New Home Forums Monthly Challenges November 2017 I've Got This! Operation Healthcaring 750Words

74 replies, 10 voices Last updated by  Laura Koller 5 years, 12 months ago
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    Laura Koller

    Today’s writing stats: 943 words

    Today the morning pages led me to an unexpected place.  Yesterday I wrote about the morning page ritual and how I’m using it to work through ideas that need expressing or whatever’s getting in the way of expressing them.  Today I wrote about whatever was getting in the way so I could get it out of the way, and surprisingly it led me to describing exactly the frustration that led me to creating this project, this course.  An excerpt:

    This morning I’ve been thinking about what I would write, and yet there’s this big, huge writing block, thinking block, living block that keeps getting in the way. I hate it It’s awful. And I wish that I could come up with some way around it, that I could improve the situation, but it’s really hard to do – probably because it’s another person and that person’s attitude. It’s consistently negative. It seems to be always focused on deficiency and what’s missing and what’s not working. And the worst part is that all this negative thinking doesn’t lead to productive solutions or even conversations. It leads to more negative thinking and an “I’ll show you” strategy. It’s about complaining and criticizing and yet not doing anything to improve the problem. It’s about taking a problem and actually making it grow. It’s about noticing all the things that are wrong in the world and instead of figuring out what can be done to improve those things or at least improve the attitude about those things, it’s about blaming and absolving responsibility for the problem. It’s a coping mechanism. I see that. The blaming and pointing fingers is a way to defuse the situation and make it not something that person is responsible for. It means no one has to do anything difficult or uncomfortable (well, not no one Just the person who’s doing the blaming and pointing fingers). It’s about noticing the deficiencies everywhere else but never taking personal responsibility for a problem. Never thinking, “What can I do that would confront this problem, that could acknowledge the issue and try to do something positive about it.”


    Sara McCann

    Laura, your writing is so beautiful, honest and open. You capture my heart and mind with it, make me feel and make me think. You have shared so much with us in your writing and I feel I can relate to all of your frustrations and carving out time problems and dilemmas and…well everything!

    I am so thrilled that you feel this writing is helping you to work things out, provide some form of therapy somehow, as well as providing content for your entrepreneurial future. I am in awe of how much you can write in such a short space of time and commend you for grabbing every moment to do it. I’ll be honest…if I had 10 minutes to spare before picking up the kids I’d find something menial to do because I’d feel it wasn’t worth starting anything productive as it would take my brain 10 minutes to get warmed up! So, honestly, you are amazing, I admire and am inspired by you so much!


    Laura Koller

    @saramccann – I appreciate your feedback and the fact that you willingly waded through all that mess.  This is my new problem, now that I’m not writing first for purpose, that I have to figure out to do with all the material: how to sort through it, how to sculpt it, what I want the finished product(s) to look like.  As for the 10 minutes bit, I’m now literally at the point where missing my writing feels like not brushing my teeth.  There’s a gap that needs to be filled and I feel incomplete without it.  Actually, now that I’ve assigned those morning pages for “expressing ideas or whatever’s getting in the way” – I crave my daily writing stint.  It is my daily therapy.  That being said, I also spend lots of moments in my day feeling forced into menial tasks because I’m engaged in childcare.  So 10 minutes of kids captivated by a screen?  I’ve now determined that’s gold in my book.  And since I don’t have time for messing around, that means I have to get to the point right away.  I’m in touch with my thoughts and my emotions so when the moment arrives, I’m ready to write whatever’s there.  It’s like bringing my conscious and unconscious minds together for a little soiree.  They like to mingle at least once a day and have the event captured by the fingers.

    In other news, I’m now characterizing all those little thoughts that constantly nag at my brain (buy snow boots for E, remember parent-teacher conferences, figure out how many teacher gifts for the holidays, buy a gift for C’s party this weekend, what’s for dinner tonight) as gnats that circle around my head.  At the moment, it seems hard to grab the right one at the right time – and those gnats are always hovering just outside my head, ready to interrupt a train of thought or moment of insight or just throw off the whole deliberate plan.  Darned gnats.  Grab a fly swatter and smash them all to the ground!


    Laura Koller

    Today’s writing stats: 2115 words (so far!)

    Before I share what I’ve written (which you should not feel obligated to read unless you want to), I want to say that I’ve really enjoyed how sharing our writing with each other has started conversations about important themes that carry through many of our projects.  Tomorrow – I want to talk about the idea of “HOLDING SPACE” because it’s a theme that seems to resonate with so many of our projects and valued experiences and today I’ve had some realizations about how that is such a metaphor for so many things in our lives – professional and personal.

    The kids didn’t have school today.  They were still sleeping when my husband came to bed this morning (he works nights and sleeps during the day) and asked if he could hold me before I started my daily marathon.  It was lovely, actually, that he was able to break through the barrier of my functional identities – mom, worker, maid, cook, enforcer – and tell me that he wanted to hold ME, connect with ME, be with Laura the person and not just observe from outside in his own cocoon and live our parallel lives that intersect only when our functions intersect.  That’s how it feels so much of the time, that the two of us have become functions and sets of skills.  We fit into specific spots and that’s what we become – not people but hole-fillers.  And the frightening thing is that we don’t even notice we’re doing this – that we’ve marginalized our humanity in the service of function and efficiency and productivity – and that while this may be effective for the short-term, we’re actually shrinking and limiting our experiences and our future selves, and we’re setting such a poor example for our children.  We spend so much time attempting to achieve a certain ideal or way of being, to do the things that need to be done in order to fulfill our obligations, and we forget to stop and observe things along the ride, to notice how we’re feeling, to listen to our gut about what’s working and what’s not working.  To relate to one another as human beings.

