Category Archives: Respect

The Value of Unstructured Data

Paul Hake, a predictive and advanced analytics specialist with IBM’s Healthcare Analytics team, discusses the emergence of cognitive computing and how it can be applied to healthcare. Paul specializes in data mining and machine learning and has 14 year’s experience designing and implementing analytics solutions in the Healthcare and Life Sciences Industries.

As part of the Medical Development Insights series on URBN, I interviewed Paul about the intersection between “big data” and healthcare. Currently, “structured data” (easily quantifiable, often seen as checkboxes on forms) dominates the healthcare data field. However, “unstructured data” (narrative information) may contain some of the most important information for understanding, diagnosing and treating patients.

Click here to listen to the interview.

Several key quotes from this interview:

  • A lot of the useful, powerful data . . . is not captured in the structured data.”
  • 70% of the determinants of your health is behavioral.”

Improving Global Health

I interviewed Beverly Brown for Medical Development Insights on the UR Business Network. Beverly is Director of Development for the Center for Global Health & Development (CGHD) at Boston University. She joined the Center for Global Health & Development at Boston University in 2010 to lead the effort to diversify the funding for programs, people, and projects. She is primarily focused on diversifying funding for global health initiatives, life science research and development.

Click here to listen to the interview.

Once again, it became clear in the interview how important bedrock project management principles can be: listening to the local community to hear their needs and how they describe their needs; planning; scheduling; budgeting; preparing a business model for sustained success.

The Deinstitutionalization of Acute Care Patients ?

An era of restricted revenue”

“The business case for lowering inpatient length of stay”

“As hospitals and healthcare systems pinch pennies”

“The number of avoidable days relative to a benchmark”

“Diagnosing efficiency benchmarks”

PiggyBank+StethoscopeimagesMuch of the healthcare sector is now focussed on reducing length of stay in hospitals. A key element of healthcare reform is both denying payment to and penalizing hospitals for “inappropriate readmissions.”

NursePatientInWheelchairimages-1This can be good for individual patients as well as for the economy. Hospitals can be very dangerous places to be. Robert Pearl, MD, highlights 4 key reasons for that.* It is the 4th that should raise a cautionary note about this trend: “Hospital stays sometimes result in problems after discharge.”

We’ve seen this potentially combustible mix before. It was then called “deinstitutionalization.”

StraitJacket-images-7By 1965, newspaper and movie horror stories had gained enough traction to push politicians to close state facilities and move psychiatric patients into nursing homes and community care. These moves were predicated on the development and provision of adequate community care.

Deinstitutionalization did improve the lot of millions living with “intellectual and developmental disabilities.” It allowed them to escape intolerable conditions in these hospitals and to live with proper support and without stigma. But it was a very different story for Americans suffering from severe mental illness.

mental-illnessCalifornia had taken the lead in aggressive deinstitutionalization.**

  • And California became “the first state to witness not only an increase in homelessness . . . but also an increase in incarceration and episodes of violence.”

  • In 1972, a “California prison psychiatrist . . . claimed to be ‘literally drowning in patients . . . who have serious mental problems.’”

  • A study of . . . patients discharged . . . between 1972 and 1975 found that 41% of them had been arrested [and] the majority . . . had received no aftercare following their hospital discharge.”

Nationally, by “the mid-1980s, 23% of nursing home residents . . . had a mental disorder.” There was no comparable increase in training or resources. It is estimated that 1/3 of the homeless and 16% of the total jail and prison population have schizophrenia or bipolar disorder.PrisonMentalIllnessimgres-1

In 1984, the New York Times reported, “The policy that led to the release of most of the nation’s mentally ill patients from the hospital to the community is now widely regarded as a major failure.”

Today’s healthcare reform is similarly predicated on the provision of appropriate aftercare. Hundreds, perhaps thousands, of apps, techniques and approaches are under development to improve home care and prevent the now-costly readmissions.

Again it is assumed that the market, our states and our communities will provide what hospitals up to now have not. As of Aug 28, 2014, 23 states – only 2 short of ½ – had not elected the Medicaid expansion under the ACA – a bad omen.

Not only was there a failure of will to provide adequate aftercare support for the seriously mentally ill. There was also what an author referred to as “one awkward reality”:

  • [T]he economic case for deinstitutionalization – highly appealing to both fiscal conservatives and civil libertarians – turned out to be almost entirely wrong. . . . Effective community-based supports are generally superior to institutional care. They aren’t necessarily cheaper; often the opposite is true.”***

So whither 21st century American healthcare reform?

* Robert Pearl, MD, “4 reasons why hospitals can be very dangerous places to be”

http://www.kevinmd.com/blog/2014/02/4-reasons-hospitals-dangerous-places.html

** E. Fuller Torrey, MD, “Ronald Reagan’s shameful legacy: Violence, the homeless, mental illness”

http://www.salon.com/2013/09/29/ronald_reagans_shameful_legacy_violence_the_homeless_mental_illness/

*** Harold Pollack, “What happened to U.S. mental health care after deinstitutionalization?”

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/06/12/what-happened-to-u-s-mental-health-care-after-deinstitutionalization/

Ingenuity of the Bionic Ear : Cochlear Implants

Sam Silberman has had a hearing problem since he was a young child. His parents got him a hearing aid early on, and as he grew he replaced his hearing aids with ever newer hearing aids. But in 1999 he did something transformational for himself: he had a cochlear implant. From somewhat indistinct sound and speech, he immediately leapt to clear sound and increasingly clear speech. Today you wouldn’t know he has a hearing problem unless he told you.

