Cast & Curious

Tag: Business & Economics

A sector within the economic system that provides goods and services to treat patients with curative, preventive, rehabilitative, and palliative care.

  • Social Media as a tool in engaging providers’ “buy in” on health care innovation

    Compared to other industries and despite milestone discoveries that saved million of lives, innovation in health care is still considered “slow” by many. There are myriad of reasons for this but healthcare system is a complex system and for innovation to take traction, it needs to satisfy many stakeholders. Systems level solutions offers a lot of potential but it’s the stakeholders’ “buy in” (or “out”) that usually doom interventions to fail.

    What drives change and innovation in health care?

    Clarifying the direction of change helps untangle the confusion and may also improve buy in of stakeholders. Improving health outcomes and lowering the cost of health care services drives change and innovation in health. These two complementary driving force put emphasis on the Patients First intention. Many health stakeholders and most especially providers, share this altruistic goal. Lowering the barriers to stakeholders engagement maybe a solution, but what’s important is that leaders engage health care providers forward to health innovation. Moreover, health leaders should recognise that a buy in to “Patient’s First” goal doesn’t mean neglecting the motivational aspirations of health care workers. Leaders need to tap in these motivation if they expect providers to be engaged and at the forefront of change in health care. I hypothesise that social media, intertwined in todays internet heavy health care, plays a role in this.

    Health leaders should recognise that a buy in to “Patient’s First” goal doesn’t mean neglecting the motivational aspirations of health care workers. Leaders need to tap in these motivation if they expect providers to be engaged and at the forefront of change in health care.

    New media as change agents in healthcare revolution.

    As the internet is now intertwined with healthcare, there’s a movement within the system to increase patient participation in the management of his or her own health. Empowered by new technology and social media, physician- patient partnership for health is gaining headway and might just ( if not already) accelerate change in healthcare. I propose that social media be used as a tool to tap in the motivations of healthcare providers and engage them towards innovations in health. If the Patients First goals drive innovations in health, social media might possibly accelerate it. How to do this is the topic of these tweetchat conversation.

    If the Patients First goals drive innovations in health, social media might possibly accelerate it.

    -unknown

    Lee and Cosgrove (2018) borrowed Max Weber’s Four Motivational Typology for Social Action as potential intervention points for leaders to tap and engage physicians as agent of change. (See picture table below).

    Photo lifted from HBR.org’s article Engaging Doctors in the Health care Revolution; here https://hbr.org/2014/06/engaging-doctors-in-the-health-care-revolution

    I suspect this holds true for all health providers and not just physicians. My hypothesis is that social media plays a role in accelerating “buy in” vis a vis these motivational tools. Let’s start crowd sourcing ideas.

    • T1. How would social media help healthcare providers engage in a noble, shared purpose? Many healthcare institution analyse the results of their Patient Satisfaction Surveys (PSS) to improve patient services. General trends of this survey and the measures implemented to improve outcomes, are posted on the institution’s social media channels for public viewing. The same general trends and specific positive results and commendations are posted on the institutions social media channels for providers viewing. The positive commendations usually motivates providers engagement to the institution’s shared goals.
    • T2: How would social media help fulfil or satisfy providers self interest? Putting the patients welfare first resonates deeply with many health providers. Like everybody else though, many are also motivated by “job security or financial rewards” while performing their duties and responsibilities of “putting the patient’s welfare first”. Many health care professionals on social media provide a vital link between institutions and patients. These health care professionals ( “influencers”) play an important role in the HCI’s organisational structure. Moreover, patients tend to consult or opine with healthcare professionals who are visible and easily accessible online.
    • T3: How would social media help healthcare providers earn respect? Like everybody else, earning respect and peer pressure are strong driver for change among healthcare workers. Although the many worst and ugly failings of the providers are publicised online, positive feedback from patients and colleagues improves performance in the long run. In the new media age where even health workers long for transparency, faster feedback and communication social media should be a good platform.

    These are just some examples of how social media could be a tool to engage providers as agent of change in healthcare. It is neither inclusive nor perfect. If we need health providers’ buy in health care’s innovative change however, health leaders probably need to tap social media.

