What is it about our need to engage in sacrificial violence, no matter how distant and remote the conflict is from our hands? Why do we bundle tighter together when we face what we agree to call a mutual enemy? Why is it that the swiftest achievements in technology transpire during war? What’s in us that lusts so speedily to transform every work of technology into another extension of our murderous urges?

COPYCATS, ALL OF US
We have an inborn ability to imitate each other. We learn by imitation. It’s a powerful aspect of our brains: in it perhaps is the crux of our success as a species. The development of our infants depends almost exclusively on this single power. This imitative mechanism opens the door to our ability to imitate the good in each other. Being good can be infectious.

Our power to imitate also induces our susceptibility to copying the wrong kinds of behavior from each other. If someone transgresses against us, we long to imitate the gesture and return the favor. Revenge is a mirror. There was a reason the Greeks locked Narcissus’ gaze downward into eternal reflection. They may not have understood fully the nature of their own mythology, but they knew somehow that their own blood-lust was rooted in the power of imitation. We have much to learn still from those little stories.

Once we understand the awe-some power of imitation in our lives, we can see the way out of war. So long as we imitate the wrong in each other, we are forever enmeshed in a web of violence.

THE WAY OUT IS IN US
When war comes, put down the mirror. The mirror is a trap. When we look to each other and feel the resonance of our collective anger and fear, that’s when the binding agents of war take hold.

Whatever your belief system, it doesn’t take much convincing to realize we all sin. Whether that sin is against some Central Being of Purpose or against each other or ourselves, it’s a universal trait. Individual instances of sin happen all the time. They can usually be addressed through face-to-face meetings, where the transgressor asks the other for forgiveness and commits to the hard work of making things up.

War is ultimately different than all other sin. The sin of war is far greater than the sum of individual sins. War provides the condition in which we silently or loudly give ourselves permission to lie to ourselves, to order murder from a distance and to re-brand our murdering policies into national pride. War is a peculiar form of sinning that runs deep in our culture.

It’s easy to protest against the obvious sins of others. Pacifists too are subject to the invisible power of imitative anger. When we are the sinners, we don’t see things that way. We not only see ourselves as innocents but also as heroes. We idolize ourselves. What could be more sinful than that?

If we are to avoid war we are going to have to understand how deeply we imitate the good, the bad, the ugly and the fearlessnes in each other. Whether you know it or not, we are entering deeper into a new kind of war. It will happen with our consent. You and I are willing sinners in a cosmic battle against our own innocence.

If we keep getting into trouble because our imitative powers are stronger than our intellectual visions, then we are going to need to point our gaze somewhere else. We are becoming increasingly sibling in our social structure. We no longer look to our elders. We increasingly look to each other through technologies which give us the illusion of community. We are in big trouble.

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What do we do if the computers go down?

Now this is an obvious concern. But it occurred to me that this line of reasoning is a deep-seated logos in the health care profession. I wanted to ask this person what the facility would do if the electricity would fail. I’m pretty sure I would hear “Well, our backup generators would kick in.” Why hasn’t this kind of acceptance of electric backup grown with respect to other kinds of technology? If we all followed this person’s logic, why wouldn’t we just go back to using gas lamps in hospitals?

What is the source of such fear? Why is our health care system so behind in the proper management of health information? Do we even know what are the economic and social opportunity costs of using paper for the majority of our health information?

A PAPER DRAGON BY THE FLAME

According to some studies, less than 10% of health care facilities in the US employ health information technology (HIT). 90% of of the health information is on paper! Is it 2008? Is this the 21st Century?

I know there are many reasons for the delay: federal and state regulations, privacy concerns, reliability, cost, etc. These are all major considerations. Something tells me, though, that even if these concerns were addressed an allayed, there would remain perhaps the single largest Dip our health care industry would have to get up and over: culture.

Social media geeks are all coked up about Twitter and FriendFeed and many other white lines on the web, but what could be more geeky than healthcare? I’ve worked in the ICU and the technical geekiness required to safely titrate a vasopressor or manage ventilator settings is far more wicked than anything on the web. If health care workers can learn these gadgets to save lives and restore the sick to wellness, what gives? Why such a gap in using health care data with as much comfort as using Google or any other informational interface?

