Harvard Business Review: How to save a meeting that’s gotten tense.

https://hbr.org/2017/12/how-to-save-a-meeting-thats-gotten-tense?utm_source=twitter&utm_medium=social&utm_campaign=hbr

I have a love-hate relationship with the Harvard Business Review. First, I think many of their articles are well-written, thoroughly researched, or illustrated well with specific business cases. I often learn a great deal about my own work through this mirror.

On the other hand, it is like drinking from a fire-hose. Subscribing to HBR gets overwhelming, and I start getting months and issues behind, unless I block out a couple of hours to read the mag cover to cover.

On the other hand, HBR has seen fit to create and publish online summaries of many of their articles for free. They also interview their authors for an online podcast. Both are effective and get their brand name out there. I also find these easier to consume.

This is one of those online articles. Meeting are a big part of my day. If you ask me, too big. But, over the years I’ve developed a number of meeting skills that have served me well, and this is a great summary of one of them.

FIRST LISTEN. Do not interject, do not object, do not state your position UNTIL YOU HAVE RESPECTFULLY LISTENED and also briefly summarized your understanding of the other participants in the meeting. This is also covered by Stephen Covey’s Seven Habits of Highly Effective People. “SEEK TO UNDERSTAND before being understood.” Crucial Conversations, is a book that also covers this: “Control your own stories. Make it safe for all. Enlarge the pool of meaning, before stating your own path.”

Once everyone has felt “heard” then and only then can a productive discussion begin. Unfortunately many meetings skip this important step and become contentious and “tense.”

CMIO’s take? Meeting SKILZ! Learn them. Lots of books on the subject. Pick a good one (like those above), devour the content, and be humble enough to know that every one of us can be better. Meetings are how large organizations make progress. Being a meeting master disproportionately influences the value of an organization.

Slicer Dicer: UCHealth providers carve up data to bolster care (article)

slicer-dicer-lead-photo-sharper-sized

https://www.uchealth.org/today/2017/11/01/uchealth-providers-carve-up-data-to-bolster-patient-care/

Thanks to my good friend Tyler Smith, a freelance writer who published this article in the UCHealth Today newsletter, on how our doctors, nurses and staff are using Epic EHR data to improve care, through an innovative self-service analysis tool that even busy providers can use to create and run reports of “missed opportunities” and get patients the care they need (vaccines, screenings and the like). Thanks for the great write up!

CMIO’s Take? The Health IT world of EHR’s needs a better, more consistent way to share our successes; all the great work we are doing. The perception from many is that “The EHR is just a black hole. You give and give, and nothing every comes back out that is useful.” Well, we beg to differ. We just need to get the word out so more people know. How is your organization doing this?

Addendum: Happy thanksgiving everyone – hope you all have a great break.

Politico (and HuffPo): The Doctor of the Future (with stuff about us, and Care Redesign at UCHealth!)

img_2227
Not only do Christal and Kathy play healthcare professionals on this website, they also do so in real life.

Thanks to Sophie Quinton at Stateline, published in Politico 10/25, for a nice feature article about Care Redesign at UCHealth:

http://www.politico.com/agenda/story/2017/10/25/role-of-physician-in-healthcare-000554

And 10/26, in HuffPo!

https://www.huffingtonpost.com/entry/team-approach-to-health-care-means-new-role-for-doctors_us_59f09780e4b02ace788ca8fb

DENVER — When patients go to see Dr. C.T. Lin for a checkup, they don’t see just Dr. Lin. They see Dr. Lin and Becky.

Becky Peterson, the medical assistant who works with Lin, sits down with patients first and asks them about their symptoms and medical history—questions Lin used to ask. When Lin comes in the room, she stays to take notes and cue up orders for tests and services such as physical therapy. When he leaves, she makes sure the patient understands his instructions.

The division of labor lets Lin stay focused on listening to patients and solving problems. “Now I’m just left with the assessment and the plan—the medical decisions—which is really my job,” Lin says in a quiet moment after seeing a patient at the Denver clinic where he works.

