I thought this image from Optum was very telling. This is why coordinated care is so important and why it’s important to leverage technology to engage consumers and support their care team.
When I was in architecture school, Michael Graves was one of those architects that we studied. Everyone wanted to be like him designing cool building like this one below. Since then, he’s gone on to be even more famous both from an architecture perspective and a design perspective (even having his own Target line).
But, since he was left paralyzed from the chest down in 2003, he’s had an incredible focus on redesigning healthcare from the perspective of the patient. [I would put him in a similar e-patient category as e-Patient Dave, but while Dave is focused on technology and data, Michael is focused on furniture and spatial experience.)
I was thrilled to get the chance to talk with him yesterday to see how this effort was taking off, and on a personal note, to see if this idea of architecture influencing outcomes would be generally accepted. My general takeaway after talking with him was that he’s getting a very positive response as he talks to people about it, but you’re not seeing a sea-change in terms of clients focusing on this or his fellow architects embracing this. But, as someone in healthcare, this isn’t surprising. We know it takes physicians 17 years to adopt new standards…why should it take the administrators of those physicians any less.
At the same time, there is a huge focus on the patient experience and on outcomes these days. Both of those can be improved through a focus on the physical experience. I asked him whether he was seeing interest from both inpatient and outpatient facilities. He indicated that the dialogue is all happening around hospitals which isn’t surprising given their investments in new facilities and the industry shift around ACOs and PCMHs. But, any of us that have sat in a physician’s office looking at posters from the drug companies, outdated magazines, or just an overly sterile room, know that these things don’t relax you or make you comfortable.
Michael tells a story that I’d seen in other articles about how he first came to understand all the problems with the physical space in the hospital. He wanted to shave one day and realized that he couldn’t see himself in the mirror and he couldn’t reach the water to turn it on. It was all designed by someone that hadn’t put themselves in the patient’s shoes (or wheelchair) to understand their perspective on the space.
Since “evidence-based medicine” is all the buzz in the healthcare area, I asked him about the term “evidence-based design” which is used in several articles and on his website. As he pointed out, it’s basically about just using common sense, but I do think there’s more there (to eventually sell this). To me, this implies a level of rigor linking more practical furniture and spatial redesign to clinical outcomes and patient satisfaction. These are the things that are going to motivate the CFO to open the purse strings to make a change. Unfortunately in our healthcare system, there aren’t a lot of changes made just because the patient wants them or they make sense. Otherwise, we’d have a healthcare system not a sick care system.
The final topic we discussed was moving beyond furniture to look at art and color and other things that could effect the patient’s experience. He told me that he’s also a painter (which I didn’t know) and mentioned that one of his clients had bought some of his art and furniture for their facility. He also reinforced a study that I’d seen before about not using abstract art but focusing more on natural scenes within the patient setting (also mentioned below).
Here’s a few articles from other interviews and a link to the work he’s doing with Stryker on medical equipment / furniture. You can also see a press release on his upcoming presentation at the end of this post.
And, while Michael is focused on the furniture and spatial experience, there are others focused on the art, colors, and other aspects of the hospital experience. I found this text from The Atlantic from a few years back that even talks about some of the studies that have been done. [Maybe case managers should be asking for specific rooms in facilities!]
Such “evidence-based design,” which draws its principles from controlled studies, is the great hope of professionals who want to upgrade the look and feel of medical centers. Much of this research follows a seminal 1984 Science article by Roger S. Ulrich, now at the Center for Health Systems and Design at Texas A&M. He looked at patients recovering from gallbladder surgery in a hospital that had some rooms overlooking a grove of trees and identical rooms facing a brick wall. The patients were matched to control for characteristics, such as age or obesity, that might influence their recovery. The results were striking. Patients with a view of the trees had shorter hospital stays (7.96 days versus 8.70 days) and required significantly less high-powered, expensive pain medication.
