I’m using my health team actively this past month. I’m bone tired, stressed about work, worried about my health, all without my usual optimism and positive thinking. I’m out of balance. Yet, my mission is to increase the balance people, caregivers, and clinicians feel as they journey together towards best health. I need the balance, too, if I’m going to continue to meet my mission. Thankfully I have colleagues on my health team that can help. My career coach pointed out to me that I spend 90% of my time focusing on the organization I work for and 10% on myself. My music teacher suggested I focus on one music venue and cut out the others for a while. My physicians are helping me manage the path through some elective surgery. My personal counselor suggested time to recover – a weekend of meditation and a long weekend in Newport with my honey. As a leader, I do think about balance with my staff. Family first! But I don’t think we really balance well. I contribute to the lack of balance by pushing, pushing the envelope.
Balance implies constant motion – seesaw-like. Balance occurs occasionally naturally while going up and down. Some time a shift in weight, sometime a major lightening of a load. Balance needs space and time to recalibrate. To think, to reflect, to adjust, to meditate, to vacation, to take a deep breath. How do we help each other create space and then balance? I worked for a Catholic organization that often used the word grace. Thanks for giving me some grace. I could use a little grace here. The agency I work for now says, first we listen. That’s another kind of space. Sometimes balance is an active process – change something, add a weight, take off a weight. More time at work, more time with family, more music, more exercise, more greens. Sometimes it’s laying back, letting life play out and return to balance as part of the normal see-saw. I’m lucky that I have a low tolerance for being out of balance. I feel it acutely. I find it easier to be active to attain balance than to give myself some grace and let let the balance return more organically. It’s feels better to be creating space and appreciating space. More optimistic, better spirit. Let’s see what happens.
I’m reading Scott Simon’s book, Unforgettable. A son, a mother, lessons of a lifetime. Beautifully written and so close to home. Scott Simon’s book resonates for me. It’s been four months since my mom died. Like Scott Simon, I, too, laid next to my mom in her bed telling stories. Before dying I was grossed out at the idea of laying in bed next to her. Now I treasure those moments. I feel her loss everyday. Actually, it’s almost every day now, not every, every day. I resent that it’s not every day. Last November I was so upset that the 11th anniversary of my boy, Mike’s death passed without me remembering. I cherish the bittersweet sadness and the exquisitely tender spots of these memories. What have I become when I forget those who color my tapestry? Yet I am recovering. Very slowly regaining my strength and my center. The surrealness of loss and grief subsides inch by inch. Thank god. I couldn’t stay floating in that ever-deepening well of grief. Grief is again becoming a quirky, intriguing companion. Oh ma, where are you now? Do you have more stories for me? I have so many for you.
Getting better – Few magic wands or silver bullets. A couple of steps forward, one back at best. It’s challenging to select when to move forward and when to wait. Does inching forward on many fronts get you better faster than moving a foot on fewer fronts? Does doing less better make sense? I play in a big band learning many charts that stretch my reading skills and dexterity. I also play in a student combo stretching my music theory and improvisation skills. I can squeak out 1 to 3 hours practice time a week. Not enough, I think, to really improve at anything. I feel so stretched I’ve stopped taking lessons. So I’m getting better too slowly for my satisfaction. On the other hand when Pablo Casals, maybe the best cellist ever, interviewed at 92 years old, he said he couldn’t talk more because he had to go practice. “Practice?” the interviewer said, “but you’re the best ever.” Casals quipped, “I’ve almost gotten it right.” I decided to stop playing in the big band and focus on the combo. I’d rather learn more music theory and improvise better. I’ll also resume the lessons. I only have so much gas in my tank. The stress of feeling overwhelmed – too many fronts – consumes fuel. Maybe doing less better with less stress burns less fuel.
Doing less better also has relevance for a team. At work we have many projects inching forward but we’re less than satisfied with the progress on any one of them. The team needs and wants to improve on many fronts, but wants to resolve most of them yesterday. Stress results. It’s more satisfying for the team to reach and celebrate milestones than sense that the foundation is rising by inches. Once again would the team’s health improve more if we do less better? We’ll see.
I took advantage of some rest and relaxation this weekend at Kripalu Meditation and Yoga Center. After six months of intense caregiving of my mom with frequent bi-coastal travel, I’m feeling an upsurge of my own MS symptoms. I spoke with someone whose mom died the same time as mine, who spent 13 years caregiving and managing his mom’s Alzheimer’s journey. My six months seems so small in comparison. Support and recovery of caregivers – so important. Remarkable how run down we can get. Running down spiritually, mentally, and physically. Caregiver recovery is like any recovery – recovering spiritually, then mentally, then physically. One minute meditations seem to help – appreciating a shower, a chocolate chip cookie, my wife’s smile, my sons, their families, my co-workers. These mini-meditations give space for a bit less worry, and an ounce more of strength to manage physical challenges. Honor the caregivers, help the helpers.
This fifth in a series of posts about health data thinks about the value we get from that data. In my last post I said, The best data has value because it reflects or motivates action. Action to improve health and wellbeing of and reduce cost to individuals and populations. Action to improve life flow of persons at the center of care and work flow for people who work in health care agencies.
Let’s think about times when data helped motivate action. At few years ago I weighed almost 200 pounds. My primary care physician turned the computer screen toward me and showed me a graph of increase in my weight since I started seeing her 4 years before. A very dramatic line graph of weight increasing from 160 to 198 pounds. OMG. No wonder my new pants were getting bigger and I went from a belt to suspenders (I still have no behind to hold up my pants-the new weight did not give me more of a butt). I was motivated to lose weight. I kept a running spreadsheet of my weight, tracked my calories, changed my eating habits considerably, and lost 35 pounds in 2 years. Hurray. Data motivated me to start losing and keep losing. I bought several hand-made vests from Etsy to celebrate. Now they’re almost too tight again. Although I’ve tracked my weight since, tracking the data didn’t keep motivating me to keep the weight off.
When I worked for St. Peter’s Addiction Recovery Center in Albany, NY, managing the care of CDPHP members with behavioral health benefits, we saw that our rate of outpatient 30 day follow-up after inpatient addictions treatment was less than 30%. Outpatient follow-up is a HEDIS measure of NCQA (The National Committee for Quality Assurance accredits health plans). This Outpatient Follow-up measure made sense to us because we knew that a person’s success with sobriety was strongly associated with going directly from inpatient to outpatient treatment. Our Follow-up rate of less than 30% embarrassed us. It motivated us to make significant changes in our practice. We made sure that people in inpatient care had an outpatient appointment before they were discharged. We stayed in touch after discharge to make sure they had transportation and child care to get to their appointment and if they didn’t make it, we recontacted and helped further. The Follow-up rate increased to 75%. The data was meaningful, we looked bad, wanted to be better, and were willing to make significant changes to workflow. Increasing the score made us feel good about the changes we made. I don’t know if the Follow-up Rates are still so high. I’ve lost touch.
The moral of these stories is that meaningful data can motivate change. Going from bad to good is pretty easy (Good to great is much harder). In either case changing personal or population results requires doing something really different about work flow, life flow and habits. Adding education, training, teaching is a weak intervention and usually doesn’t move the dial much. Sustaining improvement is a whole other challenge.