In informatics, we often are faced with big data sets and how to make this data comprehensible. Here is an example from cartography. Beautiful graphics, highly usable. We can aspire this “data density” in our own graphics.
My favorite book crafting great information graphics from data, is of course Edward Tufte’s Visual Display of Quantitative Information. He talks about data density, sparklines, lots of cool stuff. AND he has an online course. I have been his disciple for years, and have ALL his books.
The only thing better than gathering and making sense of big data, is being able to explain it clearly to change minds and behavior.
Turns out, those of us in healthcare informatics and in the midst of the pandemic think the world has come to a halt. But no, WIRED magazine reports that robots and other tech development have not slowed down. Awesome reporting.
Having read Bit Literacy a few years ago, a digital riff on Getting Things Done, I have always known there are better ways of handling the email deluge. For example: the Eisenhower box: Do it, Decide to Schedule it, Delegate it, Delete it.
Also the idea that there are URGENT things, and NON URGENT things, and IMPORTANT things and NON IMPORTANT things. Email tends to be the URGENT and NON IMPORTANT and we all have long term strategies that are NON URGENT and IMPORTANT, and how do we move our daily work from one to the other. This is the story of my life.
However, in the service of improving email communication, Mr. Orendorff, of the New York Times updates the best-practices of WRITING emails to improve your chances of being read and being effective. My favorites:
Make the Subject Line useful: REPLY REQUESTED: thenyoursubjecthere or FYI ONLY: thenyoursubjecthere. Even better, if I can possibly ask my question or make my statement really short, I write it entirely in the subject line and end with my initials, signalling there is NOTHING in the email body.
Write a TL;DR. Cool internet slang for Too Long; Didn’t Read. As an internal medicine physician, I’m always guilty of being over-explanatory. Write the extra short summary at the end of your email AND THEN if you did well with that last part, you can DELETE your original email and ONLY SEND the TL;DR. Good job!
CMIO’s take? Read the article and change your life (and your colleagues lives) Today!
I love these stories about entrepreneurs coloring outside the lines. “That can’t be done” or “There is a big gulf between theory and reality”. These are statements everyone faces when trying to change the status quo, including in healthcare.
The proposal in brief, use a massive centrifuge to speed a rocket up to 5000 mph and launch it like a slingshot so that it can coast up to the stratosphere and then a tiny rocket pushes it into orbit: it avoids the Tyranny of the Rocket Equation – that most of the mass of a rocket is dedicated to massive engine and the fuel it must burn to put a relatively tiny payload into space.
More power to folks like these. Yes, they might flame out as they get closer to a real trial, but imagine if they succeed:
Launch costs of $400k, instead of 10x as much
Being able to launch 5x month instead of 5x a year
Commoditizing access to space without massive rockets
CMIO’s take? Color outside the lines! I give it a 50:50 chance this is viable as a commercial enterprise after vaulting all the potential hurdles.
Clergy embody the trust to heal our communities. They may be the boost the Covid Vaccine needs.
This article is an elegant discussion
of the importance of clergy in addressing vaccine hesitancy among those with doubts; they are the trusted community leaders we need right now. Click the image above to go to the article.
the article discusses UCHealth’s partnership with Shorter AME (African Methodist Episcopal) Church in Denver, with a photo of Yours Truly.
Even more amazing,
Shorter’s Fellowship Hall, where we gave vaccines, is named for Omar D. Blair, a Tuskegee Airman who went on to be a civil rights advocate. This is particularly poignant, as ALL clinical researchers at University of Colorado, and across the United States, must learn about the Tuskegee Syphilis Experiment, an unfortunate chapter in the early history of medical research in the US, and a source of great distrust on the part of the black community towards American medicine.
We are therefore so grateful to develop and grow a trusting partnership between UCHealth and black churches and community centers, to fight the pandemic with our best medical tools.
A Church-based Vaccine clinic
Some interesting ways vaccination at a Black Church is different from a vaccination on-site at a UCHealth facility.
Most people know each other; these are strong communities; folks getting shots spend more time waving and chatting than getting nervous about a vaccine.
Lots of church leaders guiding, comforting, coordinating a smooth vaccine clinic, alongside our UCHealth clinicians and leaders.
As a UCHealth worker, feeling like we are invited into the inner sanctum of a close-knit extended family
When I suggest to a vaccination recipient: “You can go be observed in the chapel for 15 minutes by our nurses and doctors. However, that observation time is optional and you can leave now if you like.” The response is: “Oh, I’m going in there! I haven’t seen these folks for a YEAR! I’m gonna talk to EVERYBODY.”
