ROHIT VERMA: Good morning. My name is Rohit Verma. I am one of the moderators for this session on Health, Hospitality and Design. And we will be talking about innovators and entrepreneurs in this field. As an introduction, I am a faculty member from the School of Hotel Administration, now part of the Cornell S. C. Johnson College of Business. And I'm also the director for the Cornell Institute for Healthy Futures which is the sponsor for this session today. 

And along with myself, we have several people from the Institute. My co-moderator, Brooke Hollis, here. Brooke is an associate director at the Institute and also in the Sloan Program Administration. And Professor Mardelle Shepley over there. Mardelle is also from a professor in the DEA and an associate director at the Institute. And Elizabeth Hays back there. So this is the team which had tried to put together this session. And we have three awesome panelists. 

So just to get started, let me just give you a little background on how we decided to first of all start the Institute and why this panel is here. And then I'll hand it over to Brooke. He can introduce the panelists. And then we'll go from there, right? OK. 

So many people think of our hospitality and health care as two different industries. And they are. They have evolved in a very different way. You don't go to a hospital for fun, most of the time. But sometimes it could be exciting time in life. Let's say families having a baby. That's an exciting time as well. You don't always go to hospital just in the case of crisis. 

In the same way, when you go to a hotel, you're not always there just for pleasure. It could be for business. It could be for some other stressful situation as well. So even though they're two industries that evolved differently, they share a lot of common elements. And the reason for that is because they have evolved out of the same basic human need, which is an individual taking care of another individual in the time of need. 

So the root word for hospitality and health are basically the same. They come from the same point where you can think of it as a guest or a host or a service provider or the one who is the recipient of the service. So keeping these principles in mind, we created an Institute a year and a half ago at Cornell. It's called the Cornell Institute for Health Futures. It links three core disciplines-- the hospitality, health care, and design, which is the overall umbrella to look at these industries more critically. And we focus on things which are overlapping across each other, such as senior living, role of health and wellness in the hospitality sector, role of service and hospitality in the health care sector, and so on. So that was the logic. 

Now let me introduce Brooke here and he can take it further. Brooke? 

[APPLAUSE] 

BROOKE HOLLIS: Thanks so much, Rohit. So it's been really a privilege to get this Institute off the ground and to work with Rohit and Mardelle. They both are leaders in their own fields. And it's been a lot of fun. And we've really enjoyed what we've been able to do so far. It's also exciting to get to work with all the different people that we do. And we have a fantastic panel today which actually, I think, really represents this whole intersection between the different fields. 

So I want to give you a little bit of background. They'll talk more about their careers when we get into the session. So first, Ros Cama is the president and founding partner of her own firm and has really been a leader in the evidence based design movement, has done a lot of things in the world, and has been very, very active. Was a past chair of the Center for Health Design. Has worked with Mardelle for many years, actually, as well as Frank Becker who is the former chair of DEA. And Mardelle is just taking over as chair of DEA. She's one numerous awards both from the Center for Health Design and for her work. So she has a really interesting practice that cuts across a lot of these areas. And you'll hear more about that. 

Alexis Strong is the Director of Service Implementation and Operations at Docent Health, a really interesting company that's trying to be a revolutionary change maker in the area of patient centered care and customer experience. Has a very interesting background both in health care policy and management at Duke as an undergrad and then worked with PWC and Ritz Carlton, came back here and did a master of management and hospitality. So she's got a great crossover in terms of the hospitality and health background. And she'll talk more about her experiences. Also worked with some other places that were great experiences. 

And Michelle Punj is Director of Operations at the California Health and Longevity Institute which is part of Four Seasons in California. And actually, Rohit just happened to meet her at the Global Wellness Summit. But it's a really interesting place that combines the best of Western medicine with alternative and complementary medicine in a luxury hotel setting. They've got a 3 Tesla MRI, a 64 Slice CT scanner. This is a really serious diagnostic and treatment center. So it'll be really interesting to hear what her thoughts are. 

But also she has a very interesting background that cuts across a lot of these things. Went through the nutritional sciences program in College of Human Ecology. Became a registered dietitian and a holistic dietitian, and then came back and did an MMH, actually through Mary Tobacchi who many of you may know who was a wellness pioneer in the hotel school. And so she's really got a great combination background as well. 

So I think we'll kick it off. Each one will talk a little bit about their career and about their respective organizations. And then Rohit and I will ask some initial questions, and then we'll get into Q&A with the audience. So why don't we go in order. Ros, do you want to start out? 

ROSALYN CAMA: Sure. 

BROOKE HOLLIS: Thank you so much. 

[APPLAUSE] 

ROSALYN CAMA: So welcome. This is truly exciting for me to come up here to Cornell. I've had a relationship with the university. I am a land grant graduate from the University of Connecticut who got rid of all design programs. And so I come here with full admiration for what you've been able to do to this program and certainly have maintained a relationship with-- are Ronna and Rhonda in the room by any chance? We've actually included-- hey. So we actually, two years ago now, engaged an innovation class in a sophomore design group to take a look at a project we were doing and then Liz Oshana, who is a senior designer on our staff involved in this project, we Skyped in from Connecticut and actually enjoyed sharing knowledge across many disciplines to sort of bring interesting solutions to our clients. 

So CAMA is 34 years young in New Haven, Connecticut. The majority of folks come to the firm with a degree in interior design. But we have had people and have folks on staff with degrees in architecture, public health, art history, a variety of disciplines. And what I'd like to say about us is we're a small group of folks who understand that design of the built environment truly has an impact on who we are as human beings and our well-being. 

And I love that, not just in the realm of health care design, and the evidence that's building-- and I credit the Institution's, certainly Mardelle and many of her colleagues who have contributed to this body of knowledge in the Ivy halls, but how we form this conversation and bring it into practice. And I am firmly believing now that as our project duration's get shorter and shorter that the innovation isn't happening at a practice basis, it's happening in these partnerships that we're creating at this level. And so thank you for allowing me to share my conversation. 

So let me let me just take you through a couple of things. And one thing that I will say is if you are to-- and I'm a senior here. I have been doing this for a very long time. If you want to make a difference, you've got to know your why. So meet Jacob. Jacob is my why. 

