“When You Know What Good Looks Like…” #yam @myen

4797503676 fda53a94b3 m Its Harder to Tolerate Waste When You Know What Good Looks Like… lean

I recently “fired” my primary care physician. I’m lucky to not have to go to the doctor very often, but the last few times I did, I had to wait more than an hour beyond my scheduled appointment time (in a tiny windowless room, as pictured at left).

I had talked to the office manager about this before and, in the last visit, I complained that they weren’t respecting my time. The office manager argued back (quite rudely) that they didn’t disrespect me and that I shouldn’t jump to that conclusion. But, to me, the repeated pattern was that they cared more about physician utilization than patient waiting time. It was an usual occurrence, it was a repeated habit. It’s not that something went wrong that day that messed up patient flow – it was a very systemic problem.

I left without seeing the doctor and asked that he call to talk to me about why I wasn’t coming back. I also called and left him a voice mail asking him to call if he was interested in why I left his practice. I never got a call back. That said way more about their lack of giving a crap than anything else. I guess their business is doing just fine without me.

So I hope to find a new PCP when I need one. I’m hoping to find a better method for choosing a physician other than 1) who takes my insurance and 2) who is close to my home. But who has public data on A) waiting times and B) effectiveness and population health? That’s part of the transparency problem in healthcare – that we often don’t have good data (or any data) for choosing a doctor, a hospital, or a surgeon.

Not to make it all about me in this blog post, but I have a congenital problem with some vertebrae and it’s flaring up and bothering me. I was referred to a spine specialist practice and was on the phone yesterday trying to book an appointment (more than a week after my chiropractor referred me to them and they didn’t me call to book an appointment without me following up twice).

I was on the phone for, no joke, 21 minutes and 37 seconds booking this appointment.

The woman on the phone was complaining to me that her office had a new computer system and it was hard for her since they hadn’t trained her very well and she was now using a laptop instead of a desktop and the keyboard was funny to her. “It’s like I have a handicap,” she said, which isn’t very politically correct or very sensitive. Lack of training is a short-term focused cost-cutting choice that people make. It’s not fair to people with real disabilities, people who don’t choose to have them.

So one reason it took so long is that she was collecting (slowly) tons of information – my personal info, my wife’s info, her insurance information, etc.

She then told me that I’d have to arrive 30 minutes before my appointment to fill out a new patient information form.

I asked, “What? Isn’t that what we’re doing right now, filling out the form over the phone with you?????”

She then asked for my wife’s social security number. I hesitated and then asked, “Am I going to give it to you over the phone and THEN have write it down again on that form that I’m arriving early for, along with all of the other information that I’ll likely duplicate?”

She wasn’t the right person to be asking such systemic questions to, as she was just trying to do her job, So I gave her the info without further fussing. I’ll suffer the “waste of overprocessing” by having to give the same information multiple times when I have my appointment on Friday.

Since I was at the offices of the ThedaCare Center for Healthcare Value when I was making his call, Dr. John Toussaint walked by right after I was done and I complained a bit about the waste in the system when he saw the frustration on my face.

He said, “When you know what good looks like…”

Yes, when you know what good looks like, it’s harder to tolerate the preventable waste that we face in the healthcare system as patients or providers.

When you know that some primary care clinics and “The Lean Dentist” Dr. Sami Bahri basically have “zero waiting room” practices, the idea of waiting 60 minutes because the physician overbooked (probably intentionally) is harder to take. When you know that some hospitals have a “zero wait E.D.” it’s harder to tolerate a long time in the waiting room.

An ideal patient care experience (or “what good looks like” from Dr. Toussaint’s perspective) might include:

  • less waiting (not waiting weeks for an appointment or not waiting many hours if you arrive at the emergency department)
  • less harm (fewer infections, fewer falls, fewer medication errors)
  • lower cost (as ThedaCare has demonstrated as a provider, with 20-30% lower inpatient care cost, or as an employee of the company Serigraph, where they get free on-site preventive care and have better outcomes at lower cost, as detailed in the book The Company That Solved Health Care Its Harder to Tolerate Waste When You Know What Good Looks Like… lean

If you’re familiar with Lean healthcare improvements, you know that “what good looks like” includes a 37-minute “door-to-balloon” time at ThedaCare for Code STEMI heart attack patients (far better than the 90-minute U.S. standard). You know good looks like more patient-focused care at lower costs and better quality… so you wonder why everybody doesn’t have that now, with such excellence being demonstrated at a relatively small number of hospitals that everyone can learn from.

You wonder why the federal government has to chip in a billion dollars to drive innovation and quality improvement in healthcare, when that should already be the goal of any healthcare provider (and you can read how to do it for free online at sources like the AHRQ or for $8 (Kindle version Its Harder to Tolerate Waste When You Know What Good Looks Like… lean) in books like On the Mend).

I wonder when we’ll hit a “tipping point” in healthcare when enough people are now getting excellent care, as opposed to average typical care, when word will spread that “what good looks like” is out there. I think people often accept what healthcare throws at them because they think it can’t possibly be better. But the truth is, it can be better – better quality, lower cost, and less waiting all with happier healthcare providers and personnel.

The frequent news reports about 100,000 Americans dying each year due to preventable medical errors and another 100,000 dying due to hospital acquired infections don’t seem to be convincing anyone that things can be better. Maybe they’re just convinced that things are bad…

cc Its Harder to Tolerate Waste When You Know What Good Looks Like… lean

photo credit: Cam Vilay

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Tagged as: Customer Focus, Healthcare, Lean Dentist, ThedaCare, Toussaint, Waiting

I suggest every stakeholder in healthcare takes a good read of this article and tries to find its own implemenation in everyday practice of “WDGLL” (WhatDoesGoodLookLike)…
And when you specified what Good looks like I suggest you implement that and nothing more or less, until the next time you’re up reviewing WDGLL for that particular part of your world.

The agenda

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The agenda

The job of the CEO isn't to check things off the agenda. Her job is to set the agenda, to figure out what's next.

Now that more and more of us are supposed to be CEO of our own lives and careers, it might be time to rethink who's setting your agenda.

Posted by Seth Godin on April 16, 2011 | Permalink


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Every now and then I am blown away by these little facts Seth spits out. Set Your Own Agenda, how right is that?

Why you might choose to be in favor of transparency #yam

Thousands of doctors have signed up for a service that, among other things, they can use to try to prohibit patients from posting reviews. You can read a bit about it here. In Iowa, in a surprisingly similar move, the state government is moving ah…

Thousands of doctors have signed up for a service that, among other things, they can use to try to prohibit patients from posting reviews. You can read a bit about it here.

In Iowa, in a surprisingly similar move, the state government is moving ahead with a law that will make it a crime to take or possess videotapes of factory farming that might harm the commercial interests of the farmer.

In both cases, an organization is trying to maintain power by hiding information from the public. Can you imagine being arrested for possession of a photo of a pig?

It's easy to argue that from the public's point of view, laws like this are a bad idea. The public certainly benefits from the outing of bad doctors and from the improved hygeine of factory farms. In that sense, it's unethical for doctors and legislators to subvert their responsibilities by ordering the unempowered to shut up.

I think it's interesting to think about from the doc's point of view (and the chicken farmer), as well. The temptation is for those in charge to defend the status quo by fighting transparency. This ignores a simple truth:

When book reviews are posted, book sales go up.

Yes, the argument of fairness matters. The patients have no choice, the chickens certainly have no choice and the consumers don't have much choice either. There's an argument that goes beyond choice, though… it turns out that transparency increases profitability.

If every chicken coop has a video camera in it, quality will obviously go up. Confidence in the product will go up. Employee behavior will improve as well, because it's hard to torture a chicken if you know you're going to get caught.

But wait, you might argue… if we have to take better care of the chickens, our costs will go up as well.

Here's the thing: when consumers get used to transparency, they're also more interested in the quality of what you sell, and are more likely to willingly pay extra. They'll certainly cross the street to buy from an ethical provider. And once people start moving in that direction, the cost of being an unethical provider gets so high that you either change your ways or fade away.

Chicken farms don't need a law prohibiting possession of images. They need a producer who will make a ton of great (true) chicken movies. Inundate us with images of cleanliness and quality instead of blacking us out. Don't race to the bottom (you might win). Instead, force your competition to race you to the top instead.

[Aside: the same objection happened when we started regulating hygeine in restaurant kitchens. Yes, it got more expensive to clean the pots and kill the rodents, but it was okay, because post-Duncan Hines, demand for quality went up enough to more than pay for it.]

The same argument holds true for doctors. Once information about good doctors becomes widespread, patients will be more willing to seek out those doctors, rewarding the ones who consistently take better care of their patients. The entire profession doesn't suffer (we'll still go to a doctor) merely the careless doctors will.

One more: A leading politician in India is arguing that bribery (in certain transactions) ought to be legalized. Why? Because if the briber feels free to rat out the bureaucrat, bribery goes down.

In all three cases, sunlight is an antiseptic and the marketplace rewards those that behave–and the entire market grows when the standards increase.

Consumers and those that want their admiration ought to reward those in favor of transparency (what a great opportunity for McDonald's). And the antidote for speech a provider doesn't like isn't a contract or a law. The antidote to speech you don't like is more speech.

Seth gets it, got it and now hopefully the rest will get it too…

10 add-ons to make Evernote even more useful – TNW Lifehacks @myen

Evernote makes it easy to create and access notes in the form of plain text, Web clippings, images, audio and even video – and then access them wherever you are via the Web or a variety of desktop and mobile apps.

It’s insanely useful, and third-party developers have extended its functionality even further with a range of add-ons.

Here we take a look at ten of the best, including a couple of native Evernote features that you might have missed.

Transcribe your voice with Voice2Note by Dial2Do

Evernote allows you to record voice notes, although they’re not easily searchable and audio isn’t as flexible as text in terms of copying and pasting to other places. Voice2Note by Dial2Do converts audio notes into text to make them more easily searchable.

Simply connect your Evernote account up and the first 30 seconds of any audio note will be transcribed. You can even tag your notes by saying “Tag with:”, followed by the names of your tags. The service has a small monthly or annual fee, or you can try a limited version for free.

Send photos straight from your camera with Eye-fi

Eye-fi is an incredibly useful gadget that fits into the SD card slot on your digital camera, turning it into a Wi-Fi enabled device.

Eye-fi’s Evernote integration means that images can be sent straight from your camera as a picture note. Text recognition built into Evernote means that you can use this as a way to grab text from signs, menus, and other locations and then port them back to Evernote in a searchable, editable form. Sure, you could always use your mobile phone’s camera to do this directly, but it’s always handy to have the option of doing it with images from compact camera or Digital SLR too.

Save other people’s tweets with Twipple

This iOS Twitter client with versions for the iPhone and iPad may not be the best known out there, but if you want to keep notes of tweets it may well be worth having to hand.

As well as acting as a normal Twitter client, its Evernote integration means that tweets can be saved to notebooks and tagged, allowing you to refer back to them long after Twitter’s own search facility may have rendered them unfindable via native means.

Scan documents straight to Evernote

A number of scanner manufacturers now offer Evernote integration. Canon; Lexmark; Fujitsu; Doxie and Ricoh all offer the ability to send documents that you’ve scanned straight to your account in a searchable form. Viva the cloud!

Tweet straight to Evernote

Did you know that you could send notes straight from Twitter? It’s dead simple too. Just Follow  @myEN. It will follow you back and DM you a link allowing you to connect your Twitter account to Evernote.

Once you’re set up, you can either send notes in public by including “@myEN” in the tweet, or simply send a DM to that account. Obviously your notes will have to be short, but if it’s just a quick reminder to do something later, this could be an ideal way of ensuring that you don’t forget. You could even use it as a way of remembering other people’s tweets – just retweet them and add @myEN to the end.

Save handwritten notes, drawings and audio with Livescribe smartpens

These gadgets are, quite frankly, a genius idea. Livescribe smartpens keep a digital record of the things that you write and draw with them, and can even store audio too.

Evernote integration means that the things you’ve written and heard while using the pen can be sent and archived within your account. A similar product for the Japanese market, the Airpen, is also available.

Take notes with your finger, with FastFinga

If you don’t have a Livescribe pen, FastFinga could be just what you need. This iOS app allows you to write by hand (well, by finger) onto your iPhone, iPod Touch or iPad screen.

Once you’ve hooked up your Evernote account, you can send your notes straight through to your account where the service’s handwriting recognition will transform it into searchable text that you can copy and paste to your heart’s content. If you’re not a fan of typing on virtual keyboards, this could be a solution worth trying.

Add puzzles, city guides and more to your account

Beyond just letting you view and store content that you’ve created or copied yourself, Evernote offers a range of free notebooks offering puzzles, short city guides, recipes and more.

While they aren’t very long, they are free and they do show how flexible Evernote can be as a platform. As they can be accessed wherever you have your account, they provide a nice bit of free reading material when you’re at a loose end. Could Evernote move into selling premium content in the future? It’s certainly one direction the company could take.

Save articles to read later with ReadItLater

While it’s easy to copy text from a website to read later in Evernote, ReadItLater makes it even easier.

The service’s bookmarklet makes it simple to copy a beautifully reproduced version of a web page with the click of a button. ReadItLater’s iOS app features an option to share any page you like to Evernote. This option is useful if you use both services and want to keep an archive of popular pages in Evernote’s filing system of notebooks and ‘stacks’.

Email notes straight to your account

You might not realise it, but one of the easiest ways of all to send content to your Evernote account is via email. You’ll find the email address in your Account Settings.

You can even add notes to a specific notebook by putting @notebook in the subject line (where ‘notebook is replaced by the name of your notebook) or tag your notes by adding #tag in the subject line (where ‘tag’ is replaced by the tag). Easy!

I especially like the Twitter integration with @myen, but also the email integration is great off course. Evernote is really useful in integrating various streams of information into one place for later reference and easy recovering.