iPad Launches: Can it Help Healthcare?

Greetings All,

My colleagues at Medical Software Advice are curious to know if you think a new technology like the iPad, just launched today-A Steve Jobs classic-can assist healthcare providers.

They want to know from you. Please share your thoughts in the survey below:

Which Tablet Computing Device Will Rule the Halls of Healthcare?

There is no obligation and neither Amri Johnson or Diversity HealthWorks were compensated for promoting the survey. We simply would like to get your response. For many years there have been a variety of devices that healthcare has used to collect data. Some have been great, others not so functional. Some say the iPad's functionality can be potentially revolutionary.

Let Medical Software Advice know what you think and of course. . .

Make it a great day!

Passion and Reason

When we get down to the business of organizational transformation the road to success is difficult at best. If we desire for the principles of inclusion and cultural competence to be central to transformation the difficulty can be exacerbated.

Most people I know have some type of passion in life. This passion is coupled and/or often met with the energy of reason.

In the the classic book, The Prophet by Khalil Gibran, the speaker says about Reason and Passion:

"Your reason and your passion are the rudder and the sails of your seafaring soul. If either your sails or your rudder be broken, you can but toss and drift, or else be held at a standstill in mid-seas. For reason, ruling alone, is a force confining; and passion, unattended, is a flame that burns to its own destruction."

Many of the people I have observed who are committed to this conversation about cultural competency and diversity are very passionate about it. In fact, they have been so passionate, that their reason has been "a flame that burns to its own destruction." Their passion has met with the reason of others and the reason has rationalized away the importance and intrinsic value of the passion.

Historically when a person passionate about diversity, inclusion, and cultural competency has had their ideas or budgets minimized, it has in many instances been the result of not doing the diligence of finding the passion(s) of others in the organization. As a result, when there is an opportunity to validate one idea vs. another, the result is often a cyclical resistance of one passion to protect another or to suppress a passion with reason because of a perceived imbalance.

I think we are at a crossroads in the evolution of business in this country and perhaps globally. The crossroads is one that lies between passion and reason. Often when there is a crossroads it means that we have to make a choice. The choice for most is seemingly dichotomous. But as Gibran reminds us:

"Therefore let your soul exalt your reason to the height of passion, that it may sing; And let it direct your passion with reason, that your passion may live through its own daily resurrection, and like the phoenix rise above its own ashes."

So, as we enter into these discussions where a passion for diversity is met with a question about viability, a business case, ROI, a bottom line rationale for why what we do should be done--get excited! Get excited as we are able to meet the reason of one with the passion of another.

We are also able to discover the passions of others that we were potentially unable to discern because of our resistance to what we thought was their attempt to suppress our passion. The coupling of reason and passion allows us the space to create something that goes beyond the simplistic rift that we have historically created.

When we can understand our passions and use them as impetus for discovering the passions of others, reason when it arises is a gift. It can be seen as a balancing element of a chemical equation; an opportunity to validate something that could be transformational--the beginning of possibility.

Make it a great day!

Will short-term thinking's results ever jolt us into reality?

When I started this post it was late Tuesday evening January 5th, and I wanted to simply get on-line and finally say Happy New Year to all of you who have been so tremendously supportive of this blog and our network and the mission that Diversity HealthWorks believes is absolutely critical to healthcare being all that it needs to be for this country.

Thank you for your support. I cannot fully express my appreciation in a writing, but know that the conversations generated, and the movement made towards creating what I feel is "REAL and ROBUST" healthcare reform (vs. financially-driven political health insurance reform) is greatly appreciated.

It was hard to get it all out when I started because I have had a heavier than usual sense that we are moving more and more rapidly away from our capacity to empathize. It is being replaced by blame, fear, and a mindset of scarcity. I understand it and I sympathize because I know that folks are struggling to different degrees. My concern is that the struggle is not making us more progressive as a nation. Frederick Douglass said: "If there is not struggle, there is no progress." My worry is that struggle is resented and as a result progress is thwarted.

I expressed in the last post that I am concerned that Americans don't have anything we agree on that connects us. Perhaps my Utopian sensibilities seem unrealistic, but it occurs to me that without any common bond, we are not a United States, we are simply a bunch of individuals focused on, as Janet Jackson stated in her song and Eddie Murphy repeated in a later comedy special, "What have you done for me lately?"

We are so wrapped up in the moment that we have no vision beyond "what I get more of" and/or "what they will take more of" and/or "if I get less of anything, it is wrong". Now, this is not a universal sentiment. Some feel blessed to have or have ample amounts and are willing (at least for now) to contribute a little more of what they have for those who have little to nothing.