    Join the discussion on this topic this Saturday July 6, 2019 9:00 PM Manila Time by tweeting your thoughts with the hashtags #HealthXPh #HCSMPH2019 #HCLeadership with the following guide questions:

    • T1. How would social media help healthcare providers engage in a noble, shared purpose?
    • T2: How would social media help fulfil or satisfy providers self interest?
    • T3: How would social media help healthcare providers earn respect?
    • T4: How would social media help providers embrace tradition in the pursuit of innovative change in healthcare?

    Se you all healthcare tweeps!

  • How healthcare social media campaigns may improve provisions of health in a devolved health system

    The lack or ineffective social marketing strategy (supply side barrier) and lack of information on benefits and availment process (demand side barrier) are a few of the identified restrictions to the use of health services in complex decentralised health systems such as the Philippines.

    The Department of Health (DOH) is the lead agency responsible for the regulation and supervision of the country’s health system. It manages national policies, develops national plans and establishes health technical standards and guidelines to regulate the country’s health sector.

    The Local Government Code of 1991 devolved the provision of health services, particularly at the primary and secondary levels, through the local government units (LGUs). Hence, health service in the Philippines is managed through provincial, municipal and barangay local government offices. Provincial and district hospitals are the responsibility of provincial governments while the Rural Health Units (RHUs) and Barangay Health Stations (BHS) are managed by municipal government units.

    Complex internal developmental differences among geopolitical regions hamper provisions of health two decades after the implementation of the local government code. Less developed regions usually suffers most of the negative effects of institutional fragmentation. These least developed regions also is the least likely to recover or lags behind because it lack or poorly manages resources and is usually inefficient in allocating health resources.

    Cetrángolo et al identified supply and demand side barriers that restrict the use of health provisions in the Philippines. The lack or ineffective social marketing strategy and lack of information on benefits availment process are included in these restrictions. Grundy’s echoed the same observations in a local study.

    This author has practiced for more than ten years in areas with health units ran by local governments and in urban center with health institutions ran by DOH. While there are LGUs with efficient and effective local health councils who clearly benefitted from the devolution of health, other regions aren’t as fortunate. Case in point,  the WHO Safe Surgical Checklist.

    The WHO Safe Surgical Checklist 2009
    The WHO Safe Surgical Checklist 2009

    The WHO Safe Surgical Checklist is the single most cost effective way of minimising post operative complications reducing death and morbidity by at least 36% on the average. No other cheap, readily and sustainably implementable guideline (except maybe the handwashing guide) had so much impact on health as this checklist.  It has been incorporated into standard DOH standards operating room “toolset”, requiring every hospitals with operating rooms to incorporate such checklist in their standard operating room manuals. Yet many hospitals who have operating rooms rarely take advantage of this readily available and cheap guideline. Why is that?

    Cognisant of these complex problems, efforts has been made in the past two decades to either strengthen  or amend the local government code that devolved health provisions to LGUs. Bills calling for returning provisions of health back to the national lead agency (DOH) are now pending in the House of Representatives. It is not the purpose of this article to weigh the complex pros and cons of such amendments. Until such amendments or repeals are enacted into law, we have to deal with effectively delivering health down to grassroots level in the context of a decentralised health system.

    An effective social media campaign may narrow regional differences in the provisions of health and address the two barriers I mentioned at the start of this article.

    Join #HealthXPh this Saturday August 26, 2017 9pm Manila time as we discuss how a social media campaign may improve provisions of health in the context of a devolved health and regional developmental differences.

    • T1. Is there a role for social media as social marketing strategy for effective provisions of health in a decentralised health system?
    • T2. If you are the chief social media strategist what will your primary strategy be?Targeted? Regional? National?
    • T3. How would you measure the effectiveness of such healthcare social media strategy? Indicators? 

    Please give your final thoughts on ways by which social media could be a part (or not) of the social marketing strategy for health units or agencies in a decentralised health system like the Philippines.

