Today I participated in a webinar on chronic conditions hosted by eHI, the eHealth Initiative (NationaleHealth.org). I don’t have any expertise on chronic conditions but they asked for my voice regarding the value of patient engagement – e-patients!
Before me there were two great presentations by diabetes / weight-loss wizard Julie Cabinaw (with the amusing but misleading Twitter handle @Loser_Mama) and cardiac patient Dan Treadwell. An archive of the whole event will be posted soon.
(The webcast used a new technology, ReadyTalk, that had a lot of problems, not least of which was that it has no online audio (dial-in only) and it quickly sold out (“All lines are full”) so people could watch the slides but not hear. There will be an archive of the whole thing, but it still won’t include my slides, because I didn’t send them in soon enough – totally my bad. Thus, this post.)
Here are the slides; below are notes on what I said.
(Click this link if you can’t see the slides here)View more presentations from e-Patient Dave deBronkart.
Notes on the slides:
Slide 1 & 2: My usual opening about “the most underused resource in healthcare”
Slides 3-6: A new idea I’ll be introducing into my speeches:
Total value of care =
value created by providers (in visits)
+ value created by patients (between visits)
We’re accustomed to looking for improvements on the provider side. That’s understandable – I’m alive because of great value created by providers – but it overlooks the value we can create by putting more power in the home’s hands. That’s what the next slide is about:
How can we optimize the patient & family’s contribution?
Slides 7-8: As I’ve often said, I hate the word “compliance” – it implies that one party knows all and the other (the patient) should obey. My view is, hey, whose life is at stake here?? If it’s my goal, why not call a positive outcome achievement? Plus…
Slide 9 (“.5 x .5 = .25”): It turns out doctors and nurses have just as big a problem with doing what they should (e.g. “complying with” handwashing protocols in hospitals). So it ain’t a patient-specific problem, it’s a human behavior issue – and the 50% x 50% means together we’re only achieving about 1/4 of what we know how to do. So let’s look at what it takes to improve performance.
Slide 10-13: Long ago in another career I learned about Thomas Gilbert (1927-1995), a real guru of performance improvement, and author of Human Competence: Engineering Worthy Performance. Long before the development of Lean, he methodically analyzed what we now call the root causes of failure, and published the matrix shown here.
Healthcare can learn a lot from this. It’s about solving the problem, not casting blame.
Slides 14-18: My personal view of the most common causes of a performance failure, from studying Gilbert’s work long ago. Every one of these can be found as causes of failure, both by providers and patients. (Think about it.)
Slides 19-20: So the question is, can we make it easy to do the right thing? (This is an example I noticed while out getting some exercise last month.)
Slides 21-22: GlowCaps, an example I often cite. Note: in no other industry do we view a hard-to-do task as being the customer’s fault – the winning vendor makes it easier to do. This shows up in such basic things as automatic transmissions and anti-lock brakes. But in healthcare we blame it on the patient. Well, Glowcaps will beep when it’s time to take your pills, or even call your cell phone. And miraculously, “compliance” by those dodgy ol’ patients transforms from 50% to 99%.
See how silly it is to view all failures as the patient’s fault (healthcare), or the worker’s fault (Gilbert)? It’s just not a useful view.
And that, ladies & gents, is a great example of how eHealth can be applied to every cell of Gilbert’s matrix.
Slide 23: My list of general causes of failure, again, with the spotlight on the one that GlowCaps addresses: “Does the person know when it’s time to do it?”
Note: from fixing that one cause, a whole cascade of benefits flows forth from the better tool – not only the immediate benefit of taking the medication, but avoidance of all the sequellae (consequences) of not taking the med.
Slides 24-26: Conclusion.