• Your Consumers are Afraid a blog by Sasha Boghosian
• Alan Shoebridge LinkedIn Group Therapy Post

Group Therapy while Living in a Pressure Cooker: 
Ways of coping with the evolving work demands and the circumstances of today’s world 

• Acknowledging that we are all just human
  • How do we take a step back and do our jobs to support the organizations we work for while also acknowledging how these circumstances are impacting us as individuals?
• Evolving work pressures and the impact of stress
  • This is a new situation for all of us – the personal aspects but also professional. Whenever there is a rapid and dramatic change to what we do, it will bring a lot of challenges with it, that alone is disruptive for people within “normal” circumstances
  • These changes have resulted in staff redeployments and changing how we think about doing our work along with the ongoing need to adapt
    • Significant shifts in the nature of roles that are typically focused on in-person relationships/events. If digital wasn’t IT before all of this, then it is now
  • We are being asked to do more with less. All while trying to reframe these challenges into an opportunity
    • We want to show up and deliver given all of the massive challenges that the world is facing, but on top of all of that pressure we are also dealing with our lives outside of the “office”
• How can we manage and support our team and co-workers?
  • Openness about how we are doing and speaking to it regularly – not carrying those feelings around silently is huge right now. Creating a space to have open conversations about how you are doing with friends and family
  • Creating these spaces is a crucial part of a leader’s work – we can’t get through these challenges without an engaged workforce
    • This is an ultra-marathon, and we are only halfway in. There is much further to go, and we have to care for one another to get there — play the long game here
  • Team Support Ideas:
    • Intentionally set up a time to hear how employees are doing from a human to human point of view
    • Weekly conversations that have nothing to do with work — getting the team to build personal connections has bonded them in ways that we have never seen before
    • Look to see what resources psychology departments are offering
    • Schedule a 30-minute mindful meditation block on everyone’s calendar
    • Schedule regular town hall meetings to discuss timely topics
    • Providing personal time off or leave hours that are COVID specific
    • Instituted a no lay off policy to help settle anxieties
    • Ensure that your team has the resources they need to be successful — do not assume everyone is playing on the same level
      • Example: stable internet access or children at home

• Misinformation Statement: Kati Everett, Chief Communications Officer at Novant Health
• Article: Cue the debunking: Two California doctors go viral with dubious COVID test conclusions 
• Article: Trump's New Favorite COVID Doctor Believes in Alien DNA, Demon Sperm, and Hydroxychloroquine
• Article: An Elite Group Of Scientists Tried To Warn Trump Against Lockdowns In March

The Situation – Rogue docs 

• First, let's define
  • We're not talking about physicians publicizing PPE shortages.
  • We're not talking about the ED doctor suing for unreasonably lowering safety standards after being fired.
  • Those are more on the labor side of issues management.
• A "rogue doctor" hits two kinds of extreme:
  • They are someone who has an extreme or fringe health view.
  • And they are someone who uses an extreme level of communication — such as press conferences on the steps of the Capitol.
  • Rouge doctors discredit the seriousness of COVID-19, talking about kids not being susceptible to it, disregarding masks, etc.
• This is a risk because these doctors carry your health system name and are stating things that are potential liabilities, and it puts your name on misinformation.

Public Examples

• The original rogue doctors – two urgent care doctors went viral in April with video on Facebook claiming pandemic is a political hoax and overblown. They received 4.3 million views on YouTube, and Elon Musk tweeted, "Docs make good points."
• The Houston doctor who said hydroxychloroquine is a cure and that you don't need masks from the steps of Capitol.
• A leading scientist from one of the top AMCs in the country rallied a group of peers to convince President Trump back in the spring that coronavirus was overblown, not enough of a threat, and to not lock down the U.S. — with no credible data.
• Other examples we're seeing:
  • Rogue doctors are showing up at school board meetings advocating for reopening with fringe claims.
  • Rogue doctors are holding press conferences, sometimes from a hospital's property.
  • Rogue doctors are on TV, social media, etc.

