Tuesday, August 26, 2008

They stab it with their steely knives, but they just can't slay the beast!

So I'm currently working in the finance department.


A more honest statement would be that I am desperately trying to avoid anything remotely finance related, to no avail. It's not that I'm not bad at numbers--in fact, I'm not--it's just that it's not at all my style. I was the kid in calc class with a novel under the table, surreptitiously trying to hang out with the Bronte sisters while the teacher scribbled nonsense about derivatives and integrals all over the chalkboard. I do think there is some real beauty to be found in a geniously crafted formula, but I have always preferred to coast along upon the backs of beautifully written sentences as opposed to carefully calculated equations. For me, words transcend; numbers drag my light heart and head out of the clouds and down to the dreary world of Excel.

I know that in order for me to grow in my understanding of health care and health systems, my ability to analyze and make decisions based on financial policies is critical. It's such a complex labrynth that I must learn to navigate: Medicare, fee schedules, percent of charges, contractuals, allowances, expenses, deductions, and so on and so forth.

Qualitatively, I know what the final sum of all these numbers: the kind of care a patient can receive. Are they going to wait until their appendix explodes before showing up at the ER in agony at 3am, or are they going to have access to a myriad of preventative care docs and specialists who can monitor each sniffle and mis-shapen mole? Will they see their physician for five minutes or for half an hour? Will they get psychotherapy and psychopharms or a only quickly scrawled prescription?

Can they come to our hospital, or not?

It's a heartwrenching equation, really, and one that healthcare professionals across the country--across the world, really-- must agonize over daily. Patients, physicians, health providers, and (dare I say it!) politicians alike have all heard or (worse) experienced the horror stories and the nightmare of our current health system. What's more, we've all seen the beast of the bottom line for what it really is: an inability to provide quality access to all individuals while staying in the black, even marginally.

There are so many variables in this complex equation that I am only beginning to comprehend, even after years of work and study. The good news, however, is that I am at least aware of my own ignorance. I know that I cannot hope to slay this beast if I can't even recognize it when stares me down with its beady, insidious eyes.

So I will slowly begin to navigate this tortuous path through financial statements and cost reports, even if it makes me want to drive a steely knife through my own forehead every twenty minutes. After a few months, I will probably have edged only deeper into the tangled maze, but at least I will be a step or two closer to understanding. Hopefully my pained efforts will help me launch my own spear into the battle someday, and together we can take the steps to overcome the monstrous challenges facing us in healthcare.

(And until then, let's hope that copious quantities of Diet Coke and Junior Mints can get me through!)

Sunday, August 24, 2008

Ain't Nothin' Gonna Hold Me Down!

"The worst thing you can say about someone in a society like ours is that they can't hold down a job. It conjures images of unshaven losers with weak grips watching sadly as the jobs slip free and float away. There's nothing we respect more than work, and there's nothing we denigrate more than the eunwillingness to work, and if someone wants to dedicate himself to painting or writing poetry, he'd better be holding down a job at a hamburger restaurant if he knows what's good for him." - A Fraction of the Whole, by Steve Tolz

First of all, I am about 300 pages into A Fraction of the Whole and it has already made my top ten list of all-time favorite books...rather a selective list, I might add! It's one of those novels you read with a pen in hand, scribbling in the margins, because you can't help but want to have a conversation with the author whom you will never meet but seems to understand you better than legions of your friends and acquaintances combined. I have spent the majority of the weekend holed up in my apartment in Philly with this book, and I wouldn't have rather spent it any other way. It's deliciously cynical, hilarious, and most importantly, describes the human experience in a way that leaves you whispering, "yes, yes that's it! I'm glad someone finally noticed" as you quickly flip the pages.

Anyway, my apologies for that departure. What I really mean to comment on is the concept of "holding down a job." Where did this phrase come from? To me, it conjures images of a weasel-like creature trying to wriggle its slippery, greasey self out from under your fingers and scramble into a hole in the wall where it can spend the remainder of its days gnawing away on all your electrical lines.

"Someone grab that damn job and put it back in its cage where it belongs! And while you're at it, clean out all the shit it's piled in the corner--it's really starting to reek in there!"

Whereupon the squirming, squeeking job would be tossed back into its cage and dutifully return to its important task of turning the little hamster wheel around and around and around and around until it can make its next escape into the hole in the wall.

Anyway, perhaps my cynicism results from my voracious consumption of A Fraction of the Whole, in which most of the characters are perenially unemployed, but it seems to me like a job holds you down, not the other way around. I don't mean that to sound as negative as I know it does, but it seems like the truth. If you've got a job, you are unable to give into that capricious urge to watch 24 hours of consecutive trashy reality TV or lie about in the park watching elderly couples in matching berets or simply do nothing at all except eat an occasional ice cream sandwich. Of course, without a job you can't really do these things either, since you technically have no money. Bloody Catch-22!

I guess that's what weekends are for. And until the next one, I'm off to my little cage in the corner, hoping someone slips me a bit of ice cream sandwich as I run about on my wheel....

Thursday, August 21, 2008

Messy Marva Strikes Back!

As part of a Public Health Leadership course I am taking online through the University of North Carolina, I recently completed an assignment based on Edward Murrow's "I Believe" essays. The "I Believe" series, which began in the early 1950s and still continue on http://www.npr.org/ , asks writers of all ages and professions to profess their personal philosophies. Authors compose short essays illuminating their beliefs on anything of personal importance, from recycling soda cans to receiving heart transplants. My particular essay was assigned as a way of introducing myself to my fellow students by way of espousing my beliefs on leadership, particularly in health care.

