Healthcare's Halo Effect: Lessons from Poland Spring, Maine

This week, after 5 years of happily bubbling in the corner of our kitchen, our five gallon Poland Spring spring water dispenser is headed back to Maine.  We've ended our contract, bought a water filter and are going to be happily drinking tap water from now on. What's funny is that we've never really had a problem with the machine, or with the water that comes delivered from the back of a big truck once a month.  The product and the service seem fine.  The issue really lies with me, and an evolving disconnection between perceptions of the product was buying, and the what I actually got.

Some background:  Poland Spring, which has been a source of water since 1797, was once known for water that could cure various ailments in people who traveled to "take the waters."   In 1992 the Poland Spring Company was taken over by Nestlé and since then its water has been produced at dozens of bore holes scattered across the state of Maine. In 2017, a class action lawsuit was launched against Nestlé, claiming that the water it advertises as being from Poland Spring in Maine is, in fact, simple groundwater pumped from an aquifer, similar to how most municipalities obtain municipal water. The case has been winding through the courts,  The NYT wrote about the multi-state suit, describing plaintiff allegations:

  In its defense, Nestlé, in 2017, commissioned a legal review to determine whether Poland Spring water qualifies as "spring water" under law.   The law firm DLA Piper conducted the investigation.  The DLA investigation found essentially this:  1) The FDA relies on state certification programs to make this distinction and 2) 

Maine's state law requires the following of a spring:

  The review found that the 29 boreholes Nestlé uses across Maine all produce water that qualifies as spring water since it has the ability to come to the surface on its own pressure. Consumers, at least those on Facebook, seemed upset at these allegations:

Now, if we're going to be real,

it's clear that the whole issue (and my decision to remove our bubbler) is a head fake.

 After all, under Maine law, the main criteria for calling water "spring water" appears to be whether it flows to the surface under pressure versus whether it needs to be pumped to the surface.  

Nothing in the spring water definition appears to have anything to do with the quality, purity, clarify, taste or other attribute of the water.   Groundwater is groundwater

(and honestly we've never had any complaint with the water we got delivered). The real problem, for me, was 

how the lawsuit distorted Poland Spring's halo effect. 

  A halo effect is a cognitive bias where we attach value to one thing based upon pre-conceptions or heuristics.  We see a beautiful spring and fresh pine woods, for example,  and assume that the water is somehow better, cleaner, fresher and tastier than the water from the tap.  In other words, I had bought into this idea of Maine and assumed it extended to the water in my bubbler:

When the reality looked more like this (this is a picture Poland Spring's Framingham MA bottling plant, which was the focus of bacterial contamination investigation in 2011 per Wicked Local.

Exploiting cognitive biases is nothing new for big companies.  Many "homey" brands are (of course) produced in large factories and branding is nothing more than an exercise in attaching a story to a product.

But, the real problem with Poland Spring, and the reason my bubbler is going back to Nestlé is that there is something visceral about believing that a product is healthier, better for you, fresher and more wholesome-- only to find that it's as bad (or worse) than the alternatives.  

It's a bigger betrayal than finding out that, say, a window cleaner doesn't work any better than the competition. Yes, legally Poland Spring is probably right and the water meets all criteria for spring water.  But positioning a product as virtuous when it's really much the same as common water from a municipal tap: well, there's the rub. There is an important lesson here for healthcare.  

Our industry loves to wrap itself in a cloak of selfless benevolence.

  Healthcare companies often extend the halo of their (typically benevolent and selfless) doctors and nurses to their overbuilt campuses, redundant highly-reimbursed programs and occasionally exploitive billing practices.  For patients

caught in the gears of an overpriced, dysfunctional, bureaucratic and occasionally dystopian healthcare system, the discordance between what healthcare claims to offer and what is typically experienced by patients is hard to take.

As with the gap between Poland Spring's promise of "pure quality 100% natural spring water" and the ground water that ends up in my bubbler, healthcare's claims of caring, benevolent, competent care can ring hollow when you critically evaluate many patient journeys.  The public is right to judge us harshly:  healthcare isn't another consumer offering.  If we hold ourselves out as virtuous, our performance had better match expectations-- the letter of the law isn't the point.