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.
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.
A few months ago, I published my revised Laws of Mind Mapping in part because I do believe that the Buzan rules are great in-so-far as they go and should be followed except when they are in conflict with the content of the map or the communication expectations of the audience. Philippe Packu initially suggested in his blog a few months ago how to use ThingLink (a free Internet service) to add pop-up annotations to mind maps (on top of a jpg or png). Hans Buskes applied these methods in his usual creative way to additional content areas in several blog posts. Here is my first application. Hover over the dots for comments. I believe that the comments are useful for supplementing the map, presenting technical information or facts, listing citations, and “explaining” the “in” jokes I like to make. CLICK HERE for the annotated mind map. Then hover over or click on the black circles. A box will display my comments on each part of the map.
I guess it’s just me … I search Google for sites with “psychology mind maps” and I get lotsa pages returned. Of course very FEW of these pages let you know where the ideas, recommendations, and organization comes from. That makes me pretty pissed off.
I have a simple rule for evaluating psycho-pop, psycho-babble, psycho-art, and psycho-schmaltz: if the author (artist, developer) cannot prove to me that the information came from a credible source and is being communicated by a credible source, I assume it is psycho-fantasy and just walk (actually run) away.
Here’s a few things to ask about before you go ahead and change your job, spouse, running shoes, or haircut because somebody gives you some magic MBTI letters, a number on a test published in a self-magazine, or advice that must be right because it appears in a pretty mind map.
I love great psychology content conveyed in an easy to understand manner. I hope I produce some. Most do not produce anything except profits. Know what you are buying (and staking your life on) when you get information from a book, TV, the Internet, text, or a graphic.
Irv Oii is known to many international news organizations and researchers as a star data journalist. Being a home worker (although home may be the UK, Ohio, the Middle East, Central Africa, Hong Kong, or Antartica) and a fairly reclusive person, nobody seems to have met Irv. Some speculate that he might be a Jewish Asian-American. Others believe Irv is short for Irvelina, a Russian immigrant physician who went to Ohio (or was it Ojai, California) when the Soviet science programs collapsed and turned into the lower funded Russian collaborative efforts with the EU and USA. The collapse of the Soviet Union resulted in the closing of her laboratory in Minsk. Some even think Irv Oii is an acronym.
Irv is thus an enigma and no pictures of her/him seem to exist. An artist’s conception (mine) based on the writings and consultations of Irv Oii on healthcare breakthroughs is shown below. My belief is that a portrait of Irv should hang over the desk of every data journalist and researcher.
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.
I started writing about the importance of the content in the mind map — facts and important information well researched — back in November 2012. For the next few weeks I am intending to repost some of these posts with my updated thoughts about Mind Mapping 3.0 and what I would now call Mind Mapping 4.0. I will introduce Mind Mapping 4.0 after reviewing some of my views about Mind Mapping 3.0.]
It’s fine to put your own notes or feelings or ideas into a mind map that will be for your use or one which will be clearly labelled as you opinion. But, if you want to put ideas into general circulation as “facts,” you need to have done your homework and tie the information in the maps to established research, clinical findings, and expert opinion (and document whose expert opinion it is, whether that of someone else or yourself). Mind Mapping 3.0 was the introduction of high-quality data into this useful method of thinking.
I would categorize the pioneering efforts of Tony Buzan and others to introduce and popularize the method of mind mapping as Mind Mapping 1.0 and the parameterizations and resulting computer programs by ThinkBuzan, Topicscape, Mindjet, and others as Mind Mapping 2.0.
[As I saw it in 2012 and continue to view it in 2015] Mind Mapping 3.0 is the integration of computer-assisted mind mapping methods, artistic sensibility to enhance visualization, AND MOST IMPORTANTLY, substantive, creative, well-documented valid and reliable content of great importance.
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.
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.
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.
Technical note: this mind map was prepared with an iPad app (in iMindMap). I judge the quality of the map to be about as good as the Mac version used to create most of the other mind maps on this site. The iPad and iPhone iMindMap apps are highly recommended.
Every day, the Newseum in Washington, DC, receives electronic copies of many of the world’s newspapers. They print them and post at least one from each US state/territory and many from throughout the world.
The next day they start all over again.
It is amazing to see all of these front pages for one day adjacent to one another. The common and the local; the political and the social-entertainment.
3.16.2013. A smattering of those available inside and outside the museum.
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).
Position Opening: Physician. Thousands of opening available throughout USA. All specialties. Highest priority for primary care.
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.
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.
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.
