I pointed out in one of my earlier posts that school and work are like two sides of the same coin. At this point, I have a point to make about this. I was so excited when a topic came up at work with the title Motivational Interviewing. Dr. Ben (not his real name) presented on this subject over a period of one hour via Webex. We saw PowerPoint slides as he presented. The similarity between what I showed at the start of my blog and this topic of MI is indeed striking.
The heart of the matter is behavior change in the health care setting. How do you as health care providers promote behavior change necessary for compliance and best outcomes in the hospital setting? MI constructs all target behavior change. They include Intrinsic Motivation, Stages of Change, and Social Learning Theory.
According to the presenter, researchers noticed that in the American system healthcare providers were more confrontational when attending to patients; hoping that aggressive behavior would motivate clients to change their behavior. Evidence pointed in the opposite direction, indicating strongly, that motivational interviewing rather than confrontational approach facilitates behavior change. Alongside this evidence the overlay of theories for Intrinsic motivation and stages of change that people go through.
According to the presenter, not much research has gone into this subject especially as it relates to a group setting. How do you apply the concepts that have been studied in individuals to the group setting and organizational change? I see this spot as potential for exploration. In my opinion, and based on the experience of more than fifteen years in the HIV field, organizations and communities share many of the characteristics of individuals in these communities. Whether or not there is research in this area is something I will have to explore in the coming days. (Jan 13, 2016)
Monday, January 18, 2016
Wednesday, January 6, 2016
Questions and Pieces of Advice
My doctoral journey professor said something that is worthy thinking about and writing down on this blog. Noting the fear of statistics expressed by two students in my class, particularly one that was convinced statistics are impersonal, boring, hard to deal with, and so forth, the professor pointed out that this is a common complaint among students at residency.
The professor's guidance on the matter is to remain objective especially as marketers and dissertation researchers. She admits there are times when we "yawn at statistics"; however, she totally emphasizes the importance of objectivity in our work, saying, "We should NOT let our personal preferences influence how we approach a research problem." This got me really interested.
She raised three questions and pieces of advice for us to consider:
(a) If you plan a qualitative study for your research and the reason you give for taking a qualitative method, saying for example, "I hate statistics!" and/or "because it is easier than a quantitative method", then, according to her, "you will have a very difficult time persuading people that your methodology is appropriate." By people, she is probably talking about the dissertation committee first and foremost.
(b) If you plan a quantitative study for your dissertation and your reasoning is, "Because my instructor (or dissertation chair) told me" and/or "Because it is easier than a qualitative method", the road ahead could be long, messy and painful.
(c) If you do not have 3 to 5 peer reviewed sources that call for research about your specific topic with your proposed method, then it is highly advised to find them.
She adds this thought, "If you cannot find adequate support in the literature for your proposed work, STOP, drop, and rethink your methodology.
The professor's guidance on the matter is to remain objective especially as marketers and dissertation researchers. She admits there are times when we "yawn at statistics"; however, she totally emphasizes the importance of objectivity in our work, saying, "We should NOT let our personal preferences influence how we approach a research problem." This got me really interested.
She raised three questions and pieces of advice for us to consider:
(a) If you plan a qualitative study for your research and the reason you give for taking a qualitative method, saying for example, "I hate statistics!" and/or "because it is easier than a quantitative method", then, according to her, "you will have a very difficult time persuading people that your methodology is appropriate." By people, she is probably talking about the dissertation committee first and foremost.
(b) If you plan a quantitative study for your dissertation and your reasoning is, "Because my instructor (or dissertation chair) told me" and/or "Because it is easier than a qualitative method", the road ahead could be long, messy and painful.
(c) If you do not have 3 to 5 peer reviewed sources that call for research about your specific topic with your proposed method, then it is highly advised to find them.
She adds this thought, "If you cannot find adequate support in the literature for your proposed work, STOP, drop, and rethink your methodology.
Saturday, January 2, 2016
`My Dilemma
One week later and I am still thinking; I am not sure which way to go with my dissertation ideas. I wish the answer was easy. I envy those who made up their minds earlier based on their current occupations. Today, I had a new idea which could help me make forward movement if it has any water in it, as they say.
I am thinking of doing a basic research, one that explores a new idea to be titled: Empowering Patients through Strategic Questioning. This is the same, in my opinion, as saying give patients space to specify their expectations and provide feedback all along the way through the health care system. More specifically that means all health care providers, including the receptionists should be trainined to treat patients as special stakeholders in the system rather than as customers.
