Take care of the babies

When a book strikes my imagination and finds relevance in my work, I mention it to many of the people in my professional and work lives. A recent book that reached this level for me is Creativity Inc. by Ed Catmull and Amy Wallace.  Catmull is the President of Pixar Studios and became a leader of DisneyToon Studios when Disney acquired Pixar. The book is about Pixar, but also about fostering creativity. The book shows what works and does not work. It is humble and honest. The authors have taken the story of Pixar and expanded it so that the lessons are relevant to all organizations that care about new ideas.
 
An organization easily kills creativity. I’ve seen this, and I am sure you have too. It is hard work to sustain the generation of new ideas and innovation. How can we survive as individuals and organizations without it? Healthcare has a particular problem with supporting new ideas and innovation. It may seem otherwise when the news reports advances in training by virtual dissection or development of digestible sensors. On a day-to-day basis, changes occur slowly. Researchers report that it often takes an average of 17 years for new evidence-based findings to reach clinical practice. Wow.

We can take steps in our professional lives and our organizations to foster creativity. Catmull offers stories that show what works and does not work. His book shows the personal side of building a company; successes and failures. From these lessons, he teaches a few principles.

• ·Foster a culture that asks question
•  Getting the right people is more important than the right idea
•  The unknown is not an enemy
•  Creativity starts somewhere; it is flawed at first and needs reworking iteratively

In healthcare we like to shoot the baby, any new idea. It is difficult, messy, and does not look right. We can find many problems with it. If we destroy it right away, we cannot find out what it can become. I like the idea of protecting the baby-ideas, at least until we know if they can grow into something better. That is how we are going to improve healthcare. Take care of the babies.

Things that survive, survive

Sometimes a passage in a book keeps coming back to me. When this happens I reflect on how it might be connected to other ideas or events. Such is the case with the book This Explains Everything. In this book edited by John Brockman, many writers, thinkers, and scientists have provided essays, responding to the question “What is your favorite deep, elegant, or beautiful explanation?” Susan Blackmore suggests that Darwin and Alfred Russel Wallace offer such an explanation in the saying of “things that survive survive”. As we know, not everything survives and competition is fierce. In health care organizations are bought, they go out of business when the owner retires, and in many ways cease to exist. Other organizations survive, at least for a while. What is elegant about the saying “things that survive survive” is the idea that what allows an organization to survive today is not what it needs to survive tomorrow. The rules will change, by the survival of those that make it through to today.

It is so simple, yet very complex. We want to take a deep breath and relax a minute; we just won the race and made it across the finish line. But we can't relax, the race is still going only now with just the winners of the first event. A book that has a similar message, except for individuals, is What Got You Here Won't Get You There, by Goldsmith. As a professional you used certain skills and talents to achieve your current role, but you need other skills to tackle the next one. This seems exhausting and defeating. However it doesn't have to be that way. The answer is to keep learning.

Another essay in the book edited by Brockman is written by Brain Eno and talks about the elegance of the ideas that determinism isn't predictable and humans are not good at intuiting the outcome of predictable rules. If I bring these two essays together I see that survival in the next race requires us to avoid working with our “gut feelings” and instead collect and process data. Our past experience will likely lead us astray; we have to be thoughtful and analytical. A small change in the rules, due to the survival of some organizations, throws off the outcomes. The next set of winners won't rely on what was true in the past, instead they will be diligent and pay attention to today.

Bombs in Boston - Rehearsing to improve outcomes

When tragedy strikes, such as the bombs that exploded in Boston this week, my heart aches for the families and victims. I am also proud and appreciative of the medical response, especially with so much chaos following the destruction. The people working the marathon, as well as the knowledgeable participants and supporters, knew what to do and executed it very well. They were trained, and it made all the difference.