There are lots of different applications of mind mapping methods to such areas as brainstorming, task management, scheduling, journaling, and sharing basic information (great day to play basketball!). Other mind maps may tell us about scientific experiments and theories, political arguments, historical events, anatomical features of the human body, the quality of hotels in Barcelona, or expert rankings of world football (soccer) teams projected to finish near the top in the World Cup tournament. How do you know a real expert has ranked your favorite football teams correctly? How do you know that the student who created the cute mind map of the human body as a subway map actually put in the correct names parts and names? What are the professional qualifications of the “expert” who says the world is flat? Do experts believe the purported expert who drew the mind map? Is the information in the mind map you found and downloaded from the Internet really going to tell you what you need to know for your organic chemistry test in two hours?
I sure hope my doctors studied from factually correct mind maps, not just pretty ones given away by a pharmaceutical company. And (since I have a doctorate in psychology), I am really sick of seeing mind maps that say they contain psychological principles that will make you happier, thinner, less anxious, more sexy, and help you self-diagnose whether you have bipolar disorder and which drug would be best to help you and should be ordered from an Asian or Mexican pharmacy over the Internet (URL at the bottom of the map).
Mission critical information in mind maps should be carefully reviewed by experts in the content of the maps to minimize the number of cases where misinformation hurta people . If such a review has not been done, or if the author of the mind map does not provide adequate credentials to assess professional competence, I recommend you do not use such information for making personal or business decisions. While I love artistic maps that are well-designed and “clean” in their appearance and spend a lot of time trying to emulate the best, adherence (or not) to the mind mapping rules of Tony Buzan and the use of a wonderfully artistic program, in no way does or does not make the information in the maps correct. Think about that carefully the next time you download a mind map from the Internet and try to study or make a business decision; that’s a fact, Jack.
It’s also a fact that these comments also apply to infographics, concept maps, and other information visualizations.
My next post is going to have a lot to say about the importance of content and how to assess whether that pretty map you just found contains valid, reliable, and important information.
The USA has no highly visible, charismatic, scientifically-medically experienced, brilliant, and creative leader-spokesperson for federal healthcare programs. IMHO, the last one we had was C. Everett Koop in the 1980s.
Since being such a leader should be a Cabinet-level position, the best-qualified leader would get the same salary as an out-of-work former governor or political operative in the Senior Executive Service (about $200,000).
I favor a “healthcare czar” position to which the directors of various health-related US federal agencies report.
The effects of having a great leader with oversight on most major US healthcare initiatives would be huge. A positive thinking, creative individual should be able to get $100s of millions (or billions) out of the healthcare system while increasing quality. Instead of squeezing physicians on Medicare reimbursements we need someone who can squeeze the bureaucracy to lift money-wasting and unnecessary health regulations, squeeze the health insurance and big pharma industries to get-real about their profits, and energize the general public to personally address such preventable diseases as those related to obesity, alcoholism, tobacco use, and unwanted pregnancies. Such an individual could get cooperation from the press to research and write stories about positive system change.
Such a change costs only the small expenses of a search committee compromised of prominent health stakeholder groups, and the commitment of the President to health- and socialcare.
There are 100s of great medical-science leaders in the USA who can do a fantastic job of getting healthcare coordinated and understood by the public. Koop was a conservative, traditionally religious, Republican who took on the religious right over his medical conclusions that the reality of good medical practice in the USA had to get over homophobia and hatred of the homeless drug abusers in order to dampen the effects of the HIV epidemic. He also took on the major of lobbies of the tobacco industry in stating clearly that tobacco was addictive and responsible for millions of deaths. Koop’s politics were almost opposite to mine but the actions he concluded were necessary were the same as I would have taken from my liberal vantage points. Just as a conservative Republican can do an excellent job of guiding the healthcare system if she or he is a committed medical-scientist, so too can a liberal Democratic medical-scientist do a similarly excellent job.
Go ahead dismiss this idea. Then go back to reading my posts on your big Cinema Monitor from the company who had a charismatic leader and type your responses on a keyboard from the same company.
You want a great US national healthcare system that is efficient, treats patients and healthcare providers fairly, and stresses prevention and patient-centered care? Get a great leader. This individual will cost only about $200,000 per year and some ego stroking by POTUS and the Press. Let the unemployed former governors go find out what it is like to live on unemployment benefits and use Medicaid.
WTF hasn’t the search committee already started to form?
MindMapp is a brilliant new iPad app for mind mapping posted on the app store in mid-December. You can see my review of the app there. Break-through: this is an amazing app that changes the game, at least on the iPad (and hopefully iPhone).
To say that I highly recommend MindMapp is an understatement. Students and everyone who takes notes should have this app.
A map created in MindMapp about MindMapp. This was my first “real” map, and I know that I will get faster and better at this fairly rapidly. It took about 30 minutes to work through the instructions in the included self instruction module, practice, and then to draw the map.