With my co-host, Kevin Franck, I interviewed Sam and we explored his journey from deaf child to Senior Area Manager for Cochlear Americas, the global leader in bionic hearing devices.

Click hear to listen to the interview.

Management Mistakes In the Ebola Hot Zone

Every project starts with a worthy goal. Unfortunately we often then assume that all reasonable people will accept the initiative. The Ebola epidemic in West Africa poignantly illustrates how that can go wrong – badly and fatally – even in something as important as health care.

Ebola-virus-structure

Once it was recognized that the epidemic was Ebola (in March 2014), the international community’s response was “rapid and comprehensive – exactly what you would hope.” But therein lay the seeds of an even worse explosion of cases a few months later – making the West Africa Ebola epidemic the worst ever. “The foreigners had come so fast that they had actually out-run their own messaging: there were trucks full of foreigners in yellow space suits motoring into villages to take people into isolation before people understood why isolation was necessary. . . . [I]solation centers [were] a one-way maze [where] relatives and friends went in and then you lost them.”

images-4Rumors then started about organ harvesting at the hands of rich foreigners. As fear itself became “a contagion,” people ran from, hid from and attacked health workers. They stopped cooperating – and as they fled their ancestral homes in fear, the disease spread unseen into other, farther outlying villages.

What does this horrific story have to do with project management in our everyday workplaces?

Well, it sets out in stark relief the unforeseen collapse of some of our best intended interventions.

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If we were to replay the West Africa Ebola response, what might we do differently?

  • Realize that no matter how noble and important the effort, no problem solving will be effective without engagement of and clear communication with the affected parties.

  • Engage local champions – “drivers,” people with real credibility – to understand and explain the effort.

  • Surface and candidly address rumors. You just can’t afford to disdain and ignore viewpoints you consider irrational.

  • Have the humility to listen to the people’s experience, their concerns and fears, and cast your proposed solution in those terms – and modify it accordingly.

The source of all quotes is “Hell In the Ebola Hot Zone,” by Jeffrey E. Stern, Vanity Fair, October 2014, one of 2 excellent articles in this issue with clear implications for how we handle important problems – and ourselves – in this brave new world. I will be commenting on the other – “Anatomy of an Airliner Crash,” by William Langewiesche – in my next post.

Important Lesson From IRS Snafu

 

IRS Building

“Elizabeth Hofacre, an [IRS] agent in the Cincinnati office, . . . said an IRS lawyer in Washington, Carter Hull, micromanaged her work and ultimately delayed the processing of applications by Tea Party groups.

“She said Hull’s interest in the cases was highly unusual. ‘It was demeaning,’ she said. ‘One of the criteria is to work independently and do research and make decisions based on your experience and education, whereas on this case, I had no autonomy at all through the process.’ ” (The Boston Globe, AP, 6/7/2013)

We have taken many lessons from the IRS political circus to which we have been treated recently, and, as appropriate, keep returning to “How did this happen and how can we prevent its recurrence?” While there will be the usual political sturm und drang around this, vows of tighter control, proposals for more regulation – as the IRS agent, Elizabeth Hofacre, states, at its root, the problem came from an all too frequent lack of respect for the intelligence, ethics and decency of people in the workplace. No doubt, Carter Hull has his own intelligence, ethics and decency, but by becoming a micromanager, he exalted his own reasons and priorities above those of anyone and everyone “below” him. Heavy-handed managers seldom have the humility, usually lack a sufficiently broad perspective and rarely believe they have the time to listen to line staff.

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Should Elizabeth Hofacre have pushed back more strongly and more eloquently at this intrusion from someone in Washington? Ideally, yes. But far too many people in the workforce have already seen the consequences, for themselves and/or others, of challenging people “above” them who definitely have some kind of agenda they are pursuing. They know the dangers all too really. No, what we really need is a healthier, more vigorous demand for good, common sense management, one that sees its role as nurturing people’s ability “to work independently and do research and make decisions based on your experience and education”. That will not solve all problems, but it will bring more people’s savvy and conscience into play when crucial decisions are being made.

” . . . something special to give, but only if we don’t crush their spirits.”

