Archivi del mese: dicembre 2012

The positive side of physician burnout @Medici_Manager

by Kenneth H. Cohn

My 86-year-old mother, who values her privacy, would be upset to learn I am writing about her, but I suspect our situation is similar to that of many children trying to care for aging parents while living hundreds of miles away from home.

Last Friday, she developed painful leg swelling that turned out to be due to a blood clot. Our family arranged with her physician for visiting nurses to give her shots of Lovenox until she was anticoagulated on warfarin. Two days later, the visiting nurse contacted me that she seemed confused and out of breath; we arranged for an ambulance to take her to a nearby emergency room.

Within an hour, I received a phone call from the most pleasant emergency room physician with whom I have ever spoken. She explained my mother was experiencing a rapid heartbeat from atrial fibrillation. She outlined the tests she needed to run, estimated the time they would take and promised to call me back as soon as she knew the results. Her voice was professional and soothing. She spoke from experience and made my mother and me feel special.

She called me back hours before her estimate, reassured me that my mother had no evidence of a stroke, and arranged admission to a telemetry unit that would monitor her heart rate and rhythm continuously.

When I told her how easy it was to talk with her, she said she had been a heart surgeon until she began to experienceburnout after eight years in practice. Having spent a total of six months of my surgical residency on the cardio-thoracic surgical service, I could only imagine how difficult life had been for her. A thoracic surgeon I know wrote about surgery as an impairing experience in “Better Communication for Better Care.”

The happy ending for her and her patients is that this doctor has found her niche. She is the perfect cultural ambassador for patients and their families who come in through the ER.

When I mentor fellow physicians, I often hear them say it is easier to become a highly trained specialist than to figure out what to do with their lives after being in practice for several years (or decades). I could tell that my mother found the experience reassuring because, as she awaited transfer, she said to me, “Kenneth, I have just two words for you, ‘Don’t worry.'”

I welcome your input.

Ken is a practicing general surgeon/MBA and CEO, who divides his time between providing general surgical coverage and working with organizations that want to engage physicians to improve clinical and financial performance.


Actually, People Love Change @Medici_Manager @timkastelle

by  on 8 November 2012 in leadershipManagement

“People resist change.”

I heard this about 10 times at a workshop yesterday where I gave a keynote.  After about the fifth time, it got me thinking.  When I went up to give my talk, I asked people to raise their hands in response to these questions:

  • Who has moved away from the town or city that you were born in? (almost everyone) Who has moved to a different country? (about half)
  • Who has gotten married? (almost everyone)
  • Who is a parent? (more than 3/4)
  • Who has moved into a job that is different from the first one you took after you finished higher education? (everyone except the handful of PhD students who have just finished their higher education).
  • Who didn’t raise their hand at least once? (no one)
  • So, why do we say that people hate change?

It turns out that people don’t hate change at all.  In many cases we actively seek out change.  We move to a new city or country, we get married, we have children, we take a new job.  These aren’t just changes – these are massive changes.  And we often seek them out.

People don’t resist change.  At least, they don’t when they expect the change to make their lives better.


The kind of change that people resist is the kind that makes them worse off.  Like letting 10% of your staff go, and expecting the rest to do the same amount of work with far fewer people and resources.  That’s not good change, nor is it inspiring.

Sometimes in a crisis you do have to make that kind of change – it’s the only way for your organisation to survive.

But most of the time, people will embrace change – they just need to see what’s in it for them.

If you’re trying to change things, here are some tips:

  • Solve a real problem. If you meet a genuine need, you don’t often find resistance to change.  Well, you will, from the competitors who lose out, but that’s different.  This is another kind of change that people love.  When the polio vaccine was developed, people lined up to get it – even though getting a shot is no fun at all.  It solved a real need.
  • Turn up the purpose. Inside an organisation, change is often resisted because it is not clear how the new way of doing things will make things better.  This is especially likely to happen when the organisation does not have a shared purpose.
    Here is Nilofer Merchant on the importance of vision:

    I see executives regularly saying that they want to “transform the business” or “win the market”, but they can’t point out an end destination. And when I ask, I usually get that, “just leave me alone” look. But here’s the deal. “Transform the business” could mean just about anything, especially to the people who weren’t in the core room where the discussion and debate happened. It leaves too much interpretation up for grabs. It is fuzzy. And fuzzy doesn’t help. Fuzzy means no one can help you do it fully because they need to keep checking in. Fuzzy doesn’t turn on the spark of creativity to generate ideas on how I can help you. Fuzzy creates a dependence, rather than allowing interdependence and action by everyone.

    Her solution? Articulate a clear vision.

  • Connect. You can’t meet genuine needs if you don’t understand the people that will be affected by the change.  Your best strategy is to connect with them, and build that understanding.

I’m not trying to oversimplify this.  Innovation is hard – if it weren’t, everyone would do it.  Change is hard – if it weren’t everyone would adapt easily.

But if you’re finding that people are resisting the change that you’re proposing, that’s a very strong sign that you don’t understand what they need, and you haven’t  articulated a clear vision of the future.

Deep in their hearts, people love change.  That’s why we actively seek it out when we want to make our lives better.  If people are resisting your change, you’re not meeting their needs.

You should change that – it will make your life better.

About Tim

Idea Connector – Studies innovation networks – author, speaker & consultant on innovation – University of Queensland Business School – links to academic papers, twitter, and so on can be found here.

Top Ten Medical Uses of the iPhone @Medici_Manager @muirgray

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(SOURCE: John Bennett MD:
December 15, 2012

The creation and widespread use of the iPhone has impacted many industries, and now has affected Medicine in many ways.  In manycases the iPhone applifies the power of the device to which it is attached by its computing power.  In some, it uses it powerful photographic and optic powers to affect change.

We will examine the Top Ten Medical Uses that we feel has, and will have, a deep impact on the practice of healthcare.

1. The iPhone as  Otoscope

The Otoscope using the iPhone is also called the Remotoscope, and sometimes Cellscope.  The versatile ole iPhone is used to, not only view the inner ear with magnification, but also take pictures, to send to doctors, or specialists, from home or remote areas.  It is approved by the FDA.  This is yet another use of the iPhone as a periperal device useful in Internet Medicine.

2. The iPhone as  EKG: AliveCor

Just recently approved by the FDA (December 2012) the iPhone ECG is a single-lead electrocardiogram reader that attaches to the back of an iPhone and displays heart rate info via an app. (An Android version is in the works.) The creator, Dr. David Albert, is an Oklahoma Cardiologist, who likes to be called an “Inventor”.  Son of former Speaker of the House, Carl Albert, David believes the iPhone ECG could be used in intensive care units and used by EMTs.   His team is recently compiled data in June 2012, after which his company received more funding  from the powerful Qualcomm, a big company in the wireless industry.

