"Seven" things about communication

Yesterday, I posted a comment about the importance of linking high-end IT gadgets, things that often appear to be stand-alones, to the larger whole. I'm sensitive to this since my daughter has been hearing with a cochlear implant for the past 12 years.

I know from experience that it's easy to think you're being heard when you call a child to dinner and she shows up. She comes because she heard you say, "Time for dinner!" Or she heard something and decided to check it out since dinner is normally served at this time. Or she heard nothing but something smelled good. The outcome "showing up for dinner" is the same in each case. But you'll only replicate the results (and achieve them under tougher conditions) if the first statement is the accurate one.

In healthcare, regulators are focusing on closed-loop communication, techniques that are long-time norms in industries that deliver reliable results. Healthcare workers now have standards that prohibit transmission of high-stakes information--such as chemotherapy orders--by telephone. Clinicians receiving verbal orders have a duty to "read back," and clinicians who have given verbal orders must verify the information has been heard as intended. Other communication-sensitive initiatives include standard pathways and windows of time for notifying providers of critical lab values and radiology findings.

There's been more than a small amount of push-back from clinicians, especially from those who perceive they have never initiated, contributed to, or facilitated an error rooted in poor communication. (Every year, 1.5 million people in the US are harmed by medication errors, a statistic which substantively refutes the notion that entrenched communication patterns are sufficient.)

So I thought I'd share some communication "best practices" from my daughter, a reluctant but seasoned communication expert. She's a college student and, in the summer, the equine director at a residential camp who goes by the name "Seven." Here's what she shares with other camp staff and her campers, consider them seven from Seven:

Tips for Talking to Seven

The numbers below look different even though they're all the number “7.” Hearing with a cochlear implant is like that, too. I (“Seven”) don’t hear exactly like you do. My hearing “looks” different than yours (unless you hear with a cochlear implant, too!).

Even though I can use a cell phone and do many of the same things you do, when I miss words and exchanges that happen in “real time,” I may wind up lost, even though I was “with” you just a minute before. Here are things you can do to help me hear what you’re saying & stay current since I definitely don’t want to miss any of the fun!

I rarely overhear things, especially in noisy places (like the dining hall or a restaurant).

Be sure to talk to me directly when something important—like what we’re doing next or a change in the schedule—pops up.

I’m a really good lip-reader. Let me see your face when you’re talking whenever possible.

I’m “in my zone” when I’m around the horses. I usually know what’s going on or can guess what’s about to happen. So I may look like I’m a better hearer at the barn than I am in other places.

I don’t mind repeating things if you don’t understand me the first time I say them. I often have the same trouble with what you say. :)

I know sign language and will be happy to teach you how to make a “name sign” for yourself and help you learn some signs.

It’s okay to ask me questions about cochlear implants and how I hear.

Grand Rounds & Health IT: The man behind the curtain is..... Forrest Gump?

Good reading awaits at this week's Grand Rounds, where Dr. Joseph Kim invited bloggers to share how IT is changing healthcare.

Healthcare is full of tech-facilitated miracles. I think health care technology's best successes so far lie in applications aimed at individuals. My daughter's cochlear implant is one great example.

A cochlear implant (CI) does not make my daughter a "hearing person." But it certainly gives her the opportunity to access sounds and to make meaning of them in a way that's very similar to what people with normal hearing can do.

Deaf people don't have surgery and wake up "hearing" any more than you buy a computer and become Bill Gates. To realize the full potential of a cochlear implant, a user learns to make meaningful use of the data the implant provides.

Implant users can hear--and grasp the significance of--a toilet flushing almost immediately. But understanding and mastering a complex battery of sounds--like syllables, words, and sentences--has a much longer learning curve. Gaining meaningful use of a cochlear implant also requires concomitant support that's not technical at all: early education for language acquisition and ongoing speech therapy.

Think about another IT-facilitated product that fosters miracles: digital radiography. A lay person can see that digital images are sharper, brighter, more precise than those on old-fashioned films. But knowing what's normal, what's a normal variation, and what requires follow-up takes education and experience, an intimacy with both the imaging device and the anatomy it captures. Like a CI, radiography only becomes meaningful when the data is interpreted, communicated, and factored into a larger whole.

System-level application of IT, a late-comer in healthcare, is likely on a similar journey toward meaningful use. Right now, I'd say health care stakeholders are hearing toilets flush and noticing that some things are brighter than others.

I think there's a lot of other things that could be said about that.

But since I'm feeling a little like Forrest Gump today, I think that's all I'm going to say.

All riding is therapeutic riding

used with permission

When my daughter was eleven, I sent her to stay with her grandmother in rural New Mexico for a month, as the brewing storm in our relationship seemed certain to explode in the long, hot, empty Georgia summer days. When she returned, our suburban family included a devoted horse enthusiast, and none of us have ever been--or really wanted to be--the same.

My daughter is deaf, and she uses a cochlear implant to hear. If you're not familiar with what that means in functional terms, it's this: my daughter hears, but not always or well. The precision, quality, and reliability of the sounds received are not the same as what a person with normal hearing experiences. Distance, background noise, and lack of contextual cues bother people with cochlear implants more than they bother others. Toilets flushing are easy to discern. Speaking voices are hard. Giddy-up!

Early-on, I remember spending a fair amount of time and energy at Radio Shack, purchasing, then returning, an array of electronic widgets that might help the trainer's voice reach across the dusty, windy arena to further "level the playing field" for my daughter. But the most vivid memory I have from that era is when the trainer, now a dear friend, called me to say, "I know you know your daughter doesn't hear well. But she doesn't listen either."

I knew that.

I think there are times when we all know things like that. People who work in quality and patient safety are learning that it's impractical to rely solely on linear approaches to improve outcomes in a highly complex system, like healthcare (especially if you're looking for changes that are both safe and satisfying). Just ask anyone who is still hungry after being fed their Core Measure Happy Meal.

Therapeutic riding programs are often used to bring horses and people who have profound physical, developmental, and emotional disabilities together, with results that often exceed the primary objective for showing up in the first place. My daughter never enrolled in a riding program that claimed any particular expertise in facilitating the needs of hearing-impaired people. But hang around horses and the people who love them for any sustained amount of time, and you'll likely conclude what I have: All riding is therapeutic riding. How easy it is to see what's broken is what distinguishes riders with special needs from others.

I didn't go to the National Patient Safety Foundation Congress this week. But I followed tweets from people who did, giving me the opportunity to be pleased in real-time when I saw that teamwork and relationship-building, as vehicles to enhance outcomes, were championed. We need results that exceed the articulated primary objective, results that, as equine activities model, can be predicted to come through relationships centered around high-stakes activities and hard work. Sounds like healthcare!

Giddy-up!