90-9-1 – Brilliant idea for a web site for a concept that I often try to explain. 90% of users are the “audience”, or lurkers. The people tend to read or observe, but don’t actively contribute.
9% of users are “editors”, sometimes modifying content or adding to an existing thread, but rarely create content from scratch.
1% of users are “creators”, driving large amounts of the social group’s activity. More often than not, these people are driving a vast percentage of the site’s new content, threads, and activity.
Posts Tagged ‘participation’
Patients demand: ‘Give us our damned data’ – CNN.com
January 18th, 2010 | Popularity: 4% 0 comments | Leave a replyPatients demand: ‘Give us our damned data’ – CNN.com. Regina Holliday, Jen McCabe’s work highlighted on CNN, at DCA airport (people meet where they can in this web2.0 world…)
Journal of Participatory Medicine is launching!
October 20th, 2009 | Popularity: 2% 2 comments
From e-Patient Dave (ps. I love the part about not spending to put this on Businesswire)
Here’s the announcement of the Journal of Participatory Medicine, which will be formally launched Thursday at the Connected Health conference in Boston, as described herein.
We’re not spending to put this on BusinessWIre etc – all we care about reaching are people who’ll understand the significance. And that includes you.
Similarly, the length is not standard press release, nor is the content; we wrote for those interested parties, knowing they’ll read as much as they want. We took the time we needed to spell out what we feel is the significance of this event.
Thank you so much for your long-standing support of this cause.
Feel free to share.
For immediate release
October 21, 2009
Improving health care:
Journal of Participatory Medicine will document methods that work
for patient/provider collaboration
Launch at Connected Health Symposium
features essays by visionaries in
health care, Internet, high tech, business, and sociology
Patient engagement and patient empowerment are popular topics, with hundreds of thousands of Google hits, but there’s precious little information on how to do them well. A new academic journal being launched this week, the Journal of Participatory Medicine, aims to change that.
Created by experienced pioneers of the “e-patient” movement, the Journal will be introduced this week at the Connected Health Symposium in Boston, hosted by the Partners HealthCare Center for Connected Health. The Journal is an official publication of the Society for Participatory Medicine, founded in 2009 by the patients and physicians who have worked together for several years at e-patients.net.
“Because health professionals can’t do it alone”
Participatory Medicine is a new approach that encourages and expects active patient involvement in all aspects of care. It builds on the work documented at the e-patients.net blog, whose slogan is “Because health professionals can’t do it alone.” The group’s landmark 2007 paper “E-Patients: How They Can Help Us Heal Healthcare” tells many stories of engaged, empowered e-patients who substantially improved their own outcome and the outcomes of others by supplementing or even going beyond what their physicians alone could do.
That paper and subsequent blog posts have further documented the stresses and information overload faced by physicians today, and flaws in today’s care delivery system and personal health data, including many anecdotes of patients who made a pivotal difference through active engagement. Now, the Journal of Participatory Medicine will move the field from anecdote to science, with articles on principles, methods and evidence-based outcomes.
Authoritative and accessible; peer-reviewed by patients and health care professionals
The Journal will be written and peer-reviewed by and for all stakeholders: patients, healthcare providers, caregivers, researchers, payers and policymakers. Physicians who have practiced in the participatory model report greater satisfaction when they work with patients who are actively engaged. Similarly, participatory patients say they feel empowered, heard, and more in control.
Free continuous updates online
The Journal will publish continuously and will be freely accessible to the public at http://jopm.org. Following the inaugural issue in early 2010, articles will be published as they are reviewed, accepted, and edited; there may also be single topic special issues. Email alerts will inform subscribers when new material has been posted. Anyone can sign up to receive these alerts at http://jopm.org/register.php
Available online now is a collection of invited essays that serve as the “launch pad” from which the journal will grow. In their opening editorial “Why the Journal?” the editors write, “We consider this introductory issue an invitation for you to join us as we create a robust journal that will serve a growing community of concerned individuals and professionals.”
Mission: To transform the culture of medicine
The Journal’s mission is to transform the culture of medicine by providing an evidence base for participatory health and medicine. It aims to advance both science and practice, focusing on six content areas: research articles, editorials, narratives, case reports, reviews, and updates on related research in other media. It will explore how participation affects outcomes, resources, and relationships in healthcare; which interventions increase participation; and the types of evidence that provide the most reliable answers.
Importance of a broad-based peer review process
The Journal uses a new, broad-based peer review process to significantly improve on traditional academic journals. While still managed by experienced journal editors, JoPM’s peer review process will be open to a far broader set of minds for scrutiny of methods and analysis. Improved accuracy and effectiveness are vital as the population ages and healthcare costs continue to rise.
In the first issue of JoPM, Richard Smith MD, editor of the prestigious British Medical Journal for 25 years, writes that “most of what appears in peer reviewed journals is scientifically weak.” This echoes the words of Marcia Angell MD in The New York Review of Books, who wrote in January “It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.” Considering the pivotal role that journals play in policy and treatment decisions, JoPM’s broad-based process aims to improve the reliability of the process and the resulting research.