Basically, a peripheral device, projected to be around $100, is attatched to any Smartphone, and a real time, a high quality one lead EKG can be done. This EKG can be done anywhere a Smartphone goes, and allows for rapid, quick assessment of some cardiac problems in the field, including rhythm disturbances. To truly diagnose a full MI, however, the AliveCor is not able, since it does not give a total picture of many leads. A full EKG is indicated as Dr. Albert maintains to truly diagnose an myocardial infarction.
Additionally, its’ low cost also allows for mass screening in developing countries.

And like any wireless device, one is allowed to transmit any questionable EKG to any other Smartphone, which allows for in-the-field consultations with cardiologists, which are relatively scare in developing countries.

The thrust of this well-funded company is global. The company has moved to San Francisco.

AliveCor’s ECG device basically enables medical professionals and regular consumers to monitor a person heart health. Its cardiac monitoring technology is designed to work with the iPhone, iPad and Android devices.

3) The iPhone as a Microscope

 One has to stop thinking of the iPhone, Android, Blackberry as a phone, when dealing with its place in Internet Medicine.  It, rather, should be thought of as a powerful mini-computer, with a state-of-the-art photo equipment.  Yes, that little thing.  It can be converted to a powerful, picture-taking camera, to act as a supremely useful  peripheral device.

Of course, this would not be neeedd in most labs, but in rural area, in underdeveloped countries, it would  have unlimited potential.  No phone connection is needed, simply the peripheral and the smartphone without an internet connection.  Of course, a connection would be needed if the image is sent to other parts of the world to be interpreted.  The device will prove to be invaluable in underdeveloped countries where cost and distance are now problems to diagnose the common infectious disease in the Third World.

Here’s a comparison of microscope photos taken with a high-resolution camera, and one with the smartphone:

Basically, there is a combination of finding the right economical lens, and developing software to work with the image. The aim in underdeveloped countries is the diagnosis of infectious diseases, TB, malaria, and other microbes.


Above , in the top row, are images of pollen seen under a normal microscope.  Below are Smartphone images.  This is included, not only for teaching purposes, but because it is beautiful and colorful, and it might break the page up a bit.

The miraculous thing about smartphones and the use of the microphone, is that is shows the unlimited, fantastic potential of using portable computers for use in the field, in uses which will be tremendously exiciting, and useful in the healthcare field throughout the world, and will undoubtedly find niches heretherefore unreached.  Whew, I love using that word “heretherefore”.

4) The iPhone as a GLUCOMETER : IBGStar

What is called a “Killer App” will be the creation of a non-invasive way to measure serum glucose.  That day has not arrived yet, at least none has been approved by the FDA, but that day will soon come, andALTAPURE says they will be the first.

Until then, we have peripheral devices as on this page.

IBGStar is a blood glucose meter plug-in for the iPhone   There is a  an iBGStar Diabetes Manager App that tracks blood glucose, carbohydrate intake, and insulin dose.The benefit of this peripheral is to manage your regimen of care of the diabetes, by posting alerts, keeping log, etc.

Finger sticks with the lancet are still required. There are other devices on the horizon of the digital revolution that will avoid being stuck to check glucose.

5) iPhone as a Skin Scanner: THE  DERMATOSCOPE


From Germany, we have the development of the “Handyscope”, or Dermatoscope, which is a case that fits snugly over an iPhone, and takes up top 20x magnification. It also has accompanying polarized light to better show the skin lesion.

easily save the picture, send it to a collegue by email, or send it to the desktop.

6)  The Smartphone Ultrasound

Inexpensive, Mobile, Wireless, Portable Ultrasound

This groundbaking mobile, wireless, portable ultrasound is sure to find widepread use in all medical settings across America, and the world. And it is inexpensive, which will lead to even wider use, especially in rural and third-world areas. This device will find widepread use in Emergency Rooms, and in the surgical and medical wards, as well as in office practice. Of course, there will be times when a higher grade ultrasound will be needed, but this Smartphone Ultrasound is a great start for diagnosing all types of medical problems, as a screening device., for medical conditions  such as vascular problems, gallstones, kidney stones, abdominal masses, and other problems.  This invention will be brought to areas that could not afford it, or live in inaccessible areas.

The above model is a Mobisante, which is the world’s first smartphone-based ultrasound imaging system, the MobiUS™ SP1 ultrasound system. This device has been approved by the FDA is made to order to reduce healthcare costs and improve diagnostics in areas that cannot access imaging centers..

In their words, .”….MobiUS fuses the power and wireless connectivity of a smartphone with the Internet into a game-changing diagnostic solution that is personal and accessible. Our patent pending intellectual property makes the system easy to use and to share information with remote providers.”

7) The iPhone as a PETRI DISH

At Caltech, engineers have created a device, that aids in the process of identification of micro-organisms, with the Petri Dish process.  The iPhone is used, along with a Lego Frame, to read the Petri Dish in real time, after it is put into the incubator.

8) The iPhone to Aid Slit Lamp:  Eyepiece Digital Adapter

The above shot from aniPhone is looking at the back of the eye, at the all-important retina, a frequent site of pathology, especially for diabetics.

Eyepiece adapter for the iPhone. You can plug in your iPhone 4 or 4s and take high definition pictures and video.  Equipped to adapt to most slit lamps on the market today. (to see some examples of pictures taken with the iPhone and the slit lamp adaptor, go HERE)

Again, one can take pictures of the images seen through the slit lamp, and send them anywhere there is internet, which one of the principles show by this device.  Minicomputers getting stronger, and more work-outsourced to patients, in the future.

9) iPhone to Measure BLOOD PRESSURE: Withings Blood Pressure Monitor


This iPhone peripheral blood pressure cuff, does readings, and the app is programmed to record the readings, time of day, and keeps a log.  Also allows you to send your record to whereever you wish, including to your doctor.  This device allows a truer measure of blood pressure, avoiding “white-coat hypertension” or having falsely high readings at a doctor’s office.

The important part of a device such as this, is that allows for neat, easily retrievable records to be kept, made into graph forms by the software, and will make the patient more concious of the trends of the blood pressure.

There is also the option of using Microsoft® HealthVault™ , which keeps all your health records in one place.


SpiroSmart iPhone App

Accurately Estimates Lung Air Volume

iPhones will soon take the place of the spirometer.  At the University of Washington Medical Center, an iPhone App has been developed to make an algorithm with the audio portion of an expiration, and there is a 5% difference in studies performed, compared against the ole spirometer.

This sprirometer is based on the same principles of work that is being done on the early detection of Parkinsonism, based on the sound waves generated by a persons voice on the phone.

iPhone Breathalyzer

Another use of the iPhone is used with a peripheral used as a breathalyzer, to detect alcholo levels, from your expiration.

“Most people keep their phones on them at all times (including when you’re drinking), which is why the iPega Alcohol Breathalyzer is so convenient. This portable breathalyzer plugs right into the bottom of the iOS device and displays the 2 digit BAC (blood alcohol content) on the LCD screen. No need to use blowpipe, just blow into the air hole.”

Could help with avoiding drunk driving.

See slideshow to see how it looks on the iPhone.


