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Monday, September 15, 2014

IT frustration and criticism are by no means unique to healthcare

Read an awesome book last week:

I've been reading a lot of books and other stuff online lately, anything pertaining to "education," "training," and "learning," e.g., see my Sept. 2nd post.

Excerpt from Getting Schooled:
At some point before the first passing bell I will need to turn on my laptop and log onto PowerSchool in order to take attendance as quickly as possible. The process is always slower than I hope. My habit in past years was to take a few minutes at the start of each period to set a positive tone, tell a joke, praise a student’s achievements in another school activity, recount a current event, or read a passage I’d come across that seemed worth reading aloud, all the while taking attendance out of the corner of my eye and noting it in my grade book. The present system is more jealous of my attention. Often my first words to the class are related to the minutiae of the record keeping. We are expected, for example, to record missing homework, so that teachers in subsequent study halls can follow up and see that it gets done. To start a class by asking for a show of hands from those who haven’t done their homework (something I’ve always preferred to do confidentially and at least a few minutes into the period by walking discreetly among the students) is hardly the best way to set a positive tone. If I hit the wrong key, I need to cancel out my notations and do all of them again. If a tardy student walks into the room a minute after I’ve hit “submit,” then I need to call up the screen and do the entire roster over. As noted by the outside consultants who manage the system, it “currently lacks the capability” of maintaining a daily record of absences beyond “total to date”— a must for any teacher who hopes to keep track of when a student was and wasn’t in class and therefore was or wasn’t responsible for a missing assignment or on hand for an essential presentation of material. This means I must take attendance twice, once on the computer and once in a notebook I consult whenever I wish to know for sure what a student may have missed on a given day. The bottom line here— and I use the phrase with an eye to the mind-set that promotes these “systems”— is that I am increasingly devoting more time to the generation and recording of data and less time to the educational substance of what the data is supposed to measure. Think of it as a man who develops ever more elaborate schemes for counting his money, even as he forfeits more and more of his time for earning the money he counts.
Keizer, Garret (2014-08-05). Getting Schooled: The Reeducation of an American Teacher (pp. 51-52). Henry Holt and Co.. Kindle Edition.

My notes home become a moot point after a while because my Friday afternoons— chosen for my latest stays because of the hour and a half it takes my wife to get home from her Friday job at Dartmouth— are soon taken up with other tasks, many of them occasioned by the modern school’s almost insatiable thirst for “data” and the timely (i.e., as close to instantaneous as possible) recording of the same. In addition to grades and homework assignments, we are required to do a “productivity rubric,” which must be tallied for each student for each marking period and for the “progress report” periods in between; in other words, eight times a year. The productivity rubric is a feature of the PowerSchool grading system that allows teachers to assign numbers of 1 to 4, with 4 being the highest, to criteria presumably not subsumed by academic grades, such as “initiative,” “cooperation,” “attendance,” “behavior,” and “responsibility.” A faculty committee has designed a two-page spreadsheet that defines the meaning for each criterion of “productivity”— what distinguishes a 3 for behavior from a 2, for instance— and also attempts to reduce the vexing overlap between categories like “initiative” and “responsibility.” It goes without saying that the guide creates as many questions as it answers. What score should I give to a student who is missing far too many days of school but who does a better job of meeting her deadlines than a number of students with close to perfect attendance? Do I give her a number that amounts to a wink at truancy or a number that turns a blind eye to the efforts of a kid who’s anything but a deadbeat? What conclusions will she, or her parents, draw from the word unsatisfactory or the word acceptable? I can only give a number that designates a word; I cannot put the word into a sentence.

Though I approach the process with as much care and diligence as I can, vowing to myself that I will never allow skepticism to be a cover for shoddiness, I resent the chore deeply. I see it as part and parcel of the way in which “the school of the twenty-first century” is continually trying to mask the ambiguities of evaluating student performance by a pretense of rigorous objectivity. In English classes, for example, we avoid assigning an “arbitrary” grade for a piece of writing by constructing a “scoring rubric” of roughly ten criteria and assigning ten no less arbitrary scores to each, adding them up to achieve a grand total of subjectivity that is undoubtedly as solid as a Freddie Mac mortgage or a Miss America scoring card.

Even more I resent the way in which our jobs are increasingly dictated by the tools we employ. Form doesn’t follow function; form dictates function. I don’t want to sound dogmatic or, worse, ungrateful. Without a doubt, the PowerSchool program, once mastered, offers a more efficient way of recording grades than I’ve ever encountered. Every time you add a grade to the roster, the student’s average for the marking period is automatically computed and displayed. The end-of-marking-period all-nighter with a roped-in spouse doing backup duty on a calculator has mercifully gone the way of the mimeograph blues. But digital technology abhors a vacuum even more than nature does; it insists on reinvesting whatever time it saves, and it insists on doing so according to its own agenda. The purchaser’s need to justify the cost of the technology also plays a part. If a school system invests money in a sophisticated computer program that includes a feature for calculating the daily growth rate of a user’s moustache, then don’t we owe it to the taxpayers to see that every man, woman, and child capable of growing a moustache begins doing so at once?

The first time I try to do my productivity rubric it takes me several hours. I have roughly eighty students and five criteria, which means four hundred separate considerations and data entries. Times eight, that comes to thirty-two hundred by the close of the year; I try not to think too much about that. There are few people still left at school on a Friday afternoon, but I have received a good tutorial in advance. I should note that I never find myself floundering with a computer task because someone has handed it off with an attitude of sink or swim. But somewhere in the inner sanctums of the school’s IT system, or in the empyrean of cloud computing, or perhaps in the domain of PowerSchool itself, there resides a spore of latent indignation. Suddenly my screen is taken over by red headlines accusing me of things I’m not sure I even understand. The launching of a North Korean nuclear warhead could hardly produce a more alarmist screen. I’m unable to give a precise account of the wording because my screen goes black before I can read it a second time. Fearing that one inadvertent keystroke may have caused a digital meltdown, I run for the English teacher in the room next door, who is also working late, and ask for her help. She is a compassionate, careful woman who teaches both Advanced Placement and remedial-level English with the gentle hand that each requires, and I can tell that my stress is causing stress for her. I can also tell that she is doing her best to avoid any insinuation of stupidity on my part when she asks, “As you were going along, did you happen to hit save?”

Not once. I feared that saving before I could double-check my entries would lock in mistakes that I might not be able to change, a foolish notion perhaps, though not inconsistent with what I’ve seen so far of the system’s potential for capricious finality. As for the Armageddon screen display, it strikes my colleague as nothing more than what these machines will sometimes do. Every so often a gargantuan gorilla will seize a woman in his paw and climb to the top of the Empire State Building— just the nature of the beast, I guess, no different from the way that an exhausted human being overcome by a sense of futility will sometimes break down and sob. I will do that only once in the entire school year, and I keep myself under control until my colleague leaves the room. Anyone who stops in thereafter might wonder which member of my family has died. But there are no casualties to speak of beyond the loss of an hour or two with my wife and the jettisoning of a few quaint intentions. I entered the scores first in my paper grade book, so it seems I’ve “saved” them after all. I’ll find some other use for the fancy note cards.
[ibid, pp. 87-89]
Health IT grousing certainly has its counterparts in other domains. Easy to forget that.

This (below) is also worth noting. In the wake of his being out sick for an extended period of serious illness (PNU), Garret is given a teacher's aide to help him work his way back up to speed:
It’s remarkable how much smoother things go with a competent assistant. Some teachers have the benefit of an aide, though strictly speaking the aide is often not the teacher’s but a particular kid’s. Which is to say that the need for an aide is usually predicated on a handicapping condition in a student, not by the limits of what one human being with two hands and two feet can accomplish in a room full of twenty to thirty kids. It might surprise you, though it shouldn’t, that teachers are among the few professionals with no assistants. Think of a doctor without a nurse or a receptionist, a lawyer without a law clerk, a chef without a prep cook, even a clergyperson without an acolyte or deacon. Plumbers and electricians routinely have helpers. Rock musicians have guitar techs. Golfers have caddies. So much for the important professions. A teacher in charge of the educational development of fifty to a hundred diverse and needy human beings is routinely on his or her own. [ibid, pp. 226-227]
I could not recommend this book more highly. I posted more excerpts on one of my other blogs.

So, I seem to have sort of a study group core connect-the-dots "seminar curriculum" accruing:

By no means exhaustive. But, IMHO, useful for probing and synergizing the salient elements of effective education for a "Just Culture/Talking Stick" healthcare workforce.

I've not given any prior play to Daniel Pink's book "Drive," so I will cite from the Recap Summary:
Drive: The Recap 
This book has covered a lot of ground— and you might not be able to instantly recall everything in it. So here you’ll find three different summaries of Drive. Think of it as your talking points, refresher course, or memory jogger. 

Carrots & sticks are so last century. Drive says for 21st century work, we need to upgrade to autonomy, mastery & purpose. 

