This is worth watching

The Kaiser Family Foundation presents a creative, simple interpretation of Health Reform in this Youtube video.  Hope you'll watch

http://healthreform.kff.org/The-Animation.aspx

The following is an interesting summary of a study done on errors in research design: Empirical Evidence of Prevalence of Methodological Problems in Published Reports of Randomized Trials (Altman, 2002).

Failing to specify eligibility criteria

                25% of 364 reports in surgery journals

Not reporting an adequate method for generating random numbers

                68% of 206 reports in OB/GYN journals; 52% of 80 reports in general medicine journals

Not reporting the mechanism used to allocate interventions

89% of 196 reports in rheumatoid arthritis journals, 48% of 206 reports in OB/GYN Journals;  44% of 80 reports in general medicine journals

Failing to state whether blinding was used

51% of 506 in cystic fibrosis journals, 33% of 196 reports in rheumatoid arthritis journals; 38% of 68 reports in dermatology journals

Incorrect analysis of multiple observations

                63% of 196 reports in rheumatoid arthritis journals

Inadequate information on harmful consequences of interventions

                61% of 192 reports in 7 medical areas

Incorrect method of comparison of subgroups

                58% of 50 reports in general journals

References:

Altman, G. (2002, June). Poor quality medical research.  JAMA. 287(21). 2765-2767

How old is too old?

I’ve been searching for info all week to address the topic of  “data lag” in terms of research, i.e., "How old is too old."  It seems that many nurse researchers subscribe to "greater than 5 years old -- don't use it." 


I consulted the Director of Research and Evidence Based Practice (Rebecca Tart, PhD) at my facility.  Based on the information she provided, I see that I’ve been searching for information to support my perspective that “lots of research that uses an economic analysis perspective is not all that valid today due to the time lag.” Dr. Tart helped expand my thinking on this topic. Her perspective is that “nursing is missing the boat in that much of what is being taught in academic programs is that if research is older than 5 years it shouldn’t be considered as all that useful.” That rang a bell. In some of our prior courses, I’ve lost some points on papers for using references that were greater than 5 years old. She went on to explain that “not everything is researched consistently….sometimes there are years of lag time between published studies on a particular topic.

Dr. Tart pointed me to several relevant articles. Balas’ (2001) states there is a 17-year lag time between research and practice changes. Dr. Tart also pointed out the value of considering the long history of research in a topic such as SIDS.  The SIDS article aptly describes with statistical support the gravity of the problem of researchers discounting "old" data. It also suggests that the US lagged even further behind Europe even when the evidence was substantial.


(2163 accesses to date)

Health Services Research Websites -- Who Knew?

• Academy Health – http://www.academyhealth.org
• Agency for Healthcare Quality and Research – http://www.ahrq.gov
• American Nurses Credentialing Center – http://www.nursecredentialing.org/
• American Nurses Foundation - http://www.nursingworld.org/
• American Public Health Association – http://www.apha.org
• Canadian Journal of Nursing Research - http://www.cjnr.mcgill.ca/
• Center for Disease Control and Prevention - http://www.cdc.gov
• Centers for Medicare & Medicaid Services – http://www.cms.hhs.gov
• Center for Studying Health System Change – http://www.hschange.com
• Changes in Health Care Financing & Organization – http://www.hcfo.org
• The Commonwealth Fund – http://www.commonwealthfund.org
• Eastern Nursing Research Society - http://www.enrs-go.org/
• EBSCO – American Sentinel University (online)
• Health Affairs: The Journal of the Health Sphere – http://www.healthaffairs.org
• Health Services Research Journal – http://www.hsr.org
• The Henry J. Kaiser Family Foundation – http://www.kff.org
• How to Write a Dissertation - http://www.cs.purdue.edu/homes/dec/essay.dissertation.html
• Institute for Healthcare Improvement – http://www.ihi.org
• The Joint Commission – http://www.jointcommission.org
• Mathematica – http://www.mathematica-mpr.com/health
• Medline Plus - http://www.nlm.nih.gov/medlineplus/
• Medismart - http://www.medi-smart.com/grant-writing.htm
• Merlot - http://www.merlot.org/merlot/index.htm
• Midwestern Nursing Research Society - http://www.mnrs.org/
• National Institute of Nursing Research - http://www.ninr.nih.gov/
• National Library of Medicine - http://www.nlm.nih.gov/
• The National Quality Forum – http://www.qualityforum.org/
• NDNQI – http://www.nursingquality.org
• Nursing Portal (Research Search Engine) - http://www.nursing-portal.com/nse.asp
• Nursing Research - http://www.jcu.edu.au/soc/nursoc/html_pages/nursing_research.htm
• Rand Corporation – http://www.rand.org/health
• The Robert Wood Johnson Foundation – http://www.rwjf.org
• Southern Nursing Research Society - http://www.snrs.org/

Health Services Research

Today is the first day of this course.  So what is Health Services Research (HSR)?    The Agency for Healthcare Research and Quality (AHRQ) definition of Health Services Research (HSR) is "the multidisciplinary field of scientific investigation that studies how social factors, financing systems, organizational structures and processes, health technologies, and personal behaviors affect access to health care, the quality and cost of health care, and ultimately our health and well-being. Its research domains are individuals, families, organizations, institutions, communities, and populations ("Health services research core competencies", 2007, para. 11)."

To give some idea of what I think HSR is all about...here is one of my discussion board posts for this weeks' introduction to HSR:

Healthcare is largely about mission, although the engine that drives it is money. While other industry research is driven to make more money, in healthcare, research is theoretically driven to use less money – how do you provide higher or better care for less dollars? 

This quest for less expensive alternatives then feeds another unique characteristic of health services in that there is an expectation from the consumer that they are entitled to virtually unlimited quantities of healthcare without cost and that it be immediately available when needed.

This, in part, comes from the perspective of the consumer that healthcare is free since generally the consumer does not pay for it. Employers (through healthcare insurance), insurance companies, the government or some other entity is ultimately responsible for the largest portion of any healthcare bill.  Those without 3^rd party payors to deal with the cost, who remain nominally responsible for the charges, are largely individuals without resources to pay any portion of their costs,further driving the perspective that there is no charge, i.e., “I don’t have to pay for it, therefore it is absolutely free and I should use as much of it as I want.”

The payment structure is competing in that it wants to reduce the cost of healthcare while at the same time raising the quality as much as possible, but ultimately the consumer of healthcare is a third party who is not involved in that decision making process.

Finally, the complexity of health services is much greater than in most industries because of the virtually unlimited number of variables that impact decisions – health habits of individuals, socioeconomic status of consumers, types of services available in the community, technology available in the community, and any number of other things. Putting all of these variables together and then attempting to provide services among the infinitely variable individual consumer needs makes it virtually impossible to nail down any common factors. It is, to some extent, like nailing Jell-O to the wall.

These unique characteristics of the healthcare industry – an industry that wants more, for less, while being paid for by someone other than the recipient – have contributed to the need for a specialized paradigm of research specifically devoted to health services.

Reference:

Shi, L. (2008). Health services research methods (2nded.). Clifton Park, NY: Delmar Cengage Learning.

2 week break coming to an end

My 2 week break between courses is coming to an end on Sunday.  The next course -- Health Services Research -- begins Monday morning.  I'm already into the course work though -- reading and writing.  It's never-ending.  But that's what I signed on for I suppose.

