Expecting Different Results

Today's post is a reflection on an old saying that goes, "One definition of mental illness is making the same choices over and over and expecting different results". Another way of looking at this decision making process is to suggest that it is "rut" thinking and we all need to be cognizant when we practice it. Dr. William Osler, father of the diagnostic thought process, cautioned young physicians against treating each disease presentation like the last one they'd seen. Yet, with all of our technological prowess and availability, we still tend to have "tunnel vision and thinking" and make decisions based on the way we've always done things. I've spent a good portion of the last 25 years working in and for hospitals. Though there are more than 6000 hospitals in the United States, it is a true statement that "when you've seen one hospital, you've seen one hospital". Even those that are part of larger organizations (religious affiliations, hospital systems, corporations) still operate with their own ethos and institutional memory and practice. Time and again I"ve come to a new hospital that is wanting to improve what they do, only to be beset by the thought process of "that will never work here" or "my patients are different than those large national guidelines" or "you just don't understand how things work around here". :-) They say that they want to change, but they want to keep doing things the same way they always have. Yes, our healthcare system - and really much of our institutional behavior is quite flawed in its thinking and operation. Even when presented with data from their own institution, data that their own people have generated, I've had leaders tell me that the data don't represent what's really happening! Errors occur and are perptuated in systems that don't learn - that don't evolve. We have reached (or maybe have passed) the point where we can continue with healthcare as usual. Medicines and technologies continue to evolve and create new possibilities, yet they operate within a healthcare system that is woefully behind in its ability to integrate and understand them. New practitioners come out each year having been exposed to wonderful new ways of thinking and treating, yet they go into practice in environments that are antiquated and dysfunctional. Is it really any wonder that we have less than optimal healthcare when we keep making the same decisions?! This week I'd ask you to spend some time learning about some aspect of new technology that could revolutionize your healthcare. Look at websites such as the Society for Participatory Medicine and other empowering sites that are promoting a new and healthier relationship between providers and patients. Learn and grow and advocate for a healthier system to care for you and for those that come after. Peace for the journey, Dan

Vision Changes

My wife has promised herself that today she will finally attend to her worsening eyesight and get "real" glasses following a "real" eye examination. I rejoice for her as I know from almost 30 years of glasses wearing that the benefit is worth the inconvenience. In fact, about 5 years ago my eyes had aged to the point that I required "transitional" lenses. ;-) I was musing about all this and wondering what I would write today and I fell into the topic of vision changes. Certainly, I would be significantly impaired if I lost my glasses. I am both near sighted and astigmatic to the point that I would be severely limited in activities of daily life if I didn't wear corrective lenses. There's more to this topic of vision changes than just an exploration of my optometric needs - there's a spiritual issue as well. I was watching and listening to the President's State of the Union address the other night, and I was struck by how he chose to open (and close) his report. While I knew that this talk would be a "stump speech" to a degree, I was struck by how militaristic it was. With so many problems and so much discord in so many areas, to spend the amount of time on the Department of Defense seemed to me to be a lack of vision. I've thought more about this over the days and find that the President's vision has changed. Vision is made up of three components: visual integrity (of which acuity is one measure), efficiency and information processing. Integrity deals with the health of the eye, efficiency with how both eyes can accomodate to different visual stimuli and how they work together, and information processing with how what we see is interpreted by our brains. I suspect that the President has suffered changes to all three parts of his vision and I wonder how to help him correct the changes. Maybe it's a prescription for transitional lenses to allow for seeing much farther into the future than simply November 2012. It is also a need to have the time to process what is being seen in order to interpret it appropriately. We all know that eye witnesses of the same event can have widely different interpretations of exactly what happened. Scientists tell us that we tend to see what we expect to see. This is not the fact that we actually don't see what happened, but the manner in which the information is processed is different based on an individuals experiences. Religious faith can help us to interpret what we see and hear. A person who is grounded in a belief of how we should all be working together and leaving no one behind will interpret a new piece of information very differently than someone who believes that the world was created for them to have as much as they can acquire. A spiritual focus can improve all aspects of our vision and allow us to accomodate better to changing times - since the message of G-d does not change. Our eyes notice things that they didn't see before, and our vision tends to be sharper and more focused. I'd like you all to spend some time evaluating your vision this week. How has your vision changed and what do you need to do to get your integrity, efficiency and information processing back to "normal"? Let us know how we at Possibilities Journey Inc (www.possjrny.org) can help you with this part of your trip. Peace, Dan