Some Churches UCHealth has been to in recent weeks
PBS and Black Churches
If you missed it, PBS recently ran a special on Black Churches in American History, that is a fascinating look at how the DNA of America runs deeply through these communities (from slavery, the Underground Railroad, Civil Rights, Women’s Suffrage, Martin Luther King, and the rise of black clergy in political life). Amazing and well-told.
CMIO’s take? It is a privilege (and also the right thing to do) to partner with strong community organizations to get minorities and medically under-served communities vaccinated. It is a privilege to be part of this effort.
This was a remarkable event, and I’m glad I was there to see it.
For those who may not know or remember; Greeley’s JBS meatpacking plant was the center of Colorado’s first major outbreak of COVID illness, resulting in numerous deaths and hundreds of workers getting sick and hospitalized. Meatpacking requires close quarters, and one infection spread rapidly to many.
I watched on the news with horror as the disease spread, and Greeley, a small town in rural Colorado became national news. Greeley also led the state in COVID illness early in the pandemic.
Public Health Effort
The great news NOW, is that Colorado’s Public Health coordinated a multi-health-system effort to vaccinate the nearly 5000 employees there. When I heard of the opportunity, I dropped everything and headed up there last Friday to be part of the effort.
It would seem an insurmountable task: How do you coordinate nearly 100 volunteers who don’t know each other, in a noisy, unfamiliar plant? How do you incent workers who may have questions about the vaccine, to come discuss and be vaccinated? Will you have enough translators (at least 8 languages are spoken by employees)?
7 health systems coordinated
Soon, however, we got organized into 14 tables of 3 vaccinators, taught how to load vaccine syringes from defrosting Pfizer -70 degree vials, supplies distributed, and employees started rolling in, paper consents in hand.
We vaccinated over 2500 employees on Friday, a great day and smooth operation. See above for the write-up by the Greeley Tribune, among many news organizations on site.
The “Education Room”: Stories NOT Data
Here is where it gets interesting. I found out that I was assigned to the “Education Room” upstairs. Management at JBS was serious about maximizing employee engagement with this big push for vaccination.
The plant was closed for 2 days.
All workers would be paid for 4 hours of shift work JUST TO SHOW UP.
All workers who got vaccinated would receive an additional $100.
All workers who declined vaccine could sign a paper … AFTER they went to the EDUCATION ROOM where Dr. Lin and other physicians and nurses were waiting
Hmm. I thought I had signed up to vaccinate today …
When I heard this, my life flashed before my eyes. Not really, but I had a rapid sequence of thoughts:
I hoped they had enough translators (turns out, yes: Somali, Spanish, Amharic/Ethiopian, many more)
I hoped I had heard most of the rumors and misinformation about the vaccine before and be ready to respond
I hoped that I could avoid STATISTICS and DATA, since most vaccine-decliners have (mostly misinformed) STORIES. Data never beat a compelling Story. Only Stories have a chance to fight Stories in the battle for feelings and changing minds.
I thought back to a book I read recently, The Righteous Mind, about values, moral thinking, and how those with liberal values, and those with conservative values see morality with very different lenses. Would I be able to speak a common language to connect with those who saw the world differently?
Reasons why NOT?!?
Yes, it turns out, we only had about 100 people come through for the 6 hours I spend there. Of the 100 we spoke with, I heard a dramatic range of reasons why people were declining the vaccine:
“Well, it’s not a real disease anyway.”
“I heard the vaccine kills people.”
“The vaccine is only 95% effective. So what is the point? Like, it doesn’t even work.”
“I heard it is made from dead babies.”
“Only old people have a problem with COVID.”
“I am healthy. I don’t live with old people. I don’t need it.”
“My roommates will make fun of me. We are not getting it.”
“My parents told me not to get it.”
“Why are WE the guinea pigs, before everyone else?”
“I’m going to wait and see.”
“I’m pregnant. I heard it is dangerous for my baby.”
“I already had COVID. So, I’m immune.”
“I never get ANY shots, flu, nothing. I don’t need it.” (and more)
This was a daunting task. However, we had a room full of translators for all languages, 3 tables set up with information sheets and 3 cultural ambassadors to explain the importance of the vaccine and WHY JBS managers and leaders thought this was important, and even Union Leaders who would show videos of themselves getting the shot themselves (thank you JBS; very organized!). THEN, if the participant was adamant about their decision, fine, go sign the paper and get paid.
Less Helpful Conversations?
