Dear Healthcare Workers

Dear Healthcare Workers,

I would like to thank everyone that takes care of me in advance. Your work is greatly appreciated and needed, but I would like to go over a few things before you start taking care of me and my family. If you are taking care of me, please just ask my spouse for my medical, medication, and any allergy history. This information will probably change from the time I write this letter, but I can assure you that what she tells you is accurate. If you question any of it, please use your EMR as a reference. This letter is intended for you to understand what kind of care that I expect. It is quite simple, but please read just in case our expectations are different.

              As I stated above you can check your EMR for my history, but if something has changed since my last visit I am going to assume that some of the information has holes in it and/or is an inaccurate source of information. My request is that you talk to me if you have any questions, and if I am too sick my family knows me pretty well. When you come in to assess me please take time to focus on me. If you don’t have time to focus on me, then please assess me when you do. I am not asking for any more than 10 minutes of your time. If your EMR does not give you the time you need then please feel free to write your assessment on a piece of paper and put it in later, I will not be offended. Also, if you could have a person actually lay eyes on me every hour that would be great. I only ask this, because I am sick, weak, and in a new environment. I am probably really scared and confused, so just knowing that someone cares enough to see if I want water, need to go to the bathroom, if I am in pain, or if I am alive would be comforting. Please do a thorough assessment each shift, because things change from shift to shift. I know it is convenient for you to copy my assessment from shift to shift, but that doesn’t mean I do not need a head to toe assessment. If nothing has changed from your last assessment I could honestly care less how you chart it. Not only does this keep me safe, it keeps your license safe in case of litigation or a root cause analysis.

              Now that we have my assessment out of the way I suspect you will need to prescribe me or give me my medications. I ask that you please talk to me or my family member about what medication you are going to prescribe and administer to me, since it is my body and all. My family and I are lucky enough to have a pretty good understanding of medications, so we shouldn’t give you a hard time. If we do ask a questions can you please, at minimum, act like you are engaged and not rushed? If there are too many questions about the medications, could you please just print out basic education for me and my family so that I may have a foundation to go by? That approach will help us ask more educated questions, and should save you a little time. What would be really nice is if you could be proactive and just print it out, this should give us time to digest the information. That would just save everyone a bunch of time. When administering or prescribing medications please make sure it is on the right patient. My armband should have the right name, birthdate, and account number. This should have been checked on admission, but there is always human error. I just want to make sure that I am getting the right medications to manage my diagnosis.

              As you come into my room to talk to me and my family I ask that you be in the moment as well. If you cannot do that, I would appreciate if you could find me someone who will be in the moment. I would hate to be an inconvenience or waste your time. I apologize if this sounds harsh, but I feel that it is a privilege to take care of patients not a right. If I sound like I am entitled it is because I am. I am entitled to the right to be treated like a human being. I do not want to be treated like a product on an assembly line, that’s all. Also, if I use my call light and ask for something, do not tell me you will be right down, then never show up. If I ask you for something when you are in my room, do not tell me you will be right back, I believe that is an empty promise. This isn’t your fault, but you cannot control other patient’s needs and there could be a delay. Simply let me know that you will follow through with my request and estimate a time. If you can delegate the task to someone less busy, that works just fine for me.

              Lastly, I ask that you do not gossip to me about your organization or health care in general for that matter. I have my own problems, and I came to you to fix them. It is not my problem that your wireless is slow, you are short staffed, your EMR sucks, or that you have competing priorities. My job is to get better not to solve your problems. It’s much like going to a restaurant and your food is cooked wrong and the waitress explains to that they were running short on staff or you have a new cook. I honestly don’t care, if you have a problem then voice it to your administration.

