All physicians must be actors when performing on the health care stage

Studies show that having a caring, empathetic manner have fewer lawsuits, better outcomes.

As we demonstrated in our last column, to be successful today you must surround your existing goods and services with a rich, compelling experience — but then you also must direct your workers to act. For in the emerging “Experience Economy,” work is theater. We do not mean this as a metaphor — work as theater. Rather, we mean it as a model — work is theater! Whenever workers are in front of customers, they are acting — whether they know it or not, or do it well or not, they are acting. They must act in a way, therefore, that engages each guest with every interaction.

As renowned English stage director Peter Brook declared in the very first line of his book, The Empty Space, “I can take any empty space and call it a bare stage. A man walks across this empty space whilst someone else is watching him, and this is all that is needed for an act of theater to be engaged.”

The simplest definition of acting, in other words, is that one person watches as another person works. Anyone working in front of customers must therefore act in a way that draws them into the experience.

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Acts of theater

Flight attendants and hotel staff routinely perform acts of theater when they direct patrons to the nearest exit or rented room. The work of a retail store associate is theater when he or she straightens merchandise on a shelf. Performing a product demonstration is an act of theater, as is answering a question over the phone. And doctors who perform surgical operations in an amphitheater also perform theatrical operations by the side of every patient’s bed. But how differently (and more memorably) would all these activities be performed if those executing them understood that their work is theater and acted accordingly?

B. Joseph Pine II

James H. Gilmore

The Walt Disney Company recognizes this, of course, when it calls every employee a “cast member” and insists that they separate on-stage activity in front of guests with off-stage activity in areas where no guests are present. A cast member merely talking about what he is going to do after work that day in front of guests at Disneyland, for example, can be grounds for dismissal. This is not a principle just for costumed characters like Mickey Mouse or Goofy, however, but for everyone in contact with guests. Each worker must find his or her role, characterize that role, rehearse it, and perform it on the company’s bare stage.

Never mistake the environment for the experience. Many hospitals in particular have focused on creating a more pleasing environment through architecture, interior design, enhanced furniture and fixtures and so forth. But your place remains but an empty space unless you direct your workers to act. The experience of every guest — whether that person be a patient, family member, or any other visitor — depends on how well each and every worker engages them.

Working on stage

Back on Sept. 17, 1994, Lancet created quite a furor in the health care community when it published an article applying the principle that work is theater to medicine. In Acting in Medical Practice, Drs. Hillel Finestone and David Conter of the University of Western Ontario asserted that physicians, and by extension all others in health care, should be trained as actors. They wrote:

“If a physician does not possess the necessary skills to assess a patient’s emotional needs and to display clear and effective responses to these needs, the job is not done. Consequently, we believe that medical training should include an acting curriculum, focused on the conveying of appropriate, beneficial responses to those emotional needs.”

At the time, many physicians disparaged or ridiculed the notion of doctors becoming actors. One wrote in the Minneapolis Star-Tribune that if drama becomes a part of medical school curriculum, we would see scenes like this one: “Problem: Obesity. Old way: Doctor gives printed diet sheet. New way: Music swells as doctor stands in front of brilliant sunset, tears welling up, and makes the emotional, heart-rending promise, ‘As God is my witness, you will always be hungry again.’”

As humorous as that is, recognize that proper acting does help a patient tell more of what ails him during diagnosis, better understand treatment choices, and more readily handle the therapy. Further, medical research backs up the contention that doctors must be actors. Numerous studies demonstrate that those doctors who deal with their patients in a more caring, empathic manner – in short, those with better bedside manners — not only face fewer lawsuits but have better patient treatment outcomes.

Similarly, everyone in contact with patients must understand their role, fill it with the proper characterization and perform it well in every interaction. Whether you are a receptionist, security guard, nurse, janitor, volunteer, administrator, or have any other position that interacts with patients, that patient’s health care experience — and therefore the health outcome — depends on how well you act.

Create a signature moment

Once everyone understands this principle, look further to turn some mundane task into a singularly memorable event – the climax of the experience. Think of the world-famous Pike Place Fish Company in Seattle. The way its workers engage in routines to entice customers to buy fish is pure theater, but the signature moment only occurs when someone buys. Only then does the worker throw the fish, often 15 or 20 feet, across the counter where another worker catches it, wraps it up, and completes the transaction. It is for that one particular act of theater that this small fishmonger, is in fact, world-famous.

The same principle applies in health care. For example, at Sharp HealthCare of San Diego — winner of the 2007 Malcolm Baldrige National Quality Award — the endoscopy department created a signature moment to follow-through on its theme of a Five-Star Experience. So, postprocedure, it provides juice in stemware on a silver tray with a treat for every patient — some of whom can’t resist toasting, “Bottoms up!”

You should similarly seek out one particular task and turn it into a memorable, engaging experience that patients and their family members can’t help but talk about afterward. It is a compelling way to cap off a production of theater on your health care stage.

For more information:

• B. Joseph Pine II and James H. Gilmore are co-authors of The Experience Economy: Work Is Theater & Every Business a Stage as well as Authenticity: What Consumers Really Want. They co-founded Strategic Horizons LLP of Aurora, Ohio, a thinking studio dedicated to exploring the frontiers of business and helping executives see the world differently, and can be reached at 330- 995-4680; or e-mail: Pine&Gilmore@StrategicHorizons.com.