“It’s unfortunate, Jaded Julie. Many of our best friends are at the extreme distant end of the political spectrum from my wife and me.”
“These days, that doesn’t leave very much for you to talk about.”
“That’s for sure. About all we can safely discuss are our children, mutual friends, and the weather.”
“Have you read Clark and Panther’s insights into differences of opinion (1)? Although their examples are from business situations, the talents they hope to develop in business leaders should be useful everywhere.”
“You’re correct as usual, Jaded Julie. A leader must respect the differences of opinion that exist among colleagues and resolve them into a productive path forward. In business they can’t be by-passed in favor of a discussion of the weather.”
“To begin, an expression of an opinion is a self-disclosure of a person who is deserving of our respect. Clark and Panther have stated, ‘Even when people’s opinions differ, the process of mutual self-awareness, self-disclosure and hearing builds bridges between them.’ The leader should listen carefully to each person’s opinion and then try to find common ground to serve as the basis for resolution.”
“To use Clark and Panther’s terms, ‘along with (the speakers’) disclosing their opinion (welcoming you to their world), they may be trying to convince their hearers that they ought to share the opinion (rearranging your world for you).’ The former sheds light; the latter tends to generate heat.”
“Curmudge, the concepts of sharing one’s world vs. attempting to rearrange someone else’s for them should be critical in personal affairs as well as in business.”
“Exactly, Julie. If we all adopted a ‘welcome to my world’ attitude, I’m certain that we would find beliefs we could share. Then we and our friends wouldn’t be limited to talking about our children.”
“It’s good that you and Mrs. Curmudgeon are in accord.”
“That’s for sure. If we weren’t, our 51 years of wedded bliss would have been 51 years (maybe fewer) of wedded stress.”
Affinity’s Kaizen Curmudgeon
(1) Clark, Keith and Panther, Mike Leadership: The Art of Empowering (Monte Alverno Retreat & Spirituality Center, 2009)
Check out the latest posting in Curmudge and Jaded Julie’s personal blog, Curmudgeon’s Wastebasket.
Thursday, January 28, 2010
Friday, January 22, 2010
Father Clark's Sequence
“In an old Charlie Chaplin silent movie, Charlie was standing next to a woman, and they both were looking away from the audience. A person riding a bicycle and carrying a large package passed behind Charlie and the woman. As he did, the package brushed against the woman. She concluded that Charlie had touched her and began hitting the astonished Charlie on the head with her purse. So here, Jaded Julie, is the test: During this event, what processes did the woman experience?”
“I’ve got it Curmudge. The woman perceived something, felt that she had been improperly touched, and behaved as a Chaplin fan might expect by hitting Charlie over the head. So the three things that occurred were perception, feeling, and behavior. I guess one would say that she jumped to a conclusion.”
“It was funny in the movie but not a good idea in real life. Jumping to a conclusion is only a small part of a larger lesson: ‘A manager must be successful at managing himself before he can hope to manage others.’”
“Sounds like it’s important. I trust you’ll provide more details.”
“Of course, Julie. The details, as well as the quoted statements below, are from Clark and Panther’s book (1). The authors feel that there must be three mental steps—not one—between perception and behavior. The whole process is Perception → Interpretation → Feeling → Decision → Behavior.”
“I’ll bet, Curmudge, that this is one of those things that leaders have to hardwire.”
“Right, Julie. Let’s consider what the steps really mean. To have meaning, what is perceived must be interpreted. ‘I never feel as I do because of what somebody else did; I feel as I do because of how I interpret what I perceived of another’s behavior.’ ‘My feelings tell me that I have interpreted something as having meaning for me.’ ‘Between my feeling which prompts me toward some behavior and the behavior itself, there is a decision about what action I will choose.’ ‘My perceptions, interpretations, feelings, and decisions affect no one but myself…but my behavior has consequences beyond myself.’”
“That’s quite a mouthful, Curmudge. I’d better think through it again slowly. The steps in the process make clear what one must do to manage himself. They are a good way to avoid jumping to a conclusion or ‘going off half-cocked.’”
“Well, Julie, if the woman in the movie had known what we know now, what should she have done?”
“In interpreting her perception, she should have tried to discern whether the touch was a hand (Charlie’s, but it was holding an umbrella) or the package on the bicycle. That would have determined her feeling about the event. A better decision could have been to strike up a conversation with Charlie, and their behavior might have been walking away together, arm-in-arm. But no one watching the movie would have laughed.”