Bringing thought leadership from many disciplines to healthcare
Because of the complexity and size of the healthcare challenge, the Journal of Participatory Medicine invites participation from all disciplines that can help.
Leadership of the Journal and the Society is shared between physicians and laypeople.
· Co-Editors are Jessie Gruman, PhD, Founder and President of the Center for Advancing Health, and author of AfterSchock: What to Do When the Doctor Gives You—or Someone You Love—a Devastating Diagnosis; and Charles W. Smith, MD, Executive Associate Dean for Clinical Affairs and Professor of Family and Community Medicine, University of Arkansas for Medical Sciences, and Founder of eDocAmerica.
· Deputy Editor is Alan Greene, MD, Founding President of the Society, Co-founder of DrGreene.com, Clinical Professor at Stanford University and Chief of Future Health at A.D.A.M., Inc.
· Managing Editor is Sarah Greene, publishing and new media entrepreneur with three startups in science, health, and medicine acquired by Wiley, Elsevier, and Thomson Healthcare.
· Founding Co-Chairs of the Society are Daniel Z. Sands MD, MPH of Cisco Systems and Beth Israel Deaconess Medical Center, and his patient “e‑Patient Dave” deBronkart, of ePatientDave.com and TimeTrade Appointment Systems.
Some of the articles featured in the first issue:
· Investor and futurist Esther Dyson on “Why in the world ‘participatory medicine’?”
· Longtime JAMA editor George Lundberg MD and former AARP board chair Joanne Disch PhD, RN: “Why healthcare professionals should be interested in PM”
· Kate Lorig RN, Dr.P.H., Director of Stanford School of Medicine’s Patient Education Research Center: “Why people should be interested in PM,”
· David Lansky, CEO of Pacific Business Group on Health and former Senior Director at the Markle Foundation, on “Why payers should be interested in PM”
· Kurt Stange MD, PhD, Case Western Reserve University and editor of the Annals of Family Medicine, and Gilles Frydman, founder of the ACOR.org network of cancer communities, on “Building an interdisciplinary field of inquiry and practice”
· Richard Smith MD, former editor of BMJ, and Musa Mayer, famed breast cancer activist, on “The Value and Questions of Peer Review”
Launch is the closing event at Connected Health Symposium
The official launch of the journal will occur on Thursday, October 22 at 3:30 PM as part of a panel discussion about the “Changing Role of the Patient in Health Care and the Changing Rules of the Game for a New Publication.”
Moderated by Co-editor Jessie Gruman, the panel will include Gilles Frydman, Founder and President of ACOR (Association of Cancer Online Resources) and Editorial Board Member; Dan Hoch, MD, PhD, Dept. of Neurology, Mass. General Hospital, Co-founder of Braintalk, and Editorial Board Member; Deputy Editor Alan Greene, MD, and Co-editor Charles W. Smith, MD.
The Society chose to launch its journal at the Connected Health Symposium because of the long and sustained commitment Partners HealthCare and the Center for Connected Health have had to exploring innovative and effective ways to deliver quality healthcare outside of traditional medical settings. According to Gilles Frydman “Many of the editorial advisers and board advisers for the journal have been working with the Center for Connected Health for years. We are delighted to be partnering with them for this launch.”
About the Society for Participatory Medicine
The Society for Participatory Medicine was founded in 2009 to learn about and promote PM through writing, speaking, social networking, and other channels. It builds on the work of Tom Ferguson, MD, who envisioned the e-patient movement within months of the birth of the Web browser.
Society membership is open to anyone who shares the belief that PM should be the operative model for healthcare, that all involved parties share in a collective decision-making process, and that the patient is central to that process. Through PM we can teach patients to take responsibility for their own health and providers to effectively invite patients into this.
About the Center for Connected Health and the Connected Health Symposium
The Center for Connected Health, a division of Partners HealthCare in Boston, develops innovative and effective solutions for delivering quality patient care outside of the traditional medical setting. The Center engages in pioneering research in a wide range of connected health-related areas and works to advance the field through its convening and publishing activities. The term “connected health” reflects the range of opportunities for technology-enabled care programs and the potential for new strategies in healthcare delivery. The Connected Health Symposium asks how information technology – cell phones, computers, the Internet and other tools – can help people manage chronic conditions, maintain health and wellness, and age with independence.
