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Monitor and Alert

By Caregiver, ePatient, Family man
Working in Quality Management in health care, I’m driven by 3 things: 1) that we do no harm, 2) that we meet our standards and commitments, and 3) that we continually improve the care we give the people we serve. Health care is risky business. People are in need, their defenses are down. Providers of health care use to tools of medicine, surgery, and life style change to try to affect health. Nothing always just does as hoped. There are side effects to everything, even life style changes – For example, increased activity can lead to injuries. Anyway, this month I’ve focused on Monitoring and Alert systems at work.  We serve people with complex challenges in programs funded and regulated by many state agencies, insurance companies, and contracts. Families, neighbors care about and are affected by the people we serve. How can we monitor everything to make sure we meet our commitments and do no harm? How do we alert the people who run the programs and are served by the programs when we find something that can be improved?  A challenge is monitoring effectively and efficiently. We could spend a fortune monitoring thoroughly, but then we’d have no money left to give the services.  It’s a balance of science and art.

Monitoring and alerting for personal health is similar. We don’t want harm to come to ourselves or our loved ones. We want to keep our fingers on the pulse of our heart, our activity, our mood, our discomfort, etc. We’d like to know if we are approaching danger before it hits us. We could get tested for everything on the chance something gets uncovered-think full body scans, genome analysis. We could stay indoors to avoid an accident outside-boring. For monitoring I keep a spreadsheet of my weight, miles walked, miles on the stationary bike, hours playing saxophone, hours of sleep. When any of them (except weight) go down that’s an alert. When my wife tells me to go sit down because I’m exhausted and unstable on my feet, that’s an alert.  Monitor and alert – a magic lever of best health.

Start with the end in mind

By ePatient, Musician
How do we start a journey? We decide we’re going to work, home, to Boston, the Cape, a destination. Then we plan the route and adjust it as impediments arise (traffic, construction, weather). Same for our health journey – where are we headed?  For me since I have a chronic, deteriorating condition, I’m headed to a place that’s not worse – maintain function, keep a positive outlook, and keep fitting into my hand-made vests. These are my health journey destinations. I struggle in my very busy life, to keep my destination in mind. I keep a focus on those activities, habits, and treatments that are likely to get me to my destination – working, exercise, diet, music, family. I maintain function by walking, triking, blowing my baritone sax, working creatively, continual learning. I keep my positive outlook by controlling the circles I travel in, spending time with my family, and working with my doctors on my pharmaceutical intake.  I avoid popping buttons on my hand-made vests with exercise and calorie control. Sometimes I’m overwhelmed with keeping this all together with the overlay of fatigue I can feel. The art for me is stopping doing some of the things I really like doing because it doesn’t specifically help me on my journey. Don’t volunteer for something, back out of another thing if I can, don’t eat that great piece leftover of birthday cake in the fridge. Keeping the end in mind.

Stoking the Fires

By Uncategorized
Woke up each morning last week wondering where I would find the energy to managing everything? Exercise, diet, music, family time, work, blog, other professional endeavors, medication, massage, acupuncture. Feel like my health depends on fine balance of all these things.  Made me wonder how people do it who don’t have the good fortune, the family, the health team, the opportunities, the cognition I do. How do the caregivers find the motivation, the strength, the stamina? What helps stoke or bank the fire needed to keep moving forward in the difficult moments, hours, days, of our health journey? Reflection, laughter, meditation, exercise, sharing, rest, relief, distraction, silence, recognition, and unexpected appreciation. My grief counselor said that so much in life can’t be controlled. You find the strength where and when you can. In the meantime, he focused me on the things I could control-many of the magic levers of best health-rest, diet, exercise, other stress reduction. Now we’re back to the beginning.

