Same data, different view

I thought about sharing this post on our Traversity blog, but I’m not quite sure it’s appropropriate. I’m still learning how to navigate this whole business communications thing, and I have a feeling I need to err on the side of conservative a bit more than I would like. So I shall share it here instead.

I’ve been taking my start up obsession deeper lately and have been re-watching Silicon Valley. The final episode of season one is particularly hilarious (albeit crude) scene, even when watching the second time around.

I will try and remain professional so won’t go into the details of what they’re talking about (you can watch it here if you don’t get offended easily), but the crux of it is that they’re a small team looking at a tech problem that heaps of smart people have tried to address before, all of whom have reached a similar outcome. Their team made what appeared to be a major breakthrough recently which they thought would put them at an advantage, only to be matched by a much larger competitor. They find themselves in the position where they need to do something better, or fold.

In their moment of despair and feeling downtrodden, they turn to rude insults and banter to lighten the mood. And they go deep with the insults…using a whiteboard to map out a whole schematic with equations and everything (which are apparently mathematically sound).

As Richard, the Founder and lead developer sits absorbing the conversation around him he has a mental breakthrough. A breakthrough enabled through the structural analogy. Everyone’s been approaching the issue from the same angle – unidirectionally. What if they approached it from the middle-out – bidirectionally – instead?

This results in a mega breakthrough which catapults their technology ahead of their dominant competitor and everyone else, and they’re back in the game, at least for a few more episodes.

As inappropriate as this analogy may be, I use it because it relates to my own experience recently with my understanding of integrated care.

Integrated care is one of the major concepts that underpins health policy initiatives of many nations trying to deal with the growing demand for health services relating to an ageing population and increased prevalence of chronic conditions. When my PhD supervisor suggested that I look into the concept of integrated care I did so more out of compliance than desire. I begrudgingly worked my way through the literature, a lot of which was very wordy and confusing. It felt to me like the kind of concept that was built for policy, not practice. The interventions reported in the literature looked great on paper, but how could you possibly deliver them at scale across an entire country? It’d be like running tests based on a Rolls Royce but using Toyota Corollas for the roll out…it wouldn’t exactly provide the same user experience.

If you approach integrated care only from the top down (i.e. through policy and infrastructure etc), it doesn’t go very far. There’ll be the practices that get paid for the pilot, then a few other early adopter/innovators, but there’ll probably come a point where a local maximum is reached and it’s hard to get broad scale adoption. This is great for the pockets where the innovation happens, sure. But there’s a risk it will end up broadening the divide between the exemplary care providers (who were probably pretty good at quality improvement anyway) and those who are satisfied with sticking to the status quo. Not exactly equitable healthcare.

If you approach integrated care only from the bottom up (i.e. through practice based initiatives), it doesn’t go very far either. Say there’s a group of motivated care providers who can see a way of delivering care differently and they get themselves a grant to run a practice improvement project. This sort of practice based research is really valuable, and chances are it will produce a positive outcome for the patients that they serve. But how do you get that innovation to spread beyond that particular practice? How do they continue to deliver that standard of service once the funding runs out, as it so often does? Implementing innovation without the support needed to deliver it (remunerations, infrastructure, policy etc) runs the risk of ending up with a bunch of highly skilled but burnt out care providers, who may one day grow tired of martyring themselves and disengage completely.

For integrated care to work, it has to come from both directions. This message is throughout the integrated care literature, it’s nothing new. It just took Silicon Valley scene for me to see the practical implications of it.

Australian governments and decision makers are doing a lot of work to develop the policy framework and remuneration models to support the development of new ways of working required to deliver more integrated care. That’s great, we need this. But we also need more. We need a way of moving the concept of integrated care beyond policy speak, and into something that is meaningful to those who will have to do the work to make it happen.

I’m not talking about accreditation standards and other mechanisms of fear and control. You can’t just create a policy with accompanying standard, it won’t work. You can’t just ‘do’ integrated care.

