyone I suggested this to ahead of time told me this is “young company thinking” and if I was bringing 50 people it wouldn’t be a practical approach. Maybe so. I do know lots of people who went to JPM in 1s, 2s and 3s, burned a fortune staying in the thick of things, and then bemoaned the cost of taking a lobby meet-up at the now somewhat-infamous Hotel Nikko. On that note, has making a fleeting $30/guest/hour ever cost a hotel more in goodwill and reputation? If experience really is what resonates and lasts, Nikko may come to regret becoming the flag bearer for opportunism at JPM.


 “JPM  2019: The most expensive $30 Hotel Nikko will ever make?” photo credit


So Airbnb it I did and rented a great townhouse in Hayes Valley where 3 nights cost less than $750. And while saving thousands of dollars is a good thing, what really struck me was the experience. Excellent communication from my host Lydia, with regular follow-up to make sure the house was to my expectation, a recommendation of local places to eat I hadn’t tried before, and a hand-written note from Lydia welcoming me to her home – customer success concepts that hotels originated but rarely keep up these days. What they can’t really compete with is a beautifully furnished home, with a thousand well-worn books and the comfort of an utter silence – Lydia’s home was the perfect foil to the enjoyable chaos of the dozens of meetings, planned and impromptu, that JPM generates. And yes, I realize this is exactly Airbnb’s value proposition, and it’s a little late to share this great website for booking a stay in someone’s home – I’m just pointing out that a great experience is built less on fancy amenities and more on the direct human engagement and the feedback loop that technology enables. It remains a process critically dependent on actual people to create and sustain.


I can’t help but contrast the 5-star satisfaction of enjoying a high-end dark roast coffee made with beans purchased specifically for me to grind fresh, to my last stay in San Francisco at The Fairmont, just 2 weeks earlier. Explaining what The Fairmont is all about is not much more helpful than explaining how great Airbnb is – The Fairmont is pretty much synonymous with guest service and exceptional hospitality. And I’ll admit I’m partial to The Fairmont, with its beautiful old-world mail rack decorated with time-worn city names in gold leaf that gently nods to its days as an ambassadorial hub. I remember having breakfast there more than a decade earlier – an electrophysiology fellow about to present his first poster at Heart Rhythm Society and thinking “this place is what Success looks like.”


Fifteen years later I was reminded that a reputation for excellence is difficult to build and easy to tarnish. Having arrived as a late check-in to a pristinely made room, I crawled into bed only to discover a clearly used bedsheet with a sizable dried blood stain. Unfortunately, I discovered this after having made brief but decided contact with it. Medical training is useful in turning you into a probabilistic thinker, so my response was more muted at first than it could have been – the risk of disease transmission in a situation like this is not zero, but it is thankfully low. Still the situation was serious and needed to be addressed by management.



“Sic Transit Gloria Mundi – all good things…” photo credit


While that experience alone could have been the focus of a customer success morality play, how The Fairmont handled the situation after that disturbing fail was a textbook in how to exacerbate a bad situation. It took 3 calls to guest services – ironically named “Royal Service” - to get to a room change. In that time one of the three different people I spoke with conducted a workshop in “sorry/not sorry” while the other two were well-intentioned but didn’t seem to grasp the seriousness of having potentially exposed a guest to a blood-borne pathogen. When in frustration I pointed out I was a physician, it became the point of everyone on the phone to accentuate “DOCTOR” every time they could – somehow assuming my problem was being called “Mr.” and not the biohazard. For the record – I never use my title. And I do care about biohazard exposures.


Poor engagement skills coupled with slow, half-hearted efforts to resolve the issue quickly was the end to what should have been a great day. The next morning the Assistant Director of Housekeeping touched base and showed a great deal of empathy in hearing the story. She asked for the photos I had taken of the bedsheet, and I sent them over. Still, there was no explanation of how it happened, no indication what would be done to prevent a recurrence, and no discussion with The Fairmont’s upper management – indicating this event was a low institutional priority. She did inquire with earnestness, “what could we do for you to make this right?” Out of curiosity, I asked her what The Fairmont thought was “the right thing” to do as I didn’t want to bargain, I wanted to get on with my vacation. When the response came the next day that The Fairmont would like to comp me a single night the next time I visited SF, I had to shake my head and decline.



“When it comes to Customer Success – it takes a Village.”


To me, it seemed a bizarre offer because it was literally the very least The Fairmont could offer to a person who hadn’t asked for anything – except a room change – despite having been treated pretty awfully by an organization that prides itself on excellence and elite customer service. If you’re not being asked for something, but feel you should offer something – why would you offer to do the absolute bare minimum? Half-hearted gestures actually make things worse. Here it signaled The Fairmont did not think that a potential health-code violation, nor the manner it was handled, was that big a deal. The specific error of the cleaning staff – likely overworked, overtasked, and tired – was compounded many times over by the front-desk staff specifically trusted with making great experiences for guests. And the failure to get the leadership involved in a timely manner. On the whole, it was a strange and disappointing experience and not who The Fairmont says they are.


So how does all of this relate to the patient experience in clinical trials? As I flew home and thought about how people seeking clinical trials for themselves and their loved ones, the comparison became clearer. We in the business of conducting clinical research often treat these seekers akin to the way The Fairmont treated me – when patients desperately want to be treated the way Airbnb [and Lydia in particular] treated me. Instead of personalized notes, ground coffee, and phenomenal communications skills, we tend to give patients an institutionalized experience, resting on reputation, asymmetry of information, and generally lower on empathy than we should be.


Patients are seeking decision support, peer-to-peer engagement and answers to their pressing question – “what do I do next?” or a voice in the procedures they are suffering through. With 1 in 4 patients dropping out, with missing enrollment targets a ubiquitous reality, we have only a limited number of options to create a new shared reality – all of which should be entertained.


5 steps to better Patient Engagement:
  1. Find new places to engage patients concerning clinical trials
  2. Find new places for patients to participate in clinical trials
  3. Find better ways to communicate options and education
  4. Give patients greater transparency and decision support to help them evaluate choosing clinical research
  5. Provide peer-to-peer spaces where patients can share their journey – this is the path forward to a new perception of clinical research in the public’s mind


Anything short of committing to these approaches is bound to leave us and patients right back where we and they started – hoping for an personalized and meaningful Airbnb experience, and finding out instead The Fairmont isn’t what it used to be.


We can - and must - do better.

Written by Irfan Khan, MD

Dr. Irfan Khan is a cardiologist and the CEO of Circuit Clinical, the maker of TrialScout, the first ratings and reviews platform for people seeking clinical trial options. An evangelist for the power of the patient experience to transform the discovery of new medicines, Irfan speaks frequently on the intersection between technology, healthcare, and clinical research.