I have been drawn back to the Power of Habit at least ten times in the last few weeks. This book keeps popping up in conversations and in my thoughts. Just like it popped up when I was watching the first-responders in Boston. The emergency response was rehearsed. Not that they knew this day and event would happen, yet they were rehearsed. Just like the professional soccer player who becomes one with the field and knows just where to fire the ball to reach an open teammate, the scene was assessed and triage performed to provide the greatest good to the greatest number. Having a habit of safety, delivering high-quality care requires rehearsal. As professionals we have to rehearse responses so they become memorized by our brains and muscles, allowing us the time to identify the nuanced differences and respond accordingly. I don't think we rehearse enough.

Organizations are usually good at writing policies and procedures. Often we will have books or electronic files full of information on what to do if something unexpected happens. I have written many of these. They are well intended and usually correct, at the time they are written. Then they sit unused, and often not reviewed. For some policies this is probably fine. I am reminded of a HIPAA policy that addresses a situation not likely to ever happen, such as ophthalmology records needed for national security reasons. That being said, other occurrences are not a rare. Rehearsing the response can improve the outcome for patients.

Here are some situations that medical practices could rehearse and by doing so will improve responses; transfer of care, slip and fall, medical emergency (seizure, diabetic reaction, fainting, stroke, chest pain, etc.), and weather-related problems (tornado warning, power failure). Instead of just talking through the situation, rehearse the solution. Let your muscles and neurons learn what to do so your brain is free to understand the differences and make adjustments. I saw focus and clarity in the faces of the first responders; they knew what to do and made it happen.

Currently I am reading This Explains Everything edited by John Brockman. An essay by Seirian Sumner was right on point for this discussion. Cooperation and helping behavior is “beautiful and simple”. We want to help and it is done best when practiced.

Habits and Health Care Leadership

Right now I am about half of the way through the book The Power of Habit by Charles Duhigg. This is another social psychology book, the genre I really enjoy. The book takes a look at the research on creating, changing, and sustaining habits. Duhigg breaks habits into three key parts: cue, routine, and reward. A cue is a trigger that starts a routine. It can be something physical like seeing your running clothes laid out from before you went to bed or non-physical such as the time of day. This trigger initiates a particular sequence of actions. Once the routine is complete a reward occurs. A reward can be physical, like a piece of chocolate. It can also be psychological such as a pleasant conversation with a colleague. Brain studies reported in the book indicate the occurrence of physiological responses to the reward, and stress if the routine is not completed. To create or change habits you have to manipulate the cue or the reward. I have not finished the book where the nuances of creating and changing habits are discussed. Still, it has me thinking.

This book has me thinking about two different habits. The first is how we as health care leaders can support the development of healthy habits in the patients we serve. What opportunities do we have in front of us that support creating cues and rewards that lead to behaviors for improved wellbeing. Dr. Rosie Ward might argue that rewards support extrinsic thinking, which are not as powerful as those that are intrinsic. She is right and initially creating or changing a habit is very extrinsic. That being said, the research on habits is very compelling. Tying extrinsic rewards with an intrinsic motivation would be exceptionally powerful. Our minds and bodies automatically create habits because habits free us up to do something else at the same time. We can drive a car and talk with a passenger because of habits. Cavities and tooth decay have been reduced drastically over the last 50 years because we have created the habit of brushing our teeth. We can help our patients create healthy habits through cues and rewards, especially if the extrinsic and intrinsic are tied together.

The second habit I am considering is that of health care leadership behaviors.  What habits do we need to create (or improve) so we can help our organizations prepare for the future? Is there a cue we can find to start a routine that makes us better leaders? What might be a reward for completing such a routine? This begs the question of what makes a good health care leader?  I don’t have the answers to these questions. However, great thinkers inspire me on this topic. I have mentioned in past postings a favorite blog is that of Marie Popova. In a recent article she described the routines of famous writers. What would such a list look like if research were done on health care leaders? Notes from a conference on health care leaders list few characteristics; we have more work to do.

At the end of the day we know more about habits and Duhigg has evidence on how we can improve our lives through managing our habits. As health care leaders we need to use this information to better understand how we can help patients improve their lives and support our organizations to higher-level performance.

