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.

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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

 

Review: Stargirl

Stargirl
Stargirl by Jerry Spinelli

My rating: 4 of 5 stars

My teenaged daughter handed this book to me with a smile, stating that I might enjoy it. She’s almost always right. For some reason I do enjoy YA fiction. Is it the yearning? The optimism? The world view that “anything is possible, but its just so HARD for me right now?”

Nevertheless, this was a fun, quick read. Not perhaps in the same category as “The Fault in our Stars” but a solid rollercoaster of a read. Stargirl is a fanciful embodiment of Richard Feynman’s “What do you care what other people think?” Playing ukulele, dressing up, oblivious to the stares of others, Stargirl is both attractive and repulsive to the high-school mindset. Interesting to read it as an adult, with perspective. I’m looking forward to reading the sequel.

My favorite quote of the book:
“Like so many of Archie’s words, they seemed not to enter through my ears but to settle on my skin, there to burrow like tiny eggs awaiting the rain of my maturity, when they would hatch and I at last would understand.”

CMIO’s take? The pressure of conformity, of habit, is comforting, lulling, deadening. Sometimes it takes an extrovert or an unexpected event to shake us out of our doldrums and open our eyes again.

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Review: The One Thing: The Surprisingly Simple Truth Behind Extraordinary Results

The One Thing: The Surprisingly Simple Truth Behind Extraordinary Results
The One Thing: The Surprisingly Simple Truth Behind Extraordinary Results by Gary Keller

My rating: 5 of 5 stars

So, is it realistic to clear 4 hours of your work day EVERY DAY to work on your ONE THING? Yes, I agree, not going to happen, even if Gary Keller tells you to. However, it is inspiring to read about new ways of working, new ways of structuring the day, the week, the month, to think about focus. Given the 17 priorities I’m working on now, and my many colleagues with highly variant concerns and demands, I completely understand where this book comes from and its audacious goal.

I also know, from my recent work on APSO notes (inverting the SOAP progress note written by doctors, to place the Assessment and Plan at the top of the note, for easier reading and understanding by all), and making this change (highly resisted, because IT’S DIFFERENT AND UNFAMILIAR) throughout the 3000 doctors at our hospital system, that this was my primary focus for years, until it was achieved as a universal standard. Focus does have its benefits. When I look back on my career, it is NOT the hundreds of smaller projects, or the hundreds of thousands of emails I crafted or responded to, it is not the ‘crucial conversations’ I had with individual docs and patients that maybe moved their beliefs and attitudes very slightly. Instead, I look back at BIG projects that were HARD, and where we accomplished something as a team, as an organization.

CMIO’s take: In hindsight, it was the unintentional “One Thing” attitude that put these projects over the top. Perhaps I could learn from my past, of the projects never reaching fruition, and the few that did, and allow the “One Thing” more of an influence in what I do. Highly recommended as a book.

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Review: Steal Like an Artist: 10 Things Nobody Told You About Being Creative

Steal Like an Artist: 10 Things Nobody Told You About Being Creative
Steal Like an Artist: 10 Things Nobody Told You About Being Creative by Austin Kleon
My rating: 5 of 5 stars

This is a fun read. If you’re human, you are creative. This book gives you permission to open your arms, in big scribbled words, to something new, and not let your frontal cortex shut it down as “stupid, anyway.”

Austin unlocks the fun hidden deeply in your teenaged soul, suppressed by years of schooling and working. If you have 10 dollars and a free hour, read this book. Such an easy way to get a new perspective on creativity, enjoyment, and life. As a CMIO, my take is: many folks at my work desperately need to read this book.

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Galileo! Galileo! And enjoy the holiday season, y’all

 It seems to me that we all have less time, too many emails and too much to do. Sometimes we need to look at opportunities to slow down and sit and listen. 

Today, our UCHealth leadership brought in the Denver School of Performing Arts orchestra, right into our hospital auditorium, and I caught a bit of their performance of ‘Bohemian Rhapsody.’ Fun, amazing, and brought a smile to my face. Here’s 30 seconds. Hope you all have a happy and enjoyable holiday season.