“So here’s the lesson. Taking the wrong action on the basis of a perception can cause a physical hurt, as Charlie experienced. Saying words that hurt is more likely in the non-movie world, but that shouldn’t occur with leaders who properly manage themselves. As Father Clark has stated, this process ‘can almost assure that our conversations will allow us to connect with each other rather than collide.’”
“That must be a pretty good book, Curmudge. Would you lend it to me before you forget where you put it?”
Affinity’s Kaizen Curmudgeon
(1) Clark, Keith and Panther, Mike Leadership: The Art of Empowering (Monte Alverno Retreat & Spirituality Center, 2009)
Check out the latest posting in Curmudge and Jaded Julie’s personal blog, Curmudgeon’s Wastebasket.
“I’ve got it Curmudge. The woman perceived something, felt that she had been improperly touched, and behaved as a Chaplin fan might expect by hitting Charlie over the head. So the three things that occurred were perception, feeling, and behavior. I guess one would say that she jumped to a conclusion.”
“It was funny in the movie but not a good idea in real life. Jumping to a conclusion is only a small part of a larger lesson: ‘A manager must be successful at managing himself before he can hope to manage others.’”
“Sounds like it’s important. I trust you’ll provide more details.”
“Of course, Julie. The details, as well as the quoted statements below, are from Clark and Panther’s book (1). The authors feel that there must be three mental steps—not one—between perception and behavior. The whole process is Perception → Interpretation → Feeling → Decision → Behavior.”
“I’ll bet, Curmudge, that this is one of those things that leaders have to hardwire.”
“Right, Julie. Let’s consider what the steps really mean. To have meaning, what is perceived must be interpreted. ‘I never feel as I do because of what somebody else did; I feel as I do because of how I interpret what I perceived of another’s behavior.’ ‘My feelings tell me that I have interpreted something as having meaning for me.’ ‘Between my feeling which prompts me toward some behavior and the behavior itself, there is a decision about what action I will choose.’ ‘My perceptions, interpretations, feelings, and decisions affect no one but myself…but my behavior has consequences beyond myself.’”
“That’s quite a mouthful, Curmudge. I’d better think through it again slowly. The steps in the process make clear what one must do to manage himself. They are a good way to avoid jumping to a conclusion or ‘going off half-cocked.’”
“Well, Julie, if the woman in the movie had known what we know now, what should she have done?”
“In interpreting her perception, she should have tried to discern whether the touch was a hand (Charlie’s, but it was holding an umbrella) or the package on the bicycle. That would have determined her feeling about the event. A better decision could have been to strike up a conversation with Charlie, and their behavior might have been walking away together, arm-in-arm. But no one watching the movie would have laughed.”
“So here’s the lesson. Taking the wrong action on the basis of a perception can cause a physical hurt, as Charlie experienced. Saying words that hurt is more likely in the non-movie world, but that shouldn’t occur with leaders who properly manage themselves. As Father Clark has stated, this process ‘can almost assure that our conversations will allow us to connect with each other rather than collide.’”
“That must be a pretty good book, Curmudge. Would you lend it to me before you forget where you put it?”
Affinity’s Kaizen Curmudgeon
(1) Clark, Keith and Panther, Mike Leadership: The Art of Empowering (Monte Alverno Retreat & Spirituality Center, 2009)
Check out the latest posting in Curmudge and Jaded Julie’s personal blog, Curmudgeon’s Wastebasket.
Wednesday, January 13, 2010
Curmudgeon's Wastebasket
“It’s a new year, Jaded Julie, and change is in the air.”
“I thought it was just a breeze blowing in from a farm outside of town. So what’s the change, Curmudge?”
“Do you recall our holiday greeting last month? To say the least, it was not all sweetness and light. I was concerned that we might offend someone by referring to Orwell’s book, 1984. There are over 4,000 employees at Affinity, and we dare not offend any of them in a corporate blog like Kaizen Curmudgeon.”
“It sounds as if you are saying that the content of Kaizen Curmudgeon must be plain vanilla, pristine pure, and squeaky clean. But a totally noncontroversial curmudgeon is an oxymoron. I suppose you’ll change your name to Santa Claus and mine to Snow White.”
“No way, Julie. Kaizen Curmudgeon will be unchanged. We’re going to start a personal blog to be a companion to the Kaizen Curmudgeon corporate blog. Let’s call the new blog Curmudgeon’s Wastebasket.”
“Might as well. That’s where the Kaizen Curmudgeon rejects go when we deep-six them, especially if they contain something controversial.”
