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StopThoughts: how to improve healthcare through reverse culture shock (or why CBPR matters)

note. introducing a new category on this blog: < /stop> thoughts. < /stop> thoughts are those ideas you hear that make you stop, cock your head, blink a few times and then feel goosebumps while your brain goes in a different than you had thought about before. In < /stop> thoughts, I’ll share concepts, often loosely defined, which I think have massive potential to disrupt, improve or otherwise positively effect healthcare.


Yesterday, I had a phone call with someone who I’ve gotten to know as a big thinker around socioeconomic determinants of health. That’s a mouthful of a phrase which I love. During our conversation, she introduced me to the concept of Community-Based Participatory Research, or CBPR.

From Wikipedia:

Community-based participatory research (CBPR) is a partnership approach to research that equitably involves, for example, community members, organizational representatives, and researchers in all aspects of the research process and in which all partners contribute expertise and share decision making and ownership.

From the National Institutes of Health:

Community-based participatory research (CBPR) is an applied collaborative approach that enables community residents to more actively participate in the full spectrum of research (from conception – design – conduct – analysis – interpretation – conclusions – communication of results) with a goal of influencing change in community health, systems, programs or policies.

And, from AHRQ:

In CBPR, community-based organizations (CBOs) or groups (such as churches, church members, neighborhood organizations, community residents, and other social organizations) help researchers to recruit subjects. But they do more than that. Community-based organizations play a direct role in the design and conduct of the research study by:

  • Bringing community members into the study as partners, not just subjects.
  • Using the knowledge of the community to understand health problems and to design activities to improve health care (interventions).
  • Connecting community members directly with how the research is done and what comes out of it.
  • Providing immediate benefits from the results of the research to the community that participated in the study.

Why isn’t very hospital service conceived of, planned and executed according to CBPR?

I know, some of you rival my cynicism (and mine pegs the meter). You’ll say but Nick, these organizations are more interested in the almighty dollar… And, perhaps they are. But, wouldn’t they stand to make even more dough by building and providing services which communities actually want and need?

Fundamental to the idea of CBPR is moving past assumptions. Designers call this co-design. I’m proud to serve on the board of the Society for Participatory Medicine —an organization which, among other things, promotes the mantra let patients help! So, this idea isn’t entirely new.

Here’s the < /stop> thought:

What’s exciting, indeed the < / stop > thought here, is how simple doing CBPR is, and how doing it would inherently cause a culture shift in healthcare.

Imagine hospital executives, planners and clinical leaders spending as little as 10% of their time visiting the communities they serve, and asking “what needs do you have, and how can we, as your local hospital, fill them?”


Take it as given that we’d see new, community and people-centered services. Maybe we’d see hospitals move to all organic, plant-based menus. Maybe we’d see them open medically supervised fitness centers. Maybe we’d see them move health services out of the hospital and into schools and churches. We might also see programs for mental health grow. Who knows‽

But we’d also see how the community would affect the hospital leadership and its culture. Do communities speak about health and wellbeing using the same terms hospitals use? Do most people in a community look, dress, act and present like hospital leaders?

Can you imagine the reverse culture shock?

And here’s the best part, I suspect, for those willing to embrace CBPR, it would feel good. Revenues will probably follow, but even better, I bet there’d be more joy for everyone involved and almost certainly better outcomes.

I’m reminded of how my friend Jason Albrecht closed his recent talk at Medicine X:

“Once you start this, you don’t want to stop. It feels good. It feels good because if feels right… it leads to a much greater sense of joy for everyone involved in the care process.”

—Jason Albrecht, MHA at Stanford’s 2013 Medicine X program

stop thoughts: we need Maker culture in healthcare

note. introducing a new category on this blog: < /stop> thoughts. < /stop> thoughts are those ideas you hear that make you stop, cock your head, blink a few times and then feel goosebumps while your brain goes in a different than you had thought about before. In < /stop> thoughts, I’ll share concepts, often loosely defined, which I think have massive potential to disrupt, improve or otherwise positively effect healthcare.

Last week, I had the opportunity to speak to over 300 cardiac surgeons, cardiologists, nurses and their administrative partners at the Bon Secours Heart and Vascular Institute’s annual conference.


Anna Young was one of the other speakers. Anna represents MIT’s Little Devices Lab and its MakerNurse initiative. MakerNurse draws its name and inspiration from the maker movement.

Maker is all about DIY culture —making things, hacking things, inventing things. The movement an online magazine, Make, and several annual Maker Faire events, billed as the greatest show and tell ever. I often think my 90-something grandmother should be in the Maker movement. Not a day goes by that she doesn’t hack something, like adding a big rubbery grip to a fork to make it easier to hold. That’s what being a maker is all about.


MakerNurse draws on the realities of nurses and nursing. Every day nurses hack their environment to improve patient care. For instance, in Anna’s slide deck, she showed a picture of a nurse who figured out that office supply clips were perfect for holding small oxygen cannula to the beanies that babies wear in the NICU. The clips keep the cannula in place. In another example, nurses in some developing countries are using empty plastic soda bottles as spacers for inhalers.

And, we don’t have to stop at nurses.

Recently I spoke with a pharmacist friend who is most certainly a maker. She heard about a nurse in her hospital’s PACU who was using wintergreen oil to help patients overcome nausea (clearly a MakerNurse!). My pharmacist friend was inspired to incorporate her complementary medicine training into the hospital’s pharmacy. So she purchased bulk aromatherapy oils and dabbed a little onto cotton balls. She put the cotton balls in plastic sandwich bags. Then, she took the bags around the hospital and stopped people —environmental services, nurses, maintenance, execs —and had them test the aromatherapy. Now she wants to give them scented cotton balls-in-baggies to patients to help combat side effects from medications, or as a simple relaxation aid.

Here’s the < /stop> thought:

What if every hospital adopted a maker culture and rewarded new ideas, inventions and devices with as much emphasis as we reward a traditional career progression? What if hospitals provided employees, even patients and families, with tools and spaces to help them make new things and quickly test them out?

In healthcare, we often think vertically about careers and progressions. In the clinical environment we call it practicing at the top of the license. For instance, nurses should give injections rather than doctors, so doctors can use their time to do the things only doctors can do. When everyone is practicing at the top of their license —doing the things they are uniquely qualified to do —the system is, in theory, more efficient.

But, MakerNurse demonstrates is we can have a different type of value in our roles. For nurses, practicing at the top of their license means doing more direct patient care, clinical navigation, etc. Being a maker, by hacking processes and systems and building new things out of nicknacks, provides another avenue for nurses to contribute to improving healthcare; and that path is perhaps less limited by regulations and licenses.

If we, as an industry, valued that kind of DIY attitude, think about how many great ideas would be born, tested and put into practice? Might it also contribute to a different sort of career path or sense of professional fulfillment? What if patients were also encouraged and given tools to hack new things to improve their own care?

So, which hospital is going to be the first MakerHospital?