Posts Tagged ‘Leadership’

McChrystal’s Frank (and open) Talk on Afghanistan – 60 Minutes – CBS News

October 16th, 2009 | Popularity: 2%
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McChrystal’s Frank Talk on Afghanistan – 60 Minutes – CBS News – From 60 minutes recently. I love this quote, which speaks to the value of transparency and openness.

It’s hard to keep pace with McChrystal (he) breaks all the rules about restricting classified information to those with an absolute need to know by using video technology to conference in every one from the Pentagon to the headquarters of the Afghan army.
“One of the things I was looking at just this morning is Taliban reporting on their desire to widen the fight,” McChrystal noted during the briefing.
“The idea is as many stations as you can get in here, and as many people in each one to listen. Just, it cuts the challenge of communicating.”
“There are hundreds of people, that’s right,” McChrystal agreed.
“Do you worry about security leaks when you have so many people involved in these things?” Martin asked.
“I’m less worried about leaks than I am about the people who don’t know what we’re trying to, you know, ignorance. So, I think it’s a trade off and I think I come down on this side every time,” he said.


Life in the Bell System

September 28th, 2009 | Popularity: 4%
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Life in the Bell System – Fascinating account of measurement systems gone awry in the 1960’s Bell System. As usual, there are many analogies to health care, specifically in the way it is financed.

Life as a Healthcare CIO: The FY10 HMS IT Operating Plan

August 27th, 2009 | Popularity: 2%
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“Do you Ride?” – Learning about leadership from Harley Davidson in Oakland, California

July 30th, 2009 | Popularity: 11%
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Harley Davidson dealership Oakland CA

Harley Davidson dealership, Oakland, California

I am back in Oakland, California, at the Sidney Garfield Center Health Care Innovation Center, this time supporting the Permanente Medical Group’s course “Medicine and Management,” which brings physician leaders from across the nation to learn about leadership in all of its facets. This includes providing great care experiences for members, recruiting and mentoring other physicians, and today’s installation of the course, techniques used in innovation.

In this morning’s session, there was a surprise trip to the Bob Dron Harley Davidson dealership in Oakland, California to learn about leadership in a context other than health care. By the way, I misspoke in my twitter feed that we were going to the Harley-Davidson factory – this is where we went, and it was no less impressive. One thing I really enjoy is learning about different ways of doing things from outside of health care.

The question in the title of the post was something we were asked by several of our tour guides – they would ask, “Does anyone here ride?” as a way to identify enthusiasts up front. Despite the fact that most patients wouldn’t call themselves enthusiasts of health care, there are (as with everything I see), parallels to health care. Although not enthusiastic about health care, I’d say most patients are enthusiastic about a great patient-physician relationship.

I was impressed by the level of interest in collaborating to create a good customer experience in all facets of the relationship – from the decision to purchase, to buying add-ons, to service. Because service is such an important part of the relationship, the service area is as clean and welcoming as the sales floor is (and service involves sales, too).

This part of the day was an introduction to observation, in the process of innovation. We were coached in asking useful, open-ended questions, and then went back to the Garfield Center to convert the observations into storytelling. We also did exercises in brainstorming (see photograph below) to acquire as many ideas as possible and sort through them.

Brainstorming Exercise - Medicine and Management Course
Panoramic view of Permanente physicians learning design thinking


Tomorrow, the group will continue to learn about the skills of innovation, or design thinking, led by the Innovation Consultancy group at Kaiser Permanente. The skills being taught to this group of physician leaders are the same ones used to develop the breakthrough MedRite program, which has changed the way people think about (and do) medication administration in hospitals so that it is safer. If you look at the tools used in MedRite, they are not new computers – using design thinking, the tools are simple, effective, and can be spread easily.

I am, of course, a big fan of continuous learning, and think it’s differentiating for medical groups to teach the skills of innovation. Through the work of the innovation consultancy, and more broadly, the Innovation Learning Network, Kaiser Permanente participates in sharing knowledge across organizations, just like our members expect.

More photographs, click on any to see larger size


What’s Needed Next: A Culture of Candor – HBR.org

June 30th, 2009 | Popularity: 4%
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  • What’s Needed Next: A Culture of Candor – HBR.org – We’ll tackle upward communication first. Consider the results of an intriguing, relatively obscure study from the 1980s, in which organizational theorists Robert Blake and Jane Mouton examined NASA’s findings on the human factors involved in airline accidents. NASA researchers had placed existing cockpit crews—pilot, copilot, navigator—in flight simulators and tested them to see how they would respond during the crucial 30 to 45 seconds between the first sign of a potential accident and the moment it would occur. The stereotypical take-charge “flyboy” pilots, who acted immediately on their gut instincts, made the wrong decisions far more often than the more open, inclusive pilots who said to their crews, in effect, “We’ve got a problem. How do you read it?” before choosing a course of action.