Journal of Participatory Medicine: http://jopm.org or www.facebook.com/JourPM
Follow the journal on Twitter: @jourPM and #WhyPM
Society for Participatory Medicine: http://participatorymedicine.org or www.facebook.com/participatorymedicine
Connected Health Symposium: http://www.connected-health.org/events/symposium-2009.aspx
Press contacts:
For the Journal of Participatory Medicine: Gilles Frydman, 212-300-5900
For the Society for Participatory Medicine: Cheryl Greene, 925-964-1793 Office;
925-639-5517 Cell; CGreene@DrGreene.com
Or email editors@jopm.org
Participatory Medicine: “There might be something to this”
October 14th, 2009 | Popularity: 3% 6 commentse-patient Dave wrote me recently and asked:
Do you have a post you’d like to submit, in which you discuss Participatory Medicine either philosophically or from the physician’s perspective, so that docs and health leaders who read it think “Man, there just might be something to this”?
His request hit on a self-acnkowledged weakness (or strength, in the social media world) of mine, which is that I am not good at being prompted what to write. So, even though I missed the terrific Participatory Medicine Grand Rounds, I thought and thought about it, and I decided (spontaneously) to write something, and to show something.
What I want to write
In a post I wrote after visiting the team behind the MiVia.org personal health record for farm workers in California, I laid out this scenario. See if it helps you visualize what it could be like not to participate in your own health care.
Imagine that you were working internationally and had a serious stomach ache and needed to see a doctor. When you went into the medical clinic, the doctor asked you what medicines you were taking and what the status of your medical conditions were. What if you didn’t know or couldn’t tell them because you were in so much pain or you had seen a doctor but they didn’t give you a copy of your medical record. What if you lived in that same community for 5 years, but weren’t sure if you needed any medicine or treatment to prevent illness, and no one was keeping track. What if it felt like you didn’t belong….
Maybe this scenario is not far off from the health care you receive today, in the United States.
The title of the post is “Because Everyone Wants to Belong.” An important reason for supporting Participatory Medicine is that everyone not only wants to belong, they deserve to belong.
What I want to show
It shows the work of a person who fought to promote participation, Eunice-Kennedy Shriver. The artist is David Lenz – “Lenz, whose son, Sam, has Down syndrome and is an enthusiastic Special Olympics athlete, was inspired by Shriver’s dedication to working with people with intellectual disabilities.” (source: wikipedia)
She set out to change the world and to change us, and she did that and more. She founded the movement that became Special Olympics, the largest movement for acceptance and inclusion for people with intellectual disabilities in the history of the world. (from Statement from the Shriver Family)
You can see the drive … in her eyes. This is what excites me about participation. I can’t help it.
See if you think there’s something to participation in any or all of the above; thanks for reading, and watching.
Photo Friday: We Love Logan Circle
October 9th, 2009 | Popularity: 3% 1 comment
This week’s photograph was taken on the sidewalk near 15th and P streets, in Washington, DC, also known as the Logan Circle Neighborhood.
The retail store Lululemon was putting on an impromptu show for neighborhood residents.I have written previously about Lululemon’s approach to growing their business by integrating into the communities by building showrooms staffed by community yoga instructors. It’s a great concept for health care too.
As I have been away from DC for the past week, it’s good to be back and be reminded of the diversity and philosophy of living (see the photo on the bottom right) that draws me to Washington or this part of any city I am fortunate to visit. It’s similar to the Suze Orman philosophy: People first, then money, then things. Enjoy.
moleskinerie: MOLESKINE QUALITY CONTROL
December 4th, 2008 | Popularity: 19% 2 commentsEmphasis added to the last sentence. Participation makes things better.
moleskinerie: MOLESKINE QUALITY CONTROL
“QUALITY CONTROL N° 6484
Every notebook is handmade and it has been carefully checked for quality. If, despite our best efforts, we have overlooked a defect of any kind, please let us know. Send an e-mail to: info@modoemodo.com, and include a digital photo that shows the problem you found, the quality control number (that identifies the notebook in your hands) shown here, along with the model name and your mailing address. We will send you a new notebook.
Together, we can prevent mistakes in the future. Thank you.“
Presentation: From PHRs to Participation (National Partnership for Women and Families)
November 10th, 2008 | Popularity: 19% 4 commentsToday I gave the first official presentation in my new skin as a physician with The Permanente Federation. I was a little nervous leading up to this (as the tweet said) because this is earlier in the tenure of an organization than I would want someone to represent me.
I did this because it was National Partnership for Women and Families and the groups they work with. I am a huge fan of their work promoting friendly workplaces and blogged about this previously. I managed the newness to Kaiser Permanente by weaving in basic information about Kaiser Permanente’s onilne services (the slides in the middle) and including the names of the leaders involved and taking questions to provide more information later. I also planted a little seed at the end for the innovation potential of Washington, DC.
Today I also got to go on walking meetings with the famous (to me) Jacob Reider, MD , a family physician and health information technology innovator, and now Medical Director at Allscripts-Misys Healthcare Solutions., and soon to be famous (to me, but already to his fellow New Zealanders) Professor Jim Warren, Chair in Health Informatics and Chief Scientist for the National Institute for Health Innovation at the University of Auckland. Both Jacob and the Country of New Zealand have a lot of innovation up their sleeve, all involving patient centeredness in health care. Let’s cheer them on.