And, as a bonus for reading this far, we are presenting one of the most fascinating, and potentially earth-shaking uses of the iPhone, early in its development in Denmark


At the University of Demark, research is being conducted on using the Smartphone, along with specially programmed software, and a specialized headset, to do portable, mobile brain scans.  Of course, it is just in the beta stage, but goes to show the potential of this powerful little computer, known as a Smartphone.


The system is a mobile, wireless, real-time brain scanner, and the software allows for wireless transmission to the Smartphone program, which receives the EEG-like transmissions from the various electrodes on the head, and like anything recored on the Smartphone, can be sent to a consulting physician, anywhere in the world.  In their words:

“Our system provides a fully portable EEG based real-time functional brain scanner including stimulus delivery, data acquisition, logging, brain state decoding and 3D activity visualization. The software is realized in Qt. The raw EEG data is obtained from a wireless Emotiv 14 channel Neuroheadset with a sampling rate of 128Hz and electrodes positioned at AF3, F7, F3, FC5, T7, P7, O1, O2, P8, T8, FC6, F4, F8, AF4 (the international 10-20 system). The headset transmits the EEG data to a receiver module connected to a Nokia N900 phone. The binary data is decrypted directly on the phone, filtered and passed to the source reconstruction module that outputs the colors of model vertices for the visualization. The source reconstruction is performed over number of samples (default over 16 samples resulting in 8Hz visualization). The delay between the signal appearing in the headset and being visualized on the screen depends on the used source reconstruction window and is between 130 and 150 msec for 8Hz visualization. The framerate of the visualization (realized in OpenGL) is around 30fps.”

Source code and additional information is available on the smartphonebrainscanner2 project website.
(From milab, at University of Denmark. Milab is a laboratory at the Cognitive Systems Section at DTU Informatics offering an environment for research and teaching in the areas of mobile context awareness, media modeling, and user experiences.)

Lucida e sintetica analisi della retorica della razionalizzazione

Keynes blog

davanzatidi Guglielmo Forges Davanzati, da Micromegaonline

Per “razionalizzazione” si intende un’operazione di politica economica finalizzata a rendere più efficiente il funzionamento di un sistema economico, attraverso il contenimento (o l’azzeramento) degli sprechi. Il termine è talmente abusato nel dibattito italiano da renderlo sostanzialmente vuoto e, al tempo stesso, da renderlo socialmente accettato, dal momento che è difficile immaginare che un cittadino dotato di buon senso possa invocare politiche che incentivino prassi inefficienti. Va però rilevato – cosa ben nota agli addetti ai lavori – che, in Italia, con la massima intensità negli ultimi anni, per razionalizzazione si intende, di fatto, un’azione unicamente finalizzata a ridurre la spesa pubblica, che prescinde del tutto da considerazioni relative all’efficienza ed è unicamente motivata con l’obiettivo di accumulare avanzi primari.

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Guidelines to engage professionally in social media @Medici_Manager @kevinmd

by  on November 9th, 2012in SOCIAL MEDIA

The use of social media is a tricky business. A recent Wall Street Journal article points out the challenges that CEOs and business leaders face when using Twitter. Many CEOs and other executives relate stories of personal attacks and cyber stalking from disgruntled customers, former employees or competitors. Some have opted out of the social media space due to specific legal concerns. Other very successful business leaders continue to embrace social media and have developed a knack for keeping their tweets and posts professional. It is clear that social media is here to stay and that it can be a very effective marketing tool.

In medicine, social media can have far reaching effects. Twitter can allow a clinician to reach, educate and interact with a wide audience of patients, partners, and colleagues.   As I have mentioned in previous blog posts, social media is an effective tool for widespread communication and public relations. Nearly 50% of all Americans regularly use Facebook and almost 40% use Twitter.

Often CEOs and other business leaders seem distant and unreachable; a social media presence turns icons into real people who are accessible to all. Interestingly, many executives fail to see the return on investment (ROI) from the use of twitter and other social media outlets. According to the WSJ and an article in, 7 out of 10 leaders of fortune 500 companies have no social media presence whatsoever. However, there are real tangible benefits in both business and in medicine that can result from dedicated use of social media. An article online in April 2012 from suggests key reasons that CEOs should tweet and include connecting with employees, building relationships and connecting comfortably with the press. I believe that these applications are just the beginning. However, social media must be used responsibly and respectfully in order to be most effective.

Here are some guidelines that I like to follow when engaging professionally in social media:

1. Separate business and pleasure. A professional social media presence is just that- professional. Steer clear of posting personal items on twitter or facebook unless these are events that directly relate to or enhance your business or reputation. Certainly, it is important to help those who may follow you see you as a “real person” who is in touch with the “real world”. However, don’t cross the line.

2. Avoid polarizing topics unless the issue directly involves what you represent or stand for in your profession. For example, a discussion promoting healthcare reform or a “patient’s bill of rights” may be very appropriate for a physician to tweet or blog about. However, a physician should probably avoid posting religious or political views about abortion rights on twitter or facebook. Conversely, a CEO of an oil company may want to post about the benefits of offshore drilling even though it may be a very controversial topic. Social media allows you to tell your side of the story and can be a platform for you to provide data to support your opinion.

3. Respond to criticism in a respectful, thoughtful way. Not everyone is going to agree with you, your company or organization. Often, people feel free to express displeasure or disagreement very openly on twitter  (the internet allows people to hide behind a cyber curtain). Be careful to separate emotion from your response. Acknowledge alternative opinions and provide constructive comments.

4. Avoid saying bad things about others. Social media outlets are not the place to start a war of words. Make sure that you do not say anything about competitors, colleagues or others on twitter that you would not be comfortable saying directly to those individuals. Twitter is not the place to “air dirty laundry” or discuss private matters. Remember, twitter is a megaphone that broadcasts your message to millions of potential listeners.

5. Maintain a constant presence. Once you engage in social media, it is vital to remain regularlyengaged. Developing a following and a dedicated readership requires effort. You must provide fresh, relevant content. Avoid periods of “radio silence”. For instance, provide twitter content daily–spread out tweets to different parts of the day. I typically tweet several newsworthy items early in the morning and then again in the afternoon and evening. The only rule is be consistent.

Social media is the future. Early adopters are willing to take risks, have long term vision and already are able to see the ROI. Twitter, Facebook, and other outlets should be part of every leader’s job and executives should be held accountable for what is and is not posted. Social media provides opportunities in both medicine and business in general to educate, motivate and influence opinions. Careful attention to keeping posts professional and thoughtful will provide the best results. The world is getting smaller everyday. Twitter and social media outlets allow us to connect, interact and collaborate to accomplish common goals. Use your voice, be heard and Tweet away!

Kevin R. Campbell is a cardiac electrophysiologist who blogs at his self-titled site, Dr. Kevin R. Campbell, MD.


Il punto sulla promozione della salute in Canada dopo aver celebrato , nel 2011, i 25 anni della Carta di Ottawa.Il motore intellettuale del movimento rimane in Canada? Ecco l’intero rapporto.