Along similar lines, a 2005 study compared patients recovering from elective spinal surgery whose rooms were on the sunny side of a ward with those on the dimmer side. Those in the sunnier rooms rated their stress and pain lower and took 22 percent less pain medication each hour, incurring only 80 percent of the pain-medication costs of the patients in gloomier rooms. Other studies, with subjects ranging from the severely burned to cancer patients to those receiving painful bronchoscopies, have found that looking at nature images significantly reduces anxiety and increases pain tolerance. Not all distractions are good, however. Ulrich and others have found that inescapable TV broadcasts and “chaotic abstract art” can increase patients’ stress.
Press release about his upcoming presentation:
World-Renown Architect Becomes Healthcare Advocate After Rare Illness Leaves Him Paralyzed
Michael Graves to speak at medical conference about his passion for healthcare design
Michael Graves, the award-winning architect and product designer famous for his collection of home products sold at Target, will address the country’s top healthcare professionals during a special reception at the 2012 Health Forum and the American Hospital Association Leadership Summit next month. He will give a personal account about how paralysis fueled his desire to improve healthcare design.
Graves, who was recently named the 2012 recipient of the Richard H. Driehaus Prize and applies his design philosophy to designing better hospitals and home care environments, will be the featured speaker immediately following the welcome reception of the 2012 AHA Summit, at the San Francisco Marriott Marquis, at 7 p.m., Thursday, July 19.
In his lecture, “People First: Redesigning the Hospital Room,” Graves will discuss his own experience with a sinus infection that left him paralyzed from the chest down and how undergoing hospitalization and rehabilitation in inadequately designed hospital rooms has inspired his healthcare designs.
Graves talk will focus on design solutions for Stryker Medical, including a collection of hospital patient room furniture that addresses common hospital problems such as infection control, patient falls and clinician back.
“We are thrilled to have such a highly-acclaimed and gifted architect speaking before the healthcare community about ways of improving the hospital setting,” said Harold Michels, senior vice president of the Copper Development Association (CDA), the organization hosting the dinner event with Graves. “This is a can’t-miss event that will certainly have hospital CEO’s and healthcare advocates talking about way after it’s over.”
Graves has said that spending months in hospitals during his recovery in 2003 opened his eyes to poorly designed patient rooms, and made him realize the patient experience could be improved by design. He immediately began to sketch ideas for improving hospital buildings, room and furniture.
The event is being presented by CDA’s Antimicrobial Copper team, which is working to advance the message that copper surfaces intrinsically kill disease-causing bacteria. On display will be a variety of antimicrobial copper products, which can play a pivotal role in healthcare facilities by killing bacteria that cause hospital-acquired infections and by reducing costs.
Laboratory testing has demonstrated that antimicrobial copper surfaces kill more than 99.9% of the following HAI causing bacteria within 2 hours of exposure: MRSA, VRE, Staphylococcus aureus, Enterobacter aerogenes, Pseudomonas aeruginosa, and E. coli O157:H7.
Graves is internationally recognized as a healthcare design advocate, and in 2010, the Center for Health Design named Michael Graves one of the Top 25 Most Influential People in Healthcare Design. Graves regularly gives lectures to major healthcare advocacy groups, including AARP, the Healthcare Design Conference, Medicine X and TED MED.
About Michael Graves & Associates
Michael Graves & Associates has been in the forefront of architecture and design since AIA Gold Medalist Michael Graves founded his practice in 1964. Today, the practice comprises two firms run by eight principals. Michael Graves & Associates (MGA) provides planning, architecture and interior design services, and Michael Graves Design Group (MGDG) specializes in product design, graphics and branding. MGA has designed many master plans and the architecture and interiors of over 350 buildings worldwide, including hotels and resorts, restaurants, retail stores, civic and cultural projects, office buildings, healthcare, residences and a wide variety of academic facilities. MGDG has designed and brought to market over 2,000 products for clients such as JC Penney, Target, Alessi, Stryker and Disney. Graves and the firms have received over 200 awards for design excellence. With a unique, highly integrated multidisciplinary practice, the Michael Graves Companies offer strategic advantages to clients worldwide. For more information, visit www.michaelgraves.com.
