In Action!

Getting out of health care in action:

Being prepared to dedicate time and money to creativity is clearly one lesson but Adrià’s ability to look beyond the world in which he works is crucial. Teamwork is a recurring theme and both Adrià and Great Ormond Street Hospital have been inspired by the seamless operation of the Formula One pitstop team.

Dr Allan Goldman is head of paediatric cardiac intensive care at the hospital, and it was while watching a race with his colleague Martin Elliot that they saw they could learn from the pitstop team’s smooth functioning. For the doctors, the critical post-op handover from the theatre to the intensive care team was an area of concern.

“We spoke to the F1 teams about the processes and safety culture, and designed a simple process we could use,” says Goldman. By compartmentalising the handover it became less haphazard and errors were reduced by around 35%.

“In medicine, who is in charge is often not defined, but it became clear the anaesthetist was the most suitable person, so they head the process now. Talking to people outside made a big difference.” The Guardian

Input Platform

The Guardian:

Something had to be done to reconnect with customers, and Dell came up with IdeaStorm, a website where customers are encouraged to submit ideas to the company. The advantage of such an online forum for a company keen to innovate is clear: “For years people have been using focus groups. This enables us to do the same job but with hundreds or thousands of consumers over a period of months or weeks,” says Dell’s vice-president for communities and conversations, Bob Pearson.

Dell’s Ideastorm

41. Ask for input

Watching the crowds gather for today’s inauguration is amazing.  It is evident that people care again.  Today’s events are the culmination of a massive exercise in participation.

People want a say in the every day realities that affect their lives.  It’s as true in the work world as it is in government representation.  The Barack Obama campaign and transition teams understood this and provided an outlet for people to participate by asking for input. was the foundation of organization for the campaign: it allowed supporters to interact with each other through an online social network.  More importantly it provided the opportunity for over a million people to express themselves with the perception (reality or not) that the campaign was listening to their thoughts.

After the election the transition team launched—again, asking people to provide input.

Your Seat at the Table allowed the American public to comment on transition team work that traditionally was held behind closed doors:

This means we’re inviting the American public to take a seat at the table and engage in a dialogue about these important issues and ideas — at the same time members of our team review these documents themselves.

Health and Human Services Secretary-designate Tom Daschle asked for participation in the health care reform process through discussion parties held during the holidays that encouraged particpants to report back with suggestions on moving the debate forward.  Aside from health care, any number of issues can be commented on.

Most recently the Obama transition team announced the Citizen’s Briefing Book which is a tool that allows citizens to prepare briefings.  The briefings are voted upon by others with the highest-rated briefings being placed in a book for review by the White House.  Another opportunity to provide input.

Hospitals can do the same and the internet makes it all possible.  Provide a platform for employees, physicians, patients, community, etc. to express their thoughts.  Allow stakeholders to provide input and devise a strategy for addressing any concerns they may have.  It’s a simple idea, really; but it has powerful possibilities.

Principle #41: People enjoy being a part of something.  our own system will give them the opportunity to do so.  Engagement, empowerment, and excitement all become possible when you allow people to particpate.  Just ask.

Bonus: Wired has a great story on the challenges the Obama campaign faces in continuing its trek to bring government into the social media world.

It’s what we’ve got

Path dependent policy is a reality and Atul Gawande writes in The New Yorker that health care reform must start with what we have:

Yes, American health care is an appallingly patched-together ship, with rotting timbers, water leaking in, mercenaries on board, and fifteen per cent of the passengers thrown over the rails just to keep it afloat. But hundreds of millions of people depend on it. The system provides more than thirty-five million hospital stays a year, sixty-four million surgical procedures, nine hundred million office visits, three and a half billion prescriptions. It represents a sixth of our economy. There is no dry-docking health care for a few months, or even for an afternoon, while we rebuild it. Grand plans admit no possibility of mistakes or failures, or the chance to learn from them. If we get things wrong, people will die. This doesn’t mean that ambitious reform is beyond us. But we have to start with what we have.

Innovation through social interaction

Keith McCandless visited the Center for Integration of Medicine & Innovative Technology to speak about efforts at Billings (Montana) Clinic to reduce HA-MRSA infections.

The Billings Clinic reduced HA-MRSA infections by 89 percent from June 2005 to June 2008.  Astounding.  Even more astounding is that they accomplished the reduction by working together.

McCandless is the co-founder of the Social Invention Group.  They help people work together to innovate through social interaction on the most basic level.  Lots of innovation affecting small stuff with front-line people making big change.  He asks this question in the presentation at CIMIT:

Can we be MORE succesful transforming culture by focusing narrowly on how we tackle our complex challenges within each unit?

The answer is a resounding yes.

From the CIMIT blog (watch the 50 (or so) minute presentation for some great stories that came about through the process and an explanation of the approaches used, the power of this innovation method is impressive):

The Billings Clinic in Montana is getting spectacular results eliminating transmissions of MRSA. A variety of socially-inventive approaches are being used to unleash hundreds of small innovations. The approaches—Positive Deviance, Improv Learning Simulations, and Social Network Mapping—engage frontline staff in discovering tacit and emergent solutions for themselves… not waiting for experts in infection control or managers to solve the problem.

