For about $400 you can buy your own genetic profile from companies like Pathway Genomics and 23andMe. Giving humans this kind of knowledge about their health risks presents a tremendous communications opportunity, and challenge.

Our hope is that humans, armed with certain knowledge, might actually improve their fates. This concept, which is very nicely described by Thomas Geotz in The Decision Tree, has been around for quite some time in the field of public health. Yet, in many ways it is revolutionary.

For just one example of how serious this movement is, Johns Hopkins, the perennial hospital ranked number one in the country, has revamped its entire medical school curriculum to focus on personalized medicine – the idea of tailoring treatment and prevention based on a person’s individual genetic profile.

But uncovering the genome and its mysteries cannot stand alone if it’s to benefit society. This movement requires a guide. Individuals are fated in some ways to progress toward diseases encoded on their DNA, and the knowledge of what those diseases are in and of itself won’t change that fact. However, individuals do in fact have the power to bend this fate and shape it in a manner that might dramatically improve their health and well-being.

This is where communications will be critical. With the proper information, education, and incentives, patient understanding of their genetic risks could bring health care to an unprecedented point in medical history. Communicating the potential and providing a framework with which to deliver it is as important as the science itself.

As seen on the PRWeekus.com “Insider” blog on April 2, 2010. This blog post is the final post in a series of three blogs focusing on communications and personalized medicine. Each week PRWeekus.com features a guest blogger on its “Insider” blog.

It is estimated that 60 to 80 percent of Americans have used the Internet to find health information, rivaling physicians as the most common source of information. The term Web 2.0 has been created to signify the idea of an interactive web, one that invites users to share experiences, to lead discussions and change, and to adapt the Internet to make it a public forum rather than a static informational grid. The potential for technology to continue to influence health decisions is impressive; more specifically, its potential in transforming well-being could be enormous.

One area in which technology is nascent is in wellness programs. Employers are just starting to realize the connection for instance of providing employees with a dedicated support structure for quitting smoking or losing weight. In what might seem to be an obvious connection, the happiness of employees directly relates to their perception of work and health, among other factors. By providing them with the network to improve those facets of their lives via integrated seamless programs, employers can close this gap and create sustainability to these endeavors.

The connection between communication, technology and patient care is increasingly becoming more established.  These facts present an amazing opportunity for companies adept enough to take advantage of them. Through the use of new technology (smart phones) health information can be made available to employees at an unprecedented level, taking the emphasis on wellness to an entirely new level and reinvigorating an already thriving area.

As seen on the PRWeekus.com “Insider” blog on April 1, 2010. This blog post is part of a series of three blogs focusing on communications and personalized medicine. Each week PRWeekus.com features a guest blogger on its “Insider” blog.

Really?

Before even delving into this argument, it is germane to examine the articles themselves. The first is very specific to a “vulnerable” population aged 65 and older. The results indicate that patient satisfaction is not associated with technical quality of care, not outcomes or even quality of care, but rather technical skill. Plus, the survey results show that communication skills directly relate to higher global ratings of health care, somewhat undermining the very argument the authors ultimately posit.

The second article is completed in England, which is clearly based around a completely different system of health care delivery. Again, the survey results suggest that patient assessment scores of their own care (which is not quite the same as satisfaction) do not correlate with clinical practice such as controlling or monitoring hypertension.

I will be the first to admit that current patient satisfaction methodology does not accurately reflect how patients feel about their care, but my dissatisfaction with it stems from the limitations of the questions in capturing the patient experience. The fact is, and it has been demonstrated in multiple studies over many years, that patient adherence, follow-up, and overall outcomes are directly related to how happy patients are with their care. For all those who have been a patient or a caregiver, they have been subject to the often-chaotic movements of a system that though very good, still has many holes. Hence the 2001 Institute of Medicine report detailing the quality chasm. Those patients and caregivers understand how this complexity and confusion can add to the physical ailments and strain of the situation.

