Cast & Curious

Tag: Leadership & Management

Leadership in health care involves influencing and motivating medical personnel to contribute to the success and effectiveness of medicine, patient care, and health care practices.

  • Effective healthcare campaigns in changing digital media environment- From “You do it” to “Let’s do it!

    Vaccination and measles outbreak flooded our social media feeds recently. The sad news is we thought we eradicated measles decades ago. Measles however, only hogged the media limelight after an outbreak happened. “What went wrong with the measles campaign?” many asked. There’s no shortage of blaming on what many called “a failure” to counter an “avalanche of online misinformation” about vaccination and vaccines. Measles and vaccinations are just two of the many health campaigns that took centerstage after an “outbreak” happened. Heard of health supplements? Alternative cancer treatments? Dengue? Flu? Smoking? Vaping? Diabetes? Kidney diseases? We din’t notice until something alarming happened. We blame the new media and the people who use it for their own purposes-good or bad. Then we rush to using the same new media to counter such online misinformation. We fail and wonder. How come?

    First allow me to narrow the discussion to health campaigns on social media. Successful health campaigns are not solely because of an effective media strategy let alone a savvy social media leader. The whole caboodles of political, economic, logistical and support systems should be in place before we can even talk of launching it on social media. Having said that, and for the sake of our discussion, lets assume we all have those factors sorted out in place and we’re left with an effective social media campaign strategy to go with the health advocacy.

    In the past we had leaders adept in using media to implement effective healthcare campaigns. Think Dr. Juan Flavier and his much loved health news, radio and TV campaigns. He and his health campaigns were blockbusters, to his avid followers and critics alike. The charismatic secretary seemed to have mastered old media messaging and signalling and was very effective in mobilizing the crowd. He is interested in empowering the public, not himself nor his organization- a novel, laudable new media value. This cascading top to bottom healthcare campaign strategy worked for old media- newspapers, radio and TV. Will it work for the new media?

    T1. What old media health campaign strategies work in social media?

    Internet and social media showed much promise for advocacies and campaigns. Twitter had been instrumental in monitoring or reporting disease outbreaks for CDC and WHO. Healthcare organizations employed social media platforms to pressure health policy changes in some countries, and won. Social media campaigns played a huge part in the passage of Sin Tax Law and the Universal Healthcare Law in the Philippines. Incremental wins some may call it but a win nonetheless. Let’s not forget, the millions of money that poured in to health advocacy groups because of memes such as the “Ice bucket Challenge”. Why some organisations are successful in using social media to meet the objectives of their healthcare campaigns (and others, do not) remains a mystery to many.

    Internet and social media comprise the “new media”. Internet gatekeepers and social media platforms keep changing its policies, algorithm and strategies to achieve its bottomline- profit for its owners and shareholders. That’s not altogether bad given the social media platforms who succeeded in providing desirable value to the general public while maintaining a profitable and sustainable business model. That social media is hog washed in false information and dubious health messages is also not true. There’s no dearth of superior quality health information online according to Keselman (2019). Despite the presence of superior quality and credible online health information, some health campaigns failed to mobilize a hyperconnected populace. Why did it fail? Was it the messaging? Platform? Theme?

    T2. What are the reasons behind the failure of some health social media campaigns to mobilize the crowd and effect change?

    In their book New Power: How Power Works in Our Hyperconnected World- and How to Make It Work for You, Heimans and Timms (2018) placed leadership archetypes into a spectrum, a quadrant on how leadership structures (termed old/new power) use old/new power values to effect change.

    Leadership Archetypes in a quadrant with examples of leaders/organizations who best exemplifies each quadrant. Image from HBR article here https://hbr.org/2014/12/understanding-new-power

    Arguably, the top down, cascading model of social media campaigns don’t work effectively in digital social media environment.

    Old versus new power values. Image from HBR article here https://hbr.org/2014/12/understanding-new-power

    The “I’m the expert just follow what I say” seem to be a less appealing to social media crowd than that of the “bottoms up, grassroots or collaborative approach. The new leadership model committed to empowering the crowd with new power values are the most successful ones. Values like collaboration, radical transparency, maker mentality and overall general participation characterise this new power value. Social media smacks right into the heart of these new power values. Leaders who are adept at these new power values empower and mobilize the crowd .