    Ironically, that’s what I was jotting down last night – notes about this idea of function and role and identity, and how that does not always intersect with the idea of humanity and emotion and heart.  So timely that my husband came to me this morning and seemed to notice the same deficiency.  “I miss you,” he said to me.  “What’s going on?” and I’m thinking the same thing about him.  I’m wondering what has happened over these years since we were so close and spent so much time together.  Back then there were fewer responsibilities.  Fewer obligations.  More open spaces.  Fewer distractions.

    This is not an issue specific to my marriage or my life.  It’s a universal concern, made all the more urgent by the advent of computers and technology that purport to make our lives easier and more efficient.  “New and improved!” we think as we add these devices to our lives, upgrade to the newest model, share the technology with others through social media and online communities.

    Instead, these devices introduce higher costs, more distractions, and instead of connecting with other individuals through eye contact, human touch, or even the sound of each other’s voices and the language of emotions that we convey not only with words but also with volume and tone and speed and even the occasional pause – we miss out on all those human qualities and we are reduced to words on a screen the size of our palms.  We sit at the dinner table with our families and have conversations with people in other houses and other cities and ignore the people sitting directly in front of us who, quite honestly, deserve our attention far more than some person sitting in another room.

    Back to the idea of identity versus humanity –

    So often I feel like I’ve become Laura the mom, wife, worker, cook, laundrywoman, dishwasher, scavenger, enforcer, negotiator.  I represent all these different roles in my life, I embody them by the things that I do, and it’s so easy to get caught up in my purpose and my function.  It’s so easy for others to reduce me to my purpose and my function.  “What’s for dinner?” “I didn’t make that mess.”  “That’s not my job.”  And it’s so easy to forget that I’m actually not Laura the Function.  I’m Laura the Person with thoughts and emotions and individual experiences and questions and concerns and responses.  I’m Laura the Person who would like a rest from the constant demand of fulfilling each of these roles, and Laura the Person who would sometime like to escape from this Groundhog Day that goes on and on.  I’m Laura the Person who would like to be appreciated for my efforts, acknowledged for my sacrifices, and seen as an individual who does each thing with my own individual talents and skills and my own personal touch.  And the grand irony is that when people stop seeing the unique and individual ways that I do things in the world, it makes me feel frustrated and aggravated and then bitter and angry and resentful.  So the functions that I’ve been willing to fulfill for such a long time – I feel less fulfilled and less motivated and less wanting to do a good job at those things that once meant so much and now are just accepted functions of this body that performs them.  I want to be helpful and pull my weight, but I also want to be seen as an individual who has choices and chooses to be generous with my time and my heart when I have the opportunity to do so.

    Let’s think about how this applies to healthcare.  When a patient shows up to the doctor’s office for an appointment or to the clinic for a lab test, how often do we view this person the diagnosis, the problem, the medical chart, the appointment, the seat filler?  And how often do we see this patient as a person with thoughts and emotions and individual experiences and questions and concerns and responses.  How often do we see the patient as a parent, a caregiver, a worker, a sibling, a child, a person who matters to other people in the world and serves important functions in the lives of those other people?  When we provide care to a patient, we provide care to someone who adds value to the world in one way or another, even just by the act of existing and living and breathing?  How often do we step back and say something to the patient that demonstrates we know that they are not just a number or an insurance card, but rather a living and breathing human being with their own individual perspective on the world and their role within it?  How often do we ask the patient how s/he is doing and actually stop and listen to the answer, without interrupting or rushing ahead to the next step in our process?

    And how about our patients?  How often do they arrive at our office and think about the office and their providers as functions within their day and their lives?  How often do they see the doctor or healthcare professional, the expert, the hand that signs the prescription?  And how often do they stop to recognize that we are also parents, caregivers, workers, siblings, children, people with emotions and unique experiences, people who matter to other people in the world in different capacities than the one that we are filling at that given moment?

    What would happen in healthcare if we started each interaction by initiating and building a relationship, instead of checking off the boxes of our individual functions?

    It’s easy to look past the person who stands in front of us.  It takes time to make eye contact and step out of the role we’ve been assigned to fulfill.  The value of relationships lies in the fact that they make us feel more human by doing two things.  First, when we stop to view the other person as a human being we honor our similarities and we seek things that we have in common.  Do we share similar experiences?  Do we celebrate similar holidays?  Do we share a community or concerns about the world?  At the same time, when we stop to view the other person as a human being we also acknowledge our differences .  We value what makes each person an individual, what sets them apart from any other person who might be sitting in the same chair or speaking to us on the phone or bagging our groceries.  When we stop to view the other person as a human being, we are able to draw from our experiences with similar people and similar situations, and we also pay attention to what makes this person and this situation unique and remarkable.