It is interesting that the articles I saw highlighted on this subject are all from physicians. Their united voice argues that physicians should not be compensated, graded, or judged at all on patient satisfaction. As one points out: “a hospital is not a hotel.” As I have argued before, this view is truly a shame. Most hotel owners care about those who stay with them, they want them to have a pleasant experience, and they believe that they can influence their guests’ overall trip/vacation through simple, yet highly effective, services. And for the most part, they are correct. Just like the many studies that have been done in health care point to a very clear connection between patient satisfaction and outcomes.

The disconnect between physician attitudes (and likely other health care stakeholders) and patient expectations conveys a gap that persists in health care delivery that is discouraging and slightly scary. If the very ones who are giving the care believe that its delivery exists in a vacuum and that as long as the correct test is ordered the patient should be content, then the system will change even more slowly than it should. And patient care will continue to suffer.

PatientsLikeMe doesn’t try to be the support community that you might find in the discussion forums at American Cancer Society’s cancer.org, which are important.  Heywood’s community primarily focuses on gaining insights into living with diseases based on the collection almost everything that happens to those affected people, documented by patients themselves or their loved ones.  Heywood is not without his detractors in the medical world, especially those that would challenge the scientific rigor of conclusions the site’s data could lead one to. Privacy experts also take issue with this extent of personal data being exposed widely.

Meanwhile PatientsLikeMe continues to collect data that you can’t help but want to apply to living with a disease, which sometimes gets lost in the search for treating and curing a disease.  Heywood isn’t the first human to have the idea of initiatives to collect transactional data of life that would benefit the Homo sapien collective.  In April 2002, popular tech columnist and pundit Robert X. Cringely’s post on his PBS blog I, Cringely Chase Cringely: Finding Meaning in a Lost Life was an emotional read that detailed the loss of his infant son to Sudden Infant Death Syndrome while he held the boy in his arms.  Cringely’s search for meaning brought him to the notion that SIDS could be beat if we knew more about this mysterious syndrome.  He suggested the idea of monitoring all infants, knowing that a certain percentage would die (according to SIDS statistics) but we would know a great deal about what was going on preceding the deaths.

Image via Wikipedia

I doubt the Borg, the fictional villains from the Star Trek franchise would be having such philosophical debates and not just putting the collected data to use in real time.  So do Borg value well-being more than us real humans?  As communications professionals I think we’re just beginning to see past the trivial use of social media as a distribution channel and now look to them as part of a more organic ecosystem that both accelerates information spread but also provides real time insight and feedback.  If we can get past privacy issues associated with this type of social information sharing we might be able to deal with well-being issues that could never be solved in the linear models of communication widely accepted now.  The continuing pervasiveness of mobile technologies getting closer and closer to extensions of our human form could be part of the solution.    Until then, Borg may be more human than we are in this capacity.

In recent months, there has been a proliferation of stories surrounding various features of the iPhone. For example, one university revamped its entire curriculum to take advantage of the phone’s streaming abilities and its capacity to store and deliver information in a timely and personalized fashion and enhance participation. Another article highlighted the phone’s use in a real-time psychological study wherein participants recorded answers as they were feeling them. And others have explored how the phone has already been used in third world countries for greater access to pathology experts, in U.S. medical schools and hospitals for radiology, accessing patient records, and educating both physicians and residents/students; see some uses here. It was even reported that one survivor in Haiti used the phone to learn how to survive until someone rescued him. These examples are all happening, now. The iPad will not only accelerate this shift but also enhance it in many ways.

Amazon is noted to have changed the way individuals read books through the creation of its Kindle. But its form is still static and 2-dimensional with limited offerings other than the book itself. Few would argue that in today’s dynamic environment, reading in and of itself has dwindled. However, the iPad will change that. By linking the book with the author him/herself, photos of where the story takes place, and perhaps even videos of scenes from the book or other relevant information, reading will become an experience. And that’s how the iPad will begin to change the game in these industries: it will take our standard approaches and flip them, providing a multidimensional experience for us to be part of and live in, and do it seamlessly.

Of course right now we do not know what the iPad will do (or again, if it will even be called the iPad), but from all accounts, it seems highly likely that it will provide a new means of communication, a new form of interaction, and a new level of experience that we have not been exposed to before. Apple did it with the iPod and the iPhone, today we will learn if they can do it once more.

