Application ideas from research will be listed here…
September 26, 2015 – Hospital readmission is a well-documented problem and a significant contributor to our healthcare system’s annual $3.8T in expenditures. Fierce Healthcare provided a high-level analysis of current trends and while hospitals have increased attention to patients, the focus has been on marketing to attract patients rather than on quality and patient outcomes. High-end, hotel-like amenities seem to get patients in the door. And sure, providing convenience to patients as they are treated for an illness has its own merit. This trend, however, makes no dent on reducing unnecessary costs. As the article points out, readmission rates at these hospitals have not significantly reduced. So, the question remains: is the money better spent elsewhere?
From my perspective, yes. On a quality standpoint, I would much rather choose a hospital with a cadre of healthcare professionals that will help me with my illness the first time around. While this may be an oversimplification, my goal is to shift our collective thought process to quality of care. Considering that doctor-patient communication is an integral part of the diagnostic process, this seems to be a crucial issue to focus on, which inspired this idea: train a team of patient care coordinators/navigators.
Patient navigator programs have been implemented in hospitals across the country. George Washington University recently launched an online patient navigator course free of charge, for anyone interested. Duke Hospital System is also a pioneer in the field, specifically providing diverse staff that can bridge the cultural gaps in health literacy.
I propose a “career” track that students can enroll in. One that has a solid foundation in clinical sciences, part social sciences (psychology, sociology, social work) and part communication. Students graduating from programs like this would be a patient’s healthcare coordinator or navigator. These individuals would be the key liaison between doctors/nurses and the patients. They would understand each patient on a holistic level, including social factors (social determinants of health like SES, transportation, etc) and guide them through the complex healthcare system.
Instead of investing in marketing and the “wow factor” to get patients in the door of hospitals, invest in the care teams that interact with and treat the patients. Invest in understanding patients on a more holistic level. Take the time to understand patients’ symptoms with an upstream perspective much like what VA Dr. Rishi Manchanda describes on his TED Talk.
A focus on social determinants of health and health disparities will put a dent in reducing hospital readmission rates. And as a taxpayer, that’s where I’d like my share to go.
April 24, 2015 – Psychology and human behaviors have captured my attention this past year. Books and presentations from Dan Ariely, Dan Pink and Dan Gilbert offer some great insights on how our minds work in an often irrational way. From the public health and healthcare lens, as well as an overall social progressive point of view, I envision leveraging this new research in a positive way. A recent article from Business Insider inspired this idea and blog post. Essentially, the business community and restaurant industry, in particular, have used market research on human behaviors to their advantage. We, as consumers, subconsciously spend more money when we eat out. I hadn’t noticed it the last time I ate out, but many strategies from the article are accurate. Grocery and retail stores also use similar strategies. But is there a way to use those strategies for social good?
Earth Day was celebrated all over the globe. My social media feeds were filled with Earth-friendly content. However, a few posts that really piqued my interest highlighted the ways in which we took our planet for granted. One article from CNBC, specifically had me shaking my head. America wasted over $165 billion worth of food last year, equating to 35 million tons of food waste. The average American family throws away over $2,000 in food annually. To put this in perspective, 2,000 pounds is a ton. Some giraffes and large brown bears weigh approximately a ton. We waste 35 tons of food as a nation each year, all while people go hungry on a daily basis.
I’ve had this idea for some time and the two articles above have brought it back to my attention yet again. I’d like to set a system in place where we as consumers/diners allocate some food directly to people who are hungry. Imagine this scenario: you’re at a restaurant and you had the option to donate a portion of your meal to someone who’s hungry. Having selected the option, a portion of your plate/meal will be put aside along with other donations for the end of the night. At the end of the night, a coordinator will drop the food off to a local food kitchen or church ministry and serve that food the next day. A similar system can be set up for neighborhoods. Residents can sign up to have their excess food picked up before it’s thrown away. Uncooked foods that are designated as waste can be sent to a local food kitchen or church ministry and volunteer cooks can serve up a home-cooked meal for people who need it.
I acknowledge that there may be food safety issues and liability involved in the idea I’ve outlined. Nothing worth doing is ever easy. I know we can do better and hope others share my drive to make it so.
“A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty.” –Winston Churchill
January 29, 2015 – A MedCity News article highlighted a new startup, ExamMed and their release of their platform MedCoin to provide consumers more informed choices when it comes to acquiring medical consultations via telehealth providers. In essence, it is similar to the concept that health insurance exchanges and many other insurance models function – to empower consumers to make the best decision for their care, specifically focusing on price comparison. On the provider side, it also allows providers the flexibility to adjust the price of their services based on the principles of supply and demand. How this will smoothly this will unfold and whether or not consumers will actually use the service is still yet to be determined. But the mere fact that technology like this is shifting to the healthcare space is a hopeful sign. The prices across the board for healthcare that we as Americans pay for is exorbitant and may help reduce the financial burdens that act as a barrier to timely medical care. I remain hopeful and optimistic that more focus and attention on healthcare will lead to innovative ideas similar to the one mentioned above.
