I was alerted to this editorial by Susannah Fox’s post about it on e-patients.net, and I really liked that this topic (generational issues) is getting coverage in the medical literature:

JAMA — Web Searching for Information About Physicians, July 9, 2008, Gorrindo and Groves 300 (2): 213

The medical community is experiencing the same GenX, GenY, Baby Boomer challenge that everyone else is. I’ve written about it on this blog (See these posts, and these posts) quite a bit, as it took me awhile in my own professional work to realize what was going on - many of the discussions I was having seemed to be themed to the generation of the person I was talking to rather than the specific person. This turned out to be really helpful in creating understanding and collaboration.

I think we need each other, and if anything, my discovery (glass half-full) is that many baby boomers have the desire and ability to have their creativity unleashed. GenX-Y can and will help with that by stimulating the conversation (See my most recent read for a great example). I enjoy being sandwich guy (Gen X), it’s kind of like being a family physician, coordinating with all of the other medical and surgical specialists, all of whom add value to everything I do and (hopefully) vice versa.

Acknowledging the tension, and creating some more

I’m glad to see the authors call out that the tension exists, at the same time they create the tension they speak of in their advice, which is centered around the concept of being “aggressive” about “protecting” the physician:

Talking to Patients About How They Are Using the Internet. If a physician suspects that an Internet-savvy patient is engaged in seeking personal information about him or her, we recommend that the physician talk with the patient about the garnered information. This is particularly relevant when treating young adults or adolescents who commonly use the Internet. Physicians should clearly inform patients that the Internet is not a substitute for face-to-face conversation.

It’s not? Patients need to be talked to? We need to clearly inform them about how to use the Internet?

There’s a very cool alternative paradigm where we protect the patient, by clearly informing them about everything we are doing for and to them, and listen to them about how they use the Internet, so we can use it with them. It’s completely possible. The best part is that I’ve seen many a baby boomer embrace it. The future’s bright for our profession and those we serve….

“Why Work Sucks and How to Fix It: No Schedules, No Meetings, No Joke–the Simple Change That Can Make Your Job Terrific” (Cali Ressler, Jody Thompson)

As a leader in an organization, imagine reading this description of an employee’s workday:

A typical day for me includes waking up when my room is too bright from the sun and I can no longer sleep. I check my e-mail to make sure there are no pressing issues and respond to anyone who needs my input. I will typically watch an episode of South Park on the Internet, then walk to my local grocery store and buy some breakfast, even though it’s closer to lunch at this point. After eating I will work in front of my television with ESPN on in the background. At this point I will choose to go into the office or continue to work from home, or maybe not even work at all and go for a bike ride or jog. If there is still work to do later that night, I’ll do it then and it’s no big deal.

I’ll admit it - it kind of made me gulp when I read it.

At the same time, though, I have been in a lot of conversations with a lot of personal and professional colleagues over the past 3-4 years or so, where the question we’re asking ourselves is, “Is this how work life is supposed to be?” Spoken or unspoken, the answer is “we don’t think so.” Various companies’ data also show a trend toward less vacancy in their physical locations.

In the middle of that self-discovery, I read about BestBuy, Inc., (see “Smashing the Clock“). This is the book about their journey.

It’s time to let go and see what our employees can really do - BestBuy Manager

A Results Only Work Environment (ROWE) is as it says - one where results are measured, not time spent. There are no timeclocks, no discussion of time, and no “Sludge” as the authors refer to it. “Sludge” are the comments people make to each other about time, whether it’s about being late to a meeting, or working late at night. Simply put, the authors state, an employer is trading work for money. Why not give them what they pay for?

Reading beyond the BusinessWeek article was very useful - this is not flextime, it’s not “working from home,” it’s a different philosophy altogether. That includes the vignette above. Totally allowed, if you have the results to show for it. The concept can appear challenging; however, it makes sense, in the context of strong leadership committed to respecting employees and customers. That’s where I found similarities to the work I have done.

About respect

When I first read about this work, I asked about how this was similar or different from the LEAN transformation I participated in, in the area of health information technology. Some of the things were consistent, some seemed less so, like having technology teams physically present alongside doctors and nurses, guiding care and feeding of an electronic health record system.

My reconciliation of all of this rests with not comparing individual tools/approaches between ROWE and LEAN. What they both have in common is respect for the customer and staff, and strong leaders. It’s impressive that at the heart of the ROWE movement was (at the time) a 24 year old employee of BestBuy (Cali Ressler), who was dissatisfied with the status quo. The authors also explicitly reject war analogies in business as I have. In my own situation, there was not just a desire to change the way we worked, it was clear that not changing would be unsafe. Healthcare organizations across the country are now learning this, thankfully, but it’s a slow transformation, and the transformations that are happening are nowhere near as radical as ROWE, which is why I am interested in the movement (not because I want to be radical, but because the threats to our patients and their families’ health are so significant).

Just because you can no longer be late doesn’t mean you can be lame

Preliminary data from the University of Minnesota’s Flexible Work and Well-Being Center are showing that voluntary terminations are down, involuntary terminations are up.

Mea culpa and, as usual, I see analogies to health care

I liked the concepts in the book a lot, and have done a self-inventory of my own sludge and the sludge that’s been directed my way. The kind of sludge I get nowadays is really from people who want to understand better how technology can be used to help patients stay healthy. I welcome it as an opportunity to teach and learn. As the authors discussed, people can learn to live sludge-free, and they really want to live sludge-free. It starts with us.

I could see myself promoting ROWE in health care settings, and I think physicians, primary care ones especially, would benefit. The work I do to change health care is completely connected to the idea that health is a means, not an end, and people who go into health care want to support our patients where support is needed, mostly where they live, work, and play. I don’t believe people in health care are any more attached to time than Cali and Jody’s (former?) colleagues at BestBuy are. When I read the stories of BestBuy employees before and after, I reflected on some of the conversations I have had with health professionals (at all levels) who have really been challenged to juggle their passion for helping people and their ability to provide for themselves and their families, physically and emotionally. What would it be like for a family medicine or internal medicine specialist to provide their cognitive services to patients and families using a combination of virtual tools and office (or even home presence) when the situation called for it? Look at what HelloHealth is doing. It’s possible.

A Results Only Patient Experience (ROPE)?

A came upon this table in the book, and curiously, I found it extensible to our health care system. I hope I won’t get in trouble for using it to think about what our health care system were like if our patients experienced it the way a BestBuy employee experienced their work life. The edits are mine.

I photographed this advertisement while riding on BART in San Francisco recently - it struck me as a creative way to engage Generation Y, and in 2008, a reminder that for some people, online connections are becoming dominant to in-person ones (that and the fact that no one is advertising to Generation X, we’re the generation lost to marketers…). I liked it also because it supports my occasional motto, “in person is the new online.” On a more basic level, though, it speaks to the revolution that Web2.0 is creating around community - as I learned in the patient portal work I have done, these online connections can actually strengthen rather than weaken the offline ones.

You can see the rest of Dentyne’s innovative campaign on their site - they missed one crucial detail in their appeal to the Web 2.0 generation, though, by not making this content embeddable, which should be the case for a campaign like this. From my own experience, I know that big companies are often not of one personality, so there can be some disconnects as large organizations move into the future. In the meantime, enjoy the images.

• I’m a polarizing figure. - Jay Parkinson brings up and idea that I’ve been discussing a bit - there is a generational philosophy shift happening as boomers turn the reins over to GenX and GenY. Tension may be created as a result, but in my glass 3/4 full way, I think GenX and GenY, in the way they are less tolerant of customs with limited value (in a good way, according to Jack Welch), are awakening the interests that the boomer generation has always had and can now seize upon.

I was interviewed by journalist Kyung Song from the Seattle Times for this article, which appeared in today’s paper:

Local News | Group Heath trolling cyberspace to learn what patients think | Seattle Times Newspaper

This was the first interview I have done representing both the organization I work for, and myself as a blogger at the same time. Usually, it’s one or the other, because the words on this blog are my own and not those of my employer (although obviously our approach to patient centered health care is well aligned). The worlds are starting to collide….

I definitely believe that there is content that’s traditionally outside of the physician-patient relationship that can and should be brought in via blogs and the like. We saw it with secure e-mail between patients and physicians to be sure. It changed our relationships, in a healthy, helpful way.

My personal belief about blogs and Web 2.0, though, needs to be coupled with an organization’s need to have a workflow and platform that brings in the right information at the right time. I definitely don’t expect a physician to review the 2,000 RSS feeds of their patients (and I don’t think the patients do, either).

That’s the fun intersection, and it is good pressure, to bring everything about a patient that matters to them into every clinical interaction.

See what you think…

The Genie Industries video is especially compelling because everything they discuss is applicable in health care. What if we substituted “patient care” for making scissor lifts - we would see huge strides in improvement. Also, just upgraded the software that powers this blog. Viva open source.

• Genie Industries, Spotlight - A nice video of Genie Industry's work promoting LEAN and the customer focus in its manufacturing efforts
• Popularity Context Plugin Fix for Wordpress 2.5 -
• The Wisdom of Patients: Health Care Meets Online Social Media - CHCF.org -
• From Al Gore?s Chief Speechwriter: Simple Tips for a Damn Good Presentation (Plus: Breakdancing) - Great advice on giving presentations. The one I like best - it’s not about you, it’s about the audience.

If you are interested in innovation, I think this is a good podcast worth listening to - and the actual audio is more useful than the printed version.

I listened to it the day before I attended the latest Patient Centered Primary Care Collaborative, in Washington, DC. At the meeting, I was fortunate to run into one of my role models, Susan Edgman-Levitan, PA, and we talked about the idea that the Medical Home is about improving the care of patients where they spend most of their time - where they live, work, and play. We can help patient-centered care flourish by including ideas from everyone involved in the care, including nurses, doctors, allied health practitioners, eye care, oral health care, behavioral health care, just to name a few.

I liked what Jack said in the podcast, that in a company, there has to be

a sense that in every soul of the company, the idea that everybody innovates.

Toward the end of the podcast, Jack gets quite fired up about the idea that innovation can’t be regulated to the chosen few. My experience reinforces this. In the area of health information technology, this is critical. When most people think about implementing HIT, they think about the implementation period. The most powerful part of HIT is what happens after implementation, and using a management system like the one developed by Toyota Motor Company (as we are) can allow an organization to turn HIT into an organization wide innovation engine - if they capture all of the ideas of everyone involved in providing care and put them to use. To not do so is to waste one of the most valuable raw materials for growth - ideas and time (and most importantly our patients’ time).

One other conversation that has come up in the last several days is about generational changes in approach. Many of the Generation X and Generation Y colleagues I have been talking with were raised in a professional environment where we were not going to have all the answers, and we are uncomfortable being accountable for them. We want to share the power of coming up with the answers with our provider colleagues and our patients. This is not to say that our baby boomer colleagues don’t have this desire, too. I think we are stimulating each other to do what they’ve always wanted to do, and involving patients, their families, and all practitioners, all specialties and roles, is really going to make a person’s medical home special.

Feel free to take a listen and let me know what you think:

Finding Innovation Where It Lives

I walked past this sign, welcoming people to Pomona College, in Claremont, California. As our profession thinks about broadening consumer health informatics to help more people (from diverse backgrounds and parts of our society), we should remember to share the added riches of our learning, experience, and ideas for improving health care in trust for mankind. More innovation happens when more is shared, not less. This includes what we did well with, and what mistakes we made.

April 5th through April 8th:

• Headzoo » WP Anti-Wares - Now it looks like we have to worry about insecure wordpress themes, too.
• Electronic Prevention - washingtonpost.com - Nice writeup of the New York PCIP program. What the writer doesn’t realize, is that a patient portal is coming, so a visit isn’t always going to be required….
• Jack and Suzy Welch: Leader vs. Manager - ‘We’d wager it only comes into play when you don’t want to offend an employee who crosses t’s and dots i’s but couldn’t excite a busload of kids bound for Disney World. In such a case, what do you say? You got it. “You’re a good manager.”‘
• Generation Y’s Bad Rap - It’s not really that bad, according to Jack Welch. I agree.
• The National Physicians Alliance encourages all doctors to join our Unbranded Doctor Campaign — a national network of physicians committed to reducing the influence of pharmaceutical marketing on our profession. - NPA appears to be a grown up version of AMSA. They include consumers in their governance
• Macworld | Mac OS X Hints | Add more power to 10.5’s screen sharing - Economical screen sharing alternatives using Leopard
• Total Value, Total Return: Invest in Health Management Programs -
• Office 2004 for Mac Solution Center - Office 2004 downloads for Mac. Time to upgrade

This week’s photo was taken by DC Photographer MV Jantzen. It is a beautiful illustration of the challenge of the use of information technology in health care and in the workplace in general. It was taken during a Revolutionary War re-enactment here in the mid-Atlantic area.

For patients, it is a metaphor for the ways we ask them to be (or not be) involved in their care by restricting their access to 19th century technologies.

For health care providers and all employees, it is a metaphor for the restrictions we place on them when they leave the consumer IT sphere and enter the workplace IT sphere.

In most parts of health care, we are regularly asking patients, nurses, and doctors to forgo 21st century tools in favor of Revolutionary War gear.

Some companies, including British Petroleum, are exploring ways to support employees in leveraging all of the best tools to serve customers. We should all come to work prepared to leverage the best tools available, and have fun doing it, without checking our 21st century clothes at the door.