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What do you notice?

Before making any changes that might improve outcomes where you work you have to notice things that don’t look quite right or that hint at a solution. I know someone who notices the tiniest details even when she is out shopping. She generates a huge number of ideas about how things could be improved sometimes with the smallest tweaks. Here’s an example. As a result she is the most successful person I know. You’d be lucky to have her on your side. I know I am. What did you notice about your office, clinic, shop or hospital today?

Picture by Marcin Wichary

What is your approach to the biggest health risk of our time?

Sixty to eighty percent of people are now overweight or obese. This is associated with considerable morbidity. Yet it is a very complex issue and the causes of the condition are many and varied.

…..the dramatic rise in the incidence of obesity in many countries appears to be due to the complex interaction of a variety of factors including genetic, physiologic, environmental, psychological, social, economic, and political. Wright and Aronne

The experience of overweight people with healthcare professionals is not universally good.

Seventy‐six individuals (aged 16–72) were interviewed. Most had struggled with their weight for most of their lives (n = 45). Almost all had experienced stigma and discrimination in childhood (n = 36), as adolescents (n = 41) or as adults (n = 72). About half stated that they had been humiliated by health professionals because of their weight. Thomas et al

Over my whole 40 year dieting history I found two doctors who have said ‘well, come back once a week or once a fortnight and I will weigh you’. I found that very helpful and useful, because you feel like somebody is on your side. (65 year old female)

 They have helped because they guided me and pointed things out and they were there for me. If I’ve got questions they are helpful. (28 year old female)

 Oh well, I have spoken to my doctor about it and he just says get more exercise. I did mention it to one other doctor and he said there is only one way to lose weight and that’s meal replacement drinks or tablets. So I never went back to him because I don’t agree with that. (49 year old male)

 My doctor keeps saying, you need to lose weight. And I say, yes, I know that and I want to and I try to watch what I am eating, but it is just getting harder and harder. (59 year old female)

If you are a healthcare professional it is very likely that you will see several people today who are overweight or obese. How will you raise the topic with them? How will you know they want to address the issue? What help will your offer? How do you know you have been helpful to others in these circumstances?

Picture by Paola Kizette Cimenti

Do you mind if I don’t take your advice?

Your customers, clients or patients are free to choose. Despite your most earnest desire to save them from themselves they may choose to pass on your advice today. Is that alright? They may decide never to give up on the donuts, to stop smoking or head to the gym. As a consequence they may continue on the way to chronic illness. Do people have responsibilities from the ethics point of view?

Autonomous patients do have duties most of which are left out of mainstream medical ethics. Some of these duties flow from the obligations all persons have to each other; others are the
responsibilities citizens have in a welfare state. More specifically, patients have duties corresponding to those that render doctors captive helpers. Patients have to- morally have to do their best to ensure that they minimise this captivity and enable doctors to be willing helpers. Although doctors remain captive in the face of acute or life-threatening illness, it is not unethical for doctors to free themselves from this captivity in cases that fall short of life or death. Draper and Sorell

Picture by Viv Lynch

Show and tell

Nothing is as compelling as seeing a vision of  yourself in the future. Increasingly healthcare professionals have the scope to offer people a vision of the future. It’s possible to display projected changes on avatars, websites or infographics. How might you show people what might happen in the foreseeable future?

Recent literature shows that new technologies can be used to promote patient engagement. The present contribution focuses on Virtual Worlds (VWs), namely virtual environments that multiple users can experience together thanks to the use of avatars. Indeed, VWs offer interesting opportunities for patient engagement interventions on two levels. On the individual level, customized avatars are known to have relationships with users’ inner experience and Self-conception, so that they may constitute a peculiar additional tool for psychological assessment. Moreover, they are able to promote healthy behaviors thanks to a strong vicarious reinforcement (Proteus effect). On the collective level, VWs constitute an ideal platform to support the emergence of collective flow states (Networked Flow) which are related to the patients’ creative activity and well-being. Healthy Avatars, Healthy People: Care Engagement Through the Shared Experience of Virtual Worlds

Picture by Trina Alexander

Do you use stories?

Outcomes in healthcare can be assessed using measures, meters and monitors. The art of healthcare is to ‘sell’ health because most of what promotes health are the choices of autonomous individuals. Healthcare can choose to present facts and figures:

Your BMI is 27, your blood pressure is 150/95mmHg, your lipids are in the higher range, your K score ( measure of depression) is 26

So if this is you you’ll be advised to lose weight, exercise more, eat less and relax. Even as you hear these numbers you will glaze over. In other industries they use stories to avoid ‘push-back’. The typical story has a setting, a hero, a complication a turning point and a resolution. Story teller’s say:

He must enter the hearts of his listeners, where their emotions live, even as the information he seeks to convey rents space in their brains. Our minds are relatively open, but we guard our hearts with zeal, knowing their power to move us. So although the mind may be part of your target, the heart is the bull’s-eye. To reach it, the visionary manager crafting his story must first display his own open heart. Peter Guber

The story might be:

You know you remind me of another 45 year old chap I knew. He was a very successful and worked long hours. While he loved his job he also wanted to retire early so he didn’t pay much attention to his lifestyle. Then one night he went to the Emergency department because he had terrible chest pain. He was due to go to an important meeting in the morning but that evening he was sweating, vomiting and clutching his chest. He was lucky because it turned out he didn’t have any serious illness but he needed to change his habits. Two years later people didn’t recognize him, he put all of his skills to reinvent himself, lost weight, started exercising and having regular breaks. So although he, or should I say I, won’t retire soon I plan to live long enough to enjoy it when it does happen.

Bernadette Jiwa’s new book the Right Story might help.

Picture by MorkiRo

Do you perform any rituals during your day?

Do you perform any rituals during your day? Why? What is the value of the ritual?

Despite the absence of a direct causal connection between the ritual and the desired outcome, performing rituals with the intention of producing a certain result appears to be sufficient for that result to come true. Francesca Gino, Michael I. Norton

Picture by Sulen Lee

Where were you when I was bored and saw this?

The triggers are everywhere- Hungry? Thirsty? Bored? Sad? We have something for you right now. Meanwhile your advise is a quiet voice in the back of their mind. There is an entire industry dependent on people’s bad choices, they are not taking a holiday this year working on how to influence them more than your diet and exercise program. There’s another industry depending on those choices so that you- doctor- will prescribe their neatly packaged answer to the expanding waist lines and furred arteries. It’s about the economy. The show must go on.

Picture by osde8info

You are a prop too

In any theatre where people interact- including your office- you are also a prop. Anyone who enters that room will react to you as much as they might respond to anything else in there. Your look, smell and sound will draw a reaction. You may not be able to change many of your attributes- but you can’t afford to be unaware of them.  How do you take this into account when you plan that interaction?

Picture by Circle X

What do people see on your desk?

Okay so you might not have chosen the wall paper, the carpet or the size of your office but what’s on display on your desk? What impression is created at a glance? Do you look organised? Do you look like you’ve got the time to give your visitors some attention?

There are six reasons to clean off your desk and as Catherine Conlan suggests:

Remember, your workspace speaks for you even when you’re not there.

Picture by Andrew Tarvin

How many senses do you engage?

How many of the five senses are engaged in your office? Sure people see things, hear things and touch things but are their other senses stimulated?  Do they associate your office with a smell or a taste? What is it? If you are  a doctor it’s not likely to be something pleasant. But if you are and have done something about it then Elizabeth Ely sounds like she would approve:

Just what is it about medical disinfectant? It just smells so, well, medical. So like it’s covering up sick, and bringing you along with it, pulling you under its odourous spell.

Picture by Your Best Digs