About the Copper Development Association
The Copper Development Association Inc. is the market development, engineering and information services arm of the copper industry, chartered to enhance and expand markets for copper and its alloys in North America. Learn more on ourblog. Follow us on Twitter.
As yesterday was Father’s Day, I was thinking about my father and the many things he taught me:
- You can do anything.
- Be humble and kind to those around you.
- Family is important.
- Have values and stick to them.
- Enjoy life.
He didn’t push me to be a star athlete. He didn’t push me to get a 4.0. He did have high expectations of me, but he was more focused on building my moral code than anything else. He wanted me to learn things like the games of Chess and Bridge. He wanted me to meet lots of people. He wanted me to do chores and contribute to the household. He wanted me to have a job. He’d take me to play golf or tennis or any other sport, but only for fun, not to try to build the next pro athlete.
This made me think about other types of leaders that I’ve experienced in my life:
- Leader as mentor who takes you under their wings and tries to open your eyes to new possibilities
- Leader as teacher who is constantly trying to get you to try new things to become better
- Leader as friend who is trying to know you and hang out with you to build loyalty
- Leader as genius who is just amazingly smart and someone you want to try to be around
- Leader as innovator or entrepreneur who is pushing the envelope and trying to change the world and motivates through big ideas
- Leader as workaholic who simply motivates by working so hard that you try to keep up
- Leader as prison guard who motivates through punishment and yelling who motivates through fear of losing your job
- Leader as preacher who captivates you with stories and vision that motivates you in a cult like fashion
Is anyone perfect? Probably not, but thinking about Father’s Day got me thinking about the leader as father model who blends some of all of these. Friend, Preacher, Teacher, Punisher, Genius, Workaholic, etc. They provide you a model to follow and have a vested interest in your success whether it’s working for them or working somewhere else. They care about you being the best that you can.
A former sales executive once pointed out to me the fact that he liked to hire people that had competed at the highest level in sports. I didn’t understand why, but his explanation made a lot of sense to me.
- They learned how to set goals and train and prepare for those goals.
- They knew how to win.
- They knew how to lose, reflect on the loss, move on, and prepare to win again.
I think number three is what gets lost in the “trophy generation” that we see out there today. Kids that only know how to win and throw their rackets or get upset if they lose. They don’t understand the value of competition, of being pushed, and of learning how to lose with grace.
When I was watching the movie The Tooth Fairy last week, it really got me thinking about how some people push their kids so hard into sports at such an early age. I heard one 10 year old parents talk about their kid being in the next Olympics (when their not even the best at their sport that I know).
Here’s some examples of what I’ve seen which seem wrong:
- A 6-year old that is home schooled so he has more time for private lessons in his sport
- A kid who is only rewarded if she sets 3 records this summer
- A kid who is paid to beat certain people at her sport
- A kid who is punished by extra practice if she doesn’t perform perfectly
- Multiple kids playing on 2 or 3 different teams simulateously in the same sport
- Kids training 4-5 hours per day / 6 days a week at age 9
I see more and more parents (of kids under 11) video tapping their performances and then breaking down their play after they perform with them. The focus is always on the negative. As I heard one kid say, “be my parent not my coach”. I think that’s important. Parents can’t project their expectations of paying for college and fame on their kids at such an early age.
This leads to self-esteem issues. It leads to burnout. It leads to over training. And, it can lead to false expectations that manifest themselves in poor sportsmanship.
For example, I know one kid that my kid has to compete with came up to her and said “why are competing on this team…I can’t win if you compete”. Never mind the team spirit. This kid wants the personal recognition even in a category that she doesn’t compete in year-round, but she thinks she should be a star in whatever she does. This is what leads kids to cheat and be bullies.
