Compiling and Comparing Data

I work at a lot of coffee shops.  It’s not that we don’t have an office but there is something about being in a space with music, coffee, and energy.    There are always people there meeting for business – to stop collaborate and listen.   I have done it dozens of times myself – reached out to people who have expertise in a specific area or have started a business and can give insight from a been there, done that perspective.   This blog is spattered with some of those stories.

My one regret is how I have managed all the information that I have gathered in the last few years.  I take really crazy notes mostly with doodles and pictures.  When people say a picture speaks a thousand words- they are right (plus it’s easier to remember a picture).  The team jokes I have an addiction to spiral notebooks, there are about 50 in my office full of “valuable” information.   While I have gotten better about giving the algorithms to Kristal to be properly documented for evaluation, testing, and roadmapping  – there is a lot of information that is not that square – not a number, not an equation, more anecdotal but still important.   Those feelings that are just as important as a data point. 

I once had a friend describe working for a startup and watching the CEO of that company change in the years of its build.  The story itself was not uncommon to many I have heard before, but for some reason his words describing his perception of the emotional state of the CEO were.  Perception of the event or process – feelings – are as important as hard data.

We are working on ways to capture those thoughts of caregivers and nurses so that the square data can be compared to squiggly line data – thoughts, impressions, and ideas.  Active comparison to perception vs the reality of a situation will help to create more accurate benchmarks….just because you can be staffed to have a 10 second response time….is it necessary?  That was a hard question for me – my gut says YES of course if we can and we should but reality is there is always a cost associated with the movement.  I almost hate to say it but in this dynamically changing industry…. Is that worth the cost….

The balance between delivering the hospital leadership perception of service excellence and delivering an “Always” can be two different things. 

The “Always” can be more accurately attained if you understand the reality of the perception of the patient – if you create an expectation and meet it.  The “Always” cannot be obtained when we set unreasonable expectations with our patients, or we fail to meet a basic level of expectation.

Best Coffee Shops in KC for Working....

Mildreds in The CrossRoads District
Roasterie in Brookside
Latte Land in Briar Cliff

Haven't found any I love out South so open to suggestions....

Today.....

If we are honest with ourselves there are times in our career where we grapple with the business verse human aspects of our products. We seek balance. We balance making money with helping people. We balance “marketing messages” and big picture vision with everyday life in the weeds. We balance heart and commitment to being the change with the work that must be done.

On the 3 year anniversary of Sphere3, I find myself evaluating the balance of building a start up and staying true to my commitment to Make Life Better for Patients AND Caregivers. Today – I focus on the Caregiver.


There were two blogs that caught my attention over the past few weeks. One blog was noted by Paul Levy called “Medical Margins” by Josephine Ensign. Josephine tells the story of a RN who had made a medical error – her blog blasts the hospital for the inequality of discipline levels between Docs and Nurses. Really what struck me was Kimberly Hiatt – a veteran RN with all in all good approval ratings – was dismissed for her error of administering a lethal dose of medication to a fragile NICU baby. After which she committed suicide. (Note there is no public information about linking her suicide to her dismissal)

I struggle with the balance – a bad day for me is I publish something on the blog that irritates someone or my team misses an internal development deadline.  (which is really a bad day for them) A bad day for a RN is someone could be seriously harmed or die. Do we expect perfection? Are we being realistic to apply “lean six sigma” principles to a human based profession – patients are not cars and clinicians are not assembly line workers. The patient advocate side of me really wants to drive every ounce of error out of existence. What if that error was my child – what if that “bad day” affected my parent? Aperum™ was created to identify when workload balances are too great. Is it enough? Do we find that self reporting based EMR systems and other gadgets and gizmos really make a difference in the day of the RN?

When my brain went into over drive trying to grapple with it all another great blog was posted – this time by a Nursing Student named Jennifer-Clare Williams of my home state Missouri. Her heartfelt desire to be the super hero that “saves the world one patient at a time” brings back the sovereignty of unadulterated hope. The blog is beautiful – showing her true desire to be a help to those in need.

I replay my mistakes (“No wonder your patient was uncomfortable—you put the bedpan under her backwards!”), I cry more than I ever have in my life, and I continuously wonder how on earth I will ever learn everything I need to know.

But there is good news. I’m surviving. And I’m learning that perfection is unrealistic. That nursing really is a fluid profession: things are constantly changing, and that’s a good thing. That there are very few things that I’m going to master on the first try, or heck, even the 10th try . . . but that’s ok. I’m learning that the patients who are, let’s just say . . . unkind . . . are not launching a personal attack on me, but are facing a difficult set of circumstances and are unhappy with the situation.

The inspirational heart of this young woman pushes me forward that every nugget of information we can provide back in a visual meaningful way can make a difference to improve her ability to provide care. The S3 team has made linkages to reduce readmissions, show documented improvement to patient satisfaction scores, reduce fall rates and errors, and do all the big picture money saving things that we need to do to sell a product. That’s not what drives me – and technologist – EMR person – industry specialist – big picture lingo laden with catch phrases shouldn’t be what drives you either.

What drives me should be the thought that today – we made life better for Jennifer because we were able to identify that her workload was so great that she may make an unintended mistake. What drives me should be that today we were able to provide information to the charge nurse that over stimulation was increasing the propensity for medication error beyond capacity – so she can engage and make sure her clinicians are in an environment where they can care and not run. What is your “today” statement? What did your product, software, service do today to Make Life Better?

For a moment, stop and focus on how you can make life better. Stop thinking about selling the next big deal and start thinking about the people you are affecting.

Thanks to:

Josephine Ensign’s “Medical Margins” Blog
http://josephineensign.wordpress.com/2011/04/24/to-err-is-human-medical-errors-and-the-consequences-for-nurses/#comments

Off the Charts AJN Notes of a Student Nurse: A Dose of Reality written by Jennifer-Clare Williams http://ajnoffthecharts.com/2011/05/04/notes-of-a-student-nurse-a-dose-of-reality/

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.