Network Citizens: Power and Responsibility at Work

Not long ago I was ordering coffee and needed to wait a few seconds for the person taking my order to end a personal cell phone call. Once the call ended, she was extremely courteous, warm, and service oriented. I now realize that she was tapping into her social network, using her own information technology, at work.

There’s an ongoing conversation in many workplaces that starts with “(name your social network) is blocked by by my employer.”

This white paper, written by Demos, which bills itself as the think tank for every day democracy, delivers a broad look at social networking, and goes beyond, “your company should allow access to social networks.” On that point, though, here is what is said:

First, smart businesses recognise that ‘social’ networking is not neatly separable from ‘professional’ networking. Attempts to control employees’ use of social networking software in the office may end up damaging the organisation in the long run by depleting its network capital. Of course, bans on Facebook or YouTube are in any case almost impossible to enforce; firms may as well try to put a time limit on the numbers of minutes allowed each day for gossiping. A network permissive culture requires a degree of trust on the part of managers and responsibility on the part of employees; but to the extent that networks add internal economic value, this is usually a risk worth taking.

So, controlling access to networks in the workplace is futile (think about the coffee employee’s cell phone) and has negative consequence on recruitment, retention, and innovation among other things. At the same time, there’s an interesting conversation about the risks of networks, and not the kind of risks most people commonly think of:

Networks can build meritocracy, openness and democracy – but then can also exclude and discriminate. They can help to diffuse power away from hierarchical structures – but they can hoard power for themselves, too.

The authors point out that most social networks are opaque, compared to the transparency of the organizational chart. It’s easy to look at these and see who is connected. This is where responsibility comes in. Organizations should “go with the grain” of social networks and those engaged in social networks should be good network citizens and use the power they get from the network to further the goals of the organization. This comes together in the creation of a kind of network “constitution” or social contract, which supports good relationships, rather than hard rules. I think some companies, like Sun Microsystems, are starting on this journey through the creation of progressive social networking policies.

Some organizational approaches are to create Bespoke services, which are internally supported social-networking-like applications, and these carry some risk, as pointed out in one of the case studies:

The issue with our company is that the answer to every problem is a database. The problem is actually time – this utopian vision of being able to look up all this information and draw it down from the database is a bit unrealistic. – Interviewee, large professional services firm

I think Bespoke services can be successful if their purpose is thought of carefully and not as the solution to every problem. Every organization will likely need a portfolio of tools to support the needs of employees of today and tomorrow. The paper has a high philosophical tone, and the social networking analysis is very interesting ( I have to try that soon ). The idea here is to support the exploration of what those are in an open environment.

In this context, the fact that the person taking my order for coffee after tapping into her social network doesn’t bother me at all. I have a feeling it will help them and the organization they work for provide even better service in the long term. I hope this paper and blog post might help some have the conversation about whether (social networking tool) should be blocked or not.

Feel free to comment with your experiences in your organization, of course.

• Workers Get Health Care at the Office – WSJ.com – Some employers, such as Intel Corp., Walt Disney Co. and Toyota Motor Corp., are opening fully equipped on-site medical centers staffed by physicians and nurses that offer primary-care-type services. At these centers, employees often don't have to pay any fee for annual physicals or blood-pressure and cholesterol screenings. Getting treated for, say, a cold or stomachache might cost you $5 or $10, well below the typical co-payment for a doctor's office visit.

  What are they doing to share data?

• Wal-Mart Takes the PHR Plunge – Dossia comes to fruition with Wal-Mart

de Brantes F, Wickland PS, Williams JP. The value of ambulatory care measures: a review of clinical and financial impact from an employer/payer perspective [Internet]. Am J Manag Care. 2008 Jun ;14(6):360-8.[cited 2008 Oct 1 ]

The subtitle of this article might be, “what performance measures should employers be tracking and paying for in ambulatory care”

The article was passed to me by Sophia Chang, MD, at the California Healthcare Foundation, who has been advising and supporting on our Connectivity for Californians work, and is a nice economic study of 62 performance measures used in specialty recertifcation program and pay-for-performance initiatives.

The measures will look familiar to anyone who works in quality improvement – everything from blood pressure management, to retinal eye screening, all the way through to some measures that have less data associated with them, such as “plan of care for hypertension.” What the authors did was grade the evidence of effectiveness, add cost and benefit data based on meta-analyses and derive a “savings per patient” for each measure.

There are a few critical assumptions made, including full adherence to therapy (they used the term “compliance” which is no longer recommended), and most importantly, no quantification of indirect costs. In other words, this is not a study of presenteeism, only direct medical costs.

