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From Elsewhere: more on the need to embrace millennials and start-up culture

melI’ve written before about the changing workforce and my concerns about healthcare’s readiness to accept those changes. This week, Tom Agan (from Riva) writes in The New York Times about Embracing the Millennials’ Mind-Set at Work:

To compete for the best millennial talent, companies are having to change in fundamental ways. … Goldman made the change partly because it was losing millennials to start-ups. But start-ups typically offer less pay and equally long hours, which suggests that providing more time off isn’t the only answer. If corporate cultures don’t align with the transparency, free flow of information, and inclusiveness that millennials highly value — and that are also essential for learning and successful innovation — the competitiveness of many established businesses will suffer.

Anecdotal though it may be, I’m seeing a trend in healthcare. Fewer and fewer bright young people are queuing up for the dark suit, long hour, old white men’s club of hospital administration. Instead they go to work for a healthcare startup, or other unexpected players like Walgreens, Target or SG2.

In short, I’m worried we’re facing something akin to a brain drain in traditional healthcare —an energy drain. We’re notoriously slow to change, particularly when it comes to culture. Paternalism is as strong in administration as it is in clinical care.

How do we get hip?

  • Embrace - Tom Agan suggests: “…rather than complaining, it’s time to embrace millennials for what they can offer, to add experience from older workers to the mix, and to watch innovation explode”
  • Launch a skunk works - the term skunk works* comes from of Lockheed Martin’s advanced development programs. The idea is a start-up inside a traditional company. What if hospitals offered millennials and others the opportunity to experience start-up culture?
  • Try Google’s 20% rule - Google’s famed 20% rule was the catalyst behind gmail. Googlers are encouraged, in some cases required, to spend 20% of their time working on a project unrelated to their core job. Can you imagine if health systems encouraged the same kind of time sharing?

*Via Wikipedia:

The designation “skunk works”, or “skunkworks”, is widely used in business, engineering, and technical fields to describe a group within an organization given a high degree of autonomy and unhampered by bureaucracy, tasked with working on advanced or secret projects.

From elsewhere: NC hospital closes, but was it really because of politics?

You know you are early for your flight when...

Posting on the Huffington Post, Jeffery Young writes: North Carolina Hospital Closes, Citing No Medicaid Expansion

A small hospital in a coastal North Carolina community will close its doors within months and its parent company says Gov. Pat McCrory’s (R) decision not to expand Medicaid under President Barack Obama’s health care reform law is partly to blame.

But wait, there’s more…

Other considerations, including outdated facilities, also led to the company’s decision to close the hospital but North Carolina foregoing the Medicaid expansion contributed to the decision, Vidant Health CEO David Herman told The Huffington Post.

I’m not surprised we’re seeing smaller community hospitals struggle. Last week the great Mike Sevilla, MD wrote an op-ed for KevinMD questioning: is the end near for small community hospitals?

Without doubt, I think we’ll see more of these closures. But we have to also pay attention to the root cause, particularly in these still early days of PPACA’s implementation.

Note Mr. Herman’s other considerations —outdated facilities. At some point, buying a multimillion dollar scanner or other required life saving equipment for a 49 bed hospital just doesn’t make sense.

It also may not make sense to operate 49 bed hospitals within an hour’s drive of a larger, more sophisticated facility.

We’re seeing the shift away from the shiny hospital on the hill as the only anchor for providers and care delivery for a community.

That story is a lot more interesting than politics and Medicaid expansion.

From Elsewhere: H&R Block using retail locations for insurance exchange enrollment

About to be the least authoritative speaker at Apple's medical event tonight

Writing in Modern Healthcare, Jonathan Block pins: Reform Update: H&R Block, online insurance broker team up to sell health plans

The GoHealth platform will be available through H&R Block both online and over the phone nationwide beginning Oct. 1, said Michael Mahoney, senior vice president of consumer marketing for Chicago-based GoHealth.

Here’s where it gets interesting:

In a separate development, H&R Block on Wednesday said as part of a pilot program, it would have health insurance agents in its tax offices in Arizona to assist with choosing and enrolling in a plan.

Is this really all about the physical footprint of H&R Block’s stores?

It’s not news that funding communication around the rollout of PPACA and health exchanges as been challenge for CMS. What is a problem for the government could be an opportunity for private industry like H&R Block.