Addressing Rogue Doctors from a Communications Perspective

• Do it in a way that you're not taking on the physician, but the data and science — use a credible clinician like a Chief Medical Officer, infectious disease expert, or Chief Nursing Officer to deliver the message, not a CEO or communications member.
• There's a continued obligation for systems to be the arbiters of truth — clinicians have had incredibly high trust scores during COVID-19.
  • When public safety is involved, health systems have an obligation to use this trust clout to counter growing conversations related to misinformation or false viewpoints.
  • Speaking out also doesn't just have to be just when physicians are going rogue, it can be related to conversations happening within your communities about how schools should go back, mask wearing, etc.

Legal Options

• Depending on the situation, rogue doctors represent, at best, a headache for system leaders, and at worst, a real risk to their brand reputation.
  • We spoke with Dan Higgins, partner at Dentons, the world's largest law firm, to identify what options systems might have to address physicians that exacerbate the spread of misinformation.
• Except for when a health system directly employs physicians, there are limited recourse options, given physicians' rights to share their medical opinion with patients and the public.
  • However, if there is significant conversation surrounding a physician, a health system can counter a negative message with one of its own.
  • Point to the facts and science in these situations, ideally leveraging the Chief Medical Officer for a doctor-to-doctor comparison to the public.
  • If the affiliated physician uses a logo or the health system's platform without permission, the health system can ask for the physician to retract its statement.
• When an employed physician is involved, there are additional steps a health system can weigh.
  • Health systems should consider proactively drafting a high-level policy focused on patient precautions for staying safe and well.
  • The system can note that it wants to guide the strategy for the organization's COVID-19 communications, and that while they respect the first amendment and the physician/patient relationship, no one except those authorized by the health system should speak on behalf of the health system in relation to COVID-19.
  • This restricts physicians from any use of the health system's logo without consent. If there is any violation of this policy, the health system has the option to take employment action.

Leaders Have a Voice and Have a Responsibility

• With all of this said, health systems are needed and expected to be the voice of truth — continuing to focus on the facts — even if that lands them in hot water with policymakers and community members.
• Given their position, health systems have a societal obligation to correct any misinformation that may be spreading in their communities.
• Beware of the shaming and guilt language in your communications. Consumers are looking for us to be a stable, objective resource of facts and truth.

Scott’s Background:

• Scott: spent 20 years at various agencies working for top brands.
  • After a clinically fine but experientially horrible period of time working through medical treatments and therapies for his wife, he turned his passion for the consumer experience towards providers and payors.
  • His observation of the experience was there was nothing about it that was built for his wife — significant contrast from the large companies he worked for that obsessed over the consumer experience.

Raghu’s background:

• Having grown up in a country and a time in a culture where medical care was often part of an intergenerational relationship with your local general practitioner, the systemized medicine and care delivery system in the U.S. was a big surprise.
  • We, as a nation have seemed to have simultaneously industrialized the care process while depersonalizing the experience.
  • He was attracted to and still carries the notion that the strength of the healthcare system can be harnessed by the value of the strength between such a noble calling and we the people.