Jacob-- doing health care, you meet a lot of folks who live in the state of illness or injury and learn to master the system. So this little guy, along with a few others-- we were getting ready to design a Children's Hospital. And the large architectural team pulled the short straw and got the little kids with their parents to think about what was important to them. So I took a very simple approach. I put up two flip charts. I put up a happy face and a sad face. And I said, OK, kids, let's talk about what you really like about every time you come to this hospital. and Child Life won hands down. For any of you who know anything about pediatrics and children's care and health care. And they talked about lots of other things. 

And Jacob blurts out needles. So I went over to the sad face chart. And he said, no, no, no, no. It's a good thing. Needles make me better. So what do you know about needles? They hurt. 

So I'm a designer. I can't cure Jacob. I can't make the needles go away. Maybe one of you will design a needle that doesn't hurt. But no one's figured that out yet. 

But what I do know is that through the design of the built environment, I can create a positive distraction. And people like Mardelle tell me that if I create a positive distraction it's been measured that I can actually reduce the amount of pain medication that's administered to those who actually self-report. So therefore, I do have an impact on Jacob. But I have to make that connection between his experience and his state of well-being. And that's why we need this partnership and research. 

So I can stop right here and leave you with that story because that's probably the most important message I can give you. I need the research that comes out of these halls to make a difference every time I meet a unique individual who has a particular need. So let me just go through-- how am I doing here-- quickly. We also know an awful lot about environments. This was a hospital that we did, Dublin Methodist, 94 bed hospital in the middle of nowhere Ohio that got a lot of attention. It was led by a CEO who was a nurse who gave us T-shirts that said run until apprehended. 

And it was the first time on a project that I got to work with the landscape architects. We knew from the research, from Roger Ulrich coming out of Texas A&M that this connection to nature is so vitally important and could we blur the lines? And so we followed this landscaping pattern inside outside. 

The client allowed us to look at the business case, because that was the way we could support this up the chain at Ohio Health. That if we could add more perimeter windows in this a very gray environment of central Ohio that we could create a healing environment. And so this connection, again, between how the environment sort of sets up this perception of what care is going to be like is vitally important in the way that many patients will report out their satisfaction, which is important today. 

So to that end, I got very involved in this conversation around design thinking. And so we deconstructed our firm to think about those important things. And we're not industrial designers. But we do have a lot of good design thinking. And so we call that our lab. And many of the large firms will bring us in early on to talk to the Jacobs, to go out into the literature, to meet with those colleagues who are doing research and ask the questions that are important for the problems that need to be solved. We're traditional designers, so we also do good studio work and behave traditionally in that regard. 

And then two years ago I realized that I had some pretty decent ideas that no one was picking up on and feeling just cocky enough that I could go out and ask. I started, I went to the big manufacturers and realized I need to be lawyer up. I didn't know enough about this entrepreneurship for venture capital. All I knew was I needed to make a difference for my Jacobs in the world. And I finally landed on a manufacturer and we launched a chair that I'll show you in a second. But it also makes me realize that I can ask about other things as well. So being given permission to incentivize change in this field is important. 

There were a lot of things that drive change in health care. And unless you get the culture right, I don't care what you build, I don't care what product you develop, care doesn't change. Health care is a very entrenched industry. It's slow to take on change. And very few are willing to be the first, because it's costly. And oftentimes they feel like the expertise isn't there, although it's beginning to change. 

But at the end of the day, hospitals exist so that people like Jacob can be nursed back to a baseline of health for whatever that is for each of those individuals. So it is about call them customers, at the end of the day, they are sick, they are injured, they are patients. And what they need is an onstage ambassador, be it a nurse, be it some sort of clinician who has to be at the ready. And if you look at the studies, you understand that most of the-- I'm using my timer, because I'm going off here-- most will in fact not spend the time nursing that they want. And where it falls short are these sort of backstage, off stage, processes of delivering supplies. 

So this very delicate three ring circus of how you do just in time delivery, deliver this unknown surprise element to this customer is often falls short. And when we're asked to design this, we can't do it alone with bricks and mortar. We can't do it alone with the kits of parts. We have to engage the whole industry. 

So we've formed these multidisciplinary conversations. So we do it a variety of ways. We spend lots of time going out into the public, going out into project teams, gathering information. Never asking them what they need, because they'll only fix their old problems. What we try to do is get them to think about the future of their field. So the building that they're imagining today will last another 40 years. 

So my emphasis was the Brigham and Women's project that we did with Ronna and Rhonda and their class. And it was about taking an existing building, really beginning to look at existing bricks and mortar and changing experience through the main concourse of the building. One of the things we discovered was that the single most important thing that was happening on that concourse was food service. And so the head of facilities said, Ros, what do you know about food? I said, what do you mean what do I know about food? I like it. He said go do your Ros thing and go do a paper on it. 

So we went into the literature. We looked across a variety of disciplines and we realized how important food was. But more importantly, how important a health care institution had the responsibility to rethink their responsibility of food service. So this whole idea of the social service way of nudging through design became an important topic that we discovered for them. 

This idea of well-being is really linked to memories and how people tell stories. So we have also launched a way to capture stories that people have to tell and try to find common threads and understand where those memorable moments happen. And we've seem to figure out that it's never about the clinical event. It's about everything that happens around that clinical event. So to that point, we've been working with a lot of large firms in mapping where those moments are in building projects, and then creating checklists, which we are now starting to document in a way that we are building that isn't just on a per project basis-- there's a paper here somewhere, if someone here, wants to take this information. 

We do a lot of iterative work. Sometimes on projects-- this was a Pebble Project which was a field study research project in Princeton, New Jersey. We built a foamcore mock up, a live mock up. Now we're adding a virtual reality to this effort. We just did one down in Atlanta with HKS. And I'm looking forward-- I went to the HIMSS Conference this year-- to augmented reality, to be able to function through these spaces. But there are a number of topics that we continue to build on in this field. And we look deeper and deeper and deeper into these topics. 

