We educate for industry, when we are in the technological revolution

After becoming addicted to TED.com i think i might start a blog column relating TED talks with how they can be applied to health care! Sir Ken Robinson is the latest!

How many of us have really taken a look at our educational system? I am not talking about just medical school, nursing school, or any other health school, but rather the educational system as a whole. Sir Ken Robinson, a creativity guru, gave a talk in 2005 discussing this very subject, and I think we can apply it to they way we educate our doctors and nurses!

If you have not seen the talk, please visit http://www.ted.com/index.php/talks/view/id/66 to watch it. It is funny and powerful.

Mr. Robinson makes some very good points.
1) We educate our kids for the future, but we don't know what the future is

2) Current education is geared towards educating people for industry

3) Education stigmatizes mistakes, and failure is unacceptable

Those are some powerful remarks! Lets discuss!

1) & 2) & 3)How is it possible that we think our education system is giving our children the tools to deal with the future when we as educators have no clue what that may look like. Not to mention the fact that we use out dated technology and teaching techniques to do it. Mr. Robinson states that there is a Hierarchy in education and this hierarchy is set up to get people into universities.

Now I want you to think about this for a second. Math, Humanities, Literacy all geared to pass the SAT to get into college. Getting into college so you can get a degree. Get a degree so you can get a job. Get a job so you can work. That is the goal of education, but is one allowed to go another path?

I am sure we all have a cousin that went to art school, and what happened to them? What did the family say? He was stigmatized because he did not follow the TRADITIONAL path.

Well the traditional path is one that needs rethinking. The traditional path was one set up to get you into a good industrial type job. Sounds like medical and nursing school right? You must take these pre-med classes or you cannot qualify. What do these Pre-Med classes do, they squash your creativity, slam you with Newtonian linear science, and ship you off to be a diagnostician in health care. Same can be said with nursing, although more humanity classes are needed for nursing entrance.

We wonder why health care is so troubled to adopt new technology, or even innovate their way out of a crisis, but look at where the players came from. Risk taking and mistakes were stigmatized and that stigma was beaten into them for 20 years of schooling. Can we blame them for not being creative?


SO WHAT DO WE DO ABOUT IT!
Mr. Robinson suggests that creativity is as important as literacy, so why is it not treated that way? I don't have the answer for you. Instead, we place our hyperactive kids on medication and tell them to sit in the corner and shut up. We stop energy because we cannot control it. We promote math skills over exploration of arts because that will get you a job, but the world is changing my friends.

Of course math and science are important, and they are the foundation of the health care curriculum, but so should creativity. Can you imagine the power of innovation that would come from a class of docs and nurses that were not only prepared clinically and scientifically, but creatively as well? If they were told it was ok to take a risk to make a change? If it was ok to test a new hypothesis, design a new way, lead with new tools, and see the world differently?

In previous blogs I have tried to highlight people that have accessed their creative side and done something remarkable. Something that challenged the way we do things. Someone who goes against the grain. These are the people you need to find in your organization. Find that person that does not quite fit your typical nurse or doc. The one who questions why we do what we do.

They are not the nuisance, they are the future! Tap them, as they can be the leaders, the preceptors, the educators that break our health care education out of the PowerPoint and teacher centered learning, to the interactive, immersing, simulation based curriculum that breeds creativity.

I challenge everyone to find a tradition in their workplace and change it! just flat out say,

"NO! There has to be a better way!"

If you are in education, I challenge you to try something new. Something that makes you uncomfortable, something engaging, because if we play it safe, our future is doomed, and if we take a risk, there is the chance to change the world!

RESOURCES
www.ted.com

Inspire a friend, change healthcare

In the past few weeks I have subscribed to over 20 blogs on healthcare and change innovation. I was turned onto the www.Ted.com site and have found it an inspiration for my personal and professional life. The power of the ideas on this website are amazing and transferrable to any area of interest you may have.

I recently watched a talk by Tony Robbins about how we can create change and I wanted to explore how his message of personal satisfaction could translate into creating change in healthcare. A quote I found very interesting and appropriate to most of the countries view on healthcare was this:

“Society thinks we are our past” he goes on to say “We are if we THINK that way”.

