Finding the Missing Puzzle Piece... 3 Things to Know to Improve Patient Engagement and Outcomes

Today in health care there is such a focus on increasing patient engagement, which is primarily driven by costs.  Cost that are either saved or created by patient behaviors an outcomes.  It has been interesting to watch the various interventions that have been tested in patient environments to try and achieve changing patient behaviors.  Even myself and some others came up with a model a few years back aimed at reducing readmission to the hospital by utilizing a community-based approach similar to when I was a hospice nurse.  Obviously it wasn't viewed as the answer to every one's problems, or I wouldn't be sitting here this morning writing this blog.  I probably would, but at least I'd be doing it sitting on some sandy exotic beach somewhere in the world. :)

Seriously though, even I missed the boat with everything we were trying to accomplish.  Over the past three years I've had the opportunity to own my own business, work in leadership roles, and most recently function as a hospital care manager for the past year.  These different roles have exposed me to working with people in a variety of capacities, and have helped me reevaluate what I thought I knew about health care after 25 years.  What I believe is currently happening in health care that is alienating patients and frustrating people boils down to one issue.  A missing puzzle piece that can help us finally complete our masterpiece.  We have forgotten somewhere along the way that health care and medicine is about treating the human condition.

Each day I walk the halls of a hospital and interact with numerous physicians, other staff, patients, and their families.  Every group is playing a unique role in completing the puzzle that we're trying to build.  The one thing we all have in common, that somehow is being lost in the shuffle is that we all share the same humanity.  We are all people that experience e emotions and feelings, and respond to our environment based on those interactions.  What I've realized in the four walls of that hospital is that we're not dealing with diseases and illnesses, we are dealing with broken people whose bodies have become the physical manifestation of their brokenness.  I'm not trying to be a simpleton or deny my background as a clinician, but trying to shed light on why we might be missing the mark and be continuing to look for that lost puzzle piece.

3 steps we can implement to improve the patient experience and outcomes.

Know the person - 

All of us are part of some sort of relationship in our life.  How do you cultivate that relationship in the beginning?  We get to know the person.  Isn't that that goal of dating or the basis of building relationships.  We want to know about each.  What makes that other person tick, but why?  Think about the question for a moment as it relates to your own relationships.  We want to improve our interaction with each other.  We want to have a better relationship with our family and our friend because it enriches our lives, and creates joy and happiness.  Why should the interaction with patients be any different.  Aren't we trying to accomplish the same outcome, a better relationship that increases our satisfaction.
     
How do we accomplish this?  The same way we do in our own personal lives.  We get to know each other, so we can understand how best to communicate and meet each others needs.  What are the tools we use to accomplish this goal?  Match.com, personality tests, first dates where we ask "what's your favorite color?".  If it works in all those aspects of our lives why can't we use the same approach in medicine?  Aren't we trying to each the same outcome, just with different players?
 

Therefore, I think to start finding the missing puzzle piece is we need to know what it looks like.  One way we can accomplish that is a method of having patients take a personality test that informs us about their core values, and communication style.  Wouldn't this help us first understand them, and also help us know how we can create a successful interaction.  One tool I came across recently that I thought was very interesting was at www.hueyme.com - "Huey Me allows you to first assess yourself and then through family and friends, explore why each of us are unique and motivated by specific feelings (motivations) that explain why we do, say and react the way we do to almost everything in life!".  

Know the learner -

The next component of improving patient engagement is understanding how to share information.  Not communicate, but information that we want a patient to retain.  How many of you are good students and how many of your are bad students?  Did the way you were presented information have any impact on how you were able to retain the information as a student?  Do you like to listen to books on tape, or do you prefer to read a book, or do you like to watch a video?  These all represent the very different types of media that enhance learning.  Knowing how someone absorbs information increases the chance of them retaining what we want them to learn  Along with this intervention we have to know their literacy level, so we can present information to their unique level of learning.  Therefore, I believe to improve a patients experience and outcomes we must understand both their learning style and level.