In the age of Quicken and TurboTax, its hard to imagine that H&R Block gets as much bang for the buck out of their many physical locations as they once did. By offering in-person health insurance exchange enrollment, they might have found a niche to pull people back in.

What’s next, FedEx and UPS to follow? Maybe Apple could leverage their Genius bar for insurance advice… or, maybe not.

From elsewhere: What would happen if hospitals funded ideas from patients, docs and staff?

Med Students (and interlopers) only

From Deanna Pogoreic at Medcity News:

Stanford has established a three-year partnership with Stanford Hospital & Clinics and StartX, an accelerator for students, faculty, alumni and staff, under which the institutions will support the accelerator and create a fund called the Stanford-StartX Fund.

Teams that take part in the StartX accelerator will now have optional access to financial backing from the university and hospital if they are raising $500,000 or more in a round. The fund, which Stanford says is uncapped, will participate in rounds as a minority investor.

I like this idea, and it seems to echo a few other trends.

We’re seeing a move towards younger workers preferring contract roles. Some suggest it is employer driven, owed to increasing healthcare costs. But others —and I favor this view —say it’s because knowledge workers like to move quickly between projects and environments.

There is also a glowing ember (not ready to be called a trend) within healthcare to practice rapid iteration. For a long time perfection wasn’t even good enough. Today, we’re understanding we need to quickly test processes, tools and procedures to see what works and what can be improved.

What’s exiting about Stanford’s announcement is how it fits comfortably with our the workforce and an entrepreneurial culture.

What might happen if hospitals started funding ideas generated by staff, doctors, patients and family members? Can you imagine the pace of innovation?

from elsewhere: Barbara Armstrong on design thinking

Writing on, Kahler Slater’s Barbara Armstrong posted: It’s Time To Bring Design Thinking Down From On High

I love this post. Armstrong references Tim Brown’s TED talk on design thinking.


…design thinking is a process of integrative thinking, a process rooted in the ability to examine and exploit opposing ideas and constraints to create solutions. Design thinking, says [IDEO’s Tim] Brown, “moves the design process from consumption to participation.”

…the design-thinking process has three primary attributes: it is human centered; it is collaborative and participatory; and it is driven by experimentation. And the process begins with a single query: “What is the question that we are trying to answer?” As Brown says, “Rather than thinking to build, build to think.”

Armstrong, a veteran healthcare experience and space designer, doesn’t pull any punches when she digs into healthcare.

In today’s health care industry, there is a push for evidence-based design, a human-centered approach to design aimed at increasing the quality of patient care while simultaneously decreasing costs.

Too bad healthcare leaders had to be in crisis before they put people at the center of their problem solving. So do it now at your company. Proactively, you can drive innovative business solutions with broad, human appeal.

What I love about design thinking, particularly for healthcare, is its emphasis on empathy, participation and rapid prototyping; three concepts which have a great affinity with healthcare. For instance, I’ve never seen a hospital mission which doesn’t include some variant of empathy - compassion, caring, healing, etc.

We’re also speaking more — at least starting to speak —about participation. Ideas like shared decision-making and participatory medicine.

And, clinicians are fundamentally trained in testing ideas. Its how new techniques are developed and new treatments come to market.

But, for some reason, the business side - the systems, resources, policies, and leaders —have been slow to smash the these things together. If Reese’s were a healthcare company, no one would ever get peanut better in someone else’s chocolate.

Design thinking is about bringing those core tenants of healthcare together —empathy, participation and prototyping— to surface meaningful, desirable solutions to challenges.

In healthcare we seem value having answers. People who have answers are smart, they are sharp, and they are going places. We even pay prophets from other lands big bucks to come tell us answers.

Fundamental to the process is the belief that solutions to challenges can be uncovered by a team. That’s another reason I love design thinking in healthcare.

In design thinking, we is more important than I. Value is found in asking teams —including front line employees, for ideas, not answers. There is excitement around building on each others ideas. There is a willingness to test the ideas we co-develop and find out what actually makes someone’s life better. None of that is about being the person with an answer.

Here’s Tim Brown’s TED talk:

From Elsewhere: The Bossless Office

Bossless Office (Photo: Illustration by Marc Boutavant)

…“Management is a term to me that feels very twentieth century, … That 100-year chunk of time when the world was very industrialized, and a company would make something that could be stamped out 10 million times and figured out a way to ship it easily, you needed the hierarchy for that. I think this century is more about building intelligent teams.”

