“But my doctor ordered it.”

Please enjoy a brief digression from the usual focus on learning. This is a great anecdote and illustrates some of the confusion in our current healthcare system.


The healthcare system is like a giant jigsaw puzzle and it can be very confusing to put all the pieces together.

A friend was talking about prescription insurance challenges she is engaged in when working in a community pharmacy. Occasionally, a patient is unable to get a medication because the insurance does not cover it. The misperception is that Pharmacists in the community are the cause of this limitation in access – this denial of something that can be of great importance to us as a medication.

However, Pharmacists are in the middle…of a few systems. They get the prescription from the doctor – but – that does not mean the insurance will cover it. That medication claim is submitted to the insurance and the insurance decides if they will cover it. This second interaction is with the insurance. The last is with the customer and if the medication is not covered, it’s the pharmacist or pharmacy technician who tells the customer the insurance is not paying for it. It’s a frustrating place to be, on both sides.

The (very) basic process is:

Doctor/APRN/PA -> sends prescription to pharmacy -> pharmacy submits to insurance

From there, the insurance accepts or denies the claim, based on a pre-approved list of medications, called a formulary.

Some doctor’s offices have begun to get realtime coverage of medications, which helps to reduce the risk of a medication not being covered but the majority do not use this technology yet.

From a patient’s perspective, there are important questions you can ask. Setting aside questions related to interactions and side effects with new medications, one question is “will the insurance cover this medication?” If not, the doctor will find an alternative. Better to figure this out earlier and save yourself frustration later on.

Repetition

98,000 scripts a year.

That’s a rough estimate for how many prescriptions a community pharmacist checks in a “busy” store.

400 scripts a day; 2,000 a week; 98K a year (with vacations).

How many heart rates and blood pressures does a Nurse check in a day?

We are good at something because of experience and innate talent.

We are great at something because we practice.

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Ultralearning

A good mix with the idea of infinite learners is how we learn. One such strategy is ultralearning.

A new book from Scott H. Young, titled Ultralearning is available now and discusses key concepts for how we can learn new ideas quicker.

Here are a few of the key principles:

  1. Design your project well – set enough time aside and limit what you are trying to learn
  2. Train Focus and Productivity – limit distractions and create a system for your learning
  3. Learn actively – in addition to some required passive learning (lectures, etc.) find opportunities to practice what you are learning
  4. Get quicker, deeper feedback – find ways to get feedback and create quicker cycles (repetitions)
  5. Space your practice out – add more practice spread out over time
  6. Practice more deeply – process what you’re learning (Feynman technique)
  7. Overlearning – continue to practice even after where you feel you’re no longer seeing any improvement

As is everything, there are various degrees of how much time you’ll spend on each of these. It also depends on what you’re trying to learn.

The best plan is to start today and monitor what works for you – then it becomes an iterative process and you can learn more efficiently…and effectively over time.

The last idea which is very interesting is meta-learning. Part of this process is to reach out to other people who have done what you are looking to do and ask them questions. You may find that there are parts you thought were important to focus on, that aren’t, or parts you hadn’t thought of that you should add to your list to research further.

The book Ultralearning is worth a read, either at your local bookstore, library, or wherever you get your books (audio, e-, or otherwise).

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Infinite Learners

Infinite learners are those who not only enjoy learning but feel a constant need to acquire new skills.

Contrast this with lifelong learners who have an on-going and self-motivated pursuit of knowledge. The nuance is the acquiring of new skills.

Another subtle, but important difference is how we continue to build and leverage those new skills.

The first opportunity is the using idea of meta learning and thinking about what skills you want to learn. Then start today. The next step is to help others identify which skills (or combination of skills) they need or want.

When thinking about healthcare, gaps of knowledge is a frequent area you focus on when creating courses. This is only one layer – the knowledge piece. Another important layer is what skill sets are required to create the changes need to close the gap. What if we spent more time on building these skills?

How can you inspire and engage learners to become infinite learners?

Read more about this topic, infinite learners, in a short post from Reid Hoffman on LinkedIn.

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Improving Continuing Education

I am inspired by a recent podcast episode of Akimbo, from Seth Godin – titled Systems Thinking. The topic can push us to think more deeply about the industries we work in and how we can improve them.

Systems thinking is basically identifying how parts are connected.

You don’t necessarily have to create the system; there are many systems in place already. The question is what can you learn about the system(s) to help you create more value for the audience you seek to serve?

A way to apply this idea is seen with Jim Collins’ Flywheel effect. Here we see a cumulative process – drip by drip, step by step, with a bias for action, and it all adds up to create effective results.

Taking the lens of continuing education for health care professionals, here are the pieces of the system:

  • Accreditation organizations (those who approve accreditors and those who accredit programs/education providers)
  • Speakers
  • Learners

Part of the idea of a system is that if one of these components is removed, the system would not exist.

Without learners, there would be no one to educate. Without speakers (or SME), there would be no one who teaches, etc.

[I’ll carve out continuing professional development and self directed learning for now but we’ll cover that in a future blog post. At least for pharmacists, we are required to take accredited courses for those “hours” to count towards annual requirements.]

Bringing back the Flywheel Effect, you can focus improvement on what you want the system to look like and build changes in one part, while knowing how it’ll affect the rest of the system. It is important to remember your changes depend on how each part fits with the other parts.

