Did you ever learn an important lesson from someone that has stayed with you for the rest of your life? I first met Farhad Sholevar in 1990. I had started working at Lehigh Valley Hospital after nearby Easton Hospital decided to close their psychiatric unit, putting me out of a job. LVH offered me a position as an Assistant Nurse Manager on their psychiatric unit.
Dr. Sholevar was one of the attending psychiatrists that I met when I started working there. He was born in Iran and had served in the Shah's army before finishing medical school and emigrating to the United States. He had completed a psychiatric residency and had moved to Allentown to open a practice.
LVH had three distinct psychiatric units (two adult and one adolescent) with a Medical Director for each who was salaried as a part-time employee. The attending psychiatrists were not employees, rather, they had "privileges" meaning they could admit and treat patients, and they made their money by billing the patients they treated. One of the attendings, who is still there, was famous for admitting and "treating" up to 40 patients between the 3 units (we had a total of 54 beds). You can imagine how much quality time he spent with each patient, but they loved him and he managed to rent an apartment in Paris every summer for a month to vacation with his family, and had over 2000 patients in his outpatient practice.
The attendings took turns being "on call" at night. They did not get paid to do so, but it was a requirement for them to take call as part of being credentialed to be on staff. The mental health statute in Pennsylvania was modified in the late 1980's to require that anyone involuntarily committed had to be admitted to a community hospital, rather than a State Hospital. This meant that hospitals having someone sitting in their Emergency Department who required psychiatric admission would need to do a creative job of "selling" the patient to another hospital's psychiatric unit. If a particularly challenging patient was sitting in our own ED, they oftentimes came to us because no one else would take them. It was not unknown for some especially undesirable patients to sit in EDs for several days before some hospital (sometimes quite far away) could be convinced to take them.
The title of this piece comes from a conversation I had with Dr. Sholevar when he was sharing with me his philosophy about screening referrals for admission when he was on call. I'm sure it had it's origins in Iran from his earlier days, but the idea behind it makes eminent sense. When one is faced with an important decision, it is always a good idea to ask questions, to "sniff the carcass" in case things just don't smell right. Sometimes you had to take the patient regardless, but you also sometimes could avoid a train wreck.
So, the next time you are contemplating buying a house or car, moving, taking a new job, getting married, or anything else that's important, don't forget to sniff the carcass first.
Saturday, July 28, 2012
Saturday, July 7, 2012
Turd Polishing
The title of this piece comes from one of my fellow Psych nurses in New Zealand who was labeling something that was a waste of time. My management training called it "non-value added"; my former attorney called it "mental masturbation." Regardless of what you choose to call it, we have all experienced it.
One of my favorite fictional examples of this is a Monty Python skit entitled "Cheese Shop". In the skit, a man enters a cheese shop and asks the clerk for a particular kind of cheese. The clerk responds that they are out of that kind, and what follows is a back and forth of requests for other types of cheese (Stilton, Colby, Venezuelan Beaver Cheese, etc.) answered by a litany of excuses as to why there isn't any (the van broke down, it gets delivered on Tuesdays, the cat ate it, etc.). Exasperated, the customer finally asks if there is any cheese at all in the shop and is told there is "not a scrap; we're deliberately wasting your time."
All of us have probably been involved in situations where we are in the virtual Cheese Shop having our time wasted (at least from our perspective). That being said, one of the life lessons I learned the hard way is that, if some Vice President has an idea, it's a good idea, no matter how silly you may think it is. If you have worked in a large organization, and you are far from the top of the feeding chain, you have probably experieinced some of these "Cheese Shop" moments, although it was probably not safe to point out your views on the situation.
An example of this from one hopital where I worked was the "Leader Greeter" program. The Chief Operating Officer came up with the idea (it was, of course, a good idea) to have managers and administrators "volunteer" to spend a half hour at the entrance to greet people when they entered from the parking garage. For something like this, you would hope that there would be some measurable outcome or other reason for doing it. Even when my cat licks himself between his legs, he has a reason (because he can). For this one, though, I couldn't see any value. If I was one of the people coming in from the parking garage, I would be thinking "Don't you have anything better to do with your time?" Interestingly, after the COO got fired, Leader Greeter apparently died a quiet death.
Unfortunately for you, unless you are near the top of the ladder in your organization, Turd Polishing is likely to be a normal part of your existance. You may not like it, you may not be able to avoid it, but at least you can reconize it for what it is and value it accordingly.
One of my favorite fictional examples of this is a Monty Python skit entitled "Cheese Shop". In the skit, a man enters a cheese shop and asks the clerk for a particular kind of cheese. The clerk responds that they are out of that kind, and what follows is a back and forth of requests for other types of cheese (Stilton, Colby, Venezuelan Beaver Cheese, etc.) answered by a litany of excuses as to why there isn't any (the van broke down, it gets delivered on Tuesdays, the cat ate it, etc.). Exasperated, the customer finally asks if there is any cheese at all in the shop and is told there is "not a scrap; we're deliberately wasting your time."
All of us have probably been involved in situations where we are in the virtual Cheese Shop having our time wasted (at least from our perspective). That being said, one of the life lessons I learned the hard way is that, if some Vice President has an idea, it's a good idea, no matter how silly you may think it is. If you have worked in a large organization, and you are far from the top of the feeding chain, you have probably experieinced some of these "Cheese Shop" moments, although it was probably not safe to point out your views on the situation.