In the book, Understanding Student Learning, Entwhistle and Ramsden (2015) examine the extent to which these learning methods reflected the teaching, assessment and individual personalities of the students involved. The book contains interviews with students, experiments and statistical analyses of survey data in order to identify successes and difficulties in student learning and the culmination of these techniques is a clearer insight into the process of student learning.  Their work proves that helping people learn requires a unique approach that identifies both an individual's preferences for receiving information, and their understanding.  If we are to gain ground in helping patients with compliance, we will need to personalize the patient education experience to better serve our patients in improving their health while achieving our outcomes.

Know the reason -  

Finally, we have to again focus on what I said previously in this post.  Much of what is motivating discussions today in health care has a fiscal foundation.  Either it's about making money or losing money.  Those motives impact the way an organization does business, treats their staff, and ultimately treats their customer. Therefore, if organizations are led by internal motivations, we also need to understand that so are the patients we serve.  Why do they do or don't do things in relation to managing their health?  If we persist in providing a cookie cutter medicine approach, then we should expect to get same results that include not meeting patient's satisfaction with their care while missing the mark on our outcomes.  The only way I see to achieve a change from this direction we're going is to improve patient engagement by knowing the reason behind patient actions.

When your doctor gives you a pill isn't that action based on both his or her schooling, and also clinical studies that have proven using that type of pill is effective in treating your illness?  The answer is a resounding yes whether it's a pill, procedure, or referral to another provider.  There is a reason or evidence for the basis of every clinical action or decision.  If we believe in this approach in supporting patient safety, then why wouldn't we use the same approach in working with patients to achieve better compliance and improve quality of life?

One company that has been successful in this type of approach has been Insignia Health that has licensed the use of the Patient Activation Measure from the inventor Dr. Judith Hibbard who designed the tool from more than a decade of her clinical work.  This tool utilizes 13 statements that are presented to patients, and use their responses to stratify their level of "activation" or their own knowledge, confidence, and ability to manage their own health.  They also have a coaching application that coincides with the survey that allows you to tailor teaching to both the specific disease and their motivation level.  The levels are split into 4 categories of Activation from Level 1 (disengaged and overwhelmed), Level 2 (Becoming aware, but struggling), Level 3 (Taking action), and Level 4 (Maintaining behaviors and establishing new personal goals).  What is impressive about this tool is that it's supported by hundreds of peer reviewed journals, and has been successfully used in huge populations to achieve outcomes and positively change lives.  Now isn't that what it is truly about?

If we are looking to make a difference in the lives of the people we serve, then we need to first remember they are people.  All of us live in the same world, and have the ability to draw on the same type of emotions and perspective to impact our lives.  When we as a health care system understand that we need to Know the person, Know the learner, and Know the reason, then we will be able to develop a means to radically change the face of health care for both patients and the organizations that serve their needs.  Just my two cents.  Take care.

Dave

Here we go again - Looking to make a difference in my community...

Good morning.  I wanted to share some news with those of you who read this blog concerning some new changes that I'm pursuing.  For the past year I've had the great opportunity to work in a hospital as a nurse care manager, helping patients and families transition back to the community.  During this journey I've had the privilege to work with an amazing group of people that are all focused on positively impacting others lives.  The has been only one drawback.  On numerous occasions patients and families have had to go back into the community without much support, and even less confidence.  These are the people that often come back to visit us, because of both the clinical challenges they're experiencing and lack of self-management skills.  I've tried to help a number of these people after they've left the double doors of the hospital, but it just seems to not work from the hospital.

Therefore, I've decided to move forward with my own efforts to make a difference by offering some services to support these individuals.  I'll be offering the chance for them to talk about their struggles, provide some coaching and insights, develop a tailored plan according to their desires and needs, and connect them with various resources in the community to minimize the disruption in their lives.  I'm wanted to focus my efforts on my local community, but have come to realize after talking to friends and family nationally that these issues have no boundaries.  That is why it will be my goal to not only be open to my own community, but hopefully be a resource to others elsewhere.

If you are having challenges knowing how to help your aging or ill loved one, you need a sounding board, or you could use some guidance then please reach out to me.  Right now I'm offering FREE initial consultations without any obligation for further services.