    References:

      1. Cetrángolo,O., Mesa-Lago,C., Lazaro,G., Carisma,S. Health Care in the Philippines: Challenges and Ways Forward. 2013
      2. Grundy J1, Healy V, Gorgolon L, Sandig E. Overview of devolution of health services in the Philippines. Rural Remote Health. 2003 Jul-Sep;3(2):220. Epub 2003 Jul 1.
      3. Haynes, A.B., Weiser, T.G., Berry, W.R., Lipsitz, S.R., Breizat, A.H.S., Dellinger, E.P., Herbosa, T., Joseph, S., Kibatala, P.L., Lapitan, M.C.M., Merry, A.F.: A surgical safety checklist to reduce morbidity and mortality in a global population. N. Engl. J. Med. 360(5), 491–499 (2009)
      4. Atienza, Maria Ela L. 2004. “The Politics of Health Devolution in the Philippines: Experiences of Municipalities in a Devolved Set-up.” Philippine Political Science Journal 25 (48): 25–54.10.1080/01154451.2004.9754256

      

  • Disruptive innovations that will potentially change delivery of healthcare in the Philippines

    What is disruptive technology?

    A disruptive technology is an innovation providing a product or service that is so compelling that everyone rapidly abandons their current way of doing things and flocks to what is new- Hank C. Lucas Jr (University of Maryland)

    In an archipelagic country like the Philippines and with a healthcare delivery system lagging behind its neighbours, disruptive technologies offers us a new way of looking at problems. Disruptive technologies may also offer a cost effective solutions to lingering health care problems that has been besetting us for decades.  Healthcare problems that we often blame on lack of resources.

    Here are some innovations in healthcare that might have just been knocking at our healthcare doors (infographic from Bertalan Mesko, Medical Futurist)

    MEDICAL_infographic_final

    Here are my top three disruptive innovations that might just change the way we handle healthcare in the Philippines:

    1. Internet and social media– information explosion via the internet has tremendous leveraging effect on healthcare system. Access to medical information and collaborative work has never been easier and faster with internet. Social media on the other hand, has a provided us a new tool for engaging patients on a participatory type of medicine.
    2. Massive Open Online Courses (MOOC) revolutionized access to learning and education.  Healthcare education is already jumping on this innovation, albeit slowly in the Philippines. Although we definitely need formal, face to face, institution based medical education, other aspects of healthcare education (like learning healthcare systems or healthcare models that are not taught in medical school) can be learned tru MOOCs. MOOCs also brings down the prohibitive cost of medical education as well as “lack of resources” for learning that we so blamed in the academe.
    3. Telemedicine – Don’t have a healthcare professional in your location? Just video chat on an online physician elsewhere!  Don’t have a colleague to refer to or work with managing a patient? Just teleconference with another doctor elsewhere! The impact of this innovation to health care is enormous. In a country where healthcare delivery is very much affected by geography, human resources (the lack thereof) and prohibitive cost, telemedicine offers a unique way of addressing healthcare problems that remains under utilized until now.

    Of course there are other disruptive innovations I can add to the list. These have not yet ” landed” on our shores or are probably experimental in their uses for healthcare in the Philippines. The 3d printing technology or 3d bioprinters for example, has helped in replication tissues that are very much needed by our body. In orthopedics, 3D printers have helped scientists and doctors create stem cells that could eventually develop into both bone and cartilage in the long-term.

    So what among these disruptive technologies you think might help us solve some of our health care related problems in the Philippines?

  • 10 Financial Tips for Medical Students

    Pursuing a career in medicine is one topic I’m often asked during career talks and speaking engagements. Most questions under this topic fall into distinct but interdependent subgroup of questions  known as the “what”, “when”, “where” and “how”.  A few dared ask the “why”. Surprisingly, majority of the few  who asked the “why”  we’re already doctors !

    Here’s one question posted in the comment section of a post in this blog. 

    Hi, I’m Ian Patrick from Pampanga, I really would like to become a doctor since the day I graduated nursing in 2008. My father decided to loan our 1.7 hectare land for me to pursue the degree. I would like to ask for any suggestion where or what type of bank can we go to, or is there other option other than going to banks here in the Philippines. I really would like to go to med school and I think this is the only way for me and my family to generate money. Thank you.

