Jul 22, 2009

Swiffer Solutions for Health Care

Eva Luo “co-blogs” with guest contributor Curtis Chan, an analyst at Innosight, an innovation consulting firm in Watertown, MA co-founded by HBS professor and innovation expert Clay Christensen.

When I imagine a world without the Swiffer, I see it as a post-apocalyptic dustscape. Dead skin cells sublimate and overtake nitrogen as the most prevalent constituent of the atmosphere. People have acclimated to the ubiquity of filth, spills, and dirt: soil is no longer tracked into the house – your mom yells at you for adding a fresh coat to the carpet of mud. And, fully unbridled, wanton dust bunnies spawn like, well, bunnies.

Fortunately, Swiffer does exist. Launched by Proctor & Gamble (P&G) in 1999, the cleaning product had 75% market share of the quick-clean market, which totaled $750 million in revenue in 2005. (1) With the massive success of the product, have you ever stopped to think to yourself: “It’s a disposable towel. On a stick. Where the heck did Swiffer come from? And how in the heck did P&G dream it up?”

The answer, it seems, is by just looking. As revealed in The Innovator’s Guide to Growth, Swiffer was the product of an observational study conducted by P&G that followed consumers around their homes, looking around the house, observing behaviors, and generally hunting for clues as to what kinds of things consumers need to get done throughout the day. (2) The observed consumer needs and desires that the researchers observed helped inform P&G how to create and design innovative products or processes to help meet those needs and desires.

For fun, I’m going to take more than a few liberties with the details of an anecdote from the observational study here, but the message is faithful. This is how I would imagine an episode of the P&G study:

    Two P&G researchers followed a nice, grandmotherly lady as she ambled about, showing them around her house. When she flung the doors of her closet open, the researchers noticed that a broom covered with dust stood in the corner. In another closet, a vacuum cleaner sat, unused and forlorn. The researchers nodded conspiratorially at each other as they jotted notes.

    They all wandered into the kitchen. Jarring the researchers from their note-taking frenzy, the woman asked them, “Would you nice boys like some coffee?” The researchers agreed, blushing at being called “nice boys.” As the woman took a can of coffee grounds down from the pantry and opened it, the can slipped from her hands. She cried out as the can tumbled to the ground, strewing coffee grounds across the floor.

    Instantly, she grabbed a paper towel and attacked the mess, muttering to herself as she crouched on the floor. When she stood again, the researchers were staring at her, befuddled. “What?” she asked, the look of puzzlement on their faces engendering a puzzlement of her own. “You didn’t use the broom,” one researcher remarked. “Or the vacuum cleaner,” the other chimed in.

    With a sigh, the lady vented her frustration –the broom wouldn’t do a good-enough job and would leave coffee grounds on the floor, and the vacuum cleaner was heavy, cumbersome, needed to be plugged in, and was just overkill for the small mishap.

    The researchers nodded and wrote. Then, flipping their notebooks closed, they smiled and glanced at each other again with that same conspiratorial look, the gleam of excited insight shining from their eyes.

P&G took the findings from their observational research and created the Swiffer, a dispensable electrostatic cloth fixed on the end of a long handle, which got the job done of cleaning up small spills just right. By employing an observational approach – in the natural setting of consumption – the researchers were able to see what the old lady would never have been able to tell them in a survey or a focus group; they were able to notice products around the home that went unused and were able to watch actual behaviors during real-time events. Based on real environments and behaviors, researchers can ask more informed questions to garner more useful, reality-based consumer responses. Indeed, by employing observational research, P&G was able to understand their customers and precisely what they needed and wanted to get done in the day.

Are there health care Swiffer stories? Can observational research help us better understand our patients and what they both need and want in order to achieve better health and experience better health care? The answer, it seems, is yes.

One such example is Project HEALTH, a non-profit organization located in Boston, MA that seeks to break the link between poverty and poor health outcomes. The story of Project HEALTH’s birth is a story of observational research, just like the Swiffer story. Dr. Barry Zuckerman, Chief of Pediatrics at Boston Medical Center and Co-Founder of Project HEALTH often tells this story:

    A six-year-old boy who suffered from uncontrolled asthma arrives at the Boston Medical Center for care. Despite receiving daily oral doses of corticosteroids, a common asthma prevention medication, he was absent from school once or twice every six weeks. As a result, his mom was forced to miss work in order to take care of him and bring him to the hospital for care. The boy has insurance, so access is not the problem. He is also seeking care at Boston Medical Center, a reputable teaching hospital, so neither is quality of care the cause for his frequent visits to the hospital. Why then is asthma a major disruption in his life and the life of his family?

    On a visit to the young boy’s home, the visiting nurse discovered asthma triggers: mold due to a leaky water pipe and wall-to-wall carpeting harboring dust mites. Thus, each step of improvement the young boy tried to make was inevitably countered by his poor living conditions. Dr. Zuckerman often says, “I can provide the most updated form of medical care for low income families, but they would still get sick.” Upon discovery of the asthma triggers in the young boy’s home, negotiations with the landlord led to replacement of the leaky pipe, clean-up of the mold, and removal of the carpet. Within six weeks, the young boy had stopped corticosteroid asthma treatment and was attending school regularly. (3)

Rebecca Onie, Co-Founder of Project HEALTH adds another layer to Dr. Zuckerman’s observational research. Onie notes that several physicians understand this connection between poverty and poor health outcomes but are “frustrated because the clinical interventions that they can do in 18 minutes are not enough to change the health of their patients.” Furthermore, physicians are often unaware of what they can do to help address these psychosocial issues. This physician and caregiver inaction is a systems design problem.

Combining these two parts of observational research has led to a health care Swiffer: an innovative new care model that meets the patients’ needs called Project HEALTH. This is the logic: The hospital is the site where health care is delivered—and with just a minor stretch is also a convenient site where psychosocial interventions can be introduced to better and more comprehensively improve the health of kids and their families. The systems redesign answer is a crew of motivated college students stationed in the hospital. If doctors feel their patients need assistance obtaining housing, have food insecurities, or can benefit from utilities bills discount programs, doctors can now refer patients to Project HEALTH volunteers who work with patients to obtain those resources right there in the hospital.

A simple solution that has achieved great positive change, Project HEALTH now has locations in New York, Providence, Chicago, Baltimore, and Washington D.C. Project HEALTH was also just recognized by Michelle Obama at Time’s 100 Most Influential People Awards Gala. This year, 600 Project HEALTH volunteers will dedicate 100,000 hours to connect over 15,000 low-income children and adults with the resources they need to be healthy. (4)

How could health care improve if observational research was more commonly used? Are there Swiffer-like solutions for every health care problem?

Following the model of observational research itself: Let’s look and see.


Curtis said...

Eva, thanks for co-blogging with me!

Readers, feel free to ping me or Eva with any questions or comments. And if you liked this article, check out my company's innovation blog too! There's a short post and a link to this IHI blog article currently at the top of the blog.


Adam S. said...

Great blog, guys! I like it a lot. And go Project HEALTH! I was just wearing the PH T-shirt today.

My comment is this: the swiffer story is a success because P & G observed the CONSUMERS directly, and made a product that was marketable and attractive and SELLABLE to the consumers. With Project HEALTH, the founders observed the consumers as well, but the solution is much harder to market because it is not profitable (at least not in the short run), and the consumers themselves as patients are often not the ones paying for it. Swiffer is also a cost-saver that can replace multiple house-hold equipment, but the idea that addressing psychosocial needs of patients will ultimately save money in the long-run and improve health is much harder to sell. I'm very glad that PH is getting recognition from politicians like Barrios and Obama--this is definitely a first step. To really make it work, I think you need to be able to sell this as an attractive alternative to the status quo, just like the swiffer was.

danny said...

De acuerdo, meestah Sang. I agree that unlike the Swiffer, there is no financial incentive for providing additional health services (at least in the short term). At the same time, I think that if advocacy groups can emphasize to the government the long-term economic benefits of providing relevant health-related services beyond just diagnosis and prescriptions, their argument would be very compelling. Indeed, the replacement of a carpet and sealing of moldy pipes cost far less than repeated hospital visits, increased asthma medication, missed school days, and work days.

Curtis said...

Hey guys,

Insightful comments! Totally agree that taking into account who the buyers/sponsors/decision-makers are and what is most important to *them* is really key.

I've created a diagram that lays out what I think is a simplified version of the stakeholder map -- this map shows the relationship of the company (e.g., P&G or Project HEALTH) and their product/offering (e.g., Swiffer or the teams of college students) to the people who experience the product/offering or make decisions about whether or not to purchase or sponsor the product/offering.

An understanding of these relationships will help align interests and allow for a better design of the offering, as well as the marketing strategy.

You can see the stakeholder map here.

Basically, I think the key for Project HEALTH would be to increase the influence of the patient and other stakeholders on the Project HEALTH sponsors (the decision-makers). This would be along the lines of what Adam and Danny suggest -- marketing or improving the product offering to meet the needs of the decision-makers.

To understand the needs of the decision-makers, Project HEALTH should also study and understand, either through observational research or otherwise, the needs of these decision-makers.

Mary said...


The services that home care providers offer depends on the needs of their elderly clients. Home care services may provide skilled care which is coordinated with the client’s doctors. Skilled home care services for the elderly deploy certified health care professionals such as nurses and therapists to provide care for the clients in their homes at all times. These healthcare providers may also include medical services such as home dialysis, physical and occupational therapy.

Eva said...

Some other innovative care models:

Remote Area Medical hosting a week-long clinic at Inglewood Forum, a Southern California basketball arena.

Drive Through ER? Stanford Hospital experiments with treating patients in their cars for pandemic situations in order to reduce wait times and keep patients "isolated"

How else can the delivery system be changed to better suit the patient's needs?

Brad the Builder said...

Interesting post, thanks!

Eva Luo said...

Rebecca Onie, Co-Founder of Project HEALTH, was just awarded a MacArthur Genius Award! Click here to find out more!

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