SpeakerLink.org

When I think of SpeakerLink.org, I think of the strength of a chain.  I think of the power inherent in each link and of the smiles of a little boy named Isaac.

When my son Isaac was only three years old his favorite toy was not a toy at all.  It was a chain.  It was a heavy 16-foot-long chain. He would drag it along the floor and pretend it was a boa constrictor.  He loved that “snake.”  He would lift its heavy coils of links and smile in ecstasy.  I suppose some parents would not let their children play with a heavy chain and lift its steel links.  But, I thought that as long as it was supervised play, it was a great type of play and fulfilled Isaac's need for deep pressure.

After all, as a child I too lifted chains.  My father was a junk dealer and he sold many types of chains.  I remember some links that were as big as my fist.  Those chains were so very strong.  I learned a lot about chains.  They were strong but flexible: able to bear great weight.

They were so strong because of the links.  Those beautiful curved zeros of steel would glide out of my hand as I placed them on the flea market stall floor.  One link after another would fall.  First on its edge then on the flat, I remember it as a repeating series of 1's and 0's gliding by like some type of iron-age binary code.   

The links were important in that they made the whole. A great burden could be lifted by the strength of such a chain.

I am inviting you to be part of a chain today, a really important chain.

For the past six months, the team from TMIT (Texas Medical Institute of Technology) and I have been working on a project.  Well, really they have been working on many projects.  They have made films on patient safety, worked on standards, and went to meeting after meeting with thought leaders on better patient care. 

But the one project I have worked with them on is Speakerlink.org.

Six month ago TMIT CEO Chuck Denham, MD, asked me what did I think was the most important thing TMIT could do to improve patient care, safety and advocacy.  I told him we needed a patient speakers bureau.  He and the rest of the team broadened that vision to include speakers from every segment of society who identified with a patient centric view.

Today our dream is a reality.  This is what you will see if you go to 

SpeakerLink.org

And if you click on find a speaker you will see this. 

If you scroll down you will see more speakers.  You will see more amazing people who have decided to change the world, who refuse to accept phrases like “that is just the way it is.”  You will see mothers who have lost sons and wives who have lost their husbands, you will see people who have lost so much. 

But they have not lost hope.

You will see people who have dedicated their lives to guiding health policy.  Individuals who have devoted years to health information technology and patient safety legislation have profiles on this site. And you will see regular citizens who have no training in rhetoric here as well.  They speak because they must.  They speak because they are brave and are willing stand up and speak out if they can make a difference by sharing their story.

But this site is missing something.  It is missing you.

Register as a speaker.  Speak for those you love.  Speak for the anonymous millions that exist as a cold data set with no emotional impact.  Be a speaker from experience with patients you have helped or as the patient you have become.

Be a speaker for the dead.

But most of all speak.  For your voice is mighty and true.  It swells and fills the auditorium and fills the mind.  You have the power to change things.  You have the power to be part of a chain reaction.

For the hospital boards, the-C suites, the QIO’s, the Physician and Nursing Groups, the Venders and the Patient Communities are all links in a mighty chain of care.  Speakers connect these groups, speakers go from place to place introducing new ideas, different cultures and share the wisdom stored in so many silos of medicine.  You can become the link I know you are; for you have been through the crucible and have come out the other side.  You have been forged into the finest steel: flexible yet strong.

So, here is my request.  Sign up.  Become a speaker.   Change the world.

The Turtle's Path

Last winter I presented a speech before Centers for Medicare & Medicaid Services (CMS): Quality Net Conference in Baltimore, Maryland, on Thursday, December 2, 2010.  That day I met two very important people: one was Dr. Charles Denham and the other was Carolyn Scott, V.P. of Performance Improvement & Quality, Premier, Inc.  She gave a great presentation. 
And my speech followed her performance.  Not long after the event she told the staff of Premier about my speech and suggested they contact me about delivering a keynote. Karen Holtz, Director of Collaborative Execution soon called me up.  I told her I would be honored to speak.  But in addition, I would love to paint onsite. 

On Monday at 2:00pm, Carolyn Scott gave a marvelous speech.  She began with a slide that that combined a Nascar Race with the Logo of Quest.  During the entire conference the motif of a race would be repeated throughout. As she spoke, I immediately I began visualizing her words.  I call her painting “The Turtle’s Path.”