    Many years ago I attended a conference and I remember one social worker who spoke that day saying, “I don’t share my personal details with patients.  I don’t find that to be appropriate in a clinical setting.”  At the time I nodded my head and I thought I could understand where she was coming from.  Patients don’t need to be burdened by our individual concerns and challenges.  They don’t need to add our own worries to their own.  But that observation has never sat well with me and I’ve finally discovered why.  It’s because when we share our own personal details with patients, we are working to build a relationship that is not based only on role and function, but also on our humanity.  We’re saying that the two of us may be filling roles of expert and patient or knower and learner or two other dichotimies that place one person above the other.  When we extend an olive branch to the other person, though, we’re saying that we accept them as they are and we see that they are human like us and that we share common experiences – and somehow knowing that is reassuring to the patient.  If the patient knows that the provider has challenges and struggles, then the patient may have more confidence in the relationship and be willing to admit that they also struggle.  I can’t tell you how many breaths of relief I’ve heard, how many conversations have been started when I’ve talked about a struggle with a favorite food or a challenge with one of my kids.  It brings us together.  It honors our humanity.  And then the other person feels some kind of investment, some kind of trust for this other person that may not have been there before.  I’m not saying that the patient doesn’t trust an expert when that expert doesn’t reveal their life story, nor am I saying that the expert should lay out everything in full view of the patient or not have boundaries about what is worth and appropriate to share.  I’m just saying that when the patient feels approached as a human being and not just as a body, that patient has a greater likelihood to feel warm and open and positive about that care provider.  There is actually a phenomenon (and I can’t remember what it’s called) that when one person reveals something about someone, the other person is more likely to reveal something in return.  It’s a give and take relationship, and by being willing to give something we are more likely to gain something meaningful in return.

    One of the doctors I’ve worked with routinely tells her patients about the Thanksgiving preparations she’s making, the large number of people she’s going to have at her house and the menu that she will be preparing and serving.  One time a patient implied that the doctor couldn’t possibly bake anything, and the doctor brought the most delicious iced toffee cake to the clinic the following week so she could show her that – yes – she could bake and she could bake something delicious.  That always touched my heart, that it meant something to her for her patients to be able to view her in a different role than as a doctor and healthcare provider and prescription writer.  She wanted her patient to see that she had many capabilities, and she shared many skills and talents with the patient herself.  How powerful is that?

    So I guess that’s the moral of today.  That it’s important to build relationships so we can step outside of our functions and our roles and the technical aspects of what we do, and become real people to ourselves and our families and our patients and our own healthcare providers.  It’s important to establish similarities, so we feel as though we share something in common and that builds community, and also that each individual and each situation is different, so that establishes an appreciation for the things that make us unique and valuable.


    Laura Koller

    Today’s Writing Stats: 2013 words

    Yesterday I had a lightbulb moment about my course and the needs of my audience.  Awesome.  For anyone passionate about my course, here are the details.  Kind of rushed with multiple interruptions.  I hope I’m able to convey the idea clearly enough.

    Happy Thanksgiving! The morning was a lot of boys screaming and behaving hostile towards each other. Not the most gracious behavior that’s for sure. And now, at least for a few moments, the older boys are engaged in Minecraft on the Playstation and the twins are playing with the bin of mismatched legos. Ah, a moment of peace. I’m so thankful for that!

    Yesterday I said that I was going to talk about the idea of HOLDING SPACE – a theme that flows through so many of our course ideas. I do still hope to talk about that idea, maybe a bit today, but I had a HUGE LIGHTBULB MOMENT yesterday and I’ve been waiting for a moment to capture it in writing.

    This week I received an email from an online publication called New England Journal of Medicine Catalyst. The reason I’m on their email list is because I stumbled across their website months ago and decided to submit an inquiry to publish an article. The article idea was later rejected (oh well, at least I tried – I thought “Why I Stopped Seeing Noncompliant Patients” was well-suited to their readership but apparently not. Now I can reserve it for my own website – I think it will be a sensation) but then, as I said, I received an email this week telling me about a new publication called “Physician Burnout: The Root of the Problem and the Path to Solutions” and that publication may boomerang my course idea into new areas and realms.

    So first of all, I am not a physician. I am a dietitian. Nonetheless, this topic is important to me because a) I’m creating a website that’s dedicated to “Changing the Conversations of Healthcare Professionals” and that includes physicians, and b) I did not realize that physician burnout was so pervasive – more than half of physicians experience burnout, and it’s thought that this number is increasing due to factors including Emergency Medical Records, demands for increased productivity, as well as the increasing complexity of medical patients. If this is true for physicians, it must also be true of other healthcare professionals who support them and work in the same environments as them.

    So the first thought in my head, as I download this 48-page publication, is that WOW this means that the work I’m doing is important, urgent, and timely. There’s lists of all the bad things that happen because physicians (and presumably other healthcare professionals) are disengaged. “Broadly speaking, disengagement undermines morale.” So true. When we can engage healthcare professionals and enable them to feel competent and capable, we improve their morale, the morale of patients, and ultimately the outcomes that matter so much.

    Then I start reading through the multiple articles, and one major theme that comes through is this: As a culture, we tend to blame physician burnout on the physicians themselves, we think it is an individual problem. We can address the problem with initiatives that target the individual – resilience training, time outs. That if we just train physicians better, then the problem will improve. The reailyt, though, is this. Physician burnout is not an individual problem. It’s actually a systemic problem, and research demonstrates that this problem starts during medical school and clinical rotations. These individuals who enter this field, people with exceptional dedication to caring for others and learning copious amounts of material, start with higher than normal levels of resilience and self-affirmation (I can’t think of the exact word there, but that will do for now) and by the end of medical school and medical training, they are already falling, our system is already failing them. Anyway, the theme I want to address here is that WE BLAME THE PHYSICIANS THEMSELVES but really it is a systemic problem.

    One of the problems is that due to the increasing size of our medical systems, we are now focusing more on metrics and less on relationships. Quality indices, which are supposed to improve care, may not reflect what patients and their practitioners perceive as quality of care – but simply what managers are able to extract from the health record system. According to one physician, “Getting in and out quickly, ticking off all the boxes, and getting your records completed promptly – these are the things the system values. But my patients want me to listen to them and make sure their concerns are addressed. Being assessed every day by measures that don’t really improve patient care – over time, it takes a real toll on you. The people in charge don’t realize that you simply can’t pull real quality out of large data sets.”