We’ve been trying lots of things in our clinics at UCHealth because there is a national crisis of physician burnout, a national imperative to improve patient satisfaction, a national push towards electronification of healthcare, and a national imperative to improve quality.

We are of course, continuing our work on EHR 2.0 Sprints: see past posts Epic Sprint! Or, how we learned to love the EHR (part 1)Patients come second (so that everyone does better)! Addressing Physician BurnoutEHR Sprint team: work hard, persevere, sometimes you get to build a dream team, and stay tuned for future posts to come.

This is, so far, a separate initiative of improving teamwork, team-based care, returning joy to healthcare work. In short, we:

  • Added Medical Assistants to a primary care clinic to invert the usual ratio of 1 MA to 2.5 MD’s, to 2 MA’s per 1 MD.
  • Created an MA academy to retrain MA’s to work at the top of their certification (about tripling the usual tasks they do in the care of a patient)
  • Added scheduled time BEFORE a physician visit for MA interview and documentation
  • Asked the MA to stay in the room and scribe the patient’s history, examination and some parts of the assessment and plan, pend any orders or referrals or prescriptions for the physician
  • Asked the MA to retrieve any equipment or education needed by physician
  • The MA then completes post-visit tasks, vaccinations, education, after-visit summary printing, reminders, phlebotomy, followup appointments.
  • Physicians then move room-to-room as MA’s stay 1 patient ahead

As a result,

  • Physician burnout falls from 55% to 13%,
  • MA satisfaction and engagement improves,
  • Patient satisfaction improves,
  • Cost-per-visit DOES NOT CHANGE,
  • Access to care improves (more new patients, shorter wait times)
  • Quality metrics improve (non-physicians pay more attention to consistent screening for vaccines, colonoscopy, PAP smears, foot exams, prescription renewals, standard monitoring for chronic illness).

I have to acknowledge the hard work of our Family Medicine colleagues at AF Williams Stapleton Family Medicine and the Snow Mesa Poudre Valley Internists clinics in the University of Colorado “UCHealth” system, who pioneered this work, based off of the Care by Design model from Utah. Thank you to those who blazed a trail.

CMIO’s Take? What’s not to like? Despite “who moved my cheese” change-management issues, we’re finding that we run out of qualified MA candidates, we are hiring so many. Is this the doctor of the future? Team-based Healthcare of the future? Was healthcare supposed to be a team-sport from the beginning? It is one vision, and a darned good one so far.

2017 Becker’s review of CMIO’s (I made the list!)

noun_1187100_cc

https://www.beckershospitalreview.com/lists/50-hospital-and-health-system-cmios-to-know-2017.html

This is interesting. Nice to be recognized by Becker’s. Seems like the “CMIO’s to know” list grows each year. And, as long as I’m on the list, I’d say this is an AMAZING, THOUGHTFUL list. If I were NOT on the list, I would of course call this a nonsense popularity contest.

CMIO’s take? A CMIO’s work is never done. We will soon be in a post-fee-for-service world. In this new world, it will be necessary to re-invent healthcare teams AND optimize the EHR AND stay ahead of the uncertainty and tumult to come.

“Fasten your seatbelts, it’s going to be a bumpy ride.” (Misquoted from Bette Davis in “All about Eve”)

Article: Hot Button from the AMA community: How to make EHR’s better

easy-button

https://wire.ama-assn.org/practice-management/hot-button-topic-how-can-we-make-ehrs-better-more-usable

Thanks to the AMA for a “Running Your Practice” community discussion on “How can we make EHR’s better and more usable?”

I enjoyed being part of the panel discussion and hearing different perspectives on how health care organizations are tackling “optimization” “efficiency” “patient-centeredness” “vendor accountability” “customization” “team-based care” and “practice redesign” to improve satisfaction and reduce physician burnout.

CMIO’s take? Lets learn from each other. There are more smart people who DON’T work for you, than who do.

