Wednesday, August 25, 2010

See - Hear - Paint by Numbers

Those of us who work in automation of process often are asked to take a “look” and “see” what could be done better. Which is really the basics of what we do – visually obtain information and document it so that it can be assessed. However, you may not want to judge a book by its cover.

Several years ago my Dad went to buy a Cadillac. He showed up to the dealership on a Saturday in his old blue jeans, flannel shirt, and his post card which said if he test drove a Cadillac he could get a free pull over. The dealership was empty – not a customer in sight. He entered – found a sales person – and was promptly told that he would need to make an appointment to test drive a Cadillac. Dad persisted showing the card he had received in the mail for a free pull over with a test drive but the sales person made an assumption that he was not someone who would buy a Cadillac and turned him away. Ironically, two weeks later Dad found the model he wanted online with every feature available at a dealership in Minnesota, went there, purchased the car, and drove it home. Based on what the sales person saw he made an assumption and lost the sale. In the same way we may be looking at a process and seeing each interaction but not make the connection on what is occurring.

In the story above the sales person was focused on how Dad was dressed. Sometimes consultants are focused on what they see and don’t balance it out with what they hear. The verbal interaction with staff – explaining why an observed process had a specific method is critical. The trick is asking the right questions – in the right sequence – to elicit the honest response. Questioning people on how and why they do specific workflows is really an art blended with a science. (Anyone who tells you different is selling you something) The science is the sequence and the information needed to be gathered that provides patterns. The art is the phrasing and interaction. It’s the way you respect their environment and their specific personality.

The final point in workflow modeling is being able to develop a picture of what is occurring without looking or hearing anything. I heard a story on the radio of a woman who had lost her sight. She described how she could see objects with her hands. The form, the texture, the edges all became data points in her mind and she was able to create a picture of what she was holding. In the same way that you can look at the data that comes out of devices, integration software, systems, etc and begin to build a pretty extensive picture of what is occurring on the unit. It’s basically paint by numbers for geeks – a series of “If and Then” statements that when you put them together in the right order create a very in depth picture.  Just like when a doctor looks at a patients chart – the data creates a picture.

We have had a pretty busy month at Sphere3 - which means the blog has taken last place.  Topics are always welcome please send them through to

Monday, August 2, 2010

When Our Use becomes "Meaningless"

I recently read a blog post by Regina Holiday that was both incredibly moving and really thought provoking. Regina lost her husband to cancer and has recounted the experience throguh art and speaking. She has gained national attention because of her patient’s rights movement her voice emphasized through murals. Sometimes words are not enough.
She along with other noted leaders like E-patient Dave are paving the way for more information - better information- to let patients make informed decisions. The point that stuck out to me was the concept that the medical information could be presented to the family in a format as easy to read as the Nutrition Facts label. While I don't want to discount the difficulties to do this nationwide with consistent standards - it just makes sense. People didn't understand what everything on the nutrition label meant initially, but now most of us know sodium # high = bad. (I could soap box for days on the unhealthiness of the US and our unwillingness to read the label and make good choices but that's a different post for a different blog)
All of the “bring it to basics” mentality brought me to reflect on the creation of Sphere3. It came out of frusteration that all the creatvivity in the world associated with integration was thwarted due to the difficulties associated with trying to communicate the functional process. (that was a mouthful) In other words most geeks want to tell people "how" it's done instead of "what" will occur.

The "what" to me is like writing a book or a movie - there are characters, there are scenes, ther are props, and if all is done correctly there are great reviews. It makes what we do in integration design look really simple, which is good. My theory (which is shared by many) is a Nurse needs to be concerned with the patient and things that cannot be replaced by technology. There is nothing more frustrating then being handed additional technology to “make life better” which just complicates life more. Nurses should spend a majority of their time helping people – not fiddling with unnecessary technology.
This is a scene from my own life – and I encourage you to remember a scene from yours that will help you focus on the clinician and the patient. Remembering that the technology should be complimentary – the people should be the main focus.

One night, when BFB (Big Fat Baby - see our story) was in the hospital, he was having difficulty breathing. The Oxygen reader (aka 02 Sat) began it ring. I was "sleeping" in the chair next to his bed, my head propped against the side of the crib my hand holding the fat fingers. I turned my head to see the machine (which I had learned to read a few days prior) and the numbers where dropping. At first, I thought his toe thing is loose, so I unwrapped him to find it firmly attached. I began to follow the cable to the machine to make sure it wasn't unattached. As I did the door opened and in came the RN, followed by the Respiratory Therapist. "Please step back Kourtney" she said stepping between me and my bundle.

In my head all I could hear was a warning announcement saying "Warning! This is not a drill...".My heart stopped and everything around me seemed to be in slow-motion as the night nurse and Respiratory Therapist (among others) began poking ,prodding , and suctioning (to this day I can hardly look at that suction when I walk into a patient room for work). His skin looked gray, his fat arms barely fought the team as they suctioned, and worst of all - he wasn't crying. So, I took on the role for him. Crying dosen't really describe what I was doing - sobbing unconctrollably - the kind of experience where you know at the end of it you will look like a prize fighter. David had emerged from the bed in the back of the room and tried to comfort me. We didn’t want to watch but it was like a train wreck that we couldn't help but watch. As it ended and it seemed as though someone gave the "all clear" signal - the nurse turned to me and I said "is he going to make it through this?” She was experienced, had as many gray hairs as my mom, and had kept her cool the entire time. The kind of person you want in a foxhole with you - bullets wouldn't faze her. "The worst is almost over" she said as she touched my arm and smiled. Though she didn't say it I knew she was saying "he's going to be fine". After the group left the room - I returned to my watch post at the side of the bed, reached in, and my fingers were met by the firm grip of BFB.

A Nurse’s primary role is to care for the patient - do things that we can't do ourselves. Her secondary role is to assure you - in a way that few can - that all will be ok. Neither of those things can be replaced by technology.

Our job as "technologists" - "integrators" - "geeks" is to enable these people to do what they do best - help with people. If what we do gets in the way of those roles our use is meaningless.