Another important thing that I want to say is that in the consumer's understanding of health care is that health care is complex and confusing. And at a clinical touchpoint, you do as you're told. You hear multisyllabic Latin words and you don't fully understand. But what you do understand is what we call this time between. And we do not organize it. For those of you who are in hospitality, you do a much better job of organizing the time between the service moment. And so health care just has to get better. We feel that's an interior design responsibility so we're taking it on. 

There is so much broken in the work environment particularly now that technology has come into play. And technology, as I say, is a combination of software which is evolving and hardware which was designed for the office worker. But the clinical worker is a mobile worker. And I think it is the-- here's a clue for those of you who are entrepreneurs-- it is the hardware of the computer that is ill matched for certain populations, health care being one. 

So this is the chair and the sofa that I-- and I'm going to wrap up soon-- that I brought to market. The idea around the chair was healing power of touch. Moms had wanted the ability to get in bed with their patients. But for medical reasons and safety reasons, they could not. So I worked with a manufacturer and put before them a number of functions that we needed to be able to get to the bed as closely as possible, to be able to get it out of the way in case of a code, and to be able to empower this healing power of touch. And so we've been enormously successful. 

We're continuing on with a concept for a sleep sofa where you're only sleeping a small percentage of the time. And so how does that sofa become more of a chaise or a daybed or a way to make a much more pleasant experience. We're starting to work with a number of other manufacturers. So I'll look forward to coming back in the future and sharing some other things. 

I'm going to stop here. And say that there's so much more to tell, because health care is quite complex. But I hope that I've at least imparted that there is this connection between the human experience and the difference really between health and when you're on the injury scale where near senses become vitally more important than say our far senses which you experience in hospitality. So I will end there. 

[APPLAUSE] 

MICHELLE PUNJ: Good morning, everyone. It's a pleasure to be here today. My name's Michelle. I'm the Director of Operations for the California Health and Longevity Institute which is managed by and operates within the Four Seasons Hotel in Westlake Village which is in California. 

I wanted to start by telling you a little bit about myself and my career path. As Brooke mentioned, I did programs both in nutrition science and human ecology, as well as a master's program here at the Hotel School. I went on to gain registered status both as a registered dietitian at Massachusetts General Hospital as well as a degree in holistic nutrition in the Canadian School for Natural Nutrition. But it was really my first summer job actually in college that brought me into the destination spot industry, or health resort industry, or wellness tourism industry, it's taking a lot of names. But this used to be a very niche market, but it is now one of the fastest growing segments within global tourism. 

So before I talk about my career path, I wanted to do a brief introduction into this business section with which I operate. So I don't know if anyone's seen this before. But SRI International came out with a study on global tourism in 2013. And this was really one of the first times that there was some research done in the fields of wellness tourism and medical tourism and how they overlap with many other different markets in the tourism industry. 

But for the purposes of the conversation today, I wanted to point out this section between medical tourism and wellness tourism, which as you can see on the screen is a very niche market. And what this is is medical tourism is people are looking for a higher quality or lower cost health care, whereas wellness tourism is really people looking for more preventative medicine, health and wellness offerings while they travel. 

So the research that came out was showing not only was the wellness tourism industry growing 50% faster than any other market. It was growing at 9% per year showing to be at almost $680 billion industry by 2018. 

Now fast forward to this year. This research just came out this January but is showing 2015 statistics, which is showing that wellness tourism is actually moving faster than expected, 4% faster than that 9% change. So this is not only showing that there is growth in this industry and this isn't a trend or a fad. It is a continuous process. But it's showing that the upcoming generations are really prioritizing their personal health and well-being as more of a need and a mandate rather than a luxury or something that is selfish, which was thought of in the past. 

This quote by Ophelia Yeung who did all of this research with SRI as part of the Global Wellness Institute. She said that "Recent years have been marked by global economic contraction, but a wellness economy just keeps rising within an upward trajectory that seems unstoppable." And this is despite economic recessions. 

So this brought me to the industry that I'm in today, which is this intersection of medical tourism and wellness tourism. And this chart shows the spectrum of the different offerings that are in that segment-- from medical tourism on the left to wellness tourism on the right from generic hospital-like experiences at the bottom to authentic ashrams in India at the top. And my career path has really been able to take me through this whole spectrum of opportunities. I worked in a hospital, at Mass General Hospital, and got that clinical experience. I also had the opportunity to work with two Ayurvedic clinics-- so that's more at the top of this chart-- two Ayurvedic clinics. One in Iowa that was actually overseen by a Western medical system and one in the foothills of the Himalayas that is very traditional, pure Ayurvedic practices, as it's a traditional Indian philosophy in health and wellness. 

I then went to Six Senses Hotels and Resorts and worked at their are only destination spa property at the time, which was located in Phuket, Thailand. In that concept there, they were able to integrate Ayurvedic practices, traditional Chinese medicine, naturopathic medicine, and some Balinese philosophies of health and wellness. 

When I came back to the US, I worked with G7 Hospitality Group which gave me insight and experience into boutique hotels that were looking to introduce health and wellness practices into their businesses. And I was working with financial analysis, market research, competitive set analysis, and really gained experience in that lower quadrant of hotels spas, day spas, and this new trend of healthy hotels. I was also able to gain some brand experience. First one working with Shangri-La Hotels and Resorts up in Vancouver, British Columbia where I was able to introduce Asian philosophies of health and wellness into an urban day spa experience. 

And that brings me to the work that I'm doing today which is at the California Health and longevity Institute. And this property is really a true integrative health center which is at the epicenter of this chart here, really the blend between this medical tourism and this wellness tourism industry. So I want to tell you a little bit about California Health and Longevity Institute. It's a very long name, s. I'll say CHLI from here on out. But the CHLI model is multidisciplinary between medicine, nutrition, fitness, life balance, therapeutic spa, and complementary and alternative medicine. 

And the philosophy is that we hope our guests learn about themselves through diagnostics in a very science-based approach. We help them experience healthy living through tactical experiences and lifestyle immersion programs. And then we help them live this experience through continued guidance, integrated programs, and recently through actual virtual accountability. 

So stepping into each of these disciplines just a little bit more to help you understand this multipillar model, the medical team, their main product is executive physicals. So the same that you would get from the Mayo Clinic or the Cleveland Clinic, they really take a 360 degree look at the self and see how they can help you prevent chronic lifestyle diseases. So it's a very preventative approach. 