    As far a I know, you can sell a parcel of land to most banks and use the money to finance your medical education. The process of selling land varies from one bank to another. You can directly ask banks of these processes but make sure you have the necessary documents for your parcel of land. Selling properties to a bank is tedious, would take some time ( valuation-market assessment-actual sale) and may not yield the highest amount you expect from the sell of your land. Taxes and fees for this transaction should also be considered.

    Selling the land to third parties without legal business identities is also risky. I’m not aware of any bank that accept a parcel of land as collateral to subsidize a medical education. I would not advise you to use your land as a collateral for a personal loan because the interest rates are usually sky high. My family tried this and was only able to fully pay the debt 20 years after. The interest we paid is five times the initial loaned amount!

    I hope this answers your question Patrick.

    To help out Patrick and (potential) medical students who are roughly in the same circumstances as he is, here are financial tips that will save you some expense during med school.

    1. Choose a quality medical school with the least tuition fees. Many state colleges and universities in the Philippines have medical schools that are at par or even better than some private medical schools.
    2. Choose a medical school located within or near your place or potential place of practice. Saves you the lodging and transportation expenses.
    3. Choose a medical school located in an area where the cost of living is relatively cheaper. Regional state colleges and universities have medical schools too.
    4. Get a scholarship, if you can. Or if the scholarship is some sort of study now pay later scheme, choose the one that offers a “pay out” maximum of 1:2 ratio (e.g. 1 year of study equivalent to two years of service). A ratio larger than that is typically costly when you look at the expense -payment ratio. (±300%)!
    5. Never sell or loan every asset your family have  and hope you’d be able to pay this right after you graduate medicine. Yes, you will have a job right after med school but I doubt it that would be even enough to even buy you your own car.
    6. Borrow books if you can. Avoid buying books that will probably have another edition in 3-5 years. Maximize your library card! This will push you to efficiently study and maximize reading time.
    7. I do not recommend marrying during med school, unless of course you’re marrying a millionaire who would subsidize your medical education. A wedding will cost you at least a semester of medical education expense! What’s five years of waiting anyway when you’re too busy hurdling exams and duty schedules?
    8. Get a job during summer breaks and add that income to your medical education’s fund!  Just don’t do part time jobs during med school proper or it will wreak havoc on your grades. Take that from me :).
    9. Join a like minded group of medical students that offer possibilities of sharing resources in med school like books and instruments . Cut off the partying expense however. Admit it, you’re in med school to study medicine. You may party all you want when you pass the boards.
    10. Finally, never pursue a career in medicine with the monetary income as your primary goal after med school.  You’d be frustrated. Yes, you will have a job and you will not go hungry as a doctor. But if you aim to get into Forbes’ Top 100 Richest People via medicine alone, good luck.

    You have to finish “doctor of medicine” degree from a recognised medical school and pass the Professional Regulations Commission’s licensure exam to practice medicine in the Philippines.  Then you have to decide on what path will you take in the vast field of medicine. Are you going to be a general practitioner? A community physician? A public health physician? or take further training for specialization? This will definitely entail additional trainings depending on the field or niche you decide to practice. Still other fields require specialty board exams to fully practice that field. I’m outlining these, because these are the first few tangible short term goals you should have if you are eyeing a career in medicine. All financial considerations must be tailored efficiently towards achieving these goals. Any expense that is not contributing to achieving these goals should be stripped off your “budget” and realigned to your medical education fund!

    If you have reactions or additional tips to offer, please don’t hesitate to leave a comment in this post.

     

  • Why Talking about Money is Taboo among Physicians

    [dropcap1]D[/dropcap1]octors talk about medical stuff many ordinary people will cringe and consider foul. Stuff like STD’s or bloody eviscerations get discussed lengthily without them missing a bite of their breakfast. When discussion shifts to money matters however,  you’d hardly get discussions beyond few sentences. Here are the top  reasons why:[check_list]

    • Doctors don’t want to be heard as “bragging” their ‘high” income. Physicians generally earn more than the average worker. When doctors discuss money, it is often seen as “bragging” about their income. “Why would physicians talk about money when they’re earning more than anyone else?That’s just bragging!”
    • Doctors are rich people and rich people don’t talk about money.  While doctors earn higher than most workers, it’s nonsense to automatically consider doctors as rich people. Despite that flawed conclusion, even the truly wealthy people discuss financial matters carefully.
    • Doctors find it hard to accept they have money issues. Not a very nice thing to say about people with big suffixes after their names. The long years in med school and training gave us a sense of entitlement to spend our income wantonly. Coupled with higher than most income, this sense of entitlement often bar us from facing head on, money issues.
    • Doctors feel that money issues only affects them, alone. “The other doctors, they probably don’t have any money issues at all.” But there are telltale signs that doctors have money issues even if they don’t discuss it in public.  Complains of not enough compensation,  HMOs and claims underpayments, etc,  are all telltale signs that money for us too are issues that needed to be sorted out.  Since doctors rarely discuss money issues with their colleagues, that feeling of money issues isolation is propagated unknowingly.
    • Doctors don’t like to ask “stupid” questions.  “Who would, when I belong to an intelligent profession?” Intelligent and paid well, why would I ask such questions, hah?  When you ask someone, even colleagues for example, about money matters, the throwback question would most likely be ” Didn’t they teach you that in med school?“. There’s practically zero money learning in med school. Our professors would tell us “Ah, you’ll learn those when you go into practice. Learn from who? From experience? Thus we take this stance of “yeah I know it” when we actually do know nothing. I don’t know, but I’d look very stupid pretending to know something about money matters when in fact I don’t know anything.
    • “It’s taboo discussing financial lifestyles, it’s not us, doctors.” The dilemma most doctors have today is that as role models, we’re just here to deal with the health of our patients and communities. Nothing else. We’re not supposed to deal with finances as it confabulates our practice of the profession. Most people think we’re super humans,  that all we do for eternity is heal, care and work without having to feed our family. It’s really a good thing to render  charity service but it’s not immoral and illegal to earn from services you rendered. How can you possibly continue to care for patients when you’re wallowing in debt or without housing?  Please tell me.
    • “I’m busy saving lives, I have other more important task to finish than talking about money.” Correct. But until when? Should you wait being thrown of your mortgage house or default in your new car because you were busy and didn’t care to check on your financing? How can you save lives then when you can’t even save a part of you thats sustaining your service or profession? Again,  lets not succumbed to the idea that we’re super humans and that financial woes exempt physicians. I’m sure nobody thinks he or she can still go on hospital duty 24 hours when they’re already 60 simply because he/she didn’t plan out a retirement for him/herself. Busy you said?
    • We really have not learn money sense from our parents. Again, the more we should strive to have some sort of financial literacy or we’ll just pass that legacy to our children. For many Filipinos, financial maturity is being equated to frugality or thriftiness on everything. “It is the only trait I wanted to learn“. Well, being frugal and thrifty will surely save you money and expense but how will you plan out your retirement, your children’s education etc etc?
    • We’re afraid the internal revenue agency is eavesdropping and will hunt us down and tax us to the max. I’m not sure whether eavesdropping or maxing out on taxes is the mantra of that agency, but there’s only one reason I can think of if you’re afraid of that agency- You don’t pay the right taxes. It doesn’t matter if your excuse is ignorance about taxation laws and hence you  don’t have any idea how much you should pay. It is still not paying the right taxes and in the legal parlance, that’s still cheating. Again, If you’re at least financially literate, you would know the right taxes you should pay and which one will legally exempt you.

    [/check_list]

    Why am I enumerating these? These are the same stumbling blocks I encountered when I started learning personal finance as a physician. The taboo like treatment of money issues inside the conservative hippocratic institution is painfully hindering me from gaining financial freedom.  It is only by learning personal finance that I finally come to terms with these undeniable facts:  Even doctors aren’t exempted from financial woes and that financial freedom is not the same as getting rich. So, for as long as I needed to learn something for me to achieve that goal of having financial freedom as a physician, I’d willingly talk, discuss and listen to money issues within my profession. Taboo or no taboo for others.