In this painting, a blue sky is filled with a crimson sun.  It is the magic hour.  It is sunset or sunrise, but any picture taken now will be amazing.  The Sun within the painting swirls with the emotional intensity of the crowd listening to Carolyn’s speech.  Below this sun, three data lines rise forming the horizon.  This is the chart depicting Case mixed adjusted cost per discharge.  

The first line is the national trend from Carolyn’s Slide Set.  This line is green with a series of triangles.  On these triangles I painted little eyes and they represent the dollar.  



The next line is the compare hospitals that have not adopted Quest.  Blue diamonds represents this line. There are five diamonds on the line that have descended from the playing card: the Nine of Diamonds.  This card is often called the Curse of Scotland as legend has it as it represented the coat of arms of Sir John Dalrymple, First Earl of Stair who authorized the Glencoe Massacre in 1692.  Finally, there is the red line representing Quest hospitals.  This line is a series of squares with hearts upon them.   These hearts represent the great care Quest hospitals wish to provide for their patients.

Amidst these data lines, a mountain rises.  This is the logo for Quest.  A river pours down the mountain into the foreground of the painting.  In the center of this river is a Turtle.  Carolyn used an info-graphic in her slide set that looked just like a turtle so I painted it as one. 

This turtle swims upstream against the current.  This turtle represents all of those hospitals that are trying to make things better for patients.  



Beside the flowing banks of the river are rabbits wearing stethoscopes and they are asleep.   They are the providers who come out of the gate running, leave the conference inspired, but six months later have nothing to show for it.  The Quest providers are the turtles and at this point there are over 250 turtles.  As one Quest member from Hawaii explained, the Turtle is mighty and wise.  Or as Stephen King writes in the Gunslinger Books, “See the Turtle of Amazing Girth, on his shell he holds the Earth.”

And speaking of Stephen King, I spoke after Carolyn.  I spoke of Fred and our love, Buffy, toys, art, Stephen King and Autism.  I spoke of electronic medical records access, end of life care, the speak-up campaign, hand washing and The Walking Gallery.  I ended with my poem “The Wheals on The Bus.”  The audience cried and laughed.  And just like the last time I spoke with Carolyn, the audience rose to their feet.

The next speaker was Blair Childs, Senior Vice President, Public Affairs, and Premier Healthcare Alliance.  His speech was entitled “Pay-For-Performance: Are you prepared?”  He had a lot of interesting things to say.  Later in the evening I debated with him about patient participation and it’s meaning in within public policy.

On Tuesday June 14^th, I was so excited to hear Julie Kennedy, RN, Coach, Studer Group speak about HCAHPS in her Plenary Keynote.   I would get to paint about HCAHPS once again.  This is a painting about her speech and it is entitled: “Generational Health Care.” 

Julie began her speech talking about her medical pedigree and credentials.  I began to be frustrated as insistence on credentials and academic language can often create barriers for patients.  But Julie began talking about an entirely different type of credentialing.  She is part of five generations of medical professionals.  So in this painting is her Great-Grandmother a midwife, her Grandmother an herbalist, her mother a nurse, Julie a nurse and her daughter who is in training to become a nurse.  Each body is depicted as rising rectangles: they are a bar chart.  One of the key elements within Julie’s speech was the realization that every bar chart and graph represents real lives and real deaths.  As she stated, “Remember… the Numbers have Faces.” 

In Julie’s daughter’s hand is a smart-phone with a HCAHPS app displayed.  She is helping create a culture of always.  This is the heart of rounding.  HCAHPS coupled with core measures will create better patient outcomes.  Hence the smart-phone is framed with a heart and surrounded by a halo of apple cores.

In the lower left side of the painting, lips exhale the word “excuses.”  Julie continued her speech by saying a culture of always was possible and the common excuses were not acceptable.  To often she hears “We don’t have time for that” or “We are short staffed.” I depicted this in the painting with an image of a stopwatch and a very tiny nurse.

To the upper right of the painting is an eye.  This is the patient’s eye, the caregiver’s eye, and the nurse’s eye.  This is the oversight that makes rounding and HCAHPS work.  And finally, the number 83 is painted upon the canvas representing the amount of lives saved at another facility’s due to their decision to embrace harm avoidance protocols.

