I recently went to my doctor's office because I had been experiencing an increase in shortness of breath (I have long-standing lung problems) and occasional pressure in my chest.
The Physician Assistant who examined me decided he wanted to refer me for a "stress-echo" test. Back in 1980, I worked in Cardiology doing stress tests, so I was familiar with that part of it, but they did not do stress-echos back then. Turns out it is a combination of a stress test and an echocardiogram.
I am not addicted to exercise, and the fact that I get short of breath very easily did not give me confidence that things were going to end well. On the bright side, at least it got me out of work early.
I arrived at the Cardiology Clinic, signed in, and sat down in the waiting room. While I was killing time reading work emails on my phone, the fire alarm went off, and everyone needed to evacuate the building. We waited outside for about 20 minutes, then were allowed back into the building. I sat back down but, a few minutes later, the fire alarms went off again and everyone again exited the building. The fire department was still there, decided that there was a defect with the fire alarm, and allowed everyone back into the building.
There were three staff in the room to do the test. The Cardiac Tech (Jennie) got me connected to the wireless EKG equipment. The Echo Tech (Tiffany) operated the ultrasound equipment to test before and after the stress test. The nurse (Joy) monitored the high tech readout on the screen while I was on the treadmill. If I were being executed by lethal injection, I could not have asked for a more delightful group for the occasion.
In a stress test, you start walking on a treadmill and, every three minutes, it increases in speed and elevation. Surprisingly, I made it through the first two stages and started the third, although my legs felt like someone was stabbing them and I was struggling to breathe . If I had any pressure in my chest, I didn't notice it because of the struggle to breathe. I gave up, got back on the stretcher, and Tiffany did her thing with the ultrasound machine while I struggled to breath.
I have to thank the late Groucho Marx for the title of this piece, it was perfect for the occasion. While I wouldn't wish a stress echo upon anyone, the three ladies provided a positive aspect to an otherwise near-death experience. Thank you, Groucho, for finding the words to express my sentiments.
Saturday, June 6, 2015
Saturday, April 18, 2015
Trying to make things work in government is like trying to sew a button on a custard pie
The title of this piece is from the late Admiral Hyman Rickover. Admiral Rickover headed the efforts of the United States Navy to design and build nuclear-powered warships, and was intimately familiar with the dysfunction of the United States Government.
Examples of governmental dysfunction are countless, but among them:
- The IRS (is there a single human being on this planet that actually understands the Tax Code?)
- Congressmen introducing bills that are over 1000 pages long (Does anyone actually read them?)
- The military procurement system (Some items take so long to develop that they are obsolete by the time the military gets them.)
- The Veterans Administration System (The recent scandal involving false records of appointments to show they were doing better then they actually were says it all.)
- The Secret Service(They used to be good.)
All organizations have dysfunction to one degree or another, and these same organizations no doubt have a lot of good and competent people. Good people doing their jobs competently is what we expect, and the screw-ups should be invisible to the public. Taken as a whole, our government accomplishes a lot and delivers a lot of service. Due to its' staggering size, though, the waste and incompetence can appear to be staggering. Unfortunately, the system has evolved into something that can probably never be fixed (we probably couldn't even agree on what "fixed" is.)
Rickover had a strong personality and high expectations, and was able to be successful more often than not. If he could see us today, he would probably be thinking that the button slid completely off the pie.
Examples of governmental dysfunction are countless, but among them:
- The IRS (is there a single human being on this planet that actually understands the Tax Code?)
- Congressmen introducing bills that are over 1000 pages long (Does anyone actually read them?)
- The military procurement system (Some items take so long to develop that they are obsolete by the time the military gets them.)
- The Veterans Administration System (The recent scandal involving false records of appointments to show they were doing better then they actually were says it all.)
- The Secret Service(They used to be good.)
All organizations have dysfunction to one degree or another, and these same organizations no doubt have a lot of good and competent people. Good people doing their jobs competently is what we expect, and the screw-ups should be invisible to the public. Taken as a whole, our government accomplishes a lot and delivers a lot of service. Due to its' staggering size, though, the waste and incompetence can appear to be staggering. Unfortunately, the system has evolved into something that can probably never be fixed (we probably couldn't even agree on what "fixed" is.)
Rickover had a strong personality and high expectations, and was able to be successful more often than not. If he could see us today, he would probably be thinking that the button slid completely off the pie.
Sunday, March 15, 2015
You can get by with charm for about 15 minutes; after that, you'd better know something
The title of this piece was some sage advice shared with me by Betty, one of my peers, who worked with me at a large (15,000 employees) hospital in Pennsylvania many years ago. Betty was the manager of the Emergency Departments at the two campuses, while I managed the three psychiatric units.
In our nursing management group (our official job title was Director of Patient Care Services), Betty was a leader. While she had a doctorate in Education, you would never know it because she was more focused on doing the job competently and professionally than flaunting academic credentials. She led by example and was someone who genuinely earned your respect.
We reported to a Senior VP of Nursing and her group of Nursing Administrators. While all were academically qualified for their positions, and generally polite and professional on the surface, the Administrators seemed to often rely upon bullying and intimidation when challenged in a situation beyond their skills. Both Betty and I experienced bullying and, like many others in the nursing management group, moved on jobs elsewhere. While the Senior VP of Nursing and her Administrators were eventually fired, an environment had been created which posed a major challenge to the nursing executive who took over (who ultimately did a fantastic job of turning things around).
Being recruited to come to Vermont, I had an opportunity to start over in a new organization. In the seven years I was there, I worked for four different Senior VPs of Nursing and three different Nursing Administrators. Nursing leadership could best be described as unstable because of the turnover, with three of the four Senior VPs of Nursing being forced out because of the institutional politics.
Of the three Nursing Administrators for whom I worked, the first two were fine, the last not so much. (My severance agreement with the hospital prohibits me from saying anything negative about the institution or its' officers, so I will omit names of both.)
This individual, while she had two Masters degrees, could best be described as "highly intelligent without a corresponding level of competence". The fact that she is also married to a chairman of a politically powerful department of the hospital would seem to go a long way to explaining how she got the job in the first place and continues to survive with apparent impunity.
While it is regrettable that people like this rise to positions of power and inflict themselves upon others, they also serve as important examples to myself and others on how not to do things. People like this are (regardless of reality) never wrong, and are feared rather than respected.
When given a choice between Betty and this unnamed individual, I will always remember Betty as a positive role model. It is OK to say "I don't know" or to change ones' position on a subject if someone convinces you. While that other individual is still around, it is not a positive and certainly not because of practicing "you'd better know something". I guess I should thank her for the lesson she gave as well.
In our nursing management group (our official job title was Director of Patient Care Services), Betty was a leader. While she had a doctorate in Education, you would never know it because she was more focused on doing the job competently and professionally than flaunting academic credentials. She led by example and was someone who genuinely earned your respect.
We reported to a Senior VP of Nursing and her group of Nursing Administrators. While all were academically qualified for their positions, and generally polite and professional on the surface, the Administrators seemed to often rely upon bullying and intimidation when challenged in a situation beyond their skills. Both Betty and I experienced bullying and, like many others in the nursing management group, moved on jobs elsewhere. While the Senior VP of Nursing and her Administrators were eventually fired, an environment had been created which posed a major challenge to the nursing executive who took over (who ultimately did a fantastic job of turning things around).
Being recruited to come to Vermont, I had an opportunity to start over in a new organization. In the seven years I was there, I worked for four different Senior VPs of Nursing and three different Nursing Administrators. Nursing leadership could best be described as unstable because of the turnover, with three of the four Senior VPs of Nursing being forced out because of the institutional politics.
Of the three Nursing Administrators for whom I worked, the first two were fine, the last not so much. (My severance agreement with the hospital prohibits me from saying anything negative about the institution or its' officers, so I will omit names of both.)
This individual, while she had two Masters degrees, could best be described as "highly intelligent without a corresponding level of competence". The fact that she is also married to a chairman of a politically powerful department of the hospital would seem to go a long way to explaining how she got the job in the first place and continues to survive with apparent impunity.
While it is regrettable that people like this rise to positions of power and inflict themselves upon others, they also serve as important examples to myself and others on how not to do things. People like this are (regardless of reality) never wrong, and are feared rather than respected.
When given a choice between Betty and this unnamed individual, I will always remember Betty as a positive role model. It is OK to say "I don't know" or to change ones' position on a subject if someone convinces you. While that other individual is still around, it is not a positive and certainly not because of practicing "you'd better know something". I guess I should thank her for the lesson she gave as well.