    T3. What best strategy can you advise health leaders in using social media to mobilize and effect change in healthcare?

    Thankfully, many organisations (old and new power structures alike) are restructuring, recalibrating their health campaigns to align with the intricacies of new power tools, like social media. That is something we can learn from this deluge of disease outbreaks and health misinformation. This is the topic of this #HealthXPh chat come February 9, 2019 9PM Manila time as we build consensus of how to’s in implementing health social media campaigns that empowers and mobilizes the crowd.

    Join #healthXPh chat with these guide questions in mind:

    • T1. What old media health campaign strategies work in social media?
    • T2. Why did some social media campaigns failed to mobilize the crowd and effect change in healthcare?
    • T3. What best social media strategy will you advise health leaders in mobilising and effecting changes in healthcare?

    References:

    • Keselman A, Arnott Smith C, Murcko AC, Kaufman DR (2019) Evaluating the Quality of Health Information in a Changing Digital Ecosystem J Med Internet Res 2019;21(2):e11129 URL: https://www.jmir.org/2019/2/e11129
    • Sak,G; Diviani, N; Allam, A; Schulz, P: (2016) Comparing the Quality of Pro- and Anti-vaccination Online InformationA Content Analysis of Vaccination-Related Webpages BMC Public Health. 2016;16(38) 
    • Heimans, J; Timms, H. (2014) “Understanding “New Power””. Harvard Business Review. December 2014.
    • Heimans, J; Timms, H. (2018) New Power: How Power Works in Our Hyperconnected World- and How to Make It Work for You. New York, Penguin Random House LLC

  • Personalising Quality of Care in Healthcare Professional’s Practice

    “What doesn’t get measured doesn’t get done.”-William Thomson

    John is a 55 year old software engineer at a large firm in Manila. For four consecutive days now, he had episodes of vague “chest heaviness” coupled with some difficulty breathing. Privately insured, he asked for a day off to seek their company physician’s consult. He drove an hour to the clinic, waited for another two hours in the waiting room before being seen by the company physician lasting for 15 minutes. He was given a list of diagnostics and was referred to a cardiologist. The process of seeing a cardiologist is almost the same, only this time, much longer.

    “Travel time was two hours because of traffic, waiting time doubled to four hours, diagnostics to 2 days yet being seen by a doctor lasted only for 8 minutes” said John.  “I’m nervous. I’m not sure if its about my chest tightness or the whole rigodon of trying to determine what cause it. All I’m told it was a Non Specific T wave changes. I don’t even know what that means but it took me two weeks to finish the whole check up thing!”

    Manang Tina is a 35 year old vegetable vendor. She temporarily stopped selling vegetables because her 7 year old daughter had a throat pain, difficultly eating food and fever for 3 days already. She asked her daughter’s teacher if she can be excused for a day. “I had to bring my daughter to the rural health unit” she said. At the RHU they had to wait for almost 4 hours before being seen by the doctor. Her daughter was seen and examined for 10 minutes. “She needs a CBC, a chest x-ray and urinalysis Manang Tina” said the doctor. “Have this done and come back here once the results are out. In the meantime, your daughter may take paracetamol and gargle with this liquid 3x a day” followed the doctor. The diagnostics took a week to finish, the fever and pain now gone and my daughter able to eat painlessly now. In fact she is already back in school. What shall I do with this lab results?” ask Manang Tina.

    In this digital age, did Mr. John or Manang Tina’s daughter, received quality health care?

    Quality of health care, defined
    Agency for Healthcare Research and Quality of the US Health and Human Resources Department cite The Institute of Medicine’s definition of health care quality as “the degree to which health care services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” I has six domains- effectiveness, efficiency, equity, patient centeredness, safety and timelines but has concomittant consumer perspectives of staying healthy, getting better, living with illness, and coping with end of life.

    Complex, Divisive Issue
    Quality of care is a complex, multi dimensional topic that most healthcare professionals avoid discussing. True enough, learning quality health systems and models could take some 4 or  5 years of formal study and a lifetime of iteration and improvements. Simplifying quality of care seems to be an impossible task for every health stakeholder. Everyone have the answer to quality issues yet our health system is going everywhere but forward.