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Brandeis professor traces efforts to reshape health care @Medici_Manager @DonaldsonLiam


When President Nixon wanted to overhaul the health care system to provide universal coverage, his administration turned to Stuart Altman.

Ten years later, when Congress created a commission to improve the Medicare payment system, Altman led the effort. And, in the early ’90s, when newly elected Bill Clinton assembled a team to guide his health care policies, Altman was among the first chosen.

There may be no single person with a longer or deeper history in the health care overhaul efforts of the past 40 years than Altman, a professor of national health policy at Brandeis University in Waltham. He has advised five presidents, both Democratic and Republican; authored countless articles about health policy; and served on a variety of task forces aimed at fixing health care on both the national and state levels.

These four decades as policy maker, adviser, and scholar play a central role in Altman’s new book, “Power, Politics, and Universal Health Care,’’ which traces 100 years of debate and confrontation over one of the nation’s most intractable issues. With President Obama’s health care overhaul under attack from Republicans – and certain to be a defining issue in the November election – Altman and his coauthor, former Brandeis fellow David Shactman, show that today’s controversies have roots in the political and philosophical battles that raged a century ago.

In 1915, for example, the American Association for Labor Legislation, a workers advocacy group, proposed that the US government provide health insurance for low-income workers and their families, similar to programs adopted in Germany and England. Special interests, including the insurance industry and American Medical Association, lined up against the plan. Conservatives, raising alarms about government intervention into the private sector, joined the opposition.

“Opponents claimed that national health insurance was a tool of socialists and communists – rhetoric that still reverberates today in the halls of Congress,’’ Altman and Shactman wrote.

Altman first became involved in health care reform in the early 1970s. He earned his doctorate in economics at the University of California, Los Angeles, where he wrote his dissertation on unemployed married women, then went to teach at Brown University. Former colleagues, working at the US Department of Health, Education, and Welfare during Lyndon B. Johnson’s administration, recruited him to study the supply of registered nurses in the workforce.

When Nixon was elected president, Altman stuck around. Although a Republican, Nixon was eager to propose a universal health care plan to compete with more far-reaching alternatives pushed by liberals such as Massachusetts Senator Edward M. Kennedy. Altman was asked to examine policy options. “I was sort of thrust into it,’’ Altman said.

The challenges he confronted – ballooning health care costs and high numbers of uninsured – were “the exact problems we have today,’’ he said. Watergate intervened before the administration’s proposal got very far, and Altman returned to teaching, at Brandeis, after Nixon resigned. But his involvement in policy making was far from over.

From 1984 to 1996, Altman chaired the congressional Prospective Payment Assessment Commission, an independent panel created to oversee Medicare payments to hospitals to help control health care costs. He worked on Clinton’s transition team, only to see his recommendations to build on the existing system rejected in favor of a more sweeping plan that died in Congress.

Altman later served on the Commission on the Future of Medicare during Clinton’s administration, and advised Obama on health policy during the 2008 campaign. Altman conceived the idea for his book during the early debates over Obama’s health care proposals. Ultimately, Obama got his overhaul passed without a single Republican vote.

Altman wanted to explore why health care has proven such a difficult, divisive issue, and why so many attempts to make it more available and affordable did not succeed. Franklin D. Roosevelt, Harry S. Truman, John F. Kennedy, Nixon, Clinton, and any number of lawmakers all failed to push through major proposals.

In fact, Altman and Shactman began their book assuming that Obama, too, would fall short. The book’s working title: “Failure Again.’’

Health care reform has been so intractable because it provides a lightning rod for long-running political and philosophical conflicts over the role of government, according to Altman. While the left favors a social safety net, the right fears creeping socialism. Conservatives prefer to let market forces meet health care needs, but liberals distrust the motives of private business. Advocacy groups representing special interests such as doctors, hospitals, and senior citizens fight any proposal that may cost them money, jobs, or influence.

With these opposing forces constantly in play, the history of health care reform is replete with attempts at compromise, but short on success stories.

In 1974, in a church basement near the US Capitol, opposing factions met in secret to craft a deal on universal health care. Among the attendees were Altman, representing the Nixon administration, and an aide to Kennedy, then advocating a single-payer system, similar to those in Europe and Canada.

“It would make a good ending to the story if the secret church meetings in June resulted in a successful compromise, but it was not to be,’’ Altman and Shactman wrote. “Neither side felt they could agree to the concessions necessary to make a deal.’’

At 74, Altman remains immersed in health care policy. He advises lawmakers, administration officials, and nonprofit groups about health care economics. Chris Jennings, a consultant in Washington who worked with Altman in the 1980s and ’90s, said Altman “is still incredibly relevant.’’

“He continues to be viewed as a substantive and intellectual health policy reform expert,’’ said Jennings.

Altman said the Patient Protection and Affordable Care Act, aka Obamacare, will reduce the number of uninsured Americans – if it survives court challenges and repeal efforts. If the law is undone, Altman predicted, the nation faces “the worst of all worlds’’: high numbers of uninsured and soaring medical costs.

Altman has donated to Democratic candidates, but he is more pragmatist than partisan. Incremental, rather than revolutionary, change, he said, is the best approach for improving the complex patchwork of government programs and private coverage that has evolved over the past century.

The insurance industry remains important to the US economy and must be included in overhaul efforts, he said. At the same time, the federal government’s involvement is vital to ensuring that all have access to health care.

“The idea that you can do it without the government is pure nonsense,’’ he said. “People have a legitimate concern with ‘too much government,’ but the question is, where is the balance?’’

WHO: Climate change and human health @BertolliniR @Medici_Manager

Atlas of health and climate

The Atlas of health and climate is a product of this unique collaboration between the meteorological and public health communities. It provides sound scientific information on the connections between weather and climate and major health challenges. These range from diseases of poverty to emergencies arising from extreme weather events and disease outbreaks. They also include environmental degradation, the increasing prevalence of noncommunicable diseases and the universal trend of demographic ageing.

Related links

Letture consigliate per l’health technology assessment @Medici_Manager @SIHTA_Italia

Letture consigliate:

Goodmann Cl.: HTA 101 Introduction to health technology assessment, National Library of Medicine, 2004,

Topfer L.A e Auston I. (Eds.): Etext on Health Technology Assessment (HTA) Information Resources, National Library of Medicine, 2006,

Francesconi A.: Innovazione organizzativa e tecnologica in sanità: il ruolo dell’health technology assessment, Franco Angeli/Sanità, 2007

Cicchetti A. (Ed.): Introduzione all’health technology assessment, Il Pensiero Scientifico Editore, 2008

Health Equality Europe: Comprendere l’health technology assessment, Italian Journal of Public Health, 2009

Favaretti C., Cicchetti A., Guarrera G., Marchetti M. e Ricciardi W.: Health technology assessment in Italy, Intl. J. of Technology assessment in Health Care, 2009, 25: Supplement 1, 127-133,

Ricciardi W. e La Torre G.: Health technology assessment: principi, dimensione e strumenti, SEEd, 2010

De Rosa M. e Scroccaro G. (Eds): L’applicazione delle tecniche di HTA alla valutazione di farmaci e dispositivi medici, Infosan, 2010

Cicchetti A. e Marchetti M. (Eds.) Manuale di health technology assessment, Il Pensiero Scientifico Editore, 2010

Drummond M.F., Sculpher M.J., Torrance G.W., O’Bien B.J., Stoddart G.L.: Metodi per la valutazione economica dei programmi sanitari, Il Pensiero Scientifico Editore, 2011, (Edizione italiana a cura di Mennini F.S., Cicchetti A., Fattore G. e Russo P.L.)