“What is controversial, Julie, depends on the reader’s outlook. Nevertheless, our intent for Curmudgeon’s Wastebasket is just like that for Kaizen Curmudgeon—to share information with readers that they might not otherwise encounter. Our focus will continue to be Lean, health care, and leadership, but we’ll leave room for other topics—stuff that is so compelling that it demands to be shared.”
“I’m concerned, Curmudge. How will readers know about Curmudgeon’s Wastebasket? Should we publicize it by shouting from the top of the parking ramp? Maybe we could establish a ‘Code Curmudgeon’ to be announced whenever there is a new posting.”
“It shouldn’t be hard. We’ll just put a link in Kaizen Curmudgeon to direct readers to each new posting in Curmudgeon’s Wastebasket.”
“With all of these changes, I hope you are not forgetting about Lean.”
“This is Lean, Julie. We are respecting our readers’ sensitivities and continuously improving our blogging.”
“I’m with you, Curmudge. See you in Curmudgeon’s Wastebasket.”
Affinity’s Kaizen Curmudgeon
“I thought it was just a breeze blowing in from a farm outside of town. So what’s the change, Curmudge?”
“Do you recall our holiday greeting last month? To say the least, it was not all sweetness and light. I was concerned that we might offend someone by referring to Orwell’s book, 1984. There are over 4,000 employees at Affinity, and we dare not offend any of them in a corporate blog like Kaizen Curmudgeon.”
“It sounds as if you are saying that the content of Kaizen Curmudgeon must be plain vanilla, pristine pure, and squeaky clean. But a totally noncontroversial curmudgeon is an oxymoron. I suppose you’ll change your name to Santa Claus and mine to Snow White.”
“No way, Julie. Kaizen Curmudgeon will be unchanged. We’re going to start a personal blog to be a companion to the Kaizen Curmudgeon corporate blog. Let’s call the new blog Curmudgeon’s Wastebasket.”
“Might as well. That’s where the Kaizen Curmudgeon rejects go when we deep-six them, especially if they contain something controversial.”
“What is controversial, Julie, depends on the reader’s outlook. Nevertheless, our intent for Curmudgeon’s Wastebasket is just like that for Kaizen Curmudgeon—to share information with readers that they might not otherwise encounter. Our focus will continue to be Lean, health care, and leadership, but we’ll leave room for other topics—stuff that is so compelling that it demands to be shared.”
“I’m concerned, Curmudge. How will readers know about Curmudgeon’s Wastebasket? Should we publicize it by shouting from the top of the parking ramp? Maybe we could establish a ‘Code Curmudgeon’ to be announced whenever there is a new posting.”
“It shouldn’t be hard. We’ll just put a link in Kaizen Curmudgeon to direct readers to each new posting in Curmudgeon’s Wastebasket.”
“With all of these changes, I hope you are not forgetting about Lean.”
“This is Lean, Julie. We are respecting our readers’ sensitivities and continuously improving our blogging.”
“I’m with you, Curmudge. See you in Curmudgeon’s Wastebasket.”
Affinity’s Kaizen Curmudgeon
Thursday, January 7, 2010
Volunteering: the Seniors’ Raison D’être
“You can’t snow me with your French, Curmudge. You taught me months ago that raison d’être means ‘reason for being’ or ‘sense of purpose.’ It’s like my cat’s raison d’être is sleeping.”
“We’re going to talk about people, Jaded Julie, not lazy cats. So instead of raison d’être, we’ll use a somewhat comparable Japanese word, ikigai (pronounced ee-ki-guy). It refers to people’s feeling that their lives are valuable (1), and anyway, everything sounds more dignified spoken in Japanese.”
“I always have to ask, ‘What does this subject have to do with Lean in health care?’“
“The only connection with Lean is that ikigai is Japanese. But our subject is gerontology, which deals with the health and well-being of older people. The link is tenuous, but it’ll do until something better comes along. So let’s begin our discussion with a question: What’s an easy way to bring about the premature demise of an older, dedicated worker?”
“That’s a simple one, Curmudge. Unless the guy is an avid golfer, all you have to do is take away his job. For many people their profession is their identity. When their profession goes, their reason for being goes too. I guess the Japanese would say that their ikigai is in the tank.”
“That’s a good example, Julie, but it’s a mighty sad story anywhere in the world. To address that and other problems of aging, the Japanese have established their Silver Human Resource Center (SHRC) program which provides part-time, paid employment to retirement-aged men and women. In studies of the program’s effectiveness, Weiss et al. found that actively working at an SHRC job was associated with greater well-being (ikigai); the response was enhanced with men who had previous volunteering experience (2). Shirai et al. concluded that ‘recognition of life change through obtaining work may enhance ikigai among people who wish to engage in productive activities in the later stages of life’ (3).”
