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social, health, political imagery through the lens of George J Huba PhD © 2012-2017

Posts tagged Yoda

Missed patients appointments represent a major wasted cost within the healthcare system.

Huge amounts of resources are wasted when patients miss appointments. Expensive healthcare providers in expensive medical office space with expensive equipment and expensive staff are not utilized to their fullest resulting in a loss to the overall system.

To deal with missed patient appointments, clinics often schedule a few more patients than they have time slots in order to compensate for the number of patients who may not arrive or may arrive later than scheduled.

If everybody actually shows up at appointments in the compensatory, over-booked environment, several things happen; doctors and staff get stressed because they have to squeeze patients into the schedule and patients get pissed off their doctor cannot be in their examination room on time or earlier.

So the system needs to get patients into healthcare clinics on the correct day at the correct time. A number of strategies are typically used.

Do you think that the average elderly or cognitively challenged individual (and caregiver) understands and remembers those reminder messages left on their voice mail or those short telephone communications from an obviously harried staff member?

Do you think that the small type, too many words, black-and-white business letter does the trick? Do you think the letters get opened? Do you think that aging folks can all read small fonts or understand a packed letter without white space?

Do you want to increase the rate of patients showing up for appointments? Look at this general framework and the example I provide below.

Use a mind map, improve patient care and help make the service system more efficient.

Click on images to expand.

Reminder  [optional use of name]

Reminder Jill Brown

chapel hill ambulatory

A clerical staff member should review the completed form with a patient or caregiver.

Personally I would send the mind map home (or in the mail) with a few brightly colored refrigerator magnets (with my phone number on them) suggesting that the patient or caregiver put the appointment mind map on the door. I would also send a second copy to be put wherever these things usually go, or to share with the caregiver. Refrigerator magnets are very inexpensive and if printed with your name and phone number will increase the number of times patients will call to reschedule rather than just skip the appointment because they cannot find your phone number (and guess what percentage of elderly or cognitively challenged or disabled or practicing physician adults might not be able to find the business card and did not enter your office phone number into their smartphones?).

Oh, and even if the form slips off the refrigerator and is whisked off to recycling by a rushed and harried house cleaner, the refrigerator magnets will still be there so the patient can call to get the scheduling information.

Try something like this. If it works you save a lot of wasted time and loss of income and frustration. Your patients get better healthcare because they remember to see you when it is medically desirable to do so. The caregivers will like it because it makes their jobs easier.

And if it doesn’t work better than the same-old, same-old, you have only lost a few hours of clerical time spent implementing a system of mind map appointment reminders.

I’d suggest the hashtag #camm3 for computer-assisted mind maps, generation 3.0. I think that it is important to recognize that mind mapping 3 is different from that which proceeded it in that high quality, valid, reliable, and important content is explicitly linked to computer-assisted mind mapping methods and the linkage of content and computer methods is different from non-documented mind maps derived from “who knows where.”

There are many posts on #camm3 and using computer-assisted mind mapping 3.0 throughout this blog. Virtually every blog post on http://mastermindmaps.wordpress.com was created through a process of  #camm3.

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#camm3

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it's program evaluation,  not research, dummy

 

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evaluationmap

researchmap

Big data this, big data that. Wow. At the end we will have better ways to sell underwear, automobiles, and “next day” pills (although in the latter case politics and religion might actually trump Amazon and Google). Blind empiricism. Every time you click a key on the Internet it goes into some big database.

“Little data” — lovingly crafted to test theories and collected and analyzed with great care by highly trained professionals — has built our theories of personality, social interactions, the cosmos, and the behavioral economics of  buying or saving.

Big data drives marketing. Little data drives the future through generalizable theory.

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in praise of little data

There are a number of things that can be done to cut the cost of healthcare while, at the same time, freeing doctors and others to do their jobs better. These improvements cost almost nothing to implement [if all of the constituencies and politicians do not compete to be King Kong].

Visiting legislator who stumbled across this web page? Here’s your chance to act like a grown-up and represent the people of the world, not drug companies nor major research universities nor individual “researcher” egos and retirement funds.

