Monday, July 20, 2009

Sparta Humor Very Similar to Healthcare Humor

The Spartan Sense of Humor by Steven Pressfield is very similar to that found in First Responders and Healthcare Workers. I love what he writes:
["T]hey’re not jokes. They’re not meant just to raise a laugh. Yet they’re funny, they’re on-point. Second, they don’t solve the problem. Neither remark offers hope or promises a happy ending. They’re not inspirational. They don’t point to glory or triumph–or seek to allay their comrades’ anxiety by holding out the prospect of some rosy future outcome. They face reality. They say, “Some heavy shit is coming down, brothers, and we’re going to go through it.”

That could be said about a lot of workplaces right now...

Wednesday, July 15, 2009

Use Your Peripheral Brain

Today was a Command Urinalysis. Usually, that's not a problem, just an inconvenience. However, my name was on the list, I had requested this morning off due to another appointment, and the instructions on the Command Urinalysis list stated that a memo attesting to the individual's unavailability for this random urinalysis was insufficient. Members needed to provide copies of special liberty chits, memorandums, and leave or TAD paperwork.

Incredible. The one morning I am not at work, all bedlam breaks loose. The LPO, instead of requesting assistance from more experienced officers, directs his junior enlisted to generate a special lib chit for me and backdate it. Not a good idea. Besides, officers don't routinely route special request chits; they generally draft memos or letters requesting time off. The fact of the matter is, this wasn't an incident that would require written notification.

So, my LPO decided his brain power was sufficient for responding to this situation. If he had been on "Who Wants to be a Millionaire," he probably would have lost his opportunity to win. Steven Shapiro has a better answer and one this LPO can employ now and for future emergenices.

Typically, "Who Wants to be a Millionaire" allows you to use all your accumulated knowledge to answer questions of increasing difficulty and esoterica. You may finally get to a point where you can no longer weed out obvious distractors and have exhausted your personal information fount. That's where consulting others comes in handy.

Phone-a-Friend only works if your friend is more knowledgeable than you. In the Navy, people who are consulted by others are usually Sea Lawyers. That is not a popular moniker.

In Fifty-Fifty, two of the answers are removed. However, if you have no answers or you know that the answers you do have are probably not right, this option doesn't help.

Ask the Audience is a little better, but again, it relies too heavily on the knowledge of the crowd. As with 50-50, if you don't know your options or you know what you do have is not correct, asking your audience won't be helpful.

Finally, Ask the Expert. This is what I told the LPO to do for future problems. For one thing, consulting with someone who has considerably more experience will provide a lot more viable options. Also, the expert will tend to have more rank and authority to take the heat or to run interference for him.

In healthcare, many medical and nursing students have notecards, crib sheets, or PDAs to scribble the information they need at fingertip notice and they refer to these bits of data as their peripheral brains. In the business world, they call it networking---using people (and their collective knowledge) to find answers and get ahead.

Friday, May 22, 2009

Wind Mills and Flail Exercises

I have two months left and it is hard to summon the strength to continue to rail against waste and indifference. Six months from now it will be as though I never set foot here. And you know what? I have come to the conclusion that having the military run hospitals is stupid because we have a new Commanding Officer every two years and the status quo has to be shaken up, corporate knowledge must be lost, and politics must be endured, because no CO ever gets ahead by continuing to do what his or her predecessor has done (even if it is succeeding wildly---which has not been the case, unfortunately).

I am aghast at the amount of corporate knowledge I have accumulated and the fact that I cannot possibly communicate all the information for one-of-one situations that have happened so someone else doesn't have to reinvent the wheel or undergo a flail exercise (FLAILEX). Quite frankly, I don't think I've truly amassed such founts of information so much as I've discovered my network of people who know or who know other people who know the information I need. The biggest problem with functioning where I am is being surrounded by people who feel they must know everything and if they don't know it, there is no one else who can possibly know what they need to know. It is silo-ization at its finest. [In 2002, Vicki Casey, program director of Information Highways, used the word "siloization" to describe the smokestack-like structures that promote knowledge hoarding, rather than knowledge sharing and collaboration.]

Case Study
The LPO needed to get a bile bag (don't ask) from the OR. He called us in the endoscopy suite and said the OR tech didn't know what he was talking about. Instead of telling the OR tech, "Look, is there someone else I can talk to?," the LPO calls us. And instead of the OR tech being creative and helpful, he stops at the "Dude, I have no idea what you're talking about. End convo."

