The United States of Mind, Wall Street Journal

Rentfrow P, Gosling S, Poter, Jeff. A Theory of the Emergence, Persistence, and Expression of Geographic Variation in Psychological Characteristics [Internet]. Perspectives on Psychological Science. 3(5)

If you’re following this blog it’s pretty clear that I have been examining the impact of location for awhile now, partially for personal reasons, (”Why did you move to Washington, DC, Ted?”) and partially for professional reasons - geographic diversity may emerge to be as important as any other diversity awareness we rely on to keep our nation healthy, physically and emotionally.

This is why I was excited to read the attached article, which is the description of a model for personality characteristics, geographic expression, coupled with an extensive survey of our population and correlation to health and social characteristics. In a nutshell - what’s the personality of each State and how does it manifest?

If you want to get right to the conclusions, the Wall Street Journal has prepared an interactive map of the differences, and you can test yourself on the Big Five Inventory of personality here. In the event you’ve done the Myers-Briggs before, I encourage you to read this article about that tool by Malcolm Gladwell, which casts a fairly large amount of doubt on the usefulness of the Myers-Briggs tool.

A short primer on the dimensions of the BFI:

The central aspect of E (Extraversion) that emerged from the results seemed to emphasize social orientation; that is, state-level E seems to reflect the extent to which people in a region socialize with others. The state-level correlates of A (Agreeableness) allude to friendliness, trust, and helpfulness, which is very similar to conceptualizations of social capital. The defining features of C (Conscientiousness) that emerged seem to denote restraint, order, and dutifulness; that is, individuals in high-C states seem to place more value on rules and obedience than do people in low-C states. State-level N (Neuroticism) reflects social, psychological, and physical well-being. Indeed, the patterns of correlations converged, suggesting that individuals in high-N states are socially isolated and generally unhealthy. State-level O (Openness) seems to capture the degree of creativity, unconventionality, and tolerance in a region.

The kinds of differences described in the article hit me in the face all the time - when I step off a plane in California I can feel the difference - the inventory points to an open, tolerant, place but one that is less social. The contrast between the two Washingtons is especially impressive - Washington State, among the least extroverted (#48 out of 51), District of Columbia, among the most (#3), and also the highest in the nation on the Openness scale (we’re #1. Not so much of a surprise after visiting Tech Cocktail DC 3 recently and interacting with the people here for the past year).

The Ted Angle

When I did my BFI, I scored a perfect 5 the Extraversion scale, middle on Neuroticism, high on Openness, high on Conscientiousness and high on Agreeableness. I think the feeling is best encapsulated by something a physician colleague said to me the other day about where he lives. He said, “I like where I live a lot. Now, if I could move to Manhattan, I’d do it in a heart beat.”

This review for me is about the place that gives a person the most energy to achieve their life goals rather than whether the place we are in is enjoyable or not, as encapsulated by that comment.

Interestingly enough, when I ran one of my blog posts through another BFI engine that looks at writing, the results were similar, off the charts Extraversion, but less Agreeableness and off the charts Openness to experience.

The next time someone asks me why I moved to Washington, DC, my answer will be, “Have you seen my BFI scores?”

The Everyone Else Angle

After reviewing this piece and several other pieces on this topic, (additional link cloud here and here) some interesting questions are raised -

1. What’s the personality inventory of someone interested in patient empowerment/engagement/transforming the health care system. Are we alike?
2. What’s the personality inventory of the geography that are the epicenters of this transformation? Where does DC Stand?

Take a look, post your BFI and State correlation in the comments if you’d like. What does this mean for supporting a nation’s health?

I 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!

This week’s photograph is a special West Coast edition, about a city and neighborhood going through an enormous transition. This is Capitol Hill in Seattle, where a significant number of businesses have been relocated in preparation for a light rail station (see the photograph below), and to the north, condominums are going in (cranes in the background there).

The building of public transit can be difficult times for neighborhoods (think, Mission District, San Francisco, U Street, Washington, DC). I wish Seattle the best.

Maurena Moran, Group Health Cooperative’s Executive Director of Web Services and Enterprise Information Management, sent me a note that our work together is now published in the AHRQ Innovations Exchange:

AHRQ - Innovations Exchange: Online Tools and Services Activate Plan Enrollees and Engage Them in Their Care, Enhance Efficiency, and Improve Satisfaction and Retention

Here’s the description of the Exchange from AHRQ:

The Agency for Healthcare Research and Quality’s Health Care Innovations Exchange is a Web-based resource designed to support health care professionals in sharing and adopting innovations that improve health care quality.

The message forwarded from AHRQ encourages linking to the Exchange and having other people comment there. I have to say that this is a great resource for the times when people have asked, “tell us what it is you did again on your project?”

Prior to the existence of the Exchange, I had a PDF document on my hard drive of an application we wrote for a national HIT award that described our work in launching a personal health record and electronic health record simultaneously across the State of Washington. We didn’t win the award that we applied for, but the effort put into the application paid off well considering the number of times I sent the document out to other people/organizations. Now there’s a real place to send people to learn more.

I think the Exchange fills a niche for large organizations who want to provide open access to the work they are doing but don’t have the right place to organize this information on service-oriented Web portals. Thanks, AHRQ, and thanks to Maureena, her team, and everyone at Group Health for changing the way we think about interacting with patients where they live, work and play. It’s a great story…

Who’s Your City?: How the Creative Economy Is Making Where to Live the Most Important Decision of Your Life, by Richard Florida

The world is not flat; place matters.