I'll explain what Health Services Research is in my next post.

I've enjoyed the break between courses.  Now it's time to re-engage fully and get on with it.

From a Facebook Friend

Illegal immigration is not a new problem, Native Americans used to call it 'White People' (borrowed from David...who Borrowed this from Gordon).

This is the last week of the Quality Course

Looking back on this course, I would say that I knew a lot about this topic from my past work experience.

Here is a summary of my "aha's" from this week's discussion question.

Discussion Board Question:  Discuss your “aha” moments during this course. How will this change how you approach quality improvement?

Knowing this question was coming, at the end of each week of the course I recorded my "aha's." Below is my list. Week 1 Aha’s I believe “simple and consistent” is one of my core value (and needs) related to quality; yet, I find it so hard to honor these principles in work involving “quality improvement.” The complexity of the actual work done in health care makes this extremely difficult. The way things get “counted” in health care is nuts. I’m skeptical about the level of consistency in “measurement.” Yet, we as an industry are now on this high speed train ride, supposedly headed toward greater accountability. Week 2 Aha’s Little, if any, is done in health care that isn’t intertwined with other disciplines or services. As long as health care is paid by third parties, there won’t be alignment of (or even reasonable) expectations. In my day-to-day experience, the ones (patients) who scream the loudest are usually the ones who have no ability to pay at all. Week 3 Aha The government push for the adoption of the Electronic Medical Record (EMR) will likely move health care further along the technology adoption continuum -- but I wonder if it won’t look like the scene of a car crash a few years from now. Organizations are chasing the funding for this and moving at a "break neck" pace to implement systems. Week 4 Aha Current health care reform changes are much greater than the combined prior 75 years of reform. I am curious but not all that hopeful about what the system will be down the road. Week 5 Aha’s There are tons of quality methodologies, frameworks and tools -- Deming, Juran, Crosby, Six Sigma, LEAN, etc. These are the paths to get to a place. If leadership isn’t clear about “the place” they are going (no vision).....there won’t be much progress. My “aha” was “that’s ok” -- maybe I’m in a setting where we can contribute the “churn”....and small lessons learned and contribute that to the body of knowledge via publications....and the other places where there are tons of resources to be shared. Change requires leader clarity about the organizations culture. Even more important is that the leader understand the culture well enough to navigate prior to instituting change. Week 6 Aha This was a good “reflection” exercise to help remind me of the importance of thinking through stakeholders, clear timelines, and measures of success. Week 7 Aha The principles defined from the Contract Research Organizations (CRO) question reinforced my belief that when professionals have a narrower focus they are able to “do better” work. 1890 accesses to this site as of today

Update

Almost done with the quality course.  Will give a summary of the course as soon as I get the last discussion board post done tomorrow.

"Everything will change when your desire to move on exceeds your desire to hold on." -a.cohen

Really??????

This October has 5 Fridays; 5 Saturdays; and 5 Sundays; all in one month.  It happens once in 823 years.

Read more about this myth.....


http://unitedcats.wordpress.com/2010/10/04/this-october-has-5-fridays-5-saturdays-and-5-sundays-all-in-one-month-it-happens-only-once-in-823-years/

Saw this yesterday on a billboard

FEAR=
False
Evidence
Appearing 
...Real

Humor...essential to this journey

Tom's scrotum 
 
The pastor asked if anyone in the congregation would like to express praise 
for answered prayers.  Suzie Smith stood and walked to the podium.  She 
said, "I have a praise.  Two months ago, my husband, Tom, had a terrible 
bicycle wreck and his scrotum was completely crushed.  The pain was 
excruciating and the doctors didn't know if they could help him." You could 
hear a muffled gasp from the men in the congregation as they imagine the 
pain that poor Tom must have experienced.  "Tom was unable to hold me or the 
children," she went on, "and every move caused him terrible pain."  We 
prayed as the doctors performed a delicate operation, and it turned out they 
were able to piece together the crushed remnants of Tom's scrotum, and wrap 
wire around it to hold it in place." Again, the men in the congregation 
cringed and squirmed uncomfortably as they imagined the horrible surgery 
performed on Tom.  "Now," she announced in a quivering voice, "thank the 
Lord, Tom is out of the hospital and the doctors say that with time, his 
scrotum should recover completely." All the men sighed with unified relief. 
The pastor rose and tentatively asked if anyone else had something to say. 
 
A man stood up and walked slowly to the podium. 
 
He said, "I'm Tom Smith." The entire congregation held its breath.  "I just 
want to tell my wife the word is sternum." 

Life is meaningless only if we allow it to be. Each of us has the power to give life meaning, to make our time and our bodies and our words into instruments of love and hope.

My post to one of last week's discussion questions

What are the strategies that have worked in getting physicians and nurses to adopt evidence based practice?

“Resistance to adopting evidence-based practice is not a modern phenomenon. In his extraordinary treatise on disseminating innovations in health care (JAMA 1969;289:75), Dr. Don Berwick notes that after the discovery that sauerkraut and limes prevent scurvy, it took 147 years for that simple measure to become a matter of nautical policy” (Rubin, 2005, para. 2).

Most humans do not embrace change readily. We seem especially reluctant to do so when the change threatens to alter our personal philosophy or increases the effort needed to accomplish a task. We are creatures of habit and follow “the way we’ve always done it” as the path of least resistance regardless of the evidence presented. One need only look at the evidence between smoking or food and health issues.

Healthcare is no exception. Historically, when confronted with evidence both physicians and nurses have avoided or ignored it. That has changed somewhat in recent years. Information is more readily disseminated and new entrants to the profession are taught to value and practice according to the latest evidence.

Pham & Ginsburg (2007) frame the roots of the explosion of the use of research and EBP in healthcare to the “quiet revolution that began in the late 1980s, fueled by an expanding volume of health services research and influential reports from the Institute of Medicine on the suboptimal quality of much of the medical care in the United States” (p. 1588).

Physicians

Cultural barriers have contributed to physician opposition to evidence based practice. Historically, physicians learned under an apprenticeship model that led to a great deal of autonomy. They viewed themselves (and were viewed by the public) as “heroes” who miraculously resolved problems, much the way that current television shows such as “House” do. Physicians opposed what they perceived to be “cookbook medicine” that potentially questioned their judgment and decisions through the application of standardized procedures or protocols that took away their autonomy – and importance.

Accountability for physicians to use current evidence comes from multiple sources. First, educated consumers demand it. Online referrals and “ratings” of physicians are now more available for consumer review.

Evidence based practice has been emphasized in the training programs of the latest generation of physicians. In addition, there has been a proliferation of evidence based practice guidelines and accompanying electronic tools readily available to practicing physicians.

Physicians have been called to accountability by board certification exams that have increasingly emphasized knowledge of evidence based practices. The increased professional expectation that physicians attain and maintain board certification, has forced physicians to stay abreast of the current evidence.

Performance measurement systems and incentive programs have impacted physicians and their willingness to accept evidence based practice guidelines. Government plans, private purchasers and accrediting bodies now require physicians to practice according to current evidence or risk a reduction or loss in payment.

Finally, the health care industry is learning better how to effectively engage physicians in improving quality, i.e., IHI’s Framework for Engaging Physicians in Quality and Safety (Reinertsen, et.al, 2007). This learning is helping to drive a culture change in practitioners using the latest evidence in their practice.

