Author: Shawn Whatley

Attitude: Good, Bad & Excuses

attitudeOur attitude impacts patients.  Some disagree, but most know work goes easier with a great attitude. Do we agree on what defines a good attitude versus a bad one? Who determines attitude?  What influences it? Can we measure it?

The business literature dwarfs medical writing on attitude.  Here are a few blog posts:

Healthcare literature discusses it mostly as bias or perspective versus inclination or temper:

We know the pain of working with someone foul.  We also know how our own outlook impacts work.  Great attitude makes every situation better.  It calms chaos, turns around patient outcomes and transforms great into excellence.

Good attitude

  • Positive
  • Enthusiastic
  • Realistic
  • Solution-oriented
  • Respectful
  • Forgiving
  • Humble
  • Flexible
  • Industrious
  • Kind
  • Gentle
  • Confident without needing applause
  • Deferent
  • Magnanimous

Toxic attitude

  • Negative
  • Scoffing
  • Sneering
  • Disdainful
  • Ignoring
  • Angry
  • Petulant
  • Derisive
  • Proud
  • Arrogant
  • Suspicious
  • Critical
  • Doubtful

Dozens of things impact attitude: life experience, upbringing, personality, health, social support, faith, …  But attitude remains a choice (see Eat THAT Cookie!: Make Workplace Positivity Pay Off…For Individuals, Teams, and Organizations).

Folks are usually about as happy as they make up their minds to be –  Abraham Lincoln

Instead of choosing our perspective, we tend to let others shape us. Outside sources teach us or model how to think and feel:

  • Media, and others, tell us patients abuse the system for minor complaints.
  • Unions remind us of how bad we have it and rouse fights-rights-marches and victimhood.
  • Associations can model “no one else knows what they are doing”.
  • Colleges portray rigidity, authoritarian proclamations and black and white thinking.
  • Coroners were taught to be circumspect, suspicious and to ‘think dirty’.
  • Professional schools (MD and RN) can promote entitlement, elitism and professional hubris.

Excuses:

“Well, if you had to work as hard as I do, with the bosses I have, you’d have a bad attitude too!”

We come up with great reasons for how we earned our right to be sour.  However, not everyone is vile despite the same ‘great reasons’.  Many people with better reasons to be miserable are not.  Our list of ‘great reason’ are just excuses.

  • I work too hard; no one works as hard as me.
  • Leadership/colleagues/government/culture oppresses me.
  • I have righteous anger over lack of quality.
  • I have a really hard job.
  • My patients are tough/high needs/demanding.
  • My pay is too low; I deserve better.
  • No one listens.
  • I see terrible things/death/pain/suffering.
  • I have to make impossible choices at work.
  • I wrestle with life and death every day; faced with my own mortality.
  • I live with continual anxiety over my own incompetence/imperfection/frailty.
  • My deep concern/compassion for patients makes me angry.
  • I’m frustrated at the lack of perfection/improvement/solutions.

Attitude matters.  It’s a choice.  Bad attitude ruins patient experience even if we deliver great technological outcomes.

If we agree that attitude impacts performance, why don’t we address it?  Can we measure it?  Shouldn’t it be a core element of performance management? We measure and post time based metrics; would we ever measure and post attitude scores?

(photo credit: judiciaryreport.com)

When Viral is bad  

viralI did something that went viral.  It became juicy gossip, a ‘can-you-believe-it’ story.

It was stupid and made people feel bad.  I felt bad. I embarrassed dear friends, hurt old colleagues and gave some enemies fodder to slander.  Very bad indeed.

‘Viral’, not the good kind as in ‘going viral; more like a 36 hr flu that people hate but don’t put much meaning into.  No one died or lost a limb and most have much more interesting things to think about…hopefully.

I learned that

  • Messages get lost unless carried by the audience.
  • Interpretations drown messages.  If people choose misinterpretation,  good luck getting back on point.
  • People hear messages they expect no matter what you say.
  • Delivery becomes the message.
  • Poisoning the well works!

“Those who know do not speak.  Those who speak do not know”

Lao Tzu in Tao Te Ching.

But when does silence support atrocity?  At some point, silence can foster dysfunction. Society improves by speaking truth to power.

  • How can we encourage ‘people of good conscience’ to speak out against oppressive social structures and tyrannical thinking?
  • How can we empower those best able to speak to issues while protecting them from pillory and calumny?
  • Maybe hard questions need, once again, the cloak of anonymity and pseudonyms?

Silver Lining

Neuroplasticity says old dogs can learn new tricks (see The Mind And The Brain: Neuroplasticity and the Power of Mental Force).  We embrace mistakes – eternal possessions – and the humility in forgiveness given and received.  We appreciate relationship and the confidence of those who know us, imperfect frail people.

So, do not lust for going viral…even just a little bit viral.  You might get what you wish for.

“All tyranny needs to gain a foothold is for people of good conscience to remain silent.”

Thomas Jefferson.

PS Please stop reading…nothing more to see here…really boring stuff…

(photocredit: jessicaannmedia.com)

Healthcare Ecosystem – Wild & Messy

ecosystemAt coffee my brother-in-law, an architect, asked

“What describes an ideal healthcare system?  An airport? Airline?  A factory?  Something else?“

I paused.  He’d probably heard the healthcare-is-like-the-airline-industry line before…

“An ecosystem,” I said.  “Everyone loves to compare healthcare to  airplanes. You fly a plane over and over to figure out the safest, most efficient way to do it.  But healthcare is messy, relational, contextual.  Air travel serves people in high risk situations, but the similarity ends there.“

Pundits often complain, “If only healthcare could behave like airlines and embrace safety and protocols…”   Healthcare procedure should be as certain and precise as flight schedules.  Steve Harden starts his Never Go to the Hospital Alone: And Other Insider Secrets for Getting Mistake-Free Health Care from Your Doctor and Hospital with airlines and crashes.

Our love of precision might explain why patients love lasers.  Laser-anything adds credibility.  Laser surgery, laser vein treatments, laser smoking cessation…(what?)  Lasers aren’t new, but they sound precise, exact.  Humans crave certainty.

Ecosystems defy certainty.  Impossibly interconnected, ecosystems teeter such that change to one variable impacts everything.  Raise the water level and you flood burrows, nests, and change spawning beds.

Healthcare Ecosystems are

  • complex
  • interrelated
  • adaptive
  • resilient to some changes
  • delicately fragile to others
  • non-linear
  • dynamic
  • unique

Healthcare serves individuals from different communities with peculiar risk factors, varied social supports and unique genetic material.  While patterns exist and outcomes should be measured, healthcare will always resist the amount of control desired by bureaucrats and analysts.

Many physicians crave precision, too.  They see improvement with checklists (see The Checklist Manifesto) then apply lists to everything.  They find protocols improve outcomes and decide every patient needs the same treatment for diagnosis, all the time. It appeals to pundits in love with tick-boxes, check-lists and airline analogies.

Healthcare will never squeeze into rigid process because people don’t.  It will always defy utopian ideals of uniformity and certainty.  As tax dollars run short, healthcare gets asked to perform more and more like an airline or factory.  We need to remind planners and pundits that healthcare is an ecosystem, wild and messy.

(photocredit: movethechannel.com)