THE OPPORTUNITY COST OF GAS LAMPS

We live in a time when cost containment is being addressed by folks who aren’t thinking about the consequences of their decisions. Refusing to reimburse facilities for Hospital-Acquired Complications (HAC) is admirable and understandable. Ultimately, however, facilities will need to start documenting care for the primary benefit of payors instead of patients. Those facilities that rely on paper to document events, in turn, will place the burden of this kind of documentation on health care workers.

When does this deadly game end? When will the body count be sufficient for this Pagan God of cost efficiency? The opportunity cost of paper documentation is quality care. Period. The right ideas in the wrong heads are always dangerous.

If our health care system is still burning gas lamps in an age of light bulbs, how blind our we getting? Time for some eyes to open up. The dusk is coming and the lamps are buring low.

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After seeing this video that Seth Godin shared on his blog, I started thinking about what might be wrong with how we provide healthcare. So many rules have to be followed that I think we end up breaking them right onto each other. When you watch this video, consider how our healthcare system builds policy-compliant accidents:

If you have ever worked in a corporate environmnet, you completely get this video. Painfully, it’s dead-on with the fundamental problems of complex organizational behaviors. Governmental organizations often operate with as much derrangement.

So my question about Healthcare Fail is this: if corporations and governments operate healthcare the same way as the geniuses designing the stop sign in the video do, just who or what is the right choice? It’s easy to say “the free market works”, as the political Right claim, or “healthcare should be free for everyone”, as the Left claim. Honestly, I don’t think either of those claims make any sense these days. I wish one of those claims were true. It would make our problem easier to solve. Simple-mindedness is not simplicity.

As the costs of healthcare increase inversely with the quality provided, our public discussion focuses more on Universal Healthcare initiatives. Unfortunately, I think that our emphasis on cost has largely gotten us into trouble. It’s as if Werner Heisenberg’s uncertainty principle is meliciously at work: the more we try to batten costs down, the higher they fly.

Rather than focusing on cost, we aught to focus on the value provided to patients and the community. Once the public understands what really goes into providing quality healthcare, then we might have a chance at a benefiting from a system that is neither the result of Capitalist Fail or Socialist Fail.

Our health is too important to hand over to corporations or governments. We need another kind of organization altogether, a totally novel way to provide quality care. I wish I had a name for it. For now let’s call it the Godinizaiton of Healthcare.

Godinize the Healthcare System

Part of the problem with the economics of healthcare is that we try to satisfy every conceivable end-point. It’s important that healthcare involves regulatory controls and well-conceived designs. If every intersection involves convoluted stop signs built to comply with everybody’s rules, we will have nothing but very reliable policy-compliant Healthcare Fail.

Policy-compliance is not a goal of healthcare: healthcare is the goal of healthcare.

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You are probably one of millions of Americans in search of balance between work and life. I too have searched for that elusive condition in the past. But it’s a hoax my friends. It’s a trick the mind plays when we’re trying to escape from the inevitable stresses of life. Trying to find balance in your life is like trying to balance a bag of water on your head while hopping on one leg. It’s theoretically possible but you’ll look like a damn fool.

Sometimes when the stresses of life wear on us we seek an escape. Doing work that you don’t have any passion for is one definition of hell. Here’s my theory about getting out of hell: the way out of hell is through. That’s not the path that most of us take. Why not? My answer: because that way is laden with fear and danger. We avert both because we attach to familiarity and comfort.

A mind that neither averts nor attaches is the only one beyond the surface-tension we call suffering. That kind of mind doesn’t look for balance because it knows there’s nothing but imbalance. That kind of mind delights in the chaos embedded into every facet of our world. Look into the night-sky. Do you see balance? Or do you see a beauty in the imperfect swirling of it all? Could you look upon your life that same way? If you could, what would you see?

If you continue to go to a cog job because you have to pay your bills, then do what you have to do. But before you beat yourself up with constant ruminations of how you need to find balance between work and home-life, why not try to do some soul-digging first? Why not find out what’s really bugging you? These are important actions to take, because if you leave one way of life for another, you still have the same brain to suffer from the stresses of life. There is no way out your mind. If you find a way out, email me: info /*at*/ philbaumann.com. Better yet: twitter me.

I’m telling you this because I encounter so many people who are fed up with their jobs and stressed between their paycheck-generators and their family life. I see a lot of depression, anxiety, mania and all sorts of painful conditions in the eyes of friends, relatives, and strangers. It’s a stressful world we’re creating, no doubt about that. I wish I could change things, but I can’t. Our world has always been stressful. It always will be.