              I believe these requests are simple and straightforward. It isn’t that I don’t respect your work, I do, but our focus should be on how to manage my disease process. If that sounds selfish I apologize, but how would you feel if you were me? I know if I received this letter prior to taking care of a patient, I would take it seriously. Here is a little advice if you are unable to meet these requests. Take CONTROL of the situation. If you do not like the status quo, then try your hardest to fix the barriers you face. Complaining and not having a solution solves nothing. I know we are all guilty of it, but you do have CONTROL. Your voice is louder than you will ever know. If you want to fix an EMR, then talk to your administration. If you can’t fix it at that level, there is no one is stopping you from going a step further and fixing it yourself on a larger scale. If you don’t know computers, talk to someone in healthcare that does and see what you can do together. What I have learned is that if you are passionate about a cause, you will do everything in your power to fix it, and if you don’t know how to fix it you will find out. We went into healthcare to be patient advocates, not to complain about how things don’t work. If you have an idea on how to make patient care better then go for it.  Are you worried what people are going to say? Are you going to get scolded for trying to provide better patient care? If you are concerned about that then you either need to leave your organization or maybe even health care for that matter.  I hope this letter gives you a little better perspective of what I need as a patient. I also hope this inspires you to reflect on the current state of health care and focus on how you can be the part of the solution and not just part of the problem. This isn’t a competition on who has a better solution. This is about my health, my family, and my body so please respect that.

Sincerely,

Future Patient

                 

Communication in a Litigation Nation

Yesterday I met two lovely older ladies at the airport, and they were very interested in GLASS. They asked me all about them, and how do I see them changing healthcare. I asked them how they see it changing healthcare. After they answered my question they asked me what my goal was with all of this technology. I explained to them that technology was just a tool in my toolbox for improving healthcare. I started to tell them that I did not believe that technology was the answer to all of our problems, and that I was concerned that many people do believe that it is. I am not in the business of creating ignorant clinicians, but in the businesses of connecting the clinicians and patient. I went on to discuss a product that my team has been working on keeping patient's engaged and informed. To my surprise they told me they felt that my tool was wonderful for older patients. I have been told all along that the tool we created was great for younger patients, but would not be embraced by the older population. Now I had two older ladies in front of me explaining how our product was great for the older patient population. The product gave them information, but I wasn't overloading them with it. We were able to provide them with information without them having to sift through that damn interweb. Our design is simplistic enough that it wasn't overwhelming. Three buttons gets a person what they need when they need it. It is a communication tool, and if we are going to survive in this new healthcare structure you need two things: Transparency and Communication. With those two things you will be set. So we talked about how I was trying to empower and engage patients, and that our companies goal was to make them to feel like they were part of the healthcare team. I explained to them that I recently went to a group of clinicians and showed them our product, and that these clinicians hated it. I asked them why they think a clinician would not be open to this product. Immediately one of the ladies said, "because they are scared." I asked, "What? Scared of patients knowing what is going on?", and she answered, "No they are scared of a patient suing them. We live in a litigation nation." That's a powerful observation! A patient did not blame the clinician, they actual answered a question that I had previously had no answer for. I truly never thought of being worried about my license ever being on the line. I really thought that it was my job to do no harm, and to always take care of the patient. If I did the right thing then there was nothing to worry about. I still feel that way, but we live in a society of fear. Better get yourself that flood insurance even though you live on a mountain, don't use sweetener it will give you cancer, your kids better not go out to play flashlight tag because they will get kidnapped, and chart everything you do in healthcare just in case you get sued. All of this time I was dumbfounded on why a clinician wouldn't want a patient  to be empowered. Why would a person that went to school to take care of people not want the patient to know what they were doing? I feel it that the patient owns their healthcare record, and I feel that we need to be giving them access to it. I also feel that this lady that I was talking to made a valid point. Clinicians are scared, they are not wanting to be scared, but our society has made them that way. Malpractice lawsuits truly don't ever get that far, if they end up in court there is usually a good reason why they did. It doesn't matter that I say that, because that isn't what you hear from your peers or the news. You only hear the bad stories, and they are all one-sided. Technology and innovation is a great thing, but be careful. Sometimes it is not the solution,  and sometimes there are down-trickle effects that you didn't think of. Who would have though 15 years ago that texting and driving would be a problem? Do you really think that when texting was put out into the consumer market they really thought about people driving and texting? No they thought we will make lots of money and help people communicate faster. If you truly care about the patient then you will think about the effects that your product has on the patient and the clinician, and not the amount of money that goes in your pocket. Innovation and thinking outside the box is what healthcare needs, but take a holistic approach when you create a solution. Both the patient and the clinician need to benefit from your solution or you are doing more harm than good. Our product is still awesome, and I feel people will warm up to it because we shouldn't live in constant fear. But after that conversation at the airport, I will be reevaluating how I approach an innovative solution to difficult and complex problems in the future.