When it comes to motivation, there’s a gap between what science knows and what business does. Our current business operating system— which is built around external, carrot-and-stick motivators— doesn’t work and often does harm. We need an upgrade. And the science shows the way. This new approach has three essential elements: (1) Autonomy— the desire to direct our own lives; (2) Mastery— the urge to make progress and get better at something that matters; and (3) Purpose— the yearning to do what we do in the service of something larger than ourselves...
Chapter 4. Autonomy
Our “default setting” is to be autonomous and self-directed. Unfortunately, circumstances— including outdated notions of “management”— often conspire to change that default setting and turn us from Type I to Type X. To encourage Type I behavior, and the high performance it enables, the first requirement is autonomy. People need autonomy over task (what they do), time (when they do it), team (who they do it with), and technique (how they do it). Organizations that have found inventive, sometimes radical, ways to boost autonomy are outperforming their competitors.

Chapter 5. Mastery
While Motivation 2.0 required compliance, Motivation 3.0 demands engagement. Only engagement can produce mastery— becoming better at something that matters. And the pursuit of mastery, an important but often dormant part of our third drive, has become essential to making one’s way in the economy. Indeed, making progress in one’s work turns out to be the single most motivating aspect of many jobs. Mastery begins with “flow”— optimal experiences when the challenges we face are exquisitely matched to our abilities. Smart workplaces therefore supplement day-to-day activities with “Goldilocks tasks”— not too hard and not too easy. But mastery also abides by three peculiar rules. Mastery is a mindset: It requires the capacity to see your abilities not as finite, but as infinitely improvable. Mastery is a pain: It demands effort, grit, and deliberate practice. And mastery is an asymptote: It’s impossible to fully realize, which makes it simultaneously frustrating and alluring.
Chapter 6. Purpose
Humans, by their nature, seek purpose— to make a contribution and to be part of a cause greater and more enduring than themselves. But traditional businesses have long considered purpose ornamental— a perfectly nice accessory, so long as it didn’t get in the way of the important things. But that’s changing— thanks in part to the rising tide of aging baby boomers reckoning with their own mortality. In Motivation 3.0, purpose maximization is taking its place alongside profit maximization as an aspiration and a guiding principle. Within organizations, this new “purpose motive” is expressing itself in three ways: in goals that use profit to reach purpose; in words that emphasize more than self-interest; and in policies that allow people to pursue purpose on their own terms. This move to accompany profit maximization with purpose maximization has the potential to rejuvenate our businesses and remake our world.

Pink, Daniel H. (2011-04-05). Drive: The Surprising Truth About What Motivates Us (Kindle Locations 2737-2798). Penguin Group US. Kindle Edition.

Much of alternative medicine originated with a “lone genius” who had an epiphany, thought he had discovered something no one had ever noticed before, extrapolated from a single observation to construct an elaborate theory that promised to explain all or most human ills, and began treating patients without any attempt to test his hypotheses using the scientific method. Some of them were uneducated laymen, others were scientifically trained medical doctors who should have known better.
From my requisite daily priority blog surfing stops. Good stuff also here at one of my other destinations, The Neurologica Blog:
INTEROPERABILITY SHOULD HAVE COME FIRST: A leading health policy voice in Congress said this Monday that the nation may have put the cart before the horse when it comes to the exchange of electronic health information. Rep. Mike Burgess, a physician, noted that federal health laws and regulations placed an emphasis on providers adopting EHRs, while putting off until later the EHR systems’ exchange of patient information. “I don’t know if the focus being on meaningful use originally, maybe that focus should have been on interoperability, and the meaningful use stuff come later,” Burgess said at ONC’s Consumer Health IT Summit. He reiterated calls for wiser use of meaningful use dollars — almost $25 billion have been spent to date. Burgess said after his 10-minute talk that the House Energy and Commerce Committee, on which he is vice chair of the health subcommittee, is looking at changes to the meaningful use program as part of its 21st Century Cures work. “What that would look like is still under discussion,” he said.
From Healthcare Dive:
Part of what sucks the value out of EMRs is the reality that providers can't share data with one another. Free, compatible data flow from doctors to hospitals to other health facilities is still at a primitive stage. That's the case despite demands from policymakers that EMRs become "interoperable," a nice way of asking that vendors drop the walls forcing providers to use their product and their product only.
Yeah, but it continues to be the prevailing business case that "Opacity (+barriers to entry) = Margin." Efficient Markets Hypothesis 101.

More to come...

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