The Live Music Capitol of the World – Austin, Texas – has a different buzz downtown today. The convention center is filled with Texas’ volunteer and career emergency medical services caregivers. Held annually, the Texas EMS Conference rivals many national EMS conference events and draws industry leading faculty from across the country and caregivers from across the state.

Ernie Rodriquez, Director of EMS for Austin/Travis County EMS, has been a leader in advancing professional development for EMS leaders in the State. This year, he is joined by EMS leaders who strive to push EMS operations to the next level in a dedicated administration track. Dr. Dave Williams was invited to introduce the Model for Improvement – used throughout health care for process improvement – and share his experiences using the model with organizations across North America and Europe. The conference is always a great event and we welcome the opportunity to contribute.

American Medical Responses (AMR) is the largest private ambulance service in North America. Responding to more than 8,600 requests for service per day and with a staff of 17,000, AMR serves 2,100 communities in 38 states. It is also one of the first organizations Dr. Williams worked with as a paramedic back in Springfield, MA.

AMR sees more patients than any other pre-hospital care and transportation organization in North America. The organization’s leadership has committed strongly to improving clinical quality. They aspire to develop needed improvement skills and strive to achieve the results witnessed throughout health care.

As part of this pursuit, AMR is embarking on an improvement journey modeled after the IHI Breakthrough Series Improvement Collaborative Model used around the world and throughout health care. More than a dozen operations, from across North America, will test changes in two work streams, including sudden cardiac arrest and portfolio of clinical areas. The sudden cardiac arrest work is part of the the HeartRescue initiative sponsored by the Medtronic Foundation and the portfolio of clinical areas is directly connected with AMR Clinical’s strategic plan. This is the first patient care improvement collaborative in this segment of health care or public safety.

Dr. Williams is pleased to support AMR’s work as improvement advisors coaching on testing and measurement.

More than a 100 people convened in Austin, TX at the Austin Convention Center for Wave 2011. Sponsored by ESO Solutions, a technology company developing solutions for emergency medical services organizations, Wave 2011 is a 2-day conference produced for its clients. It brings industry leaders and ESO’s deep pool of talented staff together to provide timely and pragmatic sessions on using patient data to improve care.

Dr. Dave Williams has had the pleasure of presenting at several of ESO Solutions’ national and regional education venues. ESO Solutions’ CEO – Chris Dillie – was Dr. Williams’s paramedic partner when they worked together at Austin EMS.

Today, he presented a session on using data for improvement and learning. With so much data, it’s easy for people to struggle with were to begin. Dr. Williams focused on identifying important metrics and measuring data over time to understand process variation and improvement. The audience included many innovative, local people striving to improve the reliability and quality of care in their communities. It’s always rewarding to see people really interested in improvement and change.

For the last few weeks, I have been testing an experiential exercise to quickly train large groups to use rapid cycle, small tests of change (i.e., PDSA cycles). The exercise involves teams learning through testing how to assemble a toy Mr. Potato Head. I modified the exercise after working with with Dr. Eric Dickson on the faculty for the Instituite for Healthcare Improvement (IHI) Impacting Cost & Quality collaborative. Dr. Dickson is the Senior Associate Dean and President, University of Massachusetts Memorial Medical Group in Worcester, Massachusetts. He uses Mr. Potato Head to teach emergency physicians and medical students about lean principles. You can read a description of a session he did for the American College of Emergency Physicians here.

The modified exercise I am testing includes teams developing theories, making predictions, carrying out tests, and measuring results on run charts. In addition, participants learn how to share knowledge across teams and harness the power of the collaborative learning process. I’ve now tested the exercise half a dozen times in public safety, health care, and education audiences and  each session has improved upon the last. And, I have received lots of positive feedback from participants. IHI even bought seven Mr. Potato Heads for the home office for use in the Patient Safety Officer Course and to teach internal staff about PDSA testing.

While the use of a toy produces an element of fun, this exercise, more than many I have used, really enables participants to discover the power of making predictions, using small PDSAs to test theories, and tracking data in real time using time series charts. It’s amazing how sometimes small experiential learning exercises can really connect people with the concepts and facilitate applying them to their improvement work.

