Final days on the road with Obama - Photo essay by Brooks Kraft

Black and white image of President Barack Obama
"After months of nearly non-stop campaigning, President Obama and his team have spent the last two weeks crisscrossing the country to make their final appeals to voters. Veteran political photographer Brooks Kraft has been there to document the campaign’s final days.

This was the eighth presidential campaign that Kraft has photographed, and his sixth for TIME. Over the years, he has honed his approach to shooting some of the most photographed men and women in the United States. Kraft rarely takes his pictures from the press platforms, preferring to move around, searching out unique angles and small details. "

View Brooks' shots and Alissa Ambrose's complete post to Time Lightbox here


Play like a girl

I played a cut-throat competitive volleyball game at my community rec center last night. The weekly session was advertised as "Adult Co-Ed Pick-up Volleyball", so I thought it would be fun, as well as a great workout.

I showed up with three humble expectations; dust-off my game, burn some calories, have fun.  My daughter wanted to spend an hour+ in the nearby weight room, so it was a family exercise "win-win" of the best kind.

I love to play volleyball and know the fundamentals well. I have a mean serve, a steady bump (that can handle a lot of heat), and once in a while I even manage to make a winning set.  When considering whether I'd be able to keep up with the others, I estimated that my game would be about 80% Rec-League ready.   I was wrong. 


I forgot that I should have measured my abilities according to the "fit male with no kids" standard of play.  Oops, right away my score went down.

When I arrived at the gorgeous, state-of-the-art gymnasium, delighted by the low price of admission and the opportunity to play for a couple of hours on two regulation-sized courts with a diverse group of adult players, I was surprised to observe only a few other women in the mix (out of approximately 25).

Before my play could be evaluated fairly, I felt already like an "undesirable", given my age and gender.  They meant business; no one took time for intros, no one smiled at me, no one wanted to mix.  Two of my male teammates sandwiched me out of adequate positioning repeatedly, until I earned acceptance into the "fit male without kids" tribe.  Silly me to forget that of course they assumed I couldn't make an impact. 

It took a muscle of a different mother to stay in that game and persevere.  But I did. I stayed in and won and lost shots not to prove myself and my abilities, so much as to train myself how to endure this kind of hostile energy when it threatens one's core confidence and freedom to play. Volleyball at a rec center is play.

After 90 minutes of consistent, winning serves, feeds and set-ups, our match broke with the side I was on the obvious overall evening winner.  It was time to reassemble. The play was fast and I still knew no one's name when it was time for me to go.  Although I was drenched with perspiration and had a few "gym burns" as badges, I didn't think the evening was much "fun".  It felt like I was on trial.

... But I just might go back next week. Here's why:

That 90 minute volleyball session taught me and perhaps my middle-school age daughter who stood watching for the last twenty minutes, so much more than the lighthearted play session I had envisioned.  What happened on that court happens at every meeting. It is the real deal and whatever my invisibility was at minute one on "the court of fit males", my daughter saw me playing and succeeding 90 minutes later.  Plus, seeing one's daughter fist-pumping for her mom provides an unnamed health benefit no mother should live without!


So ... play like a girl. Don't quit, ever. Play in all ages, shapes and sizes and stay in the game. Because this IS the game.  This is the ONLY game and by playing we stay relevant; we show up; we join teams and win points; we contribute to society.  Cardio-lifts are a mere bonus. 

And while I would never ask any of my male compadres from last night's game to stay home next week (their level of play was exciting!), I would like to give them a maternal scolding of sorts to nudge them.  Guys, a winning team at the rec level is a balanced team; think screaming spike shot meets consistent, well-placed serve.  Let's play together ...

Later on at home,  after I had recounted the experience to my son he said it sounded  "like life with a bully on the fifth grade playground". Maybe he's right.


Maybe I should expect this, but I am always surprised.  Perhaps it would be better if I treated these encounters like those always-engaging recycled plots from Animal Planet; the ones about tricky rodents and pests interrupting domestic bliss.  Rodents and encounters with invisibility are just part of our lives and we have to defend against them.

Something to consider. But with the convention in Charlotte underway, I didn't want anyone at our house, neither my son nor my daughter, to miss the First Lady's speech to the American people. We shifted our focus and settled in for the evening, just as we had a week earlier to listen to Ann Romney's address.


Patient education: Scare or care?

Medical illustration focused on hip replacement device

Call me old fashioned, but when a clinical authority hands me a brochure with the title, "What to Expect", I tend to believe what it says.

