Monthly Archives: febbraio 2015

The Courage And Triumph Of The Patient @Medici_Manager @acpatient @leadmedit @pash22

Leah Binder Contributor

Improving the “patient experience” is a trending topic in health policy circles these days, the subject of many new conferences and journal articles. Providers puzzle over this. How can they improve patient “compliance” and “adherence” to doctor’s orders? What are the techniques to educate patients on “self-management”? How can we better coordinate the various services offered to each patient so the patient doesn’t fall through the cracks?

It is gratifying to see this emphasis on patients. Yet many providers still do not grasp that improving patient experience requires something more than studying the issue and implementing a few new policies. It requires nothing short of a paradigm shift in the way they think about their role in the patient’s life and the fundamentals of their practice.

The best example of providers misunderstanding the depth of this issue is how the influential provider-governed Beryl Institute defines the patient experience: “the sum of all interactions, shaped by an organization’s culture that influence patient perceptions across the continuum of care.” In other words, Beryl believes that the patient experience is the patient’s reaction to what providers do.

Trust me, that is not how patients view their own experience.

“Momma had her last radiation treatment today,” a young woman I’ll call Karen posted on Facebook last June. “Can’t even explain the amount of strength and courage that crazy lady has shown and I couldn’t be more proud to call her my Mom.”

Patients and their families see their experiences as Karen did, as the act of summoning every last reserve of strength and courage to endure each minute, one day at a time. Patients don’t see themselves as mere recipients of services. Patients and their families don’t talk about self-management or compliance or adherence. They find themselves in an epic story of survival and adventure. They are the reluctant heroes of that personal drama, Odysseus setting forth on the ultimate journey. Some patients are ready and some aren’t, but every patient is forced to try their best, since the road is before them.

One of the country’s leading thinkers on the patient experience is Dave deBronkart, who miraculously survived Stage 4 kidney cancer. His mantra (and the title of the book he coauthored): “Let Patients Help.” DeBronkart advises providers to recognize patients as journeymen, not baggage, in the quest toward recovery. He speaks to provider groups throughout the world, and gave one of the most popular TED talks ever, all with an eye toward reframing the way the health care system engages patients and insisting that patients are part of the cure, not passive recipients of care. He says that patient knowledge and wisdom and willingness to research are a wealth of untapped resources.

Most of us know someone like Karen, Karen’s mom or Dave, who stood up and squarely faced the worst news imaginable. Though doctors work with patients every day, there is something very different about being on the other side of the fence, as deBronkart’s co-author Dr. Danny Sands movingly recounts in his blog about suffering life-threatening seizures.

Providers can nurture, coach, mentor, guide and be humble enough to realize they have only a small – though critical – role to play in the larger life story of the human beings they call patients. Providers succeed when they recognize they aren’t treating a disease or filling an empty vessel with “services,” but coaching a complex person with a destiny and a legacy who, for better or worse, is the hero of her own life.

I’m sad to report that Karen’s “crazy lady” mother, Susan, 52, died from breast cancer a few days ago. Susan was beloved throughout her rural Maine community, an exceptional teacher, community volunteer, mother. She had a very special gift with children, many of whom are traveling from far and wide to come to the funeral of this woman they revered.

“I believed a miracle would happen and she would beat this beast,” said Susan’s dear friend Kathleen, “She fought the most courageous fight I’ve ever witnessed. Heaven is so lucky to have this new angel.”

In my opinion, Susan did win, though not the way we all hoped for. But a life well-lived is the ultimate triumph. “To have been given 22 years with you was such a blessing.” Karen wrote in an open letter the day her mother died. “I promise with all my heart to be the fun loving, positive and slightly wacky person you’ve taught me to be. Thank you for all the amazing memories Momma Bear.”