And we don't really do acute care. But we do have a full team of nurses, general practitioners, cardiologists, gynecologists. We have a dental unit, a dermatology unit. And as Brooke mentioned, we have a full radiology lab. So imagine all of this within the walls of a Four Seasons Hotel. So it is a very in-depth approach. And there's a lot that we're able to do directly on site. 

But after the medical exam, the doctors pass on to the lifestyle practitioners. This can be beginning with a registered dietitian who not only does one-on-one consultations, workshops, and lectures, but also an interactive cooking experience through our demonstration kitchen which is a really fun experience. It's called a Wellness Kitchen that lets our guests interact with food in a way that they're not able to do just in a one-on-one consultation setting. We do demonstration style interactive classes and then take you to the feel good dining room where we dine in a communal setting, which really brings people back to the enjoyment of food. 

We also have a team of exercise physiologists. And they not only do personal training and consultations, but have very high tech performance testing capabilities that we're only able to do, because we have a medical team on-site. 

We also have, in the life balance category, clinical psychologists and a group of mindfulness experts that can really teach stress reduction from a very basic, mindfulness-based meditation to more of the science behind clinical psychology of stress reduction, which is mindfulness-based cognitive therapy, which is really a growing industry in clinical psychology. So giving those individuals the tools to really help reduce stress to help with their life and longevity. 

So with all of this and, as was mentioned, I really believe that there is a very deep and profound connection between health and hospitality. In hospitality, it's really about taking care of people. And I think that responsible hospitality goes much further than that. And for those that are in the hotel space, I feel that we have a responsibility for that built environment of the hotel to really be health promoting, for the foods that we're feeding our guests to be nourishing and not deteriorating, and for our guest to be able to leave a property really rested and rejuvenated and healthy, rather than travel being a burden on the body. 

And this concept of the California Health and Longevity Institute has really allowed me to blend both of these fields and the opportunity to really utilize entrepreneurship capabilities to bring strategic renewal and innovation to this current paradigm of medicine and health care and hospitality, which is historically dissonant, yet is really seamlessly intertwined in this connection of human connection and compassion. So instead of offering pillars of health principles, we're now really integrating this luxury hospitality concept with real health services and experiences that teach our guests about the science of living longer and the art of really living well. 

I want to talk a little bit about a few programs that we offer at California Health and Longevity Institute that go beyond just those services that I mentioned. We have a client that works with us, a corporate client, that brings all of their executives. Over the course of five programs every year, the executives rotate each time. They come on property because their company believes that their executives should retire financially stable and healthy enough to enjoy their retirement. 

Now I think that's an absolutely fantastic way for a company to look at their people. And we've partnered with them to create a program where their executives come on site so that we can teach them how to better live a healthy life moving forward. They take care of the financial side of things, but we do the health immersion program. 

So an immersion program would look something like this-- a corporate retreat where we partner with professors and researchers from UCLA and Stanford to bring keynote addresses and workshops on whatever topic and area the company wants to focus on. So workshops can be vitality in the brain, optimistic leadership. We had just one on digestive health. And then we give workshops and electives based on what those individuals are looking for. So we're able to do health testing, metabolic assessments, skin cancer screening, whatever we need to bring to them that will help give them the tools to live that healthier life. And then consultations, if they want to go in-depth in more of an individual one-on-one setting. 

All of this with the capabilities we have within the Four Seasons, we're able to do catering through our Wellness Kitchen. So we are able to offer healthy catering from our facility for up to about 50 people. But in Four Seasons, we have 48,000 square feet of meeting space. So we're also able to offer 600 person catered events through the hotel. So the partnership is really expanding the opportunities that we have. And these corporate retreats are really bringing new insight and opportunities into incentive programs, retreat programs, and group programs that typically travel around to different hotels. 

We also have-- I was just going to touch base on one other program that we've launched, which really defines the partnership between the California Health and Longevity Institute and Four Seasons, which is a new program called Fit Four All Seasons. And this program utilizes virtual technology to allow our exercise physiologists that are on property with us at CHLI to connect digitally with the customer or the guest wherever they travel around the world using technology. So whatever wearable the guest is using connects directly and produces data to the exercise physiologist to be able to give real time communication on the program that they've designed for that person. 

So what this does is this is a first step in increasing accountability and compliance with our individual programs. And this can be for someone that's looking to run a marathon, or the corporate Four Seasons client that's traveling around the world but really wants to stay in touch with their health and wellness. 

So that's just a brief overview of my career path and what I've been doing. But I'm excited to get into this panel discussion. And on to Alexis. 

ROHIT VERMA: Thank you so much. 

MICHELLE PUNJ: Thank you. 

[APPLAUSE] 

ALEXIS STRONG: Hi, everyone. Alexis Strong, again. Brooke did a phenomenal job of explaining a little bit about my background. So I'll go. I'm bringing up the rear here, so I'll try to move pretty quickly through this. But my undergraduate degree is from Duke University in health care policy. Graduated from Duke and decided that I loved health care but I didn't want to be in politics. Then decided that I wanted to go to a graduate program and ended up at the MMH program here. So I graduated in 2008 from the MMH program. 

I remember-- I was telling them last night-- I remember my father saying when I graduated from the MMH program, he was like congratulations, Lexi, what are you going to do with those two degrees? And I remember saying, I really don't know. I remember feeling like there was a lot of crossover. And in fact, in our Quality Control and Process Improvement class, I think it was the first time we really had Sloan kids with the MMH students. And it was the first realization for me that there was opportunity in sort of this crossover between my two loves, which was health care and I wanted to be involved in something that was really sort of giving back and creating a better society, but also hospitality. 

So I then went on to work for Ritz-Carlton. I did both quality control and process improvement for them. And then also front of house operations. I worked for sort of an entrepreneurial restaurant company in LA that was looking to really sort of make customer experience their value proposition. 

But similar to Ros mentioned, you know it's important to remember your why. Somewhere around there-- my family is all from LA-- my niece who was 6 at that time had a bit of an accident. She ended up sort of-- it's a long story, but her foot got caught in a lawnmower if you will. She nearly lost a toe. It was whole thing. They had to medivac her from Florida where she was at the time back to Children's in LA. 

