Creating a Networked Imagination in Healthcare One Patient at a Time

Web 2.0, social media, and the movement from interpretation to participation can best be witnessed in how blogger/Twitter/G+ is not simply transferring knowledge or information but creating a community with reader’s and their shared experiences. I want to continue my look at the work by Thomas and Brown ‘Learning for a World of Constant Change’ Homo Sapiens, Homo Faber & Homo Ludens’ specifically moving from passive participation to active participation and what it means for healthcare.
Today all of us can participate (let’s call this learning) with writers, thinkings, film makers, and more by leaving comments on a blog, posts on our personal digital media (e.g. Twitter links, Gooogle + posts, etc) linked back to the authors posts, Twitter chats, podcasts and more. This is different from traditional media and learning (broadcasts, lectures, reading). Thomas and Brown state ‘learning was a function of absorbing (or interpreting) a transmitted message’. In this new media we find the learner engaging with information, using it more broadly in a social context. Thomas and Brown call this ‘productive inquiry’.
Productive inquiry is associated with John Dewey  He associated productive inquiry with the ability to engage the imagination. This new media “has enabled the fusion of network technology, communities of interest, and a shared sense of co-presence…’ Thomas and Brown call this ‘networked imagination’ which is a type of social and collective participation, think #hcsm. Learning is taking place in a social context. It is more effective than passive participation because it speaks to the learners needs. 
What does this mean for healthcare? I think we need to look at what it is happening to the average American and how they are using the web. And how this behavior is shaping current healthcare so we may capitalize on it. 

You’ve seen the data on how Americans use the internet for healthcare related data here  Americans are using the internet to find answers to healthcare problems they are seeking solutions to here. Americans are sharing healthcare knowledge with each other. Americans are using mobile devices to search for health information. In short and unsurprisingly Americans are going online, joining social networks, and sharing knowledge to manage their healthcare. These learners are engaging in their healthcare through the creation of networks of healthcare knowledge and information. They are doing it patient to patient, HCP to HCP, and in some cases HCP to patient. Web sites and publishers are focusing on getting health related information to consumers in an easily digestible fashion quickly. 
Historically HCP have been trained in traditional learning, absorbing a transmitted message. This works well as witnessed by the skill and expertise of our medical professionals. They leave medical school and residency as well trained as any in the world. And as HCPs continue their training in pretty much the same vain with CME lectures, online, grand rounds, etc. And further, HCP do access networks of other HCP and colleagues to learn. They to are part of this online healthcare revolution ‘networked imagination’.

So we have patients engaging in ‘networked imagination’ in healthcare. We have HCP trained in a traditional fashion, message sent message received and moving toward active participation in social media as they enter into practice. What we don’t see here is the overlap of physician and patients in a way where the HCP is taking the lead in becoming that trusted resource for the patient. Leading this productive inquiry. Becoming a valued network for the patient not just a parental figure. 

HCP need to move away from the idea that patients uniformly want a simple transfer of information or knowledge. ‘You have HTN and you need to take this.’ Because you know a majority of your patients will go do a HTN and the medication and find 20 other patients taking the medication with opinions and ideas. And if they feel welcomed they will call or come into to discuss it with you. Are HCP ready to create participation in order to manage interpretation? 

Let’s look at ‘You have HTN and you need to take this’, as part of a productive inquiry. This is not shocking to the patient, you’ve told your patient they are moving toward HTN. Both of you are prepared. What’s to keep you from handing that patient a single 8″x11″ sheet of paper with some URLs to links and PDFs on the topic of HTN and the medication that you have selected based on good evidence? Nothing. What is to keep you from adding a short paragraph about each URL or PDF as your abstract? Nothing. And you can do it with the following direction: a) Fill the Rx, begin your regimen, and read the information. b) Read the information, fill the Rx, and begin your regimen or c) Read the information don’t fill the Rx. I will see you in two weeks to follow-up with you on the medication, side effects, what you’ve read, and answer your questions. 

You have engaged this patient in a social context on a clinical topic. You are now occupying the learning receptors of patient and managing their expectations. This is not you waiting to react. It is you leading a networked imagination in healthcare one patient at a time. 


The Aporia and Epiphany of Learning, Healthcare & Social Media

My one trick pony reprise: social media is just one shinny toy in a box of other equally shinny toys (i.e. tactics). You’re drinking the Kool-Aid if you believe SM in and of itself will solve the healthcare crisis, change outcomes, improve patient care, and save money. Throwing a Twitter hashtag at healthcare without a strategy, goals, and metics is like wearing flip flops in a blizzard. 
In my view social media is a tactic best suited for education and learning. It offers those who apply it a robust tactic for learning about, learning to be, and learning to become active and engaged consumers and providers of healthcare. 
I am reading and digesting ‘Learning for a World of Constant Change’ Homo Sapiens, Homo Faber & Homo Ludens’ by Douglas Thomas & John Seely Brown. You can read the PDF here and it is well worth it if for nothing else the rich tapestry of ideas about learning in todays complex ever changing world. (Just consider how many links to new information are tweeted on your timeline in an hour, a day a week)

The authors state, rightly so, that we cannot possible keep up or engage with the sheer volume and flux of [healthcare]  knowledge occurring today. 

In the 20th century it was learning about. You accessed and learned skills and knowledge. Think slide lectures, didactic, reading, watching, etc. 
Thomas and Brown further present that later in the 20th Century value was identified as learning to be where learning was put in the context of systems, identity and the transmission of knowledge. Think patient office visit, infusion lab, patient handouts, WebMD, support groups, etc. 
Thomas and Brown further state that in the 21st Century learning is beaming a function of learning to become. We will all need to learn to become over and over. We will need to continuously reinvent ourselves to meet the constant change in information, knowledge, and data. Think changes in treatment, diagnosis, management of diseases and the aging population. Guidelines are changed almost bi-annually. 
In this new world of ever expanding content and data where attention is measured in a fruit flies life span we must embrace the key principle in healthcare–life long learning. This is not solely the purview of the HCP but of the patient because it is abundantly clear that patients expect to be part of the care team. And, to become that member they to must engage in life long learning as well in order maximize the benefits of their healthcare professional and improve their own healthcare footprint. And fr the HCP to surrender that learning opportunity to others is a failure in seeing where the puck is going to be. 
Over the course of the next couple of weeks post additional comments and thoughts from Thomas and Brown’s paper on learning and relating it to healthcare and social media. 


Leverage the Office Visit to Active Learning

In Digital Tonto’s post ‘4 New Marketing Paradigms’ here Greg’s third paradigm is titled ‘From Awareness to Activation’. The premise here is that awareness is the driver of sales. The more we beat the consumer around the head with messages the higher the likelihood that when a purchase choice is made it will be positive for the brand.
This one is a bit of a stretch for healthcare but it works. Historically the HCP (brand) really didn’t need to create awareness. Top of mind by the patient (consumer) happened when the annual physical was due, the arm was broken, the cold that wouldn’t go away, or a MI. But as I’ve stated, the office visit should not be a drive by. It is the chance to build a lasting and ongoing healthcare engagement with the patient.
In my view the two parties in this exchange brand (HCP) and consumer (patient) first need to determine if there is a need or desire for engagement. Do you (patient) want to know more, be more active in your healthcare? We can move beyond this office visit to actively share in your ongoing healthcare experience. Patient ‘I’m okay, I want to know more, yes count me in.’
What has happened in this small exchange is that two parties with overlapping goals have agreed to extend the ability to meet those goals. They are building a two part system for change. The patient with the approval to participate is now becoming the learner with a small roll as a teacher. While at the same time the HCP is becoming the teacher with small roll as learner. Each one will drive the other ones engagement in healthcare based on uptake in knowledge and learning. What is about to happen is active engagement.

More coming.


The Office Visit is Not a Drive By

 In Digital Tonto’s post ‘4 New Marketing Paradigms’ Greg’s second paradigm is titled ‘From Campaigns to Platforms’. His premise is that marketers can no longer just run ads till they wear out; they need to build campaigns that integrate social media, e-commerce, and interaction with the reader/viewer. Marketers are now ‘tailoring the message to past behavior’. I am very found of his closing sentence ‘Brands need to become authors whose stories unfold over time.’ The brand becomes the connection to reader/viewer not just a feature or benefit. 

How does this relate to healthcare? The physician is the brand. The patient is the consumer of that brand. The office visit for a check-up or care for an acute or chronic condition is the ad/commercial. It is where the consumer (patient) interacts with the brand (physician). And historically it is a flat moment where the patient is passive and the physician active. With all the changes occurring in healthcare etc. more patients are becoming active in their health and care. Many physicians are stepping up to meet that half way. But that is not enough and it misses key inflection points. Engagement between physician and patient is becoming the new black and it is up to the physician to lead the way. To in a sense create that learning narrative with the patient.

The physician as a brand should look at that visit not as a one time event in a string of events. It is a way to build a brand platform based on patient needs and goals. It is the moment where the physician can determine not just blood pressure but pressure points for knowledge uptake and begin that healthcare narrative. What are the problems/goals/needs the patient wants? How can the physician become the author of a patient narrative? Does the patient leave with an Rx? Or do they leave with a continuum of care based on integration into the brand platform? ‘My physician is a great doctor but he is also doing more then caring for me, he hears me.’ 

Yes, yes I know, not all patients want to be part of a platform or need to be. The 20 year old patient in excellent health who comes in for a check up is not looking to solve a healthcare problem. And frankly many older patients with chronic HTN are not interested either. What exists is the opportunity to for HCP to take the pulse of each patients’ needs and goals regarding their health and learning styles and to change the office visit from a drive by to an engagement for life. Why can’t patients move from grade school to graduate school in their relationship with their physician over time? Physicians need life long learning. So do patients. I’m getting all misty here 

 And yes dear readers (all three) you re correct, how does a busy HCP achieve this? Stick with me and it shall be shown.