So what’s the answer to the problem of being overly stressed between work and life? I could give you a list written for Digg. Instead I’ll just say that the answer is already within you. You know what it is. It’s your secret. You hid it away a long time ago. Our culture aided and abetted that little deception. You were told to be successful and you followed the advice. The lie was planted right from the start. You were already successful. You were already happy. You were OK.

The ancients called the balance you now seek The Pearl. That’s what they meant when they talked about the world as your oyster. What starts as a gritty irritation grows into a fascination. Throw away the grit and you’ll never find the pearl.

If you want me to help you out with a hint, all I can tell you is to follow your bliss. It’s a hard path to follow. It is a path of sacrifice, risk, danger. I ask you to consider: would life be worth anything without these three keys to truth?

We have within in us dark sparks burning to get out. Why put out the fire within you when you can set the word ablaze with your light? Bend into the work you do. The oyster does. Why can’t you?

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The healthcare industry is full of serious people. They should be serious, shouldn’t they? After all, health care is serious business. Life is at stake and life is sacred. But if you had to choose between two different kinds of providers, which one would you prefer: the serious one or the responsible one? The two kinds aren’t necessarily the same. Being serious is an emotion. Responsibility is a state of awareness. That difference could seriously influence the quality of your treatment.

THE COST OF BEING SERIOUS

Most of the people in health care are good, competent and emotionally secure human beings. Unfortunately, there are also a lot of angry people in the same industry. I know that I don’t want an angry surgeon or ticked off nurse giving me a medication. Do you? Could anger stem from being serious? I believe that it could.

Our culture teaches us to be serious. There’s nothing wrong with being serious per se. But it’s worth a peek at what grows beneath the word. The root word of serious is seryows, which sounds a bit like sorrows. Ours is a serious world. It’s also sorrowful. Perhaps there’s a connection. If language influences our perceptions and behaviors, then we need to re-think what we teach our children. Otherwise, they will grow up to confuse seriousness with responsibility. They will be depressed. Look around you if you think I’m exaggerating.

THE BENEFITS OF BEING RESPONSIBLE

Fortunately, our culture teaches us to be responsible too. Resonsible is rooted in respuns, or response. Responsibility by definition requires action, a reply. Being responsible, however, is not the same as being serious and yet our culture often equates and confuses the two words. That’s an error that might be costing us lives.

I understand the need for bearing a sacred sense of emotion when providing care to patients. I’m not arguing against the sacred. I am arguing for stripping away the assumptions we make which prevent us from being our most responsible. Experienced professionals have smashed medical equipment against walls because they were serious about saving their patients’ lives. That’s pretty serious. It’s not responsible, especially when the equipment is life-saving.

Many health care facilities still tolerate this madness. Why? I think it’s because some of the people who run those organizations are serious about healthcare and they’re afraid that by condemning the serious behavior they are violating the sacredness of life. Health care is an ancient business. It’s an historical confluence of religion, warfare, science, art, culture and just about everything else that makes a civilization. So it’s not much of a wonder why the healthcare industry is so serious about being serious. The industry can do better. It’s your health, so it’s your responsibility too.

If you want to find out for yourself, offer to volunteer at your local hospital. See if there’s anything you can do to lighten things up.

LESS SERIOUS. MORE RESPONSIBILITY.

I think it’s time we publicly recognize the difference between being serious and being responsible. The two aren’t necessarily mutually exclusive; but the semantic relationship might just be too close for us to dismiss.

I know I want to be responsible. If that means I have to be less serious, so be it. Nursing might be a lot more fun. It should be. After all, life is a stake and life should be fun. Fun is a responsiblity of the living. Seriousness is for the dead. It’s our responsibility to save our sorrows for the dead. That’s how we rescue them.

If being serious leads to anger and anger leads to error, then we need to be less serious and more responsible. Life is at stake and life is sacred. Seriously.

If you have ideas on how to improve our health care responsibilities, please comment here. If you like what your reading, subscribe to my feed and we can continue the discussion.

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It started

When I wrote my first lines.

I thought it was heaven

I was following.

Instead I found

a thread that led me home.

What was that all about? To find out what’s going on, go check out Liz Strauss’ remarkable blog.