What better quote then that to define how healthcare as evolved. We can see examples in:
1) The tradition of 12 hour shifts even though they are proven unsafe.
2) 36 hour call for interns, again unsafe
3) Teacher centered teaching and lecture, because that’s how “I” learned
4) “Eating” new grad nurses, because that’s what happened to me
5) Rewarding task orientation and “doing” something, because I grew up in the industrial age.

I am sure you can fit these examples into many aspects of your work or interaction with the US healthcare system. Healthcare is notorious for thinking that the past traditions should rule the future, just think of how hard it is to implement a change…

I recently entered into a debate with a fellow blogger about the use of technology changing physician practices and making office visits less necessary. He wrote back and argued that the telephone was just as effective as online interactivity. This is an example of tradition holding back an innovation.

As Mr. Robbins continued his talk he made another interesting quote.

“The defining factor is not RESOURCES, it’s RESOURCEFULNESS.”

Now how does that apply to healthcare. I think it really defines the future of healthcare. We are increasing costs, cutting resources, seeing sicker patients, and having to control the resources we use. If the mentality of resourcefulness overcame one of resources our system would be in a hell of a lot better shape.

Can you imagine the practitioners treating a patient using resourcefulness rather then worrying about litigation? I think it would be remarkable. No more wasted labs on a patient with obvious strep throat. No more serial enzymes of a low risk patient just to rule out an MI. No more antibiotics for the viral infection just so you can say you “did something”. What a concept!
In the educational arena how can we make better practitioners using the concept of resourcefulness. I like to substitute the word resourcefulness with the name McGyver! If every nurse, every doc, every housekeeper, every tech had the mentality of McGvyer do you think we could create some ground shattering innovations. I would love to work in a place that emphasized creation and resourcefulness.

Now as an aside, let me be clear, I am not talking about cutting corners or endangering patients because we reuse the Foley Caths, no, I am talking about looking at the resources you have and inventing new ways to use them effectively and safely.

The final topic Mr. Robbins discussed was that of growing. He described one of the major drivers of human existence is growing. Not on the cellular level, but in the spiritual and emotional sense. If one does not grow, or have the ability to grow, they become depressed. Walk into any nursing unit and observe… I bet you’ll see examples of this.
I know in my own work I have seen nurses stuck in the job, trying to make money, not attempting to learn more, not accepting new evidence, not rocking the boat when poor change decisions are made, and not taking responsibility to change the way healthcare is delivered and managed. That, my friend, is my definition of depression.

As leaders, as innovators, as friends, as family, as coworkers of these poor souls we need to reframe their thinking. Well, rather help them reframe their own thinking! Find what excites them, find their passion, find that drive within, and then give them the chance to grow. Give them a few resources to be resourceful with, give them encouragement to make a change, support their passion, and most of all be there for them to share their energy.

I want to leave you with a final quote that I think sums up my beliefs of leadership and change management. It goes as follows.

“Effective Leaders have the ability to consistently move themselves and
others to action because they understand the invisible forces that shape us”
---Tony Robbins

Focus those forces and change the world!!!

The Wrong Way to Make Change!

As some of you know I am currently working on my Masters in Health care Innovation at Arizona State University College of Nursing & Health care Innovation. My studies have opened my eyes to the world and some of the poor leadership in health care. Below is an example of how NOT to implement change.

THE PROBLEM:

There was a perceived frustration in wait times expressed by the patients in the ED. Just a side note, the wait time was an average of 30 mins.

THE BIGGER PROBLEM: The management team decided it would be a good idea to implement a change using a TOP DOWN approach. This means, no staff was included in the decision, no doctor had a say, and the triage nurses were read a memo instructing them to implement this now! (do you see my issue with this)

THE PROPOSED SOLUTION: To decrease the waiting time in the lobby, triage nurses were supposed to bring patients directly back to rooms without triaging them. These patients would then theoretically be seen faster and be happier. (Note: No evidence supports this, and the change was based on a magazine article from a small rural hospital. The hospital in question is a city Level 1 trauma center).

