Here’s the article that started my reflection on performance vs. experience: Stop Focusing on Your Performance by Peter Bregman

@judyb – You’re right about performance external / experience internal.  Thanks for saying that out loud.  I love that you appreciate the power of words and their underlying meanings.

@davidj – I appreciate your insights, as always.  I will have to look more closely at those assessment tools.  The more I delve into this new way of thinking and practicing healthcare, the more I feel as though I’m venturing into therapy waters.  I think maybe that’s why this approach can be so challenging for practitioners because “I don’t do therapy” is the response – but often it’s not therapy that’s required and just listening attentively can accomplish more than we imagine.  And I don’t want to tell you how many U.S. general practitioners I’ve met who “don’t do therapy” and also don’t have any recommendations of where to do therapy and throw it back to the patient (who has already admitted s/he is struggling so not best-case scenario) or just brush off the issue as though it’s an issue of life dynamics and not mental health.  Probably not entirely their fault, given the apparent hardships of being a physician, but when I’m willing to go the extra mile for my patients then why can’t I find someone else who is willing to do the same for me or someone close to me?  Unfair.

Yes, I’ll play around with the words.  Other thoughts include reflection, practice, deliberate, proficiency.  I’m back in the waters of trying to describe something intangible with concrete words.  Challenging.

OPTIMIZING THE EXPERIENCE OF HEALTHCARE PROFESSIONALS.  Hmmm…

@judyb – Yes those three words are the core principles of what I want to teach – and live = through my course. I’m now convinced we were sisters in a previous life!

Today’s Writing Stats: 1766 Words.  Wow!  I’m about to break 45,000 words this month.  That’s huge!

Summary: The last two days it was hard to write because I didn’t know what to write about.  Today it was hard to stay focused because I had so many ideas that I could write about.  I’m working on new life habits for HOLDING SPACE.  My intention is to unplug after dinner to play games and read stories to the kids while preparing for bed, and then after they go to bed to use that time for jotting down my own course ideas on paper (not on the computer which can be so distracting and time-sucking) and reading.  I had to be firm with the kids about turning off the screens, which is hard for me, but it was worth it because I was holding space for family time and playing games that normally collect dust on the shelf.  And then, instead of getting sucked into the computer after the kids went to bed, I was able to focus on the actual content and ideas and not get sidetracked by all those details that interfere with what really matters.

Anyway, I woke up this morning with a new idea about the course.  I think the more often I use the time before bed for collecting and sifting through my ideas sans screen, the more often I may have these types of early morning revelations – you know, after my brain has had adequate time to process and synthesize them during my sleep.  I’ve decided that the course is going to be about learning principles that healthcare professionals can apply with patients and in real life – learning to walk the walk and talk the talk because we are the most effective models for what we preach.  It’s about improving our own health and well-being and truly believing the strategies work because you yourself use them and they have made a difference in your own life.

Okay, enough of the summary (which was really more writing and not a summary).  Here’s the day’s writing.

Yesterday before bedtime I jotted down a whole bunch of ideas related to the idea of HOLDING SPACE.  That seems to be a metaphor that’s resonating with me on a whole bunch of different levels.  And I have more to say on the topic.  And the piece of paper is in my purse right now, waiting for me to pull it out later.  And I’m even thinking more about the how when we say yes to one thing by default that we are saying no to other things, and therefore when we intentionally hold space for the important things, the priorities, then that crowds out those other things that were having space held by default.  Like watching television.  That’s a default activity that can seem to grow and fill whatever time is available.  Whereas, when there are other intentional activities that we designate for those spaces (reading, playing games, phone calls with friends) then there’s not as much time left for television.  And I don’t think television itself is a bad thing – certainly it’s something that can fit within a day’s time.  The problem gets to be when we use television as a space filler and it takes the place of other activities that are more meaningful and fulfilling and better influence our sense of purpose and meaning.  Reading or playing games or even phone calls with friends can just as easily fill those spaces and crowd out other activities that are important and meaningful.  I think the important thing is to know our default activities and to be aware when we’re engaged in them that they may have a tendency to fill more time than what we originally planned for them.

This morning I woke up with a brainstorm for my course, almost a revelation.  The concept of physicians as healthcare professionals, as people who are susceptible to burnout, as people who are sometimes accused of implying “Do as I say, not as I do” (and doesn’t that apply to almost all of us?), as professionals that are often called upon to be experts on multiple topics in which they may have limited training (nutrition is an example that comes to mind). 

Why do I keep stopping to correct my typing?  This is not content for my site, and even if it was this is not the stage of the writing process when stopping to correct things is called for or even appropriate.  This is the stage when my job is to put down as many ideas as I can in the shortest time possible, and I can come back later to review and rearrange and fix things.  For God’s sake, Laura, stay focused on the most important thing right now.  Just get the ideas down in all their imperfect ways.

Anyway, I’m thinking about physicians and the challenges that they have in their daily lives.  They have work challenges – patients who are sick, patients who don’t or can’t follow the instructions that are given to them, patients who take up more time then they have available for them, tasks they don’t enjoy and suck up more time than they add value.  I’m not going to say these challenges don’t also apply to other healthcare professionals, even myself, but when I think about physicians I think about the CEOs and the most prominent examples of people who people expect to walk the walk and talk the talk.  Which is a lot of pressure, but it’s also a lot of opportunity.

These physicians also have challenges in their lives outside of the office.  Like me, they have families and friends, they have financial commitments and obligations, they have homes and hobbies and they also have their own health to think about.  And while many of us think that physicians must have things good – