In his podcast 'Against the Rules’, Michael Lewis tells the story of Athena Health. A US Healthcare provider facing into the biggest problem US doctors face... not treating patients, but getting insurance companies to pay their bills. And how they solved for it.
Which is not how you'd expect. Because the story is really the story of Sue.
Sue Henderson is what's known as a medical biller. She worked in the windowless basement of a mid-sized hospital in Boston. Day in day out she processed doctors claims on the insurance company. Year in year out. And through this she became an expert in every nuance of how to maximize reimbursement, with the least fuss.
Lewis does this great job of illustrating the work-life of a medical biller. "The whole margins of her monitor were covered in sticky notes. And I'd point at one and ask 'what's that?' and she'd say 'Oh, that reminds me that if a midwife does the delivery I have to put a CZ modifier on the code.’”
You see, every health insurer has different packages with different rules on how to bill them. The rules are opaque, poorly documented, and often changing. No one insurance company created this confusion, but also no one has any incentive to clear it up.
The podcast tells how the programmers at Athena worked systematically with Sue to extract all of that knowledge. Both that on sticky notes, and in her head! Codifying it over a period of a year. Turning it into a product that automated claims and collections. And in doing so, launching what would become a multi-billion dollar category.
All by recognizing an overlooked expert toiling in the hospital basement.
The Sues of the world are not part of the executive. Not in middle management. Not consultants. In fact they're sitting six levels down, working every day on the challenge. And that is the secret. The expertise to solve your biggest challenges is most often six levels down.
Unlocking workforce expertise
Let's change gears... I'm out in a van. Riding along for the morning with Chris, a telco field service technician, in Fort Worth, Texas. Chris is in his early forties, he's freshly shaven, with a broad smile. He talks proudly about his two boys, and their basketball. He's got a relaxed southern manner. Unless someone makes a poor driving choice in front of him. Which seems to happen often.
We're about to arrive on site at an office that has connection issues with the internet router that was installed last week...
At Joyous we have been working with some of the worlds biggest telcos, on one of the industry's biggest problems. Reducing repeat visits. That's when a technician comes on site to fix something, but it doesn't get fixed and so someone has to come back. Repeat visits cost real money. In fact tens, even hundreds, of millions of dollars a year to the biggest telcos. Not to mention the customer pain (that I'm sure many of us have experienced!).
"I can tell you right now, that the problem will be line conditioning. The last tech didn't check the lines. I don't blame him though. He would have had another job to go to." The knowledge to solve your biggest challenges is sitting six layers down.
Of course, recognizing that this expertise exists in the frontline workforce is one thing; unlocking it is another. And that's the big challenge – unlocking expertise – that we have been leaning into at Joyous. Especially at scale.
Let’s talk about how you do this, practically. Our model has four steps.
1. Start with a big challenge. And turn it into some conversation starters.
There's a science to this. Imagine a supermarket with the big challenge: "How do we reduce theft in self checkout?” Joyous can tap the experience of the folk that work in the self checkout section. But there needs to be some structure to this. We'd run it as a three week campaign, with a single short conversation per week. Week one, ask a simple question to generate ideas. As simple as "What ideas do you have to reduce theft at the self-checkout counters?" Week two, ask about impediments. Week three, figure out if there are resources needed to help prevent theft. There's a bunch of other factors to consider – reading age, focusing on a single idea, ways to stimulate thinking and much more.
2. Get those out to devices. Ask people to respond.
Most of the time now we simply send those conversation starters via SMS to employees' phones. They receive something that just feels like a text conversation, like WhatsApp or iMessage. It's a super lightweight web app, with nothing to download, not even a password to manage. Even amongst large unionized and dispersed workforces, this is the best way to reach the biggest part of the audience. And they'll reply, as long as it feels useful to them. Which brings us to the first piece of magic...
3. Turn it into a conversation. Route responses to someone who cares.
Back to Chris. "The first time I got a Joyous question on my phone, it was about fiber box installation. You know, I just typed something short. I mean why would I make an effort. Nothing ever changes, right? And do you know what happens... A few minutes later my phone pings, and I get this message 'oh that's interesting, can you tell me more?' I could barely believe it, someone was actually listening."
Joyous can route feedback in lots of different ways. But often it gets routed to a small group of subject matter experts. People in the enterprise who are working on the specific problem. They get a live feed that they can respond to. They can ask for clarification, offer support, and make change happen. This has two outcomes. It starts to create grassroots momentum – micro changes in behavior that all add up. And, it creates this extraordinary dataset, not of ratings, but of actual conversations.
4. Find the top actionable themes.
This is where Joyous uses AI to distill all of that workforce expertise to find the best answer to the big question.
Here’s Kevin Norris, who heads Data Science at Joyous. “There’s several steps to make this work at scale. The machine needs to be able to to identify when a conversation contains suggestions for improvement, or other actions. That’s the starting point, because those are the most valuable conversations. Then it needs to be able to find what those conversations are about. And then look to see what themes come up most frequently, what can be grouped together. And this is not generic. Every org has it’s own objects and concepts (and three letter acronyms!) and the machine needs to learn those, org by org.”
So, there you have it. A methodology for unlocking workforce expertise at scale, that’s proven out in some of the world’s biggest organizations. It’s a whole new category. It's Enterprise Conversations.
Including your people in your biggest challenges
When we talk about employee experience it’s often couched in HR terms. Well-being, DE&I, Culture. These things are of course important. But as we run Joyous in these large workforces we've noticed something interesting. That is not how people think about their own experiences of work.
My morning in the van with Chris was coming to an end. He was talking about that first Joyous campaign that he’d been included in.
“This used to really bug me. Whenever I install a fiber box in an apartment, half the time I get in there, and I have the wrong kind of screws. No big deal. I go back down to the van and get dry wall screws. But it’s back down the stairs, open up the van, back up the stairs, hassle the customer to let me in again.”
The big question in that Joyous campaign was about eliminating inefficiencies in fiber installation. Turns out that Chris was not the only field service technician bugged by having to go get drywall screws. It was widespread. Joyous identified this as an inefficiency, and quantified it. The solution was as simple as bundling both types of screws with the fiber box. That change immediately saved time and money.
But also, in a small way, it made life at work better for Chris. And it’s the sum of all of these little practical changes that often improve employee experience. Likewise, reducing repeat visits is good for the corporation. It’s good for customers. But also, not having to deal with the frustrated customers is good for employees.
“So now the screws come with the box, and I’m not running up and down the stairs. But the best part. The very best part is knowing that someone was interested in my ideas.”
Unlocking the expertise in your workforce may well be the most impactful change you can make to your people and your business.