Favaretti C.: La valutazione della tecnologia sanitaria: omogeneità o difformità, in Falcitelli N., Gensini G.F., Trabucchi M. e Vanara F. (a cura di): Fondazione Smith Kline Rapporto Sanità 2010 – Federalismo e Servizio sanitario nazionale, Il Mulino, 2010, 201-212

Autori vari SIHTA: Clinical Governance, 2007 (agosto)

Clinical Governance, 2008, 1

Favaretti C., De Pieri P., Fontana F., Guarrera G.M., Debiasi F., Betta A. e Baldantoni E.: La governance clinica nell’esperienza dell’Azienda provinciale per i servizi sanitari di Trento, in Wright J. e Hill P.: La governance clinica, McGraw-Hill,  2005, XXI-LXI,

Both the scientific and the social sides of medicine are needed @Medici_Manager @kevinmd

by  on October 21st, 2012 in PATIENT

The word medicine, in today’s world, seems to indicate a hard science in search of cures for many kinds of human ailments, such as cancer.  However, I believe that the true definition of medicine is the practice of healing.  Medicine is both an art and a science because it involves both human and technological interaction.  The art of compassionate care and social interaction must be combined with the science of human physiology and curative methods.  When such a combination of art and science is able to create healing, or at least the improvement of a person’s physical and mental well-being, then it is effective medicine.

The compassion, care, and human emotion required in the artistic side of medicine all make medicine very social.  For example, there are the interactions between a caregiver and a patient in a conversation, as part of a sign of affection, or in kind words of comfort.  A team of doctors and nurses discussing patients’ cases is also an example of the social side of medicine.  This team has social values and acts on those values.  Such values would be the ideals and priorities shared by the members of that team and they form an important component of a patient’s course of treatment.

I think of the scientific and the social sides of medicine not as two separate and mutually exclusive aspects of medicine, but as two important tools that need to be combined for effective healing.

Having been a two-time leukemia survivor, as well as an intern with my own pediatric oncologist, I have gained a deep and personal appreciation for both aspects of medicine.  For example, when I followed my oncologist and mentor on rounds, it was interesting to hear how differently the patients were being discussed outside their rooms as compared to inside their rooms.  Patients on charts were simply a list of facts and medical information.  Their details were analyzed with a focus on optimal medical outcomes.  On the other hand, patients in their hospital rooms are live, sensitive beings, with emotions, opinions, and often with many forms of discomfort.

I am intrigued by how a doctor starts with a lifeless chart of facts, walks into the room of a real person, and, if he or she is a truly effective physician, turns the diagnostic and planning process into a positive and compassionate social interaction with the patient.  In this way, a doctor improves the emotional and physical wellbeing of that person.

When examining the relationship between the scientific and social aspects of medicine, it seems to me that each aspect is necessary for the other to be effective in caring for patients.  My oncologist was very skilled at combining the two.  His ability to effectively combine them is what made him a leader in pediatric cancer care and what also made his patients smile brightly whenever he walked into their rooms.  I know because that is what I experienced when he cared for me.

Unfortunately, many doctors have not fully mastered that combination the way my oncologist had.   I experienced this also during my many hospital stays and visits for my two leukemia treatments, which took place at three different hospitals.   It is quite uncomfortable to have to deal with a doctor who acts indifferently, is uncomfortable talking to people, incapable of looking them straight in the eyes, or is rude when you, as a patient, feel miserable.  Poor bedside manners definitely do not help you get through your demanding cancer treatment.

It is my personal mission to gain a better understanding of how doctors can better combine the scientific and social aspects of medicine in order to increase the amount and quality of physical and emotional healing.   Training doctors in combining the scientific and social sides of cancer care is going to be important if we want to increase cancer survival rates and improve the quality of life for cancer survivors.

Clarissa Schilstra is a student at Duke University who blogs at Riding the Cancer Coaster: Survival Guide for Teens.

It is both a privilege and an honor to be a primary care physician @Medici_Manager @kevinmd

by  on October 21st, 2012 in PHYSICIAN

With all of its frustrations and challenges, I love my job.  In fact, the very things that make primary care so difficult and often times exhausting are also what make it in my opinion the most awesome field in medicine.

When I was in grade school, I wanted to be a physician.  My parents would take me to the pediatrician for routine check-ups or when I wasn’t feeling so great and I remember admiring my pediatrician like no other.  To me, he was amazing.  I was of course always pretty nervous going to see him, like that time my legs and face were covered in the itchiest rash I had ever experienced with overlying fluid-filled blisters.  I was a mess.  My cheeks and forehead were swollen so badly I couldn’t even open my eyes so I wore sunglasses so no one would hopefully notice.  I was scared and miserable and even more so because I was going to see my doctor.

He calmly sat there and listened to me explain my story to him which consisted of a weekend shooting hoops in the backyard—I kept having to go retrieve the ball from the bushes which were situated behind the basketball net.  He then asked me to pop up on the exam room table.  After he had thoroughly examined me, he calmly diagnosed me with poison ivy and gave me a prescription for prednisone.  I left and within one week, all of my symptoms had resolved.  Gone were my excoriations as well as my sunglasses and life was back to normal.  Looking back, he represented all that a real doctor truly was.  He listened, empathized and healed.

When I was in medical school, although I entered certain that I would pursue a field in primary care, I found myself gravitating towards the ROAD (radiology, ophthalmology, anesthesiology, dermatology).  For everyone who is not familiar, these are considered to be the “sexy” fields of medicine with lucrative pay … the so-called “lifestyle” fields.  I don’t know exactly how it happened– perhaps it was the confused look on the faces of my attendings as I rotated through the ROAD fields when they asked me what field I planned to pursue and I proudly stated internal medicine.

Or maybe it was the flat-out “WHY would you do that when you could be a radiologist?!” that had an effect on me.  Whatever it was, come match time, I found myself swayed down the most sought-after ROAD.  I had applied and matched in radiology.  Me, of all people!  Someone who loves patient contact and dreads vitamin D deficiency!  I had ended up from the furthest place I could have ever imagined myself happy.  But I was in a hot field and everyone told me radiology would eventually make me happy—that I would be able to get home on time and patient contact was overrated anyway.  Right?  Well, I did get home on time.  While I was at the gym and planning the menu for dinner that night, my internal medicine counterparts were moaning and groaning about call schedules and wanting to gouge their eyeballs out because they were getting out around 10 pm on non-call days.  This of course led to not having time for the gym and scarfing unhealthy food down their throats for most days of the week and needless to say lots of undesired weight gain and baseline agitation.  I figured I had clearly chosen the right field for myself.