That's what was so scary about this patient brochure: it shocked me into expecting a terrifying experience.

I'm not heading into a hip surgery, thankfully.  But if I were, I would want to get the detail view of the implant around page 12, and only then after I had been assured that this surgery took into account my whole being, not just my hip.

What happens when we zoom out and expect care for the heart, head and whole person?  Can we leave caring for "pieces and parts" behind?


3-bite desserts and the Google diet

According to this colorful infographic published by MSI:
"... Using their internal "People Analytics" program, Google looks at how their employees eat in their free cafeteria and optimizes it so they're healthier, make better eating decisions, and are more productive through that process. Google does this by "nudging" their employees into making the correct eating decisions daily. ..."
The poster captures several easy ideas, the 3-bite dessert among them, to incorporate at home.
Google Diet Infographic
Via: MSI


Brooklyn Superhero Supply Company

Brooklyn Superhero Supply, Park Slope  4/12/12
On a recent trip to Park Slope, Brooklyn, I walked by this impressive storefront and discovered that behind the superhero front are real heroics in the works.

The storefront is run by 826NYC, the New York City chapter of 826national.org.  They use it as basecamp for their free writing program for kids and young adults, ages 6-18.  Below is the description that appears in the online superhero product catalog:
"826NYC is a nonprofit organization dedicated to supporting students ages 6-18 with their creative and expository writing skills, and to helping teachers inspire their students to write. Our services are structured around our belief that great leaps in learning can happen with one-on-one attention and that strong writing skills are fundamental to future success. With this in mind we provide drop-in tutoring, field trips, after-school workshops, in-schools tutoring, help for English language learners, and assistance with student publications. All of our free programs are challenging and enjoyable, and ultimately strengthen each student's power to express ideas effectively, creatively, confidently, and in his or her individual voice. "
Learn about other 826 stores in DC, Boston, LA and Michigan


Got innovation potential?

How are you coping with the pressure to "innovate or die"?  Is it motivating or overwhelming you at your core?

Art Markman, PhD, recently penned a wonderful (and succinct) POV on the topic for MonsterThinking. I excerpt below:
[There] are three characteristics that — when found together — are good predictors of someone’s innovation potential. These characteristics are based on the idea that good innovators know a lot about a wide variety of domains and they are good at using that knowledge when faced with a new problem.
  • Openness. Openness is one of the five basic personality characteristics. People who are open are willing to try out new experiences and new ideas. ...
  • A need for cognition. Need for cognition refers to how much someone really likes to think about things. When combined with openness, the high need for cognition ensures that someone not only considers an idea, but they think it through carefully. ...
  • An ability to use analogies to solve problems. As I discuss in my book “Smart Thinking,” analogies allow people who are solving a problem in one area to draw on their knowledge of another area. ...
Art Markman, PhD, is the Annabel Irion Worsham Centennial Professor of Psychology and Marketing at the University of Texas at Austin, and the director of the program in the Human Dimensions of Organizations. He has written over 125 research papers on topics related to thinking including reasoning, decision making and motivation. He blogs frequently for Psychology Today, Huffington Post, and Harvard Business Review. His latest book is called “Smart Thinking.”

View the post on MonsterThinking here.


Persistence of vision: HIMSS and the evolution of patient engagement

The last time I attended HIMSS it was as part of a team from Eclipsys/HealthVision. The year was 2000 and we were debuting a futuristic new product called Cardiovision. Here is a quick list of goals and features we envisioned at the time:

The product was designed to reduce hospital re-admissions; to function like a "care net" for patients leaving the hospital after cardiac surgery.

The product integrated tools for  clinicians, but was envisioned for patients to use at home.

The product provided ongoing messaging, bi-weekly 3-way video teleconferencing appointments for patients with their doctors and care managers, as well as secure access to an electronic medical record.

We even used infographics for friendly display of progress/risk charts to patients and providers.

There was e-prescribing, but not just for medication. Learning and physical activity was prescribed as well, with the goal of promoting the patient's mental and physical healing. We even suggested a social network, a way to buddy up patients with walking partners.

On the behavioral side, we created a custom, lean content set designed for distribution to the patient via e-mail over a six-week period, the time when hospital readmission rates were the highest (most costly, and deadliest too).

The content was created to meet literacy levels anticipated in the community, and all manner of engagement was embedded into the program.  In addition to static articles, we created quizzes, audio and videos inspired by Prochaska's transtheoretical model of change.