Integrated care not only requires individuals to engage in new ways of working, it requires people to work together in new ways. This isn’t just hard work, it’s bloody hard work. I’m not just talking about clinicians here by the way. Administrative staff, practice managers, technologists…there are many types of people who are integral to delivering these types of complex interventions.

We need to create an environment that fosters connection between the policy and decision-makers and those who are doing the work to make change a reality. An environment built upon mutual respect. One that motivates individuals to participate in integrated care initiatives by providing them with greater fulfilment in their work. Supports them by providing what they need to get the work done. Encourages them to develop their professional autonomy, mastery and purpose.

That’s what Traversity is here for, to provide a venue for this to happen. It’s up to all of us to take action and make good things happen, so we might as well get started. Please join us.

Still here

I’ve been pretty quiet on this blog over the past couple of weeks. No, I have not abandoned my pursuit of trying to write better. Quite the opposite.

Our website went live about two weeks ago, so I’ve been trying to write some pieces for that. I wrote one that was quite fun today about the RACGP’s latest campaign Expert Advice Matters (fun to write, that is, I’m not sure about reading).

I’m still going to be on here from time to time writing, but probably won’t be as regular as I have been over the past nine months or so. But please, if you happen to read this, do come and join us at Traversity.

The community is only just getting started and we need people who want to shape the culture in a positive way. It’s pretty much covid-free (as covid-free as you can get at the moment) and is not the usual social media newsfeed/grand posturing type stuff. We are really focused on quality of interaction versus quantity of members, posts etc. but we could use more members. Honestly, right now it’s pretty much me talking into the void, so I’d really appreciate some company!

 

The next right thing

Frozen II has been the music of choice in our household over the past few months. I wasn’t that keen at first listen, but it’s grown on me (could be a survival mode thing?). It’s got a real broadway musical vibe.

In the final act, Anna has a tragic moment where she sings a song that is super sad and stricken with grief. It’s about pulling herself up off the floor to do the next right thing.

Last week in his newsletter, Ryan Holiday wrote along a similar theme
The important thing is that we are not afraid. That we don’t overthink things. That we don’t get distracted with the worst-case scenario on top of the worst-case scenario on top of the collision of two other worst-case scenarios. Because that doesn’t help us with what’s right in front of us right now. It doesn’t help us put one foot in front of the other, whether it’s on a spacewalk or a tough business call. It doesn’t help us slow our heart rate down whether we’re re-entering the earth’s atmosphere or watching a plummeting stock portfolio. It doesn’t help us remember that we’ve trained for this, that there is a playbook for how to proceed.

Not everyone who achieves things does so by having a sense of bravado and a smile on their face. Sometimes it’s more a matter of pushing through and keeping going with whatever the next step is supposed to be. It might not feel good, that’s ok. But that’s the hard thing about doing hard things.

Trailor park life

I feel like over this past month our neighbourhood has magically transformed from a closed off inner city suburb into a giant caravan park. People are sitting in their front yards, saying hello as they pass by. There are hardly any cars on the roads or planes flying by. Yesterday evening the park was a hive of appropriately socially distanced activity; dogs and children getting exercised all over the place. I fully expect to see someone walk down the street in their pyjamas before the months end.

But the thing about being in a caravan park is that they’re usually (for me) associated with holidays. Typically lazy holidays by the beach where the kids just play all day and you might get a chance to read a book or two. It is not the type of environment that is conducive to getting work done. The daily struggle with being productive while having a child to keep entertained is ever present. So is the guilt that goes along with it.

I feel guilty for not being productive enough. Not being disciplined enough to focus on my work when I get the opportunity. Conversely, I feel guilty that I’m not giving my daughter enough attention. She’s been totally cut off from all her friends and obviously craving other kids to play with. She practically chased another kid to the park the other day when she saw them walking by, just to be in their presence. She’s at an awkward age where she’s old enough to know she misses her friends, but not old enough to know how to connect with them over distance. She wants to play, not socialise.