Click on any slide to see the images closer up. If you don’t know what the point of any image is, let me know in the comments.
Oh, last thing, the video I showed at the end is Kaiser Permanente’s latest TV commercial, launched in tandem with the 2008 Olympics. Kaiser Permanente now regularly uploads its media to YouTube. Sharing is healthy.
Now Reading: Are You Listening…Are You Really Listening? (it’s the killer app for Health 2.0)
November 2nd, 2008 | Popularity: 26% 5 comments
This paper stands up really well on its own as a call to action around listening to patients and their families. It does a nice job of discussing the contribution of communication (or lack thereof) to a safe care experience, with some great quotes included, like this one, attributed to Julie Ann Morath, RN, MS, COO of Children’s Hospital and Clinics of Minnesota:
When you listen, it’s a demonstration of respect, and listening in itself is a healing practice.
The data presented are dramatic : in 77 % of patient/physician interviews, the patient’s true reason for visiting was never elicited. Patients are “redirected” by physicians on average, within 23 seconds.
This is also the hook for Web2.0/Health2.0 because what technology does is allow people to be heard, relative to their Web1.0/Health1.0 counterparts, and this is the action that the authors did not write about:
Actions that CMIO’s/CIO’s can take.
In that section, they would advise these leaders to consider carefully who the customer of their newly funded (maybe legally mandated) electronic health record is.
When they decide that the ultimate customer of the electronic health record is the patient, they would allow access to all of the information about that patient to themselves and those that care for them, privately, securely on line, inpatient or outpatient.
How does a personal health record promote listening?
When care providers open their electronic doors to questions about care, or questions about anything based on facts in their care that they can now access, listening becomes less of a choice – patients will ask questions about what they see and we’ll want to make sure they understand what we’re presenting to them in their electronic health records. This is what my colleague at Kaiser Permanente, Mark Snyder, MD, describes when he says the printed After Visit Summary “is a process, not a souvenir.” I wrote an example of this process here – I like that it gives you no option but to listen.
I found myself agreeing with a lot of the ideas written here, especially the one that the patient and their family are one of the most powerful barriers to harm in health care. The authors state it here:
“The hospital’s deepest resource of care information is patients and their families; this is because these people have the ability to share core root cause information, from symptom to outcome, that can drive the quality and safety of care in hospitals.”
And I said it almost exactly the same way in this month’s AHRQ Web M&M Spotlight Case.
Toward the end of the article, the authors write that this is not another paper that should collect dust on the shelve of a few “Safety Geeks.” Based on what I’ve been doing and what I saw most recently at the Health 2.0 conference, I can be reassuring that there are a whole lot of Geeks out there working to make listening happen. Come join us!
Look at how Anna, 12, interacts with her world. She and her cohort are the patients (and the doctors) of the future.
October 11th, 2008 | Popularity: 20% 6 comments
(click any image to see it larger) This is Anna, she’s 12 years old, and I got to meet her because her mother is Jane Sarasohn-Kahn, author of one of my favorite heatlh care blogs, Health Populi, and came to DC and wondered if I might walk to meet them today, at my favorite Smithsonian museum. Twist my arm on many levels…
Those of you who are parents (or near Anna’s age) might not think this observation is that unique, so excuse my lateness to the game, but look at how Anna is interacting with the art in the museum. When we came to the exhibit she was interested in, she immediately grabbed her cell phone camera and started taking pictures. I asked Jane if she would look at them later and said she absolutely would. “It’s her scrapbook,” Jane said.
Anna goes to a school where she’s required to write a blog post every day, covering her assigned work, with one “free day,” each week, where she and her fellow students can write about whatever they want.
In Anna’s case, instead of passively taking in the art, she immediately begins creating content with it. And this is what she is being trained to do every day at school. What will Anna expect when she is 18 from her health care system? If Anna decides to train to be a physician, what will she expect from the systems (electronic and not) that are set up to enable her to care for patients?
In 2003, it was a pretty amazing thing to have a tethered PHR in place, for patients to see their health information on line. In ushering this new world, I could be heard to say to fellow physicians, “…and patients’ e-mail messages are limited to 3,000 characters, and no attachments!”
It’s very possible that Anna and her cohort won’t be looking to provide and receive care in systems that limit how much content patients can contribute to their health care experience. They may expect just the opposite, and want that the systems that support them help them manage this intelligently.
This example should give us some energy to think about really supporting participation in Health 2.0, the real thing.
With thanks to Jane and Anna for being great teachers, on and off stage. Come back to Washington anytime!
When physicians are ready to promote patient empowerment / engagement, what do we want them to do?
October 8th, 2008 | Popularity: 61% 40 commentsThis question was posed to me by Ann Barber, MD, who I just spoke with. Ann reached out to me because she has been following the work of the group at e-patients.net, and specifically their call to recruit physicians to support the patient empowerment movement. Ann is an internist who specializes in hospital medicine, and has recently relocated to New York.