    “I leave that to experts” said Dr. D a busy private heart specialist. Dr. D is referring to quality assurance professionals, compliance personnel and regulatory agencies “to do their thing while we, healthcare professionals do what we’re good at- taking care of our patients.” We’re too busy to debate on such topic.” Dr. D explained.

    But if a healthcare professional, a primary mover and health stakeholder doesn’t have a good grasp of what quality care is, how does one know he’s providing one?

    “Look, I have a full, standing only waiting room at my clinic. If that’s not a measure of how patients see the quality of my care, I don’t know what is.” Said Dr. S a family physician.

    Making quality care, personal
    But how do we know we are giving the best of care to our patients? If you are a patient, how do you know you’re receiving quality medical care? What are our personal “yardstick” for “quality of care”? In the digital age where technological innovation has disrupted some areas of medicine- form intuition to precision diagnostics, did quality of care improved? How does this affect the present “business model” of physician’s practice? Of nursing care practice?

    These are just some of the questions a healthcare professional, student or even patients must confront head on to improve health care. While healthcare professionals need help from external personnel for regulatory compliance and quality assurance, quality of care should be “personal” to every health stakeholder. In this technological age where innovations have the potential to improve some aspects of our health system, every health stakeholder has the responsibility of knowing what quality of health care is.

    This is the topic of our #HealthXPh chat this Saturday 9PM Manila time. I’m inviting every health stakeholder out there- patients, healthcare students, healthcare professionals etc, join in your personal views on quality care in this interesting chat. In your personal practice ( if an MD, Nurse, allied professional), plan (if you are a student), experience (if you are a patient),

    • T1. What is your personal idea of quality health care and how do you measure it?
      T2. Name one innovative step you implemented to improve quality of care in your practice.
      T3. Name one technological innovation that should improve quality of healthcare in 3-5 years. Explain

    References:

    William Thomson (June 26, 1824–December 17, 1907), 1st Baron Kelvin, often referred to simply as Lord Kelvin, was an Irish mathematical physicist. https://en.wikiquote.org/wiki/William_Thomson

    Understanding Quality Measurement. Content last reviewed July 2018. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/chtoolbx/understand/index.html

    Christensen, Clayton M., Jerome H. Grossman M.D., and Jason Hwang M.D. The Innovator’s Prescription: A Disruptive Solution for Health Care. McGraw-Hill, 2009.

  • Nudges in Health: Physicians as choice architects

    Health choices could apparently be influenced or “nudged”. Consider the following hypothetical scene:

    A patient is seeking surgeon’s advise on a much needed surgical procedure and its risks. He asked two equally competent surgeons the same question.  “What is my risk of dying in this procedure doctor?”

    Here’s what the two surgeons replied:

    Doctor A: “Approximately one in 100 patients die in this procedure”.

    Doctor B: “Approximately 99% of patients live well after this procedure” 

    If you are the patient,  would you undergo the procedure? If so, who would you most likely ask to do the procedure on you? If not, which surgeon dissuaded you the most?

    Hypothetical and simplistic, this happen in many patient- surgeon conversations. In many instances, our answers are quite predictable. I’d probably wouldn’t undergo this procedure if I was listening only to Doctor A. If I chose to undergo the procedure, I’d ask surgeon B to do the procedure on me. That is, even if my risk for the procedure is technically the same between the two surgeons!

    Surprised? Don’t be. There’s nothing wrong with you either. Behavioural studies have suggested that many of our choices and consequent actions, aren’t as rational as we believe it to be. We’re homo sapiens after all.

    Physicians are trained to provide patients and the public with the best possible or optimal health choices.  We’re supposed to be adept at providing patients with evidence based health choices and convey this in a language the public would understand. Doctors are supposed to be experts on health statistics and evidence based researches in their own field. Prompt, timely  and effective communication or feedback is also key for patients to make optimal health choices. But are we really providing patients these two essential choice adjunct for them to make optimal choices?  Even experts in some fields don’t agree with each other’s interpretations of the “best evidence”. Just take for example, immunisation.  More over, we’re not better with communicating or giving feedback to patients as well. Even minute differences in framing responses (such as the scenario above) weighs heavily on patient choice.