30 Second Trick for Learning and Memory

30secTimeIMG

http://www.huffingtonpost.com/robyn-scott/the-30-second-habit-that-_b_4808632.html

Something I learned while taking that Coursera course on Learning how to Learn. Turns out it is never too late to learn something new. Here’s an idea that you can LEARN IN 30 seconds, and could have lasting repercussions:

Summarize your last meeting, or discussion, or class, or event that you want to remember, in 30 seconds. Maybe even an entire book. The act of having to prioritize, to summarize, to choose what is important, to actively recall — this engages the frontal cortex just enough to help re-inforce memories. It is indeed a “mind-sprint” equivalent of an 100-yard dash.

This is not only backed by science (see that Coursera course!) but feels right. I currently use a little black book to write down minutes of my meetings. However, I DID NOT take the extra 30 seconds to summarize. I think I will begin doing this.

CMIO’s take? Just like one should never be “too sick to go to the doctor,” one is never too old to learn something new. Thirty seconds is all it takes. Do you do this? Let me know!

 

Instagram is a diagnostic portal for depression (NYTimes)

From the colors and faces in their photos to the enhancements they make before posting them, Instagram users with a history of depression seem to present the world differently from their peers, according to the study, published this week in the journal EPJ Data Science.

I love work like this; the growing links between disparate databases that lead to innovative ideas, weird conjunctions (Conjunction Junction, anyone?). I could imagine asking our patients to grant us access to their twitter handles, their instagram posts for purposes of diagnosis, follow-up. These are fascinating, uncharted waters.

I look forward to more cool mash-ups like this in the future.

Patient Engagement HIT article on patient access to Medical Records

File sharing and transfer vector concept
From Patient Engagement HIT

Thanks for a great write up from Patient Engagement HIT, on the important topic of the Pros and Cons of Digital Patient Health IT access. It is hard work, an uphill climb, a Sisyphean task for those who promote cultural change in physicians, clinics and hospitals, but worth it in the end.

“Do you want patients to call us with terminology questions? Will they be offended when we call them obese? Or if we say they’re smoking or they smelled like smoke? This is going to be terrible,’” Lin recalled his colleagues saying.

https://patientengagementhit.com/news/4-pros-and-cons-of-digital-patient-health-data-access

The CMIO role will evolve as health systems’ needs (HealthcareDIVE)

9fb2bb859d43a2f0e2bb060b704ba712

Image courtesy of HealthcareDIVE

Thanks to Meg Bryant from HealthcareDIVE for a nice article about the evolving role of the CMIO. My quote:

“If implementing an EHR was constructing the basement of the house, we now have demands on building the first, second and third floors,” he says. “How do we innovate to reduce costs, increase quality and reduce physician burnout all at the same time?”

http://www.healthcaredive.com/news/the-cmio-role-will-evolve-as-health-systems-needs-change/439941/

Wall Street Journal: How to get patients to take more control of their medical decisions (news)

he-aa316_active_p_20170223120405
Courtesy of Wall Street Journal original article

At UCHealth, based in Aurora, Colo., as soon as a doctor finishes signing a note, it is available to patients in their electronic record, according to CT Lin, chief medical information officer. Doctors are encouraged to use language such as “you and I have agreed that you will take these actions,” Dr. Lin says. Bella Wong, 39, who had a double lung transplant four years ago at UCHealth’s University of Colorado Hospital, says online access to her own records and doctors’ notes has helped her become a more engaged patient than when she was first diagnosed with lung disease eight years ago and left decisions mostly to doctors. Though she once viewed the word of doctors as “gospel,” she says of her relationship with them now, “I want to know everything that is available to me and understand all my options—you are not just telling me what to do, we are making a decision together.”

https://www.wsj.com/articles/how-to-get-patients-to-take-more-control-of-their-medical-decisions-1488164941

Thanks to the Journal and Laura Landro for a great writeup. Proud of our team, our patients and our organization for sharing this journey.