Nurses

Nursing also has its barriers to implementing evidence based practice. Traditionally, nurses practice according to how they learned in nursing school (Koehn & Lehman, 2008) and lack research knowledge, skills and understanding simply because it was not taught in nursing education programs (Pravikoff, et.al., 2005). It’s hard to use research/EBP when you have to first learn how to research, on top of all of your other duties.

Institutional barriers such as financial limitations and lack of prioritization by the organization have also contributed to nursing’s slow adoption of EBP.

In addition to the regulatory push for adoption of EBP described above, I believe a major force in the adoption of evidence based practice has been Magnet designation. Magnet is seen as increasingly desirable for an organization and has some recognition as impacting an organizations bottom line through enhanced marketing. Magnet requires nurse involvement in research and EBP. The Magnet program is such that it’s not possible to merely give lip service to EBP, but it has to be instituted as a critical element in an organizational culture through the allocation of appropriate funding, leadership and time to make the practice a reality.

Today’s nurses are pursing more formal education than in prior decades. BSN education is becoming the norm in many parts of the country. With this increase in education, has come broader exposure to research/EBP concepts.

References

Koehn, M., & Lehman, K. (2008). Nurses' perceptions of evidence-based nursing practice. Journal of Advanced Nursing, 62(2), 209-215. Retrieved from CINAHL Plus with Full Text database.

Pham, H., & Ginsburg, P. (2007). Unhealthy trends: the future of physician services. Health Affairs, 26(6), 1586-1598. Retrieved from CINAHL Plus with Full Text database.

Pravikoff, D., Tanner, A., & Pierce, S. (2005). Readiness of U.S. nurses for evidence-based practice: many don't understand or value research and have had little or no training to help them find evidence on which to base their practice. American Journal of Nursing, 105(9), 40-52. Retrieved from CINAHL Plus with Full Text database.

Reinertsen, J.L., Gosfield, A. G, Rupp W, Whittington JW. Engaging Physicians in a Shared Quality Agenda. IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2007. Retrieved from http://www.ihi.org/NR/rdonlyres/A30445C0-6DA6-40C0-AB12-D2592A9EF1C7/0/IHIEngagingPhysiciansWhitePaper2007.pdf

Rubin, K. R. (2005, July). Resistance to evidence based practice. Emergency Medicine News, 27(7), 3, 43. Retrieved from http://journals.lww.com/em-news/Fulltext/2005/07000/Resistance_to_Evidence_Based_Practice.5.aspx

Thought for the day

When it becomes more difficult to suffer than change - then you will change.

Sunday Dance Routine

Spent all day at the computer writing school related stuff. 

Got up from desk chair thinking I was done for the day.

Walked down the stairs to see what LJ was up to this afternoon.  About half way down the stairs I noticed a black string.  My first thought was "what pair of drawstring shorts has Yoko (the dog) ruined now."  I stepped over the string and continued on down the stairs.  And then something registered in my brain.  At the bottom of the stairs I flipped on the light and voila.......MR. SNAKE.

Pardon me now....I need to go change my undershorts....and burn the pair I had on.

Add caption

Live wakefully. - Osho

Discussion Board Process

Some people have asked me about the weekly discussion board process.  Here's how it works:
a.  All weekly discussion board questions are provided to the student via the Course Syllabus at the beginning of the course.  There are generally from 1 to 3 questions posed for the week.   
b.  Each student is expected to post a response to the week's question as well as respond to any questions asked by other students based on what I post.  Finally, each student must post a response to at least at least 2 others student posts during the week.
c.  All posts to the discussion board must be cited and referenced using APA format.
d.  My routine is to do the reading during the week, outline my responses to the questions on Saturday, finalize and post my responses on Sunday. 

Below is an example of what I posted in response to one of last week's questions:


Question: 

Since customer satisfaction is a key driver in today’s healthcare organization, discuss ways that providers can educate patients and families about what is “quality care” and how they can play a role.

With the advent of insurers successfully tying reimbursement to both cost and (more recently) clinical outcomes, health care providers are learning the results of their quality measures will influence their future success. National regulators, i.e. Joint Commission (Joint Commission [JC], 2010) and CMS (HCAHPS, 2010), are working to develop measures that compare providers fairly. Private for-profit services such as HealthGrades ("Healthgrades", 2010) have seized on the quality comparison movement and are successfully using their formulas to rank both hospitals and physicians based on a 5-star point system. HealthGrades promotes their website to consumers to help them identify the “best” providers in their areas. Hospitals with 5 stars purchase the rights to use the HealthGrades brand in advertising.

The general consumer is obviously a key audience for broad based quality messages. A coordinated public relations strategy built over years of positive promotion is key to building general awareness of the quality of care a hospital and its’ medical staff offer them when they need it. Internal risk managers and hospital attorneys advise against using descriptors such as “best” in messaging as those messages come back to haunt them in litigation. Instead, hospitals use awards and external recognitions such as HealthGrades, Magnet accreditation (Magnet, 2010), and J.D. Power (JD Power, 2010) customer satisfaction results to promote the quality of the organization and its services.

The availability of diagnostic and treatment technology can influence a consumer’s choice of provider and potentially defines the quality of the organization even further. In addition, the availability of physician experts as well as the expertise of staff providers are important components of building the quality image of the organization. My own organization regularly includes physicians/surgeons in advertising promoting the latest technology such as the DaVinci robot. We also have touted the high percentage of advanced training credentials held by our nurses. Obviously, any report of a quality measure must be defined well and accompanied by an explanation of why the measure means that the organization offers quality services.

Patients and their families may choose a provider based on the foundation built by quality messages they have heard or seen over time. After the time they enter the system, though, quality is judged moment to moment.

Examples of items that might impact the public perception of the quality of an organization may include things such as: How long did they have to wait in the Emergency Department? Were the staff and physicians they encountered kind and supportive? Did they read the Joint Commission “Speak Up” posters and then count the number of times someone forgot to check their hospital identification bracelet? Did caregivers seem to give sufficient time to hear concerns and explain items, rather than rushing to get to the next patient? The list goes on and may include non-medical indicators that are easily overlooked by an organization, too.

Do the televisions in the waiting room work? Are there a variety of magazines to read? Is there internet access for those waiting? Are the restrooms clean and stocked with supplies? Are coffee and refreshments available without having to venture far away from waiting rooms? Is there adequate and convenient parking available, and is the parking lot sufficiently lit to make people feel comfortable at night?

Unfortunately, we may be judged not only on the quality of medical care, but also with regard to non-medical indicators that relate to the overall experience. You can have the latest equipment and the most qualified caregivers in the world, but if the bathrooms are filthy, THAT is what people will recall and talk about with their friends.

The bottom line seems to be that each person is an individual and brings perceptions of quality that have been built from exposure to a host of messages. Our challenges are:

- Arm staff with our quality messages including our focus on continuous improvement as our never-ending journey.

- Continuously improve our processes to ensure that our quality measures will be positive as we begin to report them.

- Include not only caregivers in the quality message, but also individuals who have supporting roles, and make sure that they realize that their contribution has an overall impact on a patient / family interactions.

- Perhaps most importantly, assure that every single patient and their family has a very positive experience every single time and views us as the best healthcare partner they could have chosen.