I should have noticed that this was not the case early on because it was pretty obvious, at least to an onlooker.  When many of my colleagues needed to actually interact with a human — like place a phone call to clarify what study they had actually ordered or locate a physician with the results of an abnormal finding — they were visibly irritated.  It was as though this was the most painful part of the day.

Whereas, this was the highlight of mine.  Abnormal appendix?  I would call the surgeon and ask him/her to bring the entire team down to the dark reading ream to go over findings.  I yearned for human contact. I secretly wished every medicine team would conduct “radiology rounds” and come visit me in the dark room so we could discuss cases together.  And I looked forward to rotations like breast diagnostic imaging and interventional radiology where I would have the opportunity to actually speak with a patient and find out how they were doing.  I always knew something was missing but I couldn’t quite put my finger on it.  And years later, it dawned on me.  That something was … people!

I ended up switching fields finally to internal medicine where I was able to develop and nurture long lasting relationships with my patients.  To me, internal medicine is both the most challenging and the most rewarding of fields.  We have the privilege to become involved members of our patient’s lives and to advocate for our patients so that they receive the best care possible.  As internists, our ultimate goal and desire is that each and every one of our patients is happy and lives well.  By dedicating ourselves fully to overall patient wellness, in return our patients reward us by sharing their life experiences with us.  This in turn makes us better humans.

Solmaz Amirnazmi is an internal medicine physician who blogs at All is Well That Eats Well and can be found on Twitter @DrSolmazA and Facebook.

Live & Learn

chart, graph, happiness, age, Andrew Oswald, aging, youth, happy

  • The behavioral economist Andrew Oswald found that from about the time we are teenagers, our sense of happiness starts to decline, hitting rock bottom in our mid-40s (middle-age crisis, anyone?). Then our sense of happiness miraculously starts to go up again rapidly as we grow older.
  • All in all, Oswald tested a half million people in 72 countries, in both developing and developed nations.
  • And it’s not only we humans who slump in the middle and feel sunnier toward the end. Just recently, Oswald and colleagues demonstrated that even chimpanzees and orangutans appear to experience a similar pattern of midlife malaise.
  • Women hit happiness-bottom at 38.6 years on average, whereas men do more than a decade later, at nearly 53.

Source: – Life Cycle Of Happiness

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Benato (Fnomceo): “Possono bastare meno medici, ma capaci di dirigere un team” @Medici_Manager

Centomila medici in meno da qui al 2034, mentre gli odontoiatri potrebbero essere la metà entro 15 anni. Ma cambiando i modelli organizzativi in una prospettiva multidisciplinare il sistema può reggere. E intanto la “gobba” pensionistica si sdoppia


11 DIC – Da tempo Maurizio Benato, vicepresidente Fnomceo e presidente dell’Ordine dei medici chirurghi e odontoiatri di Padova, studia le trasformazioni in atto nella professione medica, intrecciando i dati quantitativi con riflessioni specifiche, come nel Convegno organizzato recentemente a Padova e dedicato ai cambiamenti provocati nel mondo medico dall’avvento degli strumenti informatici (“Cybermedicina”, 28-29 settembre 2012).

Ed è per questo che abbiamo chiesto proprio a lui un commento sugli elementi più eclatanti che emergono dall’analisi dei dati che danno una fotografia dell’universo medico e odontoiatrico oggi in Italia: flessione numerica della professione; crescente presenza di donne, sostanziale staticità nella programmazione.

Per Maurizio Benato siamo di fronte ad un cambiamento di prospettiva: si può pensare ad un sistema con meno medici, ma solo a fronte di una profonda revisione dei modelli organizzativi, in modi che siano capaci di tener conto della femminilizzazione della professione medica, del crescente ruolo delle professioni sanitarie, della crescente richiesta di assistenza sul territorio.
Una sfida difficile, per un mondo medico che intanto deve fare i conti con la “gobba” pensionistica. Anzi, con una doppia gobba, perché il dromedario è diventato un cammello.

Presidente Benato, i dati confermano la progressiva flessione del numero dei professionisti attivi in Italia che in prospettiva, considerando anche i tempi lunghi di formazione di un medico, è ancora più netta, con ricadute in ambito professionale e sotto il profilo dell’assistenza. Come commenta questo dato e che cosa pensa di fare la Federazione in merito? 
In primo luogo dobbiamo inserirlo in un contesto organizzativo sanitario che sta cambiando, in cui assistiamo alla crescente professionalizzazione delle cosiddette professioni sanitarie non mediche. Questo elemento deve inserirsi nella filiera della cura e quindi alcune competenze che appartenevano al medico, ovvero erano state acquisite dal medico in un periodo in cui c’era una pletora medica, possono essere sicuramente delegate alla professioni sanitarie.
Ma soprattutto, anche nell’ambito organizzativo, dobbiamo partire dalla centralità del cittadino e non più dalla centralità della professione medica. E la centralità del cittadino richiede che ci sia un integrazione di diverse professionalità nel dare assistenza. Per questo la professione medica deve sempre di più essere in grado di amalgamare un team multiprofessionale, capace di dare risposte coerenti con la domanda della salute. Questo significa che non abbiamo bisogno dello stesso numero di medici che abbiamo avuto sin ora, ma abbiamo bisogno di medici più preparati e qualificati, che possano lavorare in una condizione di multidisciplinarietà o interdisplinarietà, interagendo con le altre professioni in un progetto sanitario unitario.

In sostanza, lei dice che la diminuzione del numero dei medici nei prossimi anni (che secondo le previsioni potrebbero ridursi di 100mila unità da qui al 2034) non produrrà difficoltà?
Questo è il concetto di fondo: da un punto di vista pratico noi sicuramente non abbiamo bisogno di più medici di quanti ce ne sono attualmente, ed anzi è anche possibile prosciugare nel tempo la quantità di medici.

Questo vale per tutte le specialità?
Per leggere i dati che riguardano le specialità bisogna tener conto del fatto che non tutti i professionisti indicano la propria specialità nell’iscrizione all’Ordine e anche che nei nostri elenchi compaiono specialisti o plurispecialisti anche degli anni passati, quando le specialità venivano acquisite non secondo le modalità europee, e quindi di fatto c’è una discrepanza tra specialisti che esercitano e specialisti “con titolo”

Secondo il suo ragionamento sulle equipe multiprofessionali i  medici dovranno avere sempre più capacità manageriali, che però ancora oggi sono quasi del tutto assenti nel loro percorso formativo, improntato piuttosto alla preparazione di un professionista “solitario”.
Occorrerà certamente introdurre dei cambiamenti. La moderna medicina parla di multidisciplinarietà, interdisciplinarietà  e transdisciplinarietà, tre concetti che sembrerebbero identici ma che invece contengono importanti sfumature di significato. La multidisciplinarietà prevede un equipe, ma nella quale  ciascuno vede le cose dall’ambito della propria disciplina; nella prospettiva di interdisciplinarietà le discipline interagiscono invece maggiormente una con l’altra; infine la transdisciplinarietà è un concetto molto più avanzato per cui tutti hanno lo stesso obiettivo, in questo caso la centralità del paziente, e quindi tutti devono concorrere a rispondere alla domanda di tutela, il che significa che queste professioni sanitarie possono superare gli steccati che attualmente le vedono separate. La transdiciplinarietà applicata alla medicina è, in un certo senso, un concetto olistico nell’ambito organizzativo.