@AaronLitherland

"Under Oveur and Over Unger"

If you haven't seen Airplane I and Airplane II you need to watch them. In my last blog I promised the next one would be about medication management. Sorry, but this about my travels to the #HIMSS14 conference. I decided to write about an experience on my travels from Indiana to Orlando and how it pertains to innovation. I have had my shares of bad experiences while flying. (More bad experiences than good ones.) When I went to pick up my Google GLASS I had the worst and most costly experience traveling to San Francisco. I will not name any airlines, but lets put it this way there was more money spent on travel than actually getting GLASS. Well, today was a completely wonderful experience. The last time I flew Delta was three years ago, and my experience with Delta was and had been awful. The last time I flew with Delta I swore there was going to be a throw down between my wife and the person taking care of our boarding pass. This was a consistent experience I have had with this company. We wrote a few formal complaints. I swore I would never fly with them again. Well on short notice I needed to book a flight to Orlando, and the most convenient one was Delta. While my last experience was three years ago I still held a grudge, but I needed a flight so that is what I chose. I arrived to the airport at 0630 this morning and saw the line for checking in baggage and I thought to myself, "This is going to be an awful day." I walked up to the front counter and the person behind the desk actually introduced himself. He interacted with me! He said, "Aaron thank you for choosing Delta enjoy your flight". What was going on? Did he just call me by my first name? I am not a sky priority member so why was he being so nice? I went through the whole TSA drill. (Funny thing was that they said all electronics need to go through xray and I totally forgot I was wearing GLASS) I go to my gate and use my QR code boarding pass. I thought to myself, "It's just that easy." All of the crew on my first flight were courteous and noticed me as a customer. After my layover in Hotlanta I boarded the plane. I walk by everyone in first class thinking the same thing that I always think, "I wish I had that much leg room." I get to the back of the plane and sit down, and as usual someone said, "Is that?" I said, "Google GLASS, why yes it is". We started talking about how awesome it is, and then she started talking about the screens on the back of the seats in front of us. I was thinking these touch screens are just another way for me to pay more money. She said, "You have to watch the safety video it's great." Who says that? Here is how you buckle your seat belt, here are the exits, and while you are flying over land if we hit a lake here is your flotation device, and if a mask falls from the ceiling put it on your face first then help your neighbor. Well the plane was getting ready to take off and there was an announcement from the CEO of Delta about how they care about our safety, and he tells us to please watch the safety video. I watched it, and laughed the whole time. Not because I was making fun of it, but because it was actually funny and engaging. Most of you have seen it, but if you haven't I won't ruin it for you because I am attaching it to this blog. The flight takes off, and I notice my screen has options for games, tv shows, and movies. I was thinking that there had to be a catch to this. I mean my battery on my phone was going dead at the terminal and while I was charging it I actually downloaded games to play on the plane and thought about buying some TV episodes. I looked through the TV shows since it was only an hour flight, and I found free new episodes of Shark Tank. What?!? That is one of my favorite shows. I hooked up my headphones and started watching it. I was able to start the next episode and it stopped. I actually was frustrated that we landed because I did't get to see what happened to the guy pitching waffles that gave you energy. I get off of the plane, check in to my room, go to TGIF and I started thinking, to myself " man that wasn't a bad trip". I realized that Delta listened to our letter, (Yep that's right my wife and I saved Delta) I know that is not true, but they did listen to everyone's complaint. They took it seriously, and really thought about how they could make the experience better for the customer. They realized it was more than getting someone from point A to point B. It was how the experience was for the person getting from Point A to point B. They were innovative. They had me engaged from take off to landing. Some of these solutions were a culture change, but some of them probably were costly. If Delta can make me not dread my flight it makes me wonder if we can do the same for patients. They were innovative, and the status quo was unacceptable. When are we going to realize that in healthcare? When are we going to realize the status quo is unaacepable? Are we not all here for the patient or customer? Shouldn't we invest in the experience? Innovation is just realizing the status quo is unacceptable so you figure out how to make it better. Delta finally realized their customers were frstrated, and with a little bit of investment and innovation they made getting from Point A to Point B a little more painless. We need to realize that the status quo is unacceptable in our healthcare system. We need to realize that with a little bit of innovation and investment we can make our patients have a better experience. We can engage our patients if we think outside of the box. I get that you may think I am comparing apples to oranges, but the truth is the concept is the same. Patients are not engaged, they are not watching our safety videos. I try to observe the world around me. I pay attention, and customer service is top priority for all successful businesses. I stated above that I thought about writing this while I was at TGIF. The reason I thought of this was that I actually knew both of my servers names without name tags. They literally shook my hand and said my name is so and so if there is anything you need let me know. It took them 10 seconds to do that, and it made a world of difference.This is when I looked back on waking up this morning expecting this day to be awful, and it ended up being really awesome. It made me think that these companies have these processes in place to make you feel important. Delta didn't get better because of our letter, collectively we screamed loud enough that it made the company become more transparent. I hope that #HIMSS14 shows me that people are truly trying to challenge the status quo in healthcare, because from my point of view we are the Delta experience I remember just three years ago, and I hate that feeling.