In an e-mail exchange recently, Tony Toledo, one of the pillars of the New England storytelling community, shared this quote from Lynda Barry:

There are certain children who are told they are too sensitive, and there are certain adults who believe sensitivity is a problem that can be fixed in the way that crooked teeth can be fixed and made straight. And when these two come together you get a fairytale, a kind of story with hopelessness in it.
I believe there is something in these old stories that does what singing does to words. They have transformational capabilities, in the way melody can transform mood.
They can’t transform your actual situation, but they can transform your experience of it. We don’t create a fantasy world to escape reality, we create it to be able to stay. I believe we have always done this, used images to stand and understand what otherwise would be intolerable.”
Lynda Barry,
What it Is

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Doria Hughes, another prominent storyteller in New England, had the following powerful reflection to add:

Lynda Barry’s quote had a very powerful resonance for me.  For the first 18 years of my life, I endured unceasing bullying at the hands of my peers; bullying which was compounded by the insensitivity and misunderstanding and sheer lack of imagination of many of the adults around me, who believed that the problem stemmed from an essential character flaw within me, the person targeted for bullying.  I was given to understand in no uncertain terms that my torment would cease if I could somehow learn to not be tormented.  To them, I was a honeypot of trouble, so no wonder that flies were attracted to me; it was up to me to fundamentally change what and who I was, not for the flies to stop buzzing.  My refusal or inability to change simply reinforced their belief that there was something wrong and bad about me.  At best I was lazy – “not trying hard enough to fix my part of the problem”; at worst, I was a truly bad person, who deserved the badness that was drawn to me.

When Barry uses the phrase “fairytale, a kind of story with hopelessness in it”, I guess you could say she was being metaphorical.  If I could be so bold as to translate her words for you, I believe that she is saying that there is a kind of sad and familiar narrative (what she calls a story or fairytale) being played out among children and adults, in schools and playgrounds.  She describes the narrative as a story/fairytale because that is shorthand for saying that it is a narrative which has been reenacted over and over and over, all over the world, throughout most of recorded time.  And she calls it “hopeless”, because we it continues to reenact itself even today, on school playgrounds and in classrooms and in homes everywhere.

In other words, we aren’t making the kind of progress we ought to be making to ease the psychic pain of children who are “different” from their peers.  We – the grownups – are failing to recognize that the “different” kids are just as worthy of love and praise and encouragement as their peers.  We are too focused on our besetting sin as humans – the desire to be similar, to fit in, and be the same – when our true virtue and our greatest strength is our differences, and our diversity.  

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The human race did not get where we are today by ensuring uniformity of thought and appearance.  We have made amazing technological and fashion breakthroughs precisely because certain individuals among us were different, and those individuals were able to fight their way through to maintaining their precious essential true selves so as to achieve a special destiny: discovering a new way of dressing, a new way of communicating, a new way to cure a disease.  The very qualities that cause some of us to be teased and scolded on the playground and in our classrooms are PRECISELY those qualities that lead to some people growing up to be Beethoven, Einstein, or Coco Chanel.  After all, what do you suppose those people were like as children?  DO you imagine that they conformed to the way all the other kids were acting, dutifully bent their head when the teacher taught them that 2 + 2 = 4?  Not when they knew that it sometimes equals 7.

Lynda Barry understands this narrative, has seen it play out in real life, and has made the connection between tales of real children to Stories and Fairytales in which imaginary children also suffer, and try to find their way.  She recognizes that Stories and Fairytales provide many of us with psychic roadmaps, or at the very least a little bit of human understanding.  They show us that we are not alone in our suffering, that other people have also been persecuted or driven away for being different.  And that sometimes those folks can have happy endings, if they persevere and have hope.  Have you heard of the “It Gets Better” project?  It’s an on-line film project where adults film themselves telling their stories about how badly they were teased and hurt in their youth for being gay, but how they have managed to survive to a happy or at least better adulthood.  Their mission is to give hope, in the form of stories, to gay youth who are facing the prospect of suicide as the only way to stop the misery of their current existence.

As Barry says in the quote which Tony posted, “[Stories and Fairytales] can’t transform your actual situation, but they can transform your experience of it.”

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I could continue to explicate Barry’s extraordinarily wise and very rich words, but I have to take my daughter to her bassoon lesson.  As a personal aside, I want to mention that she is the only child in her school who plays bassoon, an instrument that looks and sounds like a loudly farting bed post; in fact, she plays it in her Jazz Band, where she is the only girl in an otherwise all-male ensemble.  I am thankful every day that she embraces her own uniqueness, and fearlessly faces the world as a Jazz Bassoon-playing girl.  She knows that doing something which nobody else does is not something to be ashamed of, but something to celebrate, something which can bring joy to people around her.  It feels like a miracle to me that when she honked out her solo (her Jazz Band leader arranged Michael Jackson’s “Bad” for bassoon and Jazz ensemble; he is a man with fearless intelligence and imagination) last weekend in front of a gym-full of people, with the boys in her band playing backup, it never occurred to her that anyone would put her down for who she was and what she loved.

I am thankful for the grownups like Lynda Barry and my daughter’s Jazz Band leader, who understand the value of ALL children, not just the normal well-adjusted ones, but the strange and unusual ones.  All of those children have something special to give, but only if we don’t crush their spirits.  And yes, stories help.  I read stories and fairytales with hungry desperation throughout my childhood, and they were a kind of solace that, as Barry says, helped me to face the harsh reality of life in the “real” world.  “We don’t create a fantasy world to escape reality, we create it to be able to stay.”  For those youth who have no one to turn to and cannot sustain a nurturing fantasy world in the face of intolerable cruelty, many choose not to stay with us, to our eternal loss.

– Doria