—Simon Anderson, CEO of DreamHost

One of my biggest concerns about the future of healthcare is the industry’s attractiveness to bright young people. Let’s face it, unless you are doig cutting edge clinical work, there’s not a lot in healthcare which compares to Google’s sushi bars, segways and wifi-blanketed busses.

The hospital workplace is still one of the most conservative environments in corporate america. Dark suits, wood paneled board rooms and hierarchy are the norms. I haven’t spoken to many college-aged young adults who are anxious to flock to that kind of workplace.

Enter the Bossless Office. A feature this week in New York Magazine looks at an emerging trend in management, or the lack of it.

There’s a lot to like about this idea and its application to the healthcare environment. Could it help entice more of the start-up, rapid pace, rapid reward crowd? I think so.

This structure—largely flat and very flexible—is especially appealing to those new to the workforce, twenty-somethings who tend to approach work differently from their parents. “The way workers are motivated is changing,” says Anderson of DreamHost. “Twenty years ago, it was about higher pay. Now it’s more about finding your work meaningful and interesting.” As more and more millennials enter positions of power in the business world, Anderson believes we will soon reach a point where hierarchy itself is “passé.”

From elsewhere: Patient-Centered Outcomes Research Institute to Invest Up to $68 Million to Develop a National Patient-Centered Clinical Research Network | Patient-Centered Outcomes Research Institute

Today, in an open, live-streamed webinar, PCORI —the Patient-Centered Outcomes Research Institute —made a big announcement. Executive Director Joe Selby, MD started with a reflective observation:We went in thinking this would be about clinical research. We came out realizing it was about patient networks. 

I've been calling 2013 the year of the ePatient and I'd say today's announcement from PCORI further validates the assertion.

This funding and focus paves the way for online communities, ePatient groups, disease-specific groups, healthcare providers and even payors to gain funding to for their own evidence-based research. That is, in turn, critical in validating some of the intrinsic and immediately observable benefits of patient communities and patient-identified therapies.



Two innovative features of this initiative are

PCORI’s expectation that health systems, clinicians and patients will play key roles in governing the direction and uses of the networks that this funding will support, and that the interests of patients will be central to decision-making about the network’s structure, function, and uses.



via Patient-Centered Outcomes Research Institute to Invest Up to $68 Million to Develop a National Patient-Centered Clinical Research Network | Patient-Centered Outcomes Research Institute.

From elsewhere: Tracking health indicators hints towards disruptive innovation in doctor patient relationship

Pew Internet’s Susannah Fox, today, released the official report behind her amazing Stanford Medicine X talk. The report is a great read for data geeks, health wonks and ePatients alike. But there’s one part in particular I find especially indicative of an impending disruption in how we approach medical care as patients.

According to Pew:

Seven in ten (69%) U.S. adults track a health indicator for themselves or a loved one and many say this activity has changed their overall approach to health, according to a new survey by the Pew Research Center’s Internet & American Life Project.

This is the first national survey measuring health data tracking, which has been shown in clinical studies to be a tool for improving outcomes, particularly among people trying to lose weight or manage a chronic condition.

Of all the results, I find one in particular compelling:

40% of trackers say it has led them to ask a doctor new questions or to get a second opinion from another doctor.

I’m predicting 2013 and 2014 as the years we see a sea-change towards true consumer-driven health. In the past, wonks have spoken about high deductible plans and health spending accounts as the economic vehicle to compelling consumer behavior. The problem with that version is it assumes people will consume less healthcare services if they are footing the bill.

There is some truth regarding spending usage. But, largely sick people will seek care and people without access —via insurance or a government program —will delay care until the need is chronic and more costly.

What I’m excited about, based on the Pew results, is the potential of true consumer driven healthcare. Today, it’s increasingly easier to wear a gadget and get direct access to cutting edge lab tests. For $99, 23andMe will examine your DNA an report back some pretty amazing data.

So, if 40% of people report asking new questions based on following their own health indicators, how long before patients become the initiators of a care plan? Rather than rely on doctors to discover whats wrong with us, we’re moving a world where we might know more about ourselves before we seek a doctor than after seeing one.

