NYTimes: Power of Positive People

This is perfectly aligned with what I’ve been thinking recently. This combines ideas from a couple of books we’ve been reading: Nudge by Richard Thaler (a future book review), and another book on my to-read shelf: Connected, by Nicholas Christakis.

Nudge talks about how small changes in our environment, often something we can design or control, can subtly shift our behavior in either desirable or unintended directions, eg: a public school cafeteria can dramatically influence student food choices by the positioning of the food (eye level? early in the line, or late?).

Connected discusses in more detail, the idea that not only direct relationships (immediate family members, close friends), but friends of friends, AND EVEN friends of friends of friends, have some influence over our own health, eg: the NEJM research study that showed that YOUR likelihood of obesity is related to the obesity of those who are THREE relationships away from you. Wow.

And now, positive friend relationships (described as MOAI in this article, from Okinawa, Japan, with the longest-lived women, expectancy of about 90) have everything to do with long term health. I’ll leave you to read.

CMIO’s take? There are SO MANY THINGS outside of direct-healthcare that influence our health, our lives, and we are just beginning to explore them. How are you thinking about this in your healthcare organization?

Book Review: The Alchemist – Paulo Coelho


Four stars.

I’m surprised of never hearing about this book, now in a 25th Anniversary edition. By Paulo Coelho, it is a well-told parable of the journey of a young man who loves to travel, and seeks his treasure, based on a recurring dream, at the pyramids of Egypt, a continent away.

I’m not an adherent of mysticism, and also not a scholar of the Koran. I did however enjoy the themes from these traditions that percolate up through the writing, the parables told as the boy undertook his adventures.

Each episode of his adventure: selling his flock of sheep and deciding to set out to pursue his Dream, meeting an old King who gives him two precious stones named Umim and Thummim, meeting an aging Merchant who himself realizes that striving for his goal was more important than reaching it, meeting the titular Alchemist, all become swirling threads, and messages of insight and hope.

It is reminiscent of The Little Prince by Antoine de St. Exupery. Also of ‘Tales of Power‘ by Carlos Castaneda.

CMIO’s take? ‘The world conspires to help those pursuing their Personal Legend.’ Perhaps I would not have said it in this way, but yes, I agree. In the world of human affairs, even in large academic medical centers and health systems, it is so easy to get caught up in ‘governance’ and too-rigidly respecting lines of authority and influence. As a result, it ‘makes us rather bear those ills we have than fly to others we know not of.’ (Shakespeares’ Macbeth) Sometimes we are too fearful to take a chance on our ideas. Worse yet, we don’t help encourage others to try new things and support them in their nascent efforts, especially when a kind word or slight nudge of support could make a world of difference. A good parable teaches us about ourselves. A great one entertains us as well, as this does.

Who could YOU support and encourage today? Let me know.

How can the Triple Aim help patients? Here’s how.

Three amigos, with very different approaches to Aneurysm repair

My father (hi Dad!) recently was diagnosed with an incidentaloma. In medical speak, that is an “incidental” (or, unintended) finding on an imaging study conducted for an entirely different reason. His physician found an ascending aortic aneurysm of a certain size, on CT scan of the chest.

Dad was interested in finding a vascular surgeon in the Los Angeles area who was experienced in evaluating and if necessary, performing surgery for this condition. “So,” he asks me, “who’s good at vascular surgery in Los Angeles?”

I was completely stumped.

I went online, as all good internet-enabled adult children do, and found several dozen websites that purport to show and rate surgeons in the Los Angeles area. NONE of them were useful. Angie’s list, HealthGrades, lots of commercial and informal sites trying to meet an important need. Either there were no surgeons listed, or maybe there is a fragment of a listing and no data, or maybe there is a marketing blurb associated with that surgeon, or maybe someone ranting about a surgeon with whom they were unhappy. Nothing in terms of quality of care, operation case volumes, patient outcomes, very little of patient satisfaction…

And yet, we now are collecting such data in our massive EHR’s. WHAT IF we took the Triple Aim of improving healthcare:
-Improving health of populations
-Enhancing the experience of care
-Reducing costs

And gave a such tool to our patients? What if we could apply Amazon.com principles to searching for physicians and showed the screen above: how many operations of this type per year, the re-hospitalization rates; the complication rates, the patient satisfaction, the cost of that care, wrapped up with an overall star rating?

Yes, I can hear the outcry now. There are SO MANY REASONS that we can’t do this. As a former hospital CEO (Dennis Brimhall) said to me decades ago:

NO PATIENT SHALL WAIT. This is our vision. I know there are 300 reasons why patients HAVE to wait in our hospital. And yet, we ALL know that waiting is one thing patients hate about our care. So, NO PATIENT SHALL WAIT. And it will be ALL OF US working to solve the 300 things so that this can come true.

So it is, with this vision. It is hard, and nearly impossible with the sociopolitical structures we have now. The technology is just about able to do this, but the much harder work is convincing all the stakeholders in the healthcare industry (and in my own organization!) that this is valuable, this is important, and we must do it.

It is also possible, that by the time we achieve this, the 2 “surgeons” pictured above will have grown up and helped solve this problem. And that clearly irrelevant, untrustworthy guy on the right will have retired.

And, Dad’s fine, by the way. Thanks for asking.

CMIO’s take? If you don’t like change, you’ll like irrelevance even less.

Book review: Spaceman – Mike Massamino


Mike (his NASA colleagues call him ‘Mass’ and so will I) is an amazing storyteller. If you read this book, maybe consider getting it on Audible.com, as ‘Mass’ narrates his own words and journey.

Mass’s New York accent is working class-cool and fits right in with ‘The Right Stuff.’ But, instead of death-defying Air Force test pilots, we have PhD-wielding engineers and physicists competing to be the one-in-ten-thousand astronaut candidate.

I remember having watched Neil Armstrong in 1969. I was a 6-year old, and remembered some fuzzy black-and-white images, a big party of adults in our apartment, and being allowed to stay up late. I had been fascinated with space Science over the years.

I remember getting my own elementary-aged kids excited over watching the NASA channel during the landing of Spirit and Opportunity on Mars. Nothing visual interesting to see, just listening and watching the Command Center wait in hushed tones for the signal of a successful landing and the entire room of scientists and engineers erupting into tears of relief and shouts of joy. We raised our arms and hopped up and down in our own celebration. Mom walked in on us and shook her head in bemused consternation. Whew. We were such nerds. And so proud.

Mass’s story is riveting. He’s a kid from the Bronx, with childhood astronaut dreams, never straying far from home. But then a mentor suggests that if he was really passionate about Space, he would find a way. Spoiler alert: he does.

He brings as along as he barely survives a PhD at MIT, difficult post doctoral work on a Robot arm with improved human-factors feedback, vision so poor it would disqualify him, getting to fly on the Shuttle, losing close friends in both shuttle disasters, getting to work on the Hubble repair (don’t miss THAT story, OMG) doing many hours of space walks, Tweeting from space, getting to be on Big Bang Theory…

Whew! I feel like I was along for the whole ride. Mass tells us of action stories, cliffhangers, scientific breakthroughs, comedy routines, insurmountable engineering design problems, interpersonal conflicts, lifelong friendships and jaw-dropping space walks. And he is such a guy-next-door.

CMIO’s take? Lessons on how high powered individuals and teams work. And the stories are unforgettable. Get this book today. Give it a listen. You won’t regret it.