Wellness

Healthcare is Hard

It shouldn’t be so difficult….

I’m hearing this statement a lot this week and my guess is that you might be thinking the same thing too.

Let me start by giving you some context from my week.

Leadership

I was invited to interview for a spot an in upcoming national leadership summit and in preparation, was given sample interview questions. One of the questions: “how have you overcome challenges such as discrimination?” 

The reality is that I haven’t overcome discrimination [age and gender] in Corporate America but rather learned to survive it. The stats help tell the story. However, I was concerned about my answer because overcoming and surviving are two very different experiences. 

When I consulted my coach about it, her response was “it shouldn’t be so hard”. Being a subject of discrimination is hard, taking about it is hard and for some, listening to others talk about discrimination is hard. For many, it raises feelings of fear, blame and shame.

Some leaders are reportedly calling out the behavior. I’m not sure exactly what that entails but I do know that clarifying intentions during planning helps people think about their objectives and potential biases.

I’ve also started sharing some of my stories with colleagues. It’s helped to lower their defenses and made the issues easier to discuss. Sharing our challenges gives others perspective and helps leaders take the right corrective actions.

We can’t change what we don’t understand.

Physician Referrals

In the spring, I participated in a film for a public health event. The physician creating the film asked me about the role physicians should play in promoting health to their patients. He wanted to know whether they needed to be health and fitness gurus or what?

Physicians are highly trained professionals. Healthcare executives want physicians to be working at the top of their knowledge and skillset [aka: medical license] so that everyone gets the most from their expertise. Diet and exercise are foundational to health but they’re at the bottom in terms of knowledge and skill.

The problem is that in shifting to Value Based Care, physicians need to have a way to mitigate medical risk rather than only treat patients when they’re sick. Hence, the question.

What is the best way to engage physicians in maintaining the health of their patients?

We already have a universal measurement for healthy weight – Body Mass Index [BMI]. It’s something that is routinely calculated and/or captured in Electronic Health Records [EHRs]. A BMI outside the normal range is a clinical indication that something in the patient’s diet is off.

So what are physicians doing with the BMI result? I’ve never asked the question. So I’m wondering if physicians are offering patients a referral to a Dietitian and if not, why not? Dietitians are the experts in nutrition.

To solve some of the chronic health issues, we need to think about why it’s so difficult now and what needs to change to make the process easier for physicians, clinicians and patients. More specifically:

  1. Who is currently doing the work vs. who should be doing the work [considering knowledge and skills]?
  2. Is there a problem with the referral process and if so, how can we make it easier and/or better?
  3. When should digital health solutions be introduced into the discussion with patients?
  4. Who should be choosing the digital health solutions recommended to patients?
  5. Do physicians/clinicians need to monitor the patient’s progress or is the standard data collected at time of service enough? Think about what’s novel vs. necessary.

US Veterans Service

David Shulkin MD, Former Secretary of the US Veterans Affairs, wrote a new book called It Shouldn’t be this Hard to Serve your Country.

In a recent interview, he mentioned that there are back channels working in the Trump Administration to privatize the VA health system. Reportedly, his work didn’t support that effort which is why he is out.

Verily just announced their VA project to help lower the cost and improve the outcomes for total joints.

Hiring for Fit

Have you ever wondered why 80% of Americans are in jobs that they don’t enjoy?

The easiest answer is that they have the skill and need the money to support their family, pay off their school debt, buy their dream home or maybe it’s just about survival.

Whatever the case may be, the way companies hire may be compounding the problem. Why? Companies often recruit based on past job title, education, school etc. They don’t understand why people did those jobs, why they chose their school or their major.

Chances are people made those decisions early in life when they didn’t really know what they wanted to be, how they wanted to apply their skill or where they wanted to live. Their decisions were likely influenced by their parents or a teacher or life circumstance.

If they’re trained in something that they don’t enjoy and they’re continuously recruited for that skillset, they’re probably not going to be happy doing the job. They’ll do it but they’ll also keep their options open.

Understanding WHY they made certain decisions and WHY they are interested in a certain company and job, might be better ways of understanding fit.

Unless deep functional knowledge is needed to do the job well, skills and knowledge can be developed – motivation and satisfaction can’t.

