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habits | Danny van Leeuwen Health Hats - Part 2

Life Happens or Expecting the Unexpected

By | Advocate, Caregiver, Clinician, ePatient, Leader | No Comments

The New York Times Magazine has an article this week about flexibility at work. Since I am a person with a chronic illness and disability and have been a boss to many teams, it seems like a no brainer to support flexibility at work. In fact, life requires flexibility at work. If you give care to yourself or anyone of any age you need flexibility at work. This can range from a haircut to periodic hospital admissions.  I used to think that there couldn’t be flexibility if you worked on a shift, say in an ICU, when your absence would make it short-staffed and less safe.  But then my teams realized that if we expected to need flexibility then we could design the work and schedules to accommodate the unexpected.  Rather, the need for flexibility became the expected. In my first management job as a manager of an ICU I noticed that nurses didn’t stop for lunch, let alone take breaks or go to the bathroom. Crazy. We can design this work so we can take breaks!! This morphed into no one needs to be on call all the time and then, sure, you can go to your daughter’s recital.  We can figure this out. I found that when flexibility was expected and given, people stepped up to allow it to happen for each other.  No work was planned that required just one person, we always built-in redundancy and clear written descriptions so someone else could step in at a moment’s notice. Certainly, hiring the right people is critical. Flexibility doesn’t work if you don’t trust that everyone gives their all.  Do you avoid hiring people with disabilities, chronic conditions, or full of life because you’re worried about getting the job done? I hope not.

What’s the Problem with the Experience of People at the Center of Care?

By | Advocate, Caregiver, Consumer, ePatient, Family man, Leader | One Comment

Wearing my many hats: e-patient, caregiver, nurse, informaticist, and leader, I am blessed with mostly positive experiences on my health journey.  At worst, my experiences are seriously annoying. This week, attending a benefit for MITSS (Medically Induced Trauma Support Services), I’m reminded that not everyone is so lucky. As I scan the industry several problems with the experience of the people at the center of care (patients, caregivers, clinicians, direct care and support staff) jump out: Read More

Habits – Health’s ingredients

By | Advocate, Caregiver, Clinician, Consumer, ePatient, Family man, Leader | 2 Comments

Habits are the ingredients of health. My chiropractor tells me that my exercise habits should be sustainable. I need to keep them up no matter my life pace. Now I alternate days of 45 minutes of balance and core strengthening exercises  with 60 minutes of recumbent bike riding.  I could do that when working full-time and when not. Smiling and greeting you at a threshold is a habit. A habit for my mental health and yours. My newest habit is to stop putting food in my mouth every day at 7:08p.  Why 7:08?  No reason. This blog is a habit: one idea germ a week, 20-60 minutes of writing every Sunday for 3 years. Helps me keep my disorganized mind in order.

Nothing so needs reforming as other people’s habits ~ Mark Twain.

Data can motivate change. Changing data requires a change in life and work flow.

By | Advocate, Caregiver, Clinician, Consumer, ePatient, Informaticist, Leader | No Comments
This fifth in a series of posts about health data thinks about the value we get from that data.  In my last post I said, The best data has value because it reflects or motivates action. Action to improve health and wellbeing of and reduce cost to individuals and populations. Action to improve life flow of persons at the center of care and work flow for people who work in health care agencies.   
Let’s think about times when data helped motivate action. At few years ago I weighed almost 200 pounds.  My primary care physician turned the computer screen toward me and showed me a graph of increase in my weight since I started seeing her 4 years before. A very dramatic line graph of weight increasing from 160 to 198 pounds. OMG. No wonder my new pants were getting bigger and I went from a belt to suspenders (I still have no behind to hold up my pants-the new weight did not give me more of a butt). I was motivated to lose weight. I kept a running spreadsheet of my weight, tracked my calories, changed my eating habits considerably, and lost 35 pounds in 2 years. Hurray. Data motivated me to start losing and keep losing. I bought several hand-made vests from Etsy to celebrate. Now they’re almost too tight again. Although I’ve tracked my weight since, tracking the data didn’t keep motivating me to keep the weight off.
When I worked for St. Peter’s Addiction Recovery Center in Albany, NY, managing the care of CDPHP members with behavioral health benefits, we saw that our rate of outpatient 30 day follow-up after inpatient addictions treatment was less than 30%. Outpatient follow-up is a HEDIS measure of NCQA (The National Committee for Quality Assurance accredits health plans). This Outpatient Follow-up measure made sense to us because we knew that a person’s success with sobriety was strongly associated with going directly from inpatient to outpatient treatment. Our Follow-up rate of less than 30% embarrassed us. It motivated us to make significant changes in our practice. We made sure that people in inpatient care had an outpatient appointment before they were discharged.  We stayed in touch after discharge to make sure they had transportation and child care to get to their appointment and if they didn’t make it, we recontacted and helped further.  The Follow-up rate increased to 75%. The data was meaningful, we looked bad, wanted to be better, and were willing to make significant changes to workflow. Increasing the score made us feel good about the changes we made. I don’t know if the Follow-up Rates are still so high. I’ve lost touch.
The moral of these stories is that meaningful data can motivate change.  Going from bad to good is pretty easy (Good to great is much harder). In either case changing personal or population results requires doing something really different about work flow, life flow and habits. Adding education, training, teaching is a weak intervention and usually doesn’t move the dial much. Sustaining improvement is a whole other challenge.

Personal risk management – When s***t happens

By | Advocate, Caregiver, ePatient, Family man | No Comments
When I ask my doctors what worries them the most about my future health, both my neurologist and primary care doc say, they worry that I’ll fall.  Everybody faces risks – too little or too much medicine, anxious, scared, or melt-down, infection, stranded, lost, jobless, forget something important,  accident, heart attack, caregiver or neighbor moves, power goes out, no help when you need it – on and on the list goes.  While no one can anticipate or prepare for every risk, couldn’t we prepare for likely risks?  So for me its the risk of falling.  I stay as strong as I can, ride a trike that can’t tip over, walk with a cane, strengthen my core, get help for uneven surfaces, pay attention whenever I move, sit down when I’m dizzy, reduce clutter, don’t let anyone depend on me for balance.

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Limits

By | Caregiver, Consumer, ePatient, Family man | One Comment

Limits. Spending time this weekend with friends of 30-40-50 years – lots of young kids my grandsons’ ages in the mix. Watching the constant shifting dance of setting limits, testing limits. Children cutting their teeth on their parents and grandparents. Also observing us 60 something oldsters bumping up against our physical capabilities – joint disease, surgery, acute and chronic illness. How long can we keep up the pace we’re accustomed to, how long do we want to? How do we maintain or extend our capabilities? I watch my 87-year-old mother, in pretty good health, slowly winding down, withdrawing from some social and physical activities. Limits – acculturation, recalibration, will. Limits impact community engagement, social connectedness – Physical access, relationships, conduct, opportunity. We respond so differently to limits – tantrums, frustration, anxiety, negotiation, determination, resignation, relief. A magic lever of best health: our response to limits.

Focusing on the Basics

By | Caregiver, Consumer, ePatient, Family man | No Comments

I just want to focus on the basics! 

In life I reach for the sky. I’m wired that way. I’m frustrated by less. In my health journey or anyone’s health journey where I’m along for the ride I want the best possible health given the circumstances. However, its complex, it’s hard, it’s a long journey to the sky. So I think, OK, let’s focus on the basics.  The journey is built on the basics. But what are the basics? No brainer, logical, common sense stuff – the magic levers – good diet, sufficient exercise and rest, family/individual/work balance, stress reduction, an aligned team? Unfortunately, the basics shift, vary from person to person and from team to team. Basics can be the hardest to attain. When under new or added stress – the basics suffer. Good habits suffer. I learned from a fabulous grief counselor, to attend to the basics first, then I would be better able to handle the unmanageable, unpredictable stresses of death, dying, and grief. Eureka, it was true. Attention to sleep, diet, exercise increased my capacity and resilience. I need help with the basics – reminders, tracking, companionship. Lord, help me with my defensiveness and resistance to help.  I can’t make it without. So hard to accept. The health journey is paved with the basics.
Photo by Patrick Hendry on Unsplash

Start with the end in mind

By | ePatient, Musician | No Comments
How do we start a journey? We decide we’re going to work, home, to Boston, the Cape, a destination. Then we plan the route and adjust it as impediments arise (traffic, construction, weather). Same for our health journey – where are we headed?  For me since I have a chronic, deteriorating condition, I’m headed to a place that’s not worse – maintain function, keep a positive outlook, and keep fitting into my hand-made vests. These are my health journey destinations. I struggle in my very busy life, to keep my destination in mind. I keep a focus on those activities, habits, and treatments that are likely to get me to my destination – working, exercise, diet, music, family. I maintain function by walking, triking, blowing my baritone sax, working creatively, continual learning. I keep my positive outlook by controlling the circles I travel in, spending time with my family, and working with my doctors on my pharmaceutical intake.  I avoid popping buttons on my hand-made vests with exercise and calorie control. Sometimes I’m overwhelmed with keeping this all together with the overlay of fatigue I can feel. The art for me is stopping doing some of the things I really like doing because it doesn’t specifically help me on my journey. Don’t volunteer for something, back out of another thing if I can, don’t eat that great piece leftover of birthday cake in the fridge. Keeping the end in mind.

Magic lever – changing habits

By | Caregiver, Clinician, Consumer, ePatient | 4 Comments
One of the magic levers impacting best health is automatically using widely accepted, well tested practices (evidence-based practice). For example hand washing. Seems like a no brainer – washing hands between patients for professionals, before caring for your loved one, after going to the bathroom for everyone. Another is limiting antibiotic use to treat viruses. Also preventing or reversing obesity. I’m fascinated how hard it is for professionals to change practice informed by widely accepted research or even common sense. Is it similar to maintaining good life habits? I suspect that inertia plays a major role. It’s hard to change gears in a busy productive life. Heck, its hard to change gears in an unproductive life. How do we get the stars in alignment to do the right thing when we definitely know what the right thing is? How do you effect change in your professional and personal life? What are key factors that others can replicate? We spend so much money and human capital on trying to change behavior – consultants, training, how-to-manuals. What works? Being able to change habits is a superpower.