Disruptive Women in Health Care » March Man-of-the Month: Dr. Ted Eytan Interviews Holly Potter, Kaiser Permanente’s VP for Public Relations

March 2nd, 2009 | Popularity: 15%
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I’ve always respected the Disruptive Women in Health Care blog, and disruptive women in health care in general, so I was pleased to become March Man of the Month (or March’s Honorary Woman), with an interview of one of my favorite leaders…..

Disruptive Women in Health Care » Blog Archive » March Man-of-the Month: Dr. Ted Eytan Interviews Holly Potter, Kaiser Permanente’s VP for Public Relations, on the Use of Social Media in Health Care

Visiting the Kaiser Permanente Executive Leadership Program at Harvard Business School

February 5th, 2009 | Popularity: 22%
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Harvard Business School

I have just returned from Boston, where I was honored to be a visitor to the Kaiser Permanente Executive Leadership Program, at Harvard Business School. The trip came about because my boss, Marty Gilbert, MD, is the Permanente Executive in Residence at the program.

I have never been to business school, and defintely not Harvard Business School, although I have read HBS cases many times in the past. So for me, this was a treat to see the methodology used to take HBS cases and use them to teach. On this particular day, cases about Benihana restaurants, the Internal Revenue Service, and (one of my favorites) Toyota were leveraged to talk about operations flow and leading change. The professors were very dynamic and I thought their use of the chalk boards was very intriguing – this is the first thing I think a student notices. They even hand wash all the boards in between sessions.

The teaching itself seems to lend to the learning of accomplished professionals, in my opinion. The professors stop short of guiding the students on how they should apply the material in their leadership roles. They actually avoided asking for examples in people’s professional work during the interactive session, which is probably a very tempting thing to do in this situation.

Beyond the professors and the material, though, I couldn’t help but be impressed by the people in the program and Kaiser Permanente’s commitment to it/them. In my travels I have met many physicians in other health systems who are told, directly or indirectly, “Management/Leadership training is for managers/leaders, not physicians.”

The Executive Leadership Program is not just for physicians, though. Staff from across the program are involved, as are leaders from the Labor Management Partnership. Needless to say, this is a very accomplished group who I was very humbled to be present with.

With thanks to Marty, the students, and team at Harvard Business School for allowing me to watch them in action!

More images below, click on any to see full size:

Photo Friday: Servant Leadership, DC Style

January 9th, 2009 | Popularity: 27%
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Anita and Trenor

This week’s photograph was taken at Washington, DC’s Loeb’s New York Deli , and has Anita Samarth and Trenor Williams, MD, assisting fellow customers with their breakfast meals. This kind of thing just happens in a city/state that’s the #3 most extroverted in the United States.

The occasion of our breakfast was a monthly dialogue of a group of mid-Atlantic health information technology professionals that get together regularly to learn from each other and and to believe that everything is possible, because it is. Here’s a photograph of the full smiling group (except for me, the photographer…).

Clinovations

Now Reading: Results That Last: Hardwiring Behaviors That Will Take Your Company to the Top, by Quint Studer

November 19th, 2008 | Popularity: 20%
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I decided to read this book because I have been a fan of Quint Studer’s philosophy ever since reading some of his blog writings (here’s a great example, and note the power of blogs to bring in a new audience).
Results That Last is written from the perspective of a seasoned health care executive. I love stories, and Quint puts some very good ones in here. I appreciate that (a) he’s an optimist (“I believe that life rewards action more than inaction”) and that he shares his successes and his mistakes.
I think this book is especially good reading for a person starting a new position (that would be me) in that discussion on good leadership behaviors and creating a transparent plan are a great foundation for integration into an organization with a lot going on (aka every organization).
I agree with the commentary on striving for breakthrough performance – I especially like this quote that we should all remember:

Great companies must have at least 70 percent in the 5s

There are few things I didn’t like/agree with, and these could be chalked up to “controversial ideas” because I have heard them in mainstream health care. A lot. And we should rethink them:

Controversial idea #1: “I had to keep two groups of customers happy: patients and physicians.” On this one I worry that duality of customership creates confusion and doesn’t distinguish the best health care organizations, in my opinion. i understand that physicians refer patients to hospitals and need to tools to deliver great care for them. This is different than saying that they are a customer group like patients are. I prefer the approach that organizations like Park Nicollet use: “The patient is our only customer.”

