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Are you catering to those who need you?

40 years ago people older than 65 years of age were a minority in the population. In the very near future they will be a significant minority and for some service providers they will be the majority. Healthcare is a good example. However the population may be ageing but it is also changing.

This aging population has many options from which to choose and they are looking for more than just a particular retailer, restaurant, product or service. They want their purchase to count: to satisfy mental, emotional and even spiritual needs as well. Older consumers: Redefining Health and Wellness as they age.

How has this been factored into your plans for how you will respond?

Picture by Nicolas Alejandro

Do your words strike a discordant chord?

Most upper respiratory tract infections are caused by viruses. However saying that to a parent with a sick child doesn’t always help:

Parent 2: They think they make you feel better saying it’s a virus…but they make you feel worse

Parent 7: When they say it’s a virus, I mean what kind of virus? Just where does it come from? Parent 1: You’re none the wiser how they got it, what you can do, how long it will go on…

Parent 5: You feel you’re no further forward…you just have to accept it if they don’t explain further, I would like to know…

Parent 2: It’s an unknown thing to a doctor, they can’t pinpoint it, they don’t know really…

Parent 1: I feel a bit annoyed really because you think they’ve studied for years to learn that and I haven’t studied at all, you feel dissatisfied as if you wanted to hear something more…you just wish that everything was clean cut

Parent 4: At least if you really knew what it was then it’s easier to cope with (Group 3) Joe Kai BMJ 1996

What do you say in these circumstances?

Picture by Massimo Variolo

Does your performance at work depend on coffee?

Does the time of day determine how you respond at work? Are you tired by mid afternoon? Are you slow to get going in the morning? How does that impact on the decisions you make at that time?

Decision fatigue is the concept that as we make more decisions during the day, they become less and less good quality… I know that I would much rather be one of my first five patient contacts of the day than my last five. Rachel Ali

Remedies for decision fatigue might include time-dependent decision support, modified schedules, shorter sessions, mandatory breaks, or snacks. Further studies could clarify the sources of the problem and test corresponding solutions. Linder et al

Does this resonate with you? What are you doing about it?

Picture by Albert Drobin

What do you share about yourself that’s a safe topic?

Health warning:

As a doctor, the reality is you are never off duty and their status in the public eye demands a high standard of conduct at all times. Dr Naeem Nazem 

At some point someone will ask you where you went on holiday or why you have a model airplane on your shelf. You can choose to be very ‘private’ or have something you might find increases the connection with that person without befriending them on Facebook.

Physicians aged 40 to 59 years report that they most enjoy running or jogging (36%), bicycling (35%) and camping or hiking (24%). About 50% of physicians older than 60 years reported walking to stay healthy.  Other interests include golf, aerobics and cardio, skiing, tennis and fishing. Other leisure activities reported include reading, with many physicians describing themselves as avid readers; regular reading was reported by more than half of physicians under 40 years, 58% of those aged 40 to 59 years and more than 64% of those aged 60 years and older. Endocrinology advisor

The trick is not raising topics that should be off limits but it makes you more human if your client, customer or patient knows you are an avid reader, you play golf or sing in the choir. You can prompt the chat by having a prop for something that you are happy to share. My doctor has a picture of a civet cat in his room. I’d love to know why,  he tells me everyone asks him about the cat.

Picture by  Daniel Colovini  

What are you selling?

Whatever your role in life you are ‘selling’. That might be obvious because you work in a shop or own a factory but less obvious if you work in a clinic, office or a hospital. According to Dan Pink white-collar workers now spend an enormous portion of their time persuading, influencing, and moving others. He would argue that everyone is in sales.

So if that’s how you choose to frame your role in healthcare what are you selling? What do you spend your time persuading people to do? How effective is your sales technique? How do your product works? How do you know it is in anyone’s best interests to buy what you sell?

Dan Pink says it well:

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What was the journey like?

Do you know what your customer, client or patient’s journey to your office, clinic or shop was like? How did they get there? How long did it take? Who travelled with them? What did it cost? If they drove where did they park? Did you take any of that into account in your dealings with them today? Does it matter?

If you’re lying on a table waiting for radiation, you can’t just jump up and plug your meter,” she wrote to the city. “As someone who has gone through and survived cancer, I can’t tell you the anxiety experienced at finding a parking ticket on my vehicle. Nancy Piling

That patient’s experience was impacted by factors that had nothing to do with the professional care she was receiving. But…..

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What would happen if you didn’t show up at work today?