THE CONSEQUENCES: The lack of critical thinking used to implement this is mind boggling. By placing patients into rooms and closing the curtain in an ED untriaged is not only unsafe but the evidence states it is not sustainable.

Imagine for a minute your grandma was having a stroke. You take her to the ED and you get right back to a room. It's busy, a nurse cannot get into the room for at least 30 minutes to check her in! Are you a more satisfied customer?

The whole point of triage is to determine the acuity of the patient in order to determine who needs to be seen faster and who can wait. Stripping the ED of this service puts all patient at risk! Not to mention the additional time needed by the overworked ED nurses to triage and initiate treatment!

THE BETTER OPTION: So what can we do instead? Well, include the staff in decision making is the number one option. If a leader can facilitate brainstorming, the front line staff will be the ones who come up with sustainable and innovative ideas. Top Down decisions do not work!!!!

As far as wait times go, this is a much bigger issue then the ED itself can handle. Yes, we can put the docs on a pay per patient model to move through them faster. Yes, we can put a doc or PA at triage to get the initial screening done and then DC quicker. But there is a bigger issue.

We have spoken about it for years! The poor access to insurance and docs are the problems. ED's are becoming primary care clinics, and it puts all of us at risk!

A focus on prevention of disease, exercise, use of Urgent Cares, and regular check ups (even if it is from a Minute Clinic) are the key factors that will resolve the ED issues. Until then, I will have to take care of those people that come in with a fever for 1 hour, or the back pain for 4 years. JUST PLEASE TRIAGE THEM FIRST!

Does simulation mesh with human nature?

Shakespeare once suggested that humans seek out fooling. We go to the theater to be fooled and we watch magic because we are fooled by it. The most popular magicians in the world are the ones to which no one knows how the tricks are done. So, can human patient simulation draw on this human nature to be an effective and engaging learning tool?

I recently watched Alan Kay on TED and was intrigued by his new teaching techniques for math to 6 year olds using a $100 laptop. He stated, "We strive to understand ourselves to get around our flaws." I began thinking how this quote applies to health care education. Can we as practitioners really strive to understand ourselves? Do we have the opportunity to do so? And, if so, would that reduce our flaws (medical errors).

The answer to both of those questions is YES! Alan Kay listed three areas in which humans strive to understand themselves:

SENSORY

REASONING

PERSPECTIVE

So what does this have to do with simulation? Well, keep reading!

Sensory: Humans use sensory input to organize data for better understanding. The trouble with medical and nursing education is that the novice practitioner is not exposed to real sensory stimuli in a complex environment. In steps Simulation! TUH DUH. (Magician Joke). Simulation provides a tool to emulate sensory experiences in a safe environment, out of the realm of patient endangerment, and can give context to a young practitioners learning.

In short, simulation gives experiences to the inexperienced. It allows for one to self reflect on actions taken in stress full situations, and then debrief (see below) the flaws and achievements that occurred!

Reasoning: Humans use reasoning to organize and sift through data. Math and logic are examples of way the human race organizes data to make decisions in life. Medical and nursing schools strive to inject logic and reasoning, and math I might add, into the students. We all talk about critical thinking, and problem solving ability, but do we really provide the context in which this learning and skill perfection can take place. Multiple choice tests and written case studies help, but can they then apply it to the real world?

Simulation allows the student to integrate logic into the context of patient care. That is what we want right? A doctor or nurse who can recall information at the right time, and then apply it to the need task or skill with the proper rationale. Using simulation to set up real events allows us to do this, IN REAL TIME. Students are given the ability to practice logic and reasoning in a controlled environment and then debrief (see below).

Perspective: This is where learning and flaw identification come to a head. Humans reflect back on lived experiences in order to identify areas for improvement or change. Think about the last time you went to a bad restaurant. If i mentioned for you and I go eat there tonight what would you think? Most likely you are going to recall the taste and smell of the food, the long wait, or the poor service. This perspective will then inform your current decision.