Controversial idea #2: Making employees happy results in making customers happy. I’ve done a little research on this which I need to dig up (but, please help me here if you know of some) and I think the two are more comingled than people think. It’s possible that when an organization works hard to keep it’s customers happy, this results in employees being happy because ultimately they come to work to deliver for customers. The converse is also true, that an organization can keep employees very happy and have unhappy customers.

Controversial Idea #3: Focus on low vs high performers as opposed to functional vs dysfunctional processes. I think the book excels in demonstrating some baseline leadership behaviors like honesty and standard work like rounding, but I worry that there’s excessive attention paid (right up front, in the first chapter no less) on dealing with “low performers.” This is a bit antithetical to what people like me do in applying Toyota Management strategies – I suggest asking “why?” five times to see if a person is performing poorly or whether their environment is performing poorly for them.

There are two really great things mentioned in this book as well:

Impact of pre-visit and post-visit calls: Great data about the value of these, and in a system that has a personal health record, we just do “pre-visit and post-visit e-mail”. Wonderful.

Key Words at Key Times: Loved this as well. I used to do it in clinical practice – start every visit with “Welcome to our medical office” and end every visit with “Thank you for coming in to see us.” (It is interesting to me that some doctors/nurses don’t think to say “welcome” to a patient when the patient comes to see them!)

Overall, I think the book is actually a very good baseline/starter for more discovery about leadership approaches. Since I tend to be ahead-of-my-time-guy/person/citizen I’d probably recommend following this with something on LEAN or Toyota Management.


The Seven Things That Surprise New CEOs

November 13th, 2008 | Popularity: 11%
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  • The Seven Things That Surprise New CEOs – I’m not a new CEO and don’t plan to be a CEO, but I thought these ideas are useful to anyone starting a new position (and technically we should all act as if we are CEO’s of our practices/our projects/our goals for ourselves and society)

Novice to Expert: Use Collaborative Leadership to Go Further

October 28th, 2008 | Popularity: 16%
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A medical center is not a hospital — Cleveland Clinic Journal of Medicine

September 24th, 2008 | Popularity: 20%
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Now Reading: Does Diversity Pay? and Defining the Attributes and Processes that Enhance Effectiveness of Workforce Diversity Initiatives

September 16th, 2008 | Popularity: 31%
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The answer to the question in the post title is Yes.

In the last year or so, I have been challenged and challenged myself personally to understand the impact of workforce diversity, and these scholarly works helped a lot to understand it better. The impact is significant.

The first paper was written by Cedric Herring at the University of Illinois at Chicago and widely reported, both on NPR and in the Washington Post. It is a well-done regression and factor analysis of 251 for-profit business organizations’ performance dependency on racial diversity.

As defined in the paper:

Diversity is an all-inclusive term that extends beyond race and gender and incorporates people in many different classifications. It includes age, geographic considerations, personality, culture, sexual preferences, tenure issues, and a myriad of other personal, demographic, and organizational characteristics. Generally speaking, the term Aworkforce diversity refers to policies and practices that seek to include people within a workforce who are considered to be, in some way, different from those in the predominant group. In the 21st century, workforce diversity has become an essential business concern.

The paper represents a first-of-its kind analysis in that it controls for organization size, region, and age (with the idea that larger organizations typically have more racial diversity in them). And all of the tested hypotheses are statistically significant in the affirmative:

  1. The more racial workforce diversity a business organization has, the greater that business organization’s sales revenue will be.
  2. The more racial workforce diversity a business organization has, the more customers it will have.
  3. The more racial workforce diversity a business organization has, the larger market share it will have.
  4. The more racial workforce diversity a business organization has, the greater that business organization’s profits will be relative to its competitors

The second scholarly work is about the attributes of effective diversity initiatives. Not surprisingly, one of the cornerstones of effectiveness in this area is leadership, and leadership at the executive level. The intermediate outcome, that leads to the important outcomes above are the creation of an organization whose “population of underrepresented minorities experience the firm climate as being open to diversity and feel as if their race will not hinder them from career progression.”

Why is this important?

People like me are interested in the topic of diversity and disparities because we want to grow, learn, and do better every day. We also want to be in environments where we can succeed by performing well for the people we serve. Data shows that most people prefer to live in diverse environments. This information promotes the idea that people probably prefer to do business with organizations that create diverse environments. The data support the idea that leaders who are truly interested in organizational performance are interested in supporting diverse environments.