That idea might challenge some people, including doctors. Rest assured, it doesn’t eliminate the need for doctors. We’re simply looking at a period of disruptive innovation which will change the role of physicians (in some circumstances). It’s a bit like coming to an architect with your own rough draft of blueprints.

For more about Susannah Fox, Pew and the report, check out the video interview from Medicine X:

Susannah Fox - Medicine X Conversation from Larry Chu on Vimeo.

From elsewhere: Participatory medicine to fight misconceptions about disease

Beryl Benderly, writing for Kaiser Health News and NPR’s Shots blog, tackles an important topic: misconceptions from providers about disease. In this case, Benderly writes about sickle cell.

There’s a lesson to be learned in this story for providers. And, is often the case, it is one of participatory medicine.

Patients suffering recurrent episodes know what works for their pain, but some doctors and nurses take that knowledge a sign of addiction. Patients with sickle cell pain wait an average of 30 minutes longer for pain medication than people with other extremely painful conditions, such as kidney stones, Tanabe’s research shows.

Patients know what works for their pain. That’s pretty simple. The painful part, aside from the actual pain, is the stigma so many patients have to battle to get the treatment they know to be effective.

One has to imagine, in a world where providers embrace patients as part of the care planning team, trust also increases.

Source: NPR Shots: Fighting Misconceptions About Sickle Cell Disease In The ER

From elsewhere: Marketplace Radio nails it on healthcare pricing

Healthcare is a notoriously difficult thing to shop for. There a lot of reasons for that. For starters, we’re all squishy, warm, living breathing things. It’s rare there is a perfect solution to whatever ails us - that makes it hard to compare apples to apples when it comes to treatments and outcomes. On an even more basic level, the idea of consumerism in healthcare fails because we cannot shop by price. Marketplace Radio profiled L.A. Times columnist David Lazarus on his $55,000 cat bite. This is the first media coverage I’ve seen on pricing in healthcare which gets it absolutely right. Lazarus spoke with administrators at UCLA Medical Center who pealed back the curtain on how hospitals set prices.

At one point in my career, I was responsible for a large-scale project to recalibrate the pricing scheme for a health system. It was an effort which generated several million dollars in new revenue —without much, if any, out of pocket impact to patients, I might proudly add. Pricing and reimbursement isn’t a particularly special recipe. But yet, like laws and sausage, we rarely see how it’s made.

Lazarus explains the crux quite well:

“It all basically stems from the discounts that are contractually given to insurers in return for them bringing scads of patients into hospitals. So what do the hospitals do? They jack up all the prices so that the prices become so inflated, that once the discount kicks in, they’ll still be able make a profit,” Lazarus says. “You have no idea what any particular thing really costs.”

The audio is a great story, one I cannot recommend enough for any ePatient.

For us administrators, I challenge hospitals and providers to publish a few key numbers:

1) Gross charges on common procedures and diagnostics

2) Average contractual adjustment (the part Lazarus was told not to worry about - the “funny money”).

Will some see that level of transparency as a source of weakness in contract negotiations? Sure. But those are the providers who aren’t ready for accountable care and the impending at-risk payment structures based on population health Lazarus mentions.

And, by the way, Lazarus's mention of those population health measures is important. While our political attention was focused on the individual mandate, providers and CMS have been busy talking about accountable care.

Read the original and listen to the audio here:

via How a cat bite cost one man $55,000 |

The audio is available here:

Unintended uses: a mobile app to reduce germy hotel surfaces?

a20791f138332ea144be_m I’ve been staying in a lot of hotels lately. There’s a new trend of apps for in-room entertainment systems, like LodgeNet. Being the cynic I am, I question the value of these apps. I hate the idea of unlocking my phone, launching and app and waiting for it connect just to change channels. And, what’s in it for the vendor? Probably tracks my viewing habits. (Here’s a hint, lot’s of CNN).

Then, while emptying my bottle of hand sanitizer onto every surface in the room, the value occurred to me:

Top hot spots for aerobic bacteria in hotels turned out to be the bathroom sinks and floors, the main light switches and the TV remotes. The remotes, for instance, racked up a mean of 67.6 colony-forming units of bacteria, or CFU, per cubic centimeter squared.

via MSNBC: Germiest hot spots in hotels? TV remote, light switch, study finds

I might rethink my reluctance to using my phone to change channels.