The inability to think creatively is not limited to the enlisted ranks. I had another Division Officer approach me for information about wound care. I'm not an expert. I only read the labels (but I did sleep at a Holiday Inn Express last night). So I look through the Phone Book and call healthcare agency who accepts patients from our hospital. I ask to talk to someone about wound care. They transfer me to Sofia. Sofia walks me through the steps, I transcribe them, and I hunt down the products (unfortunately, we don't have a few, so I direct my Supply Petty Officer to order them). I give the instructions to the Division Officer, note the telephone number and name for her in case she has future questions, and make a mental note to bring my corpsmen up to speed on wound care supplies and information. It didn't take very long, maybe 15 minutes total, including a call to another hospital for their wound care specialist who wasn't due to work until later that afternoon.

Sunday, May 3, 2009

Overcoming Defensiveness Key to Better Workplace Environment

My LPO was being counseled by the Senior Enlisted Leader (SEL) for our directorate.
"Your problem is you're too defens---" was all he was able to get out before the LPO interrupted, saying, "No, I'm not!"

This occurred after he had already been brought in to my office to discuss progress on a self-improvement plan. In that discussion, the LPO could not get himself under control to stop talking, even after repeated and even rude requests to be quiet.

After his discussion with the SEL, he came to me and said he recognized he had a problem. "So if you see me bringing my hand to my mouth," he said. "That's my way of slowing myself down so I don't interrupt or respond right away."

I told him I was curious about when this defensiveness had started. "When I became a corpsman," he said. "People assume because I started out in another specialty, I don't have any medical knowledge." He pointed out several individuals, including the Department Head and a fellow surgical technician as culprits in minimizing his experiences and abilities. "Well," I said. "There are gaps in your knowledge and not everyone knows what they are. Isn't it better to assume you don't have an essential skill than to assume you do?"

In any case, I doubt his defensiveness just started when he became a corpsman. Argyris, a leader in adult education, believes defensiveness starts in childhood and is reinforced throughout life. However, he is taking positive steps to correct this behavior. As Jim Tamm, author of Radical Collaboration, says, recognizing defensive behavior is the first step. Dr Nathan Cobb, a psychologist and marriage therapist in Calgary, has a very good workbook on overcoming defensiveness. Although "How to Overcome Defensiveness" is directed towards marriage, my LPO admitted that he adopted a defensive attitude at home, too.

One of the important things I learned in our encounter that started this spiral was my own role. I chose to become angry when the LPO would not stop talking and, for that, I regret my responses. Ridge Training's Overcoming the Destructive Dynamics of Defensiveness could have helped me stop my inner Mr Hyde from erupting.

The second step is acknowledging the emotions that come with the awareness of defensiveness. In this case, the tenets of yoga (breathing) and Buddhism (mindfulness) are invaluable. The Miracle of Mindfulness by Thich Nhat Hanh looks promising. The link from YouTube provides mindfulness using movement.

This website provides information on using hypnosis to overcome defensiveness. I'll let you know how it goes.

Wednesday, April 8, 2009

Supervision is a lost art...

A guest article written by Michael Taplin on Slow Leadership really resonated with me. His article, "The Lost Art of Supervision," discusses how everyone has become a leader, but we've lost our supervisors, the ones who tower over us to teach us what we must do, to hold us accountable to our responsibilities, and to remind us of our moral code.

Super article—a must read for anyone who wonders where they fit into the current world.

Tuesday, February 17, 2009

Mulligans Work in Healthcare, Too

Lony C. Castro, professor and chairwoman of the obstetrics and gynecology department at Western University of Health Sciences, writes in the LA Times: If a doctor's visit is going badly, you can start over---Maybe the physician was distracted. Or spoke too quickly. Whatever the communication problem, take a deep breath and try again. Sometimes doctor and patient benefit from a second take.

This happened to me, although in an inpatient setting. The family was very angry because they had brought their mother to the ER--twice---with symptoms of a stroke. I couldn't understand why she wasn't admitted to the unit at the first visit so I was angry with the physician for putting me in this position. After a heated discussion with the daughter, I took a deep breath and said, "I'm sorry. I hate having to apologize for another healthcare provider's mistake. Can we start over?"

This was all it took to help them realize I was distressed by this injustice and we were in it together. I had some Red Dress pins in my office. When I was finished assessing the patient, I grabbed a handful and gave one to each daughter. I explained to them they were each at risk for stroke because of their mother's history and this was an opportunity for them to make lifestyle changes that could delay or prevent this occurrence for them.

Do-overs allow you to take a deep breath and start with a clean slate. If it's not your fault, then it allows the other person a little grace. And God knows, we can all do with a little of that now and then.