Monday, January 24, 2011

The Twinkie Factor

Around Christmas time, ironically, I began looking in the phenomenon of the “Twinkie Diet”.  For those of you unfamiliar with this unorthodox methodology of losing weight, it was the thought up by Mark Haub, a professor at K-State (there’s your sign) who wanted to prove a point that calories are important. Basically, for a condensed period of time he ate a strictly monitored caloric intake which included only Twinkies and protein. The result was he lost weight and improved his cholesterol.

What struck me about the diet was the intense focus on one factor – calories. It basically ignored every other health “rule” known to man. In the professor’s defense – he was not advocating for eating junk food consistently he was proving a point that calories are important. However, calories are just one factor in overall health. No, I am not a nutritionist but I, like Oprah and 90% of the US population, have had my battle share of weight gain/loss. The one major lesson I have learned is Calories/Weight Gain are just one factor in overall health.

Heart health, for example, is made up of multiple factors with different inidcations of whether you have good or bad heart health. Weight is one indicator, but it can be ultimately deceiving. You could be in good weight range, but you may have high blood pressure. Healthcare providers have learned to evaluate a number of Key Risk Indicators that look at multiple factors and lead to a decision.

The point is – make sure you are looking at multiple factors before assuming you are doing a “good” job based on one.

In a hospital – Response Time is like Calories. Response time alone can indicate efficiency to the taking care of the patient need but you really have to look at several factors to determine if the staff is being effective in responding to the request. I can eat 10 Twinkies a day and get enough calories to meet my 1500 calorie per day quota. Does that really meet the nutrition needs of a 29 year old woman? (Ok 31 year old but who’s counting) The patient may have their need noted in a prompt manner, but the need may not be met for a longer period of time. I would argue that the latter is actually just as important as the first, especially when it comes to the core measure of pain management. Specific design applications are needed to ensure that Caregivers are able to manage the flow of communications and responses to patients needs. Then the technology must be programmed appropriately to gain the information to provide accountability. Sphere3 has done this and collected the benchmarks.

I thought about renaming our Key Risk Indicator for Efficiency and Effectiveness the “Twinkie Factor” but my team thought that Efficiency and Effectiveness Indicator (EEI) may be a better name. Let me know what you think.

Saturday, January 8, 2011

Compassion - a Measurable item?

Several hospitals have the word “Compassion” as part of their core values, mission statement, or vision statement. If something is important enough to be in the mission or vision or values is it something that should be measured? Wait I know what you are thinking - seriously are you going to put parameters or compartmentalize something as important as compassion. Won’t that diminish the "feelings" associated with it? My creative free spirit side would agree - compassion should be organic, voluntary, and come from a passionate desire to care. It is locked within a smile, a touch, a tone of voice, and an attitude. My square side would argue if it's worth putting in a mission or vision or anything related to the strategy of the hospital than there must be a way to determine whether or not we are producing “compassionate care”. That while patient surveys are effective in obtaining the information of feeling of the patient, they are retroactive and the results are not generally correctable during the stay of the patient. So, how do we determine measureable factors associated with compassion, how do we identify measurable items that can be dynamically adjusted during the patients stay to move the patient experience from good to great.

Compassion is a reflection of empathetic feeling. What makes up the actions or behaviours associated with it? While, at this point, we can’t capture “emotion” I think that determining actions that can be measured is really doable. Think about the 5 Languages of Love by Gary Chapman ( Chapman contends that all feelings associated with love are made up by 5 core categories: Words of Encouragement, Physical Touch, Words of Affirmation, Quality Time, and Gifts. These core categories can then be broken down in specific actionable items such as telling your spouse how nice he looks, that you love him, spending time together, and giving heartfelt items. If you have actionable items then you can have measurement associated with success or failure. No, I don’t think you should keep a spreadsheet of your actions associated with demonstrating your love for your spouse. However, if your Spouses love language is Quality Time and you are never home because you travel for work, go out to networking events, and when you are home are preoccupied with your iPhone to show him love you clean their car or give them a gift. THEN your actions do not speak the words “I Love You” in their core language – it’s like speaking in Gernan to someone who only speaks Chinese.

So step one in defining the measurable aspects of Compassion is to identify the core categories associated with it and actionable items that can be captured by technology. There is technology available that can capture some of the actions that Sphere3 has identified. Think about what you currently have in your hospital – could you capture anything – are you capturing anything that you are not documenting?

This has everything to do with how the receiver identifies understands and recognizes that actionable items The key is - like Love - the deliverable actions may flex on those pesky hard to categorize people called patients. The hospitals other challenge will be to drive action as well as innate desire to care. Is it possible? I am not sure - am I going to figure it out - you betcha.