It also makes me wonder, is there a similar application in healthcare? We’re all gun-ho about mobile access to EMR data and appointment scheduling. Are there other uses of mobile tech which might reduce the spread of germs?

From Elsewhere: Medicare Discloses Hospitals' Bonuses, Penalties Based On Quality and man does it tell a story

Last week, CMS, the Centers for Medicare and Medicaid Services, announced the names of hospitals who received bonuses for quality. It also listed the names of hospitals which received penalties. Kaiser Health News has done a great job of covering the story.

Here’s what I find to be the single, most telling thing:

Nicholas Genna, CEO of Treasure Valley Hospital in Idaho, recipient of the biggest bonus, credited close attention to patients, including a low nurse-to-patient ratio and handwritten thank-you notes to patients, along with the fact that the doctors own the hospital. “People answer the phone with a smile on their face,” he said.

If that doesn’t validate…nay…quantify the importance of making patient experience the top priority, I don’t know what does.

Compare Mr. Genna’s comments to those from the most penalized hospital:

Thomas Filiak, the chief operating officer at Auburn Community Hospital in New York, which received the largest penalty, said executives have begun a number of initiatives to lower noise near patient hallways, including putting new wheels on squeaky food carts. “They sounded like Mack trucks going through the hallway,” he said.

One speaks to actions and the other to lip service. Sure, squeaky carts are annoying and may lead to a less than favorable result on one particular HCAHPS question. But ask yourself this, for which of these places would you rather work? At which would you rather seek care?

Don’t get me wrong, I’m applauding Mr. Filiak’s efforts and I’m sure the leadership team at Auburn Community is well poised for a fantastic turnaround — I’m looking forward to reading that story in 2013.

What I’m suggesting is that Treasure Valley’s success is clearly the result of a patient-centered culture, and it shows in how patients feel about them and in turn how Medicare is rewarding those kinds of culture.

via Medicare Discloses Hospitals' Bonuses, Penalties Based On Quality - Kaiser Health News.

From Elsewhere: Lean Blog Podcast & Making room for Empathy

One of my favorite phrases is making room for empathy. Room for empathy is about giving staff the time in their workflows to be compassionate and to deliver care which is not only clinically competent but emotionally uplifting as well. But that’s hard to do.

It’s hard because the work of providing care is increasingly complex. We’ve got EMRs with screens of data. We’ve got sign off sheets, time outs, forms, papers, phone calls, results, and, frankly, CYA work. Those things take time. So what get’s cut? Empathy. We cut out the simple things like walking someone to their destination rather than pointing. We cut out sitting with someone who looks concerned (so we look at our shoes or iPhones in the hallway). It’s a problem

There are two main ways to make more room for empathy. First, we could hire more staff. More staff (nurses, care givers, techs, managers, administrators even) mean more bandwidth. Many hands make light work. But we probably aren’t going to get more staff. Reimbursement is dropping, and there is a push to be more efficient. Hospitals are trying to see if they could survive on Medicare reimbursement rates. (Remember, Medicare pays, on average, about 80% of what treatment costs, so we have to cut about 20% of cost out of hospitals).

The other way we can make room is by eliminating work which does not add value. Productivity gurus say we should work smarter, not harder. I’m increasingly interested in the Lean methodology as a framework for evaluating how we do our work and determining if it adds value, or simply takes up valuable time. So, I’ve been trying to learn more about Lean.

I found Mark Graban’s Lean Blog which led me to his Lean Blog Podcast, a regular, downloadable audio show about Lean. In the most recent episode, Dr. John Toussaint of ThedaCare, discusses the importance Lean methodologies in healthcare.

It’s a fantastic listen and should inspire anyone looking for ways to make room for empathy and return the focus to patient and staff experience.

From Elsewhere: The Best Medicine For Fixing The Modern Hospital | Fast Company

Hospitals were designed for the wants and needs of doctors and hospital administrators. Patients werent ignored--but they werent top priority, either.

via The Best Medicine For Fixing The Modern Hospital | Fast Company.

Today's Fast Company post nails an essential problem with healthcare. The article focuses on architecture, although the quote above is really applicable to almost every part of how we deliver care.

Other industries, particularly dot com startups, know the term user centered design. It's a simple concept. What does the end user want?  Think about the best hotel you've stayed in, or something as simple as the famous Oxo vegetable peeler. What they have in common are roots in user centered design. They were created by thinking how will guests move through this lobby? Where will they sit? Is it comfortable? Quiet? Is there free wifi?  And, in the case of the peeler, how does it feel in your hand, could someone with limited grip strength hold it?