My whole family, the way we do, sort of swarmed in. Everybody came. My brother-in-law had to stay with the rest of my nieces and nephews in Florida. So it meant that we were there. I was there with my sister to take care of her. And it was that moment that I realized that there was so much opportunity. I mean Children's in LA is a phenomenal organization, phenomenal provider. But there was so much opportunity for that experience, not just for the patient, but also for the family. 

So I say that because then I went to work for PWC. I went back to their health industry's advisory group to help consult on patient experience strategy across payer provider and pharma. But really love-- I'm sort of one of those odd people who really enjoys operations. I love being in the thick of it and actually doing the thing, if you will. Right? We were creating a lot of strategy, but I wanted to be in the moment, in the provider setting, making those changes. 

So I worked for PWC for three years And then ended up moving over to Docent Health which is a startup based out of Boston really focused on, we often say, patient experience, but really we talk a lot about patient family and staff experience. And how do we drop in both with the technology that will support that experience but then also the service side of things? So I am now the Senior Director of Service Integration for Docent Health which means I run all of our service operations right now. And I'll get into it a little bit of what and how Docent Health is all about. 

If you are a hotelier in the room, if you are really a service oriented person, you may recognize this fine friend of ours. So at Docent Health, we often try to use reflections, oftentimes, to level set on what is our why, what is the purpose behind what we're trying to do? So this quote often comes up for us. "It's human nature for people to take precisely as much interest in you as they believe you are taking in them. There is no stronger way to build relationships than taking a genuine interest in other human beings and allowing them to share their stories." 

So patient experience has gotten a lot of focus of late, largely because of ACA, this whole conversation around value based care. But quite frankly that was really just an impetus to what health care really needed to learn, what they could learn from hospitality, which is that patient experience and building those relationships it's not just about reimbursements. It's not just about we talk about HCAHPS. It's not just about those things. But it's things that hospitality has known for years that health care has just not really grabbed onto yet. 

So things like when you talk about acquisition, when you talk about retention of patients. And now that that's sort of paternalistic dynamic in health care is shifting and there is a power shift to consumers, health care's starting to realize that a lot more. 

We also talk, I remember talking a lot when I was here at MMH, about this co-produced human experience. That was sort of the peril. I couldn't put the words to it when I had that health care degree and that hospitality degree. But that was the connection for me. I loved being in an environment where it's a human producer and a human consumer. It's really complicated. It means that human beings are naturally irrational. We do bizarre things at bizarre times, which makes it complicated, but also that much more interesting, I think. And it's also emotional, which is not your typical manufacturing environment. It's a human connection. 

And so that is sort of what at Docent Health what we're trying to get at which is we're looking at the bigger picture of ultimately everybody's goal is better outcomes. We're looking at better outcomes for the patient. We're looking at healthier patients. We're looking at an experience that the patient actually can glom onto and can really change as a result. 

So I sort of talked on this. I don't know that I really need to explore a little bit more. But essentially, the business model for Docent Health is that we partner with actual provider systems. 

So right now we have three relationships with three provider systems. Piloting right now, we have one pilot in orthopedics and two in maternity. But the idea being that we're piloting with providers, partnering with them, because we've sort of decided that in terms of maturity of the actual health care industry, there have been a lot of startups that have tried partnering directly with the consumer, with the patient. But whether, ultimately, we may get there, and I think that's the ideal, but kind of recognizing that we're not quite there yet. The patients don't yet know how to advocate for themselves. So partnering with actual provider systems and then bringing in outside industry experience to kind of improve that from the inside out. 

We talked a little bit about this. In fact, Ros had sort of a similar slide. It's always nice to see that kind of alignment, unexpected alignment. But we talk a lot about the fact that health care has this like standardized experience. Right? Now it's very siloed. We've gotten everything process wise. We've gotten everything down to efficiencies. And we talk about efficiencies. Everything's very clinical. Everything's checklist driven. 

But when you look at the patient experience pathways, a lot of it is emotional questions. And it's really not organized. And a lot of what happens is actually in the white space. Right? We're talking about the white space between hand-offs. Right? How do you get from a diagnostics to a pre-op to a surgery level? What are the questions that happen in between and who's answering those questions? Who does the patient go to? 

And a lot of that just isn't happening right now. A lot of times, when I was in the MMH program, we would talk about-- so when you say patient experience pathways, they're invisible, happenstance, and undiscovered. We used to talk a lot about-- and maybe this term still floats around-- but sort of like the tip of the iceberg. In our quality class, we would talk about guests would tell you only that 10% of the issues that actually happened in your hotel. The same is true in health care. So how are we creating those human connections where people are starting to tell us more about their experience, trying to indicate to us what is happening so that we can ultimately fix them? 

So when we talk about it, so how do we deal with this from a technology enabled service standpoint? So we talk about this both from the service end, but also the underlying technology. So we called them docents. Obviously, at Docent Health, that's just sort of the name we use for them. Oftentimes in hospital settings, people will refer to them as patient liaisons, patient navigators. And you'll see a lot of-- interestingly enough-- a lot of hospitality buzz words in here. 

So this is kind of the basics of this service overlaid on top of a maternity journey, primarily because that's mostly what we're in right now. But when you talk about early pregnancy, pre-hospital labor-- so the timeline of the actual patient journey. Then you'll see all the steps, which are really more hospitality goals for each of those steps. Right? You talk about foundational hospitality theory, a warm welcome, expectation management, delivering on the promise, easy transition, a fond farewell and settling in. 

So that was all based on hospitality theory. The idea being that if you think about your experiences in health care, oftentimes you don't get a warm welcome. Oftentimes a lot of these things, there are so many questions that happen in the expectation management setting that just go unanswered. And it creates a level of anxiety for the patient. 

That means if anybody is familiar with e-Patient Dave? He has-- Yeah. So he has a really great-- you should look it up. He calls it, I think it's called the Taxonomy of Burden. It's a graphic. It's an infographic, but it talks all about this idea that human beings have a saturation point. They have a stress level saturation point. 