Ann asked me the question in the title of this post, and in talking with her, I decided to ask it here as well, because I’m unsure of the answer.
I wondered if this is because I/we have assumed that the majority of physicians are not interested in empowering patients, and therefore we don’t know how to support those that are?
I did a mini-check in with myself on this, and although I have alluded to some physician groups still feeling challenged by the idea of patient empowerment on this blog, the majority of my writing here points to the idea that physicians are very interested in empowering patients, because they want to perform well for them. The overwhelming majority of my posts here point to that idea, and here’s just one example.
Back to the question – where should a physician start when they have the energy and drive to make a difference in this area? When they interview for positions, what vocabulary should they use to describe what they are looking to do? How do they find the institutions in their communities that are already forging ahead in this area? If there are no institutions identified, how do they find the ones that are open to new ideas/thinking in this area?
My suggestion was to walk the hallways of any potential medical center employer and observe and ask questions – how are patients and families involved in their care? Do nurses and doctors round at the bedside (like they do at Medical College of Georgia, and hospitals in the Kaiser Permanente system [article in Harvard Business Review describes this] )? Are there visiting hours? How does the institution keep families and informed throughout a hospital stay?
I recommended a few resources, including the Wachter’s World Blog, written by hospitalist expert Bob Wachter, MD, the Institute for Family Centered Care, to find institutions in a community that are practicing patient and family centered care in New York, and of course, HelloHealth in Wlliamsburg.
I think the inpatient setting is the next frontier of patient and family involvement in their care, enabled by technology, and welcome the creativity of Ann and other hospital medicine specialists who want to make a difference for patients and famlies everywhere, which is why I wanted to think about this more.
Are there other ideas for Ann and the physicians in our profession who are among the “already recruited?”, in New York (and beyond)? Post them in the comments, please!
And thanks to e-patients and all the patients who have made it easy to remember who I am accountable to.
Now Reading: Three Articles on Health Information Technology Adoption
September 1st, 2008 | Popularity: 35% 0 comments | Leave a reply
When I read these I thought about what my opinion was about them, and what I might write in a blog post about them. I didn’t really want to critique their opinion or lay mine on top, because I think the pieces stand up well on their own, and I am no more connected to the facts than these authors are.
So I thought I’d just end up writing a post that said that I read these articles (I know, uncharacteristic of me).
Then, I stepped on the Washington, DC Metro, and this advertisement, for a local hospital stared me in the face:
I looked at it several different ways – on the one hand, the implication is that if your child has a serious spine problem, they will take care of it. However, if you do not have a child with a serious spine problem, should you go elsewhere for primary care, or are they good at that, too?
Is 3-D imaging today’s marker for quality health care? That’s what brought me back to the point of these three pieces.
In my travels, I don’t often see advertising for health care organizations that say, “Come to us for your primary care, your child is more likely to be immunized by us.” Or, “Come to us for all of your care – we’ve been rated the best listeners in DC.”
Here’s another example from my Twitterfeed. How did health care come to this?
What these pieces do for me is support the work to move to a system where the customer is the patient. The care experience should be as good as any a person can get from any other industry, online or offline, and one that is accountable to it for the things patients care about. It’s not how many personal health records there are, but how often patients and families make meaningful decisions to stay healthy because of them.
For me, this is where the energy comes from around patient access, patient and family involvement in care, and in the design and improvement of the health system.
Finally, I just re-acquainted myself with this quote yesterday, from my reading of A Fortunate Man, by John Berger about a country doctor in 1967. Here’s what the author said about computers in medicine back then.
It may be that computers will soon diagnose better than doctors. But the facts fed to computers will still have to be the result of intimate, individual recognition of the patient.
Was he right? (rhetorical question)
Presentation: From PHRs to Participation (A little inspration back and forth at AHRQ)
August 28th, 2008 | Popularity: 21% 0 comments | Leave a reply
Where the magic happens
I had the opportunity to talk about participation (of patients, families, and communities) in health care and the design of the health system today at the Agency for Healthcare Research and Quality (AHRQ) headquarters in Rockville, Maryland, at the invitation of AHRQ’s Director, Carolyn Clancy, MD, with attendance of experts including Jon White, MD, Director of the Health Information Technology Portfolio for AHRQ.
What can I say except it was a great experience at a place I and many people who do what I do have thought highly of for a very long time.
The slides I presented are below. I want to thank the students in the University of Washington eMHA program for doing a run-through with me. One of the suggestions I was given was to know what I “wanted” in giving this presentation to AHRQ. I told the group that I thought about this, and it was – to inspire them. I think that’s both enough to want, and a lot to want.
The session is/was a reminder to me that in 2008, people who are studying health information technology (a) have a good grasp of the idea that it’s a tool to improve health and health care and (b) the importance of involving patients and families in their care. That, and we should look outside our borders, to places like Africa, to think about innovation in IT beyond the computer.