“That sounds pretty good. Perhaps the Japanese can teach us something other than the Toyota Production System. What can be done in the U.S.?”
“I read someplace that the U.S. leads the world in charitable giving. Maybe we are also as generous with our time as volunteers. Teaching children to read, feeding the homeless, serving as host parents for Rotary international exchange students; the opportunities to serve in the Valley are almost limitless. And of course, here in the hospital there are over 250 volunteers serving in 57 different assignments.”
“I get it, Curmudge. When we focus on helping others, we subconsciously raise our own ikigai. Of course it’s not subconscious with you because you just wrote it.”
“I doesn’t matter, Julie, as long as one enjoys what he or she is doing and does it with enthusiasm.”
“Ultimately each of you senior-citizen volunteers will have to face the Grim Reaper who will bring your service to an end.”
“Jaded Julie, when that happens to me I’ll just say, ‘Wait a minute, old Guy with Scythe, I have just a few more words to write.’”
Affinity’s Kaizen Curmudgeon
(1) Nakanishi, N. ‘Ikigai’ in older Japanese people. (1999)
http://ageing.oxfordjournals.org/cgi/reprint/28/3/323.pdf
(2) Weiss, R.S., et al. Japan’s silver human resource centers and participant well-being. (2005)
http://www.ncbi.nlm.nih.gov/pubmed/15870967?ordinalpos=1&itool=PPMCLayout.PPMCAppController.PPMCArticlePage.PPMCPubmedRA&linkpos=1
(3) Shirai, K. Factors associated with "Ikigai" among members of a public temporary employment agency for seniors. (2006) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1450260/
“We’re going to talk about people, Jaded Julie, not lazy cats. So instead of raison d’être, we’ll use a somewhat comparable Japanese word, ikigai (pronounced ee-ki-guy). It refers to people’s feeling that their lives are valuable (1), and anyway, everything sounds more dignified spoken in Japanese.”
“I always have to ask, ‘What does this subject have to do with Lean in health care?’“
“The only connection with Lean is that ikigai is Japanese. But our subject is gerontology, which deals with the health and well-being of older people. The link is tenuous, but it’ll do until something better comes along. So let’s begin our discussion with a question: What’s an easy way to bring about the premature demise of an older, dedicated worker?”
“That’s a simple one, Curmudge. Unless the guy is an avid golfer, all you have to do is take away his job. For many people their profession is their identity. When their profession goes, their reason for being goes too. I guess the Japanese would say that their ikigai is in the tank.”
“That’s a good example, Julie, but it’s a mighty sad story anywhere in the world. To address that and other problems of aging, the Japanese have established their Silver Human Resource Center (SHRC) program which provides part-time, paid employment to retirement-aged men and women. In studies of the program’s effectiveness, Weiss et al. found that actively working at an SHRC job was associated with greater well-being (ikigai); the response was enhanced with men who had previous volunteering experience (2). Shirai et al. concluded that ‘recognition of life change through obtaining work may enhance ikigai among people who wish to engage in productive activities in the later stages of life’ (3).”
“That sounds pretty good. Perhaps the Japanese can teach us something other than the Toyota Production System. What can be done in the U.S.?”
“I read someplace that the U.S. leads the world in charitable giving. Maybe we are also as generous with our time as volunteers. Teaching children to read, feeding the homeless, serving as host parents for Rotary international exchange students; the opportunities to serve in the Valley are almost limitless. And of course, here in the hospital there are over 250 volunteers serving in 57 different assignments.”
“I get it, Curmudge. When we focus on helping others, we subconsciously raise our own ikigai. Of course it’s not subconscious with you because you just wrote it.”
“I doesn’t matter, Julie, as long as one enjoys what he or she is doing and does it with enthusiasm.”
“Ultimately each of you senior-citizen volunteers will have to face the Grim Reaper who will bring your service to an end.”
“Jaded Julie, when that happens to me I’ll just say, ‘Wait a minute, old Guy with Scythe, I have just a few more words to write.’”
Affinity’s Kaizen Curmudgeon
(1) Nakanishi, N. ‘Ikigai’ in older Japanese people. (1999)
http://ageing.oxfordjournals.org/cgi/reprint/28/3/323.pdf
(2) Weiss, R.S., et al. Japan’s silver human resource centers and participant well-being. (2005)
http://www.ncbi.nlm.nih.gov/pubmed/15870967?ordinalpos=1&itool=PPMCLayout.PPMCAppController.PPMCArticlePage.PPMCPubmedRA&linkpos=1
(3) Shirai, K. Factors associated with "Ikigai" among members of a public temporary employment agency for seniors. (2006) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1450260/
Thursday, December 17, 2009
Holiday Greetings from Curmudge and Jaded Julie
“Curmudge, two years ago our holiday greeting was about being politically correct; last year we shared our concerns about homeless people and those who couldn’t get home for the holidays. What will we talk about this year?”