    According to this physician, her goal is not simply to meet productivity targets, but “to take the time to get to know my patients and intervene in ways that actually improve their lives.” The people who care for patients feel that “face-to-face interactions with patients, not board meetings or creative huddles, are where health care needs to focus.” Unforutnatley, “hospitals and health systems are becoming increasingly detached from the reality of meicine. As organizations grow in size, they rey less on relationships and more on aggregate data and policies. As health care shifts from relationships to data-driven, process-oriented approaches, it inevitably discounts the needs of particular patients and the people who care for them. As many physicians see it, collecting evidence to demonstrate that healthc are organizations and their executives are performing well is ultimatley less important than taking good care of patients.” The article ends by stating, “We need a renewed commitment to the most central of all medicine’s ends: caring well for patients.”

    And what that means for me – is that I can’t just create a course that’s a band-aid, something that promises that it will fix patients and the frustrations themselves, and also that I can’t presume that physicians and other healthcare professionals aren’t doing their very best already, and that they need one more set of instructions to follow. To presume that I have the one solution is ludicrous and big-headed. And to suggest that it’s a problem of individuals not carrying their own weight is short-sighted and lacking compassion for people who are already working through so many systemic obstacles to care for their patients.

    So, in essence, I don’t want to create a band-aid, a “new strategy” approach that adds more to all the other things these healthcare professionals face in their daily work. The goal is to create a course that SUPPORTS healthcare professionals and their work, so in this case it may not be just about better caring for patients, it may actually be about better caring for patients AND the healthcare professionals themselves. I can’t come in with a dictive that says “You are doing things wrong and here are the right ways to do things.” Instead, I have to say, “You’ve been doing your best to care for patients in a system that doesn’t always help you to do that the best way. Here are some strategies that you can teach your patients, and these same strategies can also enable you to take care of yourselves.” THAT is empowering.

    That leads me to the ideas presented in another article within this publication, that suggests that there’s a problem with the current prescription for physician burnout. These problems are the idea that busy clinicians will take their free time to sit by themselves and watch modules and revamp their workflow, that we expect educational resources alone to motivate behavior change, and that we spend so much time describing and diagnosing the problem rather than “experimenting to innovate solutions”, and that the solution is for individual clinicians to “practice self-defense against increasingly untenable clinical demands.” The author argues that the medical profession is attempting to address burnout with symptomatic management and treatment of the individual.

    This author suggests an idea that may propel my course in a more proactive direction. He says, “Rather than resiliency training, how about performance training? In addition to training to be competent clinicians, we must train in order to maintain that high performance – both for ourselves and for our patients. Meeting our high professional standards day in and ay out requires systematic and intentional training. Whereas stress management is defensive and reactive, performance is offensive and preemptive. Depression screenings and mental health resources help with coping, whereas performance training optimizesfor thriving. A campagin against burnout combats disease, whereasa campaign for performance promotes vitality. Self-care sounds soft, whereas performance is hardcore. Performance is immediate and tangible, whereas wellness is delayed gratification – a notriously hard sell. Minset is important; building a new skill set in personal performance to enhance both self- and patientcare generates an internal locus of control, which drives motivation and action.” The author also highlights the fundamentals of human performance – “sleep, physicial activity, nutrition, mindful awareness, energy management, and self-compassion” and likens these to the tenets of lifestyle or preventive medicine. Essentially, we are encouraging clinicians to “train for peak performance” and concludes that “when empowered and supported to take care of ourseves as whole people, we are more willing to treat our patients in kind.”

    So to summarize what I’ve stated above: it’s important to change the conversations of healthcare professionals to incorporate not just more effective strategies to use with patients, but also to discuss the daily challenges we experience at the patient and system levels that make it dififcult to practice the type of medicine that practitioners know in their hearts is the way to practice medicine. And ultimatey, any solution needs to be targeted not just to effectively engaging and educating patients, but also successfully engages and educates the practitioners who care for them.

    So the Operation Healthcaring course? It’s going to be about OPTIMIZING THE PERFORMANCE OF HEALTHCARE PROFESSIONALS – AT WORK AND AT HOME. I’m going to use all the same strategies – Mindset, Listening, Bright Spots, etc. And it’s not just going to be focused on using these strategies with patients. It’s going to be focused on using these strategies in real life, and also applying them in our work with patients. That’s why the Pill Problem story is so powerful (according to the feedback I’ve received so far) – it’s because I’ve taken a personal problem, a challenge that I’ve been facing in my own life, and I’m figuring out how to face this problem as a human being and then I’m relating it to the challenges that my patients face and suggesting that we can apply the same strateiges with them. And the best part is that these strategies are so effective and so universal, that they apply in so many different situations, and by using them we can improve the quality of our own lives, hopefully decrease the demands and stress that we place on ourselves at work and at home, and by improving our own lives we have the energy and incentive to share these strategies with our patients and improve their lives.

    That also means that the journal entries and ideas will not just be about healthcare situations. They can also be about home situations, about work/life balance (ha! that’s a joke of a term), about priorities, about efficiency vs. productivity (they’re not the same thing). That means I can talk about my own experiences as a patient and then apply those to my experiences as a practitioner. that means I can talk about my own experiences as a human being, and then apply those to my experiences as a leader.