Inspiration is a 2-way street. Thanks again Bill, Carolyn, Jon and AHRQ for the warm welcome.
Now Reading: “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)
August 25th, 2008 | Popularity: 49% 7 comments
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.
Always Just Testing : From PHRs to Participation
August 17th, 2008 | Popularity: 27% 3 commentsI started off a presentation-in-the-works to students in the University of Washington Executive MHA program, led by David Masuda, MD (who, sadly, doesn’t have a blog, just a Twitterfeed, it’s a journey…), with the words, “This is a beta test,” and I’m glad I did.
The beta test part is true, since I was asked by Carolyn Clancy, MD, from Agency for Healthcare Research and Quality to reprise and elaborate on a talk I gave at the American Board of Internal Medicine Forum in July for a seminar at AHRQ later this month. That was a 10 minute presentation, the one coming up is a little more full. The way I like to do these when the presentation is in evolution is practice to myself, of course, but also to test with a smart audience to read the feelings/emotions that are created (which is what I think a presentation is for – read more about this here) and see what ideas resonate well and which ones don’t. I usually tell the test audience that I’m testing, and it really helps, because it engages the discussion beyond the content, to how to make the content help other people after this group. Synergy.
Luckily, Dave and his co-students gave me the opportunity to do this.
Before it was my turn, I got to see Rick Rubin, President of Washington’s OneHealthPort in action, talking about community collaboration in the health information technology space. In my travels, I have seen that OneHealthPort is really a gem in the area of health information technology (when people find out about it). It’s company that supports collaboration among potential competitors who jointly have a business need for this collaboration. Whenever I mention that it exists on the East Coast, I have always gotten a good amount of interest in it (which I in turn forward on to the OneHealthPort folks).
I didn’t know before this day that Rick is from Boston, which probably accounts for some of my draw to his style. I think OneHealthPort should get more exposure nationally as a functional model for community collaboration and I reflected on the fact that doing business behind the Cascade Mountains in the Pacific Northwest sometimes shields the nation from some really good ideas. Place matters.
My turn – I worked to combine my work at Group Health with my work at California Healthcare Foundation, and beyond, with Participation as a theme, which is really where I have come to in terms of what I am about professionally. I think it went okay as a first run. I got great feedback from the students (all accomplished health professionals in their own right). I included some information about the 60 Minutes piece about Cedars Sinai and heparin. Luckily someone in the audience had first hand experience with this situation, and I need to adjust the presentation about this – it’s a reminder to be careful about telling other people’s stories, they know their stories better than I do (and vice versa).
One of the physicians in the class, who’s an Infectious Disease specialist, let me know that this approach to health care resonated with him as a physician supporting HIV patients, and how it was when his cohort of specialists began practicing a new way based on the needs of his patient population. I thought this was great to hear – I tell people that my cohort of physicians (Generation X) went through medical school during this time, and as a result we (I) graduated with the idea that I would work with patients who would know more than I would about their condition (which I embraced).
As far as the presentation I need to tighten it up more, and link every section to the concept of participation, and maybe a little leading on what should be done to foster it (study it in the leadership context among health providers? study it in the leadership context among patients guiding health systems? Going beyond studying participation of patients in their care). One of the parting commenters said to me, “It was very entertaining, it needs more substance,” and then, “you asked for feedback, so I wanted to give it to you.” I’ll take it, and since I’m now an East Coaster, directness really works.
I’ll wait to post the slides at the end of the month, so I can work up these ideas a little more.
Thanks again, Dave and University of Washington eMHA students for allowing me to continuously improve my continuous improvement!
Now Reading: A Few Peer-Reviewed Articles About Patient Willingness to Self-Monitor
July 20th, 2008 | Popularity: 52% 1 comment
Rickerby, J, and J Woodward. “Patients’ experiences and opinions of home blood pressure measurement.” J Hum Hypertens 17, no. 7 (0): 495-503.
Pare, Guy, Mirou Jaana, and Claude Sicotte. “Systematic Review of Home Telemonitoring for Chronic Diseases: The Evidence Base.” J Am Med Inform Assoc 14, no. 3 (May 1, 2007): 269-277
Little, Paul, Jane Barnett, Lucy Barnsley, Jean Marjoram, Alex Fitzgerald-Barron, and David Mant. “Comparison of acceptability of and preferences for different methods of measuring blood pressure in primary care.” BMJ 325, no. 7358 (August 3, 2002): 258-259.
Not pictured: Port, Kristjan, Kairit Palm, and Margus Viigimaa. “Daily usage and efficiency of remote home monitoring in hypertensive patients over a one-year period.” J Telemed Telecare 11, no. suppl_1 (July 1, 2005): 34-36.
There’s a potentially serious gap in the Connectivity for Californians initiative that we are addressing. Here’s a quote that illustrates it:
It is very clear from the interview data that patients have their own ideas, and spend a lot more time thinking about their BP than is apparent in the average 10-min consultation in general practice.
