Achieving Clinical Excellence: The Conference

October 26, 2009 By scottdm Leave a Comment

A few weeks ago, I announced the first International “Achieving Clinical Excellence” (ACE) conference to be held at the Westin Hotel in Kansas City, Missouri on October 20-22nd, 2010. You can now register for this and all other ICCE events, by clicking here. Through a variety of keynote addresses and workshops, participants will learn the “science and steps” to excellence in clinical practice. Attendees will also meet and learn directly from internationally ranked performers from a variety of professions, including medicine, science, music, entertainment, and sports. I do hope you’ll join us in Kansas City for three days of science, skill building, and inspiration.

In the meantime, I wanted to tell you a bit about one of the conference’s keynote speakers, K. Anders Ericsson, Ph.D. As anyone who has been following my blog knows, Dr. Ericsson is the editor of the massive and influential “Cambridge Handbook of Expertise and Expert Performance.” He is an internationally known writer, researcher, and speaker who is commonly referred to as “the expert on experts.”

At the ACE conference, Dr. Ericsson will bring his knowledge and experience to bear on the subject of expertise in behavioral health. I promise you won’t want to miss it. For a flavor, give his recent article from the Harvard Business Review a read.

The Crown Jewel of Research on CDOI: Professor Jan Blomqvist receives 2.9 million crown grant for RCT on feedback in Sweden

October 20, 2009 By scottdm 2 Comments

If you’ve been following me on Twitter, then you know that last week I was touring and teaching in different spots around Europe. First, I presented two days in Copenhagen. Then I keynoted the British Association of Counseling and Psychotherapy Conference in Newcastle, England. Early Saturday morning, I flew from London to Stockholm. My long time friend and associate, Gunnar Lindfelt picked me up at Arlanda airport and drove me back to his lovely home in the city. There, we gorged on smoked salmon, “svensk godies” (small candies, my favorite of which is “skum bananer”–dark chocolate covered marshmellow in the shape of a banana) and Cider–a non-alcoholic fizzy apple drink that is an old time Swedish favorite.

It was Gunnar Lindfeldt, a gifted clinician and expert in the treatment of drug and alcohol problems, who first introduced me to the work of Swedish psychologist Jan Blomqvist. In 1998, Blomqvist published a book entitled, “Beyond Treatment? Widening the Approach to Alcohol Problems and Solutions“ in which he made the provocative argument that common rather than specific factors held the key to effective care. Since writing the book, Jan Blomqvist has continued his research and is currently a full professor at SORAD, the Centre for Social Research on Alcohol and Drugs at Stockholm University.

Anyway, I had the pleasure of meeting with Professor Blomqvist at his home in Uppsala, Sweden this last week. Over homemade spinach soup, freshly-baked bread and cheese, we chatted about the state of the field. The pièce de résistance, however, was hearing about the 2.9 million Swedish crown grant he had just been awarded for a 4 year long study of outcome-informed treatment of alcohol problems, called “Putting the Client in the Driver’s Seat.”

The study to be conducted by Professor Blomqvist will be the largest, most comprehensive, randomized clinical trial on client-directed outcome informed clinical work. A centerpience of the study will be the routine use of the ORS and SRS and provision of feedback in the delivery of treatment services. Importantly, unlike all other studies to date, this project completely avoids claims of “allegiance effects” as no developers of measures or supporters of CDOI are participating. Stay tuned to the “Top Performance” blog for additional updates! While you are waiting, take a moment and read Professor Blomqvist’s provocative take on “addiction” in slide viewer below.

J Blomqvist 3 from Scott Miller

The Field, the Future, and Feedback

October 2, 2009 By scottdm Leave a Comment

There is an old (but in many ways sad) joke about two clinicians–actually, the way I first heard the story, it was two psychiatrists. The point of the story is the same regardless of the discipline of the provider. Anyway, two therapists meet in the hallway after a long day spent meeting clients. One, the younger of the two, is tired and bedraggled. The other, older and experienced, looks the same as s/he did at the start of the day: eyes bright and attentive, hair perfectly groomed, clothes and appearance immaculate. Taken aback by the composure of the more experienced colleague, the younger therapist asks, “How do you do it? How do you listen to the trials and tribulations, the problem and complaints, the dire lives and circumstances of your clients, minute and minute, hour upon hour…and yet emerge at the end of the day in such good shape?” Slowly shaking his head from left to right, the older and more experienced clinician immediately reached out, tapping the less experienced colleague gently on the shoulder, and then after removing the thick plugs stuffed into both of his years, said, “Excuse me, what did you say?”

Let’s face it: healthcare is in trouble. Behavioral healthcare in particular is in even worse shape. And while solutions from politicians, pundits, industry insiders and professionals are circulating in Washington with all the sound and fury of a hurricane, the voice of consumers is largely absent. Why? Of course, many of the barriers between providers and consumers are systemic in nature and as such, out of the control of average clinicians and consumers. Others, however, are local and could be addressed in an instance with a modicum of interest and attention on the part of professionals.

Chief among the steps practitioners could take to bridge to chasm between them and consumers is the adoption of routine, ongoing feedback. Seeking and utlizing real-time feedback from consumers has the added advantage of significantly boosting outcomes and increasing retention in services (several studies documenting the impact of feedback are available in the “Scholarly publications and Handouts” section of my website). Healthcare providers can download two well validated and easy-to-use scales right now for free by clicking on the Performance Metrics tab to the left.

So far, however, few in healthcare seem interested and others are downright hostile to the idea of asking consumers for input. Consider the following story by reporter Lindsey Tanner entitled, “Take two, call me in the morning…and keep it quiet.” Tanner discovered that some in healthcare are demanding that people (patients. clients, consumers) sign “gag orders” prior to being treated–agreeing in effect not to post comments about the provider (negative and otherwise) to online sites such as Zagats.com, Angieslist.com, and RateMds.com. According to the article, a Greensboro, N.C. company, ironically called “Medical Justice” is, for a fee, now providing physicians with standardized waiver agreements and advising all doctors to have patients sign on the dotted line. And if the patient refuses? Simple: find another doctor.

Can you imagine a hotel chain or restaurant asking you to sign a legally-binding agreement not to disclose your experience prior to booking your room or handing you the menu? Anyone who has travelled lately knows the value of the information contained on consumer-driven websites such as TripAdvisor.com. It’s outlandish really–except in healthcare.

To be sure, there is at least one important difference between healthcare and other service industries. Specifically, healthcare providers, unlike business owners and service managers, are prevented from responding to online complaints by existing privacy laws. However, even if this problem were insurmountable–which it is not–how then can one explain the continuing reluctance on the part of professionals to give people access to their own healthcare records? And this despite federal regulations under the Health Insurance Portability and Accountability Act (HIPAA) permitting complete and unfettered access (click here to read the recent NPR story on this subject). Clearly, the problem is not legal but rather cultural in nature. Remember when Elaine from Seinfeld asked to see her chart?

Earlier this summer, my family and I were vacationing in Southwest Michigan. One day, after visiting the beach and poking around the shops in the lakeside town of South Haven, we happened on a small Italian bistro named,Tello. Being from a big city famous for its good eats, I’ll admit I wasn’t expecting much. The food was delicious. More surprising, was the service. Not only were the staff welcoming and attentive, but at the end of the meal, when I thought the time had come to pay the bill, the folder I was given contained a small PDA rather than the check. I was being asked for my feedback.Answering the questions took less than a minute and the manager, Mike Sheedy, appeared at our table within moments of my hitting the “send” button. He seemed genuinely surprised when I asked if he felt uncomfortable seeking feedback so directly. “Have you learned anything useful?” I then inquired. “Of course,” he answered immediately, “just last week a customer told us that it would be nice to have a children’s menu posted in the window alongside the standard one.” I was dumbstruck as one of the main reasons we had decided to go into the restaurant rather than others was because the children’s menu was prominently displayed in the front window!