Health Care Should Be designed with you

A new project for your participation!

Health Care Should Be:

This is a collaborative effort in discovering ideas to improve the parts that make up health care delivery (the whole).

American medicine is good, very good. But it’s only a part of the health care experience.

Talk to almost anyone who has encountered the health care system and you’re likely to find a past disappointing experience. It might have been a lack of parking. Or getting lost navigating the hallway. Or a poor interaction with a nurse or doctor. Or an incredibly long wait. Or trouble getting your PHR to interact with the hospital’s EMR… (okay, so predicting future problems is a part of this project too).

Every day a lot of people go to work to improve health care. But there’s something lacking in the approach: the opinion of the patient.

This project in reimagination is a collaborative one. An effort, if you will, to describe a health care utopia. Share your personal opinions. Or a link to an article describing an improved registration process. Or a superior customer service story from a retailer. Or an image of a product that should be used. Or embed video of technology that could be implemented. Or a quote to provide perspective.

The information here provides only a frame for your suggestions. Don’t hold back. Share anything you feel is important, relevant, or worth pursuing. Share as much as you want, can, and/or need.
The end goal of this project, at some point in the possible future, is to implement these ideas.

Go! Now! Share!

Let the designers handle health reform

Consider the success of all reform efforts up to this point before you write this off as “creative mumbo-jumbo” or something of the sort:

The current emotional uproar has revealed that the debate over health care is about much more than mere economics alone. To be certain, much of the positioning relates to financial exposure. But when you listen to the town hall meetings, you hear the debate is supercharged with emotion. Understanding those emotional needs of the various stakeholder constituencies is what will make it possible for designers to design positive experiences from process, financial, and emotional perspectives.

By employing a full designer’s toolkit of methodologies, designers would understand and analyze our health care system and arrive at insightful solutions that go beyond logistics and economics. (Fast Company)

The reform conversation is going to continue to spiral until believable emotional refutations are constructed to combat emotional beliefs.  Only then will we be able to move onto rational discussions with those who are actually interested in discussing.  The majority of Americans will happily exclude those who are for nothing but a single-payer system or a completely free-market approach.  There is success to be found in the middle…with designers.  Sign me up.

How much your family’s health care costs in 2020: $23,842

Sooner or later health care reform will have to something to address out-of-control costs? Right? Right?

The rapid rise in health insurance premiums has severely strained U.S. families and employers in recent years. This analysis of federal data finds that if premiums for employer-sponsored insurance grow in each state at the projected national rate of increase, then the average premium for family coverage would rise from $12,298 (the 2008 average) to $23,842 by 2020—a 94 percent increase. (The Commonwealth Fund)

Bonuses don’t work, management will go away, and free time at work for everyone

Lots to process in Dan Pink‘s talk at TEDGlobal in Oxford.

1. financial motivators are almost always less motivating than intrinsic motivators
2. management is a creation of man, therefore its irrelevancy over time is as possible as the videocassette recorder
3. free time, like Google’s 20 percent time, can create some cool stuff

Potential implications.

1. P4P won’t work, executive bonuses either
2. the future health care organization will be much flatter (read up on hierarchies)
3. most health care workers don’t spend any of their time on anything BUT their approved job tasks, maybe that’s a problem…

That’s it for analysis.  The good thing for all of us is that Dan has a new book due at the end of the year titled “Drive: The Surprising Truth About What Motivates Us.”  Here’s the talk:
http://video.ted.com/assets/player/swf/EmbedPlayer.swf

The toilet test

L-O-V-E the toilet test:

Whenever I evaluate a school, my first stop is the boys’ bathroom because, without an unflushed urinal of doubt, it is every school’s least common denominator. Its sticky floors, calcified wads of toilet paper and juvenile-yet-timeless graffiti (“Here I sit broken hearted…”) are generally not what a principal shows off. Then again, I once visited a school run by the Knowledge is Power Program — which focuses on preparing students in underserved communities for college — and found fresh cut flowers next to an automatic recycled-paper-towel dispenser. At another school, there were toilet targets. (Apparently, research shows that they increase accuracy by as much as 70 percent.)