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WHAT HAPPENS ON TWITTER STAYS ON TWITTER…AND SUMMIZE AND…

Permission-based processes, whether you know it or not, have been a central dogma of medicine and nursing for many years. Acquiring informed consents or refusals has always been a right of patients, whether or not it was properly acknowledged by practitioners.

Twitter is a remarkable tool for broadcasting the latest advances in medicine or nursing. It’s also a way to establish an ambient intimacy within a community. Unfortunately, it has opened up a publicly viewable portal into the effluence of private patient information. What happens on Twitter, stays on Twitter…and Summize and FriendFeed and Disqus and ping.fm and Google’s cashes forever and ever and ever. Oh, and right on that PowerPoint slide which the plaintiff’s attorney ginormously projects onto a court room wide screen.

HIPPA IS DEFECTIVE LEGISLATION. BUT I FOLLOW ITS RULES.

Patients have a right to privacy when receiving care. That’s just common sense. Unfortunately, there have been legislative attempts to regulate how providers ensure patient privacy and information security. Those steps are honorable. Their execution, however, is matter for another blog post. Suffice it to say, HIPAA is not the optimal solution to the problem of patient information security.

HIPAA (Health Insurance Portability Accountability and Accountability Act of 1996) is one of those legislative examples of fighting the right war with the wrong means. Again, I won’t get into the merits of fighting HIPAA, but I’ll emphasize that until the act is properly amended, health care professionals are well advised to comply.

Why? Here are just two civil and crimianl penalties for non-compliance (Source):

1. fines up to $25,000 for multiple violations of the same standard in a calendar year (ouch!)
2. fines up to $250,000 and/or imprisonment up to 10 years for knowingly misusing individually identifiable health information (yikes!)

I’d hate to see any doctor or nurse lose their job, get fired or sued by a patient for violations that are easily avoided.

If you’re a health care provider and you plan on using Twitter or a similar tool to open up the world to what happens in the clinical setting (and I applaud you), here are two questions to ask yourself:

• Would I want my care to be broadcasted to who-knows-whom?
• Even if my name wasn’t mentioned, would I want my care to be on TwitterVision? If I do, did I sign a fully informed consent?

FREEDOM OF SPEECH

So, how could health care providers use Twitter to express their freedom of speech while protecting the information safety of patients? Here are some off-the-cuff suggestions:

1. Be fictive with cases if your Twitter feed is on a public time-line
2. Get permission, in writing, from patient’s or patient representatives
3. Understand the ways in which protected health information privacy rights can be violated
4. Remember that patient privacy is a part of patient safety
5. Think about the purpose of a Tweet
6. If you don’t have a real purpose to Tweet, don’t update
7. Look at your license, recall that oath (I know corny, but it’s better than staring at a jail cell wall for 10 years)

I understand the excitement over using Twitter in a clinical setting (hey, I’m one of the advocates of Improvement through Health 2.0). But I don’t want that excitement to lose its luster in the wake of avoidable violations.

I’m not a big fan of HIPAA but I follow its rules. And so should you if you want to keep your license and practice the artful science of being a Jedi. Twitter’s awesome. But I’m not going to endanger my patient’s dignity and safety over it. All that, it ain’t.

Perhaps our first Tweets about the state of health care aught to be made about a wider discussion about how to simultaneously protect patient privacy and health professional sanity. HIPPA may be a stupidly constructed work of legislative ignorance, but it has the enforceable power to fine and jail you. Tweet Smart.

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Layoffs are often botched by thoughtlessness or by fear of saying the wrong things. Some businesses do better in this department than others. For whatever reason, though, many businesses don’t really understand how to layoff. Layoffs aren’t supposed to happen. But they do. Almost everyday we hear about them. So why not outline a Layoff Action Plan that could help, not hurt, people?

Where the danger grows, so does the saving grace.

Friedrich Holderlin

A layoff can be an opportunity for a company to redeem itself from the tactical and strategic blunders it made that may have led to the layoff. For the people who actually do the layoff, a creative Layoff Action Plan can be the difference between another drink and the happiness derived from helping others overcome adversity.

HOW WOULD YOU SLICE THE KNIFE?

So, how would you do it? How could you make the most of it and turn bad news into a reason to hope?