The dichotomy is surprising, but perhaps it shouldn’t be. Most of us have purposely chosen to go to a restaurant despite knowing that the service is not good; most of us have chosen to fly rather than take a train or drive though we are aware of the extra hassle; and most of us have engaged in some behavior that we know is bad for our health but we do it anyway. What is it in us that allows us to perform all these activities even though we know they annoy or frustrate us, or make us unhealthy?

The answer of course is multifaceted; however, one plausible explanation might pivot around a crucial concept: well-being. Humans are rational creatures, we are always calculating, always thinking, and always weighing options and choices. Yes, the waiters might be rude, the wait long, and the service horrible, but have you tried that halibut? There are simply some cases in which the positive, as small as it may be, improves our well-being and allows us to overlook the negatives. We make these conscious decisions every day, and sometimes they are admittedly not even rational. Well-being is a tricky concept, there are many factors that play into it and are constantly at strife within us, and the same winner does not always emerge, even in a similar battle (sometimes that halibut just isn’t worth it!). Importantly, in nearly all cases patients do not choose to be hospitalized or visit physicians; however, satisfaction surveys clearly reveal that they universally put aside their large complaints to focus on their improved health (the halibut over the service). But given the connection with satisfaction and outcomes, shouldn’t they get the service as well? This link is critical in combating the rising cost of health care and improving outcomes.

Understanding well-being and how ethereal it can be is essential for both providers and for businesses.  Employee engagement in wellness programs has historically been feeble, and patient satisfaction numbers are on the whole subpar (see Well Being posts). The consequences of these facts are multifold and in many cases deleterious. Without proper engagement, employee absenteeism and presenteeism increase, productivity decreases, and return on investment suffers. For providers, patient adherence to medications drops, follow-up visits dissipate, and general health is not improved, ultimately leading to increased costs. This is not unchartered territory; to the contrary, many studies directly relate patient satisfaction to improved outcomes and employee engagement to a number of enhanced metrics of worker performance.

There are many ways to reverse this trend. Patients and employees should not be forced begrudgingly to make the choice of forgoing their well-being to accept the service/position they are given. One example is health literacy. There have been a number of reports recently about this topic including one this month from the Agency for Healthcare Quality and Research (AHRQ). In its assessment, AHRQ estimates that 77 million Americans (or more than one-third) encounter difficulties with daily health tasks such as understanding medication labels or following immunization schedules. (AHRQ tool) So while the medication might be tremendous, how can it help if the patient cannot understand the directions on how to take it? This example demonstrates how it is in the best interest of all stakeholders to ensure both the service and the product are outstanding.

Some have suggested that social media is a way to address this issue. In fact, more Americans get their health information now from the Internet than from physicians, and an increasingly large percentage utilizes at least one social website such as Twitter, FaceBook, or YouTube. Additionally, major health centers are beginning to introduce this sort of bridge for patients to improve their communication with them. These programs can add a distinct competitive advantage while augmenting patient satisfaction, but only if they are properly incorporated into a strategic framework. Too many companies are already facing a backlash from failed attempts at using social media without fully understanding its use. Without connecting well-being and its implications to a communications framework, messages may not produce desired effects.

In health care specifically, steps are being taken to ensure that physicians and other staff members improve communication with patients. A number of board exams and accreditation requirements have been implemented to accomplish this goal. There has also been a concerted effort to improve patient satisfaction at the broader level. But without understanding the well-being of patients, without grasping what it is they want and need while hospitalized/in the health care system, can these changes have sustainable effects? Health care is both a service and a product industry. I for one look forward to the day when I hear a patient exclaim that yes they feel better, and wow was that service impeccable!

This concept can also be applied to health care. In its seminal report “To Err is Human”, the Institute of Medicine highlighted the massive amount of medical errors that occur each year: almost 100,000 deaths! Since then, many changes have been implemented to reduce this number. And new safeguards are being added daily to ensure that patients are not susceptible to flaws in the system. But that is where the system as it is continues to fail: there is simply a paucity of regulated actions within health care to avoid errors.