“It beats me, Jaded Julie. I surely don’t envy those members of the clergy who have to think up a new holiday sermon or homily each year.”
“It sounds as if the priesthood wouldn’t have been a good vocation for you, Curmudge.”
“That’s for sure, and my wife and children will certainly agree…I’ve got an idea, Julie. Instead of talking about the end-of-year holidays, let’s focus on New Years and try to make some predictions for next year.”
“Give it a try, Ancient Oracle. I believe the outcomes of your tacit forecasts for 2009 exceeded some of your gloomiest expectations.”
“Let’s start with Affinity. Renovation of St. Elizabeth Hospital, guided by Lean and LEED principles, will be under way. You and I will remain proud to be affiliated with the ‘Lean Team.’”
“One’s micro-, or personal, happiness impacts everyone around them (1). What do you see as your personal happiness in 2010, Curmudge?”
“Barring health and family adversities and as long as I can continue to come in here every day and chat with you, Julie, my micro-happiness index should stay pretty high. And I will keep trying to spread it around St. E’s. This is the friendliest place I ever worked (if that’s what one calls what I do).”
“My guess is that you don’t feel as positive about our nation and the world around us. That would be macro-happiness or macro-unhappiness, right?”
“Right, Julie. Our nation’s macro-unhappiness seems to be high and rising. We are sharply divided on many issues, and we seem to be perpetually at war.”
“To refresh your memory on perpetual war, you went back to George Orwell’s classic book, 1984 (2).”
“It was required reading when I was a college freshman in 1952. Then, I considered it to be ‘only a book.’ Now I worry that Orwell might have been, in some ways, prescient. As his novel seems to suggest, we and our way of life may be the objectives of subjugation both from within and without.”
“Hey, Curmudge! That last part of your prognostication (did I say that?) was really depressing. Well, at least it’s something that we can revisit this time next year. So what is your one-word seasonal greeting for our readers?”
“’Hope,’ Jaded Julie.”
“’Peace,’ Curmudge.”
Affinity’s Kaizen Curmudgeon
(1) Prager, D. Happiness is a Moral Obligation. (March 2007) http://www.studentnewsdaily.com/commentary/printer-friendly/article/happiness_is_a_moral_obligation/
(2) http://en.wikipedia.org/wiki/Nineteen_Eighty-Four
“It beats me, Jaded Julie. I surely don’t envy those members of the clergy who have to think up a new holiday sermon or homily each year.”
“It sounds as if the priesthood wouldn’t have been a good vocation for you, Curmudge.”
“That’s for sure, and my wife and children will certainly agree…I’ve got an idea, Julie. Instead of talking about the end-of-year holidays, let’s focus on New Years and try to make some predictions for next year.”
“Give it a try, Ancient Oracle. I believe the outcomes of your tacit forecasts for 2009 exceeded some of your gloomiest expectations.”
“Let’s start with Affinity. Renovation of St. Elizabeth Hospital, guided by Lean and LEED principles, will be under way. You and I will remain proud to be affiliated with the ‘Lean Team.’”
“One’s micro-, or personal, happiness impacts everyone around them (1). What do you see as your personal happiness in 2010, Curmudge?”
“Barring health and family adversities and as long as I can continue to come in here every day and chat with you, Julie, my micro-happiness index should stay pretty high. And I will keep trying to spread it around St. E’s. This is the friendliest place I ever worked (if that’s what one calls what I do).”
“My guess is that you don’t feel as positive about our nation and the world around us. That would be macro-happiness or macro-unhappiness, right?”
“Right, Julie. Our nation’s macro-unhappiness seems to be high and rising. We are sharply divided on many issues, and we seem to be perpetually at war.”
“To refresh your memory on perpetual war, you went back to George Orwell’s classic book, 1984 (2).”
“It was required reading when I was a college freshman in 1952. Then, I considered it to be ‘only a book.’ Now I worry that Orwell might have been, in some ways, prescient. As his novel seems to suggest, we and our way of life may be the objectives of subjugation both from within and without.”
“Hey, Curmudge! That last part of your prognostication (did I say that?) was really depressing. Well, at least it’s something that we can revisit this time next year. So what is your one-word seasonal greeting for our readers?”