Being a household with small kids, this weekend has been filled with Halloween events. Nate’s preschool had its annual party, which is great for the little ones and Ella’s elementary school produced another fantastic Highland Park Elementary HOOT Carnival. The HOOT is produced by the PTA and raised $40,000 last year for the school. This weekend also involved some pumpkin carving, which is always a yucky, but necessary family activity.

On CNN’s State of The Union, Candy Crowely interviewed Ellen Davis of the National Retail Federation for a brief discussion about the economics of Halloween. You can watch the full interview here. In down economies, consumer spending around holidays – like Christmas – goes down, indicating that people are cutting back. The opposite is true about Halloween, where consumers actually show an increase in spending during down years. Ms. Davis hypothesized this is true because it’s a brief holiday, that’s not tied to any religion or person, it’s accessible to all socio-economic classes, and, probably most importantly, it allows us an opportunity to take a break and have fun.

Have a safe and enjoyable Halloween. Trick or Treat!

Quality Health Care by Robert Lloyd, PhD

This week, I have been reading a great book by my colleague Robert Lloyd, PhD, Executive Director of Performance Improvement at the Institute for Healthcare Improvement. Published in 2004, Quality Health Care: Developing and Using Indicators is a great resource for learning about process improvement in health care.

Last night, as I finished a chapter (Ch.3), I caught mention of a great little story Bob includes in the chapter notes (p.119). The origin is unknown, but his discovery of it comes from his mother. Reflecting on it, the story really describes what I witness, and many teams encounter in trying to plan, launch, and participate in improvement work.

The Facts of Life

The story that follows is about four (4) people named Everybody, Somebody, Anybody, and Nobody. There was an important job to be done and Everybody was asked to do it. Anybody could have done it, but Nobody did it. Somebody got angry about that because it was Everybody’s job. Everybody thought Anybody could do it, but Nobody realized that Everybody blamed Somebody when Nobody accused Anybody.

In the same chapter (Ch. 3), there is a great quote attributed to one of Bob’s graduate school professors – Dr. Bob Bealer – and how they would respond the the question about sampling, “How much data should we collect for our dissertation research?” Dr. Bealer would reply, “As much as you must and as little as you dare” (p.79). I can remember my own dissertation chair – Dr. John Adams – providing very similar sage advice.

I am very much enjoying Bob’s book. I’m only 1/4 of the way through it, so do not be surprised if other great snippets emerge later.

Dr. Ken & Monty

This Saturday, a few dozen friends came together for a private party at the Black Lagoon Gallery in Austin, TX to honor Kenneth Dion, PhD (stage right) as he celebrated the completion of his dissertation and earning a PhD from The University of Texas at Austin.

Dr. Dion is a fellow recovering paramedic and former emergency nurse who founded the very successful Decision Critical that provides online solutions for health care organizations.

Friends and colleagues enjoyed a private show by singer / songwriter Monty Montgomery (stage left). After Monty’s first set, he was joined on stage by Dr. Dion who led a set of classic favorites.

The evening was great fun for all and it was fantastic to join Ken and his friends and family to celebrate the completion of his journey. Congratulations Ken!

Jeff Selberg, MHA, COO IHI

Health Affairs, a peer-reviewed publication focused on health policy thought and research, posted an article on its blog by Jeff D. Selberg, the new Executive Vice President and Chief Operating Officer at Institute for Healthcare Improvement (IHI) titled “The Shifting Health Care Landscape: Lessons from the Clinton Error”. A former hospital CEO during the Clinton Era, Jeff attempts to compare and contrast the earlier reform effort with today and draw attention to some key lessons learned. In addition, he puts a strong emphasis on improving quality and reducing waste. The short blog article is worth the read and you can access it here.

Members make their way into the converted garage gym and spread out to stretch and prepare for the workout that’s about to begin. Dumbbells, kettlebells, and barbells line the walls and half a dozen rowers are staged just outside the rolled up garage doors with pull-up bars across each opening.

On a whiteboard on the wall is the WOD (workout of the day).

W.O.D. May 12, 2011

Power Cleans 5 X 5

21 – 18 – 15 – 12 – 9 – 6
DB Power Snatch L
DB Power Snatch R
Pull ups

It’s the end of the week, so there’s a focus on lifting heavy things. Each session will include a warm up that exceeds most people’s traditional workout, plus five increasing sets of power cleans – aiming to achieve your personal best, followed by a timed workout that includes dumbbell power snatchs and pull ups. Finish the workout and you’ll do 81 of each! Just another day at CrossFit Central in Austin, Texas.