    Must go. Children screaming. Again and again. It’s never ending. What a miracle that I was able to carve this time out for creating something that has the potential to change so many lives – when many times I’m barely capable to impact the lives in my own house in the way that I’d like to be able to do. Ah, parenthood – the ultimate measure of humility for any person on this planet.


    Laura Koller

    Two more things to add:

    I’m reading 18 Minutes by Peter Bergman, and apparently the phenomenon of depersonalization at work is mirrored in business – “It’s tempting to blame the companies [for the increase in work-related suicides]. A good article in The Economist pointed to a variety of things [including] the drive for measurement and maximizing productivity … Companies need to do more than pay lip service to the human side of management.”  So this is a phenomenon that extends beyond healthcare and into business.

    Second – I’ve got the tentative tagline for the Operation HealthCaring course – PERFORMANCE TRAINING FOR HEALTHCARE PROFESSIONALS.  I may need to include something about work/home or personal/professional. I’m not an accomplished athlete, but I can certainly relate the theme to training different parts of the Operation-style body. The ears. The eyes. The mouth. The brain. The heart, the hands.  It’s about caring for patients, and it’s also about caring for the healthcare professionals themselves and the demands in their lives.  I have all the material in my head, probably more that’s buried in my brain, but GEEZ this feels so empowering, both for me and the course as well as for the healthcare professionals I’m creating it for and all the patients and family members and friends and strangers that will be impacted by the improvement in intention, competence, relatedness, autonomy, and enjoyment. I call that the “I CARE” approach to motivation.

    My heart is singing right now, feels as though it might burst.

    Happy Thanksgiving to all!!!


    Fiona McAllister

    Wow, @laurakoller very interesting.  I look forward to see what you do with the healthcaring for professionals.  This is great.


    Bobbie Jo Van Den Plas

    @laurakoller … Just going over your entires and WOW! Very inspiring. Excited for your TedTalk (seeing it for you!)! Loved reading about the stories we tell ourselves. Love and totally agree with the humanity parts! I’ve said that ‘I miss you’ many times as well, and it is just wanting that connection. I’ve been really focusing on that with everyone I encounter. Makes life so much more beautiful. You’ve inspired me to make myself even more aware of it. Also, with some recent personal health stuff, I’ve really appreciated the providers who have listened and cared and are helping to find and answer questions and don’t mind me calling with more. Got great insights from your performance writing here as well! Also- glad to see your different writings and know it doesn’t always have to be the one project- or A project (as that’s how I first came into this challenge). So, THANK YOU!! Write-on!!


    Laura Koller

    Today’s writing stats: 2260 words.

    Summary: I finally got around to writing about HOLDING SPACE.  Also about setting priorities and determining what things only I am uniquely qualified to do.

    This morning I woke up knowing that I have to turn down the kidney chef writing gig.

    It has to do with the whole idea of holding space, that idea that runs through so many of the projects and courses that we’re planning. Here’s the idea. In order to honor something, we have to hold space for it. In a relationship, we have to hold space for the other person to express themselves without judgement or interruption. It’s like holding back all the other things that are threatening to intervene. I picture it as the listener who is holding open a bubble for the speaker, and at the same time holding back all the other people and thoughts and stories and disasters and all those other things that at our back so that we have this space that we are able to hold open for that other person. It sounds easy to hold space, but it’s not. It takes a lot of effort to keep that space open despite all the other demands and interruptions and catastrophes that threaten to get in the way. I can see the listener sweating, grimacing, the muscles tensing to hold all those other things out. It’s often not an easy thing.

    In a schedule, we have to hold space for the things that are most important. If we don’t hold space for the things that matter – our spouses, our families, our friends, activities we love, time to rest and relax – then other people aren’t going to make the space for it to happen. So if you’re thinking about your goals and priorities for the coming year, it’s important to actually determine those priorities and schedule those priorities and carve out the time for those priorities. And then – when something new comes along – then you have to decide whether you can hold the space for that new something. Many of us don’t stop to think about the implications of saying yes because we’re so worried about the implications of saying no – disappointing the other person, looking bad, not seeming like a team player, missing out on something that might emerge as a result of this opportunity. But every time we say yes, we hold space for something else. And there’s only so much space in our lives. It’s not just schedule space, the amount of time that’s available. It’s also mental space and personal space and relationship space. Every time you say yes to one thing, you’re saying no to something else. And for many of us, the no that emerges from the yes will lead to us holding less space for one of our priorities. Maybe not always – maybe sometimes that yes will actually fit in with our priorities and that makes it a no-brainer – but I’ll venture to say that most of the times when we say yes, we’re saying no to other things that we value at least as much if not more.

    Which leads me to the kidney chef gig. At surface value, this seems like something that fits with my goals and priorities really well. I enjoy writing and I want to do more of it. The audience is a group of people I care about – people with kidney disease. The project is something valuable – showing people with kidney disease that they can make food choices that support their health without sacrificing good food and good taste. And my work would be published online and people who care about the same things as I do could read it and that could bring about new contacts and opportunities and bring new traffic to my website. And though it wouldn’t be my primary reason for taking the gig, there would be some payment for my work so that makes it valuable too.