As mentioned in the second paper, the world’s best companies understand this:

Several Fortune 500 firms (e.g. IBM, Verizon, Pepsico, GE) have experienced sustained success in their efforts to recruit and retain a diverse workforce, making these firms exemplars in diversity management and ripe for future empirical research.

Why is this important for me?

Around the time that this blog post appeared, I was sitting in a Seattle Metro bus on the way home, in one of the front seats, looking at a poster of Rosa Parks placed overhead, celebrating her accomplishments. It was right after Martin Luther King, Jr’s birthday. I knew that in a different time or place, even in 2007, that I’d be sitting in one of the seats in the back. More importantly, those who would come after me would also be asked to sit in the back, if I did not make a sustained commitment. I realized at the moment that there’s a lot of good news out there – so many organizations have made clear commitments to diversity, and are able and willing to hire the best talent regardless of background. Those are the organizations I will always be a part of.

And yes, Kaiser Permanente is one of them.

(see: Kaiser Permanente’s score in the Corporate Equality Index (score: 100%)).


Strategy Execution and the Balanced Scorecard (HBS Working Knowledge)

August 13th, 2008 | Popularity: 21%
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  • Strategy Execution and the Balanced Scorecard (HBS Working Knowledge) – Excellent article with another reminder that strategy deserves its own bandwidth, and should be tied to operations, back and forth, in other words, always checking that what we're doing every day matters. Nice nod to leadership: "There are two key issues. First is leadership. Without strong visionary leadership, no strategy will be executed effectively." This can be challenging in healthcare. Luckily, our patients and their families want to help.

Hello Health Launch Party 7.31.08 – a set on Flickr

August 4th, 2008 | Popularity: 22%
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Hello Health Launch Party 7.31.08 – a set on Flickr

Thanks to Jen McCabe Gorman for sharing. The party looks like a lot of fun, and let us hope it helps patients and their families and communities become more involved and engaged in their health. Congrats to Jay & Myca.

Content of Weblogs Written by Health Professionals. [J Gen Intern Med. 2008] – PubMed Result

August 4th, 2008 | Popularity: 19%
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Content of Weblogs Written by Health Professionals. [J Gen Intern Med. 2008] – PubMed Result

This is a timely analysis of the content of blogs written by health professionals, by a fellow in the Robert Wood Johnson Clinical Scholars program. It is great to see that the RWJ Foundation (indirectly) would be studying the ways that tomorrow’s physicians will communicate. The article indicates that violations of patient privacy are rare, and suggests training of health professionals in this realm.

I agree with both, because health professionals should learn how to blog well, which really means they would learn to communicate well.

This would also mean, by the way, that I disagree with the creation of this headline about the study: Health Care Provider Blogs Do Not Maintain Anonymity, Study Says. My takeaway from this is that there is still a tendency to paint blogs in the negative within the health care press. That will change.

It is also not lost on me that the author has chosen a gmail address to be contacted, maybe blog and Twitter URL’s will follow in the world of PubMed….

People Don’t Hate Change, They Hate How You’re Trying to Change Them

July 21st, 2008 | Popularity: 17%
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I was speaking with Jane Sarasohn-Kahn today about some work she is doing for the California Healthcare Foundation and she asked me the question, “Do you think physicians would pay for their own continuing medical education (rather than being funded through industry support)?”

I immediately thought of this manifesto that I just read, whose conclusions I couldn’t agree more with, when I said, “yes we would.”

ChangeThis :: People Don’t Hate Change, They Hate How You’re Trying to Change Them

If you believe that people hate change and that it is your job to change them, they will hate it. If you believe that people thrive on change and that your job is to unleash it, you will tap into a limited source of ingenuity, energy and drive that will allow you to consistently take your ideas into big results.

This is exactly the theme we uncovered the Patient Centered Health Information Technology initiative, and what I have described many times on this blog and on the DailyKaizen blog (see: Let it Burn; a Wildfire of Respect), when I said, “in every part of every company there’s a monstrous capacity for creativity waiting to be unleashed.”

I sometimes hear about people in healthcare being “change averse.” I don’t think they are at all.

As we move toward Health 2.0, we have plenty of capacity to do things differently; nothing is static if it means doing things better for our patients. It’s what I see, again and again.

Oh So Close – HelloHealth

July 20th, 2008 | Popularity: 25%
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JAY PARKINSON + MD + MPH

How long before HelloHealth comes to Washington, DC, with the most regional-serving walkable urban places per capita in the country?