Folwell Dunbar explains his metric at Miller-McCune:

In today’s data-driven world of No Child Left Behind and high-stakes accountability, administrators and lawmakers tend to obsess over hard measures. Adequate Yearly Progress determinations and School Performance Scores are based on precise formulas — formulas made up of clean, cold and supposedly foolproof numbers. In this highly calculable place, soft measures are rarely factored in. Nonetheless, after my “inspection” discovers the good, the bad and the ugly of the boys’ john, I usually have a good sense (or scent) of how a school is doing. Though I wouldn’t necessarily hold the bathroom test up against SAT scores as a measure of school success, I do consider it a telltale sign of either problems or promise.

Oh, health care and education how you are so intricately entwined. The toilet test works in hospitals, too.  The article bullets a laundry list of “soft” tests (the soft stuff is the hard stuff…).  Ideating a few for hospitals on the decline, those areas that all visitors have access to:

• wildly outdated reading material in waiting rooms
• trash on the floors in main corridors
• outdated furniture and interior decor, anywhere (though especially on the floors taking care of inpatients on services that traditionally are profitable)
• boxy tube televisions in common areas, shared televisions in patient rooms
• anything unkempt on a mother/baby service
• posters/announcements/bulletin boards with aged information

There are…many, maybe even a limitless list (oh, those are fun…).  Care to share?  How do you judge hospitals or any other institution/place of business when you don’t have access to metrics/don’t care about measures?

(via Tom Kuntz)

1,000,000 health reform articles later…

About 1,000,000 health care/insurance reform articles ago, someone wrote that President Obama should be “selling” reform with a “because of explosive cost growth, if you want to keep your current insurance, we need reform” not a “with reform you will be able to keep your current insurance” tactic. (I searched to no avail, the keywords “Obama” and “health reform” return just a few possibilities, if you have a link to the article leave it in the comments)

Opinions on all of this are numerous.  It’s overwhelming.  (I even considered going on a health reform posting strike simply because its domination of my daily life has put me over capacity.  But then I realized that would be a complete cop out and akin to leaving a Rolling Stones concert before they play Satisfaction or leaving a July 4th celebration in Washington DC at 4:30 in the afternoon or walking out on Game 7 of the World Series after the sixth inning of a tight ballgame…just can’t do it.  So instead I continue my efforts to ingest, comprehend, and explain this crazy system and its intended fixes.  But maybe a posting strike would work if we could gain critical mass?  Let me know…)

Back to the topic at hand.  The mesmerizing costs of health care.  In an Atlantic article by David Goldhill currently making the internet rounds he puts the lifetime costs of insuring your family into perspective:

Let’s say you’re a 22-year-old single employee at my company today, starting out at a $30,000 annual salary. Let’s assume you’ll get married in six years, support two children for 20 years, retire at 65, and die at 80. Now let’s make a crazy assumption: insurance premiums, Medicare taxes and premiums, and out-of-pocket costs will grow no faster than your earnings—say, 3 percent a year. By the end of your working days, your annual salary will be up to $107,000. And over your lifetime, you and your employer together will have paid $1.77 million for your family’s health care. $1.77 million! And that’s only after assuming the taming of costs! In recent years, health-care costs have actually grown 2 to 3 percent faster than the economy. If that continues, your 22-year-old self is looking at an additional $2 million or so in expenses over your lifetime—roughly $4 million in total.

Wow.

Rational arguments are probably the worst to use because this issue is a very emotional one.  But if there’s anything that could snap emotional folks out of their daze, it’s dollar bills.  Anyway, read the article.  It’s a bit of an investment of time but it succinctly lays out the issues we’re facing in a way that’s escaped most of the millions of articles written on the topic thus far.

1. Communication is the problem, follow-through the example

The majority of problems in health care can be broadly defined as communication problems.  If you’ve ever listened to health care people talk health care troubles, communication is often explicitly mentioned.  It’s an, almost universally used blame for many issues.  But the problems are often poorly corrected.  That says one of two things: 1) the problem has been poorly defined, assessed, or 2) execution of improvement activities has been lackluster.  Neither alternative is particularly appealing.