Click on images to expand.[almost free] strategies to improve healthcare

Cartoon Rabbit - Giving A Thumbs Up

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The fictional detectives would have been great program evaluators. All looked at all types of data. Miss Marple was a model of pleasantry who could work her way into an organization or group and see it as it was without changing anything by observing. Holmes and Watson — whether in the original books and movies, the Ironman version of the movies, their current BBC incarnation in 21st Century London, or their CBS incarnation in 21st Century Manhattan with Dr John Watson now Dr Joan Watson (for the better) — use Holmes’ razor sharp mind and Watson’s intuitiveness and questioning. Sam Spade, wise cracks, an iron fist, and underlying sensitivity.

Program evaluation is not about conducting research, randomly assigning participants to conditions, or using quasi-experimental designs. Program evaluation is about understanding why programs produce certain outcomes, intended or not, positive or not, unique or not. To truly understand a program quantitative and qualitative data needs to be collected with great attention to the sensibilities, needs, risks, and potential confidentiality breaches of data of program participants, program staff, program administration, funders, and other stakeholders.

I love program evaluation. Every program is unique and at the same time representative of certain classes of human service organizations.

Be a detective. Look carefully and understand the beauty of a well-running program and how to help staff improve a program that is not working as well as it could.

evaluation detective work

A Life in Hats

Click on the image to enlarge it.

Symbols bring back a lot of memories. 1951 and being born (literally) in that tiny corner of the Bronx where Yankee Stadium faced the Polo Grounds (home of the New York, now San Francisco, Giants). My Dad told a story of studying for his college classes while caring for me as an infant and listening to the sounds coming from the two ball parks on the same summer evening. 1957 was the start of a life and elementary school in Massachusetts where my grandfather was the world’s longest suffering Boston Red Sox fan. In 1968 I left high school after 11th grade without graduating with the intention of being a physicist, discovered psychology soon thereafter, and graduated from Fordham College in 1972. In 1976 I left Yale after completing my PhD program. The Yale hat is the most important one of my life. 77 saw me at the University of Minnesota freezing my butt off and the next year I was in Los Angeles at UCLA warming it up. In 1980 I received my psychologist license and then went through the 1980s and 1990s as a committed, harried, stressed out Los Angeleno. In 1988 I started my own company and promptly appointed myself president. The 2000s were a time for becoming a committed North Carolinian, relaxing, and learning to say y’all. 9/11, of course, was the day most Americans started rethinking many issues in their lives.

The important part of this timeline is that these simple symbols mean a lot to ME and each evokes hundreds of direct memories and thousands of extended associations.

There is a lot to be said about trying techniques like this timeline to bring back cherished memories that you haven’t thought about in a while. Maybe the right symbols for you are concerts or movies or births or vacations or stages in the lives of your family members. Consider using symbols; a lot of our memories are encoded around images and not around words.

The University of Minnesota hat evokes some really funny stories like buying an ice cream cone in 20 degree weather (probably in October or April) from an outside vendor and walking down the street not having to worry about drips. Or playing marathon games of pinball or the first video games (pong, pacman) with a fellow assistant professor. That California Angels hat makes me think of standing in line from 2am on to purchase tickets for the American League (baseball) championships and then two or threes weeks later standing in line all night to get opening Saturday tickets for the Empire Strikes Back and becoming one of the first to know Darth Vader was Luke Skywalker’s father. Little things, big things, all stringing together in my memory from various symbols.

You might want to try this yourself. Works for me; may work for you too.

Aside 1: My grandfather had Alzheimer’s disease. Any time you put a Red Sox symbol in front of him you heard about Ted Williams, and the damn NY Yankees, and the Green Monster, and the times he took me to minor league baseball games as a kid, and how good (really bad) I was at baseball, etc. My baseball memories of him are those of the years before the dementia when he multi-tasked (in the 1960s) by having TWO different baseball games going on the radio at once (cacophony in that house) and a baseball game on TV. At times he was reading the then new magazine Sports Illustrated at the same time or the local sports section. If you asked him what had happened recently in any of the three games, he would tell you the last 10 plays or so or what Carl Yastremski had done in his at bats that day. And yes, he took me to at least 50 minor league (AA; Springfield Giants) baseball games every spring and summer. And I’m pretty sure he purchased a hot dog and popcorn for me at every game where we always sat in the same seats behind home plate.