Food + Health

Have you read or watched the documentary called Food Inc.? It is eye opening.

The US government reportedly subsidizes farmers to produce large amounts of corn below cost. Corn and corn bi-product is found in everything we eat – from meat to sweets.

The problem is that it’s having an effect on your health and wellbeing for a number of reasons:

1/ Your weight: Corn is being fed to chicken, pigs and cows to make them grow faster. The additional weight impairs their organs, their ability to move and in some cases, life expectancy.

2/ Your health: The way growers [aka: farmers] work, they are contaminating the environment with hazardous waste that ends up in the food supply during processing. Unfortunately, the way meat is massed processed, there is no way to trace the contamination back to the source in a timely manner. Hence, wide spread outbreaks of e coli and untimely recalls.

3/ Your job: There was a time when a meat processing job was a good paying American job – not anymore. It’s one of the most dangerous jobs and often performed now by undocumented workers. Some of the undocumented workers lost their corn farms due to US policy.

The Food lobby is strong which is why you don’t hear much about these issues in the news. Overcoming the impact is definitely a challenge for the healthcare industry.

Medicare for All?

Medicare for All vs. Single Payer System

62% of Americans support the idea of “Medicare for All” even though it’s not clear what it would cover, who it would cover or how it would be administered.

So what are people finding so appealing about it? The number of people supporting a single payer system is lower. Reportedly, only 48% of Americans want a single payer system even though the two are similar in concept.

Is that people understand Medicare coverage because they have had some experience with it or in their minds is there a fundamental difference?

Single payer systems are often plagued with access issues because all the resources are being consumed by older and sicker beneficiaries. However, if something is urgent and life threatening, it gets taken care of quickly. In short, it’s reactive care. That’s probably the scary part of a single payer system for most.

However, what few realize is that many of the single payer systems around the world have a commercial layer that provides access to complimentary care providers who help keep people healthy. Interestingly, the plans are often provided by employers and include luxury benefits like massage therapy.

Single payer vs. Medicare for All: What’s the difference to you?

Health + Healthcare

Is health a personal choice or is there a role for physicians?

A friend recently said to me that the best thing a General Practitioner [GP] could do is write a referral to a specialist. He’s not in healthcare so I had to ask whether he thought GPs should help keep people healthy. He said no. Health is a personal choice.

Are GPs limited in what they can/should do for us by our limited expectations of them? Has the healthcare system trained people to have limited expectations? Or are GPs truly limited in their scope of work?

This conversation relates to another recent conversation with a dialysis nurse as well as our post on complimentary care providers. The dialysis nurse uses a GP that works as a complimentary care provider similar to a naturopathic doctor that helps assess among other things hormones and vitamin deficiencies that affect sleep, weight, mood etc.

The work of a complimentary care providers extend our ability to live healthy lives but few people know about them or know what they can do. Why?

The problem is that complimentary care providers are typically not integrated into the healthcare system and coverage is limited.

Apparently when they are integrated, GPs get the benefit of seeing what’s done and why. They get the full scope of the patient’s care. Patients get comprehensive care that helps them live healthier.

Post: Workplace Wellness

Fundamentals of wellness in the workplace.

Wellness is for companies of all sizes. It doesn’t take a lot of money to provide employees with a workplace that promotes wellbeing and empowers them to do their best work.

1/ Environment: The workplace itself matters. Fresh paint that enhances the light and a well organized space will promote a feeling of calm.

2/ Tools: Get creative. White boards and colorful markers are great tools to engage people in problem solving.

3/ Location: Reduce travel time. Incorporate collaboration tools to enable remote work and work from home programs.

4/ Travel: Reimburse and reward healthy choices. Allow for expenses the promote walking, healthy meal choices and exercise.

5/ Education: Provide a path for growth. Online education is an affordable way for companies to promote continuous learning.

6/ Coaching: Provide diversity and equality training. Appropriate behavior and conduct for the workplace needs to be defined so that people are clear about what movements like metoo means to them.

7/ Compensation: Provide equal pay for equal work. Compensation is the foundation of health.

Everyone wins with the fundamentals.

Post: Despair

Should wellness programs include an unrestricted education benefit to stem the tide of despair?