I feel so conflicted about what to do next term. It’s been suggested that unless we can’t support remote learning that we keep our kids at home. But what does that mean? It’s pretty ambiguous. I mean, I can support remote learning, it just comes at the cost of everything else I was hoping to achieve. I think part of me wants a legitimate, regular paying job just to feel comfortable with sending my kid to school.

I’ll figure it out, I know. But at the moment I’m just going to take a moment to feel disgruntled about it within my newfound peaceful caravan park type environment; sitting on the front verandah with the birds chirping and enjoying a cup of tea. Coming up with a plan about what to do about it can wait until another day.

Voyeur

One really good thing about this past week is that the weather has been fantastic. Perfect weather for sitting and working outside rather than being cooped up in the house for the whole day. Now that it’s not just me working at home by myself I’ve needed to find alternative work spaces. Our desk setup is great for one person doing work, but doesn’t really cater for three of us at once.

On the weekend we decided that if we’re going to survive this period of home confinement we need to capitalise on every square foot of our block. This is forcing us to attend to some of the no man’s lands which, I’m sorry to say, there are more than a few. Our front yard kind of falls into that category. We got rid of some of the layer of dirt covering the verandah and moved an old couch out there like a bunch of student renters.

And as it so happens, it’s a really nice place to sit. We live in an inner city suburb, but we’re lucky enough to have a small park across the road for us with some giant gum trees full of birds. But today as I sit here doing my work, I feel a little awkward.

There must be a personal trainer living down the road because she keeps bringing women to the park to do a workout. A very short workout, mind you, so I’m not sure they’re getting much value for money. But they’re lunging along the path and squatting on the benches and so on. Directly in my line of view, but slightly obstructed by the loose foliage of a grevillea. I feel like a voyeur. It’s encouraging me to keep my eyes on my computer and look busy thought, so that’s something I guess!

 

Home school ain’t cool

Today was our first day of home school. Sorry, not home school, remote learning. It was not what I anticipated when I got out of bed this morning.

I thought this week was going to be the last week of term. Like, in person attending at school type last week of term. But at 815 this morning we received a note from the school advising that unless we were in a position where we could not support remote learning we shouldn’t be sending our kids to school. We normally leave for school at 830. Needless to say, it disrupted my day.

Home school today pretty much consisted of finding learning opportunities in whatever I wanted to do. We learned about categories, aka cleaned up the family room. Counted the dogs that walked past, aka spent time in the front yard so I could do some gardening. Created a story and scene, aka played with the Barbies in the garden to make it like they were camping so I could continue gardening.

So home school yeah, I think I would put it in that category of something that I *could* do but would prefer not to. Because on the whole, it’s kind of stressing me out a bit.

It’s not the learning bit I feel anxious about. Creating learning opportunities for a six year old is pretty easy – let them play and explore. It’s the scheduling of everything else that’s stressing me out. Reporting back to the school teacher on what we’ve been doing. Figuring out when I get to do stuff that I need to do. It’s very distracting mentally, which isn’t very helpful when your work is writing up your thesis.

I know things will settle and we’ll figure out a new routine, but its going to take a while to get there. And its going to be an exhausting journey. My productivity in other aspects of my life is going to take a hit and I need to accept that. Because at the moment I really don’t think my brain can cope with worrying about it. I just have to get on with the reality that I’m in at this moment, see where it goes, and trust that it’ll all figure itself out eventually.

Revelatory moments

Last night Fight Club was on the TV. I remember seeing it at the cinema. It was the first R rated film I ever saw at the movies. I went with my brother to the Academy cinema in the city. I’ll never forget marveling at the Tyler Durden reveal and piecing it back together on the bus ride home.