If this sounds like something that could benefit you or someone you know, please contact me today here on the blog, at www.mindwayssolutions.com, or at (253) 235-3272.  I hope everyone has an amazing day.  Take care.

 Dave

 

I like the way this guy thinks... Insights from Steve Maraboli

Some of us are stuck in life because we hang on to the things in the past.  The author of these quotes has some amazing insights on how to free ourselves and our minds of this unnecessary baggage, so we can reach the peak of our life.  Don't just hang on today, climb the mountains of your goals and dreams.  You may have to drop your pack of regrets and sorrows, but won't it be worth it to enjoy the view at the top.  Take care, and have an amazing day.

Dave

"We all make mistakes, have struggles, and even regret things in our past.  But you are not your mistakes, you are not your struggles, and you are here NOW wth the power to shape your day and your future." 

Steve Maraboli, Unapologetically You: Reflections on Life and the Human Experience

"Sometimes life knocks you on your ass... get up, get up, get up!!!

Happiness is not the absence of problems,

it's the ability to deal with them."

Steve Maraboli, Life, the Truth, and Being Free

"Incredible change happens in your life

when you decide to take control of what you do have power over

instead of craving control over what you don't."

Steve Maraboli, Life, the Truth, and Being Free

"Letting go means to come to the realization that some people are a part of your history,

but not a part of your destiny."  

Steve Maraboli

"At the end of the day, let there be no excuses, no explanations, no regrets."

Steve Maraboli, Life, the Truth, and Being Free

We all have dreams in our life.  What we want to be, where we want to go, and who we want to have in our lives.  Following dreams can be difficult because sometimes it's like waking up, and things are still the same.  That is when we have to buckle down, remember why it's important for us to pursue, and push on.  There are going to be those moments that try to make us give up on our hopes and dreams, but those are the times we need to hold tight to our vision.  Here are some thoughts for the day that support this action.  Take care, and continue pressing forward toward your dream.

"You have to dream before your dreams can come true."

A. P. J. Abdul Kalam

Don't give up on your dreams, or your dreams will give up on you."

John Wooden

"Press on. Nothing in the world can take the place of persistence. Talent will not; nothing is more common than unsuccessful men with talent. Genius will not; the world is full of educated derelicts. Persistence and determination alone are omnipotent."

Ray Kroc

"I can't imagine a person becoming a success 

who doesn't give this game of life everything he's got."

Walter Cronkite

"It is better to risk starving to death than surrender. 

If you give up on your dreams, what's left?"

Jim Carrey

"The only thing worse than starting something and failing... 

is not starting something." 

Seth Godin

The 5 T's to Ensuring You Have a Successful Hospital Stay

The 5 T's to Ensuring You Have a Successful Hospital Stay

Have you or one of your loved ones ever ended up in the hospital?  I would imagine for the majority of us the answer would be a resounding yes.  What was the stay like?  Did you feel like you had a clue about why you were there, and what they were doing?  For a lot of people the response to that question may be just the opposite with a resounding no.  The difference in those experiences can truly be altered to some degree by your own actions when you or a loved one has been hospitalized.  As someone who has been a patient, sat at the bedside next to my loved one, and been the nurse delivering the care I believe there are 5 T's that can make the difference in your stay.

Type of Patient - Admission Status
When you come to the hospital whether it is in the back of a speeding ambulance or walking through the double doors on your own, you'll initially be evaluated in the emergency room to be assigned an admitting diagnosis.  Understanding your admission status is crucial to knowing the time frame that you may be in the hospital, the type of interventions they may do to make you better, and the possible costs you may incur.  Typically there are three statuses that are used when you stay at the hospital:

• Ambulatory - This status is most often used when having a same day surgery or short stay surgical procedure that is performed in the hospital versus an outpatient center.  If you have Medicare they will generally switch this status quickly to observation or inpatient, but with a commercial(non-Medicare/Medicaid) patient you may stay in this status.  It's important to understand your own plan, so you'll have an idea of the costs you may have to pay.  Typically this should be an overnight stay unless there are complications, and then the status of the admission would change.  If you are a Medicare beneficiary this stay will not qualify you to get paid rehabilitation as an inpatient in the community.  In that way it is like observation status.

