The department head meeting yesterday was very interesting. Apparently, NO ONE from the command has gotten any formal recognition (NAM, COMM, even LOA) for the part they played in the Frank Cable mass casualty. The Commanding Officer (CO) said, "Well, there were over 200 people at Naval Hospital involved in the incident. We can't give everyone an award."
When one of the department heads said, "Well, the Frank Cable managed to give 113 awards to sailors for THEIR role in the incident," the CO said, "That never happened." Then the Public Affairs Officer cleared his throat and said he could provide the article from the Pacific Navigator.
Rumor has it that the command was submitted for a UNIT award and it was turned down...even though we were lauded throughout the Navy for our medical care.
And they wonder why there is a recruiting and retention problem for Naval Hospital Guam.
In the CO's call yesterday, he showed us two books that were passed out at the Surgeon General's conference: "Made to Stick" and "The Second Rule." I read the first and would like to read the second (I think it's on my wish list….just haven't had justification to pay for it because I have so many other books in the queue). I would recommend the CO read a few other books. My suggestions? "The Carrot Principle," "It's Okay to be the Boss," "It's Your Ship: Management Techniques from the Best Damn Ship in the Navy," and "First, Break all the Rules: What the World's Best Managers Do Differently."
All of these books state definitively that recruitment and retention efforts fail or succeed at the supervisor level and that recognition is what people crave most.
The CO can say, "Naval Hospital Guam gets kudos from all over the Navy," but until he puts his money where his mouth is and we see awards for people other than those who donated "multiple off-duty hours" to coordinating the Navy Ball (give me a break), he has no credibility for me.
Friday, February 15, 2008
Saturday, January 12, 2008
Managing by Carrots--Are You Doing It Right?
Recognizing and rewarding employees is an integral function of the leader and manager. As someone who is internally motivated, I overlooked opportunities to recognize others in the past, but the article below, reprinted with permission from Adrian Gostick and Potentials Magazine, made me rethink the purpose of recognition and how to do it right.
Several years ago, I completed a nomination for one of my colleagues for her volunteer services within the community. When I submitted the nomination up the chain-of-command, the Director looked up at me from behind her desk and said, "Thanks. I meant to do this but ran out of time." The problem is I was a lieutenant taking the time to recognize the activities of a fellow lieutenant and the director was a captain, our immediate supervisor.
If you are truly taking care of your people, how can you possibly run out of time to recognize their good works?
The only praise that doesn't work is the hollow praise of "Good job." It doesn't take much to personalize it and to let the recipient know exactly what the "good job" constitutes. The phrase that pays says, "No one cares how much you know until they know how much you care."
POINTED PRAISE PRODUCES BETTER RESULTS
Recognition without specifics can be worse than no recognition at all
Adrian Gostick and Chester Elton
The next time your young child, grandchild or niece brings home a Rorschach painting from school, try an experiment. Instead of patting her on the head and saying, “Aren’t you just the best little artist,” try talking about the specifics of the painting.
“Why did you use red here?” “What have you drawn here?” “What action is going on in this area?”
When you praise the child and hang the painting on the refrigerator, use specifics such as, “I love how your flowers are turning toward the sun; that’s very observant.” Or, “You know, I don’t know that I’ve ever seen scarier blue alien bugs.” We guarantee that your little one will light up to such specific praise and remember it for a much longer time.
Author and scholar David Cherrington gives a fun demonstration of why such specificity is so important in his book, Rearing Responsible Children.” Cherrington says of one father he observed, “He expressed appreciation to each of his three children individually in the presence of his wife. The father’s comment was a simple statement: ‘I just want you to know how much I appreciate everything you do.’ (The father supposed, like many managers, that any kind of praise would have a positive impact.)
“After he made the comment and left, his wife asked each child why the father had expressed appreciation. The 10-year-old replied, ‘I guess he must be upset because I didn’t get the dishes done like I was supposed to.’ The 13-year-old replied, ‘I don’t know. I guess he was just feeling sentimental.’ The 15-year-old said, ‘Who knows what he meant. I don’t think he understands what’s going on around here.’”
Say what you mean
In the work world, we’ve all known bosses who have fired out glibly, “Hey buddy, you’re doing a great job,” or “I appreciate all you do,” or “You sure look busy.” Unfortunately, these hollow phrases often leave employees wondering, “Does this guy have any idea what I really do around here?”
