The Value of a Good Experience

Goodluck and I have been trying to understand what defines a good health facility in Kilwa to be able to replicate the model to other facilities. In my last video I described how it’s hard to analyze data by health facility because, for example, we don’t know if increased diagnosis at a given facility implies poorer health for their surrounding communities or better service provided to attract more patients to get treatment. Based mostly on qualitative evidence gathered from on site visits and patient interviews over the past month, however, we’ve concluded that higher aggregate numbers aare almost always an indication of exemplary medical services being performed. But what does “exemplary medical services” mean?

IDEO CEO, Tim Brown, summarizes a popular concept coined in Daniel Pink’s book A Whole New Mind saying, “once our basic needs are met − as they already have been for most people in the affluent societies of the West − we tend to look for meaningful and emotionally satisfying experiences. The value of services lies in the emotional resonance they create.” The implication is that when basic needs are NOT being met, i.e. in most third world countries and certainly all of the communities Goodluck and I serve in Kilwa, the human mind doesn’t care about emotionally satisfying experiences. Fulfilling basic needs is the primary driver behind what the mind desires.

In reference to our health facilities, I’d expect “exemplary medical services” then to mean that the necessary drugs are always on hand and ailments are successfully getting treated. And that’s it. This would also imply that each health facility we work with who has low statistics doesn’t have proper drugs in stock and that the medical staff are misdiagnosing patients who therefore aren’t getting treatment.

Goodluck and I know this is not the case. We’ve been delivering medical supplies to all facilities through the year and patient numbers remain the same. The medical knowledge of health staff, though indeed varied, doesn’t vary with the number of patient attendance (we’ve moved well-skilled health staff from a strong facility to a weaker one and after a year still haven’t seen much increase in attendance).

What we have seen is that health facilities with staff who enjoy working together, are organized with paperwork and office supplies (including drug stocks), who clean their facilities (even the cobwebs by the roof), who maintain equipments such as patient beds, and who even groom their grounds with rakes and flowers, are the facilities getting the most patients. These are the marks of exemplary medical services and they contradict Daniel Pink’s notion that only certain groups of people can afford valuing emotionally satisfying experiences. He would contend that the experiential enhancement of an inviting landscaping would provide little value in terms of increasing attendance at health facilities in Kilwa, Tanzania because it’s not fulfilling a basic need. Our experience here has suggested, however, that everyone values emotionally satisfying experiences.

What I think Pink misses in his analysis is that the definition of basic needs changes for people in the third world. Not everyone in Africa is living a stress-filled existence worried about fulfilling basic daily needs. Tanzanians in my village seem to have come to a knowing realization of what their life is like. They can depend on food sources based on the season and the amount of rain in a given season. They know the best places to get water to drink so as to avoid fatal illnesses. They know that any electricity service is always temporary. And they don’t celebrate the birth of a child because they know there’s a real possibility that the child will die in its first 6 months.

Basic needs being met in the US and basic needs being met in rural Tanzania look completely different. But from the point of view of the respective communities, basic needs are being met in the majority of cases. The implication being that it is incredibly important to think about how to create safe, enjoyable, satisfying emotional experiences when trying to achieve successful services of any kind. And in the context of critical experiences such as public health services in the third world, where there aren’t private alternatives to create natural competition, the responsibility lies on the system managers to seek out facilities who are creating this type of experience and hold them up as the standard experience all facilities should be striving to provide their patients.

Freshly planted flowers at Somanga Health Facility