Susan’s a winner and so are the many excellent physicians and nurses who cared for her through her battle with cancer. As the famous doctor Patch Adams once said, “You treat a disease, you win, you lose. You treat a person, I guarantee you’ll win.” The patient experience is more the stuff of Shakespeare than Gray’s Anatomy. Providers with that wisdom will transform health care forever.

http://www.forbes.com/sites/leahbinder/2013/12/11/the-courage-and-triumph-of-the-patient/

Annunci

how to measure a professor

cubistcrystal

“Many of those personal qualities that we hold dear….are exceedingly difficult to assess. And so, unfortunately, we are apt to measure what we can, and eventually come to value what is measured over what is left unmeasured. The shift is subtle and occurs gradually”. So wrote Robert Glaser of the USA National Academy of Education in 1987.

Those words – written about the standardised tests used in American schools in the 1980s – ring so true today for the way we assess academics. The things we tend to measure, because they are easy to measure, are things like publication numbers, impact factors, H-index (regrettably not the Happiness index), citations, grant income. And we tend to value most those who have big grants and papers in big name journals. Are we “driving out the very people we need to retain: those who are interested in science as an end in itself…“?…

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Coaching or telling. Which works? Here’s the evidence… @leadmedit @muirgray @helenbevan

Given the name of my company, Head Heart + Brain you won’t be too surprised to learn I like to have an evidence base for what I do. The ‘brain’ part of the name represents understanding the science behind leadership and change. This links to my curiosity about ideas that ‘seem obvious’ to me but that don’t get traction. I talked about this in my article on Emotional Intelligence. I feel the same about coaching. Whilst many companies use external coaches to work with senior people HR find it harder to gain traction for the manger as coach. Companies we work with still have many managers who adopt a ‘command and control’ style; that is telling people what to do. What is the evidence of which works best; coaching or telling? Is coaching actually more effective than just telling people what to do especially in complex change? I will look at some of the evidence which may help to understand which will maximise performance.

Brain basics

Let’s look at how the brain works in an organisational context.

The brain functions by making connections and associations, linking what is happening now and what has happened in the past, the memories both conscious and unconscious. This combination creates a kind of map of connections in the brain. No two maps will be the same even though the biological process for creating them is. The maps are created by making over a million new connections every second. This gives you some indication of the complexity. The brain likes order so seeks to connect new information to what is already known, to categorise it. Gerald Edelman developed the Theory of Neural Darwinism which provides a physical explanation for how our mental maps compete for resources.

The way the brain seeks to predict and make connections is explained by Jeffrey Hawkins in On Intelligence. He says our prediction abilities differentiate us in the animal world. When we first encounter something we are relatively slow to understand it. Like this article we need first to get the foundations in place. In learning a new skill for example it takes a while, maybe a few minutes or days depending on the complexity, for it to become familiar, that is create the map. The more embedded these maps the more we free up mental resources. We call this process forming a habit. Habits are run by the older more energy-efficient parts of the brain. This process of shifting activity, including thinking, from the high energy, relatively inefficient, prefrontal cortex to the more efficient areas is a basic operating mode for the brain.

Linked to this is neuroplasticity. Expert Norman Doidge, in The brain that changes itself points out, there is substantial evidence we can “rewire our brains with our thoughts.” Hebbs Law states that ‘neurons that fire together wire together’. So the more you focus on something the deeper the neurological connection. When we delve into and analysis a problem we are reinforcing the connections in the brain. This occurs through a process called myelination, the more a pathway is used, the stronger it becomes. When we repeat an action, a fatty covering called myelin coats the neural pathway, making connections stronger and more secure. Because the default is to go with the pathways that are developed it is hard to change habits but easier to create new ways of working. But it is still difficult to change without focused support and intentional effort.

The other relevant question is whether there are distinct functions responsible for emotional, as opposed to general intelligence. Research by Reuven Bar-On isolated these regions by studying people with damage to the brain in areas correlated with diminished ability in understanding self and understanding others. His findings clearly point to brain areas which relate to understanding self and others, that is Emotional Intelligence, which are distinct to areas associate with general intelligence.

So with this understanding as background let’s look at the impact of telling someone to change verses coaching them to change.

Telling versus insight

A premise of coaching is that people work things out for themselves. The difference between being told and having insight is all about creating new mental maps. If you are thinking about something like how a new process will work or the reaction of your team to a new strategy you are creating a mental map. These new thoughts are energy consuming from a brain perspective so you often do this when your brain is freed up from other activity like in the shower or on the walk to work. This type of thinking creates what we call an ‘aha moment’ or an insight. This is literally new connections happening, a new map or part of a map is formed. If you are told how to carry out the new process or what the strategy means for your job you still have to create that mental map. So coaching insight is more brain-savvy than telling an employee the answer. To take any kind of action people have to think it through for themselves. They can do this for themselves and immediately create the map when the coach/manager asks questions that create insight or they do it later after they have been told. The additional issue with telling is that it is more likely to set up a threat response (see more in the CORE video) as the individual’s predictions and connections are different to what was expected. As we have observed before, this difference creates an error message and a sense of pain in the brain. This in turn moves people away from the new information and increases the likelihood of resistance.

Managers who tell rather than coach not only waste their own energy but they are potentially making it more difficult for employees to accept a new idea. Are your managers and coaches creating insight or giving advice?

Transferring skills

You will have experienced that an insight comes with a burst of motivation or energy but this quickly dissipates if not reinforced. Reinforcing the insight creates new connections and potentially new behaviour. Because this type of action and thinking is hard work, because it takes more brain energy, people may avoid it or give up too soon before a deep map is formed. But people are also adaptable and can find shortcuts.

new study provides strong evidence for a “flexible hub” theory of brain which has implications for using skills. “Flexible hubs are brain regions that coordinate activity throughout the brain to implement tasks – like a large Internet traffic router,” suggestsMichael Cole, the author of the study.

By analysing activity as the flexible hubs connected during the processing of specific tasks, researchers found unique patterns that enabled them to see the hub’s role in using existing skills in new tasks. Known as compositional coding, the process allows skills learned in one context to be re-packaged and re-used in others, shortening the learning curve. By tracking and testing the performance of individuals the study showed that the transfer of these skills helped participants speed their mastery of new tasks, and use existing skills in a new setting.

Are your coach/managers focusing people on transferring existing skills to the ‘new world’ to speed up change?

Moving to action

Conventional wisdom, in many businesses, is that if people understand rationally why they need to do something the change will occur.  Kevin Oschner estimates 70% of what we do is habitual and that includes your job. As previously mentioned habits are run by the older parts of the brain, the basal ganglia. Because habits operate out of our conscious awareness our rational understanding is not enough. Coaching on why the new behaviour matters to the individual and designing a strategy might work.

Several things need to be in place to achieve behavioural change. Matt Lieberman says we must go beyond conscious systems and use our unconscious or “reflexive” systems. Goals for the new behaviour tend to be created in the conscious reflective system but we need to also control the unconscious habit system by managing triggers that generate the old behaviour. Elliot Berkman studies goal setting and achieving new behaviour and his research suggests there are several elements that must be aligned.

For example in new habit formation there is a sequence:

  1. cue;
  2. when to act,
  3. routine;
  4. the steps to take,
  5. and reward.

Are coach/manages working with both systems? Are they creating new behaviour by creating new routines and rewards? Are there strategies to manage the triggers that will prompt old behaviour?

We are social

The science shows social needs are primary in the brain, something many forget at work. Social pain activates the same regions as physical pain. When someone is put down, or their ways of working are controlled, or they are told what to do, especially publically, a threat response is activated reducing the ability to think clearly. You know that feeling – “I’m just blank, I have no mental space.” The frontal cortex is drained as the limbic system hijacks the energy. Again, a strike against telling!

This evidence base may go some way to persuading reluctant managers to adopt a different style.

But I am not going to fall into the same trap – and will practice what I preach.  So far be it for me to tell you that telling doesn’t work.  I’ll leave you with a few questions to generate you own insight.  What reaction have you experienced when telling someone to change? When has telling someone to do something differently worked?  What has been the benefit for you of creating insight in others?  What, good, surprises have you got from asking questions rather than telling?