“Expressing appreciation in general, unspecified terms fails to communicate what the person did right and often appears insincere,” says Cherrington. Instead, when giving praise, describe the great behavior, why it was helpful, and say thanks. It’s that easy.
By taking a few minutes to prepare, and by using a few helpful techniques, your day-to-day recognition moments (and your formal recognition events) can do much more than simply thank employees for their contributions; they can enhance working relationships and increase feelings of loyalty and commitment.
No secret intelligence
To ensure that you’ve remembered everything, consider using the following mnemonic device: CIA – the Company (and department), the Individual and the Award. To help recall this acronym, remember that a good presentation takes a little bit of investigative work.
Company: Be prepared to talk about the company and team goals. You’ll want to reiterate why this is a great place to work (your success, your history, exciting changes, superior quality, etc.).
At FedEx, for example, managers use the recognition presentation as a time to talk about their values of people, service and profit.
Individual: Relate specifically what the individual did to earn this award or recognition and how this achievement helps fulfill your team and company goals. To get the most impact, except with very shy recipients, you’ll want to invite co-workers to talk about the person’s qualities, creativity, dedication and specific work achievements.
Award: Finally, talk about what you are presenting to your employee – whether a formal award for service or performance or a more informal award. If it’s a formal award, talk about the symbolism incorporated into the item – the gold company logo or emblem, the engraving, etc.
Never bad timing
The great thing about carrots is that they are always in season. When times are good in your company, effective presentations will give you a chance to celebrate and reflect. Unlike monetary rewards that dry up when times are tight, carrots can be used during downturns to bring you closer together and give you hope that better times lie ahead.
By making the presentations public, you not only make the person being recognized feel appreciated, but also inspire those who are in attendance. In fact, a great presentation should get people asking themselves, “What memorable or noteworthy things have I done for the company?”
Here’s an example of how it’s done right: Grocery store chain Festival Foods in Onalaska, WI, invites customers and employees to “huddle up” for recognition moments. Twice a year, the company brings in all store directors for hands-on training and meetings called “Festival College.”
After the training, leaders from the company offices go to stores for regular presentations – not only to ensure that recognition is being done right, but to get involved themselves and lead by example. As Festival Foods President Dave Skogen says, “While it’s crucial to have the best quality products and the cleanest, most attractive facility, ultimately it’s employee attitude that brings customers back.”
Adrian Gostick is director of marketing and corporate communications for the O.C. Tanner Recognition Company (www.octanner.com). Chester Elton is national director of performance sales for O.C. Tanner. This article was excerpted from their book The 24-Carrot Manager: A remarkable story of how a leader can unleash human potential (Gibbs Smith, 2002).
If you don't have time to read, consider listening to their podcasts:
http://www.podcastdirectory.com/podcasts/6582
Several years ago, I completed a nomination for one of my colleagues for her volunteer services within the community. When I submitted the nomination up the chain-of-command, the Director looked up at me from behind her desk and said, "Thanks. I meant to do this but ran out of time." The problem is I was a lieutenant taking the time to recognize the activities of a fellow lieutenant and the director was a captain, our immediate supervisor.
If you are truly taking care of your people, how can you possibly run out of time to recognize their good works?
The only praise that doesn't work is the hollow praise of "Good job." It doesn't take much to personalize it and to let the recipient know exactly what the "good job" constitutes. The phrase that pays says, "No one cares how much you know until they know how much you care."
POINTED PRAISE PRODUCES BETTER RESULTS
Recognition without specifics can be worse than no recognition at all
Adrian Gostick and Chester Elton
The next time your young child, grandchild or niece brings home a Rorschach painting from school, try an experiment. Instead of patting her on the head and saying, “Aren’t you just the best little artist,” try talking about the specifics of the painting.
“Why did you use red here?” “What have you drawn here?” “What action is going on in this area?”
When you praise the child and hang the painting on the refrigerator, use specifics such as, “I love how your flowers are turning toward the sun; that’s very observant.” Or, “You know, I don’t know that I’ve ever seen scarier blue alien bugs.” We guarantee that your little one will light up to such specific praise and remember it for a much longer time.
Author and scholar David Cherrington gives a fun demonstration of why such specificity is so important in his book, Rearing Responsible Children.” Cherrington says of one father he observed, “He expressed appreciation to each of his three children individually in the presence of his wife. The father’s comment was a simple statement: ‘I just want you to know how much I appreciate everything you do.’ (The father supposed, like many managers, that any kind of praise would have a positive impact.)