Generosity and Forgiveness

Hard to predict the future, so many possibilites and so many unknowns. Whether it is choosing the Super Bowl winner (and 50-50 proposition) or choosing the next U.S. President (a far lower percentage chance at this stage of the game) the future remains unknown and unknowable. One of the things that is concerning to me is the fate of healthcare legislation. Will it be declared unconsituttional on the whole or just in parts? Will a Republican President see the need to embrace the "least and the lost" and provide some sort of safety net? If the government does not step in to right the inequity in the provision of healthcare, will the private sector/social service non-profits be able to step in? Maybe it will be some new combination of the above? Where do faith communites and belief in something beyond ourselves enter into the equation? Some groups have begun programs to help those less fortunate. Many of these are faith communities. I read with interest an article in the January 25th issue of the Christian Century. The article is entitled, "Pay Pals" and describes an accountability group setting where money is pooled together and debts are paid off. By working together and pooling resources (and practicing honesty and accountability, generosity and forgiveness) people unlearn their destructive spending habits and get out from under high interest credit card debt. Other groups have formed micro-lending organizations to promote businesses, especially minority and women owned. Ethnic groups have long done this by funding and supporting same ethnicity businesses and political campaigns. This got me wondering about the future of this country. Will we continue in our individualistic and hyper-competitive mindset which leads us to continue to try and take over the world either through inequitable commerce policies and practicies or through the military-industrial complex? What if we could truly get back to the ideals of working together in small communities (possibly faith communities but it wouldn't have to be exclusive) for the betterment of all? What if we worked on knowing our neighbors well enough to know when they were in trouble and then banding together to help them out (think of a barn raising in an earlier time). This will take a major mindset and heart change. We have the resources to not only get each of us out of debt, but with some work and tough decisions, to get the U.S. out of much if not all of its debt position. It will take generosity and forgiveness, however. Two tenets of faith that are underpracticed and underappreciated in today's society. It will take the generosity of those most fortunate (many more than the 1% of the Occupy movements) who can work in accountability groups large and small to help those in debt. It will also take a large portion of forgiveness both personal and communal in order to see the process to its successful completion. These are G-d sized tasks, and it will take a G-d sized committment and faith to see them through. The question is...do we have the individual, commmunal and national dedication and devotion to making this happen? The future is so hard to predict...so many unknowns. Peace for the journey, Dan

Afflict the Comfortable

The title of this post comes from a quote attributed to an American journalist, Finley Peter Dunne, from the late 1800's. The full quote is "comfort the afflicted and afflict the comfortable". Another take on this that I saw just this morning is the statement, "you may not like your life, but someone is dying to have it". My point in all this and in this post is that we have a problem in the "developed" world with searching for comfort instead of equity. One of my least favorite "reality" shows on T.V. nowdays is "Auction Hunters" a show about two guys who go to auctions at public storage facilities. People have abandoned their stuff and these guys buy the storage unit contents for a relatively small amount of money and try to turn a profit. Now, I really don't have a problem with two guys finding a niche and exploiting it, but it points to a problem of being too comfortable and excessive. The self storage industry in America is worth tens of billions of dollars every year. Houses are 50% larger than they were on average in 1975, yet we've hoarded enough to need to spend tens of billions of dollars yearly to store the stuff we no longer have room for in our houses. Instead of Allen and Ton making money off other people's excess, what if the show was about how they distributed the abandoned goods to folks who could really use it? What if instead of people investing in a storage room, the excess stuff was given to a social service agency or other non-profit and used to improve the lot of a neighbor? All major religions teach their followers about caring for the poor, the widow and the orphan - the least and the lost. We've become a people that use divisive terminology to explain the world - "developed' vs. "undeveloped". We have the G8 and everyone else. Case-in-point, the Gross National Income per Capita in 2010 for the U.S. was $47,140 (rank 18th); 48 of the 215 countries listed had a GNI of $1200 or less. Is there really any rational or humanistic reason that the average GNI of the U.S. is 40 times more than Nigeria, Cameroon or Vietnam? We have lost our compassion, our ethical mandate, and our Kindergarten ethic of sharing equally. It is way past time to get a bit less comfortable. There is no reaason (beyond self indulgence) to continue to acquire while those near us starve. There is no reason for everyone not to have access to affordable healthcare of a decent quality. There is no reason that all people should not have access to nutritious and affordable food. There is no ethical or moral reason for us all to be so comfortable - or so smug. Remember the adage "there but for the grace of G-d go I". Has our comfort either as a nation or as individuals really come only from our hard work and intelligence? Who was it that gifted us with our talents and placed us in the U.S. instead of Cameroon? This week, let's work to recover our compassionate mandate to actually care for one another and to work for equity in all aspects of life. Peace for the journey, Dan