Of course, since I talk about and explore facets of healthcare more than anything, I have seen this response to various health insurance reform bills proposed that suggest that those with more will pay a little more in some cases. So, I applaud those who are okay with this. Personally, I cannot say that they are right or wrong for thinking this way, but I think it is honorable and anyone willing to give gets a nod from me. I dare not question their intention, it is not my job.

On the other hand, there are those adamantly opposed to anything that speaks to addressing social issues that seemingly affect a few, but in reality affect us all. There is a belief that "those people" who could be the uninsured in the case of health insurance reform, "don't deserve care if they cannot afford it".

There is no consideration of what happens to a society that thinks like this, no consideration of how they are and will increasingly be directly and indirectly negatively affected, no consideration of the future of a nation that does not care for its people.

So, why this rant from a blogger that has traditionally been very much committed to presenting as balanced a perspective as I try to have in my consciousness?

Well, my conscience is speaking to me. My intuition is clear that where we are going, under the guise of making America strong, has very little to do with preserving the integrity of these not so United States and everything to do with individual preservation and in my opinion, our rapid demise.

I feel compelled to simply express my concern that we stand in the space of exploration about who we are choosing to be, more so than perhaps we ever have in our history. And for the most part we are not going too deep in this exploration. In fact, we are not even truly exploring anything beyond short-term dynamics that historically when focused on, have lead us to another short-term dynamic with less than ideal results.

Now, I am not saying to stop questioning our political system or the possible draw backs of spending taxpayer money to fix social problems, like health insurance reform, or even the dynamics of the economic recovery. By all means, say what you feel.

My issue is that as much as we scream and as much as we disagree because of concerns for self-preservation, is it possible to simultaneously consider a longer-term reality that transcends the individual and speaks to connectivity?

The time we are in speaks to a new reality of connectedness that we have not experienced in the world we are in prior to now. What this connectivity speaks to is a necessity to consider that win-loss dynamics in any capacity will no longer work.

So, there isn't an environmental policy that is good for one and bad for another. There isn't a healthcare solution that benefits one person and harms another. Yes, there are temporary situations that appear beneficial to one vs. another in a situation with apparently dichotomous variables; however, when we go beyond the short-term we will see that they won't work for long and "for long" is a lot shorter than it once was.

The reality of a short-term mindset will jolt us into reality. It is already happening and it will make itself more and more evident moving forward. Will we recognize the effect quickly enough to begin changing the tide?

I trust that some won't; I am confident and aware that many will.

Make it a great day!

The Logic of What Might Be

We have a healthcare (insurance) reform bill passed in theory and probably soon to be passed in actuality.

The next question is: what does this mean? What does it mean, politically, functionally, to you, to me, to many others that don't have the wherewithal, desire, or ability (as a result of no connectivity or not having connectivity, if you know what I mean).

Well, if I summed it up quickly, it would go like this:

What does it mean politically?
It means that we have a president and a congress that has been in the position and created the positioning to push something through in about a year that has only been done a handful of times in the short history of the U.S. democracy.

It means that there will be attacks that happen any time any individual or group overcomes aggressive political opposition to accomplish something that the opposition vowed publicly and privately to completely derail.

It means that implicitly, something that has never been done is being done by a figure that has done something that has never been done.

It means that explicitly what we will hear is that when a figure that has done something that has never been done twice, the ultimate outcome is that there will be grave consequences because what has been done can't be that good. "There is no proof."

What does it mean functionally?
Functionally, it means that things are going to shift, some slowly, some within the next year. It means that some of us will pay a little more, some of us will pay a little less. It means that some of those folks with no connectivity or less than functional connectivity will have more opportunity to connect with things they need to feel and be connected.

It also functionally means that until we get accustomed to the shifts, that we may feel a little uncomfortable. It means that not everything that certain people wanted will be on the table immediately and in some cases not at all. There is no way this could have been all things to all people.

The inevitable consequence is that some companies and individuals that are already making a large sums of money from healthcare, will more than likely continue making large sums despite the varying stances on this dynamic. In fact, I am not sure if that would have changed more than a couple percentages in any direction because in reality, functionally, those making large sums anticipate how they can make money despite political outcomes. If we look at it logically, it is smart business. If a company does not anticipate what could be, they are subject to whatever is when it surfaces without any ability to turn the rudder when the ship requires a change of course.

So, that brings me to the title of this post. . ."The Logic of Might Be". This statement comes from Roger Martin talking about "abductive logic" in his book The Design of Business. Thinking abductively or proving what might be, asserts that past-based logic is not the only logic that drives our predictions of success. This way of looking at problems doesn't guarantee success. Nothing guarantees "success" where outcomes are concerned.

However, what it does is creates a space that allows for exploring possibility. In fact, to me it allows us to validate not just a single possibility but multiple dynamics simultaneously.