The Vision for M Health Fairview

• M Health Fairview is a relatively new (about a year and a half old) joint venture between the University of Minnesota and Fairview Health Services.
  • While the two had been partnering together in various forms for years, they have never been as closely tied as they are now.
• When Scott was hired at the point of the joint venture, he got three clear mandates from the CEO and his partner:
  • To launch the M Health Fairview brand and make it meaningful to employees and the market.
  • Get us ready to compete for consumers in a consumer-driven health economy.
  • Design customer experiences that are going to help us attract and keep a disproportionate share of customers.
• The first thing he did was take 90 days to observe, assess, and collect data.
  • What he saw was that he had a lot of nice, well-intended people but had none of the skills and capabilities that they were going to need to compete in what he calls a modern economy.
    • The modern economy, or consumer economy, right now is on demand. You can get what you want, when you want it, where you want it, how you want it.
    • The original team was not able to make this happen at the speed it would need to happen.
  • He also saw the chasm that he so often found in his consulting, between marketing, design, and IT.
    • So together, they are creating a Customer Integration Studio.
      • A place where they can design and develop new experiences.
      • Experiences are anything that touches the consumer, such as services, content, and conversations.
      • Similar to an Agile Studio: imagine technology sitting with marketers sitting with designers sitting with strategists, etc.
• They took this solution to the CEO, who then asked, “how will you pay for that”?
  • He assessed the data and saw that none of their activities up until that point were pointing to any priorities for the health systems.
  • So they cut as many of those activities as possible and streamlined the rest, which included downsizing.
  • They then formed a new web of core staff with outsourced relationships with digital development providers.
    • They are now five sprints into a new website.
    • One sprint into a new mobile app going live in the fall.
    • And have completed an automated marketing platform where internal staff can write their own brochures and assets in the correct branded templates and order them on-demand.
• They realized the need to transition from analog to digital to achieve the desired experience for a large and actively operating organization. Which required three things:
  • Fundamentally raising the digital quotient in the organization from the boardroom to the front line.
  • Recognizing the business and stability around profitable and critical care should be the result of the differentiated experience that they engineer.
  • Creating the infrastructure to make all this happen.

A shift in goals.

• At the beginning of 2020, they were clear on a small set of priorities:
  • Two service lines: oncology and neuroscience.
  • Getting our digital front door fixed.
• That was it. Everything was secondary.
  • We can’t be all things to all people. If you do everything, you’re doing nothing.
• Today, they have focused their dollars exclusively on the front door and, of course, what needs to happen for COVID-19.
  • They have a pod working on the site.
  • A pod working on the app.
  • And a pod doing the heavy lifting of COVID.
• COVID-19 manifested the No Normal
• Three factors tend to triangulate an industry is in transformation:
  • You have technical competency: new ways of delivering care.
  • You have cultural norms: new expectations.
  • Then you have regulation: regulatory authorities coming in and bringing reimbursement parity and reducing some of the barriers.
• What COVID-19 essentially did for consumers is create a new expectation.
• Many of the things we were going to implement in a year or two happened now because of COVID-19, so we have accelerated use and technology.
• The revolution of our IT department has been stunning to watch.
• The infrastructure changes that had two-year timelines changed to days, weeks, and months.
• They have figure out how to scale quickly and be less gentle with change than they were in the past.

Virtual Care

• There’s an underestimation of the pandora’s box we have opened with virtual care because of COVID-19. Health systems must understand that people aren’t going to want to go back to the way things were.
  • A quote from M Health Fairview’s CEO on Scott’s desk reads…” We are not going back to normal.”
  • They will be converting their business to virtual as much as they can.
    • Because the consumers want it, and they can make it even more convenient.
    • Because running clinics cost a lot of money, bricks and mortar is a lot to maintain. And the secret that no one is talking about right now is that most of the health systems in this country are in real financial trouble. The structure of cost and reimbursement is not sustainable. We fundamentally have to look at our cost structure differently than in the past.

Resurgence In California

• California is experiencing a new resurgence of COVID-19 in their hospitals.
  • More people are on ventilators and in the ICU than ever before.
  • A main contributor to this resurgence is that not enough people are sticking to the mask and social distance guidelines. 
• Another obstacle for California is the number of counties within the state.
  • Counties started to open up on a regional basis.
  • So, you can be in one county and go to the gym and restaurants, but in the next county over, it is completely closed down.
• Lastly, people are starting to experience cabin fever and are beginning to travel freely and frequently to open counties.