Changes in self-organizing behaviors at the unit level have shifted behaviors toward a more collectively mindful culture. As experts and leaders let go of over-control, front line staff take on more responsibility for safety and innovation. The results include more joy in work, safe practice, and spectacular results.

Imagine that, (good) communication leads to positive change.  It can work in your organization, too.

Health care marketing is hooey

Health care marketing is not marketing, it’s advertising—and few get the advertising part right.  Hospitals, health systems, clinics, etc. push push push their services through an assortment of mediums: billboards, newspapers, local magazines, television, radio, direct mail (even the new social media tools are most commonly used for telling)…

The thing about most health care services is that the patient doesn’t know they need it until they need it.  The status quo has been to inundate the patient with advertising to increase brand awareness—so that when the patient does realize they need a service, they think first of the entity that placed the most advertisements.  There is a better way.

Stop telling.  Start asking.

Instead of focusing on brand awareness, focus on brand embracement.  Build relationships.  Have conversations.

When a patient realizes health care need they are more likely to revert to past, positive relationships than to seek out new, unfamiliar associations.

Marketing: make the entire (read: entire!) patient experience with health care the best that it can be.  Focus upon the entire interaction continuum (from realizing need to forgetting it) and satisfy patients throughout.  Build a culture that provides unsurpassed customer service: endlessly dedicate resources to hiring the right people, improving appointment making, easing parking problems, encouraging communication, empowering service recovery, providing outstanding care, simplifying billing, etc. (all of the etc., too!).  Relationships will begin to materialize.

Doing so will create awesome stories (stories matter, stories are marketing) that are worth spreading.  Patients tell stories endlessly, whether they realize it or not.  They talk to others who chat with others who tell even more others.  Allow patients to tell their story of an experience that went beyond every expectation.  Health care is full of stories worth telling; allow it to happen by getting the distractions out of the way through marketing, real marketing.

In: Incredible Medical

Instead of poking, start chewing.

From PSFK:

Fortunately for the millions of diabetics worldwide, a needle alternative is on the horizon. Robert Doyle, a chemist at Syracuse University has found a way to keep oral doses of insulin intact from mouth to bloodstream. Which as it turns out, works most effectively through a chewing gum delivery system.

Via New Scientist:

For example, vitamin B12 is protected by a salivary protein called haptocorrin that binds to it in the mouth and protects it in the stomach. Once haptocorrin reaches the intestines, another chemical pathway takes over to help vitamin B12 pass into the bloodstream.

Doyle suggests binding insulin molecules to vitamin B12 so that it can hitch a ride on this protected supply chain. The insulin could ride all the way into the bloodstream, where it is released to do its work. Doyle and colleagues say early tests on rats appear to work well.

The rodents got their new treatment in liquid form, but chewing gum would be a better delivery method in humans, the team says. Chewing would ensure a plentiful supply of saliva, providing the protein needed for the insulin to make its way into the bloodstream.

A safety record to be proud of

In terms of safety, would you rather spend a night in the hospital or on the redeye flight from Los Angeles to New York?

Choose the flight.

While hospitals continue to struggle with quality and safety issues, an industry-wide example of improvement is on display:

For the first time since the dawn of the jet age, two consecutive years have passed without a single airline passenger death in a U.S. carrier crash.

No passengers died in accidents in 2007 and 2008, a period in which commercial airliners carried 1.5 billion passengers on scheduled airline flights, according to a USA TODAY analysis of federal and industry data. (USA Today)

It’s obvious that the vast majority of airlines are awful-awful-awful when it comes to customer service (everyone has a story…; I’m a staunch advocate of not using the airline industry as an example of how to treat people, ever ever!).  But they do get safety (much of the awful customer service stems from focusing on safety, btw).  Surely mistakes are still made, but they’re also corrected before harm is caused.

The Institute for Healthcare Improvement tells us that nearly 100,000 patients die annually because of preventable medical errors.  Or as some have analogized it, the equivalent of killing everyone aboard one jumbo jet every day. 

The good news from the domestic airlines comes as a result of a concentrated safety effort according to Arnold Barnett from MIT (CNN), “The manufacturers of the air frame are making better equipment. The power plant people, the engine manufacturers are doing the same. The crews are better trained. It’s just an all-around effort.”

Improvement efforts and transparency initiatives have increased hospitals’ attention to these matters.  The IHI’s latest concentration is the Improvement Map—its most encompassing safety and quality effort to date.  A grand continuation of its improvement agenda.

We’ve still a long way to go.  The checklists now being instituted in operating rooms have been borrowed from the cockpit and as the most recent statistics show, there’s room to borrow even more.

In: Important Answers

Has health care growth been riding a wave of faulty demand?


In this age of consumer-driven health care, will Americans react like retail consumers—switching aggressively to generic drugs and shopping around for cheaper docs? Or will they act like car buyers—reducing their purchases of health care, avoiding doctors, and letting prescriptions go unfilled?

Likely to be a combination of the two.  Free generics and Health 2.0 tools make the former scenario plausible.  Employment cutbacks make the latter probable.