The Fast Company article makes a very compelling point. It's not that healthcare has ignored user centered design entirely. It's just that our definition of the end user has ignored several key constituents: patients and staff.

Ok, I added staff, but I believe it to be true. Just ask a nurse. Nonetheless, the point is clear, we've got to involve patients and staff, along with doctors and us admin types, in the design of the processes, spaces and things in healthcare.

From Elsewhere: In Silicon Valley, Perks Now Begin at Home

In Silicon Valley, Perks Now Begin at Home -  

Stanford School of Medicine is piloting a project to provide doctors with housecleaning and in-home dinner delivery. Genentech offers take-home dinners and helps employees find last-minute baby sitters when a child is too sick to go to school. Hannah Valantine, a cardiologist, professor and associate dean at the Stanford School of Medicine, said the university’s experiment with helping out at home was part of a broader effort to support doctors, given their hyperkinetic pace of life.

The New York Times Reports this weekend on the new perks avant garde Silicon Valley companies give employees. Companies, like Stanford Hospital, are experimenting with things aimed at increasing work-life balance.


Because happier employees are better employees.

And the goal is not just to reduce stress for employees, but for their families, too. If the companies succeed, the thinking goes, they will minimize distractions and sources of tension that can inhibit focus and creativity.

And in healthcare, we have a problem.

According to lead author Jeannie Cimiotti, more than a third of the nurses in the study said they had an emotional exhaustion score of 27 or greater on the Maslach Burnout Inventory-Human Services Survey, which is the equivalent of being “burned out.” Healthcare Finance News, 2012

I’m intrigued by the inspired approach companies like Evernote, Facebook and Stanford Hospital are taking to reduce burnout and improve “work-life integration.” This definitely fits my goal of working smarter, not harder.

The caveat would be in having companies remove so many life-related chores, employees feel free to work around the clock. I think we are safely a long way from there.

(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.

From Elsewhere: Alec Baldwin and guest Robert Lustig on the sugar epidemic

This post is part of my From Elsewhere series.

A recent study reveals that 80 percent of the 600,000 food items in America are laced with added sugar. Lustig says, “There is not one biochemical reaction in your body, not one, that requires dietary fructose, not one that requires sugar. Dietary sugar is completely irrelevant to life.

Honestly, I didn’t expect that. Not considering the source. I mean, I’m not surprised by Dr. Lustig’s comments, but that’s not what I expected to hear when I downloaded Alec Baldwin’s podcast for the first time recently. Honestly, I’m not sure what I expected. Maybe a rating tirade about angry birds, airlines or one of Baldwin’s family members. But not a serious dialogue about the epidemic of noncommunicable disease owed to our increasingly flawed food system.

So, for those tempted to write off Baldwin’s show based on his many reported personal challenges, let me prothletise: This is a good show. This episode, in particular, is worth a listen.

Some my recognize Dr. Lustig from his popular YouTube video, Sugar: The Bitter Truth which has more than 2,600,000 views. Dr. Lustig breaks down the historical and socioeconomic events which have led to a food system full of processed, sweetened food. He goes on to discuss the toxic effect all this sugar has on our bodies and suggests sugar may be the underpinnings of the chronic diseases plaguing our society.

I’m not qualified to determine if Lustig is clinically accurate. But it doesn’t take a research scientist to know all the HFCS in our food supply can’t be helping the obesity problem.

Have a listen wither through the embedded player below or by downloading the podcast episode via iTunes.

Robert Lustig: We need a new food model. We need a new food growing model. By 2050, we’re gonna need four California Central Valleys in order to feed our population, we won’t even have one. Because of the runoff in the Sierra, the changes in soil erosion, we won’t even have one. So you know what the obesity epidemic might even take care of itself because we’ll have a famine because we are misusing our food system. Michael Pollan writes about this routinely. The bottom line is biochemically our current food environment does not work for us and until we fix it, we’ll continue to pour money down a rat hole. We will continue to be sick; we will continue to die of things like diabetes and heart disease. Medicare will be broke by 2024 because there won’t be any money to pay for it. You won’t be able to see a doctor because they’ll be too busy taking care of all the other fat people in the emergency room who are having their heart attacks and there won’t be enough food anyway.

via Here's The Thing: Robert Lustig Transcript - WNYC.