The Latest on COVID-19 Testing

• Stanford has created a centralized testing system that allows their operations to run smoothly.
  • They also opened a new hospital to combat COVID-19, and turned their ED into a testing site as well.
• Stanford is now able to test over 20,000 people per day and get results back between two hours and two days – which is significantly faster than the national average. 
• Though Stanford has international patients, they have focused a lot of their marketing communications efforts on local and regional markets.
  • Stanford has focused on being a credible source for their local are.
  • Their goal is that the community can come to them for information that they know they can trust. 
• Another standard that Stanford keeps is constantly testing employees as a part of taking all the necessary precautions to keep both patients and employees safe.
  • That has been one of the most important measures taken in the pandemic. 

• Hospitals are once again dealing with testing problems, and some consumers have to wait between 10-14 days for results.
• The mask dilemma.
  • Masks are essential to lowering the threat of this virus.
  • Right now, the dynamic around wearing a mask is polarizing. If you wear one, you are labeled a sheep, and if you don’t, you are a heartless monster. Unfortunately, we are seeing these two sides separate even further due to the contradicting reports the public has been told about masks.
  • The good news is that more and more people are coming around, and hopefully, soon, the general public would be willing to wear a mask.
• What do we do when we have to shut back down elective surgeries again?
  • Even if you are not experiencing problems, you need to start planning for it now.
  • There should be an agreed-upon plan before we find ourselves in this situation.
  • If we can stay open, how do we take the necessary steps to keep it safe and ensure the public it’s safe to receive care within our hospitals.
  • Keep the public informed. If you need to shut down, you need to be forthcoming about it.
  • It’s important to clearly communicate the why behind hospitals shutting down elective procedures again.

Offering Support to Employees Amid the Pandemic 

• The response to the workforce wellbeing amid COVID-19 involved creating a new initiative — leveraging existing resources at the very beginning of the pandemic and then adding some additional services later on. 
  • It was clear that employees needed support for their emotional needs, so in response, University Hospitals offered: 
    • A call center for on-demand support. 
    • A digital library containing helpful resources.
    • Free webinars and classes (Yoga, meditation, leadership/management). 
    • A Crisis Intervention Team.
    • "Lavender Rooms" with massage chairs to create a quiet, calming space to relax and reset.
    • Daily emails with important news and encouraging stories.

Accessing Resources 

• University Hospitals focused on offering support that was not connected to HR in order to provide a neutral space. 
  • It's important to be a role model in making sure there is a buy-in from the top leadership by using and talking about the services you offer.  
• Most of the resources are offered in an online portal, but not every University Hospitals employee has a company computer. 
  • So we also send daily emails short enough so that they can be printed and shared by supervisors or managers. 
  • This has been most effective when there is a change in shift for nurses as well as changes in cooking and cleaning crews.   

Breaking the Mental Health Stigma for Healthcare Workers 

• The focus for us is on prevention and building resilience. 
  • The goal is to let employees know that you genuinely care. 
• In terms of communication, we must tell the stories of how others are building resilience and how they face and conquer adversity.  

Tips for Wave Two of COVID-19

• It's important to validate your employee's fears and concerns before you ever offer solutions. 
  • The first step is to make sure that we listen to them.  

Communication Tools

• We use multiple modes of communication. 
  • The daily email is very short and very different from any other emails that people are receiving. 
  • We work hard to try to avoid additional files and any repetition. 
  • It's delivered early in the morning so it can be printed, posted, and shared. 
• We've also hosted town halls, webinars on zoom, and YouTube videos.    

Measuring the Effectiveness of Internal Communications  

• We track the open rates of our emails, attendance to our classes and webinars, and the usage of the call center and the Crisis Intervention Team. 
• We have different kinds of rewards/recognitions to boost morale and participation. 
  • In the weekly email, we highlight workers in our "hero interviews".
    • These are individuals that stand out and bring a great sense of team spirit. 
  • For our classes, employees get points for attending, which ultimately awards money.
    • There is a maximum amount of points per quarter.