Here’s a few other articles on this topic:
Here’s a quote from an interview with David Ellis a sports nutritionist about specializing too early:
Early bloomers typically have an advantage on these AAA teams, and while they dominate the domestic stage with their early maturity and specialization, they are not as competitive on the international stage once other competitors have matured. In fact there is evidence that the athlete who didn’t specialize early and was a little later in maturation might end up being the better athlete! Why you ask?
That multi-sport athlete kept on developing motor skills and competitive vision that might have been more challenging in totality than the narrowed focus of the specialized athlete. These multi-sport athletes are hungry to compete as they approach their prime, and because many were late bloomers, they had to be smarter players to make up for their lack of size and strength. So when their bodies do catch up maturation-wise, they often times have a sharper set of skills, and the net result is an athlete who has the tools and the motivation to compete at an elite level versus the burn out early specialized athlete who often seems to have peaked too early and below their net potential.
Another big focus area these days is around the creation of transparency solutions to enable consumers to make better cost decisions about their healthcare. While several companies have sprung up to work directly with consumers, the large payers have begun to rollout their own solutions. And, as you can see from the Towers Watson and National Business Group on Health 2012 Survey, this issue of transparency was the 3rd biggest focus area for 2013.
If you havent’ heard much about the topic, here’s several articles about the challenge of price discrepancies and surprise bills to consumers:
- Navigating out of network claims
- Healthcare price differences
- Healthcare bargain hunters
- Employers need transparency tools
- Shopping for surgery
Here’s what UHG and Aetna are doing:
A few of the companies to look at are:
Companies like GoodRx are creating solutions in this area.
You also might enjoy this infographic from Change Healthcare.
If you don’t believe this is a big issue in terms of price differentials, take a look at this data from the Healthcare Blue Book. This shows a huge swing in prices which depending on your plan design can directly impact your out-of-pocket spend.
|Test or treatment||Low||Fair||High|
|Brain MRI||$ 504||$ 560||$ 2,520|
|Complete blood count||15||23||105|
|Laminectomy (spine surgery)||8,150||11,744||25,760|
|Laparoscopic gallbladder removal||5,000||6,459||12,480|
|Transurethral prostate removal||4,000||4,409||8,875|
Turning your smartphone into a diagnostic device seems to be a large focus right now. I just saw another one called CellScope. They allow you to take a picture of your inner ear or your skin and submit those for review.
From a recent article:
Khosla Ventures also recently invested $1 million in CellScope, an alum from Rock Health’s first class of startups in 2011. The company is developing smartphone peripheral devices designed for consumers to use for at-home diagnosis.
Think of it as a “modern-day digital first aid kit.”
CellScope’s first offering will be a smartphone-enabled otoscope that will enable physicians to remotely diagnose ear infections in children. Parents will be able to use the peripheral, which attaches to a smartphone camera lens, to send an image of their child’s inner ear that physicians can use to make a diagnosis and then write a prescription if need be. CellScope says ear infections in children make up 30 million doctor visits annually in the US alone. The consumer device would help parents miss less work and potentially cut down on late night emergency room visits, according to the startup.
The startup traces its origins to bioengineering Professor Dan Fletcher’s lab at UC Berkeley, where CellScope founders Erik Douglas and Amy Sheng were developing cellphone-microscopy for remote diagnosis in developing countries. CellScope expects to launch future products focused on throat and skin exams, including non-clinical apps for consumer skincare.
Here’s a summary of some of the data from the latest Express Scripts Drug Trend Report relative to Diabetes.
- 26M Americans have diabetes
- 15% of Americans (or 39M) will have diabetes by 2020
- Diabetes costs $194B per year (health spending) and that is expected to rise to $500B by the end of the decade
- 41% of diabetes are non-adherent to their medications
- 60% of diabetics using insulin don’t regularly self-monitor their blood glucose levels
- The drug costs are $81.12 PMPY (based on high utilization of metformin (a generic)) with 14.91 Rxs per user per year (which seems low since the average diabetic takes 5 medications from what I know)
This gives you some data, but I pulled this data from an older blog post of mine from the ADA…
I found this list of diabetes fact from the American Diabetes Association in an article I was reading:
- 25.8M children and adults in the US have diabetes (8.3% of the population). This includes 7.0M who haven’t yet been diagnosed.
