These are my Thoughts.
Yes, the "T" is Silent.
Yes, the "T" is Silent.
I have been sitting in the office plugging away at my Q2 budget since 11am and it’s almost 2:45pm now. The budget is due in a week for initial review. I’ve wasted countless hours struggling to constantly reload my internet browsers to access the financial information stored in the recently installed cloud-based system. The system was meant to integrate the IT infrastructure and enable a collaborative information exchange among the hospital, insurers, and pharmacy systems. However, things have been slow since the hospital was forced to negotiate a new deal with its internet service provider (ISP). Frustrated, I look over at my phone and it says, “phone not recognized.” With my limited VOIP (voice over IP) knowledge, I plug out the cords and plug them back in. Now the phone says “Resetting” and it does this for about 10 minutes.
While I wait for the phone to reset, anxious that it won’t work in time for my 3:30pm committee call with patient safety committee and clinical operations, I call the IT department to resolve the VOIP issue. I’m on hold for about 4 minutes and then IT transfers me over to Telecom. The rep asks me for my office phone number since I had to call from my cell phone. The telecom rep says, “you have departmental coverage for this service so call your department IT service.” Perplexed, I hang up and something is still wrong with my internet browser and the financial systems are still barely loading. I suppose the company that provides our financial systems is not a preferred choice for our telecom provider. Resolving to settle and take the conference call with my cell phone if the VOIP phone doesn’t work, I go back to finishing my analysis.
John, the finance manager, comes into my office to tell me his phone isn’t working and the budget information is so slow to load and they’ll need an extension on my budget deadline, which impacts my overall budget. I take a deep breath and explain the urgency and ask if he can work offsite. “Maybe the Internet elsewhere is faster?” He is happy to work elsewhere with the possibility of faster internet and assures me he will try to get things done.
Once I get to turn back to my work, my cell phone buzzes. I get a text that my old friend from high school has been admitted to the hospital. The hospital is in Des Moines, Iowa – the city where I grew up before leaving to NYC for college. I remember a few of the hospitals there, but I have to go online to search for hospitals. “Where could he be and why isn’t there an easy way to search for someone in the hospital?” I think to myself. The clock is ticking and it’s about 3:23pm, I have just enough time to search for and call a few hospitals. I search for hospitals in the zip code 50311 and call the first. The first person picks up and I tell her that I’m looking for someone and I’m transferred twice to the Emergency Department (ED). The ED nurse tells me that he’s not there. I ask, how many hospitals are in the area or what are the major ones? She says, oh there are several large ones in the area. I sigh, watch the clock and say “ok, thank you.”
Now it’s 3:30pm and I have to jump on the conference call. I call my colleague and the phone goes straight to voicemail. I dial again in a few minutes but the phone goes straight to voicemail. I check my email, but there’s no message of postponement. Wait, it’s now about 3:40pm and I know my colleague has the same VOIP phone as me and maybe she’s experiencing the same problem. The VOIP phones were installed about two years ago to reduce costs. I just decide to walk over to the office, it contributes to my 10,000 steps per day challenge. Shoot, my cellphone service seems to work well but my apps aren’t quite syncing at the usual speed.
Just as I start walking, Gina, the call center manager, texts me, “your phones in the practice are down and no one can get through!!” I know if the phones are down, the internet must be down. That means the doctors can’t access patient medical records, complete notes and submit entries for billing. It also means the front desk can’t check in/out patients, complete prior authorization requests, send e-referrals, set new appointments and other healthcare-intense online documentation. I text Cynthia, the practice manager, and ask her how she’s doing. She says, “everything’s fine.” I decide to skip the original meeting, figuring they’ve either not met at all or begun meeting without me.
In the halls I pass Rashad, the administrator for Surgery. He looks like he’s seen a ghost. He tells me that patients and doctors are saying the telemedicine services are slow and choppy. He’s concerned about the remotely-monitored medical devices and the rural satellite clinics are slow and patient care may be impacted. I grit my teeth and tell him good luck because I need to attend to my own crisis. Then, I remember to call the next hospital on the list. The attendant says, “he’s here, let me transfer you to his nurse.” She places me on hold for 8 minutes and 43 seconds.
At the same time, I observe the front desk staff in the practice trying to calm patients who have been waiting for hours. I’m still on hold waiting to be transferred and I exchange some conversation and strategy with the staff, while on hold. “Hello, this is the nurse, I can’t give you medical information, but he’s well enough to speak to him.” I speak to Thomas for two minutes and feel assured that all is well.
I apologize to everyone in the practice for being on the phone and explain the situation. They forgive me and 15 seconds later, we jump into the chaos that has ensued as a consequence of the net neutrality repeal which led to slower choppier internet services. The hospital’s ISP was now able to charge the same rate for slower internet speed, especially since there were now only two providers in the area large enough to support the needs of this large organization. The service also provided less customer support and the IT and Telecom departments were stretched thin. However, the hospital faced costs of over $800 million for an EHR (electronic health records) implementation over the next few years and funding was just not available for the added expense for telecom...
Fortunately, nothing in this story is true because the current net neutrality regulations have not been repealed. However, as a healthcare professional, I am deeply concerned regarding any slowing of the internet especially as it relates patient care. In healthcare, we rely on the internet for nearly everything we do: Telemedicine, Interoperability Requirements, Teaching, Revenue Cycle, Electronic Health Records, Medical Software Systems and Mobile Applications.
Our patients, providers and staff deserve a healthcare system that is fast, responsive and reliable. I hope this fictional event has shed light on the seriousness of net neutrality and why we need it in healthcare. Do you agree or disagree with this scenario?
Last week in San Francisco, my second favorite city (Copenhagen is my first), I attended the second annual AfroTech conference. AfroTech brought together influencers, change makers, entrepreneurs and techies from across the country to network and share experiences in the tech industry. This trip originally began as a visit to see friends, including two of my former classmates from the executive MHA program at Columbia University’s Mailman School of Public Health; however, it morphed into something much more magical.
I arrived in San Francisco on Wednesday, and on Thursday, I was with AfroTech attendees at the Kapor Center for Social Impact, hearing from venture capitalists (VCs) and inquiring about any new health ventures. Following the event, I co-hosted a public health happy hour at Dirty Water for Bay Area Mailman alumni with Vanessa Mason, co-founder of P2Health, a public health venture firm. The evening was a huge success and I was excited for the next two days of AfroTech, where I would hear from a host of VCs, entrepreneurs, policy makers and influencers.
Some of the most influential companies were at the conference, including Johnson & Johnson, Twitter, Tinder, Facebook and Amazon. I was intrigued when speaking with people from these various tech companies, because I am constantly learning how other companies approach problem solving. In this way, I had the opportunity to conduct mini “innovisits” with these companies. Plus, I couldn’t contain my excitement from seeing J&J, the only healthcare company, and questioning the Amazon reps to find out what Jeff Bezos would do in healthcare.
On the first day of AfroTech, Mandela SH Dixon, a startup veteran and one of the emcees, told us to have our “gem buckets” ready for all of the gems we’d drop in there. Since my birthstone is emerald, that has to be the best gemstone. I received an emerald from a J&J Vice President, who said (paraphrase) mentorship is good, but sponsorship is what you need. In my career, I made sure to always have mentoring, but I had not focused on sponsorship.
Sponsorship is having a very senior person at your company who advocates for you and your career within the company. A sponsor is usually two to three levels above your position. Sponsorship is more transactional, because you need to identify clear goals for your sponsor to help you in growing your career. In a relationship based world, mentorship is not enough, we need sponsors to get us in front of the right people to further our careers. The Society from Human Resource Management (SHRM), reported that 30 percent of all hires overall in 2016 resulted from employee referrals and 45 percent resulted from internal hires.
After thinking about what mentorship and sponsorship means for my career, I reflected on my own experience mentoring first year public health students at Mailman. They often come in for interview or career advice, which I am happy to deliver, but now I am thinking about the next level, going from mentorship to sponsorship. How can I sponsor someone in her career and truly create opportunities for growth, development and mobility? On the other hand, from the perspective of a seeking a sponsor, how can I: 1. Find a sponsor 2. Use her valuable time effectively and 3. Position myself for the career I want.
Here are Tsahia's Top Five Steps:
1. Observe – your company’s leaders and take the time to determine the right fit. Look at least two to three levels above you. Be sure to choose sponsors who can push your career forward. Don’t just choose like-minded people, but choose those who can stretch and challenge you in your career.
2. Commit - to the process and do the work. In this phase, work on building trust. Neither mentors nor sponsors will commit to your success, unless you commit to the process and prove yourself.
3. Ask – and have specific goals. Don’t come to a sponsor as a jack of all trades. Let them know exactly what you want, so they can provide the right opportunities and assignments. Understand where your mission, vision and values are aligned.
4. Do - the work that’s required. You should have more than one sponsor, which means there will be a lot of work. There is nothing more frustrating than wasting someone's time.
5. Pay It Forward – and multiply the work of your sponsors. They aren’t in it for an ego boost. Sponsorship makes you look great but the work supports the company’s mission, work and succession planning.
On Friday, February 24th, I attended the Columbia Business School's 13th Annual Healthcare Conference, "Shaping Healthcare's Future: Delivering Value Along the Continuum of Care." The conference featured some of the industry's top healthcare professionals from pharmaceuticals, managed care, consulting, government, technology and hospitals. The conference theme focused on delivering value, ultimately to the consumer.
The keynote speaker was Joaquin Duato, Executive Vice President & Worldwide Chairman, Pharmaceuticals, Johnson & Johnson. He spoke extensively on the benefits of medicine, how transformative medicine has been compared to any other industry and the role of the pharmaceutical industry in lowering costs and delivering value to the consumer. However, there is a tension between innovation and affordability when it costs between $3 - $7B to develop an approved drug and there is a level of uncertainty as it pertains to the administration's next steps.
Mr. Duato's 5 Prescriptions for Controlling Healthcare Costs:
For the remainder of the day, I attended the following panels: Pharma's Next Act: Succeeding in a Value Based System; Sellers & Buyers: The Value Proposition of Digital Health; Fireside Chat: The Future of Healthcare Reform; and The $1 Trillion Idea: A Practicing Doctor & Healthcare Entrepreneur Tells US How to Really Fix Healthcare. These panels from the pharmaceutical industry gave me a new lens to view healthcare.
Tsahia's Ten Takeaways:
When we move toward value, who wins?
After reading a variety of news sources that predicted what might be next in healthcare for 2017, I decided to take a further dive into the specifics of the Republican healthcare proposals (RHCP). The next step in healthcare will likely include parts from Paul Ryan's "A Patients' Choice Act," Tom Price's "Empowering Patients First," the healthcare portion of the Republican's plan "A Better Way," and statements from President Trump.
One popular component of these plans is high-risk pools (HRPs). In this summary, I try to examine what it might mean for patients and the future state of healthcare.
Regarding High-Risk Pools
Prior to the Affordable Care Act (ACA), insurance policies sold on the individual market were medically underwritten. That means health insurance companies evaluated individuals' health status, health history and other risk factors such as pre-existing conditions, to determine price and coverage for policies. For example, a person with high blood pressure (HBP) on medication could purchase insurance on the individual market. However, the insurance would not cover conditions related to any illness that continued or developed from high blood pressure, since it was a pre-existing condition.
Since the ACA took effect in 2014, health insurers have been prevented from denying medical coverage or charging unfairly high premiums to people with pre-existing health conditions. The effect has been that insurers are leaving the exchange markets and complaining that sicker people are buying plans and healthier people are not. This leaves insurers with the burden of not enough revenue to cover health costs. Specifically, an estimated 19 million "young invincibles" have not signed up for health insurance.
To remedy the problems of insurers leaving the exchange market, stabilized insurance prices and increased access to affordable insurance for individuals and families, some conservatives and Republicans want to fund high risk pools. Their proposals include taking the sickest people out of the commercial market and putting them into "separate, tax-subsidized, high-risk plans." On the other hand, Dean Clancy, a former senior health policy advisor to congressional Republicans and the George W. Bush administration, called high-risk pools "targeted welfare." There are definitely mixed feelings on the matter by many people.
For insurers and healthy people, the HRPs seem like a reasonable approach to stabilize health insurance prices. What is the cost? If the HRPs are not adequately funded and do not provide the health care that patients need, it will result in sicker people becoming even sicker, higher utilization of emergency rooms, health disparities and tax payers consistently footing an ever increasing healthcare bill. The Ryan plan proposes federal funding of $25 billion over 10 year while Price's plan proposes $1 billion over 3 years.
Viability is a huge question regarding high risk pools. We have some historical data because some states have had or still have HRPs. A December 2014 Commonwealth Fund study concluded that the pools are:
In addition to the above, a small number of states limited enrollment in high-risk pools to control costs to the states. Even with limited enrollment, in 2011 net losses for 35 state high-risk pools were over $1.2 billion, or $5,510 per enrollee, on average. States financed these pools by revenue sources such as tobacco taxes and hospital assessments. Paul Ryan has proposed guaranteeing universal access to healthcare, but it's unclear how the government will pay for these high-risk pools. Health savings accounts (HSAs) have been part of the solution, but for high-risk pools with HSAs are not going to be nearly enough to help individuals and families cover medical expenses.
To conclude, although we have historical data on what has happened with high-risk pools, some successful and some not so successful. Without knowing exactly who will make up these pools, how the pools will be funded and where the money will come from, I am not very optimistic about saying this option is better than a "Medicare for all" which insures everyone and spreads the risk in a practical way. As of December 2016, Republicans have not been clear on which of the current ACA tax/revenue streams they will repeal or keep.
In a subsequent posting, I intend to continue discussion on this topic.
One of the books I’m reading right now is called “The Other” by Wes Moore. It chronicles the story of two men with the same name, similar backgrounds, growing up fatherless in a Baltimore neighborhood. I was drawn to this story, because I often engage in discussions about “choice” and why some of us end up choosing the wrong path and how much empathy is deserved. In the book, How Will You Measure Your Life, (see summary here) my favorite section is “Staying Out of Jail.” The chapter begins with a quote from C.S. Lewis, “The safest road to Hell is the gradual one- the gentle slope, soft underfoot, without sudden turnings, without milestones, without signposts.”
Earlier today, I finally decided to answer one of those “No Caller ID” calls (the wrong path). My phone has been ringing off the hook with these calls. Just as I suspected, it was a democratic volunteer calling to ask me to donate into a fund to support gun control and background check legislation. Because I didn’t want to get up from the couch (NYC had a mini snow storm and I was feeling very cozy in the depths of my loveseat) to get my wallet, I told her that I didn’t have any money to donate (don't judge me). Then, she kindly persuaded me to give a reduced amount and told me some statistics about how many people are killed by gun violence in the US. The passion in her voice was convincing and she mentioned Gabby Giffords. I got up and donated…
After the phone call, I started to think about Hadiya Pendleton, a special young woman whose life was tragically cut short on January 29, 2013. She was a 15-year-old girl from Chicago, Illinois who was shot and killed in a park, just after taking her final exams. Her story sparked national attention, even in the flurry of murders that happen in Chicago, because she had just performed at President Obama’s inauguration and First Lady Michelle Obama attended her funeral. There is a Facebook page dedicated to Hadiya, R.I.P Hadiya Pendleton with over 193K likes, a hashtag #wearorange to demonstrate against gun violence, and a foundation in her name, Hadiya's Promise, to inspire people to work for peace and put down guns.
I often question why Hadiya's story resonated with me so much. Even now, I find this difficult to write. However, I realize that just like the similarities of the two men in Wes Moore's story, Hadiya's life was my own. When I was 15-years-old I lived in the midwest and attended Roosevelt High School in Des Moines, Iowa. I hung out with friends in the park after final exams, played sports, gave my parents a few headaches and enjoyed walking to Godfather's Pizza or Breugger's Bagels. Although, violent crime is not rampant in Des Moines like it is in Chicago, we know that violence can happen anywhere.
Gun violence in the United States is a public health crisis, especially where children are concerned. According to the Brady Center to Prevent Gun Violence, 18,000 children and teens are injured or killed each year due to gun violence. In NYC, I rarely watch the local news because it used to depress me to hear about the constant acts of violence. Then, there are the national news stories: 9 yr old accidentally shoots her gun instructor, 1-year-old boy was accidentally shot by his sister, and 5-year-old accidentally shoots his 4-year-old brother...
In addition to these tragedies are the mass shootings, from Sandy Hook to Charleston to Orlando. Many Americans, including me, thought that these horribly tragic events would spur our representatives to some sort of action, to finally come together in a nonpartisan way and create some legislation to help ensure these events would never happen again. I was quite surprised by the response from the NRA and others after Sandy Hook, and I knew then, this country had a long way to go before creating some commonsense reforms around gun violence.
The AMA has recently adopted a policy on gun violence declaring it "a public health crisis," and will lobby to overturn legislation that prevents research in this area. But, this is not the first declaration of its kind. In 1993 the journal Health Affairs published an article on gun violence that stated, "The current epidemic of violence in America threatens not only our physical health but also the integrity of basic social institutions such as the family, the communities in which we live, and our health care system."
In public health, we know there are many factors that spur gun violence. We also know we are a long way from preventing deaths due to gun violence and dealing effectively with the persistent impact this violence has had on our society. However, we can take action and support organizations like Hadiya's Promise and the Brady Center that are doing great work in the fight against gun violence.
Everyone is making 2017 healthcare predictions for the new year; from individuals and their diet and exercise plans, hospitals and payers focusing on their relationships and the financial industry speculating which healthcare stocks will outperform which other healthcare stocks. Below, I've pulled from the best lists ranging from marketing, finance, and consulting. There is plenty of speculation to go around in this $3 trillion-dollar industry. What are your predictions? Agree or Disagree with these lists?
Bullet points pulled from the website articles, click on the links to read more.
1. Forbes: 9 Healthcare Predictions for 2017
2. Beckers: 5 Healthcare Predictions for 2017 - Behavioral analytics, patient personas & more
3. Bernard Health Blog: Healthcare Predictions for 2017
4. Health IT Outcomes: 4 Healthcare Industry Predictions for 2017
**5. Fortune: Why Drug Costs will keep Rising in 2017
6. PWC: Medical Cost Trend: Behind the Numbers 2017
7. PM360: 10 Predictions for How the Healthcare Industry will Change in 2017
8. Philips: Top 5 HealthTech Predictions for 2017
9. Fidelity: 2017 Outlook: Healthcare
10. Tsahia's 3:
I'll tell you a secret that only my very best friends know, I love reality TV! Well not all reality TV but the stories about the American experience that deliver insight into closed societies like Escaping Polygamy and Leah Rimini: Scientology and the Aftermath. Aside from those shows, I love travel shows and almost anything on HGTV. When I was younger, I loved MTV's The Real World and Cops. I can still here that infamous tune, bad boys, bad boys, what you gonna do, what you gonna do when they come for you...
However, there is one show that makes me cringe, but I watch it ...sort of like how I watch Alien or Prometheus... it's the documentary series, Beyond Scared Straight on A&E. The show details an intense day long journey of troubled young people whose parents have sent them jail. The visit includes inmates and corrections officers screaming at them until they realize jail is not the place to be. Parents visit their children in jail and talk to them through phones separated by glass barriers. At the end of the day, it is up to a judge (and the consent slip) to determine if they go home or have to spend the night. Usually, the adolescents are crying and have been through enough trauma, realizing their mistakes (if only temporarily) and are apologizing profusely to their parents, professing all of their wrongs and how they will be made right.
Why do I watch this show when the only thing scarier to me than American jail is foreign jail? To think these young people would have behavior that leads them to this place is a wonder to me. In the US, there are nearly 2.3 million people in prison, and over 200k are women. As a person, passionate about public health, for me, this show sheds light into the missing stories of what happens in prison and what leads some young people on the path to incarceration. Whether or not the method of the program - one which conveys bullying from the officers and inmates, threats of beat downs and rape juxtaposed to gentler counseling sessions, to "get through" to rowdy young people is correct; it certainly shows that BOTH a shock experience coupled with mentoring from the officers can turn lives around. The officers and inmates do not coddle or mince words, the experience is a real American jail - single cell, overcrowded, locked down, terrible food, aggressive inmates, lots of handcuffs, and tough corrections officers.
Is this the right way to rehab young people gone rogue - stealing, disrespecting their parents, fighting, drinking, drug use, etc.? I don't know. One might argue that this treatment is warranted by the terror created for families dealing with these situations. Often, the family who brings the children to the jail program are mothers, usually in a single parent household. When the viewer gets a glimpse into the homes, we see families broken apart by having other relatives in jail, poverty, lack of resources and other surrounding influences such as gang violence and drug dealing.
The show crosses racial and gender barriers, but one thing seems common for most of the families: poverty. One might argue that this show targets low income families in an attempt to exploit them, but no parent wants to see their child in prison, and this program is often a last resort. Can we or should we deal with bad behavior by a visit to prison? Will this combat the long-term issues related to poverty, crime in the surrounding area, trauma, depression, and the social determinants of health? How can we do better?
In the US, the David Lynch Foundation offers meditation programs in schools to reduce stress and violence, as we know many children live in these environments of poverty, fear, and trauma. The mediation program is having a profoundly positive effect on children and school environments. Children should also have regular visits to a general practitioner (GP). A GP can identify issues of concern and refer out to psychologists and other mental health professional to provide counseling services - but, if children and parents do not have access to a GP, it's less likely that they will have access to mental health counselling. In addition, communities and law enforcement can offer second chances to offenders by creating a "continuum of care" by referring juvenile offenders to various treatment programs, but with the ability to stay connected to their family and community.
Unfortunately, second chances don't often come around like they do on Pitbulls & Parolees, another show I love, that features the Villalobos Rescue Center, where both pitbulls and parolees can have a second chance. Outside of the US, Norway's, recidivism rate is 20% compared to approximately 75% in the United States. Why? In countries, such as Norway and Rwanda, societies believe reconciliation, education and rehabilitation are superior to a revolving door of incarceration. Even after the Rwandan genocide in 1994 where some 800,000 people were slaughtered, the government realized that it did not have the capacity to incarcerate every criminal, so it began an unheard-of process of reconciliation using gacaca courts, which has ultimately led it to economic prosperity and relatively low crime rates, especially violent crime. In all countries, the path to incarceration can always be reduced. It will be interesting to see where the US falls over the next 5 to 10 years.
2017 will present a number of challenges in healthcare, we may deal with a repeal of the Affordable Care Act (ACA), layoffs due to a downturn in the economy, or grapple with the public health crises of an opioid epidemic or gun violence. With a new presidential administration, our abilities to quickly adapt to change professionally and personally will determine a number of healthcare outcomes. We will have to continue to put the patient experience first, work towards an integrated healthcare system, and a robust interoperable IT infrastructure (and much more). The healthcare transformation will continue; and because this profession can be a very personal one, whether administrative or clinical, we have to remember to put the patient first and work together through these new challenges.
So, when it comes to professional and personal growth, I am obsessed with two things: organizational culture transformation and defining your own mission, vision and values. Transformation can happen in a number of ways but I am drawn to these two concepts because I love inspiring stories of people overcoming seemingly impossible obstacles. Plus, working at an AMC (academic medical center) connected to a general and children's hospital, I am reminded that babies are surviving open heart surgeries, HIV is no longer a death sentence, children are surviving the most aggressive cancers, and 3D printing is changing the price point and possibilities from 3D printed skin to bionic ears (I could go on for a long time). This so inspiring and hopeful.
Because I am inspired and continually working to enhance my knowledge of the world (and I have a really long commute in NYC) I turn to books to explore stories from around the world and find ways in which I can approach problems differently. The 3 books below have significantly contributed to my understanding and approach to looking at healthcare, policy and personal growth. Enjoy!
As an update to this post, I've included 2016 book lists from a few of my favorite websites. These lists are very diverse. The books cover a range of topics: refugee crises, strategy, race, culture, entertainment, American policy, the new administration, etc. Zadie Smith's, "Swing Time" and Colson Whitehead's, "The Underground Railroad" both made a couple lists. The Washington Post's list contains several categories from thriller, poetry, children's and science fiction.
Goldman Sachs: 2016 Back-To-School Reading List
Los Angeles Times: 10 Most Important Books of 2016
The Washington Post: The 10 Best Books of 2016
The New Yorker: The Books We Loved In 2016
The Fix: How Nations Survive and Thrive in a World in Decline, Jonathan Tepperman
This book is one of my favorites. I stumbled upon this book on the first floor of my local Barnes & Noble in Brooklyn, NY. Given my feelings about the uncertainty in 2017, I was drawn to the title because the book discusses how several nations and their leaders were able to truly innovate, drive ideas and thrive when all odds were against them. The Rwandan peace process, Singapore's transformation to a nearly corruption free nation, Bolsa Familia, a cash welfare program in Brazil and the shale revolution in the US are just some of the chapters in this amazing book.
Chapter 9, Give to Get, describes how the political parties and president of Mexico worked together for the greater good of the country. Mexico was able to pass the Pacto por Mexico: a collaborative and progressive 95 item reform agenda that aimed to tackle the country's most political, social and economic problems. Given the impossible gridlock we've seen in the US political system, this type of legislation seems unimaginable, but the Mexican government acted together in the interest of its citizens and the profound impact of this agenda will be realized for years to come.
Transforming Health Care, Virginia Mason Medical Center's Pursuit of the Perfect Patience Experience, Charles Kenney
I was introduced to this book as part of my Columbia grad school curriculum on hospital management. I loved the real deal narrative of what it takes to transform a hospital's culture and the patient experience, that starting from the inside and not depending on outside entities can leverage the biggest impact. It is also an account of cross-cultural and cross-industry learning. US healthcare system from Seattle, Washington meets a Japanese Toyota production facility in Toyota City, Japan.
This is essential reading for all healthcare managers and even those in other industries trying to transform their own industries.
How Will You Measure Your Life, Clayton M. Christensen, James, Allworth, and Karen Dillon
A good friend who knows me well recommended this book, so I could further contemplate my purpose, mission & vision (he knows I love this stuff). For me, the main takeaway from this book: understand your job in relationships. In many industries we focus too much on what we want to sell to our customers but not what they actually need - what job is our product or service fulfilling? I especially enjoyed the last chapter called, Staying Out of Jail. The moral dilemmas we may find ourselves in during life may be small and less apparent or very obvious and blatant. In our life, what do we need to do to live with integrity?
Interestingly, this book is connected to HBR's On Managing Yourself. I have a copy of this book as well. If you purchase the HBR book on the iTunes store, you'll get a copy of the bonus article How Will You Measure Your Life? also by Christensen.
This saying, "be comfortable with being uncomfortable," has to be one of my all-time favorite quotes right up there with Maya Angelou's famous words, "I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel." These are such powerful words. I love these quotes as guidance to live by, and I love to recite them to others when an appropriate moment presents itself. Experts across the spectrum from the military, psychology, education, mentors, etc. will likely agree that you must live in an uncomfortable space and be OK with it from time to time.
Recently, I was at dinner with a very good friend, who also happens to be a wonderfully talented life coach and meditation expert, who inspired this post. I always love our conversations and I was explaining a personal dilemma and that I don't like to live in gray spaces. After she let me talk for a bit, she cut me off and told me, "you need to learn how to live in it for a little." I was so shocked, and even as I write this, part of me doesn't want to accept the reality that sometimes I do have to live in gray spaces and not everything is black and white.
There are some parts of life that we are able to control such as career direction and strategy, our willingness to work hard, and how we let others influence our lives. But sometimes we have to wait for decisions that affect us, such as waiting for a medical diagnosis, layoff notices or company restructuring, or whether we get a certain award for our achievements. For some this can be exciting, for others this can be a nerve-wrecking time.
However, there are some aspects where we can maintain some degree of control by taking appropriate action or by waiting patiently for some set amount of time. I can distinctly remember learning how to swim from the deep end to the shallow end (only 2 years ago). I was so nervous and anxious but I would see others who were even more fearful and channel my energy calmly to calm both of us down. With enough practice, I was well on my way to swimming from end to end without fear or reservation. But this only happened because I did the steps below.
These are my techniques for living in gray space when you're a person who loves to control:
Throughout these gray moments, allow others to support and encourage you. There is no need to suffer through it without the right kind of help. In my personal and professional experience, I've found people who were willing to help me when I needed support and mentoring. For that, I am grateful and return the favor to others who can benefit.
Unions are often in the news, especially during election cycles. The unions in Wisconsin have been a controversial topic because of the dramatic reduction in pay and benefits for some union members, especially the teachers' union. Some news sources have reported that the incoming presidential administration will be less tolerant and accepting of unions. In my own profession, I have heard colleagues talk about how much they dislike unions and horror tales of bad behavior because of overly protective unions.
When I first started in administration, I did not have a clear grasp on how unions and administration worked together. It was a sobering process. Prior, I was a union member for nearly 8 years, but my history in the union was always a positive. I received great tuition benefits that helped me earn an BA in Economics, yearly cost of living increases, and low out-of-pocket comprehensive medical expenses. Most of my friends in the union used the child care benefits, attended the union holiday party and meetings.
I hope to dispel two myths: union and administration have a difficult time working together and unions are bad for healthcare.
Myth 1: Unions and administration have a difficult time working together. In my experience, as a union member and as administration, I've been on both sides of the issue. In academic medical centers, the union members are generally clerical and technical employees; whereas in hospitals, generally the nurses, clerical and some technical staff are unionized. My experience is primarily with union members in an academic medical center.
There is truth to these myths, however, much can be mitigated if both groups have a clear sense of mission and purpose. Most times conflict can happen between the two groups for these reasons:
Myth 2: Unions are bad for healthcare. I believe unions are in place to protect some of our most valued staff members and to ensure good working conditions. The benefits the union offered to me (as I mentioned) were invaluable. If a company has good management practices, there should be few issues between union members and administration. Certainly, there will be disagreements, as we've seen in the form of worker strikes and dismantling of unions. However, many union members are doing incredibly valuable and essential work in non-profit sectors for much lower compensation than they would receive in the for-profit sector. They are also doing jobs that keep the foundation of the organization running and allow management time to focus on the strategic and financial priorities.
There will always be conflict but circling back to the mission, vision and values should get working relationships back on a positive track.