Aside 2: If you look around my office or other living space, you will see that it is filled with small symbols that evoke memories (in my case baseball hats, pens, coffee mugs from meetings and vacations and schools, old office equipment in a big stack). If you look around most homes, you will see something parallel to my office. Why did you think we all patronize the souvenir shops at the national parks and airports and sports stadiums and try to keep our kids out but only half-heartedly? Symbols to organize and elicit memories.

I always look forward to the release of many Apple app updates on Saturday morning with anticipation and fear. At times these updates (really bug-fixes of not-acknowledged problems that should have been initially discovered through enough testing before release) provide useful new methods. At times they introduce a whole new set of bugs to frustrate you, hone your work-around skills, and make you look forward to the next updates.

I guess developers who sell millions of copies of small apps that replicate all of the functionality of another developer’s apps do not feel the responsibility to release a bug-free product after a lot of beta testing. Perhaps this lack of regard for the customer is because a programmer who ignored doing sufficient beta testing therefore releasing buggy and bloated software that probably wasted a year of my professional life went on to become the richest person in the world and pretend that all he ever wanted to do was to solve those six world problems that are simple enough for him to understand.

The well publicized “generosity” of the Gates Foundation is really not that; Gates is simply repaying with no interest a few cents on each dollar taken from the world as excessive profits by a monopoly and the waste of the world’s resources in the loss of billions of hours. Bill Gates should be severely criticized, not lionized for his charitable work; it is a tiny distraction from a life of greed and shirking responsibility for the products you sell. I certainly hope the little guys who “only” make a few million dollars from simple apps will not look to Gates as a role model.

Software  Updates and  Bill Gates'  Legacy

The Program Evaluator's Tool Kit

Measure, Find Relationships, Communicate

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Ask the Big Questions and Study How the Answers Relate to One Anotherimage

Decode Events and Naturally Occurring Data

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Examine in Detail

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Listen
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Find Patterns
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The Old …

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The Current …

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And the Ideal

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  • Click on images to zoom.
  • Note that both the placement of the circles AND the front to back placement are significant and intentional.

This is the first of a series of posts I am making about program-organizational (and individual) evaluation. Much of what I will discuss is not in the mainstream of traditional program evaluation methodology.

My approach is different. It works.

In this first section the point is — obviously — that evaluation is iterative and nonlinear. This led to my first model that EVALUATION IS DETECTIVE WORK several decades ago. [Perhaps that explains my current obsession with all versions of Sherlock Holmes, whether in the original, present London, present New York, or by Iron Man.] At any rate, it seems ELEMENTARY to me that instead of thinking of program evaluation as a linear research experiment with a fixed design (a metaphor that works at best imperfectly), it is more important to treat evaluation as detective work where good rules of evidence must be followed and the evaluator is at fault if all outcomes are not found.

My initial development of the Detective Model in 1992 came from my observation that in much traditional program evaluation the evaluator applies a flawed “research” experimental model and the insensitivity of this approach means that a program looks worse than it is because the evaluation methodology is in error. Who pays for this problem? The program, of course, since the evaluator walks away saying that the “program sucks” and not that the evaluator screwed up. In the Detective Model, applied iteratively and nonlinearly, the evaluator and the program are partners, and it is clear what the responsibilities and level of success each has.

Seems ELEMENTARY to me.

As usual click on the image to zoom.

Evaluation is an Iterative, Non-linear Process

We have sequestration and a US Congress that refuses to develop a realistic compromise US federal budget and long-term economic plan. Never one at loss for ideas, I propose that the US Congress initiate the following silent auction. As absurd as my proposal is, it seems no more absurd than the ideas expressed on cable news each night by our “striking” employees (the US Congress). Before starting this auction, I prefer that the Members of Congress and POTUS sit down once and for all and do their jobs in managing the economic future of the USA. Otherwise, they are going to have to conduct something like this auction (currently going on in a limited and inefficient manner through lobbyists and Cabinet Level administrators).

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USA Auction

My lack of admiration for the inability of the US Congress and the President to resolve budget issues in a way that will preserve the economic recovery, provide needed services, and balance the budget should be fairly obvious.