References

HCAHPS. (2010). http://www.hcahpsonline.org

Healthgrades. (2010). Retrieved from http://www.healthgrades.com/

JD Power. (2010). http://www.jdpower.com/

Joint Commission. (2010). Performance measurement initiatives. Retrieved from http://www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/

Magnet. (2010). http://www.nursecredentialing.org/Magnet.aspx

Update

Have spent all day (since about 7 am) at my home office desk finding relevant articles for this week's discussion forum questions.  Even after a really exhausting week, I continue to find these studies worthwhile and provoking.  Without the structure of a formal education program I wouldn't push myself to be read and integrate as deeply as I'm finding that I am now doing. 

FEAR

FEAR -- 2 options

Forget everything and run.

Focus energy and accept responsibility.

Ran across this......found it intriquing

Africa in Perspective

New Start

After 2 weeks of (that sure went by fast), the new course started today. The subject is "Quality Management Techniques."

I was able to get out of town for a few days this past week for some much needed rest and relaxation. Returned home yesterday.

Yesterday I drafted and posted my responses to the weekly discussion forum questions. Today (Labor Day) I spent drafting the first paper that is due in 2 weeks.

Life Happens Amidst School

My 6 week old nephew (Landon) was diagnosed with cystic fibrosis yesterday. Please join me in sending positive and hope-filled energy today to Landon, his parents, and grandparents. They all could use a big boost from the Universe.

Reflections on Business Intelligence Course

I always find it helpful to look back on a project and summarize what I’ve learned, what I might do differently, and how it might impact my practice. As I finish up the “Business Intelligence” (BI) course, a few key “takeaways” come to mind.

The Data Warehousing Institute (2002) defines BI as, “The processes, technologies, and tools needed to turn data into information, information into knowledge, and knowledge into plans that drive profitable business action. Business intelligence encompasses data warehousing, business analytic tools, and content/knowledge management.”

Throughout the course I’ve searched for a way to explain BI that others can understand. My best example is today’s grocery store. When we approach the check-out counter at the grocery store and scan our key fob, we just signed on to the stores Business Intelligence strategy. The key fob scan helps the grocery store to track tons of data about our shopping patterns -- the frequency we shop at their store, the items we buy and how often we buy them, the time of day we shop, our home address, etc. When this data is rolled up into a “data warehouse” the company is able to use the data (Data Mining) to better understand customer patterns. The aim of doing this is to develop strategy to entice future business. The company that has a Business Intelligence strategy knows better what items to put “on sale” that will likely bring us in to shop. They understand what days of the week and time of day to staff up and staff down based on shopper volume. They are able to instantly print out coupons that will entice us to come back to the store to shop with them. They are using their data “intelligently” to grow their “business."

How might business intelligence apply in health care. In many respects, data mining is a lot like gold mining. We’re pulling out tiny bits of relevant information from tons of other things that aren’t so relevant. The difference is that the gold miner then has that data assayed to determine it’s value and uses it as a commodity. Without a solid business intelligence strategy, we tend to just pile our gold on the ground and leave it there, hoping that it’ll make sense someday. We have massive amounts of electronic data about two of our customers -- patients and physicians -- that are widely under utilized.

What data can we put together about consumers that will make them more likely to choose our hospital when they need the type of services that we provide? A key fob probably isn’t the way to go, although maybe it is. How many of us have gotten aggravated at the bank when we call in, give all of our information and explain the problem only to be transferred to someone else and have to do it again? Do we do that with our patients? Could we take the information in once, give the patient a swipe card to carry with them so that their updated information would be immediately available that day, maybe with other information that would let us know about potential things that would make a difference to them when they choose health care? Would the information about our patient’s use of our services be useful? What if we had a way to better track and analyze how physicians direct patients to use our services? How would this improve our business strategy?

I don’t know the answers to these questions, but what I do know is that we need to improve our data mining and create a business intelligence strategy.

A few of my other takeaways from the course are:

a. Health care is significantly lagging in terms of using data for business intelligence purposes.

b. Having the BI “tools” (i.e., Data Warehouse, Data Mart, Data Mining software, etc.) in place in an organization is only part of the BI equation – processes and people are critical to a successful BI strategy as well.

c. The value of BI relates to the profitability of the business action. If data and information gleaned from the BI work are ignored, the practice of BI is of little value. Collecting data for the mere function of collecting data is pointless. You have to put it into a workable plan.

d. Senior management in most companies today aren’t well versed enough in understanding their information technology systems (unless they are techies) to know that BI is a strategy that could help move their company ahead of the competition.

The next course begins Labor Day Monday. I’ve come to understand better that the schedule structure of this program is like “year round school.”

(1410 blog views as of today)

OCD

OCD -- Opportunity for Convalescence & Dreaming

From my school colleague Chris.

"Great minds discuss ideas; Average minds discuss events; Small minds discuss people.” -Eleanor Roosevelt

Another milestone

I just posted my responses to Week 8's forum in this course on Business Intelligence.  All that remains now is to respond to my classmates postings in the forum this week.

I feel relieved -- not ecstatic yet; more like a feeling a calmness and peace. 

In the next few days I'll get a post up on here about my overall perception about the course.

I think I deserve a drink -- a nice diet coke of course.  NOT!!!!

More "excepts" from one of my papers

Nationwide, there are currently 27 state laws that require public reporting of hospital-acquired infection rates. Two states allow confidential reporting to state agencies, three have voluntary public reporting, and five states have study laws on public reporting. Only 13 states and the District of Columbia have no laws on public reporting of hospital infections, but some of those have pending bills ("State Legislation", March 2010).


North Carolina does not currently mandate public reporting of hospital infection data, but the legislature is moving in that direction. A bill introduced in the NC House last year would have appropriated $1.1 million over two years to create a mandatory statewide surveillance and reporting system for hospital infections. Dismal state finances pushed the bill off the lawmakers’ radar, granting a reprieve to those facilities that are not ready to comply with public reporting. A North Carolina Hospital Association spokesman says that the state isn’t ready for public reporting, asserting that, “inaccurate and insufficient data” could provide as much public harm as benefit (Davis, 2010).

Wisdom from my friend Dominick

"Working with a 'psych' patient years ago...she constantly kept telling me...'it's people...people make you crazy....if it wasn't for people...no one would be crazy.!!'

Today I realize what wisdom she had. "

_____________________________________

Now that makes me laugh.   eb

From "Good to Great"

In his book, “Good to Great,” author Jim Collins (2001) observes, “. . . the journey to good, or moderate success, is far easier than the journey from good to great.’” Identifying strategic solutions that will move a healthcare organization to achieve greatness and then to sustain that level of quality is not simple.


Collins (2003) and his researchers identify 11 companies in which substantial improvements in performance have been made, and sustained, over 15 years or more. Among the common factors that these companies have are:
a) disciplined people
b) disciplined thought,
c) disciplined action, and,
d) multiple generations of leaders who balance preserving their core values with stimulating progress.

According to Collins, managers of these companies understand the importance of ensuring that the right people are on board before organizational visions or strategies are decided, and are clear about the primary purpose of their organizations. They also tend to have a culture of discipline that makes workforce hierarchies almost unnecessary and exhibit a willingness to use technology to accelerate their successes.