“After he made the comment and left, his wife asked each child why the father had expressed appreciation. The 10-year-old replied, ‘I guess he must be upset because I didn’t get the dishes done like I was supposed to.’ The 13-year-old replied, ‘I don’t know. I guess he was just feeling sentimental.’ The 15-year-old said, ‘Who knows what he meant. I don’t think he understands what’s going on around here.’”
Say what you mean
In the work world, we’ve all known bosses who have fired out glibly, “Hey buddy, you’re doing a great job,” or “I appreciate all you do,” or “You sure look busy.” Unfortunately, these hollow phrases often leave employees wondering, “Does this guy have any idea what I really do around here?”
“Expressing appreciation in general, unspecified terms fails to communicate what the person did right and often appears insincere,” says Cherrington. Instead, when giving praise, describe the great behavior, why it was helpful, and say thanks. It’s that easy.
By taking a few minutes to prepare, and by using a few helpful techniques, your day-to-day recognition moments (and your formal recognition events) can do much more than simply thank employees for their contributions; they can enhance working relationships and increase feelings of loyalty and commitment.
No secret intelligence
To ensure that you’ve remembered everything, consider using the following mnemonic device: CIA – the Company (and department), the Individual and the Award. To help recall this acronym, remember that a good presentation takes a little bit of investigative work.
Company: Be prepared to talk about the company and team goals. You’ll want to reiterate why this is a great place to work (your success, your history, exciting changes, superior quality, etc.).
At FedEx, for example, managers use the recognition presentation as a time to talk about their values of people, service and profit.
Individual: Relate specifically what the individual did to earn this award or recognition and how this achievement helps fulfill your team and company goals. To get the most impact, except with very shy recipients, you’ll want to invite co-workers to talk about the person’s qualities, creativity, dedication and specific work achievements.
Award: Finally, talk about what you are presenting to your employee – whether a formal award for service or performance or a more informal award. If it’s a formal award, talk about the symbolism incorporated into the item – the gold company logo or emblem, the engraving, etc.
Never bad timing
The great thing about carrots is that they are always in season. When times are good in your company, effective presentations will give you a chance to celebrate and reflect. Unlike monetary rewards that dry up when times are tight, carrots can be used during downturns to bring you closer together and give you hope that better times lie ahead.
By making the presentations public, you not only make the person being recognized feel appreciated, but also inspire those who are in attendance. In fact, a great presentation should get people asking themselves, “What memorable or noteworthy things have I done for the company?”
Here’s an example of how it’s done right: Grocery store chain Festival Foods in Onalaska, WI, invites customers and employees to “huddle up” for recognition moments. Twice a year, the company brings in all store directors for hands-on training and meetings called “Festival College.”
After the training, leaders from the company offices go to stores for regular presentations – not only to ensure that recognition is being done right, but to get involved themselves and lead by example. As Festival Foods President Dave Skogen says, “While it’s crucial to have the best quality products and the cleanest, most attractive facility, ultimately it’s employee attitude that brings customers back.”
Adrian Gostick is director of marketing and corporate communications for the O.C. Tanner Recognition Company (www.octanner.com). Chester Elton is national director of performance sales for O.C. Tanner. This article was excerpted from their book The 24-Carrot Manager: A remarkable story of how a leader can unleash human potential (Gibbs Smith, 2002).
If you don't have time to read, consider listening to their podcasts:
http://www.podcastdirectory.com/podcasts/6582
Tuesday, January 8, 2008
Are You a Knowledge Hoarder?
In my previous incarnation as a small unit leader, I was not wildly successful. It stemmed largely from my personal insecurities. When I needed someone to cover for me or to complete a project, I was helpful...but not as helpful as I could have been. I invariably omitted some vital piece or a bit of information that could have helped the other person succeed. I called this "knowledge hoarding" and I was a consummate player in the game. It took me a long time to realize that true power comes from knowledge sharing.
As a more seasoned leader, I try to give my juniors all the information I can. The benefit of open communication means they come to me with their questions and concerns, and they often possess information I need to provide to senior leadership.
Marshall Goldsmith addresses this issue much more eloquently than I can, and he and Patricia Wheeler have graciously permitted reprinting an excerpt from one of his monthly newsletters here. Consider subscribing to Leading News---their monthly newsletter dedicated to helping leaders become successful.
Withholding Information
By Marshall Goldsmith
In the age of knowledge workers, the saying that information is power is truer than ever—which makes withholding information even more extreme and irritating.