I can honestly say that I am quite disturbed that in this country that we have become so polarized that there is absolutely nothing that we can rally around as a idea that is good for us all. In fact, it seems that whenever such an idea comes about, we, the media, political parties, whomever, seeks a contrary position and drives that resistance so quickly and aggressively, that most people take a side. They seemingly do so because dichotomous options occur to them as the only options possible. This is the Logic of What Was or What Has Been.

In this healthcare insurance reform question or any other critical issue facing us in this current reality: Can we explore "The Logic of What Might Be"? or Will we stay limited by inevitability trapped within the cycle of what has been?

Make it a great day!

Predictive Modeling of the Masses

My observation of the healthcare insurance reform debate and the war debate and the Tiger Woods debate and the economy debate and the obesity debate and the. . .is that there a lot of debates. There is little action towards an idea, centrally agreed upon that will move the U.S. and perhaps the world forward.

So, I came to the conclusion that all of us have become coffee table, computer desk, bar, stationary bike, recliner, barber shop statisticians as we are all engaged in Predictive Modeling. Let me briefly explain.

Predictive modeling is the process by which a model is created or chosen to try to best predict the probability of an outcome. (Geisser, Seymour (1993). Predictive Inference: An Introduction) In many cases the model is chosen on the basis of detection theory to try to guess the probability of a signal given a set amount of input data (Wikipedia).

The difference with us armchair statisticians in regard to predictive models for healthcare reform is that our models (for the most part) are not based on "detection theory" as described above. If so, that would mean that there was some level of understanding about how we discern potential outcomes. In most of the situations that we currently face including health insurance reform, the dynamics are completely without discernment.

In fact, most predictive modeling going on currently is based on one or a combination of: Self Interest, Fear, Preferred Media Outlet, and in the case of healthcare reform one's general depth (or lack thereof) of knowledge about healthcare.

Now, my biggest concern about the entire dynamic that we are facing is that given the circumstances (maybe given any circumstance at any time), speculation about what will happen in the future that is so highly unpredictable is a formula for failure and perhaps a formula for mass paranoia. It is not worth it.

What is the alternative? Well, I will stick to what I am most familiar with and what is the subject matter of this blog. . .Moving healthcare forward, in my opinion, will be much less dependent on reform of the system than it is on a paradigm shift in our organizations and individual consumers. The fundamental premise of healthcare is not cost, it's people, quality, and care in that order. I recognize that we have to make money to stay in business, those that know me will tell you I am far from naive in that regard.

However, the "money first" strategy has gotten us where we are in healthcare. The heuristic that emphasizes care is grossly compromised by financial considerations. In a model where people come first, efficiency is created through effective communication. Doing things well early in the process and setting the stage for effective self-care will inevitably save money.

Let's try this as a premise--1) focus on people/patients; 2) with this focus learn what effective communication is for each patient--make developing cultural competence central to effective communication; 3) resolve that effective communication for a year and the investment into it (not a highly expensive one) will impact quality/core measures more than anything else a healthcare organization can do.

Now, this premise is not going to quell the voracious appetites for the predictive tweeters and bloggers, ranting on about how the world is coming to a halt due to the actions of a single leader in one year. Nor will it make those demanding a public option without knowing enough about the pros and cons to do anything more than make an emotional plea.

What the premise above or any other premise you suggest can do is move us towards something we commonly agree on with the intent to use this heuristic to prove something or disprove something rather than speculate ourselves stagnant.


Make it a great day!

Cynics and Possibility

I often envy cynics. In the midst of change they can so easily begin their critique of the current realities. Or they can take a premise (the central idea of any breakthrough innovation) and dismantle it purely based on their past-based data and understanding alone.

In the past my orientation to the cynic went somewhat like this: In scathing displacement they deftly spin their cocoon, a blanket of protection which ironically seems to be woven in resistance to the transformation that deep down, they desperately desire.

I am not so sure that this is the case anymore. In fact, it may be that cynics are intentionally playing a role. So, the idea of the devil’s advocate may come to mind, but I think it is more profound than this. For the self-professed and consciously (perhaps conscientiously, too) engaged cynic, their role seems to be one more so that of a constant reminder to look at problems from as many angles as possible. In addition or alternatively their role is also to serve as adviser to the power of intuition.

If you feel it strongly in your gut and it is not challenged, the integrity of the idea never stands up to anything strong enough to be for certain that it is anything more than a fleeting good feeling.

Let me give an example of why I am learning to appreciate cynics more today than ever and why I think they are the some of the best generators of possibility.

Over the past several years my work has led me to generate many premises about human capital dynamics. Most recently, the premise that a focus cultural competence and quality and the components that create and drive the above, are the core of success in any healthcare organization and perhaps in any organization period where quality is valued. The components, especially inclusive leadership and employee engagement have come to be core to the premise in that they are critical in producing sustainable results.

