Using Social Networks for Behavioral Change

If you’re trying to immunize people, or to implement a behavioral change, like safer sex, or reducing smoking, how do you apply the science of Social Networks if you don’t know what the network looks like?
The authors of “Connected” put it this way: It is often not possible to discern network ties in advance in a population when trying to figure out how best to immunize it. (pg. 133)
So they asked a number of random people to name their acquaintances – and then immunized those acquaintances. Turns out that the people who have many network links are more likely to be nominated as acquaintances, as opposed to those with few links. So the people who were nominated by the randomly selected people are more likely to be near the hub than the randomly selected people! Brilliant! Can’t wait for an opportunity to apply this (smile).

Asking Doctors Tough Questions: Whose responsibility is it?

In previous posts I mentioned the issue of getting doctors to wash their hands, and how hospitals are trying to do that – from an initiative to get patients to ask their doctor, to getting nurses to remind them. So I was quite interested to see this new article from the Wall St. Journal: Finding a Way to Ask Doctors Tough Questions

For me it raises the question “Whose responsibility is it to get the Doctor to Wash his hands?” The organization’s or the patient’s? If the organization fails to make this happen, then it seems to fall on the patient. Is that how it should be? Is that even the right question? Or, should we consider this a brilliant solution: the distribution of responsibility to clinicians and patients?

Oops, They operated on the wrong knee…

Did you see that some surgeons operated on the wrong knee of their patient last week? (Feb. 18, 2009, Providence) NECN said that “After the botched procedure, the hospital began requiring surgical staff to use permanent markers to mark where the doctor is supposed to operate.”   In a similar case at Beth Israel Deaconess 2 years ago, the patient’s leg was marked and they still operated on the wrong leg.

The Sr. VP of Health Care Quality at BIDMC said “that medical workers used a marker to correctly label the side of the patient that should have been operated on but that, somehow, the surgeon failed to notice the marking…   Perhaps most crucially, the team of medical workers hovering in the operating room neglected to conduct what’s known as a “time out” before the surgeon first placed his scalpel on the patient. Time outs are safety procedures that require the operating team to verbally call out, “Right patient, right procedure, right location.”

When Deviance is Positive!

Speaking of Handwashing in Health Care Settings… Have you heard about Positive Deviance? Deviance in this case means going against the norm and achieving positive results. Sometimes, if things aren’t going well in some departments, you can look around to see if anyone in the organization is having success with that one issue. If they are, they must be doing something right! You want to figure out what they’re doing, and then you want to get other people to imitate that.

Atul Gawande is a surgeon in a Boston hospital, and he’s written 2 fabulous books on learning in health care institutions: Complications and Better. He describes how doctors, nurses, and administrators can learn – from their mistakes, from surgical errors, from places in the hospital where things are going right.

Where Cultural Competence & Organizational Effectiveness Meet

As an Organizational Development consultant, I get to think about how effective organizations are: their staff, their initiatives, their ability to deliver excellent service. As I’m also trained in cross-cultural communication, I sometimes look at organizational issues through that lens. When I’m lucky, these two fields coincide, as in my visit last year to the administrative offices of a health care organization, where I saw a patient brochure about “hand-washing for doctors”. You may know that this has been a focus in health care institutions, who are trying to reduce the spread of germs and infections. This brochure said “Have you asked your doctor if he washed his hands?”

Can you see anything wrong with this? There are power issues inherent in this question. For one thing, we tend to defer to doctors, or any authority figure, particularly when they’re wearing a white coat (or a uniform, or a stethoscope). Even I, as a white woman, feel a little intimated in front of doctors. Secondly, when you’re serving people from other countries and other cultures, who may not speak the language well, or who don’t feel fully acculturated, the authority gap is even wider. They could have saved themselves time and money if they had convened some focus groups on this question (or they could have asked people like me!