Excerpted from one of my recent papers

Almost done

I am beginning week 7 tomorrow of the 8 week course.  My final paper and associated Powerpoint are done.  All that remains are the last 2 weeks of Forum discussions.  We may have lost one student from the cohort -- not sure.  The student's conflict relates to job pressures making it difficult for her to fully participate in the coursework.  

Academic Freedom in the Age of Distance Education

Worth a read...

http://www.icte.org/T00_Library/ID126.htm

"The capacity to learn is a gift;

The ability to learn is a skill; 

The WILLINGNESS to learn is a choice." 

                                                -Unknown

Where have I been?

I'm in that "in between" phase of the course -- mid-way through.  This started week 5 (of the 8 week course).  My major paper is drafted.  I've calculated that it takes me about an hour per page for a final product, i.e., a 20 page paper requires about 20 hours investment in researching and writing.  That's in addition to the weekly forums (message boards) that must be researched and responded to as well.

All in all, no complaints whatsoever. I'm learning new "stuff"  and enjoying the camaraderie and support amongst my classmates.

So....life is good....albeit a bit boring.

Next task for this course -- develop a Powerpoint presentation to accompany the paper.

(1147 hits on this page as of today)

Professor wisdom

There's been a bit of an issue with timeliness of posting on the online forums by some of those in the class.  The professor clarified expectations today via the discussion board.  She also said the following -- which stuck with me for some reason --

"as an undergrad....you learned about the dots. When you get your Masters, you learn to connect the dots, when you get your terminal degree (your Doctorate), you should be creating new dots for those who read your work"

I like that.  But one thing I'm stuck on is......why is it called a "terminal" degree?  That brings up all kinds of negative connotations for me.  Does "terminal" represent "nearly dead" by the time the degree is attained?

Today's affirmation -- because I need it

The hidden treasure is in an earthen vessel, which is you -- which is me. You (I) have everything you (I) need inside you already.Yup, everything!

Where have I been lately?  Writing.  The discussion boards for the course I'm in takes about 5 to 6 hours a week -- sometimes more, sometimes less.  

I've also been working on the major paper for this course (Business Intelligence).  The assignment is to create a business intelligence strategy for a unique topic relevant to my work setting.  The topic I chose is Surgical Site Infections. 

(1112 hits as of today)

Good Morning! Today, you have been granted 86,400 seconds. You will never get them back, so use them wisely!!!

Excerpts from my first paper

Position Statement

Children and adolescents deserve to live free from harassment and antagonism due to their sexual orientation. A group of concerned citizens (hereafter referred to as “steering committee”) in the Hickory metropolitan area are exploring the opportunity to create a positive social support network for the area’s lesbian, gay, bisexual, and transgender (hereafter referred to as “LGBT”) youth. The steering committee’s vision is to build a social support structure for LGBT youth with a twofold purpose. First, implement a safe social outlet offering self-esteem, physical care, and self-awareness education. Second, offer intervention services such as a crisis hotline and temporary safe housing for at-risk LGBT youth.

Unfortunately, the support and service needs of LGBT youth are unique and are not being addressed by traditional local youth organizations. These youth present a convenient target for discrimination in many venues including schools, malls, churches, and other social arenas (The National Longitudinal Study of Adolescent Health, 2001). In 1995, Advocates for Youth reported that over 50% of organizations serving youth in the nation at that time believed they did not have the needed services or resources to educate or support LGBT youth. Sadly, not much has changed over the ensuing fifteen years, especially in average sized cities in the US.

Rationale

Research indicates that today’s LGBT youth are more visible within our school systems and communities. For example, in a typical class of 30 students, eight (27% of the class) will be directly affected by homosexuality of self, one or more siblings, or one or both parents (Campos, 1996). As societal attitudes toward homosexuality have moderated, more and more youth are revealing their sexual orientation at younger ages. A majority of students in a Harris Interactive survey (2005) admitted knowing gay, lesbian or bisexual students, and slightly more than one-third of teachers acknowledged knowing a student with same-sex orientation. LGBT students face the same issues all young people do regarding self-awareness, identity, emerging sexuality and relationships (Dube, 1999). Social awareness of LGBT individuals comes from various media sources and changing social mores that are, to some extent, positive and affirming. But, today’s youth are often ostracized because of their actual or perceived sexual orientation. Without traditional family, religious or educational organizations to provide appropriate and sympathetic peer groups, LGBT youth end up feeling isolated and alone. With the growing acknowledgement that LGBT youth exist, however, is the concurrent requirement that their needs be met with resources similar in scope to those allocated to support other youth groups in their communities.

Traditional support networks, such as family, peers, and religious groups, are often unavailable to LGBT youth. The networks that normally provide a sense of community and a level of social support to children and adolescents instead reject and alienate LGBT youth because of their sexual orientation. Remafedi (1987) reported that 50% of gay and lesbian youth indicate that their parents reject them due to their sexual orientation. A U.S. Department of Health and Human Services study (1989) reported that 26% of gay and lesbian youth are forced to leave home because of conflicts over their sexual orientation.

When facing these crisis situations, LGBT youth need access to emergency housing. Numerous youth who express to their parents that they are gay or are questioning their sexual orientation are ordered immediately out of their homes. In fact, approximately 40% of homeless youth across the nation identify themselves as gay, lesbian or bisexual (D’Augelli, 2002). These crisis situations are not unlike the discrimination experienced by unwed mothers prior to the 1970’s, but with a main difference -- the condition does not self-terminate after nine months.

The need for emergency housing is compounded by the fact that without a peer group, or as a member of a sexual minority, other sources of potential housing may not be available to LGBT youth. These children can easily find themselves homeless, on the streets, and subject to predators from any number of fronts.

The lack of a minimal educational foundation affects not only self esteem, but also any individual’s ability to self-support and become an employable, contributing member of society in the future. Nationally, approximately 28% of gay and lesbian youth drop out of high school because of discomfort (due to verbal and physical abuse) in the school environment (Remafedi, 1987). Discrimination aimed at LGBT students is the key. A 2003 national study of LGBT students found that almost 80% of the student respondents reported hearing remarks such as “faggot” or “dyke” frequently or often at school. Similar studies have shown that on average an LGBT high school student hears anti-gay slurs as often as 26 times each day, whereas faculty intervention occurs in only about three percent of the cases (Harris Interactive Survey, 2005 & 2007). D’Augelli (2002) reported that on average, 27% of gay and lesbian youth have been physically hurt by another student. Lambda Legal (2010) reports that gay youth are almost five times more likely than non-gay students to skip school because they feel unsafe which contributes to a drop-out rate of approximately one-third of LBGT students.

The social cost of inadequate support for LGBT youth is reflected through substantially increased numbers of incidents of suicide and depression. Gay and lesbian youth are two to six times more likely to attempt suicide than heterosexual youth. Sadly, over 30% of all reported teen suicides each year are committed by gay and lesbian youth (Savin-Williams, 2002). Obviously, the impact on family, friends and society overall must not be overlooked either. The steering committee believes that providing a support group that will address many of the issues faced by LGBT youth in the Hickory metropolitan area has the potential to help identify and direct those with issues of depression and suicidal ideations toward appropriate help.

Local Impact

Conservatively, it is estimated between five to ten percent of American students are lesbian, gay, bisexual, or transgendered (National Longitudinal Study of Adolescent Health, 2001). In Catawba County, North Carolina, this translates to between 1360 to 2721 youth who are likely facing LGBT-related issues in our local community. The stigma, bullying, and violence aimed at our LGBT youth is resulting in physical and mental harm to our children and the trend is growing. Even our local physicians are reporting an increase in the number of gay and lesbian adolescents seeking treatment in their practices.