Have you heard the term Diseases of Despair? I hadn’t until today but couldn’t help but think at least some of the drug abuse problem was a function of the fact that life just sucks for some Americans.

How do we make it better?

1/ If you think about Maslow’s hierarchy of needs, the foundation includes the basic things people need to sustain life [housing, food and water etc.] and feel safe.

2/ If you think about how to move people up the hierarchy, they need education, job training and coaching to develop the life skills needed to be independent and successful.

The problem is two fold. 

1/ Many Americans have been without a foundation for a long time. They need healthcare and in many cases, lots of healthcare to restore their health.

2/ The other problem is that the foundation is still eroding for many Americans. If foundations continue to fail, more will suffer Diseases of Despair. It’s likely stressful for employees at the breaking point.

Americans need to address the problem with social programs and stem the tide by investing in people.

Extending wellness programs to include an unrestricted benefit for online education might help stem the tide. It’s an affordable offering for employers to consider.

Post: Self-Care

What do you do afterwork to decompress and recharge your batteries?

It was a ice-breaker question that members of a business group needed to answer as part of their introduction. Almost everyone in the group started with something along the lines of “well I know that I should be exercising” but what I really do is …. guess what they said.

As some of you know, I’ve been trying to get more people working out and living a healthier lifestyle [aka: Hello Workout]. My introduction was last so there was no bias in the responses for what I do or anything that I said.

After hearing everyone’s “confessions”, I almost felt bad introducing myself and sharing a bit about my lifestyle. If you’re wondering, I am a strong believer in regular maintenance whether it’s my car or my body. Both work better when they are cared for properly.

Inspiring, nudging and telling people to workout might not be the right approach. It makes people feel ashamed and it makes people initiating the conversation feel bad. It’s awkward all the way around.

Many in the business group talked about caring for others. There is no shame in caring for others. So maybe the better question is “How do you care for yourself?“.

Words are powerful. Simple changes can make a big impact.

Shame steers people into a life of silence, inactivity, lying and hiding.

~ Harriet Lerner

 

Power of Habits

Your habits are the key to your success in business and life.

A habit is something you do when triggered by something that only you know when you crave the reward.

The Anatomy of a Habit:

A habit has four (4) parts. Once you understand the parts, you can change any habits that is limiting your success.

Cue: The cue is the trigger which can be a feeling, time of day, specific event or anything else that makes you start a specific routine.

Routine: The routine is the action or series of actions you take when triggered. The routine is specific to the trigger and is almost an automatic response.

Reward: The reward is something you get at the end of the routine such as a sense of calm, satisfaction, connection, belonging, completeness, control or whatever you feel from completing the routine.

Craving: The craving is your need for the reward.

 

The Problem:

The routine is the problem. It’s the action or series of actions that you take when you crave the reward that is limiting your ability to achieve your goal. To change the routine and your outcome, you have to identify the cue and the reward so that you can replace the routine with something equally rewarding.

We all have some habits that may not be serving our wellbeing or limiting our success. I have been referring to my need for innovation as a “nasty innovation habit” for the last several years. Like other bad habits, my innovation habit affects my wellbeing in a number of ways and it’s hard for me to break the cycle because it’s so automatic. Let me explain why…

Cue: What drives me to innovate?

It all starts with a problem or at least something that seems harder than it needs to be [cue]. I crave the challenge of adventuring into something new, something that challenges my thinking and the status quo. I’m not as satisfied by the nuance of refining one skill over the lifetime of a career as many others do.

Routine: Develop a solution to solve the problem

I ventured into e-learning during the dot com boom because it seemed like the best way to make a big impact on the industry. I didn’t know anything about the technology or methodologies for developing courses at the time. However, I hired consultants to collaborate with me.

At the time we launched, Health South missed their numbers by more than $2 billion which materially misstated their financials and caused the dissolution of the company. Unlike the other CFOs who had unintentionally misstated their numbers, Health South executives intended to deceive investors and succeeded for a long time. Several of them ended up in jail.

The contractual write-offs are still a big problem for most healthcare companies because the system is fragmented, the contract terms for payment vary from payer to payer, systems lack the needed sophistication to administer the payment permutations and the people doing the day-to-day work and reporting the numbers rarely get the needed training.

