Review: Patients Come Second: Leading Change by Changing the Way You Lead

Patients Come Second: Leading Change by Changing the Way You Lead
Patients Come Second: Leading Change by Changing the Way You Lead by Paul Spiegelman

My rating: 3 of 5 stars

I wanted to like this book more. The provocative title says a lot. However, the point could have been made with fewer words. Moreover, I looked forward to real-life examples to illustrate this idea, and was disappointed.

In brief, the authors claim that over-focusing on the customer (or in healthcare, the patient), although wonderful on the surface, can be twisted into ununtentional results. Shall we, as physicians, chase after the increasingly important “patient satisfaction” metric at the cost of, say, antibiotic overprescribing? “Oh, so you’ve had a cough for a day, and you’d like some antibiotics?” It is indeed easy, and quick, to say “Sure, here you go” and get back on track with an over-scheduled clinic day, and be assured of a higher patient satisfaction rating. Who would rather spend the 5-10 minutes to discuss the patient’s root concerns, explain the risks of overprescribing, and grit the teeth anticipating the inevitable “I drove all the way over, paid my co-pay, and THE NERVE of that doctor to withhold my necessary antibiotics” and resulting low patient satisfaction score.

Burnout.

Yes, this is not news to any practicing physicians. Yes, we know we’re being pinched from all sides. Yes, there is too much ‘fat’ in the US healthcare system and something has to be done. Yes, Obamacare did some great things and also did not do enough. Yes, we need to listen to our patients and ensure we do the best for every one of them. Yes, we need to treat our physicians better, so that they can step back from the brink of burnout, of retirement, of leaving medicine in disgust, of suicide. Yes, this book is a call-to-arms.

No, its not as helpful as it could have been. There’s less substance than the pages would indicate.

CMIO’s take? This book is more valuable for the shocking title and its use in conversation and leadership meetings, than it is for its actual content.

View all my reviews

Open Notes, a how-to Webinar with Homer Chin MD and CT Lin MD via HealthsystemCIO

easy-button
Well folks, here’s more information about Open Notes from a physician who led a city-wide initiative to get ALL the hospital systems to adopt Open Notes, nearly a decade ago, with resulting excellent patient engagement and satisfaction and improved outcomes. And then I’m also on the webinar, too! Seriously, Homer Chin MD, formerly of Kaiser Northwest, where they pioneered many aspects of Open Notes, was able to collaborate with competitor healthcare systems throughout Portland and take the entire city to Open Notes; one of the few community wide collaborations of the sort.
If you’ve not been paying attention to the growing Open Notes tsunami, well, in a nutshell, its the idea of patients viewing their doctor’s progress notes about them, online.
Listen to the HealthsystemCIO.com youtube channel recording of our 30 minute webinar:
We’ve been live on Open Notes in one form or another since our original research back in 2000, but we finally went system-wide in May 2016. None of the anticipated fears of the docs materialized in a significant way (fears of: too many phone calls, lawsuits from offended patients, volumes of complaints about pejorative terms). We found lots of benefits: patients more engaged in their care, patients more adherent to therapy, patients asking better questions (instead of “what’s my test result”, more like “I read about my results, and does it mean this or that?”).
However, not everything is straightforward; from a technology standpoint, remember to set Open Notes as “default on” with docs having to “opt out”. This will get your open notes release rate into the 95-99% range. If you allow docs to “opt in”, requiring a doc to press a button to allow a patient to view their notes, your release rates will be in the single digits. Just like Staples’ infamous EASY button, in informatics, we want to MAKE THE RIGHT THING EASY.
If any of you have not read Leading Change (maybe a blog post on this in the future), it is one of my all-time favorite and most useful books for CMIO’s. Creating a burning platform was one thing I never did well in the early days of our Patient Portal and transparency efforts. Turns out, our research and scientific data, without corroborating human stories, did not change minds and hearts. Who knew? The medical leadership at our health system did not agree to go along with this project, back in the early 2000’s.
This time (2016), I packaged Open Notes as part of our EHR system upgrade (hey, guys, turns out Epic version upgrade that’s coming on May 16, 2016 ONLY COMES WITH OPEN NOTES! Let me help you get ready for that!), obtained the leadership buy-in from our CMO’s, developed a thorough marketing plan, met in-person with key physician leaders (specifically, loud and opinionated physician ctlukeepicmanbigleaders), enlisted patients from our Patient and Family Centered Care council, conducted a small Open Notes pilot project in 7 primary care clinics for 6 months, gathered good left-brain-appealing statistics and right-brain-appealing stories, and generally jumped in with both feet.
If you stay till the end, you might hear (an improved) rendition of Doc Prudence, my anthem to Open Notes on the ukulele.
From Twitter @CIOCHIME

 

Doc Prudence (a ukulele parody) about Open Notes

I’m here at CHIME16, the College of Healthcare Information Management Executives, at the fall CIO forum, speaking about Open Notes. I’m honored to be invited to speak, and even more honored to be selected as an Encore by the audience, who choose their favorite presentations for an ‘encore’ presentation on the last day of the conference. And at the end of my talk, a ‘bonus’ presentation on ukulele of “Dear Prudence” by the Beatles, repurposed to illustrate the benefits of Open Notes and the principle of information transparency in healthcare.