Where's the Harm?

Today's post is somewhat a follow-up to the last post on wisdom deficit. In other ways, possibly importantly, it is a reflection on my struggle with the precept of healthcare professional codes of ethics which all in some form or other preclude the practitioners from harming their patients. It's not that I struggle with the Hippocratic truth that we as caring professionals should render care and not harm first and foremost. Rather, it is my struggle with how poorly we enact and live out this professional ideal in everyday life. Harm happens in so many ways and is in fact so pervasive, that practitioners (IMHO) become desensitized to the very fact that they are breaking a key ethical tenet multiple times every day. In my experience, this is the number one factor leading to practitioner burnout. Let's explore some of those harms (and I don't have near enough blog space to list them all - you will probably come up with many more). It doesn't take long for new recruits (so to speak) to learn that they will labor in systems that have been created to wring every possible dollar out of the interactions they have in order to feed the institutions that employ them. This harms both the practitioner who is a caring individual who seeks to have caring relationships and the person in need of care. When limited to 10 minutes (at best) with each person a couple of times each year, no meaningful relationship can develop. Thus the interactions become driven by direct-to-consumer marketing and limited scientific interchange. No wonder that so many antibiotics are prescribed for viral infections and 50% of all prescriptions written are never filled - and more harm ensues! Certainly we are all aware when major harm occurs through errors of omission or comission (e.g., surgically removing the wrong limb, giving the wrong dose of chemotherapy). Organizations then put into place a huge review process called a Root Cause Analysis of a Sentinel Event and try to figure out how the event happened and how to prevent it. They don't, however, look deeper into how the whole system allows for harm to occur and the cumulative effects of that continuous harm (mostly emotional and psychic). The Institute of Medicine (IoM), the Joint Commission on Accreditation of Health Care Organizations (JCAHO), the numerous State Boards of Professions and Health, the Institute on Healthcare Improvement (IHI), the Quality Improvement Organizations (QIO), and soon (if not found unconstitutional) the development of Accountable Care Organizations (ACO), are all focus on improving quality - and have been for the better part of three decades. Yet, harm occurs each and every day - even though quality is improving. Sarcastically I could thus state that the harm that occurs nowadays is of a much higher quality that heretofore! Seriously though, shouldn't we expect that our healthcare systems should operate like our healthcare professionals and be dedicated to "first doing no harm" in all of the myriad ways that harm presents?! Maybe it's time to broaden the discussion of improving the healthcare system through the lens of doing less harm everyday. Instead of focusing solely on the quality of episodic care, why not look at lessening the physical, emotional and psychic harm that occurs to our practitioners and their patients. Let's work to create a system that is fair and wholesome and that realizes and rewards the development of healthy and supportive relationships - which have been shown time and again to lead to improved health. Let's stop the harm and start the healing. Peace for the journey, Dan