Operating room procedures and blood transfusions are two areas that have progressed tremendously in the last decade. Standard protocols now dictate actions. The same is true for giving medications, as nurses are now required to check a patient’s identification band and ask the patient’s name before providing any pills. Some have argued that creating these protocols for all areas of hospital care would be absurd and impossible. One calculation estimated that in intensive care, there are over 120 steps for a patient’s care just in the morning. Between drawing blood, checking supportive machinery like IVs, and recording vital signs, among many others, following a checklist type protocol would severely limit staff ability to care for patients. IVs are a perfect example in fact of a mandate that may ultimately be destructive for patients. Current regulations recommended changing an IV every 3 days; but for many patients, losing access is a nightmare requiring multiple attempts to regain it and potentially even a more invasive procedure to ensure it. The benefit to cost ratio in those cases is not as simple to calculate.

Recent reports suggest that patients are in fact more attuned to potential medical errors than most members of a hospital staff. Unfortunately, they are not part of the chain of information. As I have pointed out before in these blogs, patient satisfaction surveys continually highlight the number one complaint of patients: that communication with staff is subpar. Understanding this problem is essential to improving the system as a whole. There is a definitive reason why reimbursement is soon to be increasingly tied to patient satisfaction and it transcends improving patient relations. Rather, it is in large part due to the complex interconnection between patient satisfaction (or as I like to point out their concerns) and outcomes. In multiple scientific studies, happy patients have been proven to have better short and long-term results along a number of variables. Concentrating on this element of health care then is critical to improving the system.

It is true that financial markets in general rise, but ask the millions of Americans who just watched their IRAs plummet over the last year how comfortable they are with that statement and you are sure to hear a great deal of skepticism. In health care, most satisfaction surveys are pointing to tremendous results and giant leaps forward; however, examining them closely delineates a different set of responses that point out some of the persistent deficiencies in health care today. Closing this gap by improving patient satisfaction may just help fend off the infrequent but devastating effects of a black swan in medical care. Because I feel confident in saying that as bleak as it is to watch one’s savings evaporate, the effects of a health-related mistake can be far more pronounced.

The timing and sequence of events in this scenario are astounding and clearly convey the power of effective strategy and brand building. Heading into the Christmas holiday, a “leak” prompted a flurry of articles surrounding a product Apple might introduce. Not has introduced mind you, or even will introduce, but might. Apple itself has not commented on the potential product release. Nonetheless, the initial hype was enough to send the stock price soaring and more to the point, to get Apple’s name in everyone’s ear over the holiday season. That couldn’t have hurt their Christmas sales. Additionally, the news effectively squashed any momentum competitors had of their big announcements. And there were some big announcements. Google for instance released its new Smartphone, the Nexus One, which is the company’s first foray into the handheld business (excluding of course its prominent positioning with the Android). Microsoft and others have already or are also expected to release their version of tablets at the Consumer Electronics Show (CES) this week.

Articles have appeared on Apple in basically every major news network imaginable, all discussing the potential of a product no one even knows for sure exists. The fact is, if it does exist, and if it is in line with what Apple is capable of and has produced to this point, it will most assuredly change the game, both of Smartphones and computers. And possibly really change it. Regardless of the product’s impact (or if there is even a product!), the lessons from this whole set of events seem clear. They are twofold: 1) that building a brand is essential to long-term success, and 2) that focusing on a communications strategy is critical to achieving market penetration. In this instance, what has not been said is as important as what has, reminding us of the power and art of subtlety. It also conveys the power of social communications. News of the pending release of Apple’s product spread quickly and efficiently through venues like Twitter, Facebook, and many others. A few key spokespeople “close to the company” fueled the fire, and the reticence of the company (other than reserving a huge conference space for their meeting) added finishing touches.