IF they had a question, one of us would get called over, and we could chat. I heard a few discussions in the room. Some less effective approaches:
Employee: “I don’t want the shot. I already got COVID. I’m immune.” JBS Supervisor: “I haven’t got COVID. I’m not immune. You don’t care about me?” Employee: “Nah man, stop talking. Where do I sign the paper.” (Confrontational)
Employee: “I don’t want the shot. I’m healthy.” Medical advisor: “You know, the shot is 95% effective. Even though it doesn’t protect everybody, the data shows that almost everyone gets immunity. Even if you DO get the infection, it is likely milder and you won’t have symptoms.” (Data-heavy, confusing, and not addressing the issue)
Employee: “It is not a real disease.” Medical advisor: “Yes it is. People die all the time. Here are 5 reasons the shot is safe and the evidence that it works…” (Not enough reflective listening, eliciting thoughts, trying to find common ground, and too much talking)
Whew. I could see myself falling into each one of these traps. I set myself a goal to find STORIES to match and counter their STORIES and to suppress temptation to exhibit my command of the DATA (sooo hard).
Here are some of the better ones we came up with. Importantly, ALWAYS begin with “What questions do you have?” and “Tell me more about what you understand.” and “Anything else?” and “I like that you are trying to get good information before making a decision. This can be very confusing and scary. I would like to help.”
Employee: “I’m pregnant. I’m afraid for my baby.” Me: “Yes, there is less information from the vaccine tests about pregnant women. HOWEVER, MOST of the women doctors and nurses at University Hospital who are pregnant have gotten the shot. And we are confident it is safe for the mom and baby.” (result: agreed to shot)
Employee: “I heard the shot makes you sick.” Me: “Well, most people do not get sick. If they do, some get a sore arm, or a headache or fever, like getting the flu. Tylenol helps. For me, I had a fever for about 3 hours overnight.” (result: agreed to consider it later)
Employee: “Why are we the guinea pigs and getting it early?” Medical advisor: “Actually, the doctors and nurses were the guinea pigs; they got the shot back in December and January. We are all healthy and staying safe, with no major side effects. We want YOU to be protected too.”
Employee: “I just don’t want to do it.” (unable to state a clearer reason) Me: “I hope you see all the doctors and nurses in this room. We are all volunteers, took a day off to come here, because we WORRY about you and your community. You are Essential workers. Last year, many of your co-workers got sick and died, and we did not protect you. We don’t want this to happen again.” (result: thanked us for volunteering, and promised to consider vaccination)
Of 100 people, about 20 agreed to the shot during our session, about a 20% conversion rate. Is this normal? I have no idea. One of my colleagues noted:
“Compared to vaccinating, this is soul-crushing. To do your best explaining why a crucial vaccine would save lives IN THIS PLANT, and not to connect. So hard.”
Nurse Practitioner in the Education Room at JBS
At the same time, we all agreed that many of the decliners also said they would think about it some more, and would consider getting it later. In motivational interviewing lingo, perhaps they were moving from “pre-contemplative” to “contemplative.” Even a mild attitude shift like that, is a win.
Some of the more effective strategies:
Listening more than talking
Finding common values: “The Broncos!” or “Protecting elderly parents”
Telling a personal story of COVID or getting vaccinated and how it felt
Talking about “looking out for each other” “protecting our community” “making Colorado safe” “keeping Covid out of your family”
Using metaphors: “Which vaccine? Its like, Dodge, Ford, Chevy. Just get in the car. We will all get there.”
Dr. Steve Hoffenberg, Emergency Medicine Physician, coordinated the vaccine efforts at JBS. Thank you, Steve.
FINALLY: Will you look over this document with me? I wrote a ONE PAGE summary of what I thought were the BEST STORIES to fight misinformation about COVID Vaccine. What do you think?
CMIO’s take? Wow, there is a lot more to vaccine work than “give shot, call next patient.” Coordinating a public health effort: massive. Focusing on high risk populations: important. Listening, connecting and changing minds: some of the hardest work of all. In the coming months, THIS will be the conversation.
Kevin Kelly: co-author of the defunct but world-changing Whole World Catalog, publisher of Cool Tools, author of What Technology Wants, and generally smart guy, is 68 (or was when he posted this). Brilliant observations. This is me Plus-one-ing his post. Some teasers:
Learn how to learn from those you disagree with, or even offend you. See if you can find the truth in what they believe.
Being enthusiastic is worth 25 IQ points.
Always demand a deadline. A deadline weeds out the extraneous and the ordinary. It prevents you from trying to make it perfect, so you have to make it different. Different is better.
CMIO’s take? Happy new year. Go read it, link above.