You can improve the quality of your speaker(s), but if the type of learning for attendees doesn’t match what learners are looking for, then you will see limited improvement in the system. If one thing moves, they should all move.

One area I’m most interested in developing further is changing the types of learners (and disciplines) who are attending meetings. Many conferences implicitly promote silos as they are created for one discipline and are primarily didactic lectures.

One way to combat this while looking at the system is to create more interdisciplinary conferences with interactive sessions and create ways to bring the content back to where attendees work (their own organization). Changes include adding different disciplines, different types of speakers who are engaging and maximize how to promote participation. Lastly, the education provider would need to provide accreditation for all the disciplines who attend. Potentially, one organization could do this but more than likely (and preferably), a collaboration of groups is what you would see.

It’s a new way forward, using the current system, and making small changes, course by course, to create a more effective way to improving continuing education.

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I have three assumptions to note:

  1. Accreditation is required to provide education to health care professionals
  2. What’s it for – continuing education is to help maintain competencies and expand on knowledge to improve patient care. What’s it sometimes for – meeting mandatory requirements.
  3. I’m starting a deep dive on systems thinking and the ideas here are subject to change…in fact, they probably will.

Ratings

If you are going to a movie, you look at the Rotten Tomatoes score.

If you buy something on Amazon, you often look at the star ratings.

Even when I’m looking for a new movie to watch with my son, I look at Common Sense Media.

The rating system is everywhere.

Even when you are completing an evaluation for an education course, you have to fill out a rating, usually a scale of 1 to 5.

However, those ratings are not shared with attendees or prior to the next conference, potential attendees.

What if ratings were collated in order to show them to Nurses or Pharmacists before they decided to attend the conference or purchase the online course.

Ratings are similar to testimonials and it is also what people already expect at other websites. They are familiar with the system and the familiarity can build trust with your website since the audience knows what it means.

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Failure

At some point during school, I made a slow transition from learning to trying to get the right answer. If that was the only step, while not ideal, it wouldn’t be terrible.

Unfortunately, the next transition is a bumpy one – from trying to have the right answer to trying to not have the wrong answer. While subtly different, there’s a huge gap in mindset.

it was in this time period when my Residency Director shared a quote with me:

“What would you attempt to do if you knew you could not fail?”

Unknown

Up to a point, this is a helpful question. To act “as if” and move forward.

Eventually, this isn’t the most important question to ask. Perhaps another subtle difference, but vitally important:

What would you attempt to do, if you didn’t know whether it might fail, and you do it anyway?

It might not work. And you do it anyway.

That’s how we learn.

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What Can Movies Teach Educators?

In a recent article from the Harvard Business Review, we can learn a valuable lesson about challenging the status quo.

The article Marvel’s Blockbuster Machine reviews how Marvel Studios bucks the trend of poor performing sequels by leveraging a few important components for design thinking and marketing. We’ll get to a brief summary – but first – it’s very interesting to see how this applies to healthcare education.

One part of continuing education that stands out is the inherent formulaic structure. While in many cases, this is a plus – making sure courses are meeting a set of basic standards. However, it also applies constraints, which can limit how well the content is learned by attendees and restricts actionable takeaways. When you identify the formula and navigate where the edges are to test collaborative ways to teach and learn, it becomes a win-win.

Marvel changes the formula by leveraging different emotional tones. Likewise, a conference can have different themes and a diversity of teaching methods (didactic, interactive, peer to peer, etc.).

The part that stands out the most is to continue challenging the formula and how Marvel’s audience looks for something different; they expect it. They know what their audience is looking for. It cannot be understated how important this point is.

What is your audience looking for and what do they expect?

As mentioned above, Marvel has recharged the genre by tackling four key points:

  1. Select for experienced inexperience (diversity of ideas)
  2. Leverage a stable core (team building)
  3. Keep challenging the formula (pick a formula to challenge)
  4. Cultivate customer curiosity

I encourage you to read the full article by Spencer Harrison, Arne Carlsen, and Miha Škerlavaj, linked above. It’s well worth 10 minutes of your time today.

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Keep Asking Questions

Every day, I hope to keep learning and keep asking questions.

Learning is the easy part – you can learn about yourself, a colleague, quite literally – anything new. That’s learning.

Asking questions – good questions, is a little more challenging. It takes curiosity, being present, and empathy. Add in a little IQ, EQ, and BQ (body intelligence), and you’re on our way.

Here is a list of my (current) favorite questions:

“What’s the ONE Thing you can do this week such that by doing it everything else would be easier or unnecessary?”

Gary Keller, from The One Thing

“What would this look like if it were easy?”

Tim Ferriss

“If you are saying yes to this, what are you saying no to?”

Michael Bungay Stanier, from The Coaching Habit

“Who’s it for? What’s it for? What is the change you seek to make?”

Seth Godin

OK, this last one, I included three – but they are each very powerful and could stand on their own.

“What do you think?”

Tom Peters, from The Excellence Dividend

“What problem are you solving?”

“Is this actually useful?”

“Will this change behavior?”

Jason Fried & David Heinemeier Hansson, from Rework

I’m sure there are many more questions we can add into our toolbox. For now, these will get you started and on your way to creating more meaningful…anything.

Keep asking questions – KAQ.

Here are links to books mentioned in this post:

The One Thing

The Coaching Habit

Rework

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