As Murrow wrote, "It would be easier to enumerate the items I do not believe in, than the other way around." As someone who still has so much to learn about both leadership and life, my core principles and beliefs are just beginning to emerge and become clear. I am sure that over the years, some of these philosophies will change and evolve as I collect experiences and mistakes, but I sincerely hope that the following will always be true:

I believe in clumsiness.

I believe in clumsiness in its finest form: the kind that leaves your newly pressed suit stained with coffee before you even pull into the office parking lot, the kind that ruins your carefully decorated cupcakes as they tumble to the floor, the kind that results in too many awkward handshakes and near-miss kisses at cocktail parties (see post below!).

My entire life I have groomed an inborn talent for clumsiness. I have always been a spiller, tripper, and all around dropper, deemed “Messy Marva” by my parents in my toddler-hood and achieving a sterling reputation for being the most scuffed-up, knee-bandaged kid on the playground by first grade. If my version of tumbling—tripping over an imaginary rock and plummeting to the ground—were considered an Olympic event, I would easily win more gold medals than Michael Phelps.

However, it wasn’t until I strapped on my three-inch heels and skirt suit a year ago that my predilection towards clumsiness flourished into a full-blown affliction. Plunged into a world of health care executives, I felt uncomfortable and awkward in my new clothes and new role, like a kid playing dress-up who suddenly finds herself itching to ditch the corset and slip into a T-shirt and ratty shorts. My first job out of college in a management fellowship at a network of private cancer hospitals required me to interact with the most senior individuals and undertake projects where, quite frankly, I had no clue how to even begin, let alone execute successfully. My anxiety, combined with such high-pressure situations and my inherent inability to control my limbs left me a literal mess. At the very moment I was struggling to fit in the most, I was spilling on myself (and worse, on others), tripping, and uttering awkward gaffes at every turn. In short, I looked like a coffee-saturated clown with a goofy smile wavering precipitously towards tears.

And so one day I cracked. I had just finished a conference call with the senior executive team, and in fumbling with the unfamiliar phone system, had inadvertently placed the call on hold, plunging the entire meeting into a loud, canned version of Beethoven’s Ninth Symphony. Worse, I didn’t realize my mistake until minutes later, when I received a scathing email informing me that the dozen most important members of the organization were still sitting on the call, seething and gritting their teeth against the strident tune. Mortified, tears instantly sprang up in my eyes and a small squeak welled up in my throat. To my surprise, however, the croak turned into a giggle which soon blossomed into a full-blown belly laugh.

Five minutes later, I wiped the tears from my eyes and the anxiety from my mind. There is so much pain, angst, and suffering in the world, it occurred to me, and suddenly it seemed both ludicrous and narcissistic to spend so much time worrying about the pen marks dotting my shirt or the pencil smudge above my nose. In a cancer hospital, you are constantly surrounded by patients in pain, terrified caregivers, and employees who are over-worked and under-appreciated. It was at that moment I chose to embrace my clumsiness. I learned to laugh at myself when the inevitable misfortune occurred (and still does, frequently), and I learned to share that laugher with those around me. I figured, if I’m going to scrape my knees or dirty my jacket, I might as well get a smile out of it.

In fact, just a few weeks later, I cracked a joke about the aforementioned phone mishap during another leadership team meeting, and ended up striking a jovial relationship with one vice president who is now a frequent mentor of mine. As weeks passed and I grew more comfortable in my own skin, I learned to joke with, smile at, and gently jest with patients and their families. For some, a slight smile or smallest of giggles might be one of the few uplifting moments of their day, when they can forget their pain, anxiety, and fear, and simply celebrate the small joys of life, if only for a second.

As I have come to assume more responsibility and leadership, I have found that there is no ice-breaker quite like a good chuckle. By inciting a group to laughter, you establish a tacit understanding of the group’s culture; you create a common touchstone to which all individual members can connect. As I’ve become more at ease with myself, I’ve noticed others following suit: the laughs come more easily, faces light up, people are more upbeat and energetic. If someone laughs with you, they are much more inclined to open up, expose their vulnerabilities and tear down the barriers which may have stood between you moments before. For me, this past year has taught me one critical lesson: the absolute importance of taking my work seriously, but never taking myself too seriously.

And so I believe in leadership through laughter. I believe in the power of sharing a moment of joy with those around me, be they patients, caregivers, frontline employees, or senior-most executives, and walking away from that moment feeling re-energized. After a hearty chuckle, we can move on filled with what Deming calls a constancy of purpose, ready to relinquish our own sense of victimization, of burden, and of weariness, and with a renewed sense of compassion and humanity, work towards making a difference in the lives of our patients, colleagues, and families. In recent years, scientists have begun to demonstrate and document the physical benefits of laughter, proving through science what so many have known for centuries. Laughter, it seems, truly is the best medicine, especially in today’s complex landscape: it is cheap, easily accessible, and its benefits can be readily spread amongst the masses, regardless of age, race, gender, or insurance plan. As healthcare paradigms slowly shift towards models of holistic and integrative medicine, laughter will become a key component of whole-person treatment, as it mends both mind and soul, patient and employee alike.

For me, my clumsiness and subsequent bursts of laughter have transformed into a bridge over which I can drive from the shores of self-involvement, across the void, to touch upon the lives of others….always being sure, of course, to keep a Stain Remover Stick in the glove compartment for all the messy moments to come.