Come risponde l’Università a questi cambiamenti, qualitativi e quantitativi? L’impressione è che tutto resti uguale.
In effetti, ci sono sempre 5mila contratti accademici di specializzazione all’anno, a fronte dei circa 8mila posti indicati come fabbisogno dalle Regioni. A questi si aggiungono altri 800 posti circa, in realtà private o regionali. E a questi occorre aggiungere gli altri 800-1.000 delle scuole regionali per la medicina generale.

Ma il fabbisogno indicato dalle Regioni è elaborato su un’analisi di prospettiva o mira semplicemente a perpetuare la situazione esistente? 
La definizione del fabbisogno mira a bilanciare le uscite previste per anzianità e pensionamento, senza ipotizzare cambiamenti nell’attuale organizzazione dei servizi.

Tra gli elementi di cambiamento più evidenti della professione medica c’è la sua crescente “femminilizzazione”, tanto che ormai da una decina di anni a questa parte si laureano in Medicina più donne che uomini. Lei stesso, in un intervento di qualche mese fa sottolineava come questo ponesse la necessità di rivedere, in questa chiave, l’organizzazione sanitaria e anche i rapporti di lavoro, contratti e convenzioni. Cosa pensa che si potrebbe fare?
I contratti e le convenzioni sono stati scritti in una logica “neutrale”, che naturalmente è invece una logica maschile, ma il cambiamento di genere richiede una rimodulazione dell’organizzazione. I contratti hanno alla base l’idea di una  professione totalizzante, mentre oggi è urgente rivedere l’organizzazione del lavoro in una prospettiva diversa che tenga conto della presenza delle donne, dello sviluppo della sanità territoriale, della crescita delle professioni sanitarie. Le donne devono conciliare molte cose e la loro presenza richiede un’organizzazione differente. Ecco che allora la stesura delle convenzioni e dei contratti deve tener conto di queste esigenze.
Mi fa un esempio concreto?
È evidente che il tempo pieno cozza con le esigenze dei tempi di vita, così come cozzano l’attuale visione delle carriere o l’attuale visione organizzativa nelle chirurgie. Penso soprattutto a quelle realtà in cui i tempi di lavoro sono non determinati: da una parte occorre rafforzare l’organizzazione di contorno o di contesto, come gli asili nido, ma dall’altra si deve anche pensare a come organizzare, per esempio, un servizio di anestesiologia in cui una donna, lasciando il servizio,  possa passare le consegne ad un’altra.

Si può pensare a delle sovrapposizioni di ruolo? E poi anche a come costruire le carriere tenendo conto di questo?
Certamente. Per esempio bisogna pensare a come consentire il rientro nella professione, dopo congedi parentali o di maternità,  recuperando a pieno la professionalità, specie nei settori,come l’anestesia o la chirurgia, che richiedono un particolare training. E questo vuol dire che forse,per avere una professionalità pienamente operativa abbiamo bisogno che ci siano nei fatti due persone.

Un’ipotesi difficile di questi tempi, con i contratti bloccati e i tagli alle risorse economiche.
Non c’è dubbio.

Vorrei chiederle qualcosa riguardo agli odontoiatri, visto che la Federazione rappresenta tutti. In questo settore mi sembra che non ci sia un forte calo di presenze, forse perché essendo in gran parte liberi professionisti mantengono una forte attrattività.
Le cose non stanno esattamente così. Attualmente gli odontoiatri sono per due terzi di formazione medica e per un terzo di formazione odontoiatrica. I numeri della formazione odontoiatrica sono costanti, ma coloro che vengono dalla formazione medica, ovvero che si sono laureati prima dell’85, tra una quindicina d’anni usciranno dalla professione, il che vuol dire che la professione odontoiatrica nel complesso potrebbe all’incirca dimezzasi quantitativamente. Credo che ne siano ben consapevoli, ma d’altra parte questo li avvicinerebbe allo standard europeo, che è di circa uno a duemila, ovvero un odontoiatra ogni duemila abitanti,mentre oggi in Italia il rapporto è di circa uno a mille.

Questi cambiamenti nel numero dei professionisti medici e odontoiatri in attività ha creato qualche allarme anche in vista della cosiddetta “gobba pensionistica”, ovvero di un forte aumento del numero dei professionisti in pensione. Secondo lei qual è la situazione?
Oggi stanno andando in pensione i nati tra il 1947 e il 1950, più qualcuno del ‘51 e del ’52. Nel complesso circa 7-8 mila persone.

Quindi la gobba è già arrivata?
Sì, invece che un dromedario si sta presentando un cammello. C’è un picco ora, dovuto anche all’allarme e all’incertezza, poi ci sarà una fase di stasi e poi dovrebbe arrivare un altro picco alla fine del decennio.

Insomma, adesso c’è una prima ondata di pensionamenti dovuti alla paura dei possibili cambiamenti delle regole previdenziali?
Esattamente. Ma oltre a questo c’è anche da tener presente che si sta preparando un grande rivolgimento organizzativo. E alcuni, della mia classe d’età,  hanno qualche difficoltà nell’affrontare il nuovo, come sempre succede. Siamo stati formati all’autonomia, ora è difficile entrare in una prospettiva interprofessionale, che cambia profondamente il rapporto con il paziente.

How to Use Your Time Wisely by Prioritizing Your Goals @Medici_Manager @CEOdotcom

BY  | October 19, 2012

In his bookExtreme Productivity: Boost Your Results, Reduce Your Hours, author Robert Pozen reveals his secrets and strategies for productivity and high performance, focusing on results produced rather than simply hours worked. In this edited excerpt, Pozen lays out six steps to analyze whether your efforts are supporting your most critical business goals and objectives.

Many executives race from meeting to meeting or crisis to crisis without giving much thought to the rationale for their hectic schedules. They spend too little time on activities that support their highest goals and often report a serious mismatch between priorities and time allocations.

Think carefully about why you are engaging in any activity and what you expect to get out of it. Establish your highest-ranking goals and determine whether your schedule is consistent with this ranking. This process has six steps:

1. Write everything down. Include the routine tasks that you have to do daily or weekly and longer-term projects assigned to you.But you can only tread water if you spend all your time responding to crises and tasks assigned by others. To get ahead, you also must think about what you want to do.