The entire product vision was based on a belief that patients were capable of and desired taking an active role in recovery, so we built tracking capabilities that enabled user input of activities and sentiments. We asked how people were feeling about the recovery process, and probed for emotional status reports too.

The product packaged up game theory into incentives for patients too. I believe one of the prizes was a pair of Nike walking shoes ...

This was 2000, not 2012. There was no broadband, few mobile phones; data was not liberated, and there were few incentives aimed at igniting consumer demand for participatory medicines.  The word "start-up" had hardly made it into the vernacular.

The prototype received a very positive reception, though many thought we were crazy ... The lead physician on the team appeared on local evening news, a big deal at the time. ... I believed we were even cited as "Best of Show" and singled out by a VC company fishing for good ideas at the conference.

The product in its entirety did not scale, though certain features were pulled out and developed further.


This trip down memory lane reminds me that the standout features of all tech-health products are their emotional features, Tracy Kidder's "Soul of the New Machine" so to speak. So at HIMSS 2012 what's so cool to me is that Biz Stone is speaking, and Regina Holliday is painting, and e-Patient Dave is electrifying listeners, and Jane Sarsohn-Kahn is guiding and Fred Trotter is gamifying ... what this means is that the soul of patient engagement has become as ALIVE as the financial market surrounding it.  The metabolism of the space is rising!

So, here's to change and to visionaries old and new. Here's to prototyping and ongoing dialogs about empowerment and seeking ways to liberate dependencies on outdated business models.

Here's to art and science, to conversation and caring. And, above all else, here's to the persistence of vision that technology and tools can be put to good use creating compassionate solutions to ease human suffering.


Vineet Nayar's thoughts on Davos make good sense for health care too

It used to be "hard power" applied from the top that got things done. In turn, it became "soft power" -- the achievement of change by persuasion. And today? [World Economic Forum founder and executive chairman Klaus] Schwab believes our future rests on "collaborative power" -- that is, "the integration of empowered newcomers" into the decision-making process.   Read the post from Vineet Nayar, CNN Money

When it comes to changing the culture of health, many will outwardly embrace the "empowered newcomer" while continuing business as usual.  All of us have wrestled with this dynamic and I propose that the wrestling is about keeping the discomfort of "not knowing" what the newcomer wants at bay.  Here's how it works:

Co-mingling empowered newcomers into mature business processes makes us anxious and awkward, some of us just a little, others a lot.

There is rarely adequate time to move through the awkward feelings meeting a newcomer brings up in time to establish a rapport a professional context.  This can take years because we approach the situation with blind spots.

One blind spot or preconceived limit is that there simply is not room for a newcomer's perspective. Why? Because some feel that newbies don't "get it", cannot "articulate it" or simply slow things down to such a point that empowered stakeholders are impatient to return to business as usual.

Squirm as we may, until chaired leaders become skilled at tolerating the anxiety and uncertainty of newcomer encounters, the conversation about innovation will leave a tremendous raw energy source untapped.  ...

It's an irrational season in American health care.  This season of seduction keeps calling us to envision care in new ways.

We hear the siren song of apps, big data, information, tools, treatments and processes promising to take us closer to healing, to loving, and to the care we received from our mothers and fathers (or did not receive).

The promises of the future are intoxicating, the needs are overwhelming, the technology nothing but mind-blowing. And yet, will we come close to realizing the potential this moment offers? ... I ask myself: 
  • How might we unleash and package the power of the individual? 
  • How might we establish trust as a product platform?  
  • How might we foster and ignite humility within the re-imagining of health and wellness?
  • How might we learn to perceive the individual's ability to "not know" as a sign of advanced thinking?
  • How might we germinate these ideas within?
  • How might we apply these ideas to a single relationship?
  • How might  we grow these ideas into a fluid layer of dialog globally?
It is the individual that powers the network and it is the individual who seeds our increasingly global, fluid kinship system.

As Vineet Mayar suggests, it's a ready acceptance of what is new or feared that may ultimately extend an individual's or group's vitality and relevance.

Reflecting on my own style in these contexts, I view my readiness to seek out the newcomer's P.O.V. to the health of my growth mindset.  When looked at this way, I see the whole exchange one of co-empowerment.

Rather than welcoming someone into the elite, we give away the idea of elite in exchange for something raw and less abstract.

By re-framing the exchange between newcomer and stakeholders as one of co-empowerment, we create a supply of related but distinct exponential thinkers over time. It's a way to accelerate the positive impact we can make on the world together.

Re-written 2/9 after conversations with Alex Jadad, MD, PhD 2/6-9, 2012, #Future Med