Listen to the music

Yesterday I played in a recital with my jazz combo-dedicated amateurs. Musically we have greatly improved.  The devil is in the arranging. Who plays when and where, in what order. Trying to get it right one player sent an email to everyone with the arrangements. We rehearsed one last time in the morning, making a few changes. He sent the revised arrangements out just before the gig.  I printed and didn’t review. One tune was a complete disaster.  The changes were not what we agreed to, I was the only one that printed the changes.  I noticed the discrepancy in the middle of the tune and chose to play as written, not as I remembered what we agreed to. I messed everyone up, the tune fell apart. Disappointment, irritability.

Alignment is tough in music and in health.  Everyone’s talent, passion, and goodwill goes up in smoke when the alignment / arrangement isn’t there. How do we align in health care?  The person at the center and their team knows and agrees on the goals and the action steps. They communicate the inevitable adjustments as they occur. A small tight group that plans is no guarantee that the alignment will hold. Sort of surprising that we expect it to be smooth or flawless. Sometimes if we listen well and hear the mismatch we can adjust and realign and sometimes we can’t. Listening. Anyway, three out of four tunes sounded great. I guess that’s not too bad. But it’s not my health.

Defining Patient and Family Engagement – Threads in the Fabric

I take part in many forums that use the term patient engagement. Most often it means patient compliance with doctors’ orders. I struggle that there aren’t terms for clinician engagement, clinic engagement, hospital engagement, or vendor engagement. The health journey is a series of relationships, partnerships, with shifting foci of ability, skills, priorities. Tools, information, work flows and life flows could help and hinder those relationships.  It’s all on behalf of the person at the center of care, who is sometimes a patient.  I understand that everyone and every team and every organization tends to be self-centered, thinking first of themselves, their own survival. It’s human nature to want someone else to act differently. I know that much of the health industrial complex is really about illness, not health.  It’s usually an illness team not a health team. I also suspect that there’s a similar - minority – proportion of people who drive their own health as there are clinicians and provider organizations that are person centered. Collaboration among people who love each other is fraught, challenging, and continual effort. It gets harder from there. I also know that shared decision-making applies to decisions about treatment AND having persons at the center on Boards of Directors, on design teams, on evaluation teams. How do we then wrestle with the power imbalance of the relationships in the health journey? I don’t think I’m ready for a definition. There’s so much involved. I keep teasing out more threads in the fabric of the health journey.

Can health care organizations learn?

I’m stuck. I’m obsessed with how organizations learn. In my day job as Vice President of Quality Management at Advocates, Inc., we’ve been considering how to promote Advocates as a learning organization including persons supported and their networks, those closest to the work, and all partners. How thrilling! What a goal!!  But how do we actually do it? I’ve read so many books and articles. But they’re prescriptions with no promise of actually working.

Access to your health team – Asynchronous communication

Much of health care depends on relationships. What do people at the center of care and professionals in health care look for in their relationship? Much as with any relationship – access when needed, exchange of information, listening, respect, speaking the same language, understanding each other’s values and priorities, follow through.  Relationships depend on access to each other – particularly tough in health relationships. Little natural about it with very different lives, different patterns, different circles, different priorities. In our personal lives we take access for granted. We know family habits and patterns. On the job we work in teams and routinely meet, our paths cross. In health relationships, not so much. Professional serve lots of people and people work with lots of health team members, many of them strangers – hence appointments and leaving messages. Kind of amazing that health relationships depend on direct connection. Why don’t we depend on asynchronous communication (NOT connecting in person or by voice, NOT in real-time). Examples include emails sent and read when each person has time; open notes (professional narrative entries into the medical record that people at the center of care can read via portal), and taping appointment and phone conversations for review after the fact with other health team members.

Technology can support asynchronous communication if people on both sides of the relationship are comfortable. Some are exceedingly uncomfortable. Especially challenging may be the change in skill set and habits. Some people at the center of care and professionals  struggle with new technology or  have no time to learn new technology – sometimes, but not always its generational. Changing habits can be tough for anyone.  Why change? I don’t want anyone looking over my shoulder! This app makes no sense, I don’t have time to learn it. I’ve learned to use it, but it doesn’t contain information important to me.
How do you use asynchronous communication for your health?