For a taste of CrossFit, enjoy a short (01:31) video by Paul Scheider called “Breathe”

Background

CrossFit Central is an Austin, Texas affiliate of the International Method of Fitness – CrossFit. Co-Founded by a brother/sister team – Jeremy Theil and Carey Kepler – in 2005, it has grown to be one of the largest CrossFit affiliates on the planet. It now runs two gyms in central Austin, bootcamps held in public parks around the city, and corporate programming on location at the workplace. Their corporate program at Sherry Matthews Advocacy Marketing was where I first heard of CrossFit. You can read about their story here.

Building Community

While people join gyms for a host of reasons, there is a 60-80% dropout rate. There are many reasons for this, but one is the lack of community found in most traditional gyms. One of the unique attributes of CrossFit is strong focus on building a community of friends pursuing fitness. This starts with coaches that get to know their clients and who build fellowship among their class members. In addition to regular classes, coaches and clients also get together for special events, picnics, and community workouts. For example, tomorrow is the Spring picnic for members and their families.

Use of Social Media & Storytelling

CrossFit is largely led by a young crew who grew up in the era of the Internet and social media and that’s clear from their approach to business and marketing. The CrossFit Central website is a running stream of content chronicling the daily CrossFit activities around Austin, promoting upcoming events, sharing videos, and profiling the success stories of real people (not just athletes) who have achieved great results through consistent hardwork. Coaches also have their own blogs and many are sharing updates on the Facebook fan page or via Twitter.  All this adds to the presence CrossFit Central has online.

Collaboration and Friendly Competition

A unique quality of CrossFit affiliates is a focus on friendly competition and collaboration. Affiliates frequently host other gyms and welcome CrossFitters to jump into class when they are visiting from out of town. Affiliate leaders swap stories of what they’ve found works and doesn’t work in spreading CrossFit and growing their membership base. In addition, competitive workouts are hosted locally, regionally, and nationally for teams to compete against others. This collaborative and friendly competition model builds the CrossFit community and aids in spreading the common goal of living a healthy lifestyle.

A Greater Mission

While their motto is “Building a Fitter Community”, coaches and members also strive to give back to the community in other ways. This includes hosting events that benefit charities like the Livestrong Foundation and the Wounded Warrior Project. This month, coaches and members are bringing their strength to Habitat for Humanity to build a home in East Austin.

Focus on Steady Hard Work & Personal Best

Coach Michael Gregory

When people discover I’m a CrossFitter, I get a wide array of reactions. Many have driven by the gym or a bootcamp and see it as an intense fitness program. I’m quick to point out that I am holding up the rear in my cohort, but that’s okay. My coach, Michael “Big Mike” Gregory says, “CrossFit is for everyone, but not everyone is for CrossFit” and that’s very true. While groups workout together and there are a lot of competitive events, the real challenge is within each of us. We are constantly competing against ourselves and doing better than yesterday. By pushing yourself, each WOD brings you a step closer to your goal and everyone walks a little taller after a session knowing they did something tougher than most and are getting better and better by the day. Success stories are all around and the feeling is addictive.

Final Thoughts…

We share the story of CrossFit not just because I’m a member, but because many of the attributes of its business model and mission are rock solid and applicable to many of the organizations we work with. A lot can be learned from a collaborative organization with a clear mission, measureable results, evangelist clients, and a sense of purpose beyond the boundaries of the core business. Go discover a CrossFit gym in your community. For a list of affiliates, go here.

Does this introduction have the potential to change how we think about computing going forward? It might. Consider this…many companies (including Positive Eye Consulting), government entities, and educational institutions have switched from Microsoft Exchange and the Office Software to a suite of Google applications that provide similar and integrated software as a service (SaaS) at a lower price point and easier integration.

Now, our digital life can live safely and accessibly in the cloud regardless of where we are or what device we use to access it. Plus, imagine you spill coffee on the keyboard or leave it befind at airport security at LAX…no worries, you can get a new one or access everything from the cloud, barely skipping a beat.

So, will this change our lives tomorrow? Doubtful. But, like the iPhone and iPad introduced in the last few years, the Google Chromebook and Chrome OS may have a significant influence on changing how we think about computing in the very near future.