In one instance, a 14-year-old male sought treatment after having been physically assaulted at school when he revealed his sexual orientation to a lifelong friend. The boy was so badly beaten that the doctor, who had treated him since birth, did not recognize him.

A second individual, a 17-year-old male, confided to his physician that he had engaged in sexual activity with over 60 individuals of all ages since receiving his driver’s license a year earlier at age 16. The young man was not only being treated for a sexually transmitted disease but was also threatening suicide.

Another 17-year-old boy experienced legal problems -- another risk LBGT youth may face. The young man met and dated another boy who indicated that he was 15 years old when he was, in fact 12. The date eventually led to a physical relationship after which the younger boy experienced regret and reported the matter to police. A detective came to the school, questioned the older boy without his parents or an attorney present, coerced him into giving a written statement, and arrested him on the charge of rape. He was given court appointed counsel who was not sympathetic and sought to pressure him to enter a plea of guilty to the lesser charge of sodomy, which carried a penalty of five years probation and listing on the sex offender registry for a period of 10 years thereafter.

After seeing this increase in LGBT youth in his practice seeking treatment, our local physician recruited a group of community leaders to assess the opportunity to develop a socially positive support venue for LGBT youth in our community. After forming a steering committee, the group of community leaders assessed the magnitude and relevance of local LGBT youth-related issues. This assessment indicates that our youth are, in fact, without appropriate resources and that there is a lack of traditional social guardians in families, churches, or schools to help these young men, women and transgendered individuals. In addition, there are no support services available for LGBT youth. The creation of a social support structure to allow them to meet and interact, while at the same time obtain mentoring and support from understanding and competent adults will help address many of these issues and direct them toward more positive self development.

Intervention

Many larger US cities have formed effective LGBT focused social support networks. The local steering committee met with representatives from both Charlotte and Greensboro to understand the methods they are employing to meet the needs of LGBT youth in their communities. The representatives confirmed that problems experienced by LGBT youth are somewhat universal in both urban and rural environments. The primary difference in implementing the peer support group concept appears to be availability of resources, not interest or identification of the need to offer services. Obviously, larger metropolitan areas have more resources available than smaller cities and towns.

Creation of a positive social support structure for LGBT adolescents by supportive adults to help guide the process will fill this void in our community. For those in need, the availability of a peer group guided by supportive and qualified adults will allow the dissemination of educational information and direction to appropriate resources without the fear of retribution. Short term housing, medical or other care can be given when necessary in order to minimize adverse effects and reduce costs to the system by addressing situations before they become overwhelming.

Benefit

Society as a whole incurs substantial expense because of the failure to support and mentor LGBT youth. Costs associated with drug addiction and suicide rates of LGBT youth significantly exceed that of the population as a whole (D’Augelli, 2002). The healthcare costs of physical abuse, failed suicide attempts, depression, substance abuse, and other afflictions can, to some extent, be addressed and avoided through the use of affirming peer groups, especially in rural areas where other LGBT resources are not readily available. A group such as ours can provide a positive social structure for at-risk LGBT adolescents.

Costs associated with the failure to provide services to LGBT youth are significant. Recognizing that education is essential in changing attitudes, positive role models afforded through affirming peer organizations will help not only local youth, but non-LGBT individuals at risk of exposing themselves and/or their employers to liability through either intentional or unintentional acts.

Conclusion

The needs of LGBT youth continue to grow. As this minority becomes more visible due to changing social perceptions, it is important that their needs be met as appropriately as the needs of other youth groups. The absence of traditional support mechanisms such as family, church, and school makes it even more important that alternate structures be created to provide not only peer counseling, but mentoring from appropriately qualified adults.

As the support structure becomes available, the ability to self-counsel and otherwise form relationships will work to the benefit of our youth, thus increasing their self-confidence and providing increased educational information to allow them both the resources and courage to make decisions that are better informed and better serve their self interests. In the long run, this will reduce costs to society associated with the statistically higher levels of depression, suicide attempts, substance abuse, physical violence and sexually transmitted disease that such youth currently experience.

1047 Hits as of today

Yeah

The first official paper was submitted today. It was the paper for my "policy" class. The assignment was to take a "position" on some sort of policy related issue. I chose the topic of the need to create a social support network for LGBT youth. Will post some of what I wrote about if I can figure out how to copy/paste into this format.

Declaration of Independence -- Worth Reading Again

This week I am reminded of the freedom we have in this country to pursue our dreams.

The version of the Declaration of Independence above (photo) and below (narrative), has two signatures, but the original had those of all the delegates assembled.  By signing this document, "people were putting their lives and property at risk -- their own and their families -- setting a firm and clear example of the responsibilities of political freedom and public discourse."

In Congress, July 4, 1776.

A Declaration

By the Representatives of the

United states of America,

In general Congress assembled.

When in the course of human Events, it becomes necessary for one People to dissolve the Political Bands which have connected them with another, and to assume among the Powers of the Earth, the separate and equal Station to which the Laws of Nature and of Nature’s God entitle them, a decent Respect to the Opinions of Mankind requires that they should declare the causes which impel them to the Separation.

We hold these Truths to be self-evident, that all Men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty, and the pursuit of Happiness—-That to secure these Rights, Governments are instituted among Men, deriving their just Powers from the Consent of the Governed, that whenever any Form of Government becomes destructive of these Ends, it is the Right of the People to alter or abolish it, and to institute a new Government, laying its Foundation on such Principles, and organizing its Powers in such Form, as to them shall seem most likely to effect their Safety and Happiness. Prudence, indeed, will dictate that Governments long established should not be changed for light and transient Causes; and accordingly all Experience hath shewn, that Mankind are more disposed to suffer, while Evils are sufferable, than to right themselves by abolishing the Forms to which they are accustomed. But when a long Train of Abuses and Usurpations, pursuing invariably the same Object, evinces a Design to reduce them under absolute Despotism, it is their Right, it is their Duty, to throw off such Government, and to provide new Guards for their future Security. Such has been the patient Sufferance of these Colonies; and such is now the Necessity which constrains them to alter their former Systems of Government. The History of the Present King of Great-Britain is a History of repeated Injuries and Usurpations, all having in direct Object the Establishment of an absolute Tyranny over these States. To prove this, let Facts be submitted to a candid World.

He has refused his Assent to Laws, the most wholesome and necessary for the public Good.

He has forbidden his Governors to pass Laws of immediate and pressing Importance, unless suspended in their Operation till his Assent should be obtained; and when so suspended, he has utterly neglected to attend to them.

He has refused to pass other Laws for the Accommodation of large Districts of People; unless those People would relinquish the Right of Representation in the Legislature, a Right inestimable to them, and formidable to Tyrants only.

He has called together Legislative Bodies at Places unusual, uncomfortable, and distant from the Depository of their public Records, for the sole Purpose of fatiguing them into Compliance with his Measures.

He has dissolved Representative Houses repeatedly, for opposing with manly Firmness his Invasions on the Rights of the People.

He has refused for a long Time, after such Dissolutions, to cause others to be elected; whereby the Legislative Powers, incapable of Annihilation, have returned to the People at large for their exercise; the State remaining in the mean time exposed to all the Dangers of Invasion from without, and Convulsions within.

