Cast & Curious

Tag: Learning & Development

Learning and development (L&D) is a function within an organization that is responsible for empowering employees’ growth and developing their knowledge, skills, and capabilities to drive better provisions of healthcare.

  • Are Healthcare Professionals Coachable?

    I’ve been an orthopaedic surgeon for decade and I thought I’ve done everything I can do to every orthopedic case in my area of practice. My mentors wasted no time training me to be a lifelong learner, provided me skills to handle most orthopedic cases and instilled professionalism and strict adherence to ethical values. These were tested of course and boosted my confidence to handle cases I have minimal exposure before, like wartime injuries. I thought performance was primarily measured by the physician surviving a challenging practice. Clearly, I am mistaken.

    It’s what you learn after you know it all that counts

    John Wooden

    The changing concepts and technology in medicine nowadays increases practice demands. Outcomes measure performance, leadership and business skills determine successful practice and government regulatory mandates are burgeoning by the day. In the field of practice, there’s no reliable way of determining your level of performance as a physician. Did my performance plateaued or dipped. Where or who would you go to? Academe? Previous mentors? Peers? For many physicians and surgeons out of the academe, this isn’t easy.

    Perfection is not attainable, but if we chase perfection, we can catch excellence

    Vince Lombardi

    What is a coach?

    A coach is a a teacher, leader, motivator and critic with typically more experience than the learner . The coach may not be the most talented performers in their field but their intangible “wisdom” from tireless study of the field compensate for this. Ironically, most of the coaches gain their insights in the field from their “failure” in the field.

    Coach Vs. Mentor

    Although both mentors and coaches aim for the success of the mentee or coachee, the former is more of a role model and the coach, a critic. We have our mentors mostly in the academe, during med school or training and they usually remain there. The coach if ever we do actively search for one, are often found in practice.

    You don’t have enough talent to win on talent alone

    Herb Brooks ( US Team Hockey Coach that won over the much talented, physically intimidating Soviet Union team)

    Many of the successful people we admire (particularly those outside medicine) have coaches behind even at their peak performance. Michael Jordan and Kobe Bryant have Phil Jackson, Manny Pacquiao (the boxer) have Freddie Roach. Even tech giants Larry Page, Sergey Brin, Erich Schmidt (Hello, Google) and Steve Jobs ( of Apple) have Bill Campbell coaching them. So why can’t physicians be coached?

    T1. What are the barriers to coaching healthcare professionals?

    If you are going to win games, you had better be ready to adapt

    Scotty Bowman

    Generally, the practice of medicine has this negative perception of coaching. In med school and training, one may easily find a mentor or role models to hone ones craft. In practice, many physicians are on their own and rarely connects with previous academic mentors. To many colleagues, being coached meant a “faltering confidence”, lack of skill and or even lack of independence. Patients who see their physician being coached may interpret this as a sign of incompetence. Consequently in practice, a physician rarely finds a physician coach and there is dearth of physician coaches.

    T2. Are there benefits/ risk to coaching healthcare professionals? Who benefits or who is at risks?

    A coach is someone who tells you what you don’t want to hear, who has to see what you don’t want to see, so you can be who you have always known you could be

    Tom Landry (NFL’s Dallas Cowboy’s winningest coach)

    The benefits of coaching in other fields is almost unquestionable. In medicine particularly in surgery, outcomes are tied to masterful performance of a given skill set or techniques. I tell residents the P2R2- Plan , Practice, Review, Repeat and they have their mentors to follow this through. In physicians practice, critiquing performance is left to peers who often, defaults to self critiquing. We all knew how self bias works.

    The bottom line of an improved performance is improving patient outcomes. Thus, while both the coach and coachee physician improve their performance, it’s the patient that ultimately reaps the benefits of a coaching relationship

    T3. What are the traits of a coachable healthcare professionals?

    Smart alecks are not coachable

    Bill Campbell, Trillion Dollar Coach, coach to Larry Page, Sergey Brin, Steve Jobs, Eric Schmidt, Jonathan Rosenberg

    After med school and training, we physicians though we knew it all. I did. Until we notice that plateauing or worst, dipping practice performance. It takes humility and open mindedness to critique one’s own performance much more so, if the criticisms came from someone else. The flexibility to adapt to changing practice and patient’s needs are also necessary. In my case the active pursuit of a relatable coach that “clicks” with me is the hardest, especially in the competitive field of medicine and surgery. I’d like to change that, even at this stage of my career.

    Join #HealthXPh chat this Saturday Oct 19, 2019 at 9PM Manila time for an interesting discussion on healthcare professional coaching. The following are our chat guide questions:

    • T1. What are the barriers to coaching healthcare professionals?
    • T2. Are there benefits/ risk to coaching healthcare professionals? Who benefits or who is at risks?
    • T3. What are the traits of a coachable healthcare professionals?

    Don’t forget to append #HealthXPh in all your tweets during the chat. See you all!