• Observation - This is a status that is utilized to provide providers and the hospital a short window of time to evaluate someone's condition (usually 48 hours), and measure their needs against the criteria necessary to switch the person to an inpatient.  Some of the conditions, illnesses, or trauma that may fall into this category are often chest pain or orthopedic injuries that don't require a surgical intervention.  Where this status creates a problem is with the Medicare population because an observation status patient doesn't qualify to have Medicare pay 100% for a rehab stay under Part A.  Part B beneficiaries also billed 20% of  their hospital stay.  You might avoid these costs if you have a supplement or long-term care insurance that will pick up the co pays and cover the cost of the rehab stay.  When you're admitted in this status as a Medicare beneficiary the hospital must inform you of your status, and have you acknowledge you've been provided the information.

• Inpatient - This status pertains to all other admissions where the individual meets the medical necessity to stay in the hospital.  Commercial patients will need to look at their policies or call the toll free number on your card to hear about the specific coverage.  Medicare beneficiaries must meet the medical necessity of this status for three qualifying midnight's to go to a Rehab facility where Medicare pays 100% for the initial two weeks prior to co-pays taking effect.  As a Medicare beneficiary in an inpatient status you have the right to appeal your discharge if you don't feel safe going home.  After the appeal is initiated a third party will review the admission, and make a determination if it's a safe discharge.  If it's considered safe, the hospital can bill you for any services not covered by your insurance.

Type of Problem - Admitting Diagnosis
There is a reason you went to the hospital.  It could have been a persistent pain you had been experiencing, bleeding that you noticed from different areas of your body, or you felt like you couldn't breath.  No matter what symptoms you presented with at the time you came to the hospital you will eventually require an admitting diagnosis.  This diagnosis will determine how the hospital gets paid and what type of care and services you may expect to receive during your stay.  Typically the course of coming to that conclusion involves taking a medical history, hearing about present symptoms, evaluating medications, and diagnostic testing.  Depending on the severity of your situation it may also require other providers outside of the Internal Medicine Hospitalist to be consulted.  These days hospitals are frequently struggling with the challenge of getting people access to services.  Therefore, there is a push to proactively start planning a patient's discharge on the day they're admitted.  Understanding your admitting diagnosis and asking the providers involved in care questions will give you the answers needed to have an idea about the duration of your hospital stay.  It will also alert you about the medications and services that may be required to support your health.

Type of Results - Diagnostic Findings
While you're admitted in the hospital you're not going to get any sleep generally.  This is because you're going to be inundated with numerous people coming into your room performing their jobs to gather the information necessary to support your treatment.  You should expect that you may be subjected to imaging(CTs or MRIs), lab tests, and surgical interventions to collect what the lab needs.  Do you struggle with a fear of needles or have claustrophobia?  Completing these tests is imperative to getting the right treatment, so make the provider and staff aware of your concerns to ensure they can find alternatives to support your comfort in completing the testing.

Once the test results are available it will be important to understand what's being done to help you, and the progress you're making required to be discharged.  Often this is where having someone in your family at the bedside is important to advocate and understand the hospital course of treatment.  If you don't have a Power of Attorney or Living Will, the hospital can provide forms.  If you're incapacitated in any way having this complete will let someone else support your goals for your care, and speak on your behalf.

Type of Action - Treatment Plan
When you're laying in that bed it's not only the physician who is impacting your stay, but a team of clinicians who are supporting your care.  It's important to engage with these individuals and understand their role in helping you to achieve a safe discharge.  One group that you will encounter more often than any other group will be the nursing staff.  They will be the eyes and ears for the physician, support you in understanding about your stay with patient education, and provide the compassionate interaction you deserve to promote healing.  There will also be many other important members of the team that include the technologists, the therapists, and the numerous support staff who will deliver your nutrition and personal care.  Even though you can rely on these individuals to provide your care, patients need to be motivated to care for themselves and return home..

As a hospitalized patient it's important to take some preventative measures to promote your safety and reduce complications.  Two of the biggest things is movement and breathing.  When you're laying in the bed your muscles can become weak, and your circulation can stagnate putting you at risk for blood clots.  You also can spend more time in bed laying in positions that compromise your ability to circulate air adequately through your lungs which increases the risks of upper respiratory infections.  An easy way to prevent these complications in addition to the medications you'll be receiving is to get moving.  You need to advocate for yourself or your loved one to have the staff help you get moving unless directed otherwise by the physician.  Getting up and walking will help circulate the air and blood, and support your recovery.

Type of Transition - Discharge Plan
Finally, you made it through your stay.  Now its time to go, but where are you going?  Hopefully it will be home, but often people require different environments and services to support their care following a hospitalization.  It's extremely important to ensure that you or your loved one leave the hospital with the resources to support your care, and prevent a readmission.  Here are some of the typical services that can support this effort:

• Skilled Nursing Facility or Rehabilitation Center - Most often used for post surgical or patients that have experienced a decline in their function that prevents them from safely returning home.  It may be that they are recovering from a hip, or have a wound, or just need to increase their strength.  It's important to know your options, and understand what facilities are available in the local area.  Have your loved one visit the potential facilities prior to discharge, so everyone will feel comfortable with the upcoming stay.

• Medications - Going home on new medications or having required changes in dosing of current medications is often also part of the hospital stay.  With new drugs coming to market all the time, sometimes they're either not covered by your payer or extremely expensive.  It's imperative to fill the prescriptions, so have a family member or hospital case manager call your payer to get information about prices and any co-pays.  If it's too expensive most pharmaceutical companies have programs where they provide the medication at a lower cost.  Walmart also has a formulary where you can get certain prescriptions for as low a $4 for a 30 day supply.  The key to staying out of the hospital is following a certain set of preventative measures which includes taking your prescribed medications when directed.                                                                          

• Medical Equipment -  After the hospital stay you may have equipment needs.  Most often these may include oxygen, nebulizer, or a variety of other Durable Medical Equipment needs like wheelchairs and walkers.  There are a number of companies that provide this service, and you will have the ability to choose who you want as your provider.  To support this decision check to see if your insurance is contracted with the provider to avoid paying privately.  You may also want to ask other family and friends about any good experiences they've have with vendors.  Ensure that these needs are set up and in place when you discharge, so you'll have the support you need to avoid returning to the hospital.

• Community Services - If the plan is to go home, there are agencies that specialize in supporting your care in the community.  At the hospital they'll arrange for these companies to contact you.  Often it is either Home health and Hospice, but it may include a Dialysis Center, Outpatient Wound Clinic , Outpatient Infusion Center, or a referral to an agency in the community that will support your personal non-medical needs in the community.  To ensure that you experience a smooth transition back home you'll need to get a copy of the discharge instructions with these services list, and their contact information.  If you don't hear from them within 48 hours of discharge call them up immediately.  These services will support your needs to stay at home, and prevent a round trip back to the hospital.

• Follow up Appointments - It will be important for anyone returning home to get follow up appointments following their hospitalization.  Ensure that you either have the information or that they were scheduled for you.  You'll need to see these providers to update them on the stay in the hospital, changes in medications, and avert another admission.

My hope is this little bit of information helps to make your stay or that of your loved one successful, and gives you the confidence to be your own advocate in getting your needs met.  Take care.

Dave

Thoughts for the Day - Seeing the best in others leads to kindness...

As a nurse I'm often placed in situations where I meet people that I initially think are very different than myself.  I quickly come to realize that I'm completely wrong.  I find through our meeting that we may have travelled different paths, but our experience of being a human in this world is something that can be similar.  We all experience the same emotions at various points during our lives, and with all the recent sadness we've seen occurring in our country it's time for us to look beyond our differences and try to see the goodness in others by treating others with kindness.  Take care, and have a great day.

