The Power of Direct Experience

During my participation in the 2015 Opening Seminar for Eisenhower Fellowships, I had the privilege of attending a leadership seminar by the social scientist Joseph Grenny.  Over the course of three hours, he presented a lot of excellent and thought-provoking concepts, but, for me, none more so than the power of direct experience.

Drawing from his thirty years of observation, Grenny highlighted a couple of examples.  First, he recalled a university call center that was under-performing.  Working at a call center is a difficult job.  It is repetitive, static, numbing, and subject to confrontations with people who don’t want to be solicited at home.  Wages are typically low and turnover high.   

In this particular call center, the university assembled the employees and brought in a young woman of color.  For ten minutes, she talked to the workers about her experience as the first person in her family to get a college education and the difference that had already made in her life. She finished by expressing her thanks to the call center workers because, through their efforts, the university had raised the money for her scholarship, without which she could never have gotten her degree.

Three months later, the university looked at the results from this call center.  Productivity had soared and the amount of money brought in had increased exponentially.

Grenny also noted a seminar for CEOs of some of the world’s largest hospitals. They were there to discuss ways to improve the overall healthcare experience for patients.  The facilitator, Dr. Don Berwick, the former leader of the Centers for Medicare and Medicaid Services, was afraid that all it would amount to was an intellectual exercise that would result in zero change. So he told the CEOs that he wanted to reconvene them in a month’s time, and that during the intervening month they should pick a patient in their respective hospitals and personally investigate their case.

The following month Dr. Berwick was amazed by the result.  The executives were emotionally connected to the cases they related, and they discussed how illusory many of their patient experience protocols actually were.  They subsequently became much more intent on making real changes to positively affect patient care.

These examples reinforced my ideas about change.  Real change does not come about through laws or policies or systems.  These are all necessary things, but not sufficient. Change happens when we are directly affected, when our empathy is engaged because we personally know someone whose life has been impacted.

This can seem daunting.  How many people must be personally engaged before a critical mass is reached and progress is made?  It becomes all too easy to be discouraged and just accept the status quo.

But we should never underestimate the power of just a few people to dramatically affect the world.  As Joseph Grenny demonstrated in a social science context, a few simple actions can have an outsized impact. Similarly, in the everyday world, the personal and passionate engagement of several individuals – or even one person – can make a consequential impact on the lives of many.

 

The key is not to wait for those others to emerge, but to be one of them yourself.

‘‘Illegality’’ as a health risk

In my continuing preparation to travel to Germany next week for my Eisenhower Fellowship, I am reading a great deal of material related to the care of immigrants in that country. A particularly interesting piece is from an anthropologist based in my home town of Tampa, Florida.  As part of an ethnographic study of a clinic in Berlin, Dr. Heide Castañeda explored, among other themes, the effect the state of "illegality" or ‘‘undocumentedness’’ has on health.  

Castañeda references a study by McGuire and Georges that found that the concept of allostatic load, defined as the accumulation of biological risk associated with persistent hyperarousal, is applicable to the lives of migrants without legal status. The investigators argued that the prolonged biological stress associated with their status worsened the health risks of migrants, in combination with variables like accessibility, affordability, and willingness to seek care.

There are already myriad reasons to provide care for immigrants, even those who are not in the U.S. legally, not the least of which is that, as a nation of immigrants, it is the right thing to do. But Castañeda's work reveals yet more evidence that by excluding immigrants from care, we may very well be contributing to the deterioration of their health which we will then have to address through uncompensated care in an emergency department or in-patient hospital setting.  This is morally repugnant and economically nonsensical.

Finished in Philly

Final day in Philadelphia was a great capper to the week.  Thanks to Natalie from the Eisenhower Fellowships staff, I met this morning with Peter Gonzales from Welcome Pennsylvania, which has done great work in connecting work-authorized immigrants with jobs.  This has obviously helped the immigrants, but it has also boosted the PA economy, creating shared prosperity.

The rest of the morning was spent in the "fishbowl," listening and commenting on the Fellows' project plans, and getting feedback from them about my own project. It was honest and informative and enlightening.

At lunch I had a dialogue with another Fellow whose project also centers on healthcare.  He reminded me that our current epiphany about healthcare as being fundamental to the social contract is really a return to the roots of the emergence of civil society, where we first moved away from seeing the person only in terms of what he/she could contribute to the survival of the  group and began to recognize the intrinsic value of a human life. 