It has been great to be here in Phoenix learning from and sharing ideas with healthcare’s pre-eminent CIO’s.

Congratulations to UCHealth’s CIO, Steve Hess, who wins CHIME16 collaboration award


At this year’s CHIME16, the annual national meeting of the College of Healthcare Information Management Executives, Steve Hess, our CIO accepted the prestigious CHIME collaboration award. CHIME is the largest organization of healthcare CIO’s, over 900 at present count. What a great recognition from Steve’s peers to be recognized in this way. 

Steve’s work with LeanTaas is groundbreaking in that we now apply machine learning tools to improve scheduling of our infusion center chairs for chemotherapy. Our hospital’s substantial growth has outpaced the capacity of our infusion center. This had resulted in patient dissatisfaction, as well as lots of nurse overtime. Steve worked with Sanjay from LeanTaas to co-develop a scheduling tool that would, with minimal adjustments, dramatically improve throughput using predictive modeling. Peak waiting times dropped by 33%, with no increase in nurse staffing or increase in facility space. Very cool. In particular, the tool can tell the nurses what to expect about their upcoming day, not just scheduled patients, but also anticipated overbooks, and can guide ‘where and when’ to place last minute add-ons to keep things flowing. Really great predictive tool. Now, our opportunity is to use this in our OR, our ED, and throughout our enterprise. This is our first big step into predictive analytics, with clever and effective feedback loops to drive change of behavior. 

Congrats to Steve. We’re on a great path, thanks to your leadership. 

Mobile Stroke Unit, 4th in the country

Cool Stuff Ahead!

Our Neurosciences and Stroke team worked with our telehealth program, bought a souped-up ambulance, installed a portable (PORTABLE!) CT scanner, and now we can send this ambulance out on any 911 call that sounds like it may be an early stroke.

Unlike current state-of-the-art facilities that take 30-60 minutes AFTER the patient arrives in the Emergency Department to diagnose a stroke, rule-out a bleed, and administer tPA, the clot-busting drug (so called “door-to-needle time”), we now have NEGATIVE door-to-needle times.

In other words, we’re driving to the patient, performing the CT scan IN THEIR DRIVEWAY at home, transmitting images to our neuro-radiologist, using a 2 way video link between neurologist and patient, finalizing a diagnosis, and administering life-saving tPA right there in the driveway. BOOM. “Needle” time occurs before “door” time. Watch the video link above for details. So proud of our teams and the technology we develop to support outstanding patient care.

NYtimes: releasing medical records

08up-records-superjumbo-v2I’m gratified that the public conversation on electronic (and also paper) medical records continues. Its a dry topic, but oh so important. Ms. Sanger-Katz writes about Casey Quinlan (and her QR code!), and the difficulty of assembling a longitudinal health record that becomes more important as we get older. The morass of privacy, mistrust, bureaucracy, swiss-cheese implementation of EHR (electronic health records) with few electronic connections, throw numerous barriers into this journey. Open Notes is just the opening salvo in trying to ease that journey.

Those who succeed in pulling together their medical records to coordinate their care are lucky indeed:

Dr. Tierney worked for years in Indiana to help the state develop a cutting-edge health information exchange, a place where most of the state’s hospitals shared patients’ medical data. After 44 years in the state, he queried the exchange for his records before leaving. He paid $100 for an inch-and-a-half-thick stack of papers.

“I went to my new doctor,” he said. “I put it on the table. And she said, fill out the form.”

www.nytimes.com/2016/09/08/upshot/release-your-medical-records-first-you-must-collect-them.html

Open Notes: a 16 year journey

Upcoming press release:

UCHealth is excited to be the first in the state of Colorado to offer Open Notes to all 1.5 million patients in our system (as of May 2016). Open notes are now available across the spectrum of care, including outpatient clinics and emergency department notes to hospital discharge summaries. We believe that information transparency is crucial; an informed and engaged patient is a healthier patient.

Or, in Haiku form:
Not sure what Doc said?
Why hide medical advice?
Open Notes are here.

Medicine in the age of Facebook #iHT2

My talk at the Institute for Healthcare Technology Transformation today, as covered by Mark Hagland of Healthcare Informatics journal:

Article at:

http://www.healthcare-informatics.com/article/patient-engagement/it-s-transparency-get-over-it-ct-lin-md-challenges-iht2-denver-audience

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