The gap is patient involvement in the design and planning of this initiative, or any healthcare initiative for that matter. Patients have many more ideas about what the problems are to be solved than can be gleaned even from articles like this – the articles simply show that the ideas are out there. Fortunately, we are committing ourselves to have a patient representative involved from the beginning, and that is coming together before any work is started.
The quote above is from the first paper by Rickerby, et. al (click on the images to the right to review any of the papers yourself), which described a qualitative study to look at a small number of patients’ attitudes toward monitoring their own blood pressure, in a practice that routinely recommends this.
The question (#1)
The reason I have reviewed these particular papers is because of the commonly posed question to me over the past several months, in the form of, “Ted, will/are patients really motivated to check their own blood pressure?” with the implication that they are not and they won’t. It’s a fair question that deserves an informed response. Several of the readers on this blog have given me some information from their own lives. These papers add to that knowledge.
The answer (#1)
They are and they will.
The question (#2)
This came up during reading of the papers. Does patient engagement come from having knowledge? Or does knowledge come from being engaged? This came up because patients in the first study who did not have knowledge about why they should monitor their blood pressure or how to do it seemed less engaged.
The answer (#2)
Unclear, with the implication being about whether to work to engage patients with more knowledge or use knowledge as a means test for engagement. I think regardless of the answer, there’s no reason not to provide information to patients. That answer is good enough in this case.
Read on for more conclusions….
» Read more: Now Reading: A Few Peer-Reviewed Articles About Patient Willingness to Self-Monitor
Personal Health Record PHR Advisory Task Force – There’s now a position for a patient.
June 23rd, 2008 | Popularity: 20% 0 comments | Leave a replyMinutes from the first two meetings are also on this page. I believe the discussion regarding patient involvement happened after these meetings happened (at least, it is not in the minutes posted)
Now Reading: Design Thinking, Tim Brown, Harvard Business Review
June 20th, 2008 | Popularity: 35% 4 comments
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.
Project Health Design : Bringing Patients Along with Teams to Washington, DC
June 20th, 2008 | Popularity: 18% 0 comments | Leave a replyAs chief blogger for Project Health Design and colleague Lygeia Riccardi notes in her post, Project Health Design Blog: The PHR as a mirror of daily life, project teams for this initiative to inform the next generation of personal health records was in Washington, DC, this week to work with policy makers and collaborate across teams, and I was invited along with Lygeia to meet the teams on one of their first nights here, at a reception.
I was epecially happy to catch up with colleague James Ralston, MD, MPH, from Group Health Cooperative’s Center for Health Studies, who is leading one of the teams, and of course, one of my first questions to him was, “how have you involved patients in this work?” His answer was a great one: “Well, Ted, I’ve brought a patient with me.”
As you can see from Lygeia’s post, there was a patient (participant was the term she used) from another team as well. Both are supported by the Robert Wood Johnson Foundation in attending and improving the efforts of these teams. Kudos.
Involving Patients: Her (Diana Forsythe’s) paper should be inscribed on cubicle walls…
June 19th, 2008 | Popularity: 20% 12 comments…of all those who aspire to develop online systems for patients. – Chapter 2 – e-Patients
It’s not a norm (yet) in medicine to involve patients in the process of care or in improvement of the system. What that means for me and others like me is that we’re going to get lots of “why?” questions about this in everything we do. Most (let’s say, all) of them are going to be intelligent, rational ones, from people who want to improve our health system.
Some of the questions are coming from myself to myself, most recently in the context of the project I am developing with California Healthcare Foundation. I think it’s really important to involve a person (patient, employee, participant) in designing the work, and that I should observe them managing their condition in their native environment (in this case high blood pressure). I recently had to remind myself, “I just gave a presentation on 5 1/2 reasons why patients and families should be involved in their care. I know why.”
Well-timed support from colleagues helps too – enter Susannah Fox, one of my favorite patient empowerment observers and informers, who referred me to this article by Diana Forsythe about a migraine headache patient education software system that was designed by physicians, programmers, and ethnographers, to empower patients with headaches.
If you don’t have access to the article through your institution or purchase it from the link above, there’s a brief summary of it in Chapter 2 of e-patients. In her journey, Ms. Forsythe discovers that a planned intervention to empower patients has the strong potential to disempower them, by connecting patients to information “needs” developed by physicians and programmers only, and not needs stated by others involved in care, including the patients themselves, nurses, and other caregivers.
I added this to what I was asked/told at the Health 2.0 conference in San Diego in March : “Why are current applications only about one to one relationships – patient to doctor?” and realize that’s the “why?” that’s really important. Since it’s a reality that people are as likely to trust someone “just like me” as much (if not more than) their doctor, both have to be brought into the picture. Which means both need to be involved in designing the system.