New ways to delivery of health care

While working on a project with a client I am continuing to revisit the key ideas in the book Beyond the Obvious regarding the question of how. What keeps coming to mind is the challenge of looking at health care delivery in a new way, a way that changes how services are rendered. As an industry, we are struggling to make a shift in what we are doing. It is hard to work differently. Physicians are pressured to do more with less and at the same time the threat of malpractice hangs over their heads. Health care providers have to sort out what is essential from what is not needed, and do it right. However, this is not an excuse to do nothing. This brings me to the point of understanding the state-of-the-art in how health care is delivered. Here is what I know.

1.              Shared medical appointments are still being tried as a way to approach the Triple AIM of outcomes, cost, and patient satisfaction. They seem to be more common in procedural services and some chronic disease management. A few small studies have been done, each with positive results. What is needed are some strong case-control studies and broader implementation.

2.              Electronic consultations and telemedicine are ways to use advancements in technology to increase access while reducing cost of delivery.  This includes hospital-at-home and self-service approaches. All of the electronic information becomes part of the personal health record and allows more accurate solutions based on clinical research and analysis. The technology for collecting data is advancing faster then the solutions for analyzing and intervening. In addition, payment lags to allow providers a way to be compensated for their time and talent. Yet, this is promising for public health and timely care delivery.

3.              Defining health more broadly is another advancement where the “how” of health care delivery addresses the person as a whole and gives providers permission to work on the source of illness. A personalized approach to health care  that includes efficiencies. As described by an article in the Stanford Review, this approach is more than the traditional physician-patient relationship. It involves a team who are looking toward improved outcomes beyond treating illnesses.

There are a number of demonstration projects being implemented. These include Accountable Care Organizations (ACO) and Population Health Management Systems PHMS). In addition, payment systems are being tested to align financial incentives with goals. In all of these delivery systems and projects we need to measure and report on health outcomes and the patient experience. This requires thoughtfulness before the change is implemented. With careful planning measurement and analysis has meaning and usefulness. 

Ignore Everybody is Beyond the Obvious

Two book reviews - quick reads and interesting ideas

Beyond the Obvious by Phil McKinney was a quick and interesting book. It is a little outside of my usual genre of social psychology, yet clearly a business and organization book. McKenney comes from the IT world with a focus on marketing and innovation. The book draws a lot from his experience at Hewlet Packard where he served as the chief technology officer. Prior to HP he was involved in start-up ventures in the technology industry. McKinney can speak to the fast-paced world of invention and innovation through his work experiences.

While reading the book I didn’t find what he discussed as new, instead it was repackaged. It was freshened with examples from recent shifts in technology, such as smart phones. Key concepts McKinney discussed included having an open mind, getting close to the customer, and asking the right questions. One area in the book did stand out for me as thought provoking was asking the question, how? In health care we have a pretty good idea about who our customer is (but probably not as clear about why a competitor was chosen, when that occurs) and why we deliver our services.  We are struggling with answering how to meet customer needs.

MicKinney suggests talking more about how we deliver services. This is particularly relevant as telemedicine advances occur, home monitoring devices become more effective, and mid-level practitioners expand their support. While not included in the book, I think the question of how also addresses the issue of quality. What value does our service bring to the public health? How do we assure that the outcomes are worth the cost and our services advance the overall health of our communities? To be relevant in the future we have to understand the question of how, more than was necessary in the past.

McKinney’s book is a pretty quick read. It is not a book about research or psychological insights. He is practical and has ideas on how to get groups to tackle the tough questions. I have started asking more questions about patients who chose other providers, how we want to deliver services, and where is technology taking health care. For these questions it is worth the time to read the book.

Ignore Everybody by Hugh MacLeod is another quick read, of a vey different type of book. MacLeod is a cartoonist with a practical view of the world. He built up his body of work slowly on the back of business card size paper. It was his passion and not mainstream. Unlike some authors who suggest a person needs to abandon the regular life and follow their dream. MacLeod encourages people to work on the side. Pay your bills so you can do only what you like, ignoring the pressure to do what makes money. Your passion may not make you rich or famous, but that is okay. There is a price for being famous. He wants his readers to do what makes them happy, not pleasing others. His cartoons are scattered through the book and make interesting highlights to his points. I finished the book quickly and felt good about staying true to what is important to me, while making sure I’m paying the bills.