He has endeavoured to prevent the Population of these States; for that Purpose obstructing the Laws for Naturalization of Foreigners; refusing to pass others to encourage their Migrations hither, and raising the Conditions of new Appropriations of Lands.

He has obstructed the Administration of Justice, by refusing his Assent to Laws for establishing Judiciary Powers.

He has made Judges dependent on his Will alone, for the Tenure of their Offices, and Amount and Payment of their Salaries.

He has erected a Multitude of new Offices, and sent hither Swarms of Officers to harass our People, and eat out their Substance.

He has kept among us, in Times of Peace, Standing Armies, without the consent of our Legislature.

He has affected to render the Military independent of and superior to the Civil Power.

He has combined with others to subject us to a Jurisdiction foreign to our Constitution, and unacknowledged by our Laws; giving his Assent to their Acts of pretended Legislation:

For quartering large Bodies of Armed Troops among us:

For protecting them, by a mock Trial, from Punishment for any Murders which they should commit on the Inhabitants of these States:

For cutting off our Trade with all Parts of the World:

For imposing taxes on us without our Consent:

For depriving us, in many Cases, of the Benefits of Trial by Jury:

For transporting us beyond Seas to be tried for pretended Offences:

For abolishing the free System of English Laws in a neighbouring Province, establishing therein an arbitrary Government, and enlarging its Boundaries, so as to render it at once an Example and fit Instrument for introducing the same absolute Rule in these Colonies:

For taking away our Charters, abolishing our most valuable Laws, and altering fundamentally the Forms of our Governments:

For suspending our own Legislatures, and declaring themselves invested with Powers to legislate for us in all Cases whatsoever.

He has abdicated Government here, by declaring us out of his Protection and waging War against us.

He has plundered our Seas, ravaged our Coasts, burnt our Towns, and destroyed the Lives of our People.

He is, at this Time, transporting large Armies of foreign Mercenaries to compleat the Works of Death, Desolation, and Tyranny, already begun with circumstances of Cruelty and Perfidy, scarcely paralleled in the most barbarous Ages, and totally unworthy the Head of a civilized Nation.

He has constrained our fellow Citizens taken Captive on the high Seas to bear Arms against their Country, to become the Executioners of their Friends and Brethren, or to fall themselves by their Hands.

He has excited domestic Insurrections among us, and has endeavoured to bring on the Inhabitants of our Frontiers, the merciless Indian Savages, whose known Rule of Warfare, is an undistinguished Destruction, of all Ages, Sexes and Conditions.

In every stage of these Oppressions we have Petitioned for Redress in the most humble Terms: Our repeated Petitions have been answered only by repeated Injury. A Prince, whose Character is thus marked by every act which may define a Tyrant, is unfit to be the Ruler of a free People.

Nor have we been wanting in Attentions to our British Brethren. We have warned them from Time to Time of Attempts by their Legislature to extend an unwarrantable Jurisdiction over us. We have reminded them of the Circumstances of our Emigration and Settlement here. We have appealed to their native Justice and Magnanimity, and we have conjured them by the Ties of our common Kindred to disavow these Usurpations, which, would inevitably interrupt our Connections and Correspondence. They too have been deaf to the Voice of Justice and of Consanguinity. We must, therefore, acquiesce in the Necessity, which denounces our Separation, and hold them, as we hold the rest of Mankind, Enemies in War, in Peace, Friends.

We, therefore, the Representatives of the United States of America, in General Congress, Assembled, appealing to the Supreme Judge of the World for the Rectitude of our Intentions, do, in the Name, and by the Authority of the good People of these Colonies, solemnly Publish and Declare, That these United Colonies are, and of Right ought to be, Free and Independent States; that they are absolved from all Allegiance to the British Crown, and that all political Connection between them and the State of Great-Britain, is and ought to be totally dissolved; and that as Free and Independent States, they have full Power to levy War, conclude Peace, contract Alliances, establish Commerce, and to do all other Acts and Things which Independent States may of right do. And for the support of this Declaration, with a firm Reliance on the Protection of the divine Providence, we mutually pledge to each other our Lives, our Fortunes, and our sacred Honor.

Signed by Order and in Behalf of the Congress,
John Hancock, President.

Attest.
Charles Thomson, Secretary.

The Velluvial Matrix

The Velluvial Matrix

 

Posted by Atul Gawande   

http://www.newyorker.com/online/blogs/newsdesk/2010/06/gawande-stanford-speech.html#commentAnchor_newyorker_2000000000211131

It's worth the read. 

Interesting

Below is a post to the forum from one of my colleagues.  This was very interesting to me in regards to this concept of being "data rich and information poor."

"Kathleen McCormick in her 4^th edition 2006 Essentials of Nursing Informatics by Saba and McCormick identifies that the average nurse on an NIH service area assigned to eight patients in 1994 collected over 50,000 data points per patient.  She predicts that is much higher today.  We collect enormous amounts of data with little to no meaning.  We do not establish the relationship of that data to the variables associated with the patient.  We do not critically think about the use of this data to move the patient along the healthcare continuum to a state of achieved health for that patient.   We collect unnecessary data and we do not act on the data we collect many times." (attributed to RS -- classmate)

Business Intelligence Forum

Tonight I got the first posting to the Forum done for the course.  It was good to begin to think about the topic of the "pyramid of abstraction" whereby today's organizations translate data into information...then use the information to improve their knowledge...and ultimately as "intelligence" to help improve the business.

A quote from the text that stood out to me was "In the last few years, the ability to create, collect, and store information has widely outpaced our ability to make significant use of that information."  (Loshin, 2003) -- I feel compelled to reference this or risk  having 5 points taken off.  Oh wait..this isn't for class.  Never mind.

At any rate....is this the modern day way of saying "you're trying to get above your raising (except I think my dad always said "rais-in")?"  Think about it.  Are we?  We have data, data, data....more than we can choke on actually.....and we're in a learning curve on how to translate it into "information" and ultimately "intelligence."

(927 hits as of today....yet more "data" to figure out how to translate into "information"...and use as "knowledge"...and make an "intelligent" decision as to whether it's worth my time to continue writing this blog for the next 2 years).

A perspective on "TIME"

Watch it...it won't take much time.....a little over 6 minutes
http://www.ted.com/talks/philip_zimbardo_prescribes_a_healthy_take_on_time.html

New Course

The new course started today....Business Intelligence. I wonder if that's an oxymoron? The topics that each student is expected to decipher and discuss (online with the class and the professors) are:

1.  Using the pyramid of abstraction (Fig 1.1, pg 4) how does your organization effectively exploit its data?

2.  How do you make the business case that BI requires not only the right data and processes but the right people?

3.  You have often heard, ‘the healthcare industry is data rich and knowledge poor’. Relate a single contemporary issue related to this statement using BI concepts and language.

4.  What are the 3 top KPIs that drive your work each day?

I suppose I need to get the reading done so I can discuss these questions intelligently.

Wednesday

This week I've been working on completing the school's online orientation module.  It was WAAAYYYY more involved than I anticipated.  It involved posting to discussion boards, writing several short papers, and working through several "technical" problem solving processes. 