What would happen if you didn’t show up to work unexpectedly today? Would the show go on? Who would provide continuity for the what you have been working on? Is there a contingency plan for that possibility?

Data from the Office for National Statistics (ONS) for 2016 recorded an absence rate across all workers in the health sector of 3.5%. This compares with an average rate of 2.9% across the public sector and 1.7% in the private sector. In its analysis of these data, the ONS says, “It is possible that the exposure of health workers to infections and diseases contributes to their higher sickness absence rate.” BMJ May 2018

….any policy that mandates strict back-to-work rules must also ensure adequate staffing and coverage of health care personnel to limit feelings of personal responsibility that encourage presenteeism. Despite the best efforts of education and mandatory exclusion rules, health care providers will likely continue to come to work if they feel that their absence would burden their colleagues or affect delivery of patient care. Policies that maximize efficiency at work can therefore be detrimental to public health. Furthermore, a policy that ensures adequate coverage may be cost-effective for health care institutions by mitigating the negative financial impact associated with large nosocomial outbreaks. Widera et al

Meanwhile what do you do to ensure someone at work knows where to find that crucial document? Who knows what you are working on? Who is  on standby if something unexpected happens? What is the risk to the team if you can’t be there tomorrow?

Picture by  Ben Seidelman 

Do you use stories?

Outcomes in healthcare can be assessed using measures, meters and monitors. The art of healthcare is to ‘sell’ health because most of what promotes health are the choices of autonomous individuals. Healthcare can choose to present facts and figures:

Your BMI is 27, your blood pressure is 150/95mmHg, your lipids are in the higher range, your K score ( measure of depression) is 26

So if this is you you’ll be advised to lose weight, exercise more, eat less and relax. Even as you hear these numbers you will glaze over. In other industries they use stories to avoid ‘push-back’. The typical story has a setting, a hero, a complication a turning point and a resolution. Story teller’s say:

He must enter the hearts of his listeners, where their emotions live, even as the information he seeks to convey rents space in their brains. Our minds are relatively open, but we guard our hearts with zeal, knowing their power to move us. So although the mind may be part of your target, the heart is the bull’s-eye. To reach it, the visionary manager crafting his story must first display his own open heart. Peter Guber

The story might be:

You know you remind me of another 45 year old chap I knew. He was a very successful and worked long hours. While he loved his job he also wanted to retire early so he didn’t pay much attention to his lifestyle. Then one night he went to the Emergency department because he had terrible chest pain. He was due to go to an important meeting in the morning but that evening he was sweating, vomiting and clutching his chest. He was lucky because it turned out he didn’t have any serious illness but he needed to change his habits. Two years later people didn’t recognize him, he put all of his skills to reinvent himself, lost weight, started exercising and having regular breaks. So although he, or should I say I, won’t retire soon I plan to live long enough to enjoy it when it does happen.

Bernadette Jiwa’s new book the Right Story might help.

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Are you a do-gooder?

Are there limits beyond which you would not go? What are they at work? Who knows about it?

  1. Will you do extra shifts?
  2. Will you see more customers, clients or patients?
  3. Will you take phone calls outside of work hours?
  4. Will you agree to stay late?
  5. Give up your lunch break?
  6. Will you tolerate interruptions when you are doing something?
  7. Will you check your emails tonight?
  8. Will you use the word ‘ No’?

If you don’t set those limits what can’t you do?

  1. Exercise?
  2. Attend a family function?
  3. Sleep?
  4. Eat well?
  5. Be present for those who love you?
  6. Generate solutions?
  7. Create opportunities?

Why are the items on the second list not a priority? Who pays the price? How long before you feel the consequences? What is the quality of your ‘doing’? Will the world end if you set limits? Will you be missed if you were to be fired today or would you be replaced within hours? (OK may be days.) What worries you about setting limits? Is that logical? Really?

If you rate yourself as a people pleaser here’s some advice from  Dr. Pamela Wible

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What do you do to unwind?

As a health care professional you are encouraged to have some down time. According to research:

Burnout and satisfaction with work-life balance in US physicians worsened from 2011 to 2014. More than half of US physicians are now experiencing professional burnout. Shanafelt TD et al

In the UK, NHS

More than half of salaried and locum GPs suffer from stress as a result of their work. BMA

So if you are in healthcare how and when do you unwind? How do you know it’s working? Are you too busy chopping the wood to think about sharpening the saw?

Picture by Zach Den Adel