Wisdom Deficit

We are confronted almost continually by the word "deficit". It has seemingly become part of our everday lexicon. Most often it is used in conjunction with a lack of a balanced Federal budget, but there are other more fundamental deficits that contribute to our budget woes. The main one, to my way of seeing the world, is that we individually and communally lack wisdom. In an age where answers to questions come at 4G speeds, information is accessible to almost everyone (at least in the developed world). Never has there been so much access to information - information that is often of questionable veracity. Yet, once an answer is found (the first answer found always wins) it is rarely debated on merit and the discussion moves on to the next "unknown". In any cases (in my experience) these factoids are quickly forgotten and there is no learning nor knowledge integration. So, though we have answers to questions, there doesn't seem to be any increased knowledge nor facilitated journey towards wisdom. The average person can learn about anything on line these days. I can quite rapidly access quite detailed information on new pharmaceutical compounds that are manufactured using elegant biopharmaceutical techniques that act on ever more specific receptor sites on cells. My more than 25 year old biology and chemistry knowledge has been supplanted and I find myself exploring new vistas of cellular communication and replication that I never knew existed. Truly remarkable and wonderful! Yet, as I watch the development of these new compounds - which come into clinical trials at a dizzying rate nowadays - and see the tremendous price tags ($10,000/month in some cases)I'm at a loss to see how they will be wisely employed. The lack of ability to wisely employ these new and expensive compounds comes from a lack of a wise healthcare system which can adequately hold the tension of the new versus the proven. Most of my professional career I've been tasked with evaluating new drugs for use within hospitals. It was my job to review these new products and to render a professional opinion on whether to allow these compounds to be used within a given organization. You might guess that at times I was very unpopular with both physicians and pharmaceutical company representatives. Yet my job was to evaluate the wisdom of adding a compound to that which was already available. What were the direct and indirect costs associated with the addition, what was the risk to the patients during the "learning curve" of the prescribers, what was the perceived legal and P.R. exposure for not having said compound available? The wisdom that I gained through this process is that there are very few innovative products developed - most are tag-a-longs to things we already have available. I also became wise in evaluating my bosses and whether or not they would support a certain recommendation. Wisdom, at least in my life, has often come at a fairly large price. Maybe that's why we have such a wisdom deficit - we don't seem to want to live with the suffering that accompanies it. Something to consider as we enter a time for choosing a new President and new legislators. Peace for the journey, Dan

Doing the Simple Things

My teenaged boys give me endless material to reflect on and to use as "opportunities for growth". ;-) My 15 year old has been laboring in a really tough stretch over the last year or so - characterized by the usual me-centric worldview and obstinence to change. Now, I know that he will eventually grow out of these things (or I certainly am hopeful that he will) and that they will morph into more socially acceptable behaviors - but they really make for a difficult environment in the short term! Thank goodness that my wife and I have surrounded ourselves with a loving and compassionate faith community and a large number of committed friends (and a growing number of therapists). Many of those persons have walked this parenting path and can give solace and a listening ear to us as we try to wend our way through the dark valley. My spiritual director also lends her sacred listening ear to the mix to continue to help point me to where G-d is in all of this - truly a wonderful addition to the mix. Just last week, a new therapist looked at my son and told him that in order to get where he said he wanted to be (out of trouble, return of privileges, a measure of independence) he needed to start doing the simple things. Success with simple things, she advised, will lead to good feelings and thus open the door to larger successes. Since last Tuesday, I've reminded him often of these words when simple things are left undone (cleaning up after himself, etc). While I found her words helpful in our world, they have also resonated with me on the larger issues that I contend with professionally (trying to mend the broken healthcare system). What are the simple things that I can promote that will lead to larger system change? These are well known and are do-able at the personal level. They all have to do with personal accountability and they lead to larger societal accountability and change. None of them are difficult, but they do require action to overcome the inertia that has become rampant in our culture. That's where programs like "Small Steps" (see: www.smallsteps.gov) come in. These programs empower people who wish to do something healthy but don't know how to start - to get started doing something. Take care of the simple things, build committment with success and larger successes will follow. In healthcare, simple things that pay dividends like listening to patients; double checking each other; having up-to-date, patient-specific information available when prescriber-patient interactions occur; active listening; developing relationships. With these behaviors practiced in each and every interaction, quality and safety improve and people become healthier. It's really not "rocket science" it really is simple common sense and compassionate caring. Once again we find the truth in the statement "all I really needed to know I learned in Kindergarten." This week,implement at least one simple change in your health routine that you can commit to continue. Each week this year, add another or move up the complexity of the action. By December 31, 2012 (or the end of the world on December 21) you'll be amazed at the difference that simplicity can provide. Peace for the journey, Dan