    The rapid technological change in internet and communications was thought to democratise and exponentially increase access to health information. More information means better  or more rational health choices. Apparently, that’s not always the case. More than half of current smokers wanted to quit but don’t. Many food and lifestyle related diseases such as obesity, hypertension, diabetes are still on the rise. More choices doesn’t necessarily end up with  a optimal choices either. There’s a plethora of toothpaste choices in the grocery store but these did not significantly decrease the incidence tooth decay in the general population.   A “no-harm-yeah-whatever- choice” isn’t also acceptable. Take the case of some vitamins and herbal medicines. Many of these are harmless to patients but are found out to be totally ineffective for diseases it is advertised for. Vitamins are still one of the most sought after over the counter substance in the Philippines.

    Indeed, many behavioural studies have suggested that humans (physicians and patients included), don’t make optimal, rational choices most of the time. This is particularly true in fields which they lack expertise or effective communication abilities. In the field of medicine and health, healthcare professionals happen to be the the “experts”. Whatever communication abilities we have, patients (and colleagues) often seek our expertise for them to make rational health choices. 

    So how do we help patients make optimal decisions for their health?  In this edition of #HealthXPh tweetchat, we’ll explore how healthcare professionals, policy makers, health professions students, patients and advocates help patients make optimal health choices.  Whether you are a patient or a physician, here are our guide questions.

    • T1. What for you, is the most important factor in making optimal choices health? Why?
    • T2. What  is  least likely to influence your health choices? Why
    • T3. When current evidence is vague or equivocal at best,  what do you advice or who’s advice do you seek? Why?

    Join us this Saturday May 12, 2018 9PM Manila time by tweeting your answers to our guide questions (and chiming in your response to others’ too) with the hashtag “#HealthXPh” between 9-10PM Manila time. Of course, for #HealthXPh your opinion matters. 

    References:

    Kahneman, D. (2013). Thinking, fast and slow. New York: Farrar, Straus and Giroux.

    Thaler, R. H. (2016). Misbehaving: The making of behavioral economics.

    Thaler, R. H., & Sunstein, C. R. (2008). Nudge. New Haven: Yale University Press.

    Nisbett, R. E. (2015). Mindware: Tool for smart thinking.

     

  • Addressing the diaspora: Return of Service Contract for healthcare workers

    There is 1 physician per 1, 153 Filipinos according to WHO’s Global Health Observatory  physician density data. In remote areas of the Philippines however,  the ratio is lower at one physician per 33,000 Filipinos. WHO recommends a 1 is to 1,000 (or less) physician to population density. This is just one of the many healthcare concerns we should address if we are to achieve this country’s millenium development goals.

    The Philippine health system devolved most (at least in paper) of its health care implementation to the local and regional government units. Except for a few retained and autonomous healthcare institutions, the Department of Health only oversees and “augments” health needs of this country. The rest of health planning, policies, and implementation are up to the various local government units.
    mededph
    The lack of medical practitioners in the rural areas is attributed to several factors:

    The diaspora of physicians from the Philippines to practice abroad is one of these factors. Majority of those who stayed in the Philippines opt to practice in  urbanized cities, where their medical education and training suits the work environment. Practice of profession is also more profitable in urban centers. A lot of Filipino physicians also choose to work as a private practitioner for a more sustainable income rather than work in a government healthcare institution.

    The lack of infrastructure and suitable working environment also discourages many doctors to practice in rural areas..  Most LGUs are unable to hire the necessary healthcare professionals in their locality. This, despite the law mandating LGUs to spend 30-35 percent of their internal revenue allotment to health needs of their locality. For decades, Department of Health’s response to doctors shortage is the Doctors to the Barrios program, started by then DOH secretary and Senator Juan Flavier. The program which has been lauded and popular at that time, had its successes limited to areas they are implemented.

    One of proposed solution is the return of service contracting for graduates of government subsidized medical schools. Graduates of government subsidized medical schools are required to render service in the country for a specified number of years.

    Join us this Saturday at #HealthXPh as we nitpick return service contracting as a solution to the lack of physicians in the country

    • T1. Do you agree that healthcare workers in government subsidized schools render return of service after graduation? Why or why not?
      T2. How can we keep our doctors from leaving the country after return of service?
      T3. How do we keep our medical education attune with the health goals of the country?

    Don’t forget 9:00PM Manila Time October 1, 2016, #HealthXPh tweetchat live. Join the discussion!

  • 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?