What the current sequestration comes down to is that 535 individuals in Congress who make between $180,000 and $240,000 per year, have exceptional health and pension plans, and have $4,000,000 (tax-free) expense accounts that can be used as needed without audit, are simply not giving the tax payer a very going return for their generous salaries and perks.

This needs to stop. If these folks cannot do their job and pass a compromise budget that meets the goals of long-term economic recovery, high priority services, and debt reduction, we should fire and replace them in 2014. After all, the fact that discussions seem to have ended means that 535 well-compensated public employees have decided to thumb their nose as those who employ them and spend their energy appearing on cable news channels or working on their memoirs or using their expense accounts to get into trouble. No business would tolerate such behavior.

If Congress refuses to work on a compromise they should feel the pain. After all, 10s of millions of Americans are currently feeling it. Every day.

sequestration pain

Over 35 years I facilitated hundreds of professional groups from 6 to 200 in size.

Here’s a few things I learned. [I did not put “have a thick skin” in the formal presentation.]

Click diagram to expand.

facilitating professional groups

Why would 536 (POTUS + Congress) people (mostly white men) play Russian Roulette with world’s health-education-welfare-economy? [circle all that apply]

a) they are arrogant (specify “they” ____________)

b) they are stoopid (specify “they” ____________)

c) they are mean (specify “they” ____________)

d) they have no ability to imagine a harmonious future (specify “they” ____________)

e) they love their face time on cable TV news (specify “they” ____________)

f) John Boehner made them do it (specify “them” ____________)

g) POTUS made them do it (specify “them” ____________)

h) Palpatine made them do it (specify “them” ____________)

g) all of the above

h) what is sequestration?

i) other comments:___________________________________________________

*****

Or as Yoda would say — Jedi not are they

Palpatine

Look around at the restaurant or on the subway or on airplanes or at bicycle riders (yup, see it a lot around here) or at store workers or person in the car next to you at the red light or in television shows and at businesspeople, teens, tweens, older adults, hospital patients, hospital doctors,  athletes, the disabled, those wearing the most trendy clothes and those dressed in all black with black hats/scarves. Data is streaming into all of their lives: email, texts, videos, music, e-magazines and e-newspapers, web sites world wide, Twitter, Facebook, Instagram, and the local restaurant’s menu. Netflix, iTunes, Amazon Prime, your bank, your doctor, your pharmacy, your local fast food purveyor, extra news and feeds from the sporting event you are attending, the latest Kardashian kamikazi komedy.

The video game is the work of the Devil.

With the exception of an increasingly small percentage of individuals with unlimited data because they were early adopters and have not changed their cellular plans, most of us are paying by the gigabyte. Those with free plans are throttled so that they really cannot use an unlimited amount of data for a fixed price so the fixed prices will go away soon.

Drop data prices, streaming will expand exponentially, the phone companies will make even more money, you will never see your friends in the flesh anymore, family dinners as we knew them in 1960 or even 1980 will be dead and replaced by family members sitting at the same table eating junk food and each watching their own data stream, and no one will want to go to the movie theater or red box anymore. Even the Columbian cocaine lords may go out of business.

Data overload will lead to data addiction and probably result in humanity evolving into the Borg Collective.

Borg

We need to make some changes before Skynet and the Terminators become inevitable.

skynet


terminators

I think the human race has no more than 30 years to evolve before the bytes take over. It will make the “War on Drugs” seem like the good old days and war with the Cylons inevitable. If you thought Big Pharma was going to control your life by promising the end to pain and disease, think again. Big Wireless will be even more insidious and the way Big Pharma has increased healthcare costs significantly will turn out to have been smaller than wireless when the historians look back in 100 years. Wireless data streaming is already starting to become the crack of the next decades.

Turn the Devil’s toys off when you: go home, go to dinner, watch TV, are in a meeting, are in a class, are in a place of religious observances, go on vacation, go to bed, take a shower, go into the bathroom (yup, your screaming boss may be in a toilet stall at DFW or ORD), or go to a friend’s home. Get out of the habit of pulling your cell phone out to take a picture of your family and then checking your email or Twitter account while you are at it. And stop modeling the “cellular data comes before everything else” lifestyle to your kids.

Even Spock turned the data stream off sometimes. Do so and “Live Long and Prosper.”