I couldn’t agree more with the latest work by Richard Florida. This book looks at the importance of place not only in the global economy but in a person’s life. I personally had a good idea that this made a huge difference some time ago, despite living and working in a world where colleagues work for organizations for which home base is irrelevant.

On this, my 300-day DCVersary, I can confirm that my experience bears this out. Moving from one of the smaller “mega-regions” (Cascadia, Portland, Seattle, Vancouver, 9 million people, $260 billion light-based regional product) to the second largest one in the world (Bos-Wash, Boston-Washington, DC, 54 million people, $2.2 trillion LRP) has undeniably made a significant difference in everything I do, even in a technology-related occupation. As Florida describes, people cluster:

(There is) the tendency of creative people to seek out and thrive in like-minded groups, and (there is the) self-perpetuating economic edge that comes from doing so.

Florida does a good job of reviewing the evidence that place matters, and the idea that its impact on personal and professional happiness has been underemphasized. He combines original research as well as data currently available to create a compelling picture of both the importance of place and the factors about it that matter. One of the interesting explorations in the book is about the personality of cities - extroverted people and agreeable people tend to be localized east of the Mississippi, where “open to experience” people tend to be localized to the coasts, with dominance in California and Bos-Wash (okay, maybe the extroversion doesn’t stretch as far east as DC, and maybe the “open to experience” doesn’t stretch as far South, but I’m pretending they do - you always see the best in something you like).

Throughout, It’s nice to imagine where you might “fit” but also how your own experience stacks up, because an important criteria of a place its aesthetic.

I have been using a curious measure for the past few years to judge aesthetic, the “touch-down” measure. It is, “In what city do you say to yourself, ‘I’m home,’ when the plane touches down on the runway.” I think you can’t fake that. Alternately, it’s the city that when the plane touches down, you say to yourself, “I can’t believe I don’t live here.”

I give strong kudos to Florida for acknowledging the role of diversity and tolerance in a place, not just for minorities, but for all people. He says:

It’s not about tolerance for tolerance’s sake. As my previous research has shown, places that are intolerant simply do not grow. And, as the Place and Happiness Survey confirms, people in intolerant places are less happy and less fulfilled than those in tolerant an open-minded ones.

This finding is similar to research that shows the same thing about organizations. As a patient said to me a very long time ago, “We don’t tolerate diversity (within the organization I work for). We LIVE diversity.” That describes a place that has a better chance of thriving, and one that most people (including me) want to be involved with.

A book by an author that writes a blog is a better read

It is worth mentioning that as I read the book, the positive impact of Florida having experience writing a blog came across, because (a) he brought his personal experiences and those of his colleagues into the story and (b) he crowd sourced several of his ideas, bringing in commentary from blog entries. This made for a much more engaging read, and I can’t help thinking that without this experience, the work might feel less connected to the experience of real people. I think this is an interesting way that blogging is changing traditional publishing because those who blog are forced to become more personal in their communication to be successful. I like it. A lot.

And the winner is…

I have experience living in three mega-regions described in the book: Bos-Wash, Nor-Cal, Cascadia and it was interesting for me to compare the decisions I’ve made with the characteristics of each. All of them offer so much. My recent experience with Bos-Wash has been, well, fantastic, both in terms of livability, ability to be extroverted, and exposure to diverse populations and cultures. Nor-Cal scores high in my book as well as it shares many of the livability and diversity attributes, as well as strong dominance in technology and innovation. Cascadia was definitely enjoyable for the time I spent there.

Who’s Your City? Feel free to post your experiences…

Health care found to be better with online help - Nice localization of the landmark Group Health study on managing hypertension using Web services, from the Seattle PI.

So…if the study and the community agree that this kind of care is better, and there is data to show that diagnosing “white coat” hypertension is cost-effective, and payers already have reimbursement policies for ambulatory blood pressure monitoring (and older type of technology to figure this out), why not create more modern policies for home blood pressure monitoring?

• A New Group Goes to Gemba (Going to Gemba) - Seattle's Children's Hospital is sending a large contingent of staff to Japan to learn LEAN.

March 14th through March 17th:

• To build a better hospital, Virginia Mason takes lessons from Toyota plants - Nice profile of a hospital that employs LEAN. The comments are not as charitable. The challenge is both to communicate what LEAN is and make sure that the core philosophy of LEAN, respect, is a part of every transformation.
• Peachpit: How to Add WordPress Category Feed Links to Posts > Subscribing to Categories - The title says it all. A little blog geekery.
• Agile Development Whitepaper - VersionOne - Agile Software Development Management - A bit of a “state of Agile” survey among its practitioners. Data is useful in figuring out where the drive to go Agile (and by proxy, LEAN) might come from an org, and also what practices are being deployed (55% daily standup - why not in cilnical medicin
• PowerCard Project Management Software - Without embracing a computerized tool for project management, I wonder if this software’s approach most closely resembles Agile. Does it? Looks like it creates burn down charts (?)
• Unconference - Wikipedia, the free encyclopedia - Unconference, I want to experiment hosting these! How would they work for continuing medical education?
• BBC NEWS | Health | Sinus bug antibiotics ‘no good’ - How long will it take actual practice to change?