    Image by David Mark from Pixabay

    References:

    • Dougherty, P & Joyce, B. (2018). The Orthopedic Educator: A Pocket Guide. 10.1007/978-3-319-62944-5.
    • Schmidt, E., Rosenberg, J., & Eagle, A. (2019). Trillion dollar coach: The leadership playbook of Silicon Valley’s Bill Campbell.
    • Gawande A. Personal best: top athletes and singers have
      coaches—should you? 2011. .The New Yorker 2011 issue.
      http://www.newyorker.com/magazine/2011/10/03/personal-best.
      Accessed 18October 2019

  • Five important reasons why health leaders need social media

    Like it or not, internet and social media are part of today’s health environment. Understanding social media is key to surviving this environment. Flexible leaders harness social media to meet better health care experience for patients. Here are the five important reasons why health leaders need to learn and harness social media:

    1. A social media post made you or your institution (in)famous.

    Most unfortunate route to learning the ropes of social media. Many health leaders stumbled social media this way. Its never too late though. Stay calm. Plan a prompt, well thought out social media response strategy.

    2. You’re not health information’s sole gatekeepers anymore thanks to internet and social media.

    Gatekeepers hold the key to information and provisions of care in the 20th century. That’s not the case in this generation. Health information is accessible to many people. Some patients wants greater participation in managing their health. Fortunately, a health professional- patient partnership is not only feasible via social media. The partnership showed better health outcomes in some areas, while lowering cost of delivery in others.

    3. Your value system is in conflict with the new value system arising from internet and social media empowered generation.

    New value system with internet and social media

    We’ve hone our leadership skills and toolboxes before internet and social media. Radical transparency a value the current generation espouse, annoys many leaders. Understanding this new value system is key to providing better health care outcomes, at a reduced cost for this generation.

    4. New and social media amplified health expectations is different from what existing system provides.

    Patients expect better healthcare experience

    With readily available information and new value system comes new health care expectations. Unmet health expectations lead to clashes and divorce in health partnerships. Fragmented health systems called silos, provide irrelevant care at skyrocketing cost.

    5. Patients and their support group wanted greater participation in managing their health.

    Internet and social media made health information accessible to everyone. Providing care though, is still in the hands of trained professionals. This may not be the case for long as many patients including their family and support groups, wanted greater participation in managing their health. It’s no surprise that social media is the platform of choice. The sooner we accept this, the better prepared we are in harnessing social media for better health care.

    Social media is here to stay. I may have painted a bleak picture but there’s a way to harness social media for better health. Leaders should be flexible enough to partner with patients in this regard. It is their health after all.

  • Strategies and technologies healthcare professionals use for learning

    Why are you still studying? Are the years of medical school and training not enough?

    Barely an hour before writing this post, a neighbour knocked on my door asking if I could look at his 9 months old nephew. His nephew is weak, have an on and off fever for a week, and is vomiting since this morning. “Your nephew is dehydrated” I said. “Bring him to the nearest hospital now. ” I couldn’t remember the last time I managed a pediatric acute gastroenteritis. As an orthopedic surgeon, I rarely deal with such cases unless one of my family member contracts the disease. Even then, I rarely manage pediatric AGE.

    This is why healthcare professionals need to continually learn even after med school and training. You’ll never know what disease or which patient will come “knocking” on your door. Besides, many of us tend to forget clinical skills we haven’t use for some time. Society also expect us to be competent practitioners, irregardless of the specialised field you’re into. My neighbour for example, believed I’m competent in managing pediatric AGE, despite him knowing I’m an orthopedic surgeon for years!

    Learning also benefits us and our patients even in our narrow fields of practice. Learning is a moral and ethical responsibility embedded in the many oaths we took entering this profession.
    The ever changing landscape of diseases, research findings, healthcare issues and clinical management skills favours health professionals who consistently learn or upgrade their knowledge and skills. The information explosion and affordances of new technologies might also help us cure some disease, alleviate the ills or empathise with our patients. Simply put, we need to continually learn for our patients.

    T1. What inspires you to learn?

    We learn for our patients, but we are the learner. Society expects healthcare professionals to be lifelong learners- perpetually proficient and competent in the medical field. In practice, our learning environment shifts from formal school to include, informal, out of school, face to face, at a distance or a mix of all these. Different environments have varying nuances for learning. Some strategies work best for a certain learning environment. Most of us couldn’t simply drop our professional practice to go back to formal school. We have to find other ways learning befitting four learning or practice context.

    T2. What is your strategy for learning?

    While we use many similar technologies for learning across these different contexts, recent technologies afforded us newer non traditional ways of learning. Online technologies for example allowed us to learn without leaving our practice. With appropriate technologies, we can now choose when, how and where to learn. Feedly for example allows me to aggregate, curate and organize medical information efficiently.

    T3. What technologies do you use for learning?

    As healthcare professionals, patients inspire us most to continuously learn. When our learning shifts from formal school alone to include many other environments, we must be able to examine and employ strategies and then find appropriate technologies to maximize learning. It is then that “we direct ” or take control of our own learning.

    In this November 10, 2018 9PM Manila time #HealthXPh chat, we will explore paradigms and technologies by which healthcare professionals learn today. By paradigm I mean a theory, a strategy, a method or “lens” by which we anchor what and how we learn. Technologies refer to any tool, mainstream or emergent that you use to learn or maximize learning. These are our guide questions:

    • T1. What inspires you to learn?
    • T2. What is your strategy for learning?
    • T3. What technologies do you use for learning?

    (If you want to learn more about my paradigm of learning and technologies I use to support it, read this article)

  • 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.

  • 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?