@AaronLitherland

How am I going to get these Patient Scores up?? Dagnabbit!!!

In the innovation zone we are focused on one thing, and that is better patient outcomes. I don't care if it is done with GLASS, Computers, Tablets, yada yada yada. It's not hard to improve patient outcomes, but the healthcare worker has made it so difficult. So you may be asking what is your solution Mr. Know it all? Ready for the answer? Doing the right thing.

It drives me insane that people think that there is some magical answer on improving our patient outcomes. Doing the right thing will create better patient outcomes, then increase your patients satisfaction scores, then your HCAHPS, then increase the amount of new and returning customers you have. Oh my gosh I think I just solved how to make patients healthy and make money! I better sell that one. Is it really that simple? Absolutely it is, but EVERYONE needs to do the right thing. It starts with senior leadership and then you work your way down. Some of you may say, "well if my staffing were better I could make that happen." You are right, and my response to you is, "refer to what I highlighted above." It only takes one mistake in a process to ruin everything. Why is it hard to get everyone to do the right thing? Well that would be because you have to define what the "right thing" is. There are many people involved in patient care, but for some reason we tend to focus on our area. As healthcare workers we tend to be closed minded. We only see what is happening in our little area. Tell me with a straight face that the majority of critical care nurses know what it is like on the med/surg floor and vice versa. If you can do that I will give you a candy bar.

Pharmacy doesn't know nursing processes, nursing doesn't know environmental services processes, and dietary doesn't know labs processes, and nurses and physicians don't have a clue what each other are doing. Do they need to know these processes? Is it really that important? The answers to both of those questions are YES. They need to have a high level understanding of each other processes, because if they do not know each others processes it is hard to truly do the right thing.

When I do something for a patient I look at everyone's process, then I ask myself what is the best for the patient. If I can say without a doubt that I am doing the right thing for the patient then I am going with that approach. I didn't go to nursing school for nothing, and if I did then you might as well just hire some random person off of the street. I went into nursing school to help patients, but does everyone that works at a hospital feel the same way that I do? Probably not, and shame on us as a healthcare system for letting that happen. I believe that the majority of people want to help others. No one wants to wake up everyday thinking that their job doesn't have a purpose. I want to tell you right now that if you work in healthcare you have a purpose. When we all realize that and we understand each others place in the healthcare system we can fix our patient outcomes. So it is as easy as doing the right thing, but as stated above it has to involve Everyone. Understand your employees, make sure your employees understand their importance, then all of your employees need a high level understanding of each others purpose, then you can consistently increase patient outcomes.

My team an I have been working on a patient engagement project to improve patient outcomes and HCAHPS. We are going to empower and engage the patient. I will be at the HIMSS 2014 conference next week, and I would love to meet with anyone who has an innovative idea. I would love to share with you what we are working on, because what we are working on is the right thing. One part of the innovation center is to share ideas, and make things better for patients. That is exactly what my goal is.