From this point of view, perhaps there could be an alignment between the interests of those who describe themselves as pro-life and those who are often at odds with this group but who adhere to humanistic principles.  In this case, both sets of people might make common cause and use their combined clout to pressure politicians and healthcare providers and payors to reconceptualize healthcare as a right. This doesn't mean that we need to abandon market-based mechanisms or turn healthcare  totally over to government.  But the first step to any real changes in the healthcare space is a change of mindset, from thinking that healthcare is for those who can afford it and/or "deserve" it, to believing that basic care is something we guarantee to all by the very fact that they are a human being. 

The Eisenhower Experience

Today was the first time my Fellowship really hit me.  I spent the entire day surrounded by people from throughout the United States and all over the world who are doing incredible things and and who are leveraging their Eisenhower Fellowships to do even more.

There is Tamiko Nakamura from Japan, striving to foster connections between the legal and scientific communities to create cross disciplinary legal education models; Noelle Lim from Malaysia, who besides being the host of the most popular English language radio show in her country, is working to provide access to the best schools in the U.S. and the U.K. for low-income Malaysian students; Ephey Malo from Nigeria, seeking to drive innovation in her country's energy sector to help create stability and opportunity; and Louella Pesquera of the Philippines, a prosecutor of government graft, looking to drive multi-national collaborations to enhance prosecutorial impact in corruption cases.

These are just some of the 32 Fellows gathered now in Philadelphia.  The discussions we had today have been amazing, and not just because they were about interesting things.  They demonstrated the dynamism of the people that Eisenhower Fellowships has put together for its 2015 programs, and I, much to my delight, have found new and gifted collaborators for the work I am trying to do.

In addition, with help from the EF staff (thanks, Natalie Barndt!) I will meet tomorrow with the ED of The Welcoming Center for New Pennsylvanians, an organization focusing on economic development and new immigrants.  Between my work at Casa de Salud and my involvement with the St. Louis Mosaic Project, I trust we will have a lot to discuss.

More from Philadelphia

Great meeting and dinner with the USA Fellows and the Fellows from around the world.  The people ranged from the brother of the king of the Netherlands to the founder of a small non-profit in Malaysia. Everyone had very compelling stories and aspirations. I especially enjoyed hearing my colleague from Australia discuss how his company plans to mine data in an effort to convert the profit motive of healthcare from treating sickness to maintaining wellness.

The other conversation that struck me today was over dinner with my colleague from Nigeria. He talked about how people waited all day in order to vote, and that voter turnout was among the highest in the region most threatened by Boko Haram.  That's incredibly inspiring, and an implicit admonishment to our complacency here in the U.S.  We forget that democracy is not gifted, it is earned.

Eisenhower kickoff

I'm in Philadelphia for a meeting of all the USA and International Fellows. An amazing group of people that I'm looking forward to working and exchanging ideas with.  I'm particularly interested in speaking with Paul Nicolarakis from Australia, who wants to establish a social enterprise supporting healthy life extension, and Stacy Chang from California, who will travel to Kenya and Sweden to identify solutions for global health.

Speaking of which, I just read a fascinating article in the Atlantic that came to my attention via Sophia Schlette, a health policy expert that I will have the honor of speaking with when I'm in Germany later this month.  The article clearly shows how successful health initiatives are those that meet people where they are and then make incremental changes, or as Vesa Korpelainen says in the piece, "relentless, congenial nudging."

Outing the Immigrant

Interesting information from my research: There is a "duty to denounce" to the authorities the irregular (undocumented) situation of an immigrant, but it is not applicable to doctors and paramedics, who are bound by "professional secrecy." Yet, public officers and civil servants, even if working within the healthcare services, are obliged to report the the irregular status of an immigrant that they encounter during the course of their work. That's quite a dynamic, one I would think is not very conducive to the creation of trust I think is necessary within the field of healthcare. And in fact, there is evidence that this undermines the access to care for these immigrants in Germany.

I will try to explore why the Germans operate in this fashion, to what extent it is affecting the care of immigrant populations, and how this compares to federal and individual state policies and practices in the U.S. with regard to providing care to the undocumented.