Intentionally withholding information is the opposite of adding value. We are deleting value. Yet it has the same purpose: to gain power. It’s the same old need to win, only more devious. And it appears in more forms than merely playing our cards close to our vest. You see it in people who exaggerate the virtue of keeping a secret; they use it as an excuse to leave you out of the information flow. You see it in its passive-aggressive incarnation in people who don’t return your phone calls, answer your emails, or only give partial answers.
If you don’t understand why it annoys people, reflect on how you felt about the following events:
- A meeting you weren’t told about
- A memo or e-mail you weren’t copied on
- A moment when you were the last person to learn something
The problem with not sharing information—for whatever reason—is that it rarely achieves the desired effect. You may think you’re gaining an edge and consolidating power, but you’re actually breeding mistrust. In order to have power, you need to inspire loyalty rather than fear and suspicion.
What I’m describing here is not just the willful poison-sowing refusal to share information, the way people behave when they want to divide and conquer. I’m also talking about all the unintentional or accidental ways we withhold information.
We do this when we’re too busy to get back to someone with valuable information.
We do this when we forget to include someone in our discussions or meetings.
We do this when we delegate a task to our subordinates but don’t take the time to show them exactly how we want the task done.
I was advising a friend who was having trouble with his assistant. They weren’t meshing as a team but he didn’t know why or how to fix the problem. I asked him, “What would your assistant say is your biggest flaw as a boss?”
“That I don’t communicate enough with her,” he answered, “and I leave her out of the loop.”
I observed him one day at work, and what I saw explained everything. He was already at his desk checking his e-mail when his assistant arrived. She poked her head in to say good morning, and he waved as he talked on his cell phone. When the call ended, he turned back to his computer. His assistant periodically came in to notify him of calls, which he took while continuing to scan his computer. After a few hours, I asked him if all days were like this.
“Pretty much,” he said.
My friend, indeed, was guilty of keeping his assistant in the dark, but he was not doing so maliciously or intentionally. His work life was like a haphazard fire drill. He was so distracted, so disorganized, so busy responding to calls and putting out fires that he never had time to sit down with his assistant for a daily briefing.
If he had, I suspect it would have solved their information sharing issue.
I suspect this is a big reason why so many of us withhold information. It’s not that we want to keep people in the dark. It’s simply that we’re too busy. We mean well. We have good intentions. But we fail to get around to it. As a result we become bad at sharing information, and over time it begins to look like we are withholding information.
Being bad at sharing information doesn’t mean we are willfully withholding it…but the net result is the same in the eyes of the people around us.
How do you stop withholding information?
Simple answer: Start sharing it.
That’s what my friend did. He made sharing information a higher priority in his busy day. He made time to debrief his assistant daily, and held to this commitment no matter what was going on.
If this is your problem, I advise the same solution. You will not only improve your communication, but you will prove that you care about your coworkers, demonstrating that what they think matters to you. It’s not often we get such a two-for-the-price-of-one solution to our interpersonal challenges…but making the subtle shift from withholding to sharing information is one of them.
Excerpted from What Got You Here Won’t Get You There, 2007
Marshall Goldsmith is a world authority in helping successful leaders achieve positive, measurable change in behavior: for themselves, their people and their teams. He has been named one of the top 50 leaders influencing the field of management over the last century (American Management Association), one of the five most respected executive coaches (Forbes) and among the top ten executive educators (Wall Street Journal). Marshall invites you to visit his library (MarshallGoldsmithLibrary.com) for articles and resources you can use.
As a more seasoned leader, I try to give my juniors all the information I can. The benefit of open communication means they come to me with their questions and concerns, and they often possess information I need to provide to senior leadership.
Marshall Goldsmith addresses this issue much more eloquently than I can, and he and Patricia Wheeler have graciously permitted reprinting an excerpt from one of his monthly newsletters here. Consider subscribing to Leading News---their monthly newsletter dedicated to helping leaders become successful.
Withholding Information
By Marshall Goldsmith
In the age of knowledge workers, the saying that information is power is truer than ever—which makes withholding information even more extreme and irritating.
Intentionally withholding information is the opposite of adding value. We are deleting value. Yet it has the same purpose: to gain power. It’s the same old need to win, only more devious. And it appears in more forms than merely playing our cards close to our vest. You see it in people who exaggerate the virtue of keeping a secret; they use it as an excuse to leave you out of the information flow. You see it in its passive-aggressive incarnation in people who don’t return your phone calls, answer your emails, or only give partial answers.