So especially in a health care environment where those anxieties are already higher, when you're at that level of heightened anxiety, you can't absorb a whole lot more. So if the doctor is giving you post-op instructions or they're trying to tell you how to integrate or how to co-create that experience, you aren't going to be able to listen to them if your anxiety levels are that high. You can't take on any more information. 

So a lot of people say, well, patient experience, you're talking about food, you're talking about-- it's all about clinical care. Yes and no. Right? It is about the clinical care. But if that patient can't understand how they're supposed to co-create that outcome, you're not going to get the outcomes, the clinical outcomes, that you're looking for. So when we talk about a lot of these, a lot of the questions we get, the docents get on the ground, are things like where do I park? Basics, right? But human beings need to understand that. They need to understand where they're supposed to go, who do they talk to. 

So we talk about that. We have all of these hospitality goals, if you will, in each of the touchpoints. And we do that through-- you will see the top line-- kind of what we call top of funnel partnerships. So we are partnering with a lot of OB/GYNs to get as far upstream as we can. But then really we do sort of a preadmit contact point. We touch the patient inpatient. And then we also do a post-discharge follow up call and try to support the patient with largely a lot of their non-clinical requests, or triaging those clinical questions to the right resources. 

Underneath you'll see the technology piece. And that's all these different areas that-- then the technology augments that. We look at segmentation. We look at HCAHPS predictability. We look at natural language processing. So not only what are the patients telling us, but what are they not telling us. Right? How do we start to get into some of that subconscious. That's where the technology augments it. 

Oftentimes, again, in sort of my hospitality background, we would talk about moments of truth. Again a buzz word that comes up often in hospitality, you will never hear it in a hospital. But also that has evolved. And so we've talked-- Docent Health-- we've talked a lot about you know, it's not just the moment of truth, but Google-- whenever that was, 2002, or something-- brought out this idea of the zero moment of truth. 

So not only do we need to talk about the inpatient moments of truth, but also what's the process for the patient when they start to search for-- Google essentially said, your first moment of truth is no longer in person. It's usually digital. It's something where you search for. So what is your presence online? What is the word of mouth? How do people first interact with you? But it moves all the way through the moments of truth inpatient to what has then been developed as this ultimate moment of truth. Which is not just at the end of their journey, it's how at the end of their journey does all that information that we've gathered about them throughout their journey then circle back into their next cycle or their next interaction with you? 

So how do we make it more of a lifelong journey, the customer lifetime value and look at it that way and carry that patient throughout? So each time they come into your hospital, we aren't asking them the same questions over and over again. 

So that's a little bit about the technology. We try to approach it-- so when I was working at Ritz-Carlton, I ran their guest relations department. If you think about Docent Health, it's very similar to a guest relations department at a hotel. We try to track the patient. Each of those touchpoints that we make with the patient, we track preferences, we track concerns and fears. Are they afraid of needles? Are they really concerned about have they had a bad experience in the past that we need to be aware of? All of those things are going to impact their future experiences. 

Then we try to-- also we're working on sort of dynamic journeys or sort of changing journeys based on segment, based on the clinical needs, based on a variety of elements so that we're creating a journey for that patient that is specific to the patient or a little bit more customized. And then also on the back end, how do we feed that information back into the provider setting? So how do we then fix that experience so that we're addressing root cause and not just tackling symptoms and running fire drills all the time? 

And the last slide. But then the other importance that we've realized is also having the people on the ground, the boots on the ground. I talk a lot about this knowing, doing gap. I spent a lot of time at PWC talking about customer strategy. And I really, really enjoyed that. But what we were finding, oftentimes, was that as much as hospitals were interested in the theory and the strategy, they didn't have the people on the ground to actually execute. 

So these are actually two of my teams. This is the Chandler team in Arizona. And that's my California team. So they are the actual docents on the ground. They're the ones who are doing the calls, the inpatient touchpoints, and making sure that the patient feels known, valued, and heard. 

ROHIT VERMA: Thank you, Alexis. 

[APPLAUSE] 

BROOKE HOLLIS: So I'm going to just throw out a few questions to get started. And then I want to make sure there's plenty of time for other people to answer them. So I guess I'll start out with Michelle. For the Four Seasons, Westlake Village is a really unusual place. But I'm curious from your experience so far if you think that more places are going to adopt something as comprehensive as you've Done and I know there's a lot of movement in the hospitality industry towards wellness. But I'm curious how many you think will go that far or something in between? 

MICHELLE PUNJ: That's a great question. We have a very integrative program where we include the medical component as well as a lifestyle component. There are other hotel brands that are entering into this space. But they're entering in with partnerships. So because there is so much complexity with HIPAA regulation when you get into medical care, I think it's very unlikely that hotel brands will take on the responsibility of the medical component. But I think that there will be much more collaboration and partnerships being developed with that luxury hospitality especially in countries around the world with preventative medicine centers. 

The lifestyle component, when you get into the nutrition and the fitness and the lifestyle, that is having broad applications across many brands, even hotels. As the perfect example with Intercontinental Hotel Group designed a full hotel brand centered around health and wellness. I would consider this pretty soft wellness, as there is just touchpoints throughout the experience. But it's still a great integration of wellness into that hotel experience. 

So I think there's great opportunity in hotels branding as wellness resorts integrating that philosophy of responsible hospitality that I was talking about by making sure that all of their touchpoints, the hotel space, the design, the food that they're serving. More and more people are looking for their hotel experience to be a healthy experience. But in terms of the full medical component, I really think that's going to stay a partnership because of HIPAA regulation and just that it's a lot of responsibility and liability to take full ownership over the medical team as well. 

ROSALYN CAMA: I can pick up on something that I didn't get to. And that is that health care has moved outside of the clinical box on the hill in most communities. But to the other extreme of hospitality, and sort of luxury markets, there is a responsibility that is being pushed by our state governments and our federal governments to take care of those who are at risk. 

And so we're actually engaged in a Department of Social Services project in New Haven, Connecticut looking at homeless drug abusers and how to keep them out of the emergency department. And all of the same principles-- I kept taking pictures of your slides because I want to bring it into community health-- we're human beings at the end of the day. And the minute you put your Johnny coat on it doesn't matter your socioeconomic condition. 