In this day and age, glaring advertisements are often the norm. Apple itself has become extremely well-known for its iPod and iPhone commercials. But sometimes a minimalist approach is warranted and can be highly effective. Not all companies can harness the power to gain free advertising like Apple has perfected, but they can learn to manage the power of consumer desires. In his book Tribes, Seth Godin explores this concept by pointing out how consumers crave this very sort of anticipation and how leaders can wield this characteristic to promote products or services.

With the emergence of the Internet and now Smartphones and all the technology advancements that come along with them, communications has taken an abrupt turn. For companies to maximize their return on investment and to understand how to use these resources most effectively, it is important to be cognizant of all the options and how social media outlets can influence decisions. As with this case, it is also worthwhile to plan a strategy that accounts for consumer desires. Finally, as the old saying going, sometimes saying less is in fact more.

In the last decade, some of the most promising and exciting technology products ever created have been not only introduced, but also widely accepted by society. The Internet has revolutionized communication and the way business is done in a number of ways across all industries. Thomas Friedman’s book The World is Flat highlights this tremendous advancement. The advent of Smartphones will only accelerate this movement and if rumors are true, other products soon to be debuted will open up new avenues for expansion even more. Simultaneously, Twitter, Facebook and other Internet social media Web sites are seeing their user base increase exponentially. With all of this activity, all of this momentum, and all of this innovation, more and more workers are finding their job boring? Something is surely amiss here.

Of course, assuming that these two facts are related is not directly intuitive. Why should advancements in technology and the massive surge of social communications augment how interesting a particular job is? That is where the notion of well-being comes in since it transcends the rudiments of daily job functioning. As outlined in previous blogs on this subject, well-being is a multidimensional construct which includes not only job satisfaction but also life satisfaction and many other elements of an individual’s mental and physical state. In the US, well-being has long been synonymous with wellness and has focused almost exclusively on health care, yet most wellness programs show meager return on investments and have not on the whole contributed to improving the health of the nation’s workforce.

So are social media Web sites and the Internet the answer to improving job satisfaction? Well, yes and no. It is not the static integration of these sites and others like them into a workplace that will create differences, but rather a dynamic interactive stream that allows workers to increase their level of involvement and ultimately their personal stake in and enthusiasm for a company. Expanding the definition and concept of well-being to encompass the true range of characteristics it includes might just help align employee desires with the broader goals of the companies for which they work.

Jobs do not exist in a bubble. They are an essential component of an individual’s identity and part of the fabric of his or her character. In most cases, workers spend more time at work than they do awake at home. Understanding this concept and its connection to well-being is paramount in improving these job satisfaction numbers. The interest is there we believe, it is just being displaced. If a company can re-center it, results could be outstanding.

Recent articles on the health care reform bill have pointed out that it may be focusing on the wrong factors. Rather than identifying methods to cut costs and make the system more efficient, drafters of the bill are attempting to provide access without considering the full picture. As the costs of our health care system continually escalate, the necessity of addressing this situation is magnified. Perhaps the health care industry could learn a lesson from the strategy UPS adopted: that is, eliminate the waste and redundancy in simple processes to streamline the system as a whole. In doing so, costs may be dramatically reduced. A few examples are provided below:

And these are just three examples, the system is rife with processes and methodology that wastes resources. Whereas at UPS, literally every turn and second of the day is timed for perfection, health care wanders in a seemingly endless maze of inefficiency. Of course, as Atul Gawande pointed out in his seminal article a few months ago, costs can be community based and heavily influenced by factors that are not directly obvious. Still, these issues arguably point to larger deficiencies, trends, and a communication breakdown.

One potential solution to the problem of skyrocketing costs is personalized medicine. Drawing on multiple factors of an individual’s history and genetic composition, personalized medicine theoretically is designed to empower patients to take control of their health care in ways never before imagined. Skeptics of this approach though are numerous, pointing out the complexity of the system and the challenges to individuals designing their care. The debate around this topic is sure to intensify in coming years.

For now, as the reform bill moves closer to approval, the impending inaction on this area of the problem stands out and is worrisome. It will take a concerted effort by all stakeholders to make the next big shift. Hopefully, this bill will start the ball rolling and lead to greater change down the road. For now, we’ll just have to keep waiting for our left turn.