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

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.

Moving from the quantified self to the quantified community...

We are seeing an explosion of smart, inexpensive technologies that can be used to track activities and support the move to the quantified self. That is very interesting to me, but what is more interesting is making this social.  Research into why people keep exercising consistently shows that stress relief and social connection are critical.

There is an increasing number of smart phone apps like Strava that not only allow you to track your exercise but also allow the sharing and comparing of that data with friends. Whenever my schedule allows, I prefer to ride with the local biking club -- but for the times individual rides between I can use the compare features to see how I rank on the tougher hills of my ride.

So what about taking the social aspect of group exercise to the next level? I had the good fortune to meet the founders of the Healthy Communities Institute who are supporting connected communities. I call this the quantified community ... so instead of just measuring yourself, your community tracks public health  by establishing real-time data dashboards that leverage easy to understand green/yellow/red widgets. As a founder of a health information exchange (HIE), I find this approach really intriguing.

Before you say "my community is not that progressive" watch what Owensboro, Kentucky did to support public health as they established community health dashboard.

What is your community doing to improve health and well-being?