Barb's Favorite resources of 2012

To be honest, I enjoy the end-of-year summaries. We hear the top news stories, songs, notable people, books, and many more. I take the first of the year to review my organizational strategies and see what needs tweaking (this year I created new categories to reflect my change in work). In looking at when needs to be changed, I also see what has worked. That led me to consider my five go-to resources for information, inspiration, and support. Where possible I have included a link so you can check it out for yourself. Let me know what strikes you when you look at this list.

Books to Read:

My favorite source of new books to read comes from the RSS feed in Fast Company (here is a link to one of the recent entries). This RSS feed is very busy and has a lot more than book reviews. I have the feed entries  go to a folder so I can pull it open when I want to look at it, not filling my inbox with low priority messages. Many other entries in the RSS feed are interesting too; stimulating ideas about new start up organizations and creative artists.

Reading efficiency:

During the last few years I have been averaging 2 or more books per month. One of my favorite ways to read a book is through audio books. There are a number of sources to get audio books, including the public libraries. For the last 5 years I have had a subscription to www.audible.com . With audio books I use the time in my car to hear the book. It works well with most books, and great with a few. Listening to a book is particularly great if the names are unfamiliar. In an audio version they are pronounced correctly (while they would be wrong in my head) and for me it seems easier to keep the characters/locations clear in my memory if spoken clearly and consistently. The format is also great when the actor(s) reading the book are able to contribute their skill to the narrative. This was particularly true for the book The Help where the actors made the story come alive in a profound way. The only books where an audio version does not work well for me is if the book has a lot of illustrations you need to see to understand the content. Often these illustrations are available with the audio file as a PDF, but that is not helpful when I am driving my car. In addition to audiobooks I have a Nook and ever-present paper book. It is a passion.

 Health Information:

A particularly good source of current health information comes from MedPage Today. This is a free news subscription that summarizes professional meeting topics, research publications, and public health-related items. I particularly appreciate the research articles. Often they help address popular press misunderstandings because the reader can see what was really published, and often mangled by the press.

Targeted health information:

While MedPage Today covers health topics broadly, I also want to keep up to date on the information specific to my interests. The best source I have found is Google Alert. Using a Google Alert is a simple as creating search criteria and waiting for the results to show up in your email. A Google Alert will not just look for journal articles published on a topic, it will also give links to blogs, press releases, and anything else on the web that matches the criteria. I set one up for each of my projects and areas of interest. Some topics will generate weekly notices, while others might be monthly or less. If the alert is not on the right path, you can refine them with additional criteria. All the directions are on the Google page under “More”, “Even More” and “Specialized Search”.

Networking Information

Since this is being posted to LinkedIn I would be remiss to not mention it as a resource. I find LinkedIn a great way to know what is happening with my network of colleagues (promotions, new positions, and project status) and find out who might be able to make an introduction to someone with skills I need. While I am not particularly active on Twitter, my LinkedIn account is connected to Twitter so I can post once and it goes to both venues. I do scan Twitter comments, watching particular posts because of their humor, insight, and interesting tidbits.

Communication Tidbits

A blog (and website) that has really great information on how to communicate numerical information is Katherine Rowell & Associates. The focus of her blog is on health care data and how to make the information meaningful and informative. She introduces new ways of using Excel and different types of graphing. I look forward to each new entry.

Inspiration

There are many places to get new inspiration; books, movies, conversations, and games. My recommendation here is not to say this is the ONLY place, rather it is a place where I have found inspiration. Maria Popova has a blog that covers may topics. She is a good writer and thoughtful in her analysis. I particularly like that she draws from other sources to make her point, while not getting too academic. Just the right balance. Some of her thoughts are edgy, while others practical. 

Here is wishing you a healthy and happy year. I look forward to our conversations.