“’Hope,’ Jaded Julie.”
“’Peace,’ Curmudge.”
Affinity’s Kaizen Curmudgeon
(1) Prager, D. Happiness is a Moral Obligation. (March 2007) http://www.studentnewsdaily.com/commentary/printer-friendly/article/happiness_is_a_moral_obligation/
(2) http://en.wikipedia.org/wiki/Nineteen_Eighty-Four
Thursday, December 10, 2009
"I'm from Corporate, and I'm here to help you."
“That has a menacing tone, Curmudge. Is it intended to be that way?”
“It’s a variation on the dreaded greeting from an inspector from the Environmental Protection Agency, Jaded Julie. ‘I’m from the EPA, and I’m here to help you.’ In a pulp and paper mill, an EPA inspection would wreck your day, or more likely, your week.”
“So did you ever use the greeting, ‘I’m from Corporate, etc.’?”
“Not those exact words, Julie, but one of my jobs long ago was to visit the laboratories of my employer’s pulp mills, ascertain that they were using EPA-approved test methods, and help them correct deficiencies before the EPA or state inspectors arrived.”
“That sounds pretty valuable. Did the mill people welcome you with open arms?”
“Not always. I spent the first half-day convincing the lab technicians that I was not an officious blowhard; thereafter things in the lab went smoothly. The real problem was that the mill’s environmental manager resented my looking for—and finding—problems that he or she should have already corrected. I guess it was human nature…really quite natural. I suspect that they trashed my report as soon as I left the mill. If I found too many problems, they didn’t invite me back.”
“Enough about the good old days, Curmudge. It’s time for you to share with me what all of this has to do with Lean.”
“It’s really quite simple, Julie. Put yourself in the shoes of a middle manager who has just learned that her department will be the subject of a kaizen event. What is her natural reaction?”
“’Why my department? I’ve done the best that I can for the past ten years. We’ve always done things that way.’ Her natural response would be to resent the whole idea—just like your environmental manager in the pulp mill.”
“That’s the connection with Lean, Julie. If the middle manager has hardwired her Lean training, she will acknowledge that continuous improvement is now our way of life, and it is often initiated with a kaizen event. If the event is part of a hoshin, she will understand the event’s importance and recognize the need to suppress her initial resentment. Process improvements following the event ought to put the damper on her earlier anguish.”
“Now I understand. It’s like the small child’s learning not to take the biggest piece of cake. This is all about doing what is right rather than what is natural. Our posting back on May 8, 2008 was on this topic. Why the reprise?”
“There are two reasons. The first is that character, i.e., doing what is right, is an essential part of leadership, and we are going to teach it until everyone has it hardwired. The second is that the connection between my mill lab audits and Lean just occurred to me.”
“You’ve made it clear, Curmudge, that your earlier life—even back to your childhood—is an open book. At your age, I guess you turn the pages very slowly.”
Affinity’s Kaizen Curmudgeon
“It’s a variation on the dreaded greeting from an inspector from the Environmental Protection Agency, Jaded Julie. ‘I’m from the EPA, and I’m here to help you.’ In a pulp and paper mill, an EPA inspection would wreck your day, or more likely, your week.”
“So did you ever use the greeting, ‘I’m from Corporate, etc.’?”
“Not those exact words, Julie, but one of my jobs long ago was to visit the laboratories of my employer’s pulp mills, ascertain that they were using EPA-approved test methods, and help them correct deficiencies before the EPA or state inspectors arrived.”
“That sounds pretty valuable. Did the mill people welcome you with open arms?”
“Not always. I spent the first half-day convincing the lab technicians that I was not an officious blowhard; thereafter things in the lab went smoothly. The real problem was that the mill’s environmental manager resented my looking for—and finding—problems that he or she should have already corrected. I guess it was human nature…really quite natural. I suspect that they trashed my report as soon as I left the mill. If I found too many problems, they didn’t invite me back.”
“Enough about the good old days, Curmudge. It’s time for you to share with me what all of this has to do with Lean.”
“It’s really quite simple, Julie. Put yourself in the shoes of a middle manager who has just learned that her department will be the subject of a kaizen event. What is her natural reaction?”
“’Why my department? I’ve done the best that I can for the past ten years. We’ve always done things that way.’ Her natural response would be to resent the whole idea—just like your environmental manager in the pulp mill.”
“That’s the connection with Lean, Julie. If the middle manager has hardwired her Lean training, she will acknowledge that continuous improvement is now our way of life, and it is often initiated with a kaizen event. If the event is part of a hoshin, she will understand the event’s importance and recognize the need to suppress her initial resentment. Process improvements following the event ought to put the damper on her earlier anguish.”