Next, I attended a break out session on UTI’s.  I very much wanted to attend this session as Fred suffered greatly from lack of proper urinary track care.  This session was called “HARM: Using Lean Strategies to Reduce CA-UTIs” it was presented jointly by Laura Bell, Assistant Vice President and Genia Odom, Director Process Management East Alabama Medical Center.  This session inspired the painting  “Avoiding CA-UTI.” 

Again the bar chart motif repeats within this painting, but this time it almost appears to be a fence separating the provider from the patient. In the center of the painting a woman stands.  Her bladder and kidneys are clearly depicted.  During the speech an info graphic resembling a Venn diagram was used.  On that diagram were the words:  strategy, epic capability and culture change.  I turned the Venn diagram into a triskelion symbol as I thought it more in line with the kind of culture change that Laura and Genia were promoting.  

During their speech they showed a wonderful poster depicting the proper placement of a catheter bag on a hospital bed.  During the Q&A, I asked them “Do you place that in every patient room that a patient is currently using a catheter, so that the patient and caregiver can insure proper use?”  The answer was no.  They had not thought of doing that, but because a patient was part of a Q&A they are thinking about it now.

A speed networking session began at 11:00am and continued until 12:30pm.  It was brilliant!  It was like speed dating, but between facilities and providers and from that session, I created my favorite piece from the conference:  “The Three Iris Eye.” 

There are three different irises because each person met a great number of new contacts during this session.  The pupil in the center is a camera lens.  Hopefully, some of the participants will utilize their photographic memory and remember the brilliant ideas of their peers. 



Each session was over in a matter of minutes and the sound of a revving engine would encourage each pair to separate and find another match.  So in this painting there are two Nascars one is painted with the logo for Christus St. Vincent Regional Medical Center and the other is Saint Louise Regional Hospital.  As I painted these two different yet similar logos, I thought about the race we had talked about for the past two days.

As I painted I thought of my favorite Bible verse that for the past three years has graced my Facebook page, “Do you not know that those who run in a race all run, but only one receives the prize? Run in such a way that you may win.” 1 Corinthians 9:11

The wonderful folks at Quest may be turtles, but slow and steady shall win the race.  And trust me I have watched them speak and have painted their souls.  They run is such a way that they shall win.

HIT Glue

I spent the last week in Oklahoma attending the 9^th Annual Rural Hospital Conference presented by the OFMQ, the Oklahoma Foundation for Medical Quality.  I had been invited by Lisa Wynn and Elanor Wallis from the OFMQ and Corrie Kaiser from OSU Center for Health Sciences.  I was there to create a conference painting and deliver the keynote speech centered on the role of the patient in relation to quality and HIT (health information technology.)  I was so happy to be there and as I spoke and painted my little sister Esther Fischer sat beside me.  I had taught her how to live tweet from my Twitter account, and we once again became the amazing team we had been as young girls. As I stood upon the dais, I dove within the tale of our medical story and the history of my youth in Oklahoma.   I felt my childhood drawl return to me and open like a prairie flower as each word escaped my lips.   I was drawn back to the life that led me to this point.  As one attendee said to me after hearing my speech, “Everything in your life happened for a reason.”

I was very blessed to attend this event because I heard a different perspective than the traditional comments I hear at most HIT events.  At 8:45 in the morning Brock Slabach, Senior Vice President of National Rural Health Association presented his speech entitled “National Legislative Update &
 How to be an Effective Advocate 
Oklahoma CAH Conference. “  He spoke about rural health throughout the nation, and specifically in Oklahoma.  He began to talk and I began to paint.  Brock spoke about the hopes and fears that many rural health providers have regarding pending legislation: ARRA, HITECH, Affordable Care Act, and the Ryan Plan.  The worries and concerns strode back and forth across the partisan political divide.   He was painting a rather undefined horizon with his words.  I began to recreate his imagery in paint.  I could feel the storm of worry and uncertainty as each bullet point within his slide set shot across the screen.

