Here, Take This!

For months, I've been carrying around a stack of papers in my planner. It's about four pages, stapled. It's my son's occupational therapy evaluation report. 

I'm not carrying it around because I need it for any reason. I'm carrying it around because of a highly annoying, yet highly prevalent health care issue: electronic medical records.

My son's therapy office emailed me the report. Great. I've used that method to share it with the school nurse and teachers. But I called my pediatrician's office and asked them how I could share that with them, and they said they could not accept it via email. 

But I could fax it. Ha! (I haven't used a fax machine in years. In fact, my office doesn't have one.)  

More importantly, it makes no sense to take electronic information, print it on to paper and then send it over phone lines to be filed and transcribed electronically on the other end. But this is evidence of our "inherited architecture" problems in health care. We can't all get on the same page.

Some people adopted EMRs early, even designing their own customized portals. Problems with different systems (both health and IT ones) led to sharing problems. With the migration of most big health systems to EPIC, maybe this will be smoother. 

But...the issues I've had are with the little guys. The independent therapy practice is not going to go EPIC. Just like my OB practice just faxed all my paper records to the hospital and they PDF'd them but couldn't search them. All the paperwork for kids' health at schools is on paper back and forth between home and school, then put in the computer there. These little glitches mean that there are redundancies and  gaps. 

We are stuck in the era of bumpy roads with EMRs -- they should be making things go faster, smoother and more directly to the right places. But, sometimes it rains and we're stuck in the mud. I finally delivered the paperwork to the pediatrician on Friday. I held it in my hand the whole time so I wouldn't forget. I would have been so mad if I left without giving it to them. But I also would have been so happy to have sent it to them via email in April! 

Advice for Entrepreneurs: Believe You Can, Make a Plan, Be Aggressively Positive

I just found some notes from a great speech from Dr. Angeline Godwin, President of Patrick Henry Community College about teaching entrepreneurship (which is hard to do!)

Here's 5 questions to ask yourself, and a few comments from me on how I started down the road to Entrepreneurville:

1. The Bird in the Hand: What do you have right now? When I started my business, I had very few concrete things. Luckily, I wasn't selling goods, I was selling my brain, my time and my experience. I had to get a new computer, business cards and a website -- and get out there! I had connections but I need projects. I had some freelance clients, but they weren't steady. I did not have any previous business experience, but I'd worked mainly for small, growing companies which taught me a few things (mostly, what to avoid!)

2. The Affordable Loss: What are you willing to lose? I was in a very stressful work situation that required a lot of hours and freelancing seemed to be a great option. I wish I could have had a better, more stepped transition but unfortunately it didn't work out that way. So, I entered entrepreneurship by jumping into the great unknown and growing wings on the way down. Depending on what day it was, I was confident or disconsolate. Some of the uncertainty was balanced by less stress and more freedom -- but it's also incredibly hard to shake the feeling that you could ALWAYS be doing more.  

3. The Crazy Quilt: Who do you know? (who isn't like you...) I made lots of lists. People i knew locally, people from previous jobs in Cleveland, people I'd met at conferences and through work over the years. It's amazing how many people you collect -- and once I was focused on health care, it was interesting to see who I knew who might hire me that i had no work connection to. It's really a testament to ensuring you have a good all-around reputation. Many of my clients have come to me in unusual ways, through friends and colleagues and I appreciate that tremendously.

4. Lemon to Lemonade: What will you do when, not if, something goes wrong? I spent a lot of time worrying about things going wrong, even when they were going right. Being an entrepreneur will make you hyper-vigilant. It's important to have a Plan B and a Plan Z (as LinkedIn founder Reid Hoffman coined) as well as just plain faith in yourself. If you are good at what you do, if you are reliable and deliver as promised, if you can adapt to changing situations -- why can't you count on that in the future? 

5. Piloting the Plane: What do you control? Well, you can only control so much, and worrying will make you nuts. So, that's what insurance is for. I got some good advice in the beginning about setting aside half of every paycheck, and to get business insurance -- not just for liability, but for errors and omissions and other business issues that might be out of your control. You can create processes and set up policies as you learn, too, so you don't make the same mistakes twice. 

Entrepreneurship isn't for sissies. But it can be tremendously rewarding and the freedom can make you never want to work for anyone else again. I love what I do -- and I love that I have created my business to serve my clients in a way that works for them, too. Dr. Godwin also said "Be Aggressively Positive" and I think that's great advice. Believe you can do it. Make a plan to do it, and get to it! 

Hospital Marketing is Not the Same as Other Marketing

After a lunch-and-learn about branding, and a "red paper" from SPM Marketing, I'm seeing an intersection of the ideas. Hospital marketing can learn so much from marketing in general, in how they reach their audience, and the ways they do it effectively. BUT, and this is big: people don't want to go to the hospital. (I want to buy some Sugar lip gloss and a Dyson vacuum cleaner, to name two ads that reached me today.) But still, you are marketing to them in many of the same ways: online, on billboards, mobile ads and magazine spreads with friendly yet competent-looking doctors, and they still don't want your product! 

That's why I think that branding is the most valuable tactic. Because when they do needto go to the hospital, it will be the sum total of all their impressions about your facility, doctors, emergency room and staff that tips it one way or the other (your competitor's nearby hospital.) In his fantastic book, "Joe Public Doesn't Care About Your Hospital,"author Chris Bevolo gets it. Being a marketer in this space is hard. Everyone thinks they know what patients need.

I am a big believer in asking patients what they need. And in general, that works for doctor's office and specialty care, and maybe even lifelong health care like skilled nursing and rehabilitation. In those cases, you may want to use some marketing tactics used in other industries. But for emergency room care, it's an emotional decision. That means branding needs to appeal to our deep need for life-saving; our hope that we'll get the smartest doctors and the most compassion nurses. In surgical care, they may have more time to make the decision, but it may also be an emotional choice based on what you've built your brand on. 

Health care is essential. That doesn't mean it doesn't need to be marketed, but it must be marketed differently than our earbuds, lip gloss, paper towels and vacuum cleaners.

(Originally published on Linked In March 16, 2016)

Health (Brand) Journalism: What is it?

 

The Society for Healthcare Strategy, Marketing and Development (SHSMD), one of my favorite professional organizations, creates a great newsletter. This month, there's a piece by Cheryl Welch about brand journalism in health care. She offers a case study of brand journalism by Spectrum Health, a Michigan health system that deployed an internal reporting team to create content for their Health Beat digital news site. This is a fantastic example of how things have changed in media to where organizations need to "be their own publishers." A health system is a great ecosystem for illustrating this concept, because a lot happens in hospitals, doctor's offices and nursing homes every day. There are triumphs and setbacks. There are innovations and routines. But one of the challenges for public relations and marketing departments is that they don't hear about these stories until someone thinks to call them. 

Internal reporting, AKA brand journalism, applies the same concepts that we learned in journalism school to tell human interest stories, in this case within the health context. These stories are not outright cheerleading for health system, but interesting, balanced and realistic stories of the people who are inside it, for whatever reason. 

I see this as a major trend in marketing and PR and it can be done well. One of the reasons this is a great tactic is that as Welch says " traditional media is disintegrating, our consumers are more demanding and savvy and the tech landscape makes it downright cheap to reach large audiences."

One caveat, of course: if you are going to do it, do it well. Get a photographer. Create a style guide. Avoid astroturf (fake grass vs. real grass.) Take the time to do rounds and listen for the best stories. Have a plan for the brand voice to come through in the right. Hire people who know what they are doing. Get permissions. And then....go tell those stories!

Words That Most People Don't Know...

I've heard people say that "medical school teaches you a new language" but that doctors don't learn how to translate that language well.

I attend a lot of meetings with physicians, and so I started putting words in my margins to look up. Things like "Baconian Induction" which to me, sounds like a cooking technique...but is actually part of the reasoning involved in scientific research, and "suboptimal hypertension control," which means your blood pressure is too high. 

This is one of the reasons why health literacy is so important -- not just assessing it, but teaching doctors to remember that most people don't know these precise terms. There are good reasons why medical terms are so precise -- Where is it? What's happening? How often? Is it getting worse? What's the cause?

But for patients, it makes things more confusing, as they are trying to listen to the doctor, read his or her physical cues, and determine just how bad it is. The more we learn about medicine, the more we need to remember that people working outside the field need simple, topline information.

  • What's is happening in my body?
  • What should I do next?
  • What will happen if I don't do that? 

Health literacy sounds simple, but as we often say in writing: "If you can't explain something simply, you don't understand it well enough." (attributed to Albert Einstein)

So I'm collecting words on a roll of paper in my office, to remind myself to keep it simple. 

 

Faxes, Paperwork and Our Tangled Mess of a Health Care System

Often, the best illustrations are personal. Here's the stats on my spring break health care administration for my sons:

1 ENT appointment                                 9 pages of paperwork

1 Occupational Therapy evaluation        4 pages of paperwork

3 dental appointments                           6 pages of paperwork

I filled it all out, with compliments from the front desk staff (I am a professional, after all.) But, I don't have great handwriting, and what are they going to do with it after I hand the clipboard back to them? They are going to type it in to their computers. Why can't I just type it into an online form? And, the dentist isn't new, it was just time for an update -- why couldn't they have read it to me and I confirm all the information, which hasn't changed one bit?

I know there's a lot of change in health care right now, but this is one of those process improvement issues that has long been adopted in other fields. In addition, the ENT's fax machine wasn't working so I went the pharmacy 3 times to pick up a medication that should have had a confirmed refill. Why is anyone faxing anything? 

I'm sure this has something to do with privacy laws, and security of information, and of course that's important. But I suspect a large part of it is that no one has pressed for this kind of improvement yet, they are too busy with other concerns. While I'm sympathetic to that, I feel it's more evidence for what Walter Cronkite said "It's neither healthy, nor caring, nor a system." A healthy system contains up-to-date health information, a caring system makes it easy for people to share their information and a system means there's an efficient process to do so. 

I'm optimistic about the requirement of electronic medical records, even though there's lots of grumbling about them. I think they can and will help patients and their care providers do better. First, let's get off the paper.  

Inoculate Yourself with Information

It all started with a conversation with my gynecologist....about Ebola. We talked late in 2014 in about how people we completely terrified about the Ebola outbreak and didn't seem to remember much about the basics of infectious disease. She said "Someone should write something about this for the general public." I agreed. Then I realized she meant me. 

So I wrote a story about this for the magazine I write for, The Health Journal, and then got an invitation to speak at The College of William and Mary about the topic. Unfortunately, we got snowed out that spring, and by the time I presented in the fall...no one seemed to care about Ebola. It didn't become an epidemic in the US.

But, luckily by that time, I was smart enough to add a virologist to my presentation, Dr. Kurt Williamson from William and Mary. He handled the virus and infection specifics, and I talked about how important it is to consume health information with a skeptical mind. It was a great chance to clarify some concepts for the general public, and for me, too! 

The Art of Yellow Shoes

As a bona fide extrovert, I love going to conferences. But, apparently not everyone does. There's a psyching up that needs to happen. At the most recent conference I went to (#SHSMD2015), I found a brilliant marketing idea. I was in line for a drink with two gentleman, and I of course started talking to them about their names, my favorite topic. But then I noticed they were wearing yellow Oxford shoes. Both of them. 

Not only was this a great way to have an instant ice breaker with the thousand-plus attendees, it tied in to their booth in the exhibit hall, also full of bright yellow accents. The entire staff had yellow shoes: pumps, moccasins, sneakers. So, on brand, attention-getting and unique. A brilliant plan for standing out in a sea of competition. Nice work Lift 1428!

Infectious!

After giving a presentation this week on infectious diseases and deciphering health information, plus attending an excellent SHSMD session on the handling of the Ebola panic, I have a few thoughts. 

1. Even if all of us who work in the medical field think that people should know something, it's best to go back to the basics. Like the super-basic foundations of science -- for example, that a virus and a bacteria are different things but both can make us sick. Or, that one study does not science make!

2. Internal communication is ultra-important in a crisis. It's not enough to reassure the public. You must communicate to your staff, your board members, your volunteers and anyone working in your hospital. Because your credibility goes in the toilet when you say "We're prepared" but the reporter interviewing nurses on the loading dock hears "We've had no training on this."

3, Fear is a strong motivator, even if people know they shouldn't be afraid. They are, and they want to play it safe. I heard from someone who was thinking of firing her nanny because the nanny's mom was a nurse. It sounds like an overreaction now, but if you recall earlier this year, we were a nation on the edge of our seats as to whether we'd have an outbreak or not.

4. Communication takes time. It can be laborious when you want to be doing (let's go!!!) but it will save you time in the long run. Return people's calls (especially reporters!) even if you don't have anything new to share. Tell your employees what to expect. I agree with Doug Levy (formerly of Columbia University Health System) who said "Communication can't solve everything but it puts you in the best position to catch flaws in your plan." 

Infectious diseases are a tough topic, but one that we will continually revisit. They won't go away -- but we can educate and we can prepare. Oh, and we can communicate! 

SHSMD 2015

It's great to be here at the American Hospital Association conference for the Society for Healthcare Strategy and Market Development. While these are "my people" since I work mainly in hospital and health system marketing, I've met some people working in interesting niches. Like those people who just work in planning and strategy -- like all day, every day. I love that these roles exist. I think one of the biggest gaps in corporate health care right now it that everyone is trying to be good at everything -- and it's not only a huge waste of time and money, it's drains energy from what a truly focused organization could be achieving. Values matter, and you need to unearth a ton of extra stuff to get down to that bedrock of what you value and your strengths.

Another big theme I'm seeing is value over volume. The keynote yesterday mentioned this huge industry shift, and it's part of the reason there's so much churn in health care right now. How can we turn a group of care providers, facilities, systems, support staff and practices the metaphorical size of an aircraft carrier? How can we turn back time to when patients were eating healthy and exercising, before they started pairing soda with every SuperSized meal, before their blood pressure rose and their waistlines ballooned. 

There's a lot happening and it's exciting to be in the middle of discussing it, in depth -- that's the value of breaking from the everyday work to sort out what we know and add to what we don't. 

Post-Traumatic...Growth?

In reading a magazine article about Post-Traumatic Growth, I was struck by this quote: 

"In healthcare, we've always been more interested in identifying dysfunction than superior functioning," says Jack Tsai, PhD, assistant professor of psychiatry at Yale School of Medicine, who has studied PTG in veterans. "Only in the last few decades have we begun redefining health as not just the absence of disease but also the promotion of well-being." 

In a previous job, I worked with people who'd been diagnosed with chronic conditions and they often surprised me with their belief that their diagnosis changed their life for the better. Over time, I came to see that although negative at first, they changed in ways they never would have without it. They re-prioritized. They were forced to become healthier in other ways. They told people what they thought, what they wanted and what they meant to them. 

In many ways, we do a disservice to people who have "bad things" happen to them because we all fear they could happen to us and we want to distance ourselves from it. So, the sooner they "get over it" the better. 
 

How does the growth happen? It's a change of path usually, and if it's an external force, people must change, even if they don't want to. So they adapt, and it can open the door to more change. Maybe it's the heart attack that makes them realize that they want to stay healthy for their grandkids. And then it becomes wanting to spend more time with the grandkids and moving closer to them. Or it's a divorce that forces a career change. 

Americans need to break up with their fear of failure. It can make us better. It can make us stronger. But first we must admit that we all fail and we can all recover -- resiliency is in short supply, in my opinion. 
 

Sometimes Health Communications is...calling 911

Coming from a family of health care providers (I was discussing cardiac catheters in depth with my cousin on vacation) means that i often feel that my non-clinical experience is not as practical. Sure, I know CPR and first aid, but how am I an emergency?

Well, yesterday at work I got to find out. A woman coming into our building fell on the sidewalk and was gushing blood from her head and face. While my office mates found the first aid kit and wet wipes, I called 911. I was clear and direct, giving my assessment of the severity of situation. 

Because vasovagal syncope (see, I know big medical words!) runs in my family, dealing with bleeding people is on the reasons that I did not pursue a clinical career. So I focus on what I CAN do, which in this case was to call in the professionals as quickly as possible, armed with the most information I could provide. 

I realized later that this is "health communications," what I proclaim that I'm a specialist at -- and it's part of the whole health care experience. Not everyone can bandage the wounds, sometimes they just facilitate getting the person who can to the person who needs it.  I'll call that a win. 

"I think the doctor said..."

I just read an article in the Journal of Patient Experience with this statistic in it: 

"Miscommunication between physicians and patients is the most common cause of medical errors and is responsible for more than 60 percent of sentinel events that lead to increased mortality or injury among hospital patients." 

Think about that. More than half of errors are caused by two people trying to communicate but failing to do so. And, I'm sure you've been there. I know I have. The doctor says to do something, in a regular tone of voice, and I'm not sure if it's a suggestion or an imperative statement. Or the doctor says "make sure to..." and I'm so overwhelmed by trying to remember it that I get confused. If you aren't in the habit of repeating it or writing it down, you may very well forget it. 

The journal article was about AIDET training (created by the Studer Group) for physicians. It seems simple but patients know that many of these steps are missed. 

A: Acknowledge (address each person in the room)

I: Introduce yourself  (and your role and your specialty)

D: Duration (how long will you be in the room, is there a procedure happening?)

E: Explanation (what's the treatment? what's the diagnosis?)

T: Thank You (appreciation for their time, questions, etc.)

In a hospital environment, these common courtesies can easily be overlooked, because everyone is in a rush. But it matters. It matters to patients, and it may prevent medical errors and miscommunication. That seems like a great reason to take the time to do it.