Many professionals have said this, but it is worthy saying again. The hospital is the one place where people generally hate to go; it is the one place where they may be forced to stay against their will; the patient expects hotel quality service, and above all, expects to pay little or nothing for services provided. In fact, the hospital can be a place of emotional, physical, and spiritual turmoil. Many people coming to the hospital are afraid of what might happen or what diagnosis may be made while in the hospital. All the years I practiced as a medical laboratory technologist I was aware of the dichotomy of health care ministry.
A lady came to the laboratory once wanting to know if she was pregnant. The urine test came out positive and I recall her words as she sat in the chair with a blank stare. '"Why?" In that moment, her life came to a standstill; she was totally transformed. I also recall on so many occasions when a person's life was touched this way or that way by all manner of issues. Cancer, HIV, diabetes, high blood pressure, and other issues affecting the human body.
The last thing one wants to find in the hospital are workers who do not care; especially the reception desk that happens to be the face of the hospital. Tenderness and empathy should accompany all those working in the health care system. Doctors, nurses, technicians, pharmacist, and non professionals too. Whoever works in the health care system should be trained to deal with patients with a degree of sensitivity.
Having said that, it is easy to overlook the fact that workers in the hospital are almost always working under pressure. This is the dichotomy I refer to. To be able to care requires someone who also feels cared for. Nurses and doctors also need to be cared for. Oftentimes as a patient we may forget that health care workers have needs too. It is not hard to see this problem multiplying itself many times over in the system where one patient is not the last one, and where some patients have challenging characters.
By asking this question (What are your expectations?) of patients as they walk into the hospital, the provider can empower the patient to consider not only what he or she might get out of the system for themselves but also what they may contribute to the system.
I have noticed in some of the good clinics that at the reception desk they have a video playing showing diseases and how to go about diagnosing and treating them. This, in my opinion, was not empowering the patient; it reinforced fears that a person might have already. What do people really need when they come to the reception desk? I suspect many patients would say they want to be heard. They want to tell their stories.
I am thinking of doing a basic research, one that explores a new idea to be titled: Empowering Patients through Strategic Questioning. This is the same, in my opinion, as saying give patients space to specify their expectations and provide feedback all along the way through the health care system. More specifically that means all health care providers, including the receptionists should be trainined to treat patients as special stakeholders in the system rather than as customers.
Many professionals have said this, but it is worthy saying again. The hospital is the one place where people generally hate to go; it is the one place where they may be forced to stay against their will; the patient expects hotel quality service, and above all, expects to pay little or nothing for services provided. In fact, the hospital can be a place of emotional, physical, and spiritual turmoil. Many people coming to the hospital are afraid of what might happen or what diagnosis may be made while in the hospital. All the years I practiced as a medical laboratory technologist I was aware of the dichotomy of health care ministry.
A lady came to the laboratory once wanting to know if she was pregnant. The urine test came out positive and I recall her words as she sat in the chair with a blank stare. '"Why?" In that moment, her life came to a standstill; she was totally transformed. I also recall on so many occasions when a person's life was touched this way or that way by all manner of issues. Cancer, HIV, diabetes, high blood pressure, and other issues affecting the human body.
The last thing one wants to find in the hospital are workers who do not care; especially the reception desk that happens to be the face of the hospital. Tenderness and empathy should accompany all those working in the health care system. Doctors, nurses, technicians, pharmacist, and non professionals too. Whoever works in the health care system should be trained to deal with patients with a degree of sensitivity.
Having said that, it is easy to overlook the fact that workers in the hospital are almost always working under pressure. This is the dichotomy I refer to. To be able to care requires someone who also feels cared for. Nurses and doctors also need to be cared for. Oftentimes as a patient we may forget that health care workers have needs too. It is not hard to see this problem multiplying itself many times over in the system where one patient is not the last one, and where some patients have challenging characters.
What are your expectations?
This question can be applied in an empowering way. Health care providers should not provoke patients to fear; instead they should learn to de-escalate tensions and fears patients may have. Some fun, some humor, some empathy can come out of the initial contact.By asking this question (What are your expectations?) of patients as they walk into the hospital, the provider can empower the patient to consider not only what he or she might get out of the system for themselves but also what they may contribute to the system.
I have noticed in some of the good clinics that at the reception desk they have a video playing showing diseases and how to go about diagnosing and treating them. This, in my opinion, was not empowering the patient; it reinforced fears that a person might have already. What do people really need when they come to the reception desk? I suspect many patients would say they want to be heard. They want to tell their stories.
Tuesday, December 29, 2015
An Idea to be Tested
This morning I was thinking about my dissertation and came up with an idea while I was half asleep. This idea is raw and has not been researched to see if someone else has already thought of it. In the coming few hours I will find out if someone has done similar work. The idea is to ask persons feeling unwell, going to the hospital, "What are your expectations?" and synthesize their answers. This is all the idea. It is really simple, actually too simple, I thought. But, in the context of the United States health care system there is nothing simple. I also expect that such findings would have significant implications on how health services are organized and carried out. So, here are some of my hypotheses:
Hypothesis 1: There is a noticeable difference in responses based on demographics
Hypothesis 2: There is significant similarity in responses based on 3 factors, economic status, race, and political affiliation
Hypothesis 3: Fundamental expectations are similar for all people going to hospital to get help.
Some permutations of this idea are as follows:
This idea sounds simple enough to carry out. If I were to get a All Clear signal I might consider the permutations later in design stage when I am sitting down at my desk. I think it is a good idea to trace some of the thoughts in my mind. So, where does this idea originate?
For more than 15 years I was part of the Africa Facilitation Team, taking the message of HIV/AIDS to parts of Sub-Sahara Africa. We helped organize communities and trained community counselors across Africa using the Community Counseling model developed by the Salvation Army Chikankata hospital (1988) that later became the UNDP's model of Community Capacity Enhancement through Community Conversation (CCE-CC). The model promotes participatory approaches to solving community problems with community ownership of the issues and solutions as a key component.
The most important part of this process asks the participants, What are your expectations? Most meetings started with expectations and ended with a review of those expectations and achievements. By matching expectations and achievements it was possible to set aside a parking lot where unmet expectations could be stored for later. A good facilitator keeps an eye on the expectations of the participants. Some expectations were realistic while others were unrealistic.
The other thing is that the facilitator also had expectations. The mix of participant and facilitator expectations was always interesting and worthwhile exploring. That mix formed the basis for successful meetings. One of the expectations of a facilitator might be that all participants would remain in the meeting until the end. Expectations are very important in any relationship especially in the patient-doctor or patient-nurse situation. The worst thing is for people to assume things about others; to assume that we know what people expect in a relationship can lead to disaster. Asking is not hard; however, in the health care system everyone is generally very busy and preoccupied. People are preoccupied with things that may not even be related to the patient sitting in front of them at that moment.
The doctor may be thinking of an issue relating to Continuing Medical Education (CME), or family conflict going on, or something in the past or future. What if the first question the reception desk at the clinic asked a patient was, What are your expectations today? instead of asking the patient What is your problem? That, I think, would be huge, if the question was asked in earnest. The health care system is full of contradictions. How often does a patient approach a clinic thinking, I am going to see the doctor; he or she will ask me What can I do for you? Instead, the patient finds a waiting room that is filled with waiting patients and a set of cold forms waiting to be filled in and a near absent minded receptionist behind a large computer screen. Unlike in the 7-Eleven where the shop assistant shouts a "Welcome to 7-Eleven" and asks you later, Is that all for you today?, in the clinic the nurse might say nothing to welcome you and nothing at the end of the encounter. The health care system trains doctors and other professionals in expensive colleges through a rigorous process and curricula.
It is unusual to find a doctor waiting at the reception desk (as a receptionist); instead, one usually finds a non medical professional stationed at the reception desk. She or he is the face of the clinic. The patient has to put on two different hats, first to meet the non medical professional and another to meet the medical personnel. No matter how one thinks of it this is a troubling scenario when the receptionist asks you in a loud voice in front of all those patients in the waiting room, What is your problem today? What are you supposed to say? I have pain in my abdomen? Is that true or is there a more private situation going on? What happens if you lie to the receptionist? ... What if the receptionist was trained simply to ask, What are your expectations today? This question can be modified without losing its essence.
I have been to see a doctor; I am partly reflecting upon some of my experiences. As a doctoral student I criss-cross barriers as a patient and a provider. In my work I am a Clinical Quality Improvement Coordinator. That means an added relationship to the health care system. In my previous careers I trained laboratory technicians and in future I will probably return to training. This idea would be great if it is cleared for me to carry forward.
Hypothesis 1: There is a noticeable difference in responses based on demographics
Hypothesis 2: There is significant similarity in responses based on 3 factors, economic status, race, and political affiliation
Hypothesis 3: Fundamental expectations are similar for all people going to hospital to get help.
Some permutations of this idea are as follows:
- What if I could ask each of those people shortly after their return from hospital, "Were your expectations met?"
- What if I returned at 3 month intervals for one year to the same individuals to find out their perspectives on health services based on the original interaction that they had with the hospital/ clinic?
- What if I did exactly the same at two locations in the United States, at a rural clinic and in the urban setting?
This idea sounds simple enough to carry out. If I were to get a All Clear signal I might consider the permutations later in design stage when I am sitting down at my desk. I think it is a good idea to trace some of the thoughts in my mind. So, where does this idea originate?
For more than 15 years I was part of the Africa Facilitation Team, taking the message of HIV/AIDS to parts of Sub-Sahara Africa. We helped organize communities and trained community counselors across Africa using the Community Counseling model developed by the Salvation Army Chikankata hospital (1988) that later became the UNDP's model of Community Capacity Enhancement through Community Conversation (CCE-CC). The model promotes participatory approaches to solving community problems with community ownership of the issues and solutions as a key component.
The most important part of this process asks the participants, What are your expectations? Most meetings started with expectations and ended with a review of those expectations and achievements. By matching expectations and achievements it was possible to set aside a parking lot where unmet expectations could be stored for later. A good facilitator keeps an eye on the expectations of the participants. Some expectations were realistic while others were unrealistic.
The other thing is that the facilitator also had expectations. The mix of participant and facilitator expectations was always interesting and worthwhile exploring. That mix formed the basis for successful meetings. One of the expectations of a facilitator might be that all participants would remain in the meeting until the end. Expectations are very important in any relationship especially in the patient-doctor or patient-nurse situation. The worst thing is for people to assume things about others; to assume that we know what people expect in a relationship can lead to disaster. Asking is not hard; however, in the health care system everyone is generally very busy and preoccupied. People are preoccupied with things that may not even be related to the patient sitting in front of them at that moment.
The doctor may be thinking of an issue relating to Continuing Medical Education (CME), or family conflict going on, or something in the past or future. What if the first question the reception desk at the clinic asked a patient was, What are your expectations today? instead of asking the patient What is your problem? That, I think, would be huge, if the question was asked in earnest. The health care system is full of contradictions. How often does a patient approach a clinic thinking, I am going to see the doctor; he or she will ask me What can I do for you? Instead, the patient finds a waiting room that is filled with waiting patients and a set of cold forms waiting to be filled in and a near absent minded receptionist behind a large computer screen. Unlike in the 7-Eleven where the shop assistant shouts a "Welcome to 7-Eleven" and asks you later, Is that all for you today?, in the clinic the nurse might say nothing to welcome you and nothing at the end of the encounter. The health care system trains doctors and other professionals in expensive colleges through a rigorous process and curricula.
It is unusual to find a doctor waiting at the reception desk (as a receptionist); instead, one usually finds a non medical professional stationed at the reception desk. She or he is the face of the clinic. The patient has to put on two different hats, first to meet the non medical professional and another to meet the medical personnel. No matter how one thinks of it this is a troubling scenario when the receptionist asks you in a loud voice in front of all those patients in the waiting room, What is your problem today? What are you supposed to say? I have pain in my abdomen? Is that true or is there a more private situation going on? What happens if you lie to the receptionist? ... What if the receptionist was trained simply to ask, What are your expectations today? This question can be modified without losing its essence.
I have been to see a doctor; I am partly reflecting upon some of my experiences. As a doctoral student I criss-cross barriers as a patient and a provider. In my work I am a Clinical Quality Improvement Coordinator. That means an added relationship to the health care system. In my previous careers I trained laboratory technicians and in future I will probably return to training. This idea would be great if it is cleared for me to carry forward.
[August 20, 2021. I never carried this idea forward. Instead I did something different for my dissertation.]
Sunday, December 27, 2015
In Search of Inspiration for a Doctoral Dissertation
I revisited my old writings from years ago when I was searching for a topic for my doctoral dissertation.
Over a weekend, I took a break from my classes and went to Washington DC for some family business. While there, I was also on the lookout for a suitable topic for my doctoral dissertation. But I found it difficult to settle on one idea, as there were too many options in my mind and none of them seemed clear enough to settle on.
After my last post, I traveled to Washington DC and returned to Lawton over three days. I flew into the Reagan National Airport on a Wednesday morning, and started back for Lawton that same evening, driving a rented truck.
I say this because I found an excellent time to reflect on my doctoral journey, especially on the aeroplane on my way to DC. I took with me a recent Reader's Digest and found time to go through the articles. I told myself to listen, to look out, to pay attention, and to keep my mind open so that I could get the inspiration for my doctoral dissertation. I wrote down the main ideas that came to me along the way.The first series of thoughts came to me out of the Reader's Digest. They are as follows, not in any particular order of importance:-
On page 8 of the Reader's Digest (Dec 2015/ Jan 2016 edition) there is a letter written by Judy of Utah where she explains why she studies Memory. The reasons include her experiences with her parents. Memories linger for a long time in our minds; however, we can choose what to do with those memories. In my mind, I was inspired to look for a subject in my memory rather than go out there looking for something new to study, no matter how appealing it might appear to me. I must find a subject that means a whole lot to me. By searching through my memory bank I might find one. On page 9 I wrote, "A subject I'll study not just now but always." On the inside of the back cover, I wrote, "A subject/topic I have been interested in for a long time."
The other inspiration coming out of the Reader's Digest was in the form of a question: Do I want to be remembered? The context of this inspiration is a story on page 112 about Forever Memory. Simon Parkin wrote these words, "What if our recollections could live on long after we were gone?" In the article, the fundamental question is whether or not we would like to be remembered when we are dead and long buried. Surprisingly, my response was neither yes nor no; I turned the question to my doctoral subject: What is it I want to leave behind as my heritage and gift to the world? What knowledge, what thought?
In a matter of one week since my first blog post, I have come up with a SWOT analysis of sorts. My strengths, weaknesses, opportunities and threats. Of these I looked first at my strengths, things I know I am good at... things I have accomplished in my life and things that brighten my heart when I think of them. They include my work in community counselling and community capacity enhancement; training and development, and my love for academics. These are the practical things I have done as a person of faith as my contribution to the world.
As these relate to health care and to current issues in health care, I wrote down the following points: Leadership studies; Finance, Planning, Monitoring and Evaluation; Management training, Team dynamic, transformational leadership, relational leadership, patient satisfaction, and measurement.
I am spending quality time in a deep soul search for the topic that I will cover for my doctoral dissertation. I am looking for something I have always loved to know and do; I am looking for a subject I am willing to keep on studying always, and one on which I can write many articles starting very soon. As of today, I have not yet identified the topic for my doctoral dissertation.
Tuesday, December 22, 2015
How the Journey Started, Retracing the Steps
My Doctoral Journey Starts
September 24, 2015. I signed the papers to change/switch programs from Masters Health Administration (MHA) to Doctor of Health Administration (DHA). At that point I enrolled in the doctoral program and first course, DHA711A-Leadership Theory and Practice. The doctorate program feels different from the Masters program, in texture and at granular level.
The School of Advanced Studies (SAS) is a unique place containing resources for students in the doctoral program. I was introduced to the SAS by my Academic Counselor. She also walked me through the library for special resources there. I saw many new things on the SAS site including the Analysis, Evaluation, and Synthesis (AES) model in PowerPoint.
The doctoral journey started in earnest on September 29, 2015 when I opened the door to the classroom and joined a group of 11 other doctoral learners. I soon realized that only one other student in the group was in the Health Care concentration. I thoroughly enjoyed my first course and received a good evaluation for it at the end of the course.
My second doctoral course, DHA714, Health Care Marketing, is where I am today. I am in week 4 and am prompted to keep a journal so that I can record and track what transpires along the way.
This Marketing course has exploded with content. We are required to read a large number of chapters of textbooks and a whole lot of articles from the library. To claim that I am reading a lot is an understatement. I think I am reading too much. Anyway, what is amazing to me is that I am actually internalizing all this stuff. Last week alone, I probably read the equivalent of half the Bible, in order to complete a 3 page written assignment. The other thing is that I am actually reading entire articles with the boring tables and statistical analyses, the stuff I love to keep on the sides until I really must do it.
The problem is that after all the effort I made last week I ended the week with one of the worst assessment I have ever received since joining this college nearly six years ago. It was a wake up call for me. I sat down to ask myself why! Actually, I think I know what did not work well. So, I am sitting up and getting ready to face this battle head on when the holidays are over. To do so I believe I have two challenges that I have to resolve in the coming two to three weeks time.
The first is that I have to find my own voice in the doctoral journey. It seems I have always spoken using other peoples' voices and ideas if that makes sense at all. The other is that I have to come up with a Dissertation for my doctoral work. I thought there was plenty of months until I have to choose a study topic. Suddenly in the last few days it has come to me to identify the topic and focus on my Dissertation. I am going to need guts to achieve both because these are the ultimate of a doctoral course. In my doctoral class we are five, that includes four ladies.
If I was doing my bachelor's course I would ask for ideas as to what I might do for a research project, kind of like picking the low hanging fruit; at doctoral level I cant even think like that. I want something fresh; something to challenge my intellect; something I will relish to study and write about. The problem is that I am not sure that I am passionate about any particular niche in Health Care. So, I am going to spend time observing, listening, talking to people, and internalizing some more studies to see how to respond to the two challenges I face today.
More later.
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