What came out near the top of measures with the most impressive savings profile? Hypertension management. Here’s the detailed analysis:

This study has a specific informative value in my mind – which is to encourage employers’ engagement around the performance measures that will likely result in a return on investment for them. This is not a call to action for the health system to reorient its priorities for maintaining community health. I think the idea is that if an employer has an interest in promoting efficient use of the health care dollars they spend on behalf of employees, an analysis like this provides an idea of where to start.

Incidentally, when I did the same analysis using my own literature review, but without the complex analysis employed here, I came to the exact same conclusion around hypertension, which surprised me. I thought I would become an expert in remote monitoring of congestive heart failure or coronary artery disease. The data led me a different way.

See what you think.

IBM Health Care Executives Receive Highest Honor from American Academy of Family Physician — Media Center — American Academy of Family Physicians

From the AAFP press release:

“Comprehensive, continuous, patient-centered, personal and holistic primary care which is based on strong relationships between patients and their physician — this is foundational to good health. Practice and payment reform are the prescriptions for achieving it,” Grundy recently told health care blogger, Ted Eytan, M.D.

I am happy to be told anything, anytime by Paul Grundy – his energy and interest in doing the right things for patients everywhere make him a fine addition to the community of America’s Family Physicians. Welcome, Paul!

• Living Well : Transforming America’s Health Care – A nice overview (I think) of the current state of health care, produced by the Federal Health Care team at IBM. It also details what IBM is doing to support the wellness of its 500,000 employees worldwide.

• Health-Care Reform, Corporate-Style – Toyota and others are opening onsite medical centers. It's possible that employers in this situation are most able to have a societal perspective.

Shai, Iris, Dan Schwarzfuchs, Yaakov Henkin, Danit R. Shahar, Shula Witkow, Ilana Greenberg, et al. “Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet.” N Engl J Med 359, no. 3 (July 17, 2008): 229-241.

“The Employer as Health Coach,” October 11, 2007.

I initially reviewed this article for my interest in the question, “What kind of diet is best for losing weight?” (with good news for low carbohydrate and Mediterranean dieters), but I quickly became fascinated with the way this study was performed – on the worksite, at the Nuclear Research Center Negev, in Dimona Israel.

To quote:

As Okie recently suggested, using the employer as a health coach could be a cost-effective way to improve health. The model of intervention with the use of dietary group sessions, spousal support, food labels, and monthly weighing in the workplace within the framework of a health promotion campaign might yield weight reduction and long-term health benefits.

I think this is as significant as the weight loss intervention itself – that the study authors worked to modify the work environment to support the study aims. In the supplemental materials (linked here), you can see an example of the signage placed in the cafeteria to alert employees to the different food choices available, depending on which arm of the study they were in.

I think this fact of the study design is under-emphasized and marks an important trend in supporting interventions like this moving forward. With thanks to the Research Center in Dimona for teaching the world about more than nuclear science.

(presentations online here)

Paul Grundy, MD – “Think huge”

Purchaser guide – there have been many of these, but the first time one prepared with consumers and providers

Health Information Technology – help educate, advocate, demonstrate around PCMH the technology that will be necessary to help physicians make the transformation

Panel – What Does it Cost to Become a Patient Centered Medical Home?

Bob Berenson, MD, Senior Fellow, The Urban Institute

“A good medical home”- patient with superficial phlebitis treated via one office visit, 6 phone calls, 6 e-mails, including hematologic consultation, one reimbursement for in-office care

Julia Pillsbury, DO, Alternate RUC Representative, American Academy of Pediatrics

New G codes for Medical Home-type work. Crosswalked to currently existing codes, some subsume current G codes, some do not. Tier 1, 2, and 3, between 6.5 to 9.2 minutes per patient per month, may be around $50/member/month.

Patient Partnership

Sabrina Corlette, Director of Health Policy, The National Partnership for Women and Families

Grant from the Wellpoint Foundation to introduce consumer advocates to PCMH and involve them and shaping it. Environmental scan, Focus Groups, Develop consumer/patient principles

Debbie Peikes, Ph.D., Mathematica Policy Research

We should involve patients and providers in primary care assignment, using claims retrospectively is expedient perhaps but has difficulties

As the title says, my Internet holiday is complete. It was as fun as being in the cloud, to be sure. I’ll be back to regular publishing now, and comments and pings are turned back on.

Patient Centered Primary Care Collaborative, Washington, DC

I’m resuming life in the cloud by attending the Patient Centered Primary Care Collaborative Stakeholders Working Meeting, here in Washington, DC. I hope to post updates throughout the day – we are all fortunate that this group operates with an impressive level of openness and interest in collaboration (just as its name implies). The agenda and materials are online for others to peruse.

By the way, here’s what an Internet Holiday looks like.