If you don’t understand why it annoys people, reflect on how you felt about the following events:
- A meeting you weren’t told about
- A memo or e-mail you weren’t copied on
- A moment when you were the last person to learn something
The problem with not sharing information—for whatever reason—is that it rarely achieves the desired effect. You may think you’re gaining an edge and consolidating power, but you’re actually breeding mistrust. In order to have power, you need to inspire loyalty rather than fear and suspicion.
What I’m describing here is not just the willful poison-sowing refusal to share information, the way people behave when they want to divide and conquer. I’m also talking about all the unintentional or accidental ways we withhold information.
We do this when we’re too busy to get back to someone with valuable information.
We do this when we forget to include someone in our discussions or meetings.
We do this when we delegate a task to our subordinates but don’t take the time to show them exactly how we want the task done.
I was advising a friend who was having trouble with his assistant. They weren’t meshing as a team but he didn’t know why or how to fix the problem. I asked him, “What would your assistant say is your biggest flaw as a boss?”
“That I don’t communicate enough with her,” he answered, “and I leave her out of the loop.”
I observed him one day at work, and what I saw explained everything. He was already at his desk checking his e-mail when his assistant arrived. She poked her head in to say good morning, and he waved as he talked on his cell phone. When the call ended, he turned back to his computer. His assistant periodically came in to notify him of calls, which he took while continuing to scan his computer. After a few hours, I asked him if all days were like this.
“Pretty much,” he said.
My friend, indeed, was guilty of keeping his assistant in the dark, but he was not doing so maliciously or intentionally. His work life was like a haphazard fire drill. He was so distracted, so disorganized, so busy responding to calls and putting out fires that he never had time to sit down with his assistant for a daily briefing.
If he had, I suspect it would have solved their information sharing issue.
I suspect this is a big reason why so many of us withhold information. It’s not that we want to keep people in the dark. It’s simply that we’re too busy. We mean well. We have good intentions. But we fail to get around to it. As a result we become bad at sharing information, and over time it begins to look like we are withholding information.
Being bad at sharing information doesn’t mean we are willfully withholding it…but the net result is the same in the eyes of the people around us.
How do you stop withholding information?
Simple answer: Start sharing it.
That’s what my friend did. He made sharing information a higher priority in his busy day. He made time to debrief his assistant daily, and held to this commitment no matter what was going on.
If this is your problem, I advise the same solution. You will not only improve your communication, but you will prove that you care about your coworkers, demonstrating that what they think matters to you. It’s not often we get such a two-for-the-price-of-one solution to our interpersonal challenges…but making the subtle shift from withholding to sharing information is one of them.
Excerpted from What Got You Here Won’t Get You There, 2007
Marshall Goldsmith is a world authority in helping successful leaders achieve positive, measurable change in behavior: for themselves, their people and their teams. He has been named one of the top 50 leaders influencing the field of management over the last century (American Management Association), one of the five most respected executive coaches (Forbes) and among the top ten executive educators (Wall Street Journal). Marshall invites you to visit his library (MarshallGoldsmithLibrary.com) for articles and resources you can use.
Friday, December 14, 2007
Checklists for Healthcare Providers
There is no way healthcare providers can rely on their memories to guarantee evidence-based practices. We are too busy, too fragmented, and too hurried.
This article from The New Yorker explains why checklists work:
The Checklist
The biggest push in patient safety today is crew resource management which is based upon standard practices to achieve safety in the aviation industry. I think we will be seeing huge differences in medical/healthcare practices in the future.
This article from The New Yorker explains why checklists work:
The Checklist
The biggest push in patient safety today is crew resource management which is based upon standard practices to achieve safety in the aviation industry. I think we will be seeing huge differences in medical/healthcare practices in the future.
Thursday, December 6, 2007
Attention to Detail...
I recently got my birthday card from the Commanding Officer. It was handed to me by one of the corpsmen on my old unit, F-2. I've been off that unit since July. The CO has seen me many times since then and knows my current assignment since I was called in to his office on a patient satisfaction issue a week ago and the appointment was set up weeks prior to that.
My first birthday card from this CO went to the ICU. I cut him some slack because he was relatively new to the command and I figured I was just another face in the crowd. To make a mistake like this a second time, well...I realized it just doesn't mean anything at all. So it went right into the trash.