Background to the Facebook Boycott

• Initially, Mark Zuckerberg and Facebook came across as noncommittal.
  • They have since committed to adding more context to problematic political posts, and has broadened its definition of hate speech.
• Sheryl Sandberg and Mark Zuckerberg met with the Anti-Defamation League, NAACP, and Color of Change.
  • The groups were disappointed with the outcome of the meeting — wanting more to be done.

To Join or Not to Join 

What's the reach and impact of pausing Facebook in your marketing efforts? 

• Your media plan is essential to reach as many people as possible.
  • 70% of adults in the U.S. are Facebook users.
• When you start looking into making up for the incremental reach that's being lost by moving away from Facebook, you have to start looking to other larger media channels like print, TV, and radio, which have a high out-of-pocket cost.

What do you think brands or hospitals and health systems specifically need to consider if they're going to decide to join this boycott? 

• The number one consideration of your decision needs to be about the authenticity of your brand.
  • What are your values and practices? Those are the things that will persist beyond just this month and that you should be living by.

What are the risks of joining the boycott? Could hospitals and health systems make a change in the way Facebook operates? 

• The first thing you need to look at is the structure of their leadership.
  • It's unique versus what we would see from any other company.
  • The operation is entirely led by Mark Zuckerberg, he exercises complete voting control over the company, and shareholders can't remove him.
  • This complicates the entirety of the boycott campaign.
• Nearly a thousand total advertisers have joined this boycott.
  • Forty of those fall into their top 100 advertisers in terms of their yearly ad spend.
  • Even if all 100 of their top advertisers pulled out, it would only account for about 6% of Facebook's advertising spend.
  • As much as Facebook needs the advertisers, we as advertisers need Facebook a lot more.

What should we do to avoid being reactive in a situation like this? 

• Consumers and patients are looking for certainty and someone to trust.
  • The voice of hospitals and health systems is more critical than ever to keep that trust and have the ability to put out future messages.

What if you have joined or are planning to participate but are still trying to reach people and drive ROI? 

• This should be addressed on a campaign by campaign basis.
  • But if you are going to boycott, I would suggest taking the hit when it comes to losing the Facebook reach.
• Advertisers are using this boycott as a way to pressure Facebook into giving more control of the platform.
  • Traditionally, Facebook will not allow many things that would be acceptable with most other advertisers.
    • They don't allow third-party audits on their site, whereas typically, when you run a digital campaign, you can have a third-party source, and they can confirm that your ads are running as promised.

Corporate Activism 

• Corporations are being forced to take a stance on some issues.
  • Hospitals and health systems are going to be at the center of that for two reasons:
    • Many issues that we're talking about today are related to health.
    • Whether you view yourself as a leader or not, most health systems are one of the biggest employers in their region and to have top-line revenues is a big deal even if your margins are slim.

Preparing for the Roll-out of a Vaccine 

• There may need to be a process or an index that you can use to say what you know, what your decision making process was, and how you're going to help our most vulnerable.
  • It needs to be aligned with what you've decided as your company mission and point of view.
• We need to navigate this together with our clients and make sure that we have a united front.
• It's critical to think of your internal team's hearts and minds when creating your organization's point of view.

Travel Industry Lessons After 9/11

• Security changes were made behind the scenes and gradually travel resumed.
• It wasn’t until after the financial crisis of 2008 that the airline industry started to recover.
• A couple of lessons we learned from this:
  • We’re going to see substantial financial impacts across the healthcare industry.
  • We could see the healthcare industry restructuring as small health systems start to merge with large systems.
  • We have to challenge our pre-COVID-19 thinking and be nimble moving forward.
• We’re working with United on a program called Clean+ to help build traveler’s confidence in flying again.