Saturday, November 22, 2014
Sometimes a Cigar is Just a Cigar
People and situations be complicated but, as Sigmund Freud points out, not always so.
I have been in various management and leadership positions since 1986, and one of the things that has been taught in several training sessions over the years is the Myers-Briggs Scale. For those not familiar with it, it was developed about 50 years ago by two women, and consists of a questionnaire that leads to a four-letter rating or designation that shows you to be introvert vs. extrovert, thinking vs. feeling, etc.
While I do not doubt the validity of the tool, I definitely doubt its' utility in my day-to-day functioning at work or with family or friends. A psychologist I know described it as "a nice party game". I would describe it as getting in your car and driving a mile to cross the street. There is a lot of extra effort that does not need to be there for the same end result. If you had to cross a moat full of alligators to cross the street, that makes the situation more complicated, and you would do things differently, but only because you needed to in that particular situation.
In one of the trainings, I and co-workers were being encouraged to know other people's Myers-Briggs ratings in order to plan how to interact with them. While Myers-Briggs may be a useful way to teach a concept, do we really need this added complication in our relationships? One of my co-workers described a challenging individual we both know as " a douche-bag". I personally find this more helpful than knowing that person's Myers-Briggs rating.
Another revelation that came out in a recent training that I found to be validating is when a participant pointed out that, while she had one particular Myers-Briggs rating, she had to function totally differently at work in order to be successful, and the instructor conceded that this was sometimes necessary. If that is true (and it is), my question is: Why bother with Myers-Briggs?
People can be sad, angry, depressed, in an OK place, or a host of other descriptors. I find it easier and more practical to meet the person where the are at the moment. Life is complicated enough. Don't make it more so artificially.
I have been in various management and leadership positions since 1986, and one of the things that has been taught in several training sessions over the years is the Myers-Briggs Scale. For those not familiar with it, it was developed about 50 years ago by two women, and consists of a questionnaire that leads to a four-letter rating or designation that shows you to be introvert vs. extrovert, thinking vs. feeling, etc.
While I do not doubt the validity of the tool, I definitely doubt its' utility in my day-to-day functioning at work or with family or friends. A psychologist I know described it as "a nice party game". I would describe it as getting in your car and driving a mile to cross the street. There is a lot of extra effort that does not need to be there for the same end result. If you had to cross a moat full of alligators to cross the street, that makes the situation more complicated, and you would do things differently, but only because you needed to in that particular situation.
In one of the trainings, I and co-workers were being encouraged to know other people's Myers-Briggs ratings in order to plan how to interact with them. While Myers-Briggs may be a useful way to teach a concept, do we really need this added complication in our relationships? One of my co-workers described a challenging individual we both know as " a douche-bag". I personally find this more helpful than knowing that person's Myers-Briggs rating.
Another revelation that came out in a recent training that I found to be validating is when a participant pointed out that, while she had one particular Myers-Briggs rating, she had to function totally differently at work in order to be successful, and the instructor conceded that this was sometimes necessary. If that is true (and it is), my question is: Why bother with Myers-Briggs?
People can be sad, angry, depressed, in an OK place, or a host of other descriptors. I find it easier and more practical to meet the person where the are at the moment. Life is complicated enough. Don't make it more so artificially.
Sunday, August 10, 2014
Religion is Like a Pair of Shoes
The late George Carlin once said, "Religion is like a pair of shoes; find a pair that fits you but don't try to make me wear them". All of us have strong opinions about things (not just religion), which is fine. What starts to sometimes make me a bit testy is when people are convinced about themselves being right and needing to convince me of this. While I will generally be polite and listen (it is good manners in my job to do so), there is a difference between fact and opinion that some people don't always separate.
If an issue is factual, and I am mistaken, by all means correct me (it is OK to tell me the world is not flat). If it saves me from going down a wrong path or looking silly, I am all for it.
In matters of opinion, the bar is a little higher. I am extremely opinionated and judgmental, but in my working relationships, this is not an endearing quality and something I want to keep in check and to not inflict upon people. I try to look at issues from other perspectives. Believe it or not sometimes someone else has a better idea. I respect people who listen and are able to change their minds when they need to, and I try to be one of them at work. It's also not a bad idea to practice this with family and friends as well.