 

An ominous sky began to spread over my canvas.  It is blue and relatively flat unlike virtually every over sky I have ever painted.  Traditionally my skies are painted with data swirls and filled with symbols of deliverance via cloud technology.  This sky is still. A few small clouds are isolated within the piece and sprays of far off rain descend.  This is an Oklahoma sky and the storm is coming.   This is rural Oklahoma with too little broadband access and no cloud EMR coming to aid small critical care clinics.  Below this sky, a field smeared with the promise of winter wheat fills the lower half of the painting.  A poorly defined road disappears into the distance.  It is barely a smudge of dirt or gravel. The infrastructure is failing and underfunded. 

Beside this forgotten road, Telephone poles grow small in the distance.  At the end of the line, a patient speaks urgently into the phone line as it has morphed into a stethoscope.  The patient is too large for the distance and scale of the piece.  My sister chuckled at his size, “Isn’t he a bit big?”  I answered her, “You know I have never been overly worried about perspective nor scale nor following the rules of art.”  He is big because he must be. He is the patient and his need is great.   

The telephone poles in foreground have fallen down.  Communication cannot be sent if there is no method of support.   A doctor kneels, trying to hold the overly heavy stethoscope.  He is attempting to listen to the far off patient.  The doctor is far too small and straining under his load.  He is alone and understaffed and trying to utilize a broken system. 

To the extreme right and left of the painting a farm couple spans the canvas.  The farmer is concerned. He stares in stark profile, stretching his hand across the road.   He clasps his wife hand and she looks up at his solemn countenance.   Her arm also strains to connect with him.  They must travel upon this road.  They are “off to see the Wizard,” and a tornado is rapidly approaching.   This was the image of the farm family I heard in Brock’s speech.  This is the strain of a system where families must often travel many miles to get care.  Is the farmer’s back to you and his arm unnaturally twisted?  Or is he facing you and his neck is craned at an impossible angle?  This image is wrong, twisted and backward, representing laws passed by bureaucrats coming from districts that represent a less than 20% of a rural population.   

Look at how gently this farmer holds his wife’s hand.  It seems as though she is descending from a buggy or being greeted as a bride.  Look how young they seem.  But perhaps they are truly elderly, and this is how they see themselves through the mists of time.  Perhaps they have been left behind on the farm.  Valiantly they try to harvest wheat, bending damaged knees above the combine seat or clasping the feed-truck wheel using fingers swollen with arthritis.  Their need is great and their options few and without the funding provided by Medicare or Medicaid they are one bad harvest away from abject poverty.

As the day continued I heard about HIT glue.  The adoption of Electronic Medical Records and a fully functioning Health Information Exchange has created a great deal of hope among providers.  I heard Susie Cook, RN explain the change process that medical practices undergo as the implement a new EHR (Electronic Health Record) system.

She mentioned the four types of personalities the staff tends to embrace.  First there is the Victim.  This is often an older or conservative nurse not confident with using new communication technology.  In the painting I depicted her fallen upon the ground wearing the classic white nurses dress while virtually drowning in the flow of HIT Glue.  Beside her is the Critic who offers no help and only hinders.  Susie says this person’s stance must be stopped as soon as possible as it can bring down the whole team and does not help the victim.

Next to the critic is the bystander.  She stands with her eyes rolled to the side and her arms across her chest.  She will not hinder nor will she help.  Finally there is the navigator, who stands to the far left.  He wants to help and has his hand on the wheel.  He will sail the EHR ship away from the overflowing stream and into calmer waters.  The EHR ship is a sailing vessel.  It is exploring and testing the waters, it is just beginning its journey.

As I explained this ship imagery before the gathered crowd in Oklahoma, I mentioned my first thoughts at being asked to speak on April 12^th 2011.  It was almost 99 years to the day that the Titanic sunk.  When I speak about HIT I often ask what sunk the Titanic.  Most people respond an iceberg.  I say no, failure to correctly use wireless communication is what sunk the Titanic.  There was a wireless set on the Titanic and if they had only used their information exchange correctly, over a thousand lives would have been saved.

So when we talk about the painful process of EMR implementation, we must think of the lives saved.   When we talk about the desperate need for a fully functioning HIE, in your mind’s eye I want to you to think of those brave navigators who with a compass and the stars set sail for unseen shores.   That is where we are right now and we have a whole world of better health care to discover.