These may be long-term goals, such as advancing your career, or short-term goals, like developing a new skill. Add these aspirations for your work to your list. Be as broad as possible; capture all your tasks and goals.

Related: When ‘Just Do It’ Just Doesn’t Do It: Maximizing Interruptions As They Happen

2. Organize by time horizon. Divide your list into three time categories:

  • Career aims: Long-term goals over at least five years.
  • Objectives: Professional goals over the next three months to two years.
  • Targets: Action steps that should guide your work on a weekly or daily basis–or example, finishing one part of a larger project.

Make sure that each objective has one or two associated targets. If any lacks a target, think hard about the next actionable step you can take to advance that objective, and then add it to your list of targets.

3. Rank your objectives. Think about what you want to do, what you’re good at, and what the world needs from you. These are distinctly different — and there may be some conflict among them.Determining what you want to do is critical to your ranking decisions. For instance, if you have a burning desire to invent your company’s newest product, you should rank that objective higher.

Then, ask yourself, “What am I better at doing than others? Which objectives play to my strengths?” Rank an objective higher if you have a comparative advantage in accomplishing it because of your personality or skills.

Lastly, ask what the world needs from you. You can’t be fully productive by looking only at the supply side. You must also consider the demand side — what the world, your organization, or your boss needs most from you.

Write down two or three top objectives for your organization and think about the metric used to evaluate performance. Ask yourself what one change you could make to help achieve success: more time visiting clients? Recruiting a talented professional to replace a retiring employee?

4. Rank your targets. Your targets, or action steps, will typically fall into one of two categories: enabling targets, which help you accomplish your objectives, and assigned targets, which are given to you. First decide which targets belong in which category and then try to rank them.

For example, finishing my book was a very high objective for me, so writing the first draft of a chapter tended to be my highest-ranked enabling target. An enabling target also can further an objective in more subtle ways. Suppose that you’ve been told that you’ll be assigned a major project (i.e., an objective) that will require your full attention. So, you want to get many of your small tasks out of the way. Completing these lower-priority enabling targets supports your new objective by clearing away distractions.

Related: 4 Ways to Discover Your Strengths

List and rank your enabling targets based on the objective’s importance and how effectively the enabling target furthers it. Assigned targets are daily and weekly chores that often seem unrelated to your bigger picture. They are very different than those that support your objectives. Although assigned targets are immediate and concrete, that doesn’t mean they are important enough to consume your schedule. Consider them low priority and spend as little time on them as possible.

5. Estimate how you spend your time. Once you’ve ranked your objectives and targets, determine how effectively your schedule matches your high-priority goals. Take out your calendar and answer these six questions:

  • How many hours do you spend at work vs. other activities?
  • What are the three main work activities on which you spend the most time?
  • How many hours each week do you spend on meetings, forms or reports, and responding to emails?
  • Will your weekly schedule be similar a year from now?
  • What will be your three main activities during the next year, and will they change?
  • How will you measure success and failure over the next year?
  • Compare your allocations of time with your ranked list of objectives and targets. What percentage of your time do you spend on activities that help you meet your highest objectives and targets? How much time do you spend on lower-ranking items?

6. Address the mismatch. You’ll likely find that you are spending no more than half your time on your highest priorities. Some professionals haven’t carefully thought about their objectives and targets, and so often neglect an important goal — until it becomes a crisis, demanding their full time and effort.

Related: 5 Tech Time Wasters and How to Avoid Them

Read more stories about: ProductivityProductivity toolsTime managementBusiness Efficiency Center

Robert C. Pozen is a senior lecturer at Harvard Business School and a senior fellow at the Brookings Institution. He was formerly chairman of MFS Investment Management and served on the president’s bi-partisan Commission to Strengthen Social Security. He is a former vice chairman of Fidelity Investments and was a partner at the Washington, D.C., law firm Caplin & Drysdale.

Nine Lessons on How to Teach 21st Century Skills and Knowledge @Medici_Manager @RANDCorporation

As Thomas Friedman put it in a recent New York Times column, globalization compounds the urgency for students to develop the skills and knowledge they need for economic and civic success in the 21st century. Yet despite widespread agreement among parents, educators, employers and policymakers worldwide that students need skills like critical thinking, problem solving, teamwork and creativity, these skills are stubbornly difficult to teach and learn.

The “transmission” model, through which teachers transmit factual knowledge via lectures and textbooks, remains the dominant approach to compulsory education in much of the world. Students taught through this method typically do not practice applying knowledge to new contexts, communicating it in complex ways, solving problems or developing creativity. In short, as our new paper lays out, it is not the most effective way to teach 21st century skills.

Decades of empirical research about how individuals learn, however, provide valuable insight into how pedagogy can address the need for 21st century skills. Indeed, the research suggests nine lessons that inform how to teach these skills:

  1. Make it relevant. The relevance of learning specific knowledge and skills is much clearer to students—and much more motivating—if they understand how a given topic fits into “the big picture,” or a meaningful context.
  2. Teach through the disciplines. Students develop their 21st century skills and knowledge as they learn why each academic discipline is important, how experts create new knowledge, and how they communicate about it.
  3. Develop lower and higher order thinking skills—at the same time. Students need to comprehend relationships between given variables and how to apply this understanding to different contexts.
  4. Encourage transfer of learning. Students need to develop the ability to apply skills, concepts, knowledge, attitudes and/or strategies they develop in one context, situation or application to another, reflexively (low-road transfer) or after deliberate thought and analysis (high-road transfer).
  5. Teach students to learn to learn (metacognition). Since there is a limit to how much students learn through formal schooling, they also must learn to learn on their own.
  6. Address misunderstandings directly. People have many misunderstandings about how the world works that persist until they have the opportunity to develop alternative explanations.
  7. Promote teamwork as a process and outcome. The ability to work collaboratively is an important 21st century skill, not to mention an important condition for optimal learning of other key skills.
  8. Exploit technology to support learning. Use of technology is another critical 21st century skill, essential to help develop many of the other skills mentioned here.
  9. Foster students’ creativity. Creative development requires structure and intentionality—the ability of the mind to form representations—from teachers and students, and can be learned through each of the disciplines, not just through the arts.

Progressing from the outdated “transmission” model to the “21st century” model will involve entire educational systems. As educational purposes change, curriculum frameworks, instructional methods and assessments must also. The changes demand increased teacher and administrator capacity and affect many facets of human capital, including teacher training, professional development, career mobility and the teaching profession’s cultural standing.

While there has been progress in preparing students for the 21st century, the remaining work will require of teachers, administrators and policymakers precisely the skills that we deem critical for students—as well as the political will to ensure that educators directly involved in transitioning to the 21st century model have the time, support and resources they need.

This study was presented as part of Asia Society’s Global Cities Education Network Symposium in May at our new Centre in Hong Kong. Anna R. Saavedra is an associate policy researcher at the nonprofit, nonpartisan RAND Corporation, and V. Darleen Opfer is director of RAND Education.

This commentary appeared on Education Week on October 24, 2012.