But how do we begin to understand the responsibility we have across the whole spectrum of who we are as human beings? And so we're starting to imagine what a place of well-being is. And I liken it right now to Carnegie's model of illiteracy or access to knowledge by the public library system that happened at the turn of the last century. And what kind of environment would that look like if I passed by it and didn't pass judgment on it. I mean I pass judgment at a Four Seasons. I have an opinion about who accesses that. 

But what part of it makes it democratic that health care is a right that we all have, and as a society, that we not let those not capable of caring for themselves come into the system at some level? And a lot of it is case management. A lot of it is having just another human being who will nudge you to a better place. And what responsibility do we have there? I don't know the answers yet, we're on this exploration. Anyone doing research in this area come see me. But I think there's a spectrum to this conversation that we shouldn't lose sight of. 

BROOKE HOLLIS: That's great. Do you have a question. 

AUDIENCE: Yeah. I wanted to ask one question. Maybe it's going back to you, Michelle, building on what has been said. So many people say that all this wellness movement is great, but it's targeted towards being at the higher end of the society. People who have either the financial resources or the time. Or they're already predisposed to following a certain type of behavior and so on. But when will those type of ideas about the retreats and the other various interesting ideas you talked about will filter down to the larger part of the population? 

MICHELLE PUNJ: That's a great question. I think it's already starting to happen. When I entered into this field, my first entrepreneurial idea was how to take all of these health and wellness concepts to the masses. And how do we make it accessible? And I have not figured that out yet. And I challenge all of you to help us figure that out. 

But I think that in starting in the place that we're at today-- the California Health and Longevity Institute was started by a very wealthy man who had a great idea to help prevent chronic lifestyle diseases. And so we're creating this model right now to bring products and services that can be accessible to people. Right now the price point is a higher price point. And it is in a luxury facility. 

But I always see that as kind of the leaders in the development process. And with these properties popping up and all the destination spas around the world that are a luxury market, from there is where even hotels came out, which is a very middle market product that is still considering this philosophy of preventative health very important. 

So I think that there is great opportunity. And I have a deep passion in providing more opportunity to the masses. And you're seeing it pop up more and more so in not for profits that are coming out of these wellness resorts. Rancho La Puerta has a great not for profit that they're working for. Canyon Ranch has a great program that they are working with to bring the products and services that they offer to the community. So I think community involvement with these facilities will be very important. And then just figuring out ways to make the cost less. And that's really more feasible in group programs. 

ALEXIS STRONG: Yeah. I would also argue that I think even forums like this where we were just talking about this morning. We talk a lot about innovation and startups being kind of tech startups and new idea, which oftentimes those are great and those are solving real issues. But they are usually point solutions. And I would push us to start working on the innovations of partnerships. How do we start to leverage these partnerships a little bit better? 

Because I would say for instance Marion Regional Medical Center, one of our sites, is in a largely agricultural Weehawken community. Socioeconomically, it's not a very wealthy area. And a lot of it is around patient engagement questions. How do you get patients to engage? How do you get them to connect with you? Is it via phone? Is it in person in the community? 

There's a lot of that work that hotels have already done. It takes the money, oftentimes, to be able to play with some of those models. And so in having this conversation, you build these partnerships. And you say what have hotels seen? Maybe we don't have all those resources at our disposal, but at least then we can learn from each other and say, OK, well this model worked, right? A phone call followed by a text message is what really got them to engage. Or we had to go actually out to a community center to talk to them about this. And what does it take to get those people there? 

It's a different demographic, but I think there are more similarities for us than there are differences necessarily. And I think there's an opportunity for that trickle down. It's just that it's harder. It's harder in that lower socioeconomic group to really apply those things, because there isn't a lot of funding. And there are just particular complications. But I think there's a lot of shared learning there. 

ROSALYN CAMA: And if I can just build on that. So one other-- you know from practice to research-- that when we make change, particularly I think of it in terms of design of the built environment and ultimately impact on human behavior, we've got to build a business case. There's no question-- I'm feet on the ground not head in the clouds understand that if I want to make anything happen, I've got to build a business case for it, because money really drives most of the decision making. And we can say we're a caring society, but it is economic. 

So what I'm learning is that the moment is right right now to have a conversation about the economics of health care. And the system that exists is not sustainable. And it is at the at risk population, although most of us, most of you are young enough, but I can say that again happens. And comorbidities occur after a certain point in life even you've been if you've maintained a healthy lifestyle. And that's where the majority of money is spent in health care. 

But earlier in life, it's mostly in an at risk population. So if we could do more studies around those populations, if we could begin to understand how the environment, how the community, how partners across the medical lines have a responsibility to keep these populations at the even level, not the up and down cycles that cost so much money, the government, at a minimum, will start to pay attention. Certainly the incentives around the Affordable Care, for whatever will happen in the evolution of that, it's still going to be financially based. It's going to be how can we care for more people in a responsible way? And it's these conversations that I think will find the clues for solution. Mardelle? 

MARDELLE SHEPLEY: Ros, I think we have to-- there's another discipline we need to bring into the discussion. And that is education. So if you're talking about trying to provide access to people who normally don't have the access to supply a business case-- are there people in here from the Sloan Program who have been following the capstone project for [INAUDIBLE]? So [INAUDIBLE] Hospital System has a certain number of outpatient rooms that are located at schools. And the Bronx where they're located is especially high needs in terms of high access to health care services. 

What they are finding, they have a branch built at [INAUDIBLE] 30 school locations. So one of the [INAUDIBLE] of that return on investment is that children who are in the schools that have this kind of facility, actually access the emergency department system less frequently which save money for the system. In addition to the supplementary programs that enable children to have education, prevents drug use, and impacts of teen pregnancy, and all of that. So I think that is why you can't embrace too many disciplines in this journey. So by bringing education on board, I think it's going to be a pretty strong field. I don't know if anyone in the Sloan Program wants to comment on their experience in working with them. 

AUDIENCE: Yeah. I was going to add to that. That's my group. But it's a fabulous program. And just through our data search, we've really found these school based programs, they've shown 50% reduction in pregnancy prevention and positive test results. Even for parents at work, parents don't have to come home and take their kid and go to the pediatrician or whatever. Their kid can stay at school until the end of the day. If it's not anything real bad. So it's really just a community benefit overhaul. And I guess it would be great to see those types of programs even in areas that aren't so poor and desperate, but in just general communities to save parents' time and kids to promote healthy behaviors. 