An example of this from one hopital where I worked was the "Leader Greeter" program. The Chief Operating Officer came up with the idea (it was, of course, a good idea) to have managers and administrators "volunteer" to spend a half hour at the entrance to greet people when they entered from the parking garage. For something like this, you would hope that there would be some measurable outcome or other reason for doing it. Even when my cat licks himself between his legs, he has a reason (because he can). For this one, though, I couldn't see any value. If I was one of the people coming in from the parking garage, I would be thinking "Don't you have anything better to do with your time?" Interestingly, after the COO got fired, Leader Greeter apparently died a quiet death.
Unfortunately for you, unless you are near the top of the ladder in your organization, Turd Polishing is likely to be a normal part of your existance. You may not like it, you may not be able to avoid it, but at least you can reconize it for what it is and value it accordingly.
Tuesday, July 3, 2012
Lying Pig-Dog Weasels
Mom and Dad taught me not to lie to people. Even though it has limited my career, my integrity is more important to me. While I will never get to be Vice President of anything, knowing that people can and do trust me is much more important.
I remember being told in one of my management training classes long ago that sociopaths or people with sociopathic tendencies often became very successful leaders of profitable corporations. I guess to sometimes be successful, one has to make decisions that sometimes do not favor the individual employee. Many people may remember the CEO of Fletcher Allen Health Care, who was convicted of lying to regulators and was sentenced to a year in prison. I have worked for others who were equally, if not more sleazy; they just didn't get caught.
What these people fail to realize (or don't care about) is that, if they lie to us and we figure it out, we aren't likely to believe anything they say going forward. As a manager of 25+ years, this was an important lesson for me. If I were to lie to my staff, I would have no credibility, and this was something that was unacceptable to me. Think about it. Who would you rather trust: someone who you knew to be honest, or deal with someone who you wouldn't trust if they told you the sky was blue?
Oftentimes, managers may be placed in a position where the actual situation should not or cannot be disclosed for some reason. Face it; we are not always free to speak about everything. Some managers I know have gone the route of shading the truth. My approach has either been to tell you I am not free to speak about the situation, or to tell you "This is what I know as of today." You may not have gotten the true story, but you also weren't lied to.
Many politicians would seem to fall into the category of Those Who Frequently Tell Whoppers. I moved to Vermont from Pennsylvania. While I was in PA, I was amazed at how corrupt a political system could be. When I go back to visit relatives, and read the local newspaper, it is a rare occasion when I don't read about a State Legislator or staffer either being arrested, on trial, or going to jail for corruption. Politics seems to be less about public service and more about how one gets re-elected. Congress has an abysmally low approval rating for a reason: they earned it. I have never voted in my life, and I can't imagine ever doing so. To me, the system is broken, and, even though I can't fix it, I can choose not to participate in enabling it to continue on it's dysfunctional path. My wife tells me I have no right to complain because I don't vote. I feel I have every right to complain because I didn't do anything to make the system continue as it is.
Even though I am destined to go no further in my career than being a middle manager, looking at some of the negative role models in my life, I don't consider that to be a bad thing. Mom and Dad: Thanks for raising me the way you did.
I remember being told in one of my management training classes long ago that sociopaths or people with sociopathic tendencies often became very successful leaders of profitable corporations. I guess to sometimes be successful, one has to make decisions that sometimes do not favor the individual employee. Many people may remember the CEO of Fletcher Allen Health Care, who was convicted of lying to regulators and was sentenced to a year in prison. I have worked for others who were equally, if not more sleazy; they just didn't get caught.
What these people fail to realize (or don't care about) is that, if they lie to us and we figure it out, we aren't likely to believe anything they say going forward. As a manager of 25+ years, this was an important lesson for me. If I were to lie to my staff, I would have no credibility, and this was something that was unacceptable to me. Think about it. Who would you rather trust: someone who you knew to be honest, or deal with someone who you wouldn't trust if they told you the sky was blue?
Oftentimes, managers may be placed in a position where the actual situation should not or cannot be disclosed for some reason. Face it; we are not always free to speak about everything. Some managers I know have gone the route of shading the truth. My approach has either been to tell you I am not free to speak about the situation, or to tell you "This is what I know as of today." You may not have gotten the true story, but you also weren't lied to.
Many politicians would seem to fall into the category of Those Who Frequently Tell Whoppers. I moved to Vermont from Pennsylvania. While I was in PA, I was amazed at how corrupt a political system could be. When I go back to visit relatives, and read the local newspaper, it is a rare occasion when I don't read about a State Legislator or staffer either being arrested, on trial, or going to jail for corruption. Politics seems to be less about public service and more about how one gets re-elected. Congress has an abysmally low approval rating for a reason: they earned it. I have never voted in my life, and I can't imagine ever doing so. To me, the system is broken, and, even though I can't fix it, I can choose not to participate in enabling it to continue on it's dysfunctional path. My wife tells me I have no right to complain because I don't vote. I feel I have every right to complain because I didn't do anything to make the system continue as it is.
Even though I am destined to go no further in my career than being a middle manager, looking at some of the negative role models in my life, I don't consider that to be a bad thing. Mom and Dad: Thanks for raising me the way you did.
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