The emergence of new channels for learning and collaboration allows us to move from the information-seeking behaviors of the 20th century to evolve new skills for information seeking and communication in the 21st century. Though how we learn may not be changing per se, how we collect information and become empowered has changed dramatically and rapidly. Perhaps the most critical shortcoming of the recent communication revolution is that there have been few if any efforts applied to support the basic skills that allow for an individual to adopt new solutions and no place is this truer than in healthcare.
It is my belief that concerted efforts must be made to help individuals leverage our new models for learning. The high-stakes nature of healthcare means we can longer leave this to chance. Before we can leverage new collaborative models of information flow, learning, and healthcare improvement (I discuss these at length throughout #SocialQI), we must begin to focus on supporting individual interactions, sharing, and empowerment within these new systems and this is a fundamentally different process.
Upon reflection the social media efforts I engaged in over the past few years have allowed me to deduce very specific skills that I had, needed, or cultivated that ensured that I was able to harness these new technologies – I have boiled these down to five such skills that I believe makes one truly able to become ‘digitally’ empowered in their own healthcare.
Individual Skill #1 – Establishing personal credibility and reputation
Perhaps the most fundamental element of the new collaborative models of healthcare is that they are inherently social. There will be more engagement, more interaction, and more conversations. I should be clear: I do not envision, nor am I advocating for, a system that is completely devoid of hierarchy. I am simply making the point that as collaborative models of healthcare emerge, how we assess personal credibility and reputation may change dramatically. Increasingly contribution to learning and improvement will define one’s reputation in the community. As the long-established models of hierarchy begin to change, and the systems become flatter, and as the bottom rungs of the hierarchical ladder gain a greater voice, we will each have to develop new skills for assessing the credibility of information and the reputation of the source.
Individual Skill #2– Filtering, curating, and searching content and context
The closed and disconnected nature of our current information stream has led to three-, four-, and even five-fold variations in the quality of healthcare that is provided in this country. But if we release the bottleneck by creating new collaborative models of information flow, learning, and healthcare improvement, some might argue that we risk further overwhelming the already overwhelmed. A logical point perhaps, but fortunately it is not as simple as that. If 1) new models accelerating information flow and learning are engineered AND 2) the end users (patients, physicians, and biomedical scientists) are given new controls to filter, curate, and search this information flow, then the bottleneck is released AND a new, manageable, steady state can emerge ― one that I believe, and I think I can prove, will drive us to achieve a higher quality provision of healthcare across the board.
I personally would rather delete ten emails than miss one important fact; my wife figures if something is important enough, it would be hard to miss so she tries to avoid signing up for anything and hardly ever shares her email address. I have a high tolerance for noise, while my wife has a very low tolerance…and undoubtedly most people fall somewhere in between. We each have a signal-to-noise level that we are comfortable with and we need to be able to own this, to control the information flow, to set the speed, breadth, and depth of the system.
Individual Skill #3 – Providing and receiving feedback and criticism
The third skill that we, as potential users of collaborative models of healthcare, need to evolve gets at the very heart of the social nature of the new models ― that is, playing well with others. I could write a dissertation on the topic but I could never say it any better than this: Everything you need to know to participate in collaborative models of healthcare, you probably learned in kindergarten. In some ways it is just that simple, but I would also add one caveat: In collaboration, getting along should never be as important as getting things done.
The difference between simply being social and being social as a means of collaboration is that the former thrives in the absence of conflict, and the latter thrives because of it. Learning, growth, and improvement only occur when mistakes are made and lessons are learned, and lessons cannot be learned by avoiding conflict. I have seen far more collaborations fail because members were too nice to each other than I have because members were honest and constructive in their criticism.
It is important to remember that although collaborative models in healthcare are intrinsically social, they are more importantly “directed”― that is to say that the community has a goal, and the members have a goal. To achieve these goals there are times when the community must redirect itself, when members will disagree, and when feedback will be more critical then congratulatory.
Individual Skill #4 – Accurately assessing one’s own ‘topic’ literacy
The fourth skill is perhaps of the most challenging. To get the most out of new and emerging collaborative models for healthcare we must be able to adequately assess our own knowledge base. I say this is perhaps the most challenging because I know from experience (and a preponderance of evidence) that we humans are not necessarily rational beings. We have blind spots and biases that often lead us to see the world in unique ways ― I know my wife loves to hear me admit this.
The good news is that there are two factors working in our benefit. The first is that the open and social nature of these collaborative models for healthcare actually helps in that it provides us with constant feedback and perspective from the community (if we are willing to accept it). The second is that the digital nature of the collaboration ensured that we can revisit conversation, we can “analyze our data” to measure how effective we are at participating and contributing to the system (again, if we are willing to accept it). But still there is a risk that some (probably the people who didn’t buy my book) are all too unaware of their own strengths and weaknesses to find constructive opportunities to engage, to share, or to learn. This is why the third skill related to providing and accepting feedback and criticism and this fourth skill are so tightly linked: Because the best way to accurately assess you own topic literacy is to be open to others in the community to share their perspective and provide constructive feedback to you. If you can find members to help you and you are open to their advice, then you have an infinitely better chance of accurately knowing where you stand.
Individual Skill #5 – Critical thinking and decision making
The final skill that supports our individual participation in collaborative models of healthcare builds upon the first four and in many ways it is the keystone to our success. One we build the ability to assess credibility and reputation; learn to filter, curate, and search efficiently; once we understand how to give and receive feedback; and learn to effectively assess our own topic literacy; then, finally, we must be able to pull it all together to think critically and make important decisions.
In short, critical thinking requires us to know what we know and simultaneously understand what we don’t know AND not to be paralyzed by the reality that we rarely (if ever) have all of the information we need. Then, once we have thought critically through an issue, we must act; therefore, critical thinking and decision making go hand in hand. For those who immediately recognize the challenge that comes with critical thinking and decision making, I recommend two books that provide a variety of ways to build these skills: Jonah Lehrer’s “How We Decide” and Barry Schwartz’ “The Paradox of Choice.” [And if you have an especially urgent interest, you might want to Google each author and you will find a number of great short videos to get you started.]
As with the other skills, here too the system can help. In as much as we will have access to others who have confronted similar circumstances and made similar decisions before, the open, connected, and social systems will empower the individual to learn from the collective intelligence, dramatically simplifying the challenge of critical thinking and decision making. But the fact that this is challenging in no way negates the necessary reality: The better we each become (patients, physicians, and research scientists) in our ability to critically think through all of the credible evidence and information that we have filtered, curated, and searched, the better able we will be to leverage new collaborative models of healthcare to make decisions that drive healthcare that is safe, timely, effective, efficient, equitable, and patient-centered.
Fortunately, there is still time to make the changes that need to be made such that we can get the healthcare system back on the right track. We have enough data and enough experience to propose a new set of solutions that will meet both short-term needs and long-term necessities. This is the ultimate lesson to learn from my book: Real change can only come from engineering new collaborative models of information flow, learning, and healthcare improvement. To do this we need to build new systems for empowerment and these systems must be must engineered to leverage a culture of improvement. But in parallel we must empower the end users with a new set of skills to leverage these systems…I hope the ideas above help to do just that.