Dave

“Be kind, for everyone you meet is fighting a harder battle.”
― Plato

“Do your little bit of good where you are; it's those little bits of good put together that overwhelm the world.”
― Desmond Tutu

“How would your life be different if…You stopped making negative judgmental assumptions about people you encounter? Let today be the day…You look for the good in everyone you meet and respect their journey.”
― Steve Maraboli, Life, the Truth, and Being Free   

“No act of kindness, no matter how small, is ever wasted.”
― Aesop

“I would rather make mistakes in kindness and compassion than work miracles in unkindness and hardness.”
― Mother Teresa, A Gift for God: Prayers and Meditations   

Thoughts for the day - Taking a Risk to be Happy

Have you ever taken that leap of faith because you weren't where you wanted to be in life?  How did you do it?  What made you take that first step?  Well, after a few years of working for others I'm going to take that leap again myself because I need to realize my hopes and dreams of helping people in the way I feel will create the greatest impact.  I actually only have a few weeks left of my security blanket job, and then I'll take the plunge.  Calculated and smarter than last time, but still a chance at realizing my dreams.  What will you do today?  Here are some quotes I found that might inspire both of us on our life's journey.  Take care.

Dave

“If we never had the courage to take a leap of faith, we'd be cheating God out of a chance to mount us up with wings like eagles and watch us soar.”
― Jen Stephens, The Heart's Journey Home

“Never be afraid to trust an unknown future to a known God.”
― Corrie ten Boom

“The future belongs to those who believe in the beauty of their dreams.”
― Eleanor Roosevelt

“The future depends on what you do today.”
― Mahatma Gandhi

“Above all, be the heroine of your life, not the victim.”
― Nora Ephron

Transitions - The turnstyle of life

 

Transitions - The turn style of life

I'm sure this image provides a familiar and often frustrating memory for many of us.  Whether it was hopping on a subway in some urban destination, trying to quickly get through it for the big game, or dragging our kids off to the state fair for some fun.  Each of us can relate to using a turn style as a means to get to our final destination.  The thing that I remember most about my experience with turn styles is the challenge I had getting through when I rushed the process or was impatient.  When I took my time I was easily able to get through and to where I was going.

I believe the transitions in our lives can be very similar to getting through the turn style.  When we understand that going through these brief barriers is just part of the journey, it can prevent us from getting stuck in life.  Here are three ways to successfully transition through the turn styles in our lives:

•  Define the Why? - If you're facing a transition in your life whether it's a new job, a change in your health, a new relationship, or possibly some unplanned event, try to look for the why?  Some people may be thinking that's crazy especially for an unforeseen barrier, but why is it?  If we look at the history in our lives we each have travelled down various paths to get to our current destination.  Did those twists and turns teach you anything or did they give you new insights you didn't have previously?  Transitions are the gate way to changes in our lives, but to minimize the frustration and avoid getting stuck we need to first define the Why?

• Enjoy the Moment - The turn style is also the mechanism that slows down progress.  Think about that big game or concert that you couldn't wait to see, but all of the sudden the line to a screeching halt.  What tends to be our first reaction?  I must admit for me that it can be frustrating, but is that helping the line to move quicker?  When I stop to realize that I'm still going to get in, then I have the freedom to mingle with the people around me or drink a beer while I wait.  When we're going through the transitions in life we need to enjoy every part of the journey.  We never know when we may meet that special person or be exposed to a priceless nugget of wisdom that could positively impact our life.

• Believe in the future - Have you ever been asked the age old question, "Is the glass half full or half empty?"  I'm sure we've all encountered that question at some time in our lives.  What was that person asking trying to discern?  For me they were trying to determine my perspective on the situation, and wanted to see how I face the challenge.  Going through transitions in life are challenging for each of us, but how we respond can determine the experience.  That glass of milk, water, or even a shot of whiskey isn't really the focus of the question, but your mindset.  In a transition we must remind ourselves of why we're on the journey, stop and smell the roses along the way, and finally believe that it will eventually lead to greener pastures.

I hope you can get through the turn style in your life today, and enjoy the journey you're on to the next great experience in your life.

