better health by designLearn More

How long will it take you to get to work tomorrow?

Does your journey to work impact on your performance? How? If it does as the evidence suggests, what are you going to do about it?

This paper offers a multi‐perspective examination of commuting drawing upon the literature in transport, planning, geography, economics, psychology, sociology and medicine. It examines statistical evidence on trends in commuting travel behaviour and finds that one in 25 commuters now travels to work in excess of 100 km (both ways) and one in ten commuters now spends over 2 h/day travelling to and from work. Lyons and Chatterjee

In healthcare performance is thought to be largely a factor of policy.

Looking forward, the seven countries we studied face the shared challenge of how to integrate care in an era of specialization and shortages of primary care physicians. Achieving better care coordination will likely require designs that include a mix of formally integrated organizations, co-locating or sharing services, and connecting through information systems. Schoen et al

But on closer quarters performance is highly impacted by the personal choices healthcare professionals make.

Picture by Darren Cowley

Why do you keep me waiting?

We often have to wait in line to be served. In healthcare that happens a lot. If you had to wait an hour or more every time you needed something from somewhere would you continue going there? Why or why not? Does queuing have to be  fact of life in healthcare? How long before someone works out it isn’t necessary and offers an alternative? What will happen to those places that fail to keep up?

Although appointment systems are often designed to avoid doctor idle time (without considering patient waiting time), it is possible to reduce patient wait time without significantly increasing doctor idle time.

Picture by Michael Dales

Why did you change over the years?

Have your attitudes and opinions changed since you started doing whatever you do today? If you have changed, how so? Is that a good thing?

And so I approach the patient/physician encounter as a sanctuary from the rapacious, counterfeit, profit-driven world that I have to navigate through every day. I really am curious about these people who come into my exam rooms. I am interested in their seemingly trifling anecdotes and back stories. I love when they ramble on about some trip planned to Montana or the vegetable garden they had last summer or whatever. I am there as a privileged guest, invited inside, if but for a short while, when they are vulnerable and hurting and completely open and trusting. I have been allowed behind the curtain, and I don’t want to betray them, I don’t want to let them down. I want them to like me and trust me and believe in me. I need this to be true, and it doesn’t have anything to do with high HCAHPS scores or patient satisfaction metrics. Jeffrey Parks

Picture by United Nations Photo

Could you do better?

Do you think your work could be better? How? If you think it could be improved what are you waiting for?

The intense debate about how to move forward is a sign that overtreatment matters,” Brownlee says. “We want everyone involved and sharing their expertise on potential solutions. There is room for many political ideologies and beliefs about how to pay for healthcare. The crucial step right now is to get the medical community mobilized around the idea that overtreatment harms patients

BMJ Jeanne Lenzer

Picture by Carlos Ebert

How do you celebrate?

Do you celebrate with your customers, clients or patients? Why or why not? As a healthcare professional you know at least one date that is very special to them. It presents an opportunity as a teachable moment:

Data from a sample of 2,518 college students suggest that 21st birthday drinking poses an extreme danger: (a) 4 of every 5 participants (83%) reported drinking to celebrate, (b) birthday drinkers indicated high levels of consumption, (c) 12% of birthday drinkers (men and women) reported consuming 21 drinks, and (d) about half of birthday drinkers exceeded their prior maximum number of drinks. Current problematic alcohol involvement and its typical correlates strongly predicted both the occurrence and severity of 21st birthday drinking. It is imperative that investigators consider a variety of potential interventions to minimize the harm associated with this rite of passage.

Rutledge et al

Picture by Taku

Where were you when I was bored and saw this?

The triggers are everywhere- Hungry? Thirsty? Bored? Sad? We have something for you right now. Meanwhile your advise is a quiet voice in the back of their mind. There is an entire industry dependent on people’s bad choices, they are not taking a holiday this year working on how to influence them more than your diet and exercise program. There’s another industry depending on those choices so that you- doctor- will prescribe their neatly packaged answer to the expanding waist lines and furred arteries. It’s about the economy. The show must go on.

Picture by osde8info

When did you last have dinner at our place?

We advise people about all sort of things- this is good for you, that will work for you, the other is bad for you…..But can you imagine yourself having a meal at that person’s home? Sitting in their car? Watching television in their sitting room? Shopping in their company? What’s it like walking in their shoes?

Picture by Jeff Kramer

Is what they do next door a mystery?

When did you last speak to the person in the office next door? What is their role in helping those who come through the front door? What can you do to help? How would that help make you more effective at what you do?

Picture by Penn State

How do you know your solution is the best?

Healthcare professionals offer solutions to problems. Doctors at community healthcare offer a solution to another problem every 10-15 minutes. Meanwhile the people seen there are making choices that seem entirely unrelated.

I’ll eat this, I’ll drink that, I’ll spend my money on this. I’ll work here. I’ll interact with these people. I’ll frame my problem like this…..

Some seemingly unrelated choices impact on the solutions offered by their health practitioner. It may be that people carry on making choices that undo all the benefits offered in prescribed, neatly packaged and costly labelled boxes.

If you are in healthcare how do you know the solutions you are offering are effective or even the best available? Could you do better?

Picture by World Bank Photo Collection

What’s the most annoying thing you hear when things go wrong?

Sometimes things don’t go to plan. The package doesn’t arrive, the flight is cancelled, the meal is cold or the documents are lost. The most unhelpful thing you can be told by someone you contact in those circumstances is:

Sorry, it’s not my job. Nothing I can do. We are short staffed, we told the boss that months ago. Call back after the weekend during office hours.

  1. What would you say?
  2. What do you say to your client, customer or patient?

Picture by Jesper Yu