Work-Life Balance

By ePatient, Musician
Once again, I’m self-focused as I transition from sabbatical to full employment.  This too will pass:) After 2 weeks I’m acutely aware of my struggle to keep up my exercise, diet, family time, and music, not to mention all the non-work professional activities that accrued during my sabbatical. Fortunately, my new work environment is both intensely busy, focused, rewarding and actively supportive of work-life balance. My strategy so far is to book family time first, only a little scaled back. Then I’ve cut my music time easily in half, but I haven’t yet figured that out – not cutting any group playing – the combo and big band. Two gigs coming up. The job has a jam once a month. Longer between lessons? Oh, lord. Exercise is harder. Maybe ride the trike every third day and not every other day. Strangely, diet is easier. I’m so much more deliberate about my meals – packing a lunch. I think my diet is better and I’m losing the few pounds I’ve gained during the sabbatical. Longer between massages? I hate to. Makes so much difference in my overall well-being. I will maintain this weekly blog. You all are a gas and a half. Much less TV. What’s suffering most is time with my wife. I definitely need to schedule some date time!! Work-life balance: a magic lever of best health.

Spring Musings

By Family man
8am: Just finished an 11 mile ride on my recumbent trike in an hour and a half. I’ve been riding a recumbent stationary bike in the basement 30-50 miles per week in the basement all winter hoping it would keep my strength up. Takes so long to build up when I lose it. It worked!! I saw a bit of snow hanging on near the path next to Trader Joe’s. Today, let’s enjoy whatever health we have. We’ve earned it.

The Marathon Bombings remind me to appreciate what I have.  It’s precious: my honey, my family, trust. It can change in a second. Appreciation is a magic lever of health. It’s a good sign that the media spices the stories of mayhem with stories of helping in the immediate aftermath. Those affected will need help for a long time.  Honor the caregivers, help the helpers.

System Magic Levers of Best Health

By Caregiver, Clinician, Consumer, ePatient, Leader
I am an e-patient, a caregiver, a nurse, an informaticist, and a leader.  I live and work where the patient, the caregiver, the clinician, and technology intersect. Writing this blog for the past six months has helped me focus on magic levers of best health. The magic levers of best personal health include: Rest, diet, exercise, resilience, network, team, trust, mindfulness. The magic levers of best organizational health: leadership, purpose, alignment, trust, vulnerability, mindfulness, learning, execution. How about system magic levers of best health?  Here’s my first stab at that:
  1. Mutual goals and plans set by the health team (people, their caregivers and clinicians)
  2. Tools and relationships maximize the health team’s ability to follow the plans set to meet mutual goals
  3. Accessible evidence supports just-in-time health decision-making by people and their caregivers
  4. The entire health team works from the same goals and data set
  5. Transparent health care costs
  6. Healthy health care organizations
  7. Hardwired continual learning from evolving experience and evidence
  8. Financial and human incentive alignment
What would you add? More in future posts!

Exercise – the instant magic lever

By Clinician, ePatient
Seems like a no brainer. Exercise, the instant magic lever for best health. Profoundly affects spiritual, mental, and physical health. One of the ways I discovered that I had multiple sclerosis was my inability to stay on a bicycle. I kept falling off when I stopped. Receiving the diagnosis was sobering at best! Sometimes very sad and depressing. Six months after my diagnosis I bought a Recumbent tricycle. I cried with relief that I could still get my favorite exercise. Can’t fall off a trike. Good for my soul, good for my heart, good for my quads. The direct connection between activity and recovery is so well documented.

How have we redesigned healthcare to include more activity? In that last 20 years patients walk right away after surgery and recover much more quickly. When I was an ICU manager we incorporated more activity into our standard operating procedure. We needed to use the families and caregivers to increase activity. We struggled with reluctant patients. But more activity for patients led to fewer complications, shorter stays, and better outcomes. Good for staff as well.  Have we taken this far enough? Do we build our organizational systems to maximize activity for staff?  I wonder if the magic levers of best health are obvious but fundamentally challenging-like the golden rule. Obvious and tough. 

What have you done to include physical activity in the routine of care giving?