“You cannot swim for new horizons until you have courage to lose sight of the shore.”
― William Faulkner

“It is often in the darkest skies that we see the brightest stars.”
― Richard Evans

“I am fundamentally an optimist. Whether that comes from nature or nurture, I cannot say. Part of being optimistic is keeping one's head pointed toward the sun, one's feet moving forward. There were many dark moments when my faith in humanity was sorely tested, but I would not and could not give myself up to despair. That way lays defeat and death.”
― Nelson Mandela, Long Walk to Freedom: Autobiography of Nelson Mandela   

Lessons from Dad - A choice to make an impact

Today is Father's or Dad's Day.  A day when we get the chance to celebrate either the joy of being a child or being a Dad, but for many I understand it may be a day to be forgotten due to different circumstances.  I am grateful that in my situation I have memories of a man who was and is there for me, and I feel truly blessed for the impact he has made on my life.  Yesterday I stopped by the store on the way home for work to get a few groceries, and to my dismay there were very few things being sold to celebrate this special occasion.  This struck a core in me, and made me a bit sad at first.  Therefore, I started to think about my Dad, and the lessons he taught me about life that have helped form me into both the person and Father I am today.

These lessons started to invade my mind with images and words that vividly reminded me of how my Dad has impacted my life through his actions. Words that represent the example he showed day in and day out.

Dedicated - Growing up my Dad was busy at work, but always made time for his sons.  I remember waiting for him to get home because he'd always whistle as he entered the house.  This was the signal it was our opportunity to jump on Dad, or go out in the backyard and throw the ball.  He was always present with us when he came through that front door.  Even though he continued to advance in his career, he was dedicated to ensuring he was at the table each night showing us the importance of family and balance in life.  These actions were a result of my Dad's core beliefs and values.

Devoted - My Dad lives his life based on a set of beliefs that guide his actions.  He instilled in us that each of us is driven by a desire to connect with something greater than themselves.  My Dad's connection was his faith in Jesus Christ.  Today that seems to be a point of contention for some people, but why?  I believe it's because they may not have heard or been taught what I was taught.  Let your actions speak louder than your words.  I can't think of someone in my life who has been more devoted to letting their beliefs positively affect their own life, and choosing to use their actions to impact others lives with kindness and love. 

Decisions - Just as my Dad has made decisions about his faith, I also was taught that we have the capability to make choices each day.  Growing up my Dad tried to remind me on numerous occasions that we all have choices, and they come with consequences both good and bad.  Therefore, choose wisely.  Whether it's a decision about something you want to do or the way you choose to act, be thoughtful about your choices.

Display - Finally my Dad taught me about being real, and that men can also be real with their emotions.  I've seen this first hand throughout my life.  My Dad wouldn't hesitate to show us he loved us with affection, he also taught us how to respect women by treating my mom with love, or on the few occasions where I saw him break down as he cried about the loss of those he loved.  

There are so many lessons I've learned from My Dad over the years listening to him, but more importantly seeing him live honestly and with purpose.  On this special Father's Day I want to thank my Dad for being an amazing example, and hope to impact this world, other people, and most importantly my own precious child by living boldly with purpose and integrity.   Thanks Dad.  Happy Father's Day.  I love you.

Your Son

Sometimes it seems like a gray sky even when it's sunny and bright.  In those times that everyone experiences how do we get back to the sun?  Here are some quotes by some folks that have some insight on that issue.  I hope this will bring back the rays and warmth if you're feeling blue today.

Take care, Dave.

“You may encounter many defeats, but you must not be defeated. In fact, it may be necessary to encounter the defeats, so you can know who you are, what you can rise from, how you can still come out of it.”
― Maya Angelou

“Never, never, never give in!”
― Winston S. Churchill

“Many of life's failures are people who did not realize how close they were to success when they gave up.”
― Thomas A. Edison

“Never confuse a single defeat with a final defeat.”
― F. Scott Fitzgerald

“Let me not pray to be sheltered from dangers,
             but to be fearless in facing them.  Let me not beg for the stilling of my pain, 

but for the heart to conquer it.”
― Rabindranath Tagore, Collected Poems and Plays of Rabindranath Tagore

Three ways we can help our patient - Look, Listen, and Feel

Three ways we can help our patients - Look, Listen, and feel.

Health care continues to change daily with new treatments, equipment, and positions designed to support these efforts.  It seems the only constant that remains in health care is that person lying in the bed or sitting on the exam table.  The patient.  Hopefully they will continue to be the focus of all this new activity, but it seems that the relationship we need with our patients to create positive change is slipping away.  How can we restore that relationship, and help our patients?