Note: There’s been some buzz about walkability for other cities as well, also fine choices for those who love living in places that support walking.

Hello Health-Concierge Care for All | Nexthealth

June 23rd, 2008 | Popularity: 21%
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Now Reading: Design Thinking, Tim Brown, Harvard Business Review

June 20th, 2008 | Popularity: 35%
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Rachel Block, the Executive Director of the New York eHealth Collaborative (NYeC – pronounced “nice” – get it?) alerted me to this article in the June, 2008 issue of the Harvard Business Review. It’s available for free on their Web site now, so waste no time in getting it.

The article is written by the CEO and President of IDEO, Inc., and talks about several projects that created value for customers using design thinking. The first project described is one at Kaiser Permanente, where, through this approach, nurses changed their rounding strategy to “at the patient’s bedside” instead of “at the nurse’s station.” This in and of itself was striking to me, because it’s exactly the approach that other national leaders in patient and family centered care are pursuing. How great that the same conclusion was reached about where nurses can best serve patients.

Beyond the great health care example, there are other examples that demonstrate the same thing:

Many of the world’s most successful brands create breakthrough ideas that are inspired by a deep understanding of consumers’ lives and use the principles of design to innovate and build value.

As Diana Forsythe discussed in her article on creating a patient education system for migraine sufferers, the most valuable innovations are the ones that understand the lives of the people they will touch, and then support those lives with the product/service/technology to make things better, rather than the other way around. To me, understanding the lives of the people that innovations touch means going to where those lives’ experience happen, and bringing the people who feel the impact into the design of the innovation.

I happen to have been to the Kaiser Permanente Garfield Innovation Center in Oakland, California (here’s a post about it and a little about its namesake, Sidney Garfield, MD), where we received a demonstration of the IDEO process underway on a project in one of the Kaiser Permanente Hospitals. I brought my most critical LEAN goggles with me to assess the process for respect for patients and those who serve them, and I was very favorably impressed. The Garfield Center is an impressive place in general, if you look at the photos in the post, or get a chance to visit yourself.

The theme of patient (and community) involvement in the design and leadership of systems has been on my mind in the next phase of work I am doing, hence these posts. I am glad that there are people like Rachel who know me well enough to add the right fuel to the fire….Enjoy the article and please post your thoughts on what it means for what you do.

What You Permit, You Promote « Sharing thoughts, ideas and suggestions on hardwiring success

June 2nd, 2008 | Popularity: 8%
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A Few Links Regarding the Continuity of Care Record (CCR) Standard

May 22nd, 2008 | Popularity: 80%
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May 15th through May 18th:

EMC’s Employer Managed PHR; TimeDriver Web Scheduling App; Fletcher Allen Signs for an EHR

April 26th, 2008 | Popularity: 100%
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I have been intrigued by EMC’s work in managing an employee personal health record – it seems above and beyond (in a good way) how an human resources function and grow and support talent. Also, time to upgrade Office for Mac. It went OK. I’ll update “my own CIO” tools list in the near future.

Learning More About the Medical Home and Finding Innovation Where It Lives

April 16th, 2008 | Popularity: 55%
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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

Social Network Analysis; Kaiser Permanente Health Education using Video; Rite Aid working with MedStar

April 14th, 2008 | Popularity: 53%
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What’s a Leader vs. a Manager?; GenY is Hard Working; New York PCIP Doing Well

April 11th, 2008 | Popularity: 82%
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April 5th through April 8th:

Medication Adherence messages; Tools for scheduling meetings

April 8th, 2008 | Popularity: 30%
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The one thing that I haven’t quite been able to do well is scheduling meetings with people not on the same computer network. Come to think of it, I never figured out how to do it on the same network either. I looked at some tools below that are emerging that let you do that. I think the most promising looking one is Timebridge. They are also part of the iCal consortium, which supports calendaring standards.