As a believer in good stewardship and using limited resources wisely, it pained me. Whether the CO actually signed it or not, someone took the time to type out a message on command letterhead (good quality) and he signed it or someone stamped his name. Someone made sure my letter got out of his office. And then they couldn't follow through.
My first birthday card from this CO went to the ICU. I cut him some slack because he was relatively new to the command and I figured I was just another face in the crowd. To make a mistake like this a second time, well...I realized it just doesn't mean anything at all. So it went right into the trash.
As a believer in good stewardship and using limited resources wisely, it pained me. Whether the CO actually signed it or not, someone took the time to type out a message on command letterhead (good quality) and he signed it or someone stamped his name. Someone made sure my letter got out of his office. And then they couldn't follow through.
Saturday, December 1, 2007
The Business of Being Born
Celebrity actress/host Ricki Lake's new movie, "The Business of Being Born" points out that some of the most traditional practices of contemporary obstetrics have everything to do with the convenience of the physician, but can actually make delivery more difficult for the mother.
The Next Inconvenient Truth?
"Birth is miraculous, a natural process. But birth is also big business and this movie will change your mind about everything you think you know about it," said Sabrina McIntyre, a Fairfax County mom and former flight attendant who delivered one daughter by Cesarean section (c-section) and another at home by midwife.
To most people, the idea of giving birth outside of a hospital seems foolish and even dangerous: why would any parent limit their newborn's access to technology in the event of an emergency? Why would any couple put their child's life in the hands of a midwife instead of an obstetrician? "When my friend Ricki (Lake) approached me about making this film, I admitted to her that I was afraid to even witness a woman giving birth, let alone film one," said Abby Epstein, the Emmy-winning director of "The Business of Being Born." "I discovered that the business of being born is another infuriating way medical traditions and institutions -- hospitals and insurance companies -- actually discourage choice," said Epstein.
"The point here," observed Dr. Marsden Wagner, former Director of Women's and Children's Health, World Health Organization, "is there's not a good history in obstetric practice of careful study of the long term effects of all these interventions. This is why; if you really want a humanized birth, the best thing to do is get the hell out of the hospital."
A Movement Underway?
Arlington-based midwife, Tammi McKinley, said her practice has "boomed" with the number of women questioning high-tech birth. "Women are really starting to understand that all those gadgets don't always mean a safer birth, and women are looking to replace high-tech birth with high-touch birth," said McKinley, who delivered one child by c-section and her second at home by midwife.
Statistically, the use of c-section, a major surgery, is being widely employed, more as a measure of convenience for both doctor and patient instead of a last resort in the event of an emergency. Dr. Michael Brodman, Chief OB/GYN at New York's Mount Sinai Hospital, cites a study that reveals the peak hours for c-section procedures are 4:00pm and 10:00pm. Brodman interprets the data from the perspective of the hospital-based physician:
FAST FACTS:
-- In America, midwives attend less than 8% of all births and less than 1% of those that occur outside a hospital. At the same time, the US has the second worst newborn death rate in the developed world. Lake and Epstein ask, "Why do less than 8% of Americans take advantage of the benefits of midwifery, which is statistically safer and cheaper than physician-attended birth?"
-- The five countries with the lowest infant mortality rates in the March of Dimes report -- Japan, Singapore, Sweden, Finland and Norway -- midwives were used as their main source of care for 70 percent of the birthing mothers.
-- C-section is the most commonly performed surgery in the US, at a cost of $14 billion per year. Cesarean-delivery rates are now at an all time high in the United States, standing at 1.2 million, or 29.1 percent of live births in 2004. The increase represents a 40 percent increase in the past 10 years.
-- In one 1999 survey, 82% of physicians said they performed a C-section to avoid a negligence claim.
Jennifer Block, author of "Pushed: The Painful Truth About Childbirth and Modern Maternity Care," writes, "Too many Caesareans are literally medical overkill. Yet some US hospitals are now delivering half of all babies surgically. Across the nation, one in four low-risk first-time mothers will give birth via Caesarean, and if they have more children, 95 percent will be born by repeat surgery. In many cases, women have no choice in the matter. Though vaginal birth after Caesarean is a low-risk event, hundreds of institutions have banned it, and many doctors will no longer attend it because of malpractice liability."
She adds, "We've become dangerously cavalier...the Caesarean rate should be a major public health concern."
Natural Solutions to a "Medical" Problem
Midwives are definitely a viable solution; however, many find it difficult to assist with birthing because of the impossibility of obtaining malpractice insurance. Peggy Vincent, a midwife in California, writes candidly about her life as a midwife and the barriers she encountered with regulations and insurance in her book, "Baby Catcher: Chronicles of a Modern Midwife."