COVID-19 Response 

• We first saw patients with COVID-19 in Abu Dhabi, so we initiated our incident command structure that includes all of our locations around the world.
  • We started planning in early January by looking at clinical processes and surge capacities as well as gathering stockpiles of PPE.
  • Then, the focus was setting up drive-through testing, building surge capacity, and finally, recovery and reopening.
• Now we’re looking at trying to get back to our pre-COVID-19 numbers while being prepared for flare-ups.
• Our digital platforms have had a significant impact on reaching patients and communities all over the world.
  • Since March 13, we’ve done 8,000 social media posts.
  • Our website has had 120 million sessions so far this year.
  • We’re sending a million emails a week.

Recovery Mode 

• In response to the resistance for people to return for routine care:
  • We've downsized our outpatient spaces to allow for social distancing.
  • We're running at 75% capacity but making it up through virtual visits.
  • We're doing thermal screenings and continuing to enforce mask-wearing.
  • We're encouraging our clinical departments to extend hours and provide virtual options to ensure maximum flexibility.
• We have also created predictive models, which are looking good 30 days from now.

Virtual Care 

• The physician community and health systems around the country and world have undoubtedly adjusted to virtual visits.
  • It’s only going to get better and smoother as technology advances.
• We’re looking forward to remote monitoring tools that can send reliable data to physicians and integrate with health records.
• If we do it right, we should be the big winners in virtual health.
  • Consumers will want to come to Cleveland Clinic for virtual health and not a third party, one-off visit.

What No One is Talking About (But Should)

• Elevating your internal communications.
  • We’ve learned that through COVID-19, our internal communications were a guide throughout this process.
  • Our caregivers have opened 3.3 million of our internal emails since March.
    • We have an 83% open rate with emails from our CEO.
  • We've created 25 videos with messages from our CEO.
• Regulatory areas that need to be addressed.
  • Our supply chains are predominantly outside the United States.
    • The swabs we needed for COVID-19 testing were made in Italy at the height of the COVID-19.
    • Our masks and gowns come primarily from China.

Acute Home Healthcare

• One of our goals as a health system is to reduce the length of the patient’s stay.
  • Infection rates are lower when we can get people home, so we are very focused on that.
• We have a home health division at Cleveland Clinic, and it's an integrated part of the care that our institutes provide.
  • We do it for chronic diseases, especially working with EMS teams that go to people’s homes to try and keep chronic disease patients out of the hospital.

Reimbursements for Virtual Visits 

• From a regulatory perspective, it needs to be one of our highest priorities.
  • We're going to continue to see virtual visits move forward now that we have had such a huge trial period for them.
• Those discussions take place on a state-by-state and insurer-by-insurer basis except for Medicare, but I think you have to give CMS and the government credit that they opened that up very quickly.

• ReviveHealth Article: The Era of "No Normal"
• ReviveHealth White Paper: Five Core Issues for Providers Post-COVID-19

The "No Normal" 

• We don’t know what normal looks like.
  • There will undoubtedly be profound changes in our society.
  • We’re still in the midst of this, and it will take months or even years for the healthcare industry to feel like things are starting to normalize.
• To recover from the financial strain, we have to learn to live and thrive through this uncertainty.
  • That’s why we created this podcast.

Five Principles for Success

• Make no assumptions.
  • We can’t assume what we did in the past will work moving forward.
  • Market research has a short shelf life (2-4 weeks).
  • We’ve seen considerable shifts in just three months of surveying for clients.
• We’re living in a fluid environment.
  • The industry will continue to change as we navigate through multiple waves of COVID-19, the seasonal flu, and the economic unrest we’re experiencing.
  • We’re going to experience a fluid environment from now into 2021 or possibly even 2022.
  • The market has essentially been on a sugar high, but now we are looking at even more layoffs in July when the CARES Act runs out.
• We have to be in a mindset of constant learning.
  • Our decision-making process needs to be faster and feedback loops need to tighten.
    • We have to be agile enough to learn through the waves of COVID-19.
  • Let’s make decisions and adjust our course as we go.
    • The old way of research and committees will leave you behind.
• There will be massive ripples – this isn’t just about COVID-19.
  • We must be ready for the significant changes COVID-19 will bring on.
  • There's been ten years of societal and digital advances in just a few months.
• We have to be comfortable in chaos.
  • There’s an opportunity in this chaos to restructure the healthcare system around the consumer instead of the physician.