Challenging Peer Review (on several fronts); Consumerism in Health Survey 2007; Accepting suggestions from Customers using Web 2.0 at Starbucks

March 30th, 2008 | Popularity: 77%
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March 28th through March 29th:

  • WordPress ? Search and Replace « WordPress Plugins – Wordpress 2.5 is out. I have a feeling this plugin will be useful to have handy
  • JAMA — Preserving Confidentiality in the Peer Review Process, March 24, 2008, DeAngelis and Thornton 0 (2008): 299.16.jed80000 – With tremendous respect for Catherine DeAngelis’ leadership during a tough situation. I am left wondering if the best place to hide is out in the open – if peer review became more Web2.0 like. What would happen in a situation like this?
  • Findings From the 2007 EBRI/Commonwealth Fund Consumerism in Health Survey – EBRI – About 2 percent of the population is enrolled in a consumer directed health plans. Significant points for me: (1) almost half of the population with a chronic condition reports not filling medications or skipping doses or delaying care due to cost. Sobering reminder that patients can and do choose to do what we doctors prescribe. (2) “There have been no significant gains int he provision of information on provider cost and quality by any health plan type over the three years of the survey. There has been no increase in the share of CDHP or HDHP enrollees who say their health plans provide them with quality and cost information about their providers, and they remain no more likely to receive such information than enrollees in more comprehensive plans.” Okay, one more point – they did not ask about the impact of involvement in care in choosing a health plan – no mention of medical records access or involvement in information sharing at the level of the encounter.
  • My Starbucks Idea – How about doing this for a health care org?
  • Bronson Beta – Mail.appetizer – Nice Mail notification tool, Leopard

Photo Friday: Remember

March 28th, 2008 | Popularity: 26%
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This is a community where there are visible reminders everywhere to recommit yourself to what’s important.


The Reflecting PoolThe Reflecting PoolThank You

Remember

I just read that at the exit of the headquarters of the business maverick ING Direct National Bank, employees see a sign that says, “Did Today Really Matter?”

More Health2.0 = iPhone2.0 – Apple Digital Fitness System; Larry Weed; EMC’s Hypertension Management Program; GHI+HIP = Medical Home

March 28th, 2008 | Popularity: 69%
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A lot of stuff going on this week…

LEAN Hospital and Public Comments; The Unconference Concept; The State of Agile (LEAN Software Development)

March 18th, 2008 | Popularity: 37%
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March 14th through March 17th:

“I can ride a horse in here (Second Life)” – Great Patient Voice videos from Health 2.0

March 13th, 2008 | Popularity: 22%
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Scribemedia and the organizers of the Health 2.0 Conference have put the videos that they showed from the conference online. They’re terrific.

My favorites : A patient with reflex sympathetic dystrophy:, A patient with multiple sclerosis who can dance every night in Second Life

I think they’re moving from a patient, provider, and health system leader perspective. I especially enjoyed the one about chronic pain. We are taught in residency to support patients with pain by encouraging them to document their symptoms over time. Then we don’t give them tools to do it. Then we wonder why they didn’t document their symptoms. Then we ask them to document their symptoms. In the video I got the sense that bearing witness to one’s own symptoms is therapeutic in and of itself. Would I want this information brought into a consultation with a patient? Is it more important than asking if prescribed drugs were effective? Absolutely. See what you think.

Video will help the patient and consumer voice be heard in ways not thought possible before. Better health care will result.

Innovative Reimbursement for EHR-using physicians; 9 Principles of Innovation (Google); Twitter; Services for Farm Workers Online

March 12th, 2008 | Popularity: 28%
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March 7th through March 11th:

Health 2.0: Interesting new EHR Platform, Microsoft and Google, Wrapup

March 5th, 2008 | Popularity: 42%
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Health 2.0 is now over, and it was a great experience. I am not the only person in the room that remarked that they felt less innovative than ever in this room of innovators. The patient experience was front and center. I / we need to see that, often.

The post-lunch surprise was a demo of Microsoft’s HealthVault, accompanied by a post-demo comparison of the HealthVault and Google Health product by Missy Krasner. Overall a great discussion. I’m happy that more, rather than less, is happening here.

From my perspective I thought a big splash was made by the new EHR platform that Jay Parkinson, MD, demonstrated, manufactured by Myca. It has a compelling patient portal aspect as well. Interesting to see what happens when people start from scratch and build things the way they want to use them.

My comments in the Seattle-PI Health Blog; Characterizing Respect for People in a LEAN organization; A Cooking Light Best City (Washington)

February 23rd, 2008 | Popularity: 27%
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February 20th through February 22nd:

A CIO that embraces 2.0; Walmart going into the EHR business?; The Superfriends

February 18th, 2008 | Popularity: 39%
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February 10th through February 14th:

Better walking in DC; BIDMC going LEAN?; CEO Blogging; Best Companies 2008

February 7th, 2008 | Popularity: 71%
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February 4th through February 6th:

Sign of the Times

January 30th, 2008 | Popularity: 17%
2 comments

finallyblog

I received this insert in the mail recently. No better time like the present than to start blogging. It’s from The Department of Health Policy News, which is described as follows:

The Department of Health Policy at Jefferson Medical College is committed to conducting research and education programs that will contribute to the quality, safety, and cost-effectiveness of health care. The Department’s activities are meant to inform decisions made by government policy makers, providers, payers, and other health system stakeholders about how best to deliver and finance care in order to improve the health of the public.