“Now I understand. It’s like the small child’s learning not to take the biggest piece of cake. This is all about doing what is right rather than what is natural. Our posting back on May 8, 2008 was on this topic. Why the reprise?”
“There are two reasons. The first is that character, i.e., doing what is right, is an essential part of leadership, and we are going to teach it until everyone has it hardwired. The second is that the connection between my mill lab audits and Lean just occurred to me.”
“You’ve made it clear, Curmudge, that your earlier life—even back to your childhood—is an open book. At your age, I guess you turn the pages very slowly.”
Affinity’s Kaizen Curmudgeon
Friday, December 4, 2009
It Takes More Than a Team
“It takes more than a team to do what, Curmudge?”
“To establish a medical home, Jaded Julie. It also requires an angel.”
“Angels? Aren’t those dead people with wings?”
“No, Julie. In this case angels are live people—or organizations—with money. It’s a term used in the theater to describe people who finance a new production.”
“I must admit, Curmudge, that I was puzzled at the idea of a solo-practice doc, who has to see more and more patients to keep his head above water, hiring lots more people, proclaiming his shop to be a medical home, and suddenly becoming financially viable. There must be a ton of transitional expenses; I guess they are paid by the ‘angel.’ So why should an organization support a practice’s transition to a medical home?”
“An insurance company might be a good example. They would anticipate that the medical home would take better care of their members (policy holders) so they would have fewer specialists, duplicate tests, and ED visits to pay for. Their support could be in the form of capitation, i.e., dollars per member per month. Another example would be a large health care organization that envisions the medical home to be the wave of the future in primary care.”
“Let’s assume that the medical home has recruited their team, purchased their information technology, and trained everyone as we have discussed in recent weeks. What must they do to put the operation in the black?”
“My one-word answer, Julie, is ‘efficiency.’”
“Wow! That’s the first time ever that your one-word answer was not ‘Lean.’ Of course we already know that the team members gain much of their efficiency by using Lean principles and tools. Can we look at some of the ways that the medical home improves their efficiency?”
“Let’s start with an intuitive, uncomplicated look at physician compensation (of course, there isn’t such a thing). Mid-level providers will handle routine patient care; this will enable the physician to provide higher-intensity services, as measured by relative value units (RVUs). Electronic technology will reduce the physician’s non-value-added time with each patient; he/she will not have to shuffle through chart pages, can use the decision-support tool to confirm his diagnosis and treatment plan, and can generate notes for the encounter in real time. These attributes of the medical home should permit the physician to see more patients and perform more services per day. This will enable him to increase his compensation, or alternatively, maintain his compensation while working fewer hours.”
“I assume, Curmudge, that someone has investigated the financial side of the medical home more rigorously.”
“It was studied by Spann and a long list of coworkers in 2004 (1). We won’t discuss the assumptions used in their model; the list would stretch from here to Darboy. Here are some of the features of a medical home (they called it the ‘New Model’) that they studied and the outcomes predicted by their model (not all are intuitive):
Open-access scheduling (some same-day appointments)—Fewer visits per patient, but higher RVUs for services provided.
Electronic health records—Overall increase in efficiency (after training) including more accurate billing.
Online e-visits—Presently no reimbursement. If implemented, it would be at a lower level than an office visit.
Team approach (leveraging clinical staff)—The physician can serve a larger panel of patients by using clinical staff to perform routine tasks.
Clinical practice guidelines software—Allows physicians to rely more effectively on a team approach to medicine.”
“I trust you read the more recent paper by Rosenthal (2).”
“I did. He said that reimbursement policies will require reformulation in order to institutionalize the medical home, and he reported on reimbursement models recommended by several physicians’ associations. They included:
· A fee for service, including e-visits.
· A per-member per-month management fee.
· A quality incentive that recognizes achievement of standards of care.”
“Curmudge, from the financial standpoint it appears that the team approach to medicine and the use of electronic technology are going to be the big winners for the clinic. Of course, one of your ‘angels’ will be needed to help them get through the expenses of transition. You must be pleased at the essential role played by teamwork and empowerment.”
“I certainly am, Julie. The medical home should be a viable way to practice primary care if it is implemented efficiently by committed leadership and involved staff.”
“Involved? Committed? I thought those two words meant almost the same thing.”
“Not when you consider eggs and bacon, Julie. The hen was involved, but the pig was committed (3).”