My bottom line conclusion is that online education requires a fairly high level of experience with navigating the internet.  I don't think anyone brand new to using electronic media could deal with the hassle of become competent in the use of the media as well as master the content being taught.

I have also devoted about 45 minutes per day to the "policy" paper for the Health Policy class.  Still not done with it though.  Unlike LJ, I tend to write in layers, improving the overall quality with each revision of the prior draft.

Not a lot of exciting stuff to share right now until I get through these two things.  The next course -- Business Intelligence -- begins June 28.

Sunday -- Father's Day

Spent Friday evening and Saturday morning doing the online orientation modules.  What struck me is that many of the questions on the quizzes at the end of each module asked lots of questions about "computereze" things.....

a.  zipping files when there are multiple file types to submit for an assignment
b.  clicking on the "Home" icon takes you to....

This was the first time I've realized how difficult it must be to create an online education program with the varying degrees of competence of the users.  I can't imagine the volume of calls the HELP desk receives.

APA Style

Spent the evening trying to figure out APA formatting style for papers.  APA stands for American Psychological Association.  That's the required style for all papers for this university.  I understand the need for some uniformity but this is ridiculous.  My perception is that the "paper graders" are highly stringent about following the prescribed format to the letter.  Seems like a lot of wasted energy if you ask me.  I've had a number of things published in professional journals.  I'd say I've gotten the format reasonably close to the publishers requirements and the journal publisher does the rest.  Who knows?

Jessica's Affirmations

I think I'll use Jessica (in the you tube video below) as my reminder of the power of positive affirmations.

http://www.youtube.com/watch?v=qR3rK0kZFkg

Awake

at 2:00 am EST....that's midnight in Denver.  Woke up worrying about getting it "all" done.  Work today and Friday....hosting an event to benefit ALFA Saturday.....Father's day on Sunday......a paper to write....an online module to complete......away again next weekend.  Next class starts on the 28th (online).  Reality hits.

Coping strategy.....put it all in the "box" (metaphorically speaking)....and deal with it as it comes my way...one thing at a time.

Home again, Home again

Arrived home safe and sound by about 6:30.  Already unpacked and laid out ready to watch a little tv.  Content to be home.

From 35,000 ft in the air

Usairways now has Internet access in the air. So I'm writing this entry somewhere over the middle of the country. Course 2 is now complete except for the paper. 2 down 12 courses to go. Feeling a bit of a let down to have to leave my new found friends. However looking forward to home.

More later as I begin the next step on this journey.

Thought for the day

On my last day here in Denver, I start the day by sharing the following "thought" from "TUT.com". 

"Throughout the hallowed ages, those in the unseen have always marveled at the accomplishments and creations of humankind. Whether a sandcastle or a skyscraper; a painting or a poem; they're humbled by your ability to reflect, to engineer, to craft, and to create something that has never before existed within time and space.


But it's not the creation that impresses; these all exist here to the nth degree. It's the persistence and determination of the seemingly mortal dreamer who steadfastly holds a new thought in mind, either of the creation or of its inevitable success, and moves with it, even while the rest of the world is content dreaming their father's dreams.
 
This is what is admired; not just because it's so rare, but because it is so, even when such innovative potential lies within all.
 
Cool, huh?
    The Universe"

My final evening in Denver

Well I have almost made it through two full courses.  We'll finish up tomorrow mid-day and I'll be on my way back to North Carolina.  It's 8:25 pm now here in Denver.  The daily learning schedule has tended to spill over into dinner many evenings.

Am I glad I did this?  Absolutely.  No doubt in my mind that it is the right time in my life for me to do this.  It is intellectually stimulating.  I'll be able to immediately incorporate the knowledge I have gained into my work and be a better leader. 

In this last course, I have gained a ton of knowledge about "policy and politics." 

Below is a list of websites and journals that are recommended by the professor to help keep up with policy/politics:

healthaffairs.com
fedstats.gov
hschange.com
nashp.org
ncpa.org
stateline.org
TED.com
healthaffairs.org
economist.com
modernhealthcare.com
rwjf.org
kff.org
cmwf.org

Time to pack now.  Looking forward to being home tomorrow night.

Last FULL Day of Class

This morning will be "Women's Health" and "Aging" policy.  This afternoon will be more individual student presentations taking a position on a policy issue related to health care reform.

An interesting statistic I learned yesterday -- last year 25% of the master's degree's in nursing were completed via online programs. 

Grateful

I am grateful that I have a wonderful home and family in North Carolina.

I am grateful that I have a fantastic career, surrounded by unsurpassed professional colleagues.

I am grateful for the deep and abiding friendships in my life.

I am grateful to have good food to eat....cause lord knows I love to eat.

I am immensely grateful that I am continuing to learn new things.

And finally,  I am immensely grateful to have completed day 8 of this 10 day "intensive"  doctoral marathon.  That brings up a thought.......this gives all new meaning to the term "intensive care" for me. 

Monday AM

I hear it is oppressively hot in North Carolina.  Here is Denver it is 48 degrees this morning.  It's been cold and rainy all weekend.  The rain is anticipated through Tuesday or Wednesday.   Hasn't really mattered to me all that much since I'm in class all the time anyway.

No time to write much this morning.  The lecture topic I'm assigned for the morning is "What is essential healthcare."  I have 45 minutes to facilitate class dialogue on this particular subject. 

And finally, a "lesson learned" that I'd like to share.  One of my classmates birthday is today -- Roy turns 60 years old today. The lesson....we're never too old to learn.

Sunday PM

Wow.  It's been a really long and intense day.  I'm just back to my room a little after 9pm.  We started at 8 am today.  We had a little later start yesterday so we had some "time" to make up.

Today's topics were very stimulating.  This is a "Health Policy" course.  It's all about policy and politics.  On the surface it sounds boring but each seminar (in 4 hour blocks) has been fascinating to participate in.

The first seminar of the day was titled Health Policy and Politics of Health.  We delved into two different organizations and their positions about health care reform.  The organizations were AARP (supportive of health care reform) and US Chamber of Commerce (opposed healthcare reform).  My bottom line take away is that policy and politics are about money and relationships....and sometimes the greater good is served.  But usually the greater good is an after-thought.

The second seminar (4 hours) was titled "Identifying, Understanding, and Addressing Population Health Problems."  We dug into the history of the Public Health System and where it has evolved to today.  My take away from this session was...health care reform is going to pay for "sick care;" meanwhile well care and prevention programs will continue to suffer.

The evening seminar was titled "Preparing for Terrorism."  We picked apart the oil spill in the gulf.  Dr. Garner (the Dean) facilitated this session.  Even though this event was an industrial accident, it could just as easily been the result of a terrorist attack.  We had a deep and stimulating discussion about the how the policy and politics of this is playing out.

I'm enjoying this.   Am ready to finish up though and return home.  I get to go home Wednesday evening.  By then, I'll have 2 courses behind me (except for the big paper that I have to write for the policy class).

I can't remember if I wrote about the dissertation yesterday or not.  Bottom line, I have a pretty good idea of what I'll do my dissertation on -- effective models or traits for leadership transitions within an organization.  This is going to be a huge issue as the baby boomer workforce retires over the next 15 years.   Much of America's intellectual and practical experience and wisdom will be moving out of the workforce.  What can we learn from prior experiences with effective leadership handoffs -- that'll most likely be my research topic.

It's time for some sleep now.  Another long day tomorrow.

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