The Internist’s Problem
This is the story of my life. As a detail oriented (read: Obsessive-Compulsive) Internal Medicine physician, I’m trained to sweat all the details, think through complex situations, and explain them as carefully as I can to my patients and colleagues. That’s what I’m good at.
Do you have a few hours? Let’s get into it! (Sorry, you’re right, this is a blog, just kidding).
The problem is, this is NOT the skill you need in organizational leadership. No one has time for an hour-long PhD dissertation. You get maybe 5 minutes, maybe just 10 seconds, to make your point in a board room, a steering committee.
Furthermore, as an introvert, I’m not good at punchy one-liners, off-the-cuff banter, deft debate skills to win over recalcitrant colleagues. What to do?
Don’t do THIS!
That is exactly what I did wrong in 2001. I helped conduct a research study to show that Open Notes and Open Results (releasing notes and test results online to patients) was safe and effective. I wanted to win over my colleagues in a large, multi-specialty University practice. I wrote a 17-page Q/A handout answering ALL POSSIBLE QUESTIONS. It did not go well. Maybe you heard of me and my disaster? –> My 16 year journey to Open Notes.
So, what to do?
In the intervening, wound-licking years, I developed a solution: the 1-PAGER. Other names you may hear me say: The Executive Summary, the SBAR (Situation, Background, Assessment, Recommendation; a format familiar to nurses, and their effective communication analog to the physician SOAP note).
General Principles of a 1-pager
- Don’t exceed one side of one page. This restriction forces clear thinking and writing, like a newspaper article with limited space, cutting away unnecessary words and information.
- The title should be specific and direct, START WITH WHY
- An executive summary, in 3-4 sentences, giving some nuance to WHY and WHAT needs to be done.
- Include both data AND ALSO stories and quotes. (Daniel Kahneman: “No one ever changed their mind because of a number. They need a story.”
- With every item on the page, ask yourself “Who is my audience? Do they care about this item? Does it help tell the story? Does this align with the audience’s or organization’s goals?” Slash ruthlesslessly.
- Include interesting graphics; no one will pick up a boring paper with dense small font, but a picture? or a curious graphic? Maybe you have a chance.
Here are some examples to consider
My 1-pager describing our move to adopting OurNotes patient questionnaire across 80 primary care clinics, about 400 primary care providers, where patients co-author their own progress notes. Proposal: accepted.
Download document: 2022-0208 OurNotes Patient Questionnaires Future Exec Sum
My 1-pager describing the benefits of our outpatient Sprint program, both data and stories: “I no longer seek early retirement to escape EMR.” Similar documents helped get Sprint teams funded.
Download document: 2018-08-ExecSum-Sprint-Aggregate
My 1 pager describing “How long will my IT/EHR request take?” Our leaders better understand why some things take a longer time than others.
Download document: 2020-0707 EHR Pyramid of Possibility CTL
My 1-pager advising patients what to expect when expecting a test result. Download document: 2020-1026-for-patients-getting-a-test-at-uchealth
My 1-pager advising clinicians how to avoid potholes in writing a progress note that will be read by patients. Notice: it is no longer 17 pages long. Download document: 2017-0904OpenNotesDocuTipsCTLin
Heres’ the thing. An expert knows a LOT of detail and has trouble holding back all those details. A beginner / learner / leader needs to know just enough to make a judgement whether to support a project or not. How can an expert adopt a beginner’s mind? Start with WHY, write a disciplined ONE PAGE argument, tell a STORY backed with data. Revise, revise, revise until it is clean, succinct, and passes muster with a colleague or mentor who is willing to critique your writing.
Oh, are you still reading? What is a PIG-let, you ask? One of my newer physician informatics colleagues, poking fun at our Large PIG / Small PIG meetings, wanted a PIG-let meeting, for the newbies. Cute. Like Tony Hsieh did, for Zappos in “Delivering Happiness”, I’m looking to build an on-boarding set of skills for our PIG-lets. Skills, tools, books.
CMIO’s take: What do you think? Have you tried this? Do you disagree? What has worked for you? 1-pagers for everybody!