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Be A TIGER! with Harold, Marion and friends. No golf required!

September 12, 2008
by Joe Bormel
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Last week, I attended my first Informatics Grand Rounds at Johns Hopkins. The speaker was Marion Ball and the topic was International Informatics . My goals with this post are to share two things:

  • awareness of this great resource (The Grand Round Seminar Series); and
  • observations from and about Marion’s major points

The Johns Hopkins Medicine Division of Health Sciences Informatics Grand Rounds series and its faculty are terrific; this is especially worth mentioning since you can attend current and future sessions virtually, and their video archives are on-line and very impressive. Here's the link to the entire schedule.

Joe, how do you find the time?

I watch educational materials while doing my daily exercise.

Marion, in yet another tour d'horizon, summarized an impressive time span and global perspective, making it clear that certain informatics themes are highly useful. The full video archive is available here.
One initiatives that Marion’s is involved in is called TIGER. The Technology Informatics Guiding Educational Reform (TIGER) Initiative aims to enable practicing nurses and nursing students to fully engage in the unfolding digital electronic era in healthcare. Marion and others have identified that a central bottleneck in healthcare transformation is operational informatics, and nurses have the key role. She’s right, of course.

The TIGER riff in the topic and leading graphic? See original.

She shared a number of quotes. One was: “What we learn from history is that we don’t learn from history.” (George Bernard Shaw)

I’d like to share a variation: History doesn’t repeat itself, but it does rhyme ” (Mark Twain) To me, that means that certain driving forces (which are learnable) that are recurrently ignored. Number one of these, according to Marion:

People Matter:

it wont take you a second to think of your own example.

This grand rounds session was beautifully facilitated by Harold Lehmann, M.D., Ph.D., including a Q and A session that created a lot of independent value.

One question was “what is the real goal of 100% E H R adoption (that we’re so dismally short of)?” My take is that there isn’t an answer, either within any organization, or nationally. We’re too pluralistic. That said, my answer: An E H R should be an enabler in the coordination of care. Implicit in that is ‘appropriate care,’ and ‘from the standpoint of the person/patient/consumer of the needed services.’ Most of us would add in ‘always informed by evidence-based medicine and management, where it exists.’

The last observation I’d like to share here about International Informatics is that we’re all too darn parochial. Marion called out these recurring issues:

  • people clearly don’t read the work of their predecessors or contemporaries
  • one size doesn’t fit all – what works in one place really wont work in all others
  • we need to listen, read, converse, and think, more inclusively of our extended community than the historical norm (more on this in a moment)
  • Since People Matter, we need more investment in social behaviors, personal energy and style. When is the last time you had a facilitator doing dialogue mapping, for example? ( Dr Jeff Conklin)

I’d like to add:

- Miller's Law (from psychologist George Miller):

o "In order to understand what another person is saying, you must assume that it is true, and try to imagine what it could be true of." Many, perhaps all of us at times, are very quick to dismiss others and not really listen. Conversation is more effective when you assume (not accept) that the other person is correct, and try to figure out what it’s true of, usually by asking.

- The comfortable assumption, that ‘there’s no one who has done good work worth discovering’ seems to be a common trap along the way to ‘not learning from history or others.’

o If history is telling us anything, it’s that we self-justify that we need to invent (actually blindly re-invent), because nothing useful in our particular space exists or is practically discoverable.

o What does this look like? Often it's the dissing, explicitly or subtly, of academics, competing provider organizations, associations (AMIA, IHI, etc), vendors, consultants, and, my favorite, superiors. This shuts down the cross learning opportunity and shuts it down cold.

o Self-interest needs to be attended to for change to happen (not a new concept to anyone reading this)

- Marion’s talk, and the conversation that ensued, made it clear that more intelligent conversation is needed and very worthwhile.

The Johns Hopkins Informatics Grand Rounds is a great forum for some of that necessary conversation. They’ve got a great track record of speakers, leadership and audience. I reviewed a few of their video archives. Really fantastic. (See Ben Ben Shneiderman as one example, here.)

What hidden treasure resources are you ready to share?

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