It's as easy as to  Look, Listen, and Feel.  For many of us that conjurs up visions of other medical training or actual interventions, but I'm speaking to how we must engage our patients to honestly help them experience positive change.

“There is nothing like looking, if you want to find something.”

J.R.R. Tolkien, The Hobbit

Look - We first have to look or see our patients.  Often this can be challenging because our vision is blurred by the view of a patient who's not acting as we would choose, or maybe the smell is burning our eyes, or maybe we have our eyes closed because we're disgusted with the situation before us.  The challenge is that we can't help the people we serve unless we truly look at them, and see them for who they are in that moment.  It's like looking at an oil painting from accross the room.  What we see is the finished product of the image we see, but when you're next to the painting you can the uneven surface and brush strokes.  Our patients are like the painting because each brush stroke may be an experience that has impacted their life resulting in the physical manifestations of their health problems.  Without getting close enough to look at them we won't appreciate the foundation of the person, and know how we can or can't help them.

“Most people do not listen with the intent to understand; they listen with the intent to reply.”

― Stephen R. Covey, The 7 Habits of Highly Effective People: Powerful

Listen - How true are the words by Stephen Covey?  For many of us we either don't stop to listen to others or are distracted by thoughts in our heads.  Either way we miss out on the story we need to hear.  Listening can be difficult and time-consuming, but without listening we can't appreciate the journey.  It reminds me of the numerous vacations I was blessed to enjoy as a child with my family.  My Dad was a school administrator, and therefore had part of the summer off each year.  When he was off we would hop in the car, and travel accross the country producing amazing experiences seeing places like Mount Rushmore.  On these long road trips my mother would help her two rambunctious boys pass the time by reading us books.  Whether it was the Hardy Boys or the Lion, Witch, and the Wardrobe my Mom's voice would draw us into to an exciting story.  In these instances our listening created visions of characters, and took us on journeys that enriched our experiences.  In order to have that same experience in our interactions with patients we must listen to the story they're telling.  Without truly listening we can't appreciate, understand, or attempt to help in a way that will benefit them and impact their health.

“We think too much and feel too little.”

― Charlie Chaplin

Feel - The act of touching another person to convey caring, compassion, or empathy.  Also, to connect with someone emotionally to produce a positive interaction.  With the hustle and bustle that occurs in most health care facilities there has become very little time for making these connections.  Time is often our enemy, so we have to take advantage of the interactions we have with our patients.  We need to be in the moment with them, and put away any assumptions about them or their situation.  We must try to understand their situation without measuring it against our own judgement and values.  To honestly help, we have to be with them in their pain and let the experiene unfold.  We have to absorb the anger and the grief they are feeling, and not distance ourselves with some phoney excuse about maintaining professionalism.  It's difficult to embrace the feelings because it can elicit emotions on our part, but that's what is needed to show them we can help in their time of need.  We are not treating diseases, but people who need us to Look, Listen, and Feel their need for our help.  Then we can drive positive change in the lives of those we're trying to serve.

"Be kind for everyone you meet is fighting a hard battle"

Thoughts for the Day - Looking for the Gold in Your Life

Sometimes it's challenging to see the positive things happening in our lives or recognize the good things that have occurred.  In those times we need to remind ourselves of the gold in our in lives.  The things that we treasure, and be grateful.

“When you are grateful, fear disappears and abundance appears.”

― Anthony Robbins

“It makes no difference where you go, there you are. And it makes no difference what you have, there’s always more to want. Until you are happy with who you are, you will never be happy because of what you have.”

― Zig Ziglar

“We all have a reason for living

I am blessed mine has two eyes a heartbeat and calls me mum.”

― Nikki Rowe

“I've started to look at life differently. When you're thanking God for every little you - every meal, every time you wake up, every time you take a sip of water - you can't help but be more thankful for life itself, for the unlikely and miraculous fact that you exist at all.”

― A.J. Jacobs

“When you arise in the morning think of what a privilege it is to be alive,

to think, to enjoy, to love ...”

― Marcus Aurelius, Meditations