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15 Minutes

By Advocate, Leader

In my career I’ve often found myself bewildered when I’m amazingly ineffective in engineering a change that appears to be a no-brainer. I’m kind, smart, experienced, charismatic, brave and strategic. Where does the resistance come from? Don’t they get it?  What’s the deal? Well, I’ve learned that you can’t have more than a 15 minute advantage on your constituency. Your constituency can be your team or your organization. When you have more than a 15 minute advantage, you have to go back and get them.  Dramatic change comes from within, seldom from without. People need to be ready for change. They need to understand the language you’re speaking. You need to understand their’s. People and organizations can only change a little at a time when pushed. I have found that even if people embrace and talk about a  change, they can only be influenced/guided to change gradually. Usually I’m too far ahead and have to go back, take the temperature, listen, understand their language, their incentives. And then bring them along slowly, planning and executing smaller steps. Takes great patience – not my long suit – exercising my weak patience muscles. Then I need to be prepared to move forward when the time is right. The fun part of being a change agent is finding and working with those like-minded colleagues who will co-engineer change with the 15 minutes in mind. If it seems that it will never be possible, it’s time to move on. Please lord, help me to know that time.

Get to here from there – lessons from a teenager

By Advocate, Caregiver, ePatient, Leader
I was 17, hitchhiking through Europe, found myself lost, hiking alone through the Rondane Mountain Range. A rookie mistake. I’m geographically challenged, I’d been warned not walk by myself. I had a map, a compass, some food and water, and no sense. I was hiking a trail from one hikers’ chalet to another.  Mountains were giant mounds of boulder rubble from glacier melt.  The trail was marked by big red T’s painted on rocks. With my infinite wisdom I decided to follow a stream below the trail markings.  Naturally, I got lost, couldn’t find the trail. Compass and map were useless to me. That night I wrote a letter to my girlfriend, If you get this I probably didn’t make it. I’m such an idiot. The next morning I woke up, made a little ramen breakfast and headed toward the stream to wash up and fell over a rock – with a big red T on it.  I stood on the rock and looked until I saw the next big red T, went to that one and so on and so on.

big red T
Today, I’m challenged and energized by large change projects in health care – Researching, selecting, and implementing an electronic health record,  designing and creating an outcomes management system, advocating for people at the center of care.  Now that I’m seasoned I know that massive change projects require equal measures of sense and standing on a big red T, looking for the next one, going there, and on and on.

Can health care organizations learn?

By Advocate, Consumer, Leader
I’m stuck. I’m obsessed with how organizations learn. In my day job as Vice President of Quality Management at Advocates, Inc., we’ve been considering how to promote Advocates as a learning organization including persons supported and their networks, those closest to the work, and all partners. How thrilling! What a goal!!  But how do we actually do it? I’ve read so many books and articles. But they’re prescriptions with no promise of actually working.

First, we listen

By Leader
First, we listen. The tagline for the organization I work for now. Inspiring! Challenging! As an e-Patient and professional change agent in health care, it’s music to my ears. How do I learn about a new organization in a new environment? How do I listen? At what pace do I jump in and participate? Much of what I hear leaves me an enthusiasing teenager: OMG (Oh my God), that’s fabulous! Every hour I discover something else that I didn’t know I didn’t know. Some of it starts my wheels turning to solve the low hanging puzzles of organizational alignment (everybody rowing in the same direction). But a new guy, is a new guy. He’s curious for only a minute. Then the team work begins. So, I’m listening, integrating (cataloging and categorizing) what I hear and see, building relationships, asking, What can I do for you?, taking a breath, playing some music, hanging out with my grandsons.  Life is good.  Listening – a magic lever for best health.


By Advocate, Leader
Innovation: such a pregnant word. Innovation usually accomplishes something pretty basic – a solution to a problem we know or don’t know we have, a new or long standing problem. Innovation can be a tool, a process, technology, or a service. Innovation includes widespread use of the solution. Setting diagnostic or clinical treatment aside, the health journey for the whole team primarily involves people: behavior and relationships. Innovation in health behavior and relationships leads us to magic levers of best health. This week I heard about primary care teams that weren’t built around the licensed clinicians (physicians, physician assistants, nurse practitioners, nurses) The key people seemed to be the patients, their caregivers, and the offices’ health coaches (5-7 coaches per clinician). Patients have assigned coaches to partner in their health journey and serve as a bridge to services and clinicians. I was hearing about Iora Health and Mass General’s Center for Primary Care Innovation. This could be innovative! It’s a magic lever. Phew!

I say could be because the challenge with so-called innovations such as health coaches is to accomplish  widespread availability. What did it take to nurture that potential innovation and how does it spread? Well, somebody was dissatisfied with the status quo, became an entrepreneur and had the gumption to find or create a space for the idea, process, and service to germinate and flourish. The entrepreneur(s) had to align incentives (funding to develop a test and a payment model to feed the service) in a market that needed and wanted the result. It takes a very different kind of change agent to create and pilot something than spread it.