Just like the moment Kevin Spacey walks away from the interrogation in the Usual Suspects, when Bruce Willis has his moment of self discovery in the Sixth Sense, the final dialogue between Richard Gere and Ed Norton in Primal Fear. They don’t happen often, and its much harder these days, but every so often a movie delivers a twist in the narrative that most of us don’t see coming.

Life isn’t like in the movies, of course. But once in a while it too dishes something up that surprises us. These are often not the happiest moments in life- a cancer diagnosis, an accident, a global pandemic.

It feels like we’re in a total shit storm now, for sure. It’s hard to see a way through it that isn’t going to be a long hard slog. But you never know. Paradigm shifts mean a new world order. Maybe a solution will bubble up that most of us never even knew was possible until we were hit in the face with it like Ed Norton’s fist. Maybe there can be good surprises in life too.

Resilience in Uncertain Times

I listened to this podcast episode this morning and it was exactly what I needed to hear. I’ve been feeling really un-focussed this past week or two. I work from home usually, and am typically quite disciplined, but the uncertainty of not knowing what’s going to be happening with schools/childcare, feeling guilty about not working as a proper pharmacist, and my husband also working from home has made me feel completely un-moored. Well maybe not completely, but definitely not my usual self. I trust that I’m just going through a readjustment period, but I’ve got to say that the readjustment kind of sucks a bit.

This podcast was what I needed because I found it balanced two things really well. It acknowledged the chaos without being alarmist, and it provided practical strategies for getting through that chaos, without the superficial “take this time to learn a hobby” or “marie kondo the house” type stuff.

I’m not saying that I find myself completely focussed and ready to write a chapter of my thesis after listening to it. But it did firm my resolve that it is resilience that is important in uncertain times. We can help make ourselves feel more capable and more resilient by making a contribution. Helping others in whatever way we can and supporting one another.

I’m sure that many of you who are working in clinical practice know very well that you’re making a contribution at the moment; the challenge for you will probably more likely be managing that contribution and effort so that you can sustain it over time without burning out.

The only bit of it that I do not endorse is the CBD oil sponsorship bit and the claim that making a spray water soluble would make it better absorbed…not so sure about that. I think its more about the size of the droplets. Anyways, other than that, I think this is a really honest conversation about dealing with the world as it is today. If you’re feeling like me lately, give it a listen and see what you think.

Kimchi Problems

The kind of problems where the deeper you bury it, the hotter it gets.

I heard this on a podcast episode this morning and it’s my new favourite saying.

I think a lot of kimchi problems are making themselves known at the moment. And there are a lot more to come over the coming months. Problems with the health system. Social support. Individuals and their relationships. We’re all being tested in so many different ways all at once.

As tough as this is though, this difficult time is going to present us with a valuable opportunity to face up to such problems and deal with them once and for all. Reduce the red tape that’s standing in the way. Focus on what needs to be done rather than who might be offended by our actions.

If we can keep our heads and remember what’s important I really do feel that some pretty cool stuff could happen. Especially in healthcare. And we all know we need it to.

Swimming No More

Walking back to the car from after school care, I was surprised by daughter’s reaction was so calm. Maybe it was moderated by the freshly baked muffin that was warming her hand. She had just heard the news that the week of school swimming was no longer going ahead because of the corona virus. And she seemed kind of cool with it.

This was not the reaction I was expecting. On Monday she was literally skipping to school, telling me how this is the best week of the whole year. I thought I’d see some disappointment at least. I mean, I’d seen much worse reactions from adults finding out that a concert was cancelled three months from now.

At 8pm her reaction was not so calm. The reality hit in a flood of emotions that can only be experienced by a small child who is too late going to bed. “I hate the corona virus” “this isn’t fair” “what if there’s no more swimming ever?” “what if it goes all year?” “this sucks”.

Yes, it does suck. Uncertainty is not easy to deal with for anybody. We can’t do anything about it, and that’s hard. We need to adjust to a new reality, and that’s hard too. It’s ok to feel pissed off about this every now and then. It’s an important part of getting through it. And we will get through it.