So where does the New Grad Nurse or Intern get the perspective on a critically ill patient with a low blood pressure and stab wound? They struggle to think back to reading page 2433 in Lewis text on Med Surg nursing and what that damn table said about bleeding. Simulation changes that. Simulation provides the experience they can draw on.

The other aspect of perspective is how we self reflect. After simulation is the debriefing. This is the time when the facilitator guides the students to identify the flaws of the previous events. As the student thinks back on his or her lived experience they are able to connect their personality traits, problem solving ability, and critical thinking skills and identify ways to improve practice. This is done without ever touching a patient.


So are we building a safer health care system using simulation? YES. Does the use of simulation mesh with how humans identify errors and process information? I will tell you, it sure as Hell beats reading a PowerPoint! As we as a community continue to perfect the use of simulation i can only see improvements in the care of our patients! What an exciting time to be a practitioner!

RESOURCES

Alan Kay (Watch Alan Kay's talk on TED.com)
TED (http://www.ted.com/)

INNOVATION: Statewide Sim Coalitions, the next have in HFPS

Note: I am going to try a new format comments are welcome... this is always and adaptable work in process!!! Or A complex adaptive system :)



The INNOVATION:


As the use of Human Patient Simulation increases innovative leaders are bringing together stakeholders to create simulation coalitions. These groupings of hospital, nursing schools, medical schools, and allied health educators are providing a venue to rapidly advance the effectiveness and quality of simulation as a training tool for health care practitioners. Below I have featured a few of these and I invite you to join any of them!

Bay Area Simulation Collaboration

Oregon Simulation Alliance

Arizona Simulation Network

Visit Arizona Simulation Network

The IMPACT:
As independent coalitions are developed state by state a gathering of early adopters is reaching critical mass. Simulation scenarios are standardized, faculty are trained in proper techniques, and tricks for improving the educational experiences for the students are being perfected. These coalitions are allowing innovators to have conversation, test limits, and rapidly gain experience.

These Innovators are faced with many obstacles: Resistant faculty, dwindling budgets, and lack of EBP all sit to stifle the innovators march to a better training method. These state groups are providing a twelve step support group that allows the innovators to reconnect with the energy and passion to push on. As we know, the start of innovation is not evidence based, because if it was, it would not be true innovation!

The NEXT STEPS:

Where do we go from here? These groups are in an early phase of development. As they begin to leverage resources within their state simulation practice will begin to improve. As this happens the innovators will demand more sophisticated simulators, new technologies will be integrated faster and more efficiently, and new simulation techniques will be tested and perfected. Eventually, one can imagine a national simulation alliance that brings together all the simulator groups, not to engage in policy creation or regulation, as that will happen, but rather to energize the innovators to lead and create new and exciting ways to effectively educate our health care practitioners.

RESOURCES:

BASC
Oregon Simulation Alliance
Arizona Simulation Network

Don't be a resistor!!! Change is ok, I promise!

Lately the medical blogosphere has been buzzing about a doctor named Jay Parkinson (see ScienceRoll). Dr Parkinson has set up his practice using web 2.0 tools, a Mac, and a vision to use technology to make doctors practices better! I recommend you watch the video (see the link above) and see for yourself. His commentary is right on!

The issue of using the web to schedule appointments and answer questions from your doctor seems to be a revolutionary concept to innovation resistors. It is interesting that Papa Johns Pizza can get orders from text message, web, phone, and in person, yet our medical professional are still using pens and paper, phones, and face to faceto schedule appointments and answer questions.

I understand that many people think a face to face contact with the physician is an integral part of the medical process, but I challenge you to think about how much face time you actually get with your primary care doc. Ten minutes, if that!

In those ten minutes, can you get all your questions answered adequately? Is the face to face interaction of a regular visit really needed? Could a web camera, and email or IM get the same result with less hassle? It appears that is the way of the future.

After all, if we can order a pizza to clog our arteries, don't you think we should be able to request a lab result, ask about a pathology report, or ask about a drug side effect without having to go into the office. One of the troubles of the current system is that the practitioners own the information. As a ED nurse, the amount of paperwork and permissions I have to get before I can print out a lab report is ridiculous. (HIPPA stopping innovation is another topic for another day).