Five Issues for Providers in COVID-19 (download the full report here.) 

1. Maintaining a safe environment.
2. Virtual care.
3. Working capital solutions.
4. The idea of physician-hospital integration.
5. Reexamining scale.

Resources Mentioned in Today's Episode

Vox Article: NPR Article predicted by June 6th we would be at 110,000 deaths

Yahoo Finance Article: Houston on ‘Precipice of Disaster’ With Virus Cases Spreading

Vox Article: Arizona’s new coronavirus spike is worrisome

Vox Article: Oregon pauses its reopening plans for one week after coronavirus cases hit new high

Today Show Article: Coronavirus deaths could reach 200,000 by early fall, Harvard doctor warns

Key Takeaways

The Daily Briefing Wrap Up 

• Everyone seems to be talking about the idea of a "new normal." What are we going to do with the new normal, and when will the new normal hit? There's nothing that's going to look like normal anytime soon. Especially as we hear this is going to continue to the end of the year.  It's more like "No Normal".
• This event we're going through is the same level as at least the Great Recession of 2008 and 2009, the Great Depression, and World War ll and the implications coming out of an event like this takes a long time to settle in.

Looking back to the beginning of Daily Briefing Live 

• At the beginning of the show, we were discussing what you call this thing, is it COVID-19? Now we know so much more, but there is still so much unknown. As far as a health system marketing team, there are many lessons that we've learned.
• We did a SWOT analysis of where we've seen the strengths, weaknesses, opportunities, and threats to marketing teams due to the current crisis, and that was an exciting conversation.
• The industry was at a level of uncertainty before, we were going through a profound transformation in the health care system, but it was kind of slow. This is like somebody poured a gallon of gas on that transformation.
• The first episode, when you were talking about what to call it, that was March 18th. We had heard about the coronavirus up to this point, but people weren't alarmed, then the NBA canceled a game. On March 12th, President Trump gave a speech, the NBA canceled their season, and Tom Hanks announced he tested positive.
• We started gearing up right away. We set up the podcast, and our first survey was released on March 21st. We found with research that 65% of people didn't know how to get tested. 42% of people surveyed had not heard of telehealth.
• March was a whirlwind, and I remember when we moved into April thinking "good riddance to March," but my feeling about April was that it was way darker.
• At the beginning of April, we started seeing a couple of stories about the financial impact on hospitals. On April 2nd we released the idea of rapid recovery and realized the financial hole this event is causing.
• April 4th, we released our second survey findings, where we started to come to grips with the idea that one of the challenges to rapid recovery is consumer fears.
  • 40% of consumers were saying it would take 3 to 6 months to get back to normal.
  • 64% of consumers wanted to hear from their hospital at least once a day.
• In May, it became apparent that this is a big deal, and it's not going away anytime soon.
• We had somebody from a southeastern health system come on our other podcast and reported they had 25 DOA's in April 2019, and in April 2020, they had 50 DOA's. So they had doubled their DOA's from people not going in to receive care, and that was just another sign of the delay of care that fear was prohibiting people from going into a hospital.
• The story of May was the loss of revenue from hospitals. On May 12th, it was reported that health systems are losing $60 billion a month.
• We realized primary care was being affected, and if we apply that same thinking to other up funnel encounters down the road, we're going to have what we started calling the missing domino effect.
• You knock over the primary care domino that knocks over the diagnostic imaging domino that knocks over the specialist consulate domino, which leads to the surgical domino. If you take away some of those initial domino's, the surgical domino never falls.
• We started hearing from clients that people were coming back into the hospital because they put off severe health conditions, but our pipeline two or three months down the road plummets.