Outsourcing only solves part of the problem. Every step of the process and very transaction posted into the billing system makes a difference to the accuracy of the numbers. Rather than fixing the problem, the industry added more solutions to address the consequences and shift the blame. The revenue cycle industry generates more than $52 billion annually and is still not satisfying any of the stakeholders – especially patients.

My first solution addressed the training deficit of the people doing the work and reporting the numbers. I thought it would be kind of like writing a book in that it takes an upfront investment of time and effort but then pays off over time. Like Starbucks, our courses provided professional credits that could be used for college courses. With a 10% initial pass rate, I worked harder than I ever imagined. It wasn’t like a book at all because clients transferred performance expectation to me. I tried to be really inspirational during virtual meetings and relatable in our marketing collateral. Our messaging was on the right track but we missed the need for teaching basic life skills.

Starbucks’ program reportedly teaches skills such as “how to live, how to focus, how to get to work on time and how to master emotions”. My sister who is a psychologist identified that her clients at the time were similar to my students. She was just trying to get them through life whereas I was trying to turn them into star performers. I connected the dots, but still couldn’t close the gap.

It was a missed opportunity because we’ve created more problems since then. Offering people a way forward in life empowers them with keystone habits that makes it easier to change other habits to improve their lifestyle and live their best life. In short, education has the power to change lives.

Reward: What do I get for solving the problem?

I often joke with people that I got the whole employment equation all wrong. When you innovate with your own money it often requires significant sacrifice and for some, it seems like unnecessary hardship.

The reward while on the journey are all the “small wins” that reinforce the belief that the goal is achievable. I can actually feel the pleasure center of my brain light up with a win. Another entrepreneur who I met early in my career used to talk to me about progress. The concept of progress stuck but I didn’t fully appreciate the value of it then.

It took experience for the value of progress to really resonate. As with any big goal it takes months or even years to achieve and there are many setbacks that make you question whether you can get through another week or month. I have a sticky note on my monitor with the words “Do whatever it takes”. I move it to eye level on those days when I need a constant reminder to get out of my comfort zone. Of course there are some ethical limits to the “whatever” but I have had to do things and have had conversations that were way beyond my comfort zone. It’s something that needed to be done. Everyone has the power to bust through their self imposed limits.

Carving: What makes me keep going?

My friends and family wonder what drives me to keep innovating. I do well as a consultant and consulting without personal projects provides for a more balanced life. Truth be told, there are times when I crave more balance. Some days I can even hear my subconscious saying “I want my old life back” as though a pouting child. However, the craving to feel the “rush” of solving a bigger problem is more compelling. So I just keep going.

Goals: What are your goals?

I have always wanted to have a “positive impact” on healthcare. Those words alone have served as a guiding force for the type of work that I do as a consultant, the way that I conduct myself within the industry and the types of problems that I tackle on my own. It’s kind of like Google’s “do no evil” mantra.

When Paul O’Neil became CEO of Alcoa, he focused the company on safety. When he spoke about safety at his first annual meeting, investors thought he had lost the typical Republican plot of “synergy, rightsizing and co-opetition”. However, what the investors didn’t understand was that by focusing on safety he united the company around a common goal. As safety improved, productivity and profit improved.

We need a common goal to unit the healthcare industry. The triple aim lacks identity and is hard to remember. I like Patient Wellbeing because it encompasses safety, outcomes, experience, cost and wellness. I’d love to hear your thoughts.

Power of Habit

If you haven’t read the Power of Habit by Charles Duhigg yet, I encourage you to do so. It was enlightening for me on many levels and provided food for thought about how I want to approach my work and life going forward.

If you’re struggling to loose a few pounds, I’ll leave you with the two most important things from the book that you can do everyday:

Eat Breakfast — It will help to keep you full throughout the day and eat less.

Weigh yourself Everyday — It will help inform you which foods make you gain weight and which foods make you loose weight.

Of course, if I was to add a third it would be exercise.

About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

Join us on Hello Workout for help covering the weekly minimum requirements for good health, advice from professionals and other tips to help you achieve more success in work and life.

