Posts Tagged Health inSite
We are a cool species, engaging with our world in a very different way than any other species of which we know. We shape our world physically, mentally, and socially to suit myriad fantasies, individually and collectively. This results in a shifting landscape of reality in which we, as Daniel Kahneman points out in his final chapters of Thinking Fast and Slow, are subject to our cognitive biases that may have positive or negative sway in any given situation. The key to best engage with that reality on a day to day basis is to recognize these imperfections in our cognitive wiring in a reflective way.
In those final chapters, Kahneman points to a need to recognize, that as remembering beings, our memory often fails us. It’s subject to outside influence and shortcuts on our own behalf. Taken together, this means that there is an opportunity for each to shift our remembering self towards a different understanding of an event than our experiencing self, the one that’s actually present during an event. This is because our memory is subject to duration neglect and a product of our episodic memory – we are prone to ignore duration as opposed to intensity. If we were to have a true recording of events, we might not remember correctly that vacation taken last year, when it rained for the first three days, but the last day was so gorgeous (and all of our pictures were from that day) that we may remember it more fondly than we experienced it.
What effect does this have on adherence? Quite a lot actually, and this is where perception has a great opportunity to hop into the world of Behavioral Health and Substance Abuse treatment. Simply by altering the treatment protocols to take into account this remembering self, it is possible to focus on the peak-end rule. The peak-end rule says that when we are remembering an event, we more heavily weight the experience of the most painful or pleasurable event (peak) and the last thing (end) that occurred in a timeline. If a treatment protocol were to decrease the peak of a particular episode and include a positive, context-provoking end to the episode, the remembering self will have a different memory as it progresses towards more positive outcomes.
There is another major implication of this very important understanding of the remembering self vs. the experiencing self and it is related to a concept called Salutogenesis (basically “from health”). Salutogenesis is a concept coined by Aaron Antonovsky, a Medical Sociologist, as a counter to our current health model, which has a pathogenic slant to it. I would venture that our health system is as much a product of our two selves as potentially influenced by a change in the approach. Our duration neglect and base-rate neglect lead us to an imperfect memory of the picture of health that we have for ourselves. This leads us to looking at healthcare as episodic – we go to the doctor in a self-encapsulated event, we get ill, we deal with symptoms. These are all pathogenic experiences of our overall wellbeing. If we had a tool that helped our experiencing self more accurately engage with our health reality, that we are always to some level healthy and to some level ill, duration neglect would be mitigated, increasing our ability to engage with our health as if in two realms, time and space, rather than simply in a given moment in time.
So what does a salutogenic framework look like? Mindfulness, resilience, focus on daily health-promoting activities that increase our ability to get healthier, rather than fend off illness. Of course, a fee-for-service model doesn’t bode well with this concept, so unless you’re enrolled in a highly visionary health promotion healthcare system, you’re probably on your own – for now. If so, here are some resources we’ve seen that might be helpful for you to consider when you begin working towards your healthiest self:
SuperBetter.com – This site allows you to engage in a number of different challenge “packs” to help increase your emotional, social, mental, and physical resilience. You can even invite your friends to help you complete these challenges!
FitBit – not simply a pedometer, this device will help track your sleeping patterns, too, giving you the opportunity to analyze some of your base-rate metrics and progress in your fitness.
Various apps and websites – there are literally thousands of apps out there now for tracking everything from heart-rate to nutrition to fitness to mental resilience to even sobriety (check out sober24, an online community for alcoholics in recovery!). Keep in mind that when you are looking at these programs, you are more likely to be successful if you are doing it with someone else. And if you invite someone else to participate, they are as likely to make you healthier as you are to make them healthier!
Your EAP – while most people think of their EAP (Employee Assistance Program) as something they use when things are bad, keep in mind that MINES has many programs that may help you no matter what level of health you’re at – including career coaching, financial coaching for learning to save, and more. You don’t have to be in pain to give us a call; we’re here whenever you want to talk.
To our health,
Blended, not segmented
In an increasingly interconnected world, the rift between the person and the role within the workplace is diminishing. Again, highlighting a moment from our presentation at the EAPA 2011 Conference back in October, we provided a brief demonstration of the change that is coming with the introduction of smart technology that is cheap, intuitive, and pervasive. We added many of the ingredients of our everyday lives – personal photos, TPS reports, business cards, a beer (non-alcoholic, of course), and some others – to a blender. After pureeing the ingredients, we had the mish mash of our lives in a soupy representation of its non-segmentation. Slowly, but surely, we continue to blur the lines between our personal and professional lives. The generation entering the workplace today, as well as the mavens that have been productively using social media over the past decade, are contending with very significant issues when it comes to their personal versus professional circles.
Which is perfectly fine for them as, characteristically, they are less concerned about the space between work and personal that has existed in previous generations.
But it does bring up a new combined reality wherein the interconnectedness of all things plays a new role, e.g., less applying for jobs and more networking with previous co-workers and current friends. This is a powerful change in the culture of hiring as we can rely more on data points that are trusted, rather than on the various axes we might consider from an interview.
We’ll have chips, you bring the dip
This is further aided by the number of devices (and the consolidators like cloud computing and apps) on which we can maintain a seamless online life. Our ability to share, connect, and compute through these various devices has led to a revolution for some workplaces. We’ve gone from intentional VPN connections on desktops into the workplace, to push-based access to email on our phones.
Now we have the opportunity for individual employees to Bring Your Own Device (BYOD). Gone are the days where individuals carry two phones, or a personal phone and a work laptop. A new tide is rising where an employee can use their personal device to connect to work. This has obvious implications associated with it. In my last blog, I walked through some of the changes in the landscape regarding social media in the workplace and its potential for the leaking of PCI (a play on Private Health Information, Private Corporate Information). Imagine the concerns regarding that PCI on a device that can literally be left on a street corner! Consider data from Lookout Security (a mobile app that tracks lost phones) alone: 9 million lost phones in 2011. By the way, if you have employees using mobile devices for work purposes, either company owned or personally owned, you should have a solution like Lookout or iOS’s Find my iPhone in place. It’s just another thing to add to the technology section of your HR manual.
We can access statistics and reports from virtually anywhere with a WiFi or data signal, and we can do it on the same devices as our social media and personal activities. This means increased efficiency for some, and others less so as there are more distractions on the same device; however, it also means being less tied down to a workstation. Enabling employees to function in their role fluidly and dynamically means a potential for faster response rates and less commuting or booting (as in booting up a computer) time. So long as you are not also operating in System 1 by multi-tasking.
What does this have to do with health?
I’m so glad you asked. The mobile revolution has another impact on our lives: the ability for our physical wellbeing to be more social and integrated with our daily activities. For an employer, this can mean increased health outcomes to decrease premiums as awareness of one’s health can increase attention to keeping oneself healthier. Integrated with Social Media, this also allows for real time feedback from our social network, encouraging and assisting in the process of growing our health. And since we spend 1/3 of our week working, ignoring this time because it’s “work time” is simply the wrong way to go about creating a healthier workforce. Population health strategies necessitate an integrated approach to health – and even more so when you are self-insured!
If that’s not interesting enough, using both hardware and software, new tracking of the quantified self enables a feedback system that helps provide data to be reviewed by System 2, resulting in increased awareness of our current health status. Knowing your heart-rate through events, in real time, allows for biofeedback-based solutions to situations. Literally translated, our at-the-moment health can enable greater productivity at work – whether that’s at a coffee shop, your home, or at the office. As these pieces of technology become cheaper and more precise, BYOD might one day allow for the inclusion of health devices for work too.
To our health,
Have you read the book The Experience Economy? To explain it very quickly (and not do true justice to the ideas proposed in the book), there are various levels of economic offering that warrant different valuations, and thereby ability to generate revenue. The levels of development discussed in the book are elegantly displayed in the graph below by Pine and Gilmore (the authors of the book):
This progression has expanded over time with new levels being added as the market strives for differentiation. Many of the examples brought up are clear and concise, such as Starbucks as a purveyor of coffee (a commodity) that really charges the market at the level of a Service. Pine and Gilmore stop at the level of Service in their description of Starbucks, but I would readily argue that they reach towards the level of experience. Starbucks actually refers to this in their training materials as creating “The Third Place;” it’s not your work, or your home, it’s that other place where you can unwind a little bit. Even though the customer isn’t actually brewing their own coffee, as is a hallmark of many experiences, they are engaging with the sounds and smells of the coffee shop in a very intentional way.