So, I have this premise and some of the people in organizations that have agreed that this premise is worth pursing are going about testing hypotheses and questions that relate to the ideas of our model. They are of course leaning heavily on those components that serve their specific needs right now.

What the so-called cynics have done for me is inspire me to not be stuck on a single point of possibility. Where before I recognized that the various parts of our model can give organizations a way to connect the often separated components of organizational development.

Lately as a result of some of my ideas being challenged and sometimes told to not be practical or feasible, have given me insights towards possibilities that simply were not considered before. I see the value in going deeper into any one component of the model and connecting to the others naturally without having to do 8 other things to legitimize the premise. I questioned a central premise based on a cynical response and in my questioning I discovered a new space to explore and share with you.

Now, my envy for the cynic is not envy for their being cynical but appreciation of what they inspire and hopes that I can take on a little more of their characteristic skepticism in order to create and recognize possibilities as they arise.

Make it a great day!

Everyone's at Fault-Everybody's at Risk

In the healthcare insurance and healthcare reform debate (I consider the financial side a part of overall reform, but it is not the complete picture of reform) there are obviously sides that have been taken.

On one side is the "'we need universal healthcare', 'we need a so-called 'public option'; 'healthcare is a right not a privilege', 'those bad health insurance companies are bringing us all down,'" contingency. You are familiar with this side or you subscribe (at least in part) to it so you understand it experientially. On the other side is the "'this costs too much,' 'I like my healthcare just the way it is,' 'we are turning to socialism,' 'I really don't know what is going on with health insurance reform, but if it is anti-Obama I support it'" crew.

The fact is, both of them are creating something that we have seen often in the political process, They are creating an ever-narrowing bottleneck to progress.

In 2006, Harvard Professor Robert Putnam, author of the best seller Bowling Alone and an expert on human/social capital wrote a widely debated paper on social captial, increasing global diversity, its challenges and opportunities. His statements, when taken out of context indicated that he was anti-diversity, when in fact his intention was just the opposite. Writer William Goldsmith of the Harvard Crimson shares an interview with Putnam:

In more ethnically diverse communities, respondents were more likely to “hunker down.” Those results held true even when Putnam controlled his study for a host of other factors that might affect trust levels—including gender, education, and income.

“We act like turtles,” Putnam said. In diverse communities, people are not only less trusting of neighbors from different backgrounds, but also of those from their own ethnic and racial groups.

Los Angeles, one of the most diverse cities in the world, has the lowest level of trust in the United States, Putnam said. He attributed this to a “socio-psychological system overload,” a type of shock resulting from an influx of heterogeneous newcomers into a generally homogeneous society.

But Putnam said people’s turtle-like behavior when first confronted with diversity fades over time.

What is my point? Like this article by Putnam, interpretation is creating the outcomes vs. facts driving the dialog doing so. People saw all of this change in their surroundings and they began to trust no one, then they began to look to those who were as scared or as vocal as they were or desired to be to connect with.

By nature of the topic and historical political factions, the dynamic is inherently emotional. Of course, the emphasis on philosophical differences that has been primarily perpetuated by extreme so-called conservative groups is a much more viable tool in emotional manipulation.

However, in the situation the U.S. is in where healthcare (and our overall economy and society) is concerned, the result of creating emotionally-based bottlenecks is that everyone loses.

Indeed, there are many things to consider including the idea of increased taxes, how to pay for this whole thing, the dynamics of reform beyond cost: namely cultural competence and quality and all that they entail including health disparities, patient-centeredness, and other essentials to real reform. There is also the cost of perpetuating a self-destructive paradigm for our society that is based in too large a part on financial gain.

So, short-term thinking and political jockeying is creating the appearance of something that is dichotomous because the paths to getting where we know we need to be have slight philosophical differences. And of course who will take the credit (negatively or positively, visibly or invisibly) plays a major role, too.

The fact is, we are all at-risk of severe consequences as a result of this political cacophony (sounds redundant, huh). Health (insurance reform) is not just about health insurance reform (see Parrots and Protectionism). Our response as members of a society that desire to see our country evolve is very much a determinant of eventual outcomes. In fact, while we don't have 100% of the say in how this whole thing goes, our attitudes are being probed for and our ignorance is being preyed upon (and it is not party-centric)

I am not talking about whether or not there is a public option. I am not talking about who pays (the bottom line is that regardless of the outcome, we all pay and the cost is not going to be considerably lower. I hope that at the least we can keep it from increasing beyond the cost of inflation) or how much. My concern is that we keep this mindset that someone is taking something away from "me".

NEWS FLASH: It has ALREADY been taken away! If we understand this, mentally lying down along political lines will be less restful. If you "sleep" on either line you will be at fault.

Make it a great day!