We Have Met the Enemy

I'm sure that avid cartoon strip reader's are smiling right now with the title of this post. It is a fragment of a sentence in the strip Pogo (probably printed almost a million years ago) that states, "We has met the enemy, and it is us!" So much truth contained in such a few words. In this time of New Year's Resolutions, one needs to pause and consider why it is that so many are made, and then never implemented fully. Another way to put that is, why don't we change the things we can change and be at peace with those we can't (aka Reinhold Niebuhr's Serenity Prayer)? One of the problems that gets in the way of personal change is the ability to recognize that our basic mindset is dualistic (read comparative or competitive). This "We vs. They" or "Us vs. Them" or "Keeping up with the Joneses" worldview sets up any personal behavior change as a competition or comparative (we create an enemy). Thus we can only win or lose - we can never be at peace. I was amazed at a new weight loss commercial that finally realized this and changes the goal of the process to how you will feel about you - what your personal wish is for the process. Finally, a commercial that recognizes some of the issues that get in the way - and re-frames success in terms of win-win. Faith communities are no different...really no institution is. Well meaning and busy people come together to try and "do" things for an organization. For faith communities, this means that in the best of instances they try to discern the will of G-d for the organization. Unfortuantely, all too often the discernment becomes secular decision making and voting (i.e., it becomes win-lose) and enemies are created within the community. People will leave and other people will become passive-aggressive and sabotage any endeavor that didn't go their way. Sound familiar?! My own community struggles with the concept of consensus. Consensus is often seen as "everyone agrees or we don't make a decision". Instead, consensus is a process of seeking unity of purpose rather than 100% agreement on an issue. When we are unified in our understanding of our need to continue to be in right relationship with each other, then we understand that budgets need to be approved and personnel need to be hired/fired in order to move the mission forward. I will probably not agree with some of the decisions, but can I remove my personal enemy (ego or enmity) from the mix and allow space to see what happens? This is true consensus - but it is very difficult for dualistic minds to grasp and to accomplish. This week as you go about your tasks for whatever community(ies) you may support, look inside yourself and identify your personal enemy. What is getting in your way to be what G-d intends you to be? Ask for help with this ball of feelings and resolve to reduce the impact that this darkness has on the decisions you help make in 2012. Seek unity of purpose in all that you do. Peace for the journey, Dan

"Nothing Changes on New Year's Day"

The title (as readers of a certain age will know) is a line from the song by U2 "New Year's Day". My senior pastor used it for his homily yesterday, and it got me thinking of how true this statement really is. Many resolutions are made and then go undone, the world keeps spinning in the same way that it always has, no real progress is made on global warming or many other social ills, the political and governmental processes remain broken and unwholesome. Yet, other more positive things remain the same as well such as the work done by Charity Water and other NGO's, the tireless work of volunteers that support so many needed projects, the role of faith communities in helping the least and the lost. It certainly is good that these things don't change on New Year's Day. It doesn't have to be this way (the lack of change) - we all know that. Change is difficult and demanding, we're likely to get ridiculed for stepping out of line with some of our non-worldy viewpoints. Case-in-point, Tim Tebow. Here is a young man who was very successful in college football, yet went undrafted due to concerns about his ability to play well in the NFL. He's worked very hard at his craft and has had a very successful rookie season. Even though he is making the usual rookie mistakes, it's a very positive experience. The world has noticed that he is a very prayerful person and has taken his prayer stance ("Tebowing") and made a pardoy and a mockery of it. I've seen it in my own teenagers and I've pointed out their judgemental behaviors of a person who believes enough to show others what is most important. It has been a good learning opportunity however, for me to show my sons how the world views religion and religious people. Those who stand up for their beliefs are ridiculed - it has always been this way. Does it have to always be this way? We have a new year to play with, 12 months to do something amazing! What is it that you will change this year to make your part of the world a bit better? We at Possibilities Journey Inc. will be working to improve the health and wellness of communities by linking faith communities and health care. We believe that this model of wholeness will return us to a state of shalom. We invite you to join us on this journey, or to let us help you with you personal change. Indeed, change can come on New Year's Day, we just have to have the fortitude and commitment to see it through together. Peace for the journey, Dan