The book spends a great deal of time discussing offerings that are on the level of Experience but certainly takes a moment to tip its hat toward Transformations, a burgeoning new market offering. Transformations are marked by the engagement of the customer in a way that enables that person to learn or grow, exactly to Transform, themselves in a way that is truly valuable to the customer. It includes giving the customer the skills and motivation to make changes that will both provide some immediate value but also cascade down into further value down the road.
In healthcare, this understanding of the market is significant and valuable. As we, as an industry, discuss Accountable Care Organizations, capitated care models, and participatory medicine, it’s important for us to keep in mind where value is derived in the typical marketplace. Healthcare, while arguably different in many ways from other industries by its virtual necessity in every citizen’s timeline, still must compete under the same rules as many other industries. Many times, in healthcare, we present ourselves on the level of Service – that is that we are doing something for someone, for a fee. As we look at these new systems, it is time for us to consider what the future of healthcare delivery will require under a population health model of delivery.
Eschewing the fee-for-service model opens up the possibility for the healthcare industry to reconsider offering the long-term value of teaching individuals how to keep themselves healthy, at least in terms of the 80% of healthcare costs that are mediated by behavior. This decreases the time and services that must be provided creating new forms of cost savings. As we move further up the economic offering ladder, it will become more necessary to move our industry into the Transformation realm. In fact, there is no other industry more suited to it.
To our health,
In a recent article published by NPR, Gain Together, Lose Together: The Weight-Loss ‘Halo’ Effect, two studies were mentioned that suggest that our social networks have a significant effect on our overall health and well-being. Since weight is oftentimes affected through behaviors (exercise, diet, smoking, drinking, etc.), those with whom we engage in those behaviors have a direct impact on the outcome. It’s pretty simple when you think about it, but certainly, easy enough to miss. We do know that your friends’ friends make you fat.
However, the article highlights another very interesting second-node response to those receiving treatment for obesity. While there may have been behavioral changes that were enacted by family members (first degree of separation) as they complied with the treatment plan for the patient’s (first-node) benefit, the article suggests that there may have been another influence on the weight of the patients’ family members – additional education.
This does add a new layer of influence that might create additional change. If you are engaged in the treatment, even just on the education level, what possible changes might that make to your cognitive approach to the subject. Said differently, even if your behaviors aren’t initially, directly adhering to the treatment plan, is it possible that through continuous education on the subject, you might potentially change your behaviors simply through thought pattern change? We do know in psychology that simply logging what you eat will result in weight loss. Where your mind goes, the energy goes.
Of course, the way Psychology views the Halo Effect – a cognitive bias that involves one trait influencing others in one’s judgment of another person or object – a little different than what is described in the study – but it would be interesting to see if perception of success of the patient had an influence on the outcomes of the family members. In other words, if there were a Halo Effect regarding the overall interpretation of the composite qualities of the patient by the family members adhering and discovering success with a treatment plan, if that in turn could create the opportunity for a cognitive reframe of self-perception – a sort of, “they are doing it and maybe I could/should too.”
If anyone knows of an interesting article or study that has delved into the topic, we would love for you to share it.
To our health,
Now is a great time to work in the Healthcare industry. While the changes in the landscape following the Affordable Care Act (and the challenges to the Affordable Care Act) have led to some pretty interesting scrambling to meet “the market,” it has also been fun to see new, emerging voices that have the foresight to begin considering the effect that Health IT can have on our overall well-being as patients.
Today’s inSite highlights a very well-written article (Do We Need Doctors or Algorithms?) that lays out some of the ways in which Healthcare may be changing, be it through our intentional effort or our naturally-occurring social meanderings (I use the Wikipedia article intentionally!).
Consider some of these possibilities with a view of their overall impact on our Healthcare landscape. While some of these may, at first, seem far-flung, they are quite insightful and not as far off as one might think when you consider what we are already capable of accomplishing with mobile technology as well as data integration and management systems. While it may be a natural reaction to respond with some concern – how fantastic would it be to have systems that imbue all providers with the confidence and accuracy that a system like the one mentioned in this article could provide. Then our providers could be really focused on treating the relapse issues that can often creep their way into the patient’s treatment compliance. It’s very possible that our docs’ roles may be shifting once again from diagnosis to advising to (now) nudging as patients become more empowered and informed to make their own decisions.