I am still bitter about my birthing experiences at San Diego Naval Medical Center. As an active duty sailor, I was not permitted to have a midwife assist with my labors nor was I permitted to have a homebirth. Consequently, I got the physician only on-call when I went labor and that resulted in a an emergency room physician (not even someone doing their residency) catching my baby for only the second time in his life. I suffered a fourth degree laceration (extending through the rectal mucosa to expose the lumen of the rectum) with an infant that weighed only 5 pounds, 13 ounces. At least, I didn't have a Caesarean, although they threatened me with that.
Addendum
ABC News published a story on unassisted home births. You can view the story and comments here:
DIY Deliveries: More Women Go It Alone
Here's an additional resource on the history of childbirth. As someone who studied medical sociology, this book should add depth to the rise of the American Medical Association:
http://www.mcfarlandpub.com/book-2.php?id=978-0-7864-3362-9
The Next Inconvenient Truth?
"Birth is miraculous, a natural process. But birth is also big business and this movie will change your mind about everything you think you know about it," said Sabrina McIntyre, a Fairfax County mom and former flight attendant who delivered one daughter by Cesarean section (c-section) and another at home by midwife.
To most people, the idea of giving birth outside of a hospital seems foolish and even dangerous: why would any parent limit their newborn's access to technology in the event of an emergency? Why would any couple put their child's life in the hands of a midwife instead of an obstetrician? "When my friend Ricki (Lake) approached me about making this film, I admitted to her that I was afraid to even witness a woman giving birth, let alone film one," said Abby Epstein, the Emmy-winning director of "The Business of Being Born." "I discovered that the business of being born is another infuriating way medical traditions and institutions -- hospitals and insurance companies -- actually discourage choice," said Epstein.
"The point here," observed Dr. Marsden Wagner, former Director of Women's and Children's Health, World Health Organization, "is there's not a good history in obstetric practice of careful study of the long term effects of all these interventions. This is why; if you really want a humanized birth, the best thing to do is get the hell out of the hospital."
A Movement Underway?
Arlington-based midwife, Tammi McKinley, said her practice has "boomed" with the number of women questioning high-tech birth. "Women are really starting to understand that all those gadgets don't always mean a safer birth, and women are looking to replace high-tech birth with high-touch birth," said McKinley, who delivered one child by c-section and her second at home by midwife.
Statistically, the use of c-section, a major surgery, is being widely employed, more as a measure of convenience for both doctor and patient instead of a last resort in the event of an emergency. Dr. Michael Brodman, Chief OB/GYN at New York's Mount Sinai Hospital, cites a study that reveals the peak hours for c-section procedures are 4:00pm and 10:00pm. Brodman interprets the data from the perspective of the hospital-based physician:
"It's obvious," he says, "that four in the afternoon is 'It's late in the day, I don't know what's going on here, I want to get out of here and the ten o'clock at night is, 'I don't want to be up all night.'"
FAST FACTS:
-- In America, midwives attend less than 8% of all births and less than 1% of those that occur outside a hospital. At the same time, the US has the second worst newborn death rate in the developed world. Lake and Epstein ask, "Why do less than 8% of Americans take advantage of the benefits of midwifery, which is statistically safer and cheaper than physician-attended birth?"
-- The five countries with the lowest infant mortality rates in the March of Dimes report -- Japan, Singapore, Sweden, Finland and Norway -- midwives were used as their main source of care for 70 percent of the birthing mothers.
-- C-section is the most commonly performed surgery in the US, at a cost of $14 billion per year. Cesarean-delivery rates are now at an all time high in the United States, standing at 1.2 million, or 29.1 percent of live births in 2004. The increase represents a 40 percent increase in the past 10 years.
-- In one 1999 survey, 82% of physicians said they performed a C-section to avoid a negligence claim.
Jennifer Block, author of "Pushed: The Painful Truth About Childbirth and Modern Maternity Care," writes, "Too many Caesareans are literally medical overkill. Yet some US hospitals are now delivering half of all babies surgically. Across the nation, one in four low-risk first-time mothers will give birth via Caesarean, and if they have more children, 95 percent will be born by repeat surgery. In many cases, women have no choice in the matter. Though vaginal birth after Caesarean is a low-risk event, hundreds of institutions have banned it, and many doctors will no longer attend it because of malpractice liability."