    When I stop to think about my top priorities, however, it’s just a little off the mark. My priorities include my family (a big commitment including 4 boys under the age of 12 and a marriage that could benefit from holding more space), my work (a full-time job that enables me to support that first priority, and also enables me to do meaningful work that adds value to my own life). And now I have this other priority – starting my own online business dedicated to supporting healthcare professionals in starting new conversations and training them to optimize their performance on the job, off the job, and everywhere in between. Right now I don’t hold space for this third priority – rather the project is like a beverage that finds space when it spills around the other priorities. I’ve managed to carve out time every morning to think about it while my fingers capture it on the screen. I listen to audiobooks during my work commute that add creativity and complexity and new realizations to the material I’m creating. And I steal moments during the day to collaborate with my online community about my project ideas and share in the feedback and support from others in similar boats. I would like to become better about holding space for this other priority, I would like to earn some money from this third priority so I can hold less space for the second priority and therefore create some dedicated space for priority #3. At the moment, though, it’s a lot of creative balancing and that can be stressful – especially when priority #3 conflicts with the demands of priorities #1 and #2. Which is actually pretty often, that I’m engaged in one and feel the need or the desire to switch to the other priority.

    So when I think about this kidney chef writing gig, I think about how it fits with my top priorities. I don’t think a person can have more than 3 top priorities, and in fact 2 would be preferable (and when I can get priority #3 off the ground I hope it will actually take the place of priority #2 – work – and therefore my life will be at least a little more simple. Maybe?). So where does this writing gig fit?

    Well, it certainly doesn’t fit with the family priority. Taking on this writing gig will hold space that could have been dedicated to playing with my kids or spending time with my husband after they’ve gone to bed. So that’s a fail on that one.

    It does fit with the work priority, in terms of the audience and the meaning in the work. The only problem with that it’s something “extra” I’d be doing beyond all my other obligations on the job. It’s not something my company would value. And any time I’m able to hold space for writing and editing an article for kidney chef during my time at work – it would be space I’m holding at the expense of something else I could have accomplished during that time that might have benefitted one of the other priorities. So it’s an almost fit on that one, but not quite.

    And last, the online business priority, it seems to fit. If the goal for priority #3 is to build an online business dedicated to changing the conversations of healthcare professionals and training them to optimize their performance on the job and off the job, this fits with that. I’m providing tools for patients, and presumably tools that healthcare professionals can read themselves, for teaching people how to change their behaviors in effective ways and stressing the things that really count when it comes to managing disease with our lifestyle behaviors. That’s a win there.

    The only problem is that, at least in this case, the online business I’m supporting is not my own, and the articles I write for this website will not work on my own site because a) I’d be writing for a slightly different audience (patients instead of healthcare professionals themselves) and b) I can re-use some of the content but I can’t publish the same article. Add to this, I’m an obliger and therefore agreeing to publish these articles for someone else’s site will end up trumping my own commitment to creating articles for my own site. I’ll spend more time worrying about the quality of the articles I create for this other website than what I actually end up publishing on my own site. So even if it’s manageable time-wise (which I’ve already realized that time dedicated to this new writing gig will be space I’m holding at the expense of creating content for my own site), it will actually be a mental drain from one of my top priorities, and maybe from ALL of them.

    Add to that the uniqueness factor. Thinking about me and the priorities I want to hold space for in my life, which are the priorities that REALLY REALLY matter. In other words, what are the priorities that I can uniquely fill and no one else can take my place? In terms of my family, there is no one else who can fill that priority in the same way that I can, with the same dedication and knowledge and commitment. I suppose I could get a babysitter or put more responsibility on my husband (which he already does a lot for the kids, and that wouldn’t necessarily strengthen our marriage – might add more bitterness and resentment unless there’s a better payoff for him like he can cut back on his hours at work). So the FAMILY priority – I am uniquely qualified in a way that no one else in the world is.

    At work, I have unique qualifications that make me a good fit for my job, but in my job as a dialysis dietitian at a dialysis facility? There are other people who are capable of filling my role. Heck, in the last 6 months I’ve helped to cover 2 maternity leaves. If I’m able to cover maternity leave for 2 dietitians in 2 different facilities, then no matter how valuable those employees are to their facility, it means they’re not irreplaceable. It’s always possible for someone to NOT return from their maternity leave, and that means someone else will need to be found and trained for the position. So I am uniquely qualified for this role and yet I am replaceable. Which is why I can choose to cut back my hours or leave my position when I start generating enough income from my online business. The next person won’t be the same – she’ll have her own unique qualifications – but someone else can still step into the same role.

    As for the online business, I am uniquely qualified for this role based on my education, my experiences, and my passion for the project. This is something I feel compelled to pursue not just because it’s meaningful to me, but because I’m not seeing anything else like it on the landscape, at least not yet. And even when it comes to online education for dietitians, the course I’m envisioning is going to be unique even in that arena because I’m envisioning a community and opportunities to practice these skills out in the real world and share those experiences with others.

    And that leads me back, once again, to the kidney chef gig. I am uniquely qualified for this role – but there are many other people out there who are also qualified for this role. When I think about my phone interview with the guy in charge, he wasn’t “SOLD” on me from the very start. He was just intrigued by my profile. But he didn’t remember that we didn’t speak after his first contact, he hadn’t noticed that I was an English teacher before I became a dietitian – essentially, there were details in my profile that made me a good fit that he hadn’t even appreciated when he reached out to contact me. So I’m thinking that he wants qualified candidates to write for his site, but there’s nothing so unique about me in his head that I couldn’t be replaced by someone else with similar qualifications. He’s holding a space for a renal dietitian, but that renal dietitian doesn’t have to be Laura Koller – it can be another renal dietitian who is interested in writing for an audience they feel passionate about and have their name published in the online business world.