- 1.9M new cases of diabetes were diagnosed in people 20+ in 2010.
- 215,000 or 0.26% of all people under 20 have diabetes.
- In 2007, diabetes was listed as the underlying cause of death on 71,382 death certificates and as a contributing factor on another 160.022 death certificates.
- Adults with diabetes have heart disease death rates 2-4x higher than adults without diabetes.
- The risk for stroke is 2-4x higher for people with diabetes.
- Diabetes is the leading cause of blindness among adults ages 20-74.
- Diabetes is the leading cause of failure accounting for 44% of new cases in 2008.
- Total cost of diagnosed diabetes in the US was $174B in 2007.
And, depending on if you focus on pre-diabetics, the population becomes even larger. I expect with more and more companies doing onsite biometric screening that the population in diabetes management programs will increase significantly over the next few years. The keys will be treating them differently based on risk, disease understanding, and patient preferences to make the programs cost effective.
I read a great article the other day about adherence. It took a great big picture view of the topic.
You can’t expect a patient to be adherence to a medication or compliant with your orders if they don’t understand their condition and/or the medication. This is a very necessary topic even if they’re not a newly diagnosed patient.
This brings into account their literacy level, their plan design, their experience with you as a provider, their experience with the drug, their home life, and many other factors.
I’m going to use an experience from this past week outside medicine to reinforce this point…
I was down in the Destin Beach area this past week and wanted to go out on a charter fishing boat with my family. We finally found a boat and rented it. At 6:30 am when we were about to get there, the captain called to cancel because the boat wouldn’t start. We were disappointed, but I’d rather be stuck on land then trapped at sea.
But, with 4 others in tow, I wanted to make good on my coordinated plan so I walked the docks for 20 minutes and found a captain who’s charter had no showed. I’ve been on a few charters so I had some expectations. But, in the end, I was very disappointed.
- The captain drove the boat like a madman bouncing all of us around and never really gave any directions.
- His first mate had only been doing this for 2 weeks and while more personable wasn’t much help.
- Apparently, they have to catch their live bait every morning which ate up over an hour of our trip before someone shared some of theirs with him.
- And, after a 4 hour trip, we only caught two catfish.
To make it worse, when we pulled in there were boats unloading all kinds of huge fish.
So, did we hire the wrong boat? Did we get ripped off?
I don’t know, but I know that the paper said that the waves were so ruff that 4 boats capsized the day before leaving fishers in the water being tossed around and requiring the coast guard to save them. (This was certainly not what I wanted.) I also know I had a choice between bay fishing (more calm) and gulf fishing (more rough).
My point with this comparison was:
- Although I’ve been fishing before, like a patient going to a new provider, they could have set some expectations for me by knowing what they do compared to others.
- Communications are key. If the captain had provided some perspective on what he was doing instead of just doing it, I might have had a better expectation and perspective. Do fish bite in rough water? Why would they catch a lot in the gulf and nothing in the bay? Were others catching more?
Now if only fishing would move to a pay-for-performance experience then I would have left there disappointed but not having paid for being disappointed.
I know we can all complain about the government telling us what to do, but at the end of the day, they’re not saying we can’t drink soda. As far as I know, you can still have unlimited refills in NY. They are simply reframing one aspect of drinking soda to try to nudge us into being healthier. Ultimately, this should be a good thing for us for several reasons.
- We eat or drink whatever is put in front of us. Just look at this research.
- Soda and other sugary drinks are generally not good for us. Just look at the infographic below.
- We have an obesity problem in this country (in case you didn’t know it).
- Obesity drives diabetes, kidney problems, hypertension, and many other problems that are driving up our healthcare costs and turning us into the first generation to potentially live shorter lives than our parents.
- Nudging people into behavior change works.