Johnson, lorraine cue 6.4.12 final final

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Johnson, lorraine cue 6.4.12 final final

  1. 1. CUE: The Journey from Outside In Lorraine Johnson, JD, MBA
  2. 2. TR IndividualANSF OrganizationalODoes Like AttractR Like?MAT SocietalION
  3. 3. “Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values.” David SackettSackett D et al. Evidence-Based Medicine: How to Practice and Teach EBM (2000)
  4. 4. It’s All About the Science, Right?
  5. 5. Evidence alone is never enough • How good is the body of evidence? • What about Evidence is never enough – evidence gaps? —it is always evidence in – evidence quality? the context of values and – scientific uncertainty? preferences that influence – Close calls and trade- guidelines and clinical offs? care. • Whose values count— when? Dr. Gordon Guyatt • What do we default to when evidence is weak or uncertain?EBM debate Guyatt, G. and Montori, V. (March 21, 2011) available at http://www.youtube.com/watch?v=KjLD5AkD0Ws
  6. 6. Values and perspectives matter 6
  7. 7. Miles Law: Keeping your perspective on values Where you stand depends on where you sit."The Origin and Meaning of Miles Law," Public Administration Review, September – October 1978.
  8. 8. Journey from without to within
  9. 9. CUE: Funding sources preserve perspective
  10. 10. CUE: Learning community Dr. Dickerson and Musa Mayer: Understanding Evidence-based Healthcare: A Foundation for Action Dr. Richard Rosenfeld: Consumer Involvement in Guideline Development. 2011 Annual Meeting 2010 Summit Facebook
  11. 11. Cue Organizations: Does like attract like?
  12. 12. Or are we different?Broad consumergroupsDisease specificgroupsDemographicgroupsPatients,consumers,caretakers
  13. 13. Context and perspective shape patient voiceWhere you stand depends on where you sit.• Patient safety• Pharmaceutical industry influence• Access to care issues• Over-reliance on medical solutions• Informed choice
  14. 14. Where you stand depends on where you sit."The Origin and Meaning of Miles Law," Public Administration Review, September – October 1978.
  15. 15. Differences matterIt is hardly possible to overrate the value...ofplacing human beings in contact with personsdissimilar to themselves, and with modes ofthought and action unlike those with which theyare familiar... Such communication has alwaysbeen, and is peculiarly in the present age, one ofthe primary sources of progress. John Stuart Mill
  16. 16. The Ties the Bind• Organizations cannot be dominated by industry funding• Organizations must be committed to evidence based principles• Patients need to be empowered and educated to be effective partners in healthcare problem solving
  17. 17. Partnership requires parity
  18. 18. Patient voice: individual or preparedrepresentative?Individual patient voice Prepared consumer advocate•represents their own interests •represents larger issues of•may be easily intimidated by collective groupexperts •is empowered to speak on their•may defer to authority behalf•may self censor •has strong voice•may be easily discounted by •can serve as a bridge betweendecision makers individual patients and•can lead to tokenism researchers •can lead to true partnership
  19. 19. Patient voice should not be easily dismissed
  20. 20. Where you stand depends on where you sit."The Origin and Meaning of Miles Law," Public Administration Review, September – October 1978.
  21. 21. Content Travels--Change happens•Individual Perspective•Organizational Perspective • Within CUE • Within non-profit • Within alliances•Societal Perspective
  22. 22. Misaligned Incentives We have a long way to goIllustration Leo Jung from Carlot, D., Dr. Drug Rep. The New York Times. November 25, 2007
  23. 23. Is it business as usual or do we “have the chance to turn the world upside down just a bit?” Dr. Harlan Krumholz, PCORI
  24. 24. Culture does not change becausewe desire to change it.Culture changes when theorganization[s] [are]transformed; Does Like Attract Like?[C]ulture reflects the realities ofpeople working together everyday. Frances HesselbeinThe Key to Cultural Transformation, Leader to Leader(Spring 1999)
  25. 25. CUE: The Journey from Outside In Lorraine Johnson, JD, MBA CEO LymeDisease.orgSteering Committee, Consumers United for Evidence-Based Healthcare
  26. 26. CUE: The Journey from Outside In Lorraine Johnson, JD, MBA CEO LymeDisease.orgSteering Committee, Consumers United for Evidence-Based Healthcare
  27. 27. CUE: The Journey from Outside In Lorraine Johnson, JD, MBA CEO LymeDisease.orgSteering Committee, Consumers United for Evidence-Based Healthcare
  28. 28. CUE: The Journey from Outside In Lorraine Johnson, JD, MBA CEO LymeDisease.orgSteering Committee, Consumers United for Evidence-Based Healthcare
  29. 29. CUE: The Journey from Outside In Lorraine Johnson, JD, MBA CEO LymeDisease.orgSteering Committee, Consumers United for Evidence-Based Healthcare
  30. 30. CUE: The Journey from Outside In Lorraine Johnson, JD, MBA CEO LymeDisease.orgSteering Committee, Consumers United for Evidence-Based Healthcare
  31. 31. CUE: The Journey from Outside In Lorraine Johnson, JD, MBA CEO LymeDisease.orgSteering Committee, Consumers United for Evidence-Based Healthcare
  32. 32. CUE: The Journey from Outside In Lorraine Johnson, JD, MBA CEO LymeDisease.orgSteering Committee, Consumers United for Evidence-Based Healthcare
  33. 33. CUE: The Journey from Outside In Lorraine Johnson, JD, MBA CEO LymeDisease.orgSteering Committee, Consumers United for Evidence-Based Healthcare
  34. 34. CUE: The Journey from Outside In Lorraine Johnson, JD, MBA CEO LymeDisease.orgSteering Committee, Consumers United for Evidence-Based Healthcare
  35. 35. CUE: The Journey from Outside In Lorraine Johnson, JD, MBA CEO LymeDisease.orgSteering Committee, Consumers United for Evidence-Based Healthcare
  36. 36. CUE: The Journey from Outside In Lorraine Johnson, JD, MBA CEO LymeDisease.orgSteering Committee, Consumers United for Evidence-Based Healthcare
  37. 37. CUE: The Journey from Outside In Lorraine Johnson, JD, MBA CEO LymeDisease.orgSteering Committee, Consumers United for Evidence-Based Healthcare
  38. 38. CUE: The Journey from Outside In Lorraine Johnson, JD, MBA CEO LymeDisease.orgSteering Committee, Consumers United for Evidence-Based Healthcare
  39. 39. CUE: The Journey from Outside In Lorraine Johnson, JD, MBA CEO LymeDisease.orgSteering Committee, Consumers United for Evidence-Based Healthcare

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