The annotations on the mind map below listing my contact information were made with Napkin for the Mac. a fairly inexpensive app quickly mastered. Easy to make just about any image (graph, chart, pdf, photograph) — whether created by you or another individual — communicate more effectively. After all, who hasn’t drawn on a napkin or the back of an envelope or a photograph or an illustration in a book? [I’m trying to help you refrain from marking up the expensive original of one of those Ed Tufte books or create some new content suitable for presenting or posting.]

Click on the image to zoom.

Napkin 4

Here is a little experiment.

iMindMap of newly minted pseudo-words I have never used online before.

torken

Wordle of newly minted pseudo-words I have never used online before.

hypotheticalwordle

I will update this blog post with comments as the experiment continues. My bet is that the engines will find the content very rapidly.

June 4 2013. Thus far, the only word google has found is torken. I am assuming that is because the font and tilt are like normal test.

Thus far, the moral of the story seems to be that if you want google to not find a word in your mind map, use organic mind mapping. Conversely …

Since humans can readily see the words in both the mind map and the woordle, this does illustrate (that at least in this case) google is not working like the human brain. I will check Bing later and update this post.

More to come. I also want to see what happens with the output of other mapping and graphics programs. I would argue that if google cannot detect nonsense words that humans can see in an organic mind map but can see those that appear in a non-organic, flat mind map (such as those from Mindjet and Mindnode, and XMind), then that would tend to argue that organic mind mapping is more like human thinking.

I invite everyone who mind maps to run simple experiments like this. These are very easy to do.

Position Opening: Physician. Thousands of opening available throughout USA. All specialties. Highest priority for primary care.

Requirements:

Four-year medical degree, several years of supervised post-doctoral clinical experience. Additional research experience a plus. In possession of a medical license within the state of practice.

Proven effectiveness in communicating with ill, confused, poor, disenfranchised patients, many with co-occuring mental illness and/or chemical dependency and cognitive impairment. Fluency in written and oral Spanish, Chinese, Russian, Farsi, Tagalog, and Arabic a plus.

Ability to work closely with a multi-disciplinary team and communicate well with nurses, social workers, allied health professionals, patients, families, insurers, and malpractice lawyers all of whom may complain at any time that the physician asserts too much influence on patient care.

Willingness to work in conditions were salaries are decreasing annually, patient-doctor ratios are expected to be dramatically higher, and one will be subject to working long work weeks, religious and family holidays, and on an irregular schedule.

Ability to work in a larger healthcare system subject to rules of practice detrimental to patient care with unnecessary and inappropriate regulations, attacks from the public as well as politicians and the press, frivolous malpractice lawsuits that require expensive and lengthy litigation, and very high accompanying stress.

Ability to accurately make life-death decisions while stressed, tired, and in non-optimal settings. Willingness to do so for a low compensation rate.

Willingness to maintain licensure and take regular continuing education courses without compensation.

Ability to spend a large percentage of time completing unnecessary forms in order to obtain insurance reimbursement and to avoid frivolous malpractice lawsuits.

Compensation Range: very low to low.

Immediate openings throughout United States.

In the past, I thought it was quite ironic that the “pad” apps on the iPad were kind of junky. In the most recent updates that has changed. I now find that there are three great choices. Each is inexpensive. Here’s what I think.

Click on the image to zoom.

3 Legal Pads for  the iPadiPhone

Biggerplate.com (@Biggerplate) has started to post video recordings of the presentations at their recent mind mapping conference in London on their web site.

The first four presentations are now available online at this link.

All four presentations are excellent and are by experts willing to talk to their peers frankly and clearly thus resulting in a very large exchange of bottom-line information.

The 20 minute presentation by Chris Griffiths (@GriffithsThinks) is probably the best talk on modern mind mapping I have ever seen; watch this if you want a jump start into modern mind mapping. I agree with about 90% of what Mr Griffiths says, and he is extremely articulate about the big issues.

This appears to have been a great conference. Four more similar conferences are being scheduled around the world, with two coming up in the USA (San Francisco, Chicago).

Liam Hughes and his staff at Biggerplate facilitated an excellent conference and more importantly, started a valuable ongoing communication process.

Highly recommended. If you believe that visual thinking (and mind mapping) can be useful in your field, try to watch some of these short videos. Like them, I do.

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