Aaron Litherland

@AaronLitherland
The Health Innovation Zone on G+

Patient Wearing GLASS

When I was in nursing school I remember thinking to myself, "Is this ever going to end!!!??".  I think people underestimate what it takes to get through nursing school. I would take a test and receive a C, and think, "you have to be kidding me, I have studied hours upon hours for this test." I always felt that the questions were made to confuse me. I kept my eye on the prize and moved forward. All I have ever wanted to do as a nurse is help people. I just wanted to do the right thing. So I finally finished nursing and I was ready to save the world, right? I got off to a really bumpy start, I am great at communicating with people, but sometimes I am a little to wordy. Then all of a sudden I am in really difficult situations and having to have difficult conversations with families and patients. Not like the ones I had in nursing school, where I explained their diets, side effects of their medications, or their plan of care. As a "real nurse" I had to talk to people about death and dying. I had to make split second decisions where communication was key. How come no one told me I was going to have to do this!?!? How come no one helped me communicate appropriately and directly? It would have been nice to have that practice, and even more beneficial if I were able to review how effective my communication was in uncomfortable situations. This is where I circle back to the innovation zone. We recently started working with Indiana University School of Medicine, and had the opportunity to help med students work on their communication skills. The students practice giving bad news to standardized patients. They are recorded for review, but we wondered how we could make the experience even more meaningful to the students. The video below is a patient wearing GLASS while a  Medical Student tells the patient that his pancreatic cancer has metastasized and offers him hospice. In doing this we hope that this perspective will help students see what they are doing right and focus on what they need to work on. When it comes down to it, I learned a lot through my schooling over the years, but there is always room for improvement. With new technology we have the opportunity improve our education and create more prepare clinicians. Does this video save the world? No, but just maybe it will somehow inspire you to be innovative and creative for our patients. What we did wasn't rocket science it's just being creative with what you have.

Understanding the Innovation Zone

When we initially started this blog we thought everyone would understand what we were trying to accomplish. As we started to post more and more blogs we realized  that maybe we were going about this all wrong. Below is a blog video, which was taken by GLASS.  Collectively we can make a difference. We are looking for people that want to make a difference in others lives. I encourage you to join us in this journey whether you work in healthcare, IT,  a patient, or just someone who wants to be part of something that touches others lives. I want YOU to understand our passion, and what better way to do this than to reintroduce myself and our mission in the video below. Early next week we will be sharing our recent use of GLASS with medical students.

Innovation, Diffusion of Ideas, and the Medical Home

Early in my medical school education, I heard about the "science to service gap" , i.e. "it takes 13 years for proven medical improvements to become mainstream".  But after 20 years of clinical practice and 17 years of work with informatics, I consider it a truism.

During my medical informatics work, it has become more than a curiosity as to why the science to service gap exists.  About 5 years ago, I discovered a series of books that explain the Diffusion of Innovations by Everett Rogers who was a professor of communications.  It helped me to understand that there is a natural variation, a bell curve of sorts, for how any group adopts innovation.  Since negative news travels fastest, physicians often get a bad rap when it comes to adopting health information technology (HIT) due to the vocal nature of what Rogers called "laggards".  That is a complex topic for posts in the future. I would encourage anyone interested in innovation to read Rogers 2003 5th edition of Diffusion of Innovations as it includes many lessons learned during the 40 year period following his 1st edition in 1962.

I recently re-visited a web site which comprehensively documents the 18 year journey of a medical home practice that was formed in 1995 called SETMA.  The link to the SETMA site is a great example of how diffusion of innovation can happen within an organization with visionary leadership.  I had the pleasure of meeting Larry Holly, MD the founder of SETMA and I would encourage anyone interested in how to create a cultural framework for innovation to read his web site which is beyond comprehensive in its depth and breadth of information shared.

Believe it or not, in 2013, the medical home is still being questioned as a valid approach.  So perhaps the science to service gap for team work, process improvement, and user-centered design in health care is a bit longer than 13 years.  I am encouraged by the work being done in both my local medical community as well as at the national level -- American health care really needs the medical home innovations more than ever.