Health 2.0 serves to change that. In a generation of instant information and gratification the day long trips to medical records to get test results will not be tolerated. Even email is becoming too slow. Soon the market will demand a practitioner or the care extender to be available at all times for questions.

In my vision, I see this reducing ED use, increasing face time with the docs, placing health care accountability back into the patients hands, and changing how we see our physicians. As hospital care becomes more and more based into the home, actual visits to the office or hospital will no longer be for antibiotic use (we all know that can be done at home) but rather for critical events. I am excited to see the new generation of caregivers enter health care market and demand better and more effcient processes. As technology changes the way we practice nursing and medicine I will be an early adopter!

SEE RELATED

Interview with Jay Parkinson, the web-savvy doctor
From Doctor 2.0 to Patient 2.0: On Video
ZocDoc: Doctor Appointments Online

Potential Uses for health 2.0 in nursing education

In the past 24 hours I have subscribed to over 15 blogs related to web 2.0 and Health 2.0. Although the content is very interesting very few of them actually describe how we can use these resources in an educational capacity.

Second Life has had a buzz in the educational arena for quite awhile. John Miller at Tacoma Community College has really helped pioneer nursing resources in the famed social network. Check out NESIM in world, and you will see the beginnings of Human Patient Simulation in a virtual world.

So how can health care educators use second life and NESIM to create learning opportunities for their students? There are a multitude of ways to convey information to people in world. Power point can presented in a more interactive manner. Imagine, the Neuro lecture you spent 8 hours creating coming alive. Your avatar can demonstrate a seizure, students can treat the signs and symptoms you talk about. On your Second Life island you can build interactive models of the heart, lungs, and brain that students can twist, take apart, see video, and share thoughts about.



Although Second Life is still a rudimentary version of what will be reality in a few years, becoming comfortable with type of experiences that can be realized in world is a good idea for any educator. This is the precursor to the Holideck.

Social Networking: MySpace, Ning, & Facebook have started, and maintained, a culture of sharing ones life online. I recently was at a conference on the future of education in California, and listened to a presentation by Diane Skiba, a well known nursing informaticist. When she mentioned her thoughts on social networking a buzz arose from the crowd. The faculty in the audience immediately began to tell stories of how MySpace could be trouble and how their kids had posted content with questionable motives. I prefer to think about the way this technology can provide a place to connect and mentor students.

Recently I started using the site NING to create my own social network to bring together educators in Arizona to form a Statewide Simulation Network! So far we have over 30 members and the site has been up for 2 weeks. The site provides a central place for members to blog about experiences, share information learned, post videos of simulation, share pictures of props, and meet others to share resources.

So how does this relate to students??? Every school can create their own social network for FREE. Educators and students can enter into a mentoring relationship simply by logging in. It's easy, it's effective, and its safe. Social Networking will bring out questions and thoughts that may not have been shared in an intimidating face to face conversation. You may find out more about your impact on students and the issues surrounding their learning experience. In my opinion, it can only better the educational experience!

Twitter:
For those that have not been to Twitter yet, it is a micro blogging site that allows users to answer the simple question, "What are you doing right now?" in 140 characters or less. This message is then placed on the site, sent to phones, or instant messaged to your followers.

OK, imagine you have a sudden change in assignment criteria, you have found a great article or web resource, or you just had an experience in clinical that you want to share with the students instantly. You can Twitter it on your phone and have it sent to your students in the blink of an eye. No more emailing and hoping they check it. As we all know, this upcoming generation has the phone in the pocket at all times. In fact, email is too slow for these new techies. Instant connectivity can provide learning opportunities both in and out of the hospital.
Check it out here!!!

Conclusion:

As faculty technology should not scare you or turn you off. It is the way of the world now and it is important that we realize student centered learning is where our focus should be. As the next generation of students hits our classrooms the PowerPoint lectures are not going to hold their attention. It will be important to use our imaginations and our expertise to create interactive learning techniques that will engage and create more competent and confident health care practitioners