Understand your Brand

Whether you know it or not, you have a personal brand.

A new year is right around the corner. You or someone you know may be thinking that they need or want to do something different and need help refining their personal brand.

One of my friends found a mentor earlier this year because she is contemplating the next step in her career and felt that she could benefit from having some guidance. We went for a walk this weekend and when I asked what was new, she told me about her recent meeting with her mentor.

There may have been more said during the meeting but what was relayed to me was that her mentor suggested that she develop her brand attributes and establish a schedule for regular blog posts. It was clear that she didn’t know how to start.

I’ve outlined the plan we talked through during our walk this weekend. It’s designed to be done over the course of a year. You may be able to do it faster.

Establishing a personal brand

If you’ve been hired to do a job, a project, a gig of some sort then you already have a brand. It’s the reason people chose you over all the other people applying, pitching or trying out for the gig. Do you know why they chose you and not someone else?

The first step to developing your brand is to understand why someone chooses you. If you’re not sure — ask your your boss or your client — why they chose you.

The plan

I started living my life in quarters when I started my own consulting business back in 2000. Not many people other than those sales likely think of life in quarters, but for me it helps set my focus for a specific effort and gives me a specific timeframe to evaluate that effort.

Thinking in quarters, we talked through a plan to understand and refine my friend’s personal brand so that she’s ready to start a new consulting business in 2018.

Q1: Discovery:

Collect the information needed to define what and who. During the first quarter of 2017, my friend is tasked with talking to at least three (3) people that she has worked for in the past to learn why they chose her and what she did that they valued most. I know some of her colleagues so we talked through some specific people and what to ask. In general, you want to consider the person that you’re speaking with whether they are or were your manager, client, colleague or co-worker to frame your questions in a way that draws out the answers you need.

Remember, you’re not looking for flattery but rather honest input about the value you bring to the organization, department, project, team or whatever is relevant to your relationship with that person. Your job is to uncover the attributes that they find valuable so that in the future you can identify others like them that will realize similar value.

Q2: Review the feedback

Define what and who. During the second quarter, my friend will be reviewing all of the responses carefully to distill the themes. She needs to identify the cross section of what people value and what she likes to do and wants to do next to uncover the “what”.

Some of the answers may be revealed quickly and others may be harder to distill. People at different stages of their career, different levels and with different backgrounds will likely respond differently which is why you have to look for the common threads or themes. If the answers you need aren’t clear, ask more questions, speak with additional people or do some research about the field to get the needed clarity.

Q3: Test your work

Publish a few blog posts. During the third quarter, my friend will be writing and publishing a few blog posts to test her hypothesis of “what” and “who”. The tone of her posts will also help develop the “personality” of her brand and flush out a manageable publishing schedule.

Blogging is no easy task which is why many companies outsource the work to professional writers. It’s something that I’ve always enjoyed but it requires creativity and discipline. If you haven’t done much writing in a while, start slow and don’t be too critical of your work. It’s a skill that gets better with time. Publishing has never been easier with so many different social networking sites.

Q4: Commit to your Brand

If everything has gone well in Q1 — Q3, my friend will be ready to formalize her “brand attributes” next year at this time. Brand attributes are the foundation of the brand and include the name [if different than her own], logo, personality and pricing.

Knowing your brand attributes is just as important if you’re looking for your next job.

Photo: Your logo may be a professional photo that you can use on a blog and all social sites you choose to share your ideas, case studies and examples of your work.

Posts: Your personality should come through in your posts so that people hiring you or who will be working with you, get a sense of you before you ever step foot through the door.

Pricing: Your pricing should be reflected in the compensation package you negotiate. Understanding the fair market value of your work is the first step in negotiating a fair package.

I was introduced to the idea of a personal brand years ago at a HBA event when Ellen Looyen presented. I hope the process outlined above makes it easier for you or at least gives you some ideas of how to start. Let me know how it goes.

About the Author: Shannon Smith is a healthcare strategist with over fifteen years of experience helping companies achieve greater success. She is also the founder and CEO of Hello Workout.

Join us on Hello Workout for help covering the weekly minimum requirements for good health, advice from professionals and other tips to help you achieve more success in work and life.