Would you stealthily order your lawyers to structure the layoff so you don’t have to call it a layoff? After all, that would save the PR fees which qualm your fears of how the word layoff will make you look to the general public. Whatever would Wall Street do with your stock if they discover your secret? Heaven forbid!

Or would you consider these completely different approches?

1. INTRODUCE YOUR EMPLOYEES TO YOUR COMPETITORS

Introduce your employees to your competition and say:

Here are one hundred remarkable employees. We know they’re remarkable because we hired them. We’re having a tough time right now and we don’t quite know what to do with them. Maybe you or your connections do. Please do what you can because we want our industry to thrive and these people are our industry’s future.

2. INTRODUCE YOUR EMPLOYEES TO THE WORLD

Introduce your employees to your vendors, your suppliers, your alumni, you neighbors, your minister, your rabbi, your monk, and your therapist {the risks of depression and suicide increase after layoffs}. Introduce them to your friends or relatives who own businesses thirsty for the remarkable talent that you’re pouring away.

If nothing else, your employees will feel appreciated. They could be energized to find a beautiful land beyond your crumbling empire.

3. INVITE THEM TO YOUR LINKEDIN PROFILE

Invite them to your LinkedIn profile and write them recommendations that will last in their profile for the rest of their careers? Would fewer calls for reference checks lighten your newly weighted workload?

Use the Answers and other features to promote your former employees in creative ways. You should do this selflessly, of course, but could you think of any beneficial side-effects from this approach?

4. PROCLAIM YOUR LAYOFF ACTION PLAN

Instead of playing legal word-games, call a spade a spade and proudly proclaim your layoff to the world. Let the whole world know that you’re liberating enormous talent for hire into the community. Issue a press release on your own terms that outlines that you’re doing #1, #2 and #3. Let the world know how much you sincerely care about the social consequences of your economic misfortune.

Now is the time to invoke the genius of your PR folk. Get them to market your employees to the community. This is a radical departure from the status quo; this isn’t your boiler plate PR. It would be unique and remarkable PR for PR. Imagine how your employees and the community would feel about you now.

What would happen to your company’s wealth if you simply explained what happened and how you intend for your company to thrive in a time of adversity?

Do you think that your customers and the public would LOVE that story? Do you think that Wall Street would entrust your long-term leadership with more of their investing dollars because NOW you look like you know what you’re doing? After all, it’s clear now that you’re not afraid of acclaiming your status as a remarkable leader in your industry. You’re in it for the long-run now, not the short-term speculative nonsense that’s puling our Republic into mindless consumerism.

This post is a Capitalist Manifesto.

WOULD YOU LAYOFF YOUR TALENT USING THIS APPROACH?

So, what do you think? Do think these steps are worth a try? How much psychological and economic depression could our contry avoid if we did things in steps 1 through 4? Since it’s my goal to improve the health care of every child, woman and man in the world, this would advance my cause.

Perhaps some would say: This is too much work! To that I’d say: No wonder you have to layoff your employees! If a business can’t do the hard work needed to get through its Dips, then it should responsibly close up shop and leave it to competitors who know how to work hard and creatively.

Is it possible that so many companies botch layoffs because it’s culturally expected that layoffs are a bad thing, a terminal curse? What would happen to our world if we shook up the bowl, thought and did things in ways we never did before? Sometime we are more programmed for certain responses than we realize.

We are more than the product of our assumptions.

The world’s changing, whether you’re in denial about it or not. Why not make your next layoff remarkable?

If you have ideas to add to this list, feel free to add. Who knows, a brokenhearted CEO might stumble upon this blog. Maybe she’ll change the world and found a novel way to network talent for the 21st Century.

CLOSING WORDS

If you’re in a cog job, find out why. Go bookmark Seth Godin’s blog (he’s not just for Marketing types; in fact I think he’d appreciate it more if cog-jobbers read him as if he were our Poet Laureate). Also, download A Brief Guide to World Domination, print it out and read it.  It will expose that lie you were told years ago.

For those of you who have been laid off, or who might one day end up at the end of the layoff riffle, here’s a little secret I’d like you to keep:

You must change your life.

Rainer Maria Rilke

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It’s exciting to finally see nursing get its Alltop page. My hope now is that quality content all of kinds within nursing can now be displayed for use by the nursing community and the public at large.

Congratulations to Elizabeth Anderson for getting nursing finally to the top of the web on Alltop!

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