On the topic of computer programmers, it might be tempting to interpret the story in the article as evidence that software engineers cannot express their coding (or other) creativity and need to be handed specific things to code. What I’ve seen in my own work is that the opposite is more effective – bringing more of the specialized team members into the patient experience is better rather than more shielding from it.
There’s an important clue about this – it’s noticed that several project team members have significant experience with migraines as patients but do not bring these experiences into their professional roles on the project.
Everyone has something meaningful to contribute if they understand (and observe) the customer’s experience, and it’s the role of project leaders to create an environment where this happens.
My Definition of Health 2.0 : The Transition to Personal, Participatory Health Care
May 2nd, 2008 | Popularity: 55% 18 commentsHealth 2.0 is the transition to personal, participatory health care. Everyone is invited to see what is happening in their own care and in the health care system in general, to add their ideas, and to make it better every day.
When I went to medical school, a person’s ability to influence the health care system was linearly correlated with the length of their lab coat. Actually, in my medical school, medical students and attending physicians all wore the same length of lab coats, because I trained on the West Coast. I was exposed to the labcoat length protocol when I was a medical student and a new group of residents began training at our hospital. One of the residents was obviously from an East Coast medical school because she asked me permission to do something for a patient, and it took us both a few minutes to realize that she thought I was the “in charge” doctor because I wasn’t wearing a short lab coat. Neither of us wanted to relate in this way, and we transformed the relationship right there, in a beneficial way for our patients.
Flash forward to 2004, when my organization implemented an enterprise wide electronic medical record system for doctors, nurses, and staff. All of a sudden, we were on a common platform, and every member of the team had a contribution to make in each other’s learning of the new system. Once, when I was ordering an injectable medication, a nurse colleague came over to me and said, “here, let me show you how to do that, Ted.” Now, this new technology was creating an obvious platform for colleagues to teach each other, regardless of role. It was and is great.
In 2008, in organizations like ours where patients are regularly participating in the creation of their health record via secure e-mail and online health profiles, and participating in the creation of ideas and their health care stories inside and outside of our health care system, health care improvement is now more democratic than ever. When we combine that with management systems like LEAN (Toyota Management System) that support respect for our customers and our colleagues and use tools like visual systems and daily improvement methods, it is possible to see what the difference between Health 1.0 and Health 2.0 is. The technology has definitely stimulated this change by making it easier to participate, but the lasting intervention will be the participation of patients, their families, and every stakeholder (health care providers, businesses, philanthropies, non-profit associations, etc) in the improvement of our care system.
In 2006, The Economist referred to the transition from Web 1.0 to Web 2.0 as the transition from mass media to personal, participatory media. I think the same is true for Health 1.0 to Health 2.0.
I have spoken about the idea that physicians in my generation (Generation X) are a group that trained during an explosion of medical information. We are a group that is challenging the mental model of “omniscient physician” – we don’t want to hold all the answers for our patients because we’ll fail if we do. We want to learn something new from every patient, every colleague, and every industry, every day, so we can be good educators, too. Now we can, and we are.
The “Showroom” Concept in Yogawear – applicable in health care?
March 22nd, 2008 | Popularity: 19% 0 comments | Leave a reply
I had an interesting retail experience last week when I went to find Washington, DC’s Lululemon Store, to buy a piece of workout clothing (healthy for life…).
I had a tough time finding it (hint, don’t rely on Google maps, the address on the Web site is the right one), which seemed odd for a store in a rapidly growing national chain. When I finally found the nondescript signage, I noted a decor that was definitely staff inspired, along with a community feel – free yoga classes on site? This was not what I had encountered in either the Vancouver, BC or just-opened Seattle, Washington store. I asked, what was this all about?
Here’s what I learned (and please forgive me, official Lululemon representatives, if I am not 100% accurate, I was impressed): This is not a store, it’s a “showroom,” designed to build experience operating the business in the community. With success, the showroom will be replaced with a store. However, the showroom is a store also – products can be purchased and staff are available to provide a full level of service. On certain nights of the week, they invite local yoga instructors in, clear the floor, and have a class right in the space, at no additional charge.
As I tried on and purchased my garment, I thought about how this could work in health care. What if an organization set up a health care showroom, where practitioners could work in a lower-overhead space to get to know their community, in anticipation of a full service operation? Just like with this showroom, there would be minimum functionality, such as functioning information technology, appropriate licensing, etc. However, prior to making a big investment, an organization could understand the distinct needs of the community, and maybe involve them in creating a functioning medical center.
I like the concept, especially if we believe that 80 % of all the health care delivered in the United States is done by patients themselves. A health care showroom might introduce the community to itself, in terms of self-management resources or even physical activities. Maybe doctors new to a community could go for walks with patients to talk physical fitness, nutrition, and healthy living where they live and work prior to settling in for a new practice. Why not?
I took the liberty to copy the job description of a Lululemon Showroom Manager and am posting it below. What would the Showroom Manager of a new health care center be responsible for?
» Read more: The “Showroom” Concept in Yogawear – applicable in health care?