She adds, "We've become dangerously cavalier...the Caesarean rate should be a major public health concern."
Natural Solutions to a "Medical" Problem
Midwives are definitely a viable solution; however, many find it difficult to assist with birthing because of the impossibility of obtaining malpractice insurance. Peggy Vincent, a midwife in California, writes candidly about her life as a midwife and the barriers she encountered with regulations and insurance in her book, "Baby Catcher: Chronicles of a Modern Midwife."
I am still bitter about my birthing experiences at San Diego Naval Medical Center. As an active duty sailor, I was not permitted to have a midwife assist with my labors nor was I permitted to have a homebirth. Consequently, I got the physician only on-call when I went labor and that resulted in a an emergency room physician (not even someone doing their residency) catching my baby for only the second time in his life. I suffered a fourth degree laceration (extending through the rectal mucosa to expose the lumen of the rectum) with an infant that weighed only 5 pounds, 13 ounces. At least, I didn't have a Caesarean, although they threatened me with that.
Addendum
ABC News published a story on unassisted home births. You can view the story and comments here:
DIY Deliveries: More Women Go It Alone
Here's an additional resource on the history of childbirth. As someone who studied medical sociology, this book should add depth to the rise of the American Medical Association:
http://www.mcfarlandpub.com/book-2.php?id=978-0-7864-3362-9
Friday, October 19, 2007
Relationships Critical in Effective Leading
This month's issue of Center for Creative Leadership says "the ability to build and maintain relationships and work well with others is in big demand - and in short supply."
While I might think a leader is the one on point setting the pace, it's the manager who collaborates amongst departments to share resources, develop programs, and train personnel while simultaneously integrating direct reports' career and family desires with senior management edicts. So who really adds more value to an organization?
CCL says "Organizations are increasingly operating in ways that involve interdependent, boundary-spanning work - creating a greater demand for leaders who are skilled at participative management, building and mending relationships and change management."
Today's Navy Nurse manager [Division Officer] usually cannot offer choice job assignments although senior management does try to match career desires with billet openings. I have found that giving an expected timeframe for this transfer to a coveted position helps as well as exploiting opportunities for cross-training when workload is light. It also helps that nurse develop relationships with nurses already working in that department so this person is not only getting the benefit of me "pushing" this person to that department, but the department is "pulling" that person to come work with them in staffing meetings.
We cannot pay someone more for working the off-shift, weekend or holiday. This past summer, when staff members were working 18-20 twelve-hour shifts and on-call for more, the Nursing Middle Management Council wanted to reward those staff members with----a pizza party. I rolled my eyes. "Why not reward them with something that REALLY matters?" I asked. "Why not submit a nomination for a Navy Achievement Award---something that would appear on a fitness report and be presented in front of peers by the commanding officer?"
The response? "I'm really busy. I don't have time to write up a nomination." So, calling Pizza Hut or Dominoes is the ineffective leader's gift to direct reports. And it gives me a very good insight as to this manager's relationship abilities.
While I might think a leader is the one on point setting the pace, it's the manager who collaborates amongst departments to share resources, develop programs, and train personnel while simultaneously integrating direct reports' career and family desires with senior management edicts. So who really adds more value to an organization?
CCL says "Organizations are increasingly operating in ways that involve interdependent, boundary-spanning work - creating a greater demand for leaders who are skilled at participative management, building and mending relationships and change management."
Today's Navy Nurse manager [Division Officer] usually cannot offer choice job assignments although senior management does try to match career desires with billet openings. I have found that giving an expected timeframe for this transfer to a coveted position helps as well as exploiting opportunities for cross-training when workload is light. It also helps that nurse develop relationships with nurses already working in that department so this person is not only getting the benefit of me "pushing" this person to that department, but the department is "pulling" that person to come work with them in staffing meetings.
We cannot pay someone more for working the off-shift, weekend or holiday. This past summer, when staff members were working 18-20 twelve-hour shifts and on-call for more, the Nursing Middle Management Council wanted to reward those staff members with----a pizza party. I rolled my eyes. "Why not reward them with something that REALLY matters?" I asked. "Why not submit a nomination for a Navy Achievement Award---something that would appear on a fitness report and be presented in front of peers by the commanding officer?"
The response? "I'm really busy. I don't have time to write up a nomination." So, calling Pizza Hut or Dominoes is the ineffective leader's gift to direct reports. And it gives me a very good insight as to this manager's relationship abilities.
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