That being said, the whole rest of the world is swirling around us with ideas or opinions that I may not agree with and don't have to. I once described Congress as "Monkeys with guns" because, as a group, I think they are useless. While this is me being opinionated and judgmental, I also don't feel the need to point this out to them, nor am I offended if you have a different opinion of the group. (Thank you, George.)
While I can be extremely opinionated about many things, there are even more issues about which I choose not to have an opinion. I am not going to Save the Whales or protest outside an abortion clinic (or anywhere else) or volunteer for anything. I will donate to Goodwill and the United Way because I believe they do good things without me needing to know a lot of details.
For those of you who want to get involved with a cause about which you are passionate, please feel free. As for me, I have my own shoes.
If an issue is factual, and I am mistaken, by all means correct me (it is OK to tell me the world is not flat). If it saves me from going down a wrong path or looking silly, I am all for it.
In matters of opinion, the bar is a little higher. I am extremely opinionated and judgmental, but in my working relationships, this is not an endearing quality and something I want to keep in check and to not inflict upon people. I try to look at issues from other perspectives. Believe it or not sometimes someone else has a better idea. I respect people who listen and are able to change their minds when they need to, and I try to be one of them at work. It's also not a bad idea to practice this with family and friends as well.
That being said, the whole rest of the world is swirling around us with ideas or opinions that I may not agree with and don't have to. I once described Congress as "Monkeys with guns" because, as a group, I think they are useless. While this is me being opinionated and judgmental, I also don't feel the need to point this out to them, nor am I offended if you have a different opinion of the group. (Thank you, George.)
While I can be extremely opinionated about many things, there are even more issues about which I choose not to have an opinion. I am not going to Save the Whales or protest outside an abortion clinic (or anywhere else) or volunteer for anything. I will donate to Goodwill and the United Way because I believe they do good things without me needing to know a lot of details.
For those of you who want to get involved with a cause about which you are passionate, please feel free. As for me, I have my own shoes.
Saturday, June 14, 2014
Slower than a herd of turtles stampeding through peanut butter
One thing that I have learned along the way about State government is that doing something quickly is not a common trait and, doing something both quickly and well is just not the way we do business. I know a lot of State employees whom I like and respect and believe are highly competent, but there are many departments who, when you need help from them, respond like the turtles in the title of this piece.
While I always prefer things to be done right, a little speed, at least occasionally, is not a bad thing. If you like things this way, one of the things you want to avoid becoming involved with (at least with the State) is contracts. The State pay scales are such that it is sometimes hard to attract the skilled people who are needed to do a particular job. Rather that adjust the pay scales to make them competitive in the market, people at the upper levels of State government won't blink twice about signing a multi-million dollar contact for the service, ultimately paying more then they would if they adjusted pay scales. There is probably a good reason for this; it just escapes me.
The person in my department who manages contracts is very nice, extremely competent, and there is nothing negative to be said about her or how she does her job. She is very helpful at making sure that the contract is properly prepared and that all of the requirements have been met. It is after it leaves her hands that the turtle stampede begins. First, her boss reviews it (and may send it back for revision if there is something she doesn't like or for which she wants more of an explanation. Next, someone in Finance looks at it, who may also send it back. It then passes on to one of the attorneys, who again can send it back. Finally, it goes to the office of the Secretary of the Agency, where one of the Secretary's minions reviews it and, if not sent back, signs to approve it. Aside from the Department's contract person, everyone else who has to review the contract has other things to do, so this task is way down the list of priorities and, no matter how quickly I may need the contract in place, there is no required timeline for completion. I am told that, if a contract is "fast tracked" it can be completed in "only" 12 weeks. Needless to say, there are a host of unpleasant things I would rather do than put together a contract through State government.
Unfortunately, the State does not have the capability of performing all of the services that it needs, so contracting is a necessary evil. Once the contract is actually completed and in place, things are generally OK, unless the person with whom the contract is executed is an incompetent idiot (always an unfortunate possibility; people can lie to you or inflate their capability). Overall, my results have been mixed, but more good than bad. We contract with a lot of skilled, competent people. When they are not, it's less common but the results are generally more spectacular.
If you don't work for the State, but have an opportunity to provide service under the contact, it can be a very good experience. Just be prepared to deal with the herd of turtles in the beginning.
While I always prefer things to be done right, a little speed, at least occasionally, is not a bad thing. If you like things this way, one of the things you want to avoid becoming involved with (at least with the State) is contracts. The State pay scales are such that it is sometimes hard to attract the skilled people who are needed to do a particular job. Rather that adjust the pay scales to make them competitive in the market, people at the upper levels of State government won't blink twice about signing a multi-million dollar contact for the service, ultimately paying more then they would if they adjusted pay scales. There is probably a good reason for this; it just escapes me.
The person in my department who manages contracts is very nice, extremely competent, and there is nothing negative to be said about her or how she does her job. She is very helpful at making sure that the contract is properly prepared and that all of the requirements have been met. It is after it leaves her hands that the turtle stampede begins. First, her boss reviews it (and may send it back for revision if there is something she doesn't like or for which she wants more of an explanation. Next, someone in Finance looks at it, who may also send it back. It then passes on to one of the attorneys, who again can send it back. Finally, it goes to the office of the Secretary of the Agency, where one of the Secretary's minions reviews it and, if not sent back, signs to approve it. Aside from the Department's contract person, everyone else who has to review the contract has other things to do, so this task is way down the list of priorities and, no matter how quickly I may need the contract in place, there is no required timeline for completion. I am told that, if a contract is "fast tracked" it can be completed in "only" 12 weeks. Needless to say, there are a host of unpleasant things I would rather do than put together a contract through State government.
Unfortunately, the State does not have the capability of performing all of the services that it needs, so contracting is a necessary evil. Once the contract is actually completed and in place, things are generally OK, unless the person with whom the contract is executed is an incompetent idiot (always an unfortunate possibility; people can lie to you or inflate their capability). Overall, my results have been mixed, but more good than bad. We contract with a lot of skilled, competent people. When they are not, it's less common but the results are generally more spectacular.
If you don't work for the State, but have an opportunity to provide service under the contact, it can be a very good experience. Just be prepared to deal with the herd of turtles in the beginning.
Monday, May 5, 2014
The Right to Make Bad Choices
In Vermont, an individual's right to refuse mental health treatment is supported more strongly than the process to compel treatment upon that individual. For those who are sent to a hospital for an "Emergency Evaluation", a sometimes lengthy process starts down the road to decide whether or not that individual is involuntarily committed into "the care and custody of the Commissioner" (of Mental Health). It is, to put it nicely, a convoluted process that can take quite awhile (there is no required deadline for completion of the process).
Some of these individuals, because of their illness, are unable to make choices that are in his/her best interest. Unfortunately for these individuals, unless there is a legal determination of incompetency (and a guardian is appointed), they can make some really bad decisions while they are unable to leave the hospital. For some of these individuals, taking medication would be helpful, but many refuse, and the process to get a court order to override their refusal is another lengthy, convoluted process.
Opponents of this process refer to is as "forced drugging" a pejorative term which does nothing to advance their position. While I would prefer that people not be involuntarily medicated, I see people who are so sick that they cannot ethically be discharged from a hospital. Many have pending legal charges because their illness has contributed toward some unacceptable behavior in the community.
Currently, people are confined to hospitals for prolonged periods of time at taxpayer expense, some with no likelihood of being able to be discharged (I know of one who has been hospitalized for more than a year with no end in sight). It is hard to say that this is OK, but it is the system we have in place today. People have a right to make bad choices. Unfortunately, they do not have a right to be well.
Some of these individuals, because of their illness, are unable to make choices that are in his/her best interest. Unfortunately for these individuals, unless there is a legal determination of incompetency (and a guardian is appointed), they can make some really bad decisions while they are unable to leave the hospital. For some of these individuals, taking medication would be helpful, but many refuse, and the process to get a court order to override their refusal is another lengthy, convoluted process.
Opponents of this process refer to is as "forced drugging" a pejorative term which does nothing to advance their position. While I would prefer that people not be involuntarily medicated, I see people who are so sick that they cannot ethically be discharged from a hospital. Many have pending legal charges because their illness has contributed toward some unacceptable behavior in the community.
Currently, people are confined to hospitals for prolonged periods of time at taxpayer expense, some with no likelihood of being able to be discharged (I know of one who has been hospitalized for more than a year with no end in sight). It is hard to say that this is OK, but it is the system we have in place today. People have a right to make bad choices. Unfortunately, they do not have a right to be well.
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