    So saying yes to the kidney chef gig means saying no to holding space for my top priorities, including one that so far doesn’t have dedicated space held for it. I can say yes to this writing gig and it might lead to some interesting experiences and opportunities BUT it also means taking time away from something else that might lead to some interesting experiences and opportunities engaged in my own online business. And when I think about the opportunities for which I am most uniquely qualified and irreplaceable, I know that the top two items are a) mother and wife to four boys and a husband, and b) starting an online business dedicated to changing the conversations of healthcare professionals and training them to optimize their performance on the job and off the job. Moving into the new year, I need to be sure I am holding space for those top priorities, even at the expense of minimizing space or turning away other opportunities, because those are the things that truly matter to me and that I am truly meant to do.


    Bobbie Jo Van Den Plas

    @laurakoller Yes, yes, YES! This is SO good! Thank you!! You’ve inspired me to connect in now and write out my space holding priorities. So much inspirational goodness in this. Thank you for sharing!


    Laura Koller

    @bobbiejo – I’m so inspired that you’re inspired!!!  Amazing how daily writing can connect a person with her priorities.  And whether or not those priorities are connected specifically to your online course, don’t they all matter in the long run?  Look up the Four-Burner Theory for a similar perspective on the concept of limiting priorities.  I hope you’re setting yourself up for a successful and priority-laden 2018 🙂

    @fiona – Thanks for stopping in and sharing your support.

    Oh, another thing.  I thought I would call the course Operation Healthcaring – but I’m not.  That will still be the website, dedicated to Changing the Conversations of Healthcare Professionals (haha – spellcheck corrected that first word to “Chaining”).  The course itself will be called SUPERTRAINING: Superior Performance Training for Healthcare Professionals – train for your own peak performance on the job, off the job, and everywhere in between.  The Motivation Superhero in me just can’t get away!!!


    Laura Koller

    Today’s Writing Stats: 1881 Words.

    Summary: I reflected on my family’s media habits and money habits – two areas of focus for me at this time without any clear solutions, mostly muck.  And then I stepped aside to think about the title of my course.

    The latest thinking was Operation Healthcaring: Changing the Conversations of Healthcare Professionals with a course called Super Training: Superior Performance Training for Healthcare Professionals. Peak Performance Strategies to Live Your Best Life At Work, At Home, and Everything in Between. I love this new direction, and I see some even bigger possibilities – including physicians as a target group and maybe even medical school training programs. HOWEVER I really want to get away from the word and the concept of performance, which to me implies pretending and/or putting on a face for other people even when it’s not how you feel from inside. I want this course to be about improving yourself from the inside out, living more fully and in line with your values and beliefs. Something like that – that’s not exactly it. I’m thinking about EXPERIENCE training – but then that doesn’t have the same implications as performance training which seems powerful. But I want to increase presence and satisfaction and things like that. They may happen because of how we perform, but it’s not about performing, it’s about being present and experiencing moments rather than acting out some type of role. It’s about being true to yourself. Experience is the first thing I can think of, but EXPERIENCE training doesn’t have the same power and oomph to an audience. I’m still seeking clarification and enlightenment on that one.


    Laura Koller

    Today’s Writing Stats: 935 Words.

    It’s about 15 minutes before 10am when my husband will be walking in the door from work. All 7 boys in the house (all under the age of 12) are right now in the basement playing pinball and video games and on their devices. I’m actually not sure. I just sent them down there after the Koller classic breakfast of eggs, bacon, and bacon-grease English muffins. And thinking I have 15 minutes (not sure if they’ll be without interruption – that’s a gamble) then I can sit down and put in my morning pages, my words for the day.

    The only thing is I haven’t really thought about what I was going to write today. I don’t have a topic at the tip of my brain, something I’ve been mulling over in my head or just waiting for the right moment to express. I’m sure I’ll have one or more thoughts like that at some point today, likely at times I’m not able to capture them, but at this time my mind is scrambling to figure out what I’m going to fill this space with, the space that I’m holding to empty everything that’s in my brain and hopefully come up with something that might apply to my course – the content, the theme, the script, whatever things I need to finish, whatever things I want to finish. The Stuff That Needs To Get Done.

    So perhaps I can start there, with the items that need to get done.

    First – I need to get the blog up and running. All the elements are there. I just need to publish a few posts and make sure the tech part is working. I have it on good advice that it will. I think I can dig back through the material I’ve written this month and come up with material for at least a few posts. The stuff about what healthcare isn’t and COULD be. That’s the one that’s popping into my head right now. But then there’s other stuff I probably don’t even remember that’s been forever immortalized at 750 words and I will wonder who actually wrote it back when because I don’t remember actually thinking or writing it. When my fingers are flying across the keys it’s often like capturing my unconscious thoughts when I’ve barely had time to think or consider or evaluate them. Which is good. It just means it doesn’t always register in my brain when it’s expressed on the page.

    Which is getting off the topic of stuff that needs to get done. You wonder why I haven’t gotten stuff done. I’m so busy exploring the tangents that I’m not pursuing the core of my work. Hmm mph.

    Next – after the blog is up and running and I have some content (not sure how often I’ll plan to post it, although a structured schedule would probably be good for disciplining myself to get it done) then what’s next? I’d like to work on my lead magnet. Which I’m thinking is going to be that four-week four-email course about FOUR WINS in FOUR WEEKS and creative teaching strategies. Mindset. Bright Spots. Shrink the Change. Build Habits. Somehow I can capture each of those ideas in a (somewhat) brief week’s worth of assignments – I want to save the really deep stuff for the course itself – and put it out there so others can use it.

    I do have a lead magnet I could use now – the article “Why I Stopped Seeing Noncompliant Patients” – which I think could interest people just enough to subscribe to email list because they’re thinking, “Gee, I’d like to stop seeing noncompliant patients. That would make my job so much easier!” Maybe they’ll be disappointed with what I say, or maybe they’ll be enlightened. Maybe they’ll unsubscribe because it’s not what they want. But that could actually be a good thing because if the “Why I Stopped Seeing Noncompliant Patients” article doesn’t resonate with you, then you’re not going to be interested in the rest of the stuff I’m going to share. Probably not anyway. And maybe those people who were ticked off my the fact that I actually didn’t stop seeing any of my patients, that I just stopped seeing them as noncompliant, maybe it will come back to them and make them think and then maybe – later on even after they’ve unsubscribed – they’ll decide to come back and see what more they can learn.

    And then the course. Of course. And since I’ve hit 750 words and there are 7 boys meandering about the house and my husband will be walking in the door in another 5 minutes – I think this will be it for today. At least for this morning.

    One more thing – I need to look at my schedule for this week and I need to hold space for the most important tasks. If I don’t hold space then the tasks will likely not get done. They’ll just keep waiting for the right opening in my schedule that will never exist specifically for the task. And if I want to make progress on this passion project – then I need to be deliberate about holding space regularly, maybe even routinely at some point. For now, though, at least I’m holding space for the thinking and the writing and the thoughts that will, at some point, propel me forward into a new space that I’ll be holding for the realization of this vision, this dream.



    Boy are you digging in and getting the heart of things @laurakoller! Love it.

    I was reading what you’re pondering the other day, and wanted to speak to a part of your message regarding the meaning of the word ‘performance’.

    HOWEVER I really want to get away from the word and the concept of performance, which to me implies pretending and/or putting on a face for other people even when it’s not how you feel from inside.

    I think maybe from other conversations around here you might know that I have a background as a performer on Broadway/concert stages around the world/TV, etc. And I also spent years studying and teaching other performers/artists during the decades when I was actively performing. You’ve hit on a critical issue that those of us who took the art of performance seriously, and were seeking to create artful communications that were meaningful to our audiences…

    During all of those years, I often found- especially newer, inexperienced folks- that there was a misconception about what constituted ‘performing’. They were often operating under the notion that they needed to be ‘something shinier’ than they actually were. They were usually imitative, plastic…over-working…And my work as a coach was to get them to DROP the pretending, DROP the pushing, the overselling, the trying-too-hard…and to begin to understand that THEY WERE ENOUGH. The work was to help those individuals to access their own authentic self, their authentic point of view, their unique personality and way of being in the world, and allow THAT to be the starting point of their work. That’s harder than it sounds, because it’s often accompanied by the history of shame, of the ‘critics’ in our lives that actually somehow communicated to us that who we were was somehow lacking.

    Beyond that, ‘performance’ has been given a bad name by all of the slick, over-produced, plastic work that has been allowed out of the gate in the world of TV, as well as some bad movie work. It’s really a by-product of the post-war world of “Mad Men” who thought that the goal was to ‘fool’ people into buying stuff; and has been perpetuated by that world as well.

    However…my thought, my challenge to this, is: the problem isn’t the word ‘performance’. Perhaps that word has been overused in the ‘peak’ sense. I, too, played with that phrase when tinkering with the thought of a functional nutrition course. And like you, it felt too slick…conjured up images of plastic, ‘happy-peppy-people’…

    But ‘performance’ is something we admire in many fields: certainly in sports; in medicine, we appreciate ‘healthy performance and function’ in the body’s systems; under-performing thyroid, or adrenals or kidneys, or pancreas…well that’s not good, right? And we’ve all sat in a darkened movie house after a film ended, feeling so moved, so affected…by the performances we’ve experienced…which brings me too…

    I think there’s something else though that you’ve hit on: ‘experience’. In the best of all possible worlds- and something I always focused on with the folks I coached- is that a ‘performance’ worth its salt ALWAYS creates an ‘experience’ for those who are in the audience for that performance. Which leads me to: ‘performance’ done well, in an authentic way, and ‘experience’ are the flip sides of the same coin. And…the way to insure that that happens is that the PERFORMER isn’t ‘pretending’ or ‘pushing’ or trying to ‘make something happen’, but instead is having their OWN experience, which allows the audience to witness something both deeply powerful, and intimate and fragile…

    I hope this provides some insight for you- I love where you’re going, and I think you’re really close to getting the language that works for you…and I’m very much into the conversation if it helps you to keep things going!


    Laura Koller

    @tripphanson – I really appreciate your connection and your insight!  You and I are definitely on the same page about this one.  The last time I got up to speak to a group of people, I made myself repeat the word experience in my head several times.  I wanted to provide an experience – not a performance – for the audience, I wanted to fully experience the talk, and I wanted this to change the experiences of my audience.  I find that EXPERIENCE is such a key word in so many aspects of life, my current theme word, to remind me to slow down and actually be present in every moment as much as I can and think about how others are experiencing the same moments given their own past experience.  So the word experience is quite key here, but unless you’ve arrived at that conclusion already I don’t think it’s going to be the thing that hooks my audience.  There’s still something compelling about performance, especially from an athletic and training perspective that will fit in nicely with my course outline and lessons.  But I’ll have to sit with it longer.  And probably land on something else that I’m entirely sure about.  And then decide that something else is more appropriate.  That’s the way things usually roll.

    Anyway, thanks for reading and joining in the conversation.  I value your input and experience 🙂


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