I support blogging by health system leaders to support a conversation with the people we serve. Of course I subscribed to the RSS feed.

Hoshin Kanri Tutorial; Retail Clinics shuttered at Wal Mart; IOM supports national clinical effectiveness assessment

January 30th, 2008 | Popularity: 50%
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January 16th through January 29th:

Promising Reimbursement Methodology; More on Music and Real Estate Industries; Another Blog Post Goodbye to an Employer

January 15th, 2008 | Popularity: 45%
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January 12th through January 13th:

  • Prometheus Payment, Inc. – A new payment model that supports outcomes, evidence-based care, and transparency
  • The music industry | From major to minor | Economist.com – “Then they had the money and could have built the competence by buying concert agencies and merchandise companies,”…Now it may be too late.
  • Coverity Incorporated Scan – Company working with the US Govt to harden open source code for use by agencies including Homeland Security. They are finding bugs and the bugs are being fixed.
  • Online Real Estate Sites Work To Get A Listing Standard – Another industry that is seeing the benefits of standards, and the challenges of disruption
  • Gone Indie ? Thought Palace – Interesting insight on the work environment at Apple. LEAN production? You decide. I will say, though, that even though Apple is not embracing Web 2.0 like other companies are, I have solved many problems using their hosted discussions. These actually work well on Apple’s site I think because they do a great job of leveraging their loyal customer base. Yet another blog “goodbye” to an employer.
  • Lean Manufacturing Blog: 1 Hour Kaizen – Excellent template and approach to small improvements. Just takes an hour. Can we have physicians shadowing nurses and vice versa?

Spirit of Innovation, as told by Apple, Inc.

January 14th, 2008 | Popularity: 22%
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I love this new ad, because it’s a bit of a metaphor for generational change and innovation within organizations. Sometimes it feels that innovators are moving at 10 times the pace of the normal beat of things. The joy of creating change is to present the face that is going at the same beat or just slightly faster, so others can join in.

Also, on the eve of MacWorld, I dug out one of my favorite quotes, from 2006:

“We have a lot of health-care customers and maybe 1 percent of a company’s research department is on Macs but they have 99 percent of the influence.” – Jim Murphy, practice manager for Strategic Computer Solutions, a Syracuse, N.Y.-based IBM partner.

Original source for the ad can be found here.

The Art of the Walking Meeting

January 10th, 2008 | Popularity: 32%
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Update October, 2008: Here is a post about some scientific evidence that may lend credibility to the idea that a walking meeting may stimulate feelings of trust and personal warmth.

I was perusing through the Department of Veterans Affairs National Center for Health Promotion and Disease Prevention’s excellent December, 2007 issue of Health Power! Prevention News, and happened on a review of this systematic analysis of the impacts of using pedometers to increase physical activity and improve health (Bravata DM, Smith-Spangler C, Sundaram V, et al. Using Pedometers to Increase Physical Activity and Improve Health: A Systematic Review. Jama 2007;298:2296-304.)

More on that later, though. It stimulated me to write a post about how I use the pedometer in my work life, and my journey to develop “The Walking Meeting,” the coolest part of getting things done that I have added to my repertoire.

So what is this? About 3 years ago now, I was offered a pedometer as part of a test of a walking challenge. I have since upgraded to a non-freebie variety, as recommended to me by Mark Graban, publisher of the well regarded LEAN Blog. In the LEAN world, pedometers are great for time-motion studies.

They have been great for bringing fitness into the work environment, too, and changing conversations. My other nickname for this is “WWW” or “work while walking” (or maybe “walk while working), and here’s the recipe:


» Read more: The Art of the Walking Meeting

How not to lead Geeks; Being a Chief Inspriation Officer

January 10th, 2008 | Popularity: 49%
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HIT Resources; Blogging about “breaking up” with your company; Dr. Phil (Marshall) joins the blogosphere

January 7th, 2008 | Popularity: 28%
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iMedix allows patients to share treatment stories; Health Plans and Customer Experience; Handy Tip for Leopard Users; Handy Tip for DC Residents

December 27th, 2007 | Popularity: 42%
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December 24th through December 26th:

Now Reading: Punching-In: The Unauthorized Adventures of a Front-Line Employee, by Alex Frankel

December 26th, 2007 | Popularity: 25%
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This book was tailor made for the experience I am having now. It’s the travelogue of a man who goes undercover as an employee in some of our most iconic organizations: UPS, The Container Store (not quite, he didn’t pass the interview), Enterprise Rent a Car, Gap, Starbucks, and The Apple Store. This is a true trip to the Gemba, in that Mr. Frankel actually goes to work for the companies discussed as an employee. I am doing a similar thing, but I am not undercover, and I am not actually practicing medicine in the organizations I am spending time with (I suppose I could do something similar as a health professional, but at a huge cost to the organizations and patients they serve). I am, however, putting myself at the interface between the customer and the organization, and I, too, am thinking a lot about culture and about how people and organizations work. It’s an awesome experience, as I’m sure Alex’s was.

Throughout my journey, I have resisted using the term “front line” because the war analogy doesn’t make sense to me in health care. However, I liked the way that Alex described the “front line”:

In the military, the front line is the border between two opposing armies; in retail and service companies it is the invisible divide between customers and employees

This definition frames the experience well in terms of how organizations fixated on “brand” see themselves, and the author stimulates thinking on this, in my opinion.

No one is selling what we think they are selling

The thing we think these companies are here to do doesn’t seem to be the thing they are actually doing. An Enterprise employee is really selling insurance in the form of collision damage waivers. A Gap employee is selling lines of credit. An Apple Store employee is selling add ons (warrantees, etc) onto the main products. Starbucks is selling the “third space” that is not our homes or our work.

» Read more: Now Reading: Punching-In: The Unauthorized Adventures of a Front-Line Employee, by Alex Frankel

First recorded spam; Physician Blogs; Enjoying culture of DC Neighborhoods; Empowering staff; LEAN definitions

December 24th, 2007 | Popularity: 44%
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December 24th:

Shadow Dancing – going to be where the patient is

December 6th, 2007 | Popularity: 9%
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One of the greatest things I heard from a CEO of a health care company I really admire was, “Sometimes I go back to my office and ask myself what the heck I am doing.”

And, sometimes I go back to my office and ask myself what the heck I’m doing.

I am just finishing up a week (more or less) of visiting a total of four different health care organizations, in the San Francisco Bay Area. It was a great week. I never know what I’m going to see or learn when I do this, and I learn a lot. The reason for this is that I do shadow – asking to go into the exam room with patient and physician (after proper consent). I typically don’t sit down with people at meetings, and instead talk to them on the fly, in the context of patient care. Sometimes I will give a presentation, on request, which I am happy to oblige.

It’s a bit of an unusual way to learn, and it can be challenging to get there in the first place. This includes everything from knowing my tuberculosis status (to protect patients I may come in contact with) to understanding privacy practices and protecting the security of medical information.

When I visit a practice, there is invariably a conversation that starts with, “who are you and why are you here?” I have a bit of an elevator speech that I’ve developed over time. The reality is, that in medicine, it’s not the “norm” to perform quality improvement a little at a time. People are used to data-driven quality, which can take months to compile and more months to release as people discuss methodology. They don’t really watch each other practice and critique and improve on the fly. So, I sometimes find myself in a situation where I have to represent my value very quickly.

The good news is that I have been uniformly welcomed, even by busy clinicians, which has been so impressive to me. Some of the clinicians I am following are not having the smoothest days, and some may not be having the smoothest weeks or smoothest months. And, that’s okay. I’m a visitor serving them, not the other way around.

In a health care system where quality happens every day, a bit at a time, it would be more likely that a physician (or nurse) would be shadowed by a colleague, and so my presence wouldn’t be a novelty. But that’s not the case, so every new request to shadow is going to bring a challenge with it. It would be much easier to acquire information by setting up meetings, but I think the quality of information would be inferior. So, I’m not going to do that, but I will set myself up for disappointment and maybe even failure, if an organization or practice feels that there isn’t a need to have me observe what they do.

The reason why it’s okay, to do this more complicated thing, is because of all of the things I have seen and heard, the moments of “the heart of family practice” that I have had in every place I’ve been. Maybe one day all patients will expect to see another physician in the exam room with their own who is working to help their colleague to be a better doctor.

Such is the life of the change agent….

Analysis of Paralysis; More health leaders’ blogs; Role Experience and Performance

November 12th, 2007 | Popularity: 30%
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November 5th through November 10th:

Bookmarks for October 25th through November 4th

November 5th, 2007 | Popularity: 16%
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October 25th through November 4th: