next up: Patient Centered Technology 4/26

Next week, on Friday 4/26, I’ll be speaking at RichTech’s Health Forum. I’m talking about the rise of patient-centered technology.

More info and registration here


Title: Patient Centered Technology — how smart phones and the web are empowering patients and changing healthcare

In March 2013, Dr. Eric Topol gave Stephen Colbert a complete physical…with his iPhone. The web and connected devices have proven to be disruptive technologies and healthcare is no exception. Today, an increasing number of patients have access to some or all of their medical records through Electronic Health Record systems (EHRs). Smart devices, mobile apps and fitness gadgets also allow people to collect an unparalleled amount of self-generated health data. You can even get a DNA profile for less than than it costs to fill up an SUV.

What does all this mean for patients and the future of healthcare delivery? We’re already seeing a shift. Some call it consumerism, and sometimes it is referred to as mHealth (mobile health) or eHealth (electronic health). Often these terms are spoken about in conjunction with participatory medicine.

We’ll will examine where we’ve been with patient-facing technology in healthcare, where we are today and where we are headed. It will include discussions around EHRs, the quantified self movement and the future of the doctor/patient relationship as influenced by technology.

what about employee-centered care?

Yesterday I was lucky enough to hear Chip Conley speak to an intimate group at Experia Health’s Patient Experience Round Table. Conley shared an anecdote about meeting the then CEO of Southwest Airlines. He was handing out peanuts during a flight. This was 2010, before Southwest began advertising their bags fly free campaign, although they were not charging at that time anyway. When Conley asked the executive why they didn’t charge his answer was an interesting one.

“We don’t want to put that burden on our employees. First, it’s uncomfortable to collect the fee, people expect their bags to go with them as part of air travel. But what we really don’t want is to ask our staff to deal with having to check bags once the overhead bins are full. Have you seen the flight attendants on those other airlines, they are miserable now.”

(Well, he said something like that, I’m paraphrasing the paraphrase)

I’m concerned about how we work in healthcare. Despite the rewards caregivers get from taking care of patients, largely the work of healthcare has become a lot about things other than clinical work and caregiving. It’s meetings, hand-wringing, politics, wrought processes, data entry, reporting and analysis. Don’t get me wrong, some of those are worthwhile tasks —hey, it’s a large percentage of my job (hopefully not the hand-wringing part). But, there are two problems. First, we’ve built a lot of inefficient, difficult to execute processes under the banner of regulation, reporting needs, and analysis. Secondly, we’ve failed to adapt to modern work environment expectations.

The modern workplace has changed, and how we work has changed. Today, Millennials entering the workforce want to work in jobs which provide smart phones, offer flexible work hours and have cool cultures. Does that sound like many health systems?

Airlines, banks, mobile app developers —they all got hipped to the importance of realtime data years ago. Do you think it takes US Airways two weeks of abstracting and analysis to know the demographics of patients on any given flight? No way. And staff at telecom giant Vodafone don’t even have to be in the office to get data. Realtime dashboards are pushed straight to their phones and tablets via a platform called Roambi.

This may sound like a tech post. It is not. It’s a people post.

When we add layers of complexity on top of an antiquated work environment, well, this is what we get.


Here’s what we know, companies which are great places to work take better care of their customers. At Bon Secours, we measured employee engagemnt with Gallup’s Q12. the Q12 is a remarkably effective and simple way to understand how employees feel about their work. Gallup tells us an indicators of employee engagement include having the tools to do your job and working in a supportive environment. Until we wake up and realize we’ve made the process of working in healthcare less desirable than other industries, how will we ever tackle patient experience in a meaningful way?

I’m not suggesting the key is giving everyone an iPhone. I think we can start with some even easier steps:

1 Take Something Away – This is the first, crucial step to working smarter, not harder. Examine all the work our teams have to do, and take at least one thing away. Remember the lesson of Southwest and the baggage fees. Something which may look like attractive revenue on a spreadsheet can actually push staff past the breaking point. Which would you rather have? It can be the least important thing and you probably won’t have to look far to find it. Maybe it’s a superfluous field in a registration screen, maybe it’s a non-clinical tasks for a nurse. Whatever it is, ask yourselves do we really need this? If not, stop doing it.

2 Practice gratitude Chip Conley speaks about recognition in his TED talk. Taking the time to acknowledge each other is a surprisingly powerful emotional uplifter. Hey Joan, you worked later than expected last night to care for those patients… thank you for doing that! The trick is to make it a ritual. Start huddles or end meetings with moments of gratitude. It works.

3 Think about Employee-centered care too Patient-centered care is a result of engaged employees. Managers, try this: walk into somewhere you have employees and pretend it is your first day at work and you are hired to do their job. How’s the space? Is it clean, is it nice to work in? Do you have the tools do do your job? Do you clearly understand what your job is? Most importantly, ask yourself if this is the job you dreamed of walking into. Just because they didn’t give us dot-com style offices when we started in healthcare, doesn’t mean we can’t be the change we want to see.

Remember, every system is perfectly designed to achieve the result it achieves * . So, reverse engineer the system. If you sense, or worse can measure, staff dissatisfaction or burnout, consider the root cause. If you are focused on patient experience, observe the system in reverse order. What influenced those experiences? Likely it’s interactions with employees. Are those employees loving their job – are they called to it?

*Good luck attributing that often used quote. Most suggest Don Berwick first used it in 1996. Goolge returns several articles and transcripts of talks, each purporting to be the originator.

(Briefly) Winning the Olympics – pride and success from Phyllis Dawson

        Since we went early, when our marks were announced we had the best score so far, and for a brief time were in the lead.  My mother started telling everybody she saw, “My daughter is winning the Olympics!”  Embarrassed, I tried to shush her, pointing out that none of the really top horses and riders had gone yet.  “I know,” she answered, “that’s why I am saying it now, while I can!”

Phyllis Dawson on Albany in the 1998 Olympic Games

That’s my Grandma Grace’s rye style. Celebrate when you can, smile always and be quick with the joke. Only this time, it wasn’t a joke. Her daughter, my father’s sister, and my aunt was actually winning the Olympics. Phyllis was in a commanding lead over an unusually difficult olympic cross country course.

I remember being somethingorotherdoesntmatter years old – young enough to be silly and old enough to know watching your aunt on NBC riding in the 1988 Olympics was a big deal. I remember bragging. Man did I glow about that one. Did you see my aunt on TV last night? Friends started calling the house – remember when you had one phone downstairs and really long, twisted, medusa braid of a cord? No, then you are too young to read this blog. Get lost. The rest of you remember that? So here I am, on the downstairs phone, cord stretched around the door frame, down the hall and back into the TV room. Yeah, that’s my aunt Phyllis. Pretty cool huh? Ring, ring. Oh, you saw that? Yeah, I know her, she’s my aunt. Ring Ring. It’s for me? Hello, this is Nick, yes, yes my aunt was in the Olympics tonight.

If I could have pulled off a top hat, cane and, perhaps a chauffeured limo on the way to school the next day, I would have.

That’s how cool pride is. Pride is that feeling you get when you are associated with something awesome, and Phyllis is awesome.

Let’s recap:

  • Youngest of five
  • Owns and manages a substantial, working horse farm with over 50 horses
  • Evented at the world-class level
  • Olympian – 1988
  • Master equestrian teacher
  • Great photographer

But bullets alone do not tell the story. Phyllis’s story is about doing what you love, and loving what you do.

I know, cliche. Except when it isn’t.

My aunt Phyllis has made a life out of doing what she loves: riding horses. She is successful by many measures. There is something to be said about following your passions.

Last weekend, Susan and I had the opportunity to stop by for Windchase Farm’s 25 year anniversary. The day before, Phyllis wrote a compelling reflection on her experience in the 1988 olympics. If you want to know what success must surely feel like, read the rest on her site, Team Windchase.

Below is a snippet from her  detail on riding the cross country couse:

  Finally it was time for the Games to begin.  Eventing is always at the very beginning of the schedule, and we had our first veterinary inspection in the morning on September 17th, the day of the Opening Ceremonies.  It was a great relief to have the jog-up over with.  The team consisted of Bruce Davidson with Dr. Peaches, Karen Lende (O’Connor) and The Optimist, Ann Sutton (Taylor) with Tarzan, myself with Albany II, and Jane Sleeper as the alternate rider.

The Opening Ceremonies are always really interesting to watch on television, but it is very different from the athlete’s perspective.  We spent most of the ceremony lined up on the hot tarmac outside the stadium, waiting for our time to enter.  Toward the end of the ceremonies, each nation’s athletes would enter the stadium and walk around the track, in alphabetical order by country.  We were instructed to form rows for the procession around the track, but there were hundreds of athletes and coaches there from the United States, and unfortunately nobody to take charge and direct us.  So while most of the other countries’ athletes marched in orderly columns, the Americans ended up entering the stadium in a slightly disorganized group, looking around in awe and waving at the crowds, savoring the moment.  We were later criticized in the press as appearing disrespectful, but actually we just needed a drill sergeant.

But despite the glitches in our organization, there is no feeling in the world like walking into that Olympic Stadium in front of 100,000 people.  The Olympic torch was lit and the Olympic flag was raised.   It was an extraordinary experience, and an incredible sense of patriotism welled up inside us.

Finally the start of the competition came.  It had been decided that I would go first for our team, so I had an early ride time.  I worked Albany in the morning, and then returned to the stable for Jineen to braid him before the test.  When I got back to the stall slightly later than planned, Jineen told me that I would have to braid Albs myself, since I was the faster braider and I hadn’t left her enough time.  The other riders seemed surprised, but Jineen was my best friend as well as my groom, and it worked out well since it gave me something to focus on besides my nerves.

I was nervous of course, but I was also having the time of my life.  After all, this is what I had spent years working for, and now I was going to enjoy every last moment of it.  Albs was also enjoying himself; he had definitely picked up on the atmosphere – he liked crowds, and was enough of a showman that he was quite pleased that everyone was looking at him.

Albany warmed up well, but when we entered the final holding area before our test he got a bit tense, no doubt responding to my own tension.  There was a lot of atmosphere, with flowers and Olympic logos and the huge grandstands.  But as soon as we started trotting around the outside of the arena, he began to buckle down to business.

I will never forget the feeling of riding around the outside of the dressage arena just before beginning my test, and looking up at the big scoreboard and seeing my name in lights:  Phyllis Dawson, Albany II, USA.  As I turned up the center line, I was thinking, “Oh my God, this is it!  I am actually riding in the Olympics!”  It was the culmination of many dreams.  It was a pretty emotional moment, and it made me feel so proud to be there, riding in the Olympics, representing my country.  I rode into that arena feeling on top of the world, and Albany put in the best test of his career.  We finished the dressage phase in 10th place.

Phyllis Dawson and Albany II, USA.

via Windchase.

Elmo and the biofeedback loop of happiness

Elmo loves you, he just loves you, and everyone can understand that – Sesame Street Puppeteer

Kevin Clash, has found the secret to the best biofeedback loop of them all. By making others happy for a living, he’s become one happy guy himself. Clash is the voice, wrist, and hand behind – or rather, inside – one of the most well known Muppets, Elmo.

I know what you are thinking. No, we haven’t spontaneously acquired toddlers. Clash is the subject of the newly released documentary, Being Elmo. Yes I watched it. Yes, I loved it. And, yes, you need to see it too!

Being Elmo chronicles how Clash’s childhood interest in making people smile through puppetry turned into a career of making people happy, which, in turn, makes him happy too. As a young, aspiring puppeteer, Clash honed his skills by preforming for sick children in hospitals. It wasn’t the captive audience which drew him to sick kids. As his parents narriate, it was all about making those kids smile. That’s exactly what Clash has spent the rest of his career working on.

Clash's early start preforming for sick and disabled children

Watching Clash, Elmo, Jim Henson, Kermit (both Love and The Frog), and Frank Oz light up as they bring smiles to others’ faces made me wonder: what are the keys to unlocking the happiness biofeedback loop and can we inspired more happines in the deliver of healthcare services?

Here is what I observed from Being Elmo:

  • Support – Clash’s parents encouraged him to pursue his dream, despite having restricted means. When Clash was a teen, his mom tracked down Jim Henson’s Muppet designer, Kermit Love, and asked him to mentor her son. Love agreed. One of Kevin’s Sesame Street colleagues reflects on the influence of his support system: Elmo is not Kevin, Elmo is Mr. and Mrs. Clash.
  • Focus – Kevin recognized his dream early. According to his brother: Clash stuck with his dream and stayed true to what he had in his heart.
  • Rapid iteration – When Clash made a new puppet, he sat in front of a mirror and tried hundreds of voices to find the one that fit. He glued himself to the TV and watched Henson’s Muppets and kept building new versions to try and figure out how they were built, to get it right. Once Clash took on Elmo, he tried different things with his hand to manipulate Elmo face, from that developed Elmo’s surprised, sad and confused expressions.
  • Be Inspired – Jim Henson, Frank Oz, the Muppet Show and Sesame street… hard to find better inspiration for happiness creators.
  • Have Mentors – Clash identified Kermit Love who coached him on making vowel sounds, puppet motion, manufacture, projection and character development.
  • Seize Opportunity – When Kevin’s senior class went to New York, he used the trip as way to afford to meet Kermit Love for the first time.
  • Go for broke – This seems to be a common theme among passionate, successful people; one which is hard for most of us because we’re tied to lifestyle, objects, locations, etc. For Clash when he was starting out, putting everything he had on the line, each time he auditioned or preformed meant taking risks – financial and personal. By taking those big risks, he also gained big rewards, scoring early roles on local Baltimore TV, with Captain Kangaroo and eventually the Muppets.
  • Curiosity – never stop learning. One of the first things Clash asked Kermit Love about was “the Jim Henson Stitch,” a sowing technique which resulted in a hidden seam between two pieces of material. Learning the stitch evolved Clash’s puppet making abilities.
  • Share your expertise – Clash traveled to France to teach the French cast about preforming Sesame Street. In one scene he shows how opening the puppet’s mouth, even a little bit, creates a subtle smile effect. When Clash does it for the first time, everyone’s face warms into a broad grin, subconsciously and automatically.
  • Stay Humble – When Kevin got his first chance to work directly with Frank Oz and Jim Henson, he was in awe, and so nervous he fumbled his lines. Clash, who had already had a lot of success at that time, says it reminded him to to stay humble.
  • Become Essential – Kevin became a key part of Sesame Street’s production, first as director, then executive producer; Part of sharing expertise
  • Be a mentorWhen Elmo grows up, Elmo wants to be a teacher. When Elmo knows he helped somebody thats pretty important because it feels good. – Clash as Elmo to a live audience of Make-A-Wish children.

Towards the end of the documentary, Kevin Clash discusses how he approached creating Elmo’s personality: I knew that Elmo should represent love… And it worked. Almost instantly, after taking over Elmo, the majority of the time Sesame Street preforms for Make-A-Wish or sick kids, they ask for Elmo first.

Notice Clash's expression as he preforms as Elmo for a Make-A-Wish participant.


I strongly believe healthcare, as a vocation, has a unique ability to foster the happiness biofeedback loop. Caring for others can, and should, make us feel good. I am excited to spend some time reflecting on the themes of Being Elmo and thinking about how they can be applied to enhancing the happiness we get out of working in healthcare. I’d also love to hear what thoughts and experiences you have to share.

you are not stuck in traffic, you are traffic.

You are not stuck in traffic. You are traffic.

You are not stuck in traffic. You are traffic. Who hasn’t been there? You move a few inches, then a sea of cascading red tail lights rolls towards you like a petroleum powered wave. You pound the steering wheel, let out a sigh and slouch back in your seat. You’re stuck. If only these bozos would just mooovvveee!!! What’s the hold up anyway? Don’t they know you have somewhere to be?

I met a civil engineer once who specialized in traffic flow. I asked her how traffic happens. Is it one person slowing down that creates a ripple effect, is it talking on cell phones, is it bad drivers? Nope. It’s us. We are the problem. There’s just too many people on the roads. And the sad reality is it’s not happening to us, we are the cause.

Last week, Bob Anderson from The Leadership Circle spoke to a group of our leaders at work. He shared an anecdote about his own career. He was positioned as a change agent in his organization and convinced that his inability to produce results was surely the fault of the culture, senior leadership, buy in, resources… anything but his work. He was an expert in change, after all.

Mr. Anderson's slide on leadership evolution

Bob’s realization was simple, he wasn’t leading his own team the way he was coaching others. He was highly effective at getting others to understand and work through change, but he wasn’t practicing what he peached. When he retooled his thinking. He began to work as a change agent for himself and his team. The end result? Things started moving in the fast lane.

I can relate to Bob’s story. The role of a change agent can be a difficult one. Remember that great conversation about empathy I posted about a few weeks ago? We also talked about affecting change in cultures and organizations. It probably doesn’t come as a surprise there’s a high rate of burn out among innovators and people who promote change. Sometimes the organization has accepted or implemented all they have a capacity for, at a given time. Sometimes the agent them self has given all they can; taken the group or project as far as they can. Hopefully that timeline coincides with success, and a successful transition.

I think a lot about change. I work in a role all about innovation. We look at new ideas and trends and practices and think about design and process and user experience. How do all these parts fit together? Is there something we can do with widget A and process Z and team N?  Usually, success comes when a team or group picks up the threads and the shell you’ve created and makes it their own. It goes from conceptual and testing to operationalized.

But for one area in particular, that hasn’t been the case for me lately. I’ve been stuck. Red taillights as far as the eye can see. It’s goto to be some idiot 2 miles up the road talking on their phone, fiddling with their GPS…if only they’d move faster, this traffic would clear.

Then it hit me: I’m not stuck in traffic. I am traffic.

How am I going to take my foot off the break and open up the throttle? It starts with Bob Anderson’s realization - We’ve got practice what we preach. If I was trying to coach another group through a similar challenge, where would we start? I’d ask questions:

  • Have we identified the challenge?
  • Do we understand the goal, barriers, stakeholders?
  • Have we put ourselves into an empathic mindset about the end user of this process? What do they really want?

In short, I need to take myself and team through the same design process I’d work with others on.

To be fair, it wasn’t exactly a a lightbulb moment. I can be pretty dense about autodidactic growth. A few friends and big thinkers helped me think through the problem and how to design through it. How’d they get through my daft brain? They asked questions. What are you challenges? Do you know where you want to go? Have you though about doing XYZ, would people react differently if it did? See what I mean, smart people.

And, in fairness, it also helps to be married to an awesome OD expert in change management.

These friends are on twitter and you should follow them. The following example tweets from them are apropos of nothing in this post: