THANKSGIVING 2014

Earlier this month, we held our annual Santa Fe Seminar with about 30 people from all over the country in attendance.  There was a contingent from California but also people from the Midwest and East as well.  Leadership and Design (www.leadershipanddesign.org) holds a number of workshops, seminars and gatherings and the one in Santa Fe is designed as time out and time away in order to have an opportunity to reflect, renew and regenerate.  People seemed extraordinarily grateful for the experience and I believe there are several reasons for those expressions of deep and genuine gratitude for the gift of time away from the daily grind.

In the first place, most busy, committed people who spend their lives taking care of others do not often take time out for themselves either because they haven't yet figured out the value of doing that or because they aren't "selfish" enough and feel "guilty" being self-indulgent.   All I can say to that is get over it and get on with it!  You're worth it and you will be a whole lot better at taking care of others if you take care of yourself.

Secondly, there are so many other commitments in the name of professional development and meetings away from work (regional and national) that to add one more to the calendar seems hard to justify.  To that I say you need to make yourself a higher priority and skip one of the other meetings.  You will be glad (and grateful) that you did.  Why do you think you have to attend all those other meetings anyway?  Really?  When you make and take time for yourself you are also serving as model for others who could derive a similar benefit for body, mind and spirit.

Lastly,  making deeper and more meaningful connections with who you are and what you are about enables you to connect with others in more genuine and honest ways.  As one of my friends says as one of her mantras, "Tell the truth, be kind and remember to say thank you!"    To all who were in Santa Fe, I say thank you for sharing yourselves, for asking some penetrating and provocative questions and for demonstrating that you are among those who lead and serve with distinction.  On behalf of the hundreds of people in your communities who count on you to inspire them to do their best work, I say thank you for your commitment, your courage and your continuing good work.
You are indeed a blessing to those who are privileged to know you and work with you on a daily basis. 

And to the rest you who may read this blog, celebrate this Thanksgiving season with that attitude of gratitude that is contagious.  Maybe we can create a different kind of epidemic and help more people catch the spirit.  One final note of a previous exercise.  Years ago I made a practice of writing, on average, five thank you notes each week based on what I had seen, heard or experienced that I believed was noteworthy.   It was easy and the notes were handwritten, not emails. They were brief and signaled that I appreciated someone's effort to help make the community or organization a better place for all.  These were sent to teachers, students, parents and colleagues as well as others in the larger community.  Try it and see what happens.

ORGANIZATION WELLNESS CHECK (another reprise or for some a surprise)

How well is it working?  Here are four indicators that you might review to get a better idea of where things stand according to these criteria.  They may suggest where you might want to consider a shift to something different in order to perform at a more efficient or productive level.  

Structure -  How is the institution, company, team, division, department or individual organized?   What are the essential features of how the parts connect with one another and work for both efficiency and effectiveness?  When you look at it from the outside what do you see?  Is there a chart, one of those diagrams that show people and how they are all connected? And if there is, when was it last updated?   If form follows function then this would not be the first thing listed but perhaps the last, as it would be formed and informed by the work that needs to be done.  Think about it.  When putting an organization together, where do you start?  Or if you are re-forming and re-shaping an organization, team or whatever, it might be better not to start rearranging the tables and chairs (and people) until you have a really good idea of how its working.

Function -  Is it working?  So many responses are that if it's working, don't mess with it.  Don't fix it if it's not broken and I say that if you think it's not "broken" perhaps you're not looking hard enough or far enough or deep enough.  It does not have to be broken to make it better or to rearrange some pieces in order to make it work or function better, more efficiently for example.  You may want to increase the flow or the capacity or maybe you even want to slow it down.   Maybe you want to do something entirely new and different or add a piece to what already exists.  Are you willing to consider what you might want to discard in order to replace it with a newer, better model?  Of course, the marketers are all about built in obsolescence in order to keep selling the new stuff.

Process -  Here is where the proverbial rubber hits the road and two of the words that have gained popularity recently in the parlance of organizations are "traction" and "recalibrating."   I am all for gaining traction as that is what moves us forward.  How do you measure progress?  Assessment and evaluation have become enormous markers for determining success, so much so that they are an integral part of the process.  As for recalibration, maybe that just means that in the face of so much change so fast, we need to make certain adjustments in the way we adapt to change or even design change as part of the process itself.  If you believe you have a good process, then it's important to let it work on behalf of the organization and/or the individuals who comprise it.  If you need to design a new plan, then go for it.

Outcome -  Here is where your goals and objectives rest and wait for you.  You may think you have determined what they ought to be and depending on your values, whether bottom line profit for the stakeholders and shareholders or individual and corporate success by some other measure, the results
"prove" or demonstrate that what you are about is worth all the investment of time, effort, energy and resources.  When you and those with whom you work are excited and energized by your mission, your vision and values, these are what will drive the decisions that will eventually produce the outcome.  Mission driven decisions, according to the research, are the most effective ones.

In summary, have a look and if you need some outside, more objective expertise to do that, then get it. You will be glad you did!

REPRISE - LESS IS MORE

(Moving toward Thanksgiving, November 27, 2014)

This phrase, “less is more” appeared in a love poem (line78) in 1855 by Robert Browning , “Andrea del Sarto” called The Faultless Painter. The phrase was adopted by Mies van der Rohe, an architect whom I studied briefly in an undergraduate course called “The House.”  He, along with a number of others, including Frank Lloyd Wright, were leaders in the minimalist movement that tried to scale things down rather than up, clean lines, good design. 

Since then that phrase “less is more” has been popularized by all kinds of movements and people from philosophers to musicians.  Most notable among these are St. Francis,  Ghandi, Albert Schweizer, Henry David Thoreau, and more recently, E. F. Schumacher in his 1973 work, Small is Beautiful, a study of economics as if people mattered.   Two musicians known for their work in this genre are Steve Reich and John Cage.   There are numerous others from many fields, some in the environmental movement.

Living a more simple life has been espoused by various religious and secular groups, including the Quakers. Related notions such as self-sufficiency, conspicuous consumption, sustainability, downsizing, intentional community, and the slow movement are all expressions from those who do not necessarily agree with the economics of a culture where GNP is the measure of success.  There are many people who believe that there are other values that could contribute to a meaningful and productive life so that that we do not base our worth on the market value of goods and services produced in one year.

What if we looked at a quality of life based not on how much we have but how much we can give?   What if the measure of a man or woman at the end of their lives was not how much they had accumulated but how much they had been able to give away?  Then we might have a bumper sticker that says the one who ends up with the least wins instead of the one who ends up with the most toys wins.  It seems to be true that simplicity and clarity which lead to good design applies to much more than objects. How about designing our lives around simple and clear rather than complicated and
cluttered?  

The small house movement has gained in popularity the past few years as more and more people discover how efficient and economical it is to live in fewer square feet.  There is even a small house society whose tag line is “better living through simplicity.”  (http://smallhousesociety.net/)  Thas is quite different from DuPont's better living through chemistry!

You can find many people who live full time on boats of various sizes all over the world and we have met many fellow travelers on the road whose only residence is their RV or recreational vehicle.  These range in size and kind from small to large and ones that you pull behind a truck or that are self propelled by their own gas or diesel engines.  Most are self contained and are able to provide adequate and comfortable space along with the necessary functions of heat, light, cooking, bathing and even connectivity with the rest of the world.

We have taken several steps in that direction ourselves.  We sold our house and six acres lived for 9 months in a house on wheels, read motor home.  Gypsies, someone said. No house or apartment, just wandering here and there, working and living on the road.  Our theme song could be Willie Nelson’s “On the Road Again” http://www.youtube.com/watch?v=1TD_pSeNelU  Since then, we purchased a small manufactured house (mobile home), one third the size of our previous house.

That is but one illustration that affords us a level of freedom, independence and a significant reduction in possessions, equipment and property that must be cared for, maintained and supported.  More importantly perhaps is asking this question. What would improve the quality of your life that is within your reach?  The answer may or may not have to do with “living space” but chances are at some point you will arrive at a time of transition and then you can design the change and make the choice.

6429 - Follow up on the medical assembly line

“6429”

More observations, experience and impressions – We walk into the day surgery unit at the local, regional, medical center at 5:30 AM Monday morning and are given a card with our number on it, #6429.  There are codes below the number that can give an update on the patient’s status, provided somewhere on a screen so that any family member can know where the patient is and what is happening. 

We are there for a rather straightforward procedure, a minor repair that is supposed to take an hour beginning at 7:30 AM with an hour or so recovery time and then home.  Why it takes two hours to sign in and get ready remains a mystery as it seems at least an hour was mere wait time, no registration, no preparation, just wait.  We will call it insurance time, in case it’s needed. 

A man comes out from behind some doors and calls our number “6429” and in we go, off with the clothes, on with the gown, vital signs, etc. you probably know the drill.  There will be seven people attending this procedure, the pre-op nurse, an OR nurse, the nurse anesthetist, the main surgeon, his PA, a surgical resident doc and a surgical technician.  There is a 8th wandering around,  an orderly for help with transport from gurney to OR table.  The last thing I remember was someone putting a pillow under my head and looking up at all the lights and wires.  After an hour of invasive surgery, I am transported, unconscious, to recovery, 6429 changing status for another hour, and then awake and preparing to leave.  My wife’s face is most welcome waking up and she helps me get dressed and chauffeurs me home, still woozy from the anesthesia and in a rather weakened condition.

By 11:30 AM I am in my own bed, resting quietly.   About 2 PM we notice blood oozing out from the wound above my belly button and I felt miserable.  A call to the doc and we are told to come back to his office and he would see what was going on.  There by 3PM on the table, sprawled uncomfortably with my feet on a stool because the table was too short.  Or am I too tall?  He said he would call the hospital, see if they could get a bed and I could be readmitted.  An hour and a half later, we shuffle across the road via wheel chairs and car to the emergency entrance for a “direct admit” foregoing all the emergency room registration, admission procedures.

I am ushered into the CDU, “Critical Decision Unit” just off the ER where there at least 10 cubicles, one for each patient being observed and evaluated. I spend the next 18 hours there and here is an abbreviated account of that piece.

CDU, at least not ICU.   It is about 5 PM and the usual intake procedures are initiated, more vital signs for the record, the weight, recorded by the bed itself, temperature, pulse, blood pressure, oxygen, all within normal ranges.  An IV is started for some hydration and nourishment since I have not eaten anything in over 24 hours, perhaps contributing to a sense of weakness, no fuel.  I ask if it’s still possible to order dinner and yes, it is.  Good news as I am very hungry.  Looking at several choices, I opt for pot roast, mashed potatoes, sliced peaches and some chicken noodle soup for starters.

Some medications are prescribed and the nurse comes to flash the laser on my bracelet to see what they are so they can be ordered from the pharmacy.  When she goes to put the information into the computer, the screen gives her a message that will not allow any further progress.  She mumbles something about the system not working and I agree wholeheartedly.  She blames the pharmacy.   I suggest that perhaps since I was discharged from the day surgery outpatient unit, I have not been re-entered into the hospital admission system.  She says, no, your name and information are right here, pointing to the bracelet and the computer.

Three hours later, they discover that since my bracelet wasn’t changed on readmission, their system would not recognize the new me.  Meanwhile, pain and discomfort have increased although I am still hungry. The nurse and patient traffic outside my CDU # 10 continues all night long with a variety of blood tests on me and changing of IV by my own bedside.  Sleep is next to impossible.  By morning, I want simply to get out of there ASAP.  I order a large breakfast of scrambled eggs, fresh fruit and toast, consume it probably too fast and it all erupts twenty minutes later.  Several doctors stop by, make some observations and comments, and the surgeon says if I feel like it, I can go home by noon.

It is now Tuesday afternoon, I am home and recovery is much slower than expected.  By Friday morning, I am on the mend, feeling better but still a ways to go to get back to being fully operational, no pun intended.  My conclusion is that the insurance companies are holding the medical system hostage to lousy patient care and I will be hard to convince otherwise.  The “critical decision” should be whether or not the patient is better, not whether time and the UCR has expired.  In case you did not know, UCR is “usual, customary and reasonable” and has to do with fees.  What the insurance company apparently does not take into account is that there are situations that are unusual, unreasonable and not customary.  It seems there might be a case made for getting it right the first time rather than taking the additional time, extra trouble and serious inconvenience to do it over again.