HCSM Review - Patient Experience & Innovation Edition

It’s live!

This week’s Health Care Socil Media Review is chock full of great stories. Thanks to everyone who submitted something.

First, a little background. The #HCSM Review is what the cool kids call a blog carnival. Every two weeks, the hosting blog (that’s me this week) rotates. We ask for your submissions, and boom, just like that your awesome stories magically* appear here.

*By magically I mean with lots of wordpressy CSS technical bits which no one really understands.

Last week’s call for submissions generated exciting, thought provoking some links. I’m excited to share them here. Originally, I wanted focus on innovation-related posts, which were certainly a theme in your offerings. The big news of the week was The Walking Gallery at HealthData in Washington DC. The Wallking Gallery is the creation of the brilliant and inspiring @ReginaHolliday Read the Storify stream of the event here.

Regina's Walking Gallery is a huge innovation in patient experience. Regina has created a living, moving, growing, ever-evolving art instillation. The power of this project is in it's ability to remind any observer of the humanity at the core of medicine. Everyone wearing a painted jacket is a person, with a story and an experience - sometimes multiple - with the healthcare system. Seeing the gallery, even images via the web, is a disruptive innovation to be sure!

Another Storify post of the Walking Gallery comes from Wen Dombrowski.  According to Wen, This Storify captures the essence of The Walking Gallery at the Kaiser Permanente Center for Total Health in DC, Monday June 4. Regina Holiday paints the backs of jackets for people who agree to wear them to conferences and spread the word about patient access to health data. Regina paints on each jacket an allegorical painting explaining the wearer’s relationship to health data and its liberation, which may or may not involve a personal or family story about an encounter with the medical-industrial complex.

Everything we understand about knowledge is changing. That’s the subject of Dr V’s great post on 33 Charts. For Doctors, the World is Too Big to Know. How should accessible network information be balanced with that committed to memory? How will the doctor of 2050 process and apply information appearing faster than any traditional authority can conceptualize?

Ben Miller PsyD, offers his thoughts on why politics and SCOTUS will not interfere (too long) with healthcare innovation on the Occupy Healthcare blog. According to Ben: We will do what we must to continue to create a high performing and effective system we all deserve. Regardless of the ruling, you cannot stop the innovation in our communities. We will wake up, have our coffee, see the outcome of the decision and continue going back into the trenches working towards a comprehensive whole person system.

David Harlow, writing on his Health Care Law Blog, offered his review of Health Data and Innovation Week. Included in this post is a vlog of a random walk through the Health Datapalooza exhibit hall and lobby spaces, where I interviewed nine entrepreneurs and found that most of them could not have launched their businesses all that long a go – they are fueled by the open data movement that has turned the government into a free sharer of a tremendous amount of information. Many of these tools for health care improvement have social components to them, as well.

Jean Kelso Sandlin, EdD, shared Gatewatching: A Social Media Strategy for Hospitals. Consider how social media gatewatching can position your hospital or clinic as a trusted source for health information and help it earn a reputation for being responsive to patient and community concerns.

Matt Allen, writing at HealthWorks Collective, pins about Gamification and Government Health Care. According to Matt: The move to adopt video games for healthy living initiatives represents a huge innovation in how public health is tackling the lifestyle diseases that are such a burden on our healthcare system. Using games to promote healthier behaviors will help prevent health problems before they start.

Also on HealthWorks Collective, Barbara Duck shared her concerns about a new Facebook app touting secure patient-physician communications. It doesn’t appear to be free for the doctors; the site states that it is $69.95 a month. When you visit their free standing website the RegisterPatient has all the whistles and bells that can integrate with a medical record system, etc. so why do you need Facebook in the portal?

For something a little different, although nonetheless inspiring, Lisa Fields shared an unlikely musical remix - Mr. Rogers singing Garden of Your Mind. It's a auto-tuned mashup of a classic Fred Rogers song, stitched together with cut scenes from his iconic children's show. The lyrics, along with Rogers immutable presence, are great reminders of the power of the human mind. And, if that's not enough, the slide whistle solo is worth the watch alone.


That’s a wrap for this week’s HCSM Review. Remeber to follow the HCSM Review twitter account for the next round of submissions and roundups.