Application – Can we catalyze a movement that gets other healthcare professionals on board? For example, using this same platform to create a marketplace for nutritionists, personal trainers, wellness coaches and mental health counselors? I imagine it can be done with a few modifications. Where the problem lies is in its implementation. Buy-in from these groups of health professionals will take some time and effort, but amount of time and effort required for this undertaking can only help our country to get more bang out of our healthcare buck. Any reductions in healthcare spending can then be funneled into other sectors, such as professional development/training, education and vital social services, which all directly or indirectly result in an individual’s health outcomes. If a healthier population is our collective goal, we need to shift our attention to the underlying causes of their illness.
January 17, 2015 – NPR recently wrote about a struggle that many individuals face at one point in their life or another – loneliness and fear of rejection. As Alix Spiegel describes in his article, Jason Comely faced one of his biggest fears – rejection – head on and that decision has changed his life ever since. In summary, Jason challenged himself to face his fear of rejection on a daily basis. And when he realized that the consequences of being rejected in various situations were so minimal compared to the results that he originally imagined, his entire world changed for the better.
Application – What if we used the same basic concept – a simple card game – and leveraged gamification to improve health outcomes? For example, to tackle obesity in children, why not introduce health challenges via card games? I envision a simple card game that children can play to challenge themselves, but also keep track or “score” to compete against their friends. One card would ask children to convince their parents to replace one meat-based meal every Monday to encourage eating fruits and vegetables. Resources and recipes could be found on various “Meatless Monday” websites. A more intensive extension of this idea: integrate healthy lifestyles into school curricula. Math lesson plans that focus on addition and subtraction could calculate daily calorie intakes and also introduce healthy lifestyles at an early age. The more exposure children get to healthy lifestyles increase their likelihood that those healthy lifestyles carry on into adulthood. Furthermore, the family unit could be strengthened by actively encouraging each other to be healthier. Research and evidenced-based programs and interventions are immensely insightful, but their impact is limited unless the individuals themselves “buy-in” and proactively engage in health-seeking behaviors.
October 11, 2014 – Forbes contributor Joon Yun, MD offered an idea to improve the healthcare system: educational reform to include health topics. His premise: why should only an elite few (who are not professional teachers, but practitioners of medicine) have the knowledge required to navigate through the very complex system “that is supposed to help” patients?
Application – What if educators or trainers with expertise in patient navigation and health education engaged, trained and empowered the deep volunteer base of political campaigns? Health is a non-partisan issue, so traction on both sides should be left out of the conversation altogether. One of the barriers from public health that I often come across is the issue of limited resources. By empowering and mobilizing groups with existing infrastructures, e.g. political campaign bases, we have the opportunity to revolutionize the healthcare systems from its current state to one that focuses on keeping patients well throughout their lives, rather than offering them care after onset of an illness or malady.
August 14, 2014 – NPR released a piece on the state of healthcare in Ethiopia, which is “improving.” It notes that there are many things hospitals there need, most importantly, access to basic medical supplies. The list includes, but is not limited to: Equipment to measure infant oxygen levels; Oxygen, or at least a steady supply of it; Baby scales; Thermometers; Generators for when the electricity goes out.
Application – A social enterprise that purchases outdated or non-functioning equipment, then refurbishes them to certifiably working condition. Countries like Ethiopia can purchase refurbished equipment at a deep discount and provide adequate care to their citizens.
August 2, 2014 – A recent article in Academic Medicine chronicles the innovation and strategy to improve the Veterans Health Administration.
Application – This model can be applied at larger hospital systems that have locations nationwide. A simple website can be developed to “store” the best practices of each healthcare provider. For instance, healthcare providers can be grouped by similar characteristics, including, but not limited to: size (how many patients reached), location, demographics served, types of services offered, business model, among others. When knowledge and experience is shared freely and openly, I strongly think that the quality of patient care will improve.
July 17, 2014 – I’ll preface this update with one of my favorite analogies. If you’ve taken any public health classes or attended a conference, you will probably recognize it. If not, I hope you enjoy it…
“Imagine a large river with a high waterfall. At the bottom of this waterfall hundreds of people are working frantically trying to save those who have fallen into the river and have fallen down the waterfall, many of them drowning. As the people along the shore are trying to rescue as many as possible one individual looks up and sees a seemingly never-ending stream of people falling down the waterfall and begins to run upstream. One of other rescuers hollers, “Where are you going? There are so many people that need help here.” To which the man replied, “I’m going upstream to find out why so many people are falling into the river.” Saul Alinsky, in Shelden & Macallair (http://wiki.preventconnect.org/River+Story).
Now to the research – the social determinants of health is a holistic approach to prevention efforts. It acknowledges that improving health comes from addressing multiple variables at the same time (ideally at the same time). It acknowledges that health is complex and I believe this paper by Baker, et al illustrates the basic concepts well.
Now to the application – Healthy Eating Active Living (HEAL) cities have adopted the model and the initiative is present in 22 cities and towns throughout Maryland and Virginia.