#s4pm

Blame and Burden: Is Hand-washing the Responsibility of the Patient, or the Health Care System?

On the heels of my talk about design and health care at the 2013 Cusp Conference, I wanted to comment on this article which recently came out in the WSJ. Hand-washing is critical for avoiding the spread of infections acquired in hospitals, but only about half of health care professional comply with hand-washing protocols, despite a variety of different interventions to improve hand-washing rates, including penalties, electronic sensors, and video cameras. @lauralandroWSJ reports that newer interventions are now focused on having the patient ask the health care provider to wash his/her hands.

"Some monitoring systems emphasize patient engagement and sound an electronic alert to remind patients to speak up when a staffer enters the room."

Really? Are we training our patients to be Pavlovian dogs? I am not sure how I would feel if I had to speak after a bell went off.

"The nonprofit Association for Professionals in Infection Control and Epidemiology is kicking off a campaign this month including posters mailed to 15,000 hospitals with tips on how patients can take an active role. It suggests asking staff about hand hygiene and requesting that hospital rooms be cleaned if they appear dirty."

Patients have to first determine whether the room is clean (mind you the bad bugs don’t really make themselves known in an obvious way) and then they have to request one if it’s not? Is it not the right of every patient to have a clean room?

As a “medical designer”, I have written previously about how we blame our patients instead of blaming the design of the health care system. But this takes things to a whole new level. I think it’s a pretty sad state of affairs for the health care system to ask patients to do our job for us. We are getting paid to do supposedly deliver high-quality healthcare, yet we are putting the burden on the patients to protect their own health, and we make them do it for free. Don’t our patients have other things to do, like focus on their illness and recovery? Not to mention the fact that “the white-coat barrier” keeps them from saying anything anyway.

"…one-third of patients surveyed at the University of Pittsburgh Medical Center said they observed doctors failing to wash their hands, but nearly two-thirds said nothing to their doctor about hand hygiene. Most didn’t believe it was their role to do so and said they felt embarrassed or awkward and worried about reprisal."

Could Doctors Have Something to Learn from Designers? 

The most important reason for Diabetes Health Care Providers to be on Social Media

I listened to this fantastic story on NPR last week, which featured Maurice Lim Miller, who runs the Family Independence Initiative (FII), a nonprofit here in San Francisco that helps families tackle poverty.  He created the FII when Jerry Brown (who was the mayor of Oakland) gave him the opportunity to do anything he wanted to do to address poverty, and he had just a few weeks to come up with a solution.

“He says that…he wracked his brain, but he realized he didn't know the answer. Then it dawned on him: His mother was a poor Mexican immigrant, and she had somehow figured out — on her own — how to get him out of poverty.” So, he told Brown, why don't we take the money and pay poor families to show us what they would do?”

Through this revelation, Lim created the FII, which at its core, recognizes that the experts in poverty are the individuals who live in poverty.  The program taps into that expertise, and empowers the families to find support and solutions to improve their situation. 

What is unique about this program? Families are in charge, instead of the social workers. A family who participates assembles a small group of peers that meets on a regular basis to share ideas, resources, and advice, and to hold each other accountable. Families are also required to collect data on a regular basis, logging onto an online journal to input and update information such as income, savings, health, education and housing, as well as their leadership and networking participation. For this effort, families receive an average monthly stipend of $160 and a laptop computer. They also get feedback from the online journal: a picture of their progress over time with graphs of their income and savings. 

It’s still a pilot program, but it seems to be having impressive outcomes, including an average 20% increase in income over 2 years and higher school grades and homeownership rates and savings.

As Lim says, “We trust that as a group the families have the knowledge, initiative, and the capacity to lead themselves. Our process just catalyzes this potential.”

I listened to this fantastic story on NPR last week, which featured Maurice Lim Miller, who runs The Family Independence Initiative (FII), a nonprofit here in San Francisco that helps families tackle poverty.  He created the FII when Jerry Brown (who was the mayor of Oakland) gave him the opportunity to do anything he wanted to do to address poverty, and he had just a few weeks to come up with a solution.

“He says that…he wracked his brain, but he realized he didn't know the answer. Then it dawned on him: His mother was a poor Mexican immigrant, and she had somehow figured out — on her own — how to get him out of poverty.” So, he told Brown, why don't we take the money and pay poor families to show us what they would do?”

Through this revelation, Lim created the FII, which at its core, recognizes that the experts in poverty are the individuals who live in poverty.  The program taps into that expertise, and empowers the families to find support and solutions to improve their situation. 

What is unique about this program? Families are in charge, instead of the social workers. A family who participates assembles a small group of peers that meets on a regular basis to share ideas, resources, and advice, and to hold each other accountable. Families are also required to collect data on a regular basis, logging onto an online journal to input and update information such as income, savings, health, education and housing, as well as their leadership and networking participation. For this effort, families receive an average monthly stipend of $160 and a laptop computer. They also get feedback from the online journal: a picture of their progress over time with graphs of their income and savings. 

It’s still a pilot program, but it seems to be having impressive outcomes, including an average 20% increase in income over 2 years and higher school grades and homeownership rates and savings.

As Lim says, “We trust that as a group the families have the knowledge, initiative, and the capacity to lead themselves. Our process just catalyzes this potential.”

@gfry of Smart Patients brought my attention to this article. 

“Medication Nonadherence”: A Diagnosable and Treatable Medical Condition”

The authors write:

“How can adherence be improved? We propose that the first step is to view medication nonadherence as a diagnosable and treatable medical condition...To further improve the diagnostic accuracy of the problem, attention should be paid to the underlying behavior(s) at hand. There are at least 6 representative medication nonadherence phenotypes, highlighting the differences in underlying behaviors and barriers that exist at the patient level: (1) the patient does not understand the relevance of medication adherence to continued health and well-being; (2) the patient has concluded the benefits of taking medications do not outweigh the costs; (3) the complexity of medication management exceeds the information processing capacity of the patient; (4) the patient is not sufficiently vigilant; (5) the patient holds inaccurate, irrational, or conflicting normative beliefs about medications; and (6) the patient does not perceive medication to have therapeutic efficacy.”