Affinity’s Kaizen Curmudgeon
(1) Spann, S.J. et al. Report on Financing the New Model of Family Medicine.
http://www.annfammed.org/cgi/content/full/2/suppl_3/s1
(2) Rosenthal, T.C. The Medical Home: Growing Evidence to Support a New Approach to Primary Care. (Sept. 2008) http://www.jabfm.org/cgi/reprint/21/5/427
(3) Hunter, J.C. The Servant, p. 120 (Crown Business, 1998)
“To establish a medical home, Jaded Julie. It also requires an angel.”
“Angels? Aren’t those dead people with wings?”
“No, Julie. In this case angels are live people—or organizations—with money. It’s a term used in the theater to describe people who finance a new production.”
“I must admit, Curmudge, that I was puzzled at the idea of a solo-practice doc, who has to see more and more patients to keep his head above water, hiring lots more people, proclaiming his shop to be a medical home, and suddenly becoming financially viable. There must be a ton of transitional expenses; I guess they are paid by the ‘angel.’ So why should an organization support a practice’s transition to a medical home?”
“An insurance company might be a good example. They would anticipate that the medical home would take better care of their members (policy holders) so they would have fewer specialists, duplicate tests, and ED visits to pay for. Their support could be in the form of capitation, i.e., dollars per member per month. Another example would be a large health care organization that envisions the medical home to be the wave of the future in primary care.”
“Let’s assume that the medical home has recruited their team, purchased their information technology, and trained everyone as we have discussed in recent weeks. What must they do to put the operation in the black?”
“My one-word answer, Julie, is ‘efficiency.’”
“Wow! That’s the first time ever that your one-word answer was not ‘Lean.’ Of course we already know that the team members gain much of their efficiency by using Lean principles and tools. Can we look at some of the ways that the medical home improves their efficiency?”
“Let’s start with an intuitive, uncomplicated look at physician compensation (of course, there isn’t such a thing). Mid-level providers will handle routine patient care; this will enable the physician to provide higher-intensity services, as measured by relative value units (RVUs). Electronic technology will reduce the physician’s non-value-added time with each patient; he/she will not have to shuffle through chart pages, can use the decision-support tool to confirm his diagnosis and treatment plan, and can generate notes for the encounter in real time. These attributes of the medical home should permit the physician to see more patients and perform more services per day. This will enable him to increase his compensation, or alternatively, maintain his compensation while working fewer hours.”
“I assume, Curmudge, that someone has investigated the financial side of the medical home more rigorously.”
“It was studied by Spann and a long list of coworkers in 2004 (1). We won’t discuss the assumptions used in their model; the list would stretch from here to Darboy. Here are some of the features of a medical home (they called it the ‘New Model’) that they studied and the outcomes predicted by their model (not all are intuitive):
Open-access scheduling (some same-day appointments)—Fewer visits per patient, but higher RVUs for services provided.
Electronic health records—Overall increase in efficiency (after training) including more accurate billing.
Online e-visits—Presently no reimbursement. If implemented, it would be at a lower level than an office visit.
Team approach (leveraging clinical staff)—The physician can serve a larger panel of patients by using clinical staff to perform routine tasks.
Clinical practice guidelines software—Allows physicians to rely more effectively on a team approach to medicine.”
“I trust you read the more recent paper by Rosenthal (2).”
“I did. He said that reimbursement policies will require reformulation in order to institutionalize the medical home, and he reported on reimbursement models recommended by several physicians’ associations. They included:
· A fee for service, including e-visits.
· A per-member per-month management fee.
· A quality incentive that recognizes achievement of standards of care.”
“Curmudge, from the financial standpoint it appears that the team approach to medicine and the use of electronic technology are going to be the big winners for the clinic. Of course, one of your ‘angels’ will be needed to help them get through the expenses of transition. You must be pleased at the essential role played by teamwork and empowerment.”
“I certainly am, Julie. The medical home should be a viable way to practice primary care if it is implemented efficiently by committed leadership and involved staff.”
“Involved? Committed? I thought those two words meant almost the same thing.”
“Not when you consider eggs and bacon, Julie. The hen was involved, but the pig was committed (3).”
Affinity’s Kaizen Curmudgeon
(1) Spann, S.J. et al. Report on Financing the New Model of Family Medicine.
http://www.annfammed.org/cgi/content/full/2/suppl_3/s1
(2) Rosenthal, T.C. The Medical Home: Growing Evidence to Support a New Approach to Primary Care. (Sept. 2008) http://www.jabfm.org/cgi/reprint/21/5/427
(3) Hunter, J.C. The Servant, p. 120 (Crown Business, 1998)
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