We may not know where we're going, but we're making good time.

The title is a quote from one of my favorites, Yogi Berra. When I think of this, I often think about the myriad of programs and projects that I have seen over the years that seemed to suffer from a staggering lack of cohesion, thought, or planning, or follow through. I have worked in health care for almost 40 years (I started when I was 16), so I have had plenty of opportunities, some of which will stay with me forever.
One hospital where I worked decided to adopt TQM (Total Quality Management). It is a system developed by a gent named Deming, and revolves around the concept of "Do it right the first time". The idea is that, if you can plan to be efficient and not have to re-do tasks, you can save money in a variety of ways (materials and labor). I took the class,along with throngs of other managers, was given a "Q" pin (which I never took out of the little plastic bag) and we were off. This was back in 1991 and, at that time, the hospital spent $3 million on the training. About a year and a half later, the entire program was quietly dropped. Why? There was no "champion" in leadership, no follow through, no real effort to organize the necessary effort. We basically learned that we couldn't do it right in the first place to save our lives.
Another program (at the same hospital) solicited ideas from employees on how to save money. Each idea was evaluated (you got a flashlight as a thank-you just for submitting an idea) and, if the idea was adopted, the employee who submitted the idea got a check for a percentage of the amount the hospital saved. The program was very popular with the employees, and hundreds of ideas were generated, some of them excellent. Many programs like this one, though, suffer from the Law of Diminishing Returns, where the longer you continue, the less effective it is. Programs such as this probably should have run over a defined period of time and then been discontinued. The hospital leadership, though, when the ideas petered out, decided to make submitting ideas a requirement for managers, and it was reflected on our annual evaluations and tied to any salary increase. Needless to say, my boss was not pleased when I pointed out that creativity is probably better when encouraged rather than mandated, and I learned an important lesson about shutting up.
A final example from this hospital was the famous Employee Satisfaction Survey. The administration decided to do a hospital-wide survey, and launched a huge campaign to communicate it and promote participation. They survey (allegedly anonymous) came to each employee in an individually addressed envelope. Each survey had a number on it (checking with others, I found the numbers were different on each survey, so the idea that it was anonymous began to be suspect). My suspicions were confirmed because, when I did not return the survey, I got an email from my boss right before the deadline reminding me to complete the survey. I realized I needed to return the survey to be politically correct, but I was not inclined to be helpful. Out of 100 questions, I answered 15 or 20, so they would got a returned survey from me, but not one that was statistically valid.
When the results were tallied, the administration withheld them because the feedback was so extremely negative, and they were totally unprepared to address the concerns in a meaningful way. Almost a year later, the results were released quietly, and managers were told to create action plans, few of which they had any authority to carry out. Overall, the survey was a huge flop. A lesson that administration hopefully learned was that, if you really don't want to know what's going on, and you don't intend to fix it, don't go there in the first place.
While not every idea is bad (I have been fortunate to have been involved in many good ones) there are some that should just be killed, but not all are. You have no doubt experienced many yourself from places you have worked, business you have patronized, screwball relatives, etc. The world is full of good judgement and bad and, while you want to escape the bad, sometimes it just isn't going to happen. Let's just hope the good outnumbers the bad. Some days, that's as good as it gets.

He looks dead to me.

I started working in health care when I was in the tenth grade, working as an orderly in the small hospital in the town where I lived in Pennsylvania. I worked after school and weekends and later, when I went to college, it was close enough that I could come home to work every weekend.
I had the opportunity to work with some very colorful people at that hospital, but the most memorable was a surgeon named Dr. Erskine. Although he was in his 60's at the time, one got the impression he was somewhere in his 80's. He had white hair and moved at a pace that reminded one of a turtle who was not in a hurry. Even though he looked like he could have operated on Moses, his mind was razor sharp and he had a great sense of humor. He also was having an ongoing affair with the hospital administrator, who started her career there passing out meal trays to patients and never went to college (but that's a story for another time). Here are two incidents that illustrate what a character he was.
My father and I were both volunteers on the local ambulance. We got called out one night to go to a house in town where the husband had died. Back then, the procedure was to transport the person to the hospital to be pronounced dead by a physician and then take the body to the morgue until the funeral home sent someone to pick up the body.
My father and I lifted the body onto the stretcher, put it on the ambulance, and we drove to the hospital.
I went into the Emergency Department to notify the nurse, who called Dr. Erskine in the On-Call Room. My father and I sat on a bench outside of the Emergency Department to wait. Awhile later, Dr. Erskine shuffled out wearing a lab coat over his green scrubs with his white hair sticking up in all directions and his glasses perched on the end of his nose. My father helped him up into the back of the ambulance where he took a seat on the bench opposite the stretcher.
Usually, when physicians pronounce someone dead, they will check for pulse and respirations, sometimes using a stethoscope or checking for a pulse with their fingers. Dr. Erskine apparently felt no need for any of this. He contemplated the gent on the stretcher for a few moments and announced, "He looks dead to me" after which he got up, walked back into the hospital, and went back to bed.
Another incident was related to me involving Dr. Erskine at the scene of a car accident. Dr. Erskine had been instrumental in developing the training program for Emergency Medical Technicians in Pennsylvania, and one day came upon a car accident on the Pennsylvania Turnpike. There were two cars involved, with at least one person injured. He got out of his car and walked up to the accident to help. As he arrived at one of the cars containing an injured person, he was shoved out of the way by a middle-aged woman who loudly announced, "I studied First Aid, I'll help him." Dr. Erskine stepped back for a few seconds, then quietly approaced the woman, leaned down, and tapped her on the shoulder. "When you get to the part of your book where it says 'call the doctor', I'm right here."
Dr Erskine passed away while I was in college (he died when he was on-call at the hospital). Even though this was over 30 years ago, these are treasured memories for me, and I thank you for letting me share them with you.

Never eat anything you can't lift.

The title of this piece is a quote from Miss Piggy of the Muppets. It came to mind after I made a trip to Costco this past weekend with my wife and daughter. Going through the food section, I continue to be amazed by the size of many of the items that are for sale. Six pounds of ground beef, three pounds of coffee, a gallon of salsa, two hundred garbage bags, seventy-two batteries, thirty dinner rolls in a bag, two pounds of trail mix, five pounds of hot dogs, and the list goes on. I was thinking that if I lived alone, a lot of this stuff would go bad before I finished it. For large families or smaller families with a lot of storage space, it can be economical to buy in bulk, but I also think that we often end up buying much more than we need.
Before I go shopping, I make a list of the things I need so I make sure I don't forget anything. Making a list before you go to Costco is a futile gesture, though, especially if you are accompanied by my wife and daughter. My daughter is home from college for a week and will be returning to Pennsylvania this weekend to do a 3-month internship, living in a rented cottage. As my wife and daughter went through the aisles, they amazingly found so many items that "would be nice to have at the cottage". Soon my original list of 12 items grew to 40+, and the cart was overflowing. While we defintely got some useful items, some of it was definitely "Impulse Shopping". I don't have to file for bankruptcy, but I definitely spent more than I intended. As I told the clerk at the checkout counter, coming in here was like being offered crack. It's a good thing I only go there 2 or 3 times/year.
I love my wife and daughter, and don't begrudge them for the things they picked out, but I'm also sure we would not have bought nearly as much if we had shopped anywhere else. Costco has a great business plan, though, with free samples everywhere, lots of fresh products, and a huge variety. They definitely know how to weaken ones' defenses, but I have no one but myself to blame.
Fortunately, it will be a long time before there will be any need to go back, so I have plenty of time to prepare myself and, when I walk through the door, to remember Miss Piggy's sage advice.