The first step in correcting this situation (generally, solving health care’s problems—or opportunities if you prefer optimistic rhetoric) relates to alternative one above: recognizing that the issue at hand is one of a breakdown in communication.  What better way to do that than through examples?

Example 1: Following through

Ted Eytan recently blogged about a study that concluded 7.1% of the time, on average, information was not communicated to patients regarding abnormal test results.  What makes this even worse is the “no news is good news” doctrine:

It’s impressive that in 2009, believe it or not, there really aren’t firmly established processes for handling information about test results. A lot of what is done today is bred from custom, such as the infamous “no news is good news,” which the authors found was the protocol in 8 out of 19 medical practices studied. Everyone who likes this approach to test result notification, please raise your hand…

Here’s a real example from Disruptive Women (via Ted Eytan) of a communication breakdown.  Notice that policies and procedures were in place, the lack of follow-through is where the problem rose:

One year later, as Dr. Rosenthal walked into the exam room eyeing Sam’s medical record he stopped for a moment, raised his eyebrows and then looked sheepishly at Sam. “I’m sorry,” he said, “the pathology report from your surgery showed prostate cancer. And, I am afraid I did not see the report until now.” Sam was confused as to how that could have happened. Although he had not previously requested a copy of the report, he asked for one now.

After calming down, finding a new urologist, and making plans for the testing to find out how far the cancer had spread over the past year, Sam finally sat down and read the report. Typed in large, bold type across the top of the report was the following statement: “Results telephoned in to Dr. Rosenthal on 05/05/08? … one year prior to the visit. Turns out not only did Dr. Rosenthal have a copy of the report, he also had received a verbal notification that Sam’s pathology report showed cancer of the prostate. The hospital had a strict policy of calling the surgeon, in addition to faxing and mailing a copy of the report whenever there was a finding of cancer.

Transferring culture

Noah links to this Nike article.  A nice tidbit on culture and organizational values:

It’s an inevitability that most companies the size of Nike will eventually lose touch with the core values instilled by their founders. It has arguably already happened to Google in a much shorter space of time. However, Nike’s philosophy of ‘innovation and inspiration’ is still present in absolutely everything it does.

Nike employs over 30,000 people.  Maybe it’s because of the traditionally siloed, hierarchical structure of health care organizations, but it doesn’t take size like Nike’s to lose touch with cultural values.  The inevitability of progress combined with the struggles of change make staying true to original intentions difficult.  Here’s how Nike does it:

Ekins are official company storytellers employed to evangelise about the Nike brand and its sports technology. Before being unleashed on the world, Ekins are required to undergo an almost military-like training regime comprising a nine-day rookie camp at Nike’s headquarters in Oregon and a full day’s running at the Hayward field track where Bill Bowerman worked as a track coach. Almost unbelievably, as a further sign of their devotion to the brand, each Ekin is then invited to have the Nike ‘swoosh’ tattooed on their ankle ahead of their ‘graduation’.

Hmmm, tattoos…

Sharing private medical information

Having yet (we’re all going to need care eventually) to be a patient of significance in health care, I’m extremely appreciative of individuals who share their private medical information.  There have been many and the collective good will improve awareness, medical science, and health care as Jeff Jarvis explains in his Guardian column:

By revealing my cancer, I realise benefits, and so can society: if one man’s story motivates just one more who has the disease to get tested and discover it, then it is worth the price of embarrassment. If many people who have a condition can now share information about their lifestyles and experience, then perhaps the sum of their data can add up to new medical knowledge. I predict a day when to keep such information private will be seen by society as being selfish.

Collectively, we will use the internet’s ability to gather, share and analyse what we know to build greater value than we could on our own. That is the principle of transparency that I want companies and governments to heed: that openness in their information and actions must become their default, that holding secrets only breeds mistrust and robs them and us of the value that comes from sharing.

Stop your screaming, the expert’s lesson

Seth’s sensemaking is brilliance.  But we all know that.

If you want to challenge the conventional wisdom of health care reform, please do! It’ll make the final outcome better. But if you choose to do that, it’s essential that you know more about it than everyone else, not less. Certainly not zero. Be skeptical, but be informed (about everything important, not just this issue, of course). Screaming ignorance gets attention, but it distracts us from the work at hand.