ROSALYN CAMA: So the design question from my point of view would be what would the archetype of the school evolve to take on that responsibility? I mean I'd take that conversation to whoever's in the School of Architecture and Design. Get together, please. Have that conversation. 

AUDIENCE: So I'm actually a part of that group, too, with [INAUDIBLE]. It's a great program. We love it. One of the issues we are seeing is the buy in from the physicians in the community. So I'm just curious what kind of issues may arise with maybe Michelle with the wellness. Like what is their response to this kind of what you're doing? 

MICHELLE PUNJ: Yeah. And I would say the medical community in Westlake Village has responded very well to the lifestyle services that we've brought together to offer. Because a lot of times, there isn't that experiential approach to being able to help your client. 

Let's say we're in the business of preventing chronic lifestyle diseases. So if people come to us, with pre-diabetes, we have a whole team of experts that are very well equipped to provide the educational resources to help guide that person before they get diabetes. In the local community, a lot of clinics are restricted in terms of what they're able to offer or the team that they have. And even taking it in the example with our registered dietetics team, we are able to give that experience experiential cooking demonstrations, going into the gardens, how can you apply this into your daily life? Because those are the tools that we need to teach those people in order to help prevent them from getting to the next step. 

Also from the medical perspective, they're only in the field of preventative care. So we don't do acute care on-site, which means that all of that acute care is still done throughout the community. And we do lots of referral programs between the external community and our facility. 

ALEXIS STRONG: Can I just ask when you say they're resistant, is it the buy in to the program? Or is it that they think it's an additional thing they're going to have to manage? 

AUDIENCE: With substitution, and they think that they're going to be using the program over the actual PCP services. That's one of the issues. They think the quality of care is not as good. Those are pretty much the major issues that are happening with the school based health programs. 

ROSALYN CAMA: Part of it is communications early on in the development of these programs to engage the community. And the New Haven project, we're calling them PODS, Places Offering Dynamic Services, starting this collaborative conversation that everyone has a strong opinion of the service they offer. And the minute you introduce a competing service, they'll never get along unless they were engaged in it. 

And so if you're doing something for the good of the community, engaging these folks seems to help. It won't solve all political issues. You know, again, you got to follow the money. 

BROOKE HOLLIS: Just before we are out of time, I just thought it would be interesting. We're trying to launch a multidisciplinary minor to cut across all these areas and have people augment and things, because all of you actually have a multidisciplinary training. And I was curious about from a management standpoint when you're actually working with clients and people how you found that to be beneficial to kind of work across these professional boundaries? 

ALEXIS STRONG: It's fine. That-- 

BROOKE HOLLIS: Is that what you were going to say? 

ALEXIS STRONG: That's kind of where I was going with that. Because I think that's indicative of a systemic issue. I think a lot of the challenges, at least from my standpoint that we're dealing with, is also it's cultural. It's change management. And when you talk about the skill set that at least I think I bring to what we're trying to accomplish, a lot of the work that I do is that change management piece. 

It's communicating to the teams on the ground. And that comes from I mean-- the operations stuff is one thing. Right? You know Disney is famous for saying it's not magic, its process, process, process. So there's an element of I'm establishing process. So half of my time is spent doing that. The other half of it is really talking to people. It's relationship building. It's trying to get buy in. It's trying to convince them that this is the direction that is-- and telling them the why. Explaining why that is. Giving them the evidence that they need to do it. 

I don't think we can discount how important that is in creating the change that we're trying to create in health care and in hospitality both. Right? It's changing both of those perspectives to understand that interchange. And I spend a lot of that time-- and I credit a lot of that to a multidisciplinary background. And I think, as I said, I would love to say that my background was strategic and it was planned and I knew exactly where I was going. 

But I think if I can say anything, it was just pulling at the strings of curiosity. Like taking one thing and saying, hey, I see something here, I don't really know what it is. But let me take that and run with it while I can until it leads to the next thing. And where I am right now, I feel like I honestly pull from every one of the experiences I've had thus far despite the number of times my father told me I had zero direction, I didn't know where I was going. But then when I got this job, he was like, I don't know how you did that, but that was amazing. It's all right there. You did a bunch of things I thought were crazy. And then it landed in a job where you use them all. So I guess that's it for me. 

AUDIENCE: So we only have a couple of minutes couple of I need to ask is there any advice you want to give [INAUDIBLE] some [INAUDIBLE] 

ROSALYN CAMA: I'll just make a two minute pitch for a nonprofit that I belong to. So a great place if you're truly interested in this topic is to engage with an organization called the Center for Health Design. It's based out of California. And it really looks at this intersection, particularly of the design of the built environment and the way we impact health. But it is a multidisciplinary, interdisciplinary conversation that is evidence based that has certainly-- Mardelle has been involved for many years, be at the Center for Health Design. There are other organizations. 

Once you leave your academic program, find those places where you can have these conversations because life is rich. Opportunities come across as our societies evolve, as our global platform expands. I think you've got some tremendous conversations to have in your careers and stay engaged, because that's where you make the difference. 

AUDIENCE: Michelle? 

MICHELLE PUNJ: I would just say for those of you that are in the Hotel School. And when I went and did my MMH program, there was only two of us that had a background in health. One was a doctor. One was myself as an RD. The hotel environment is a great environment to help people learn a lifestyle. 

And to go back to what I was talking about in terms of responsible hospitality, so hospitality is really a field that had a reputation of a lot of waste in terms of sustainability efforts and things like that. But really take a look at the opportunity within hospitality, because you're taking a person into a home. You have that opportunity to help change their life and help change their life for a better. So take a look at that. 

Take a look at how-- I think that was a great conversation starter in how to bring health and wellness services more to the masses, because healthy lifestyle really should be an opportunity for everyone. It's not a privilege. It's a right. And I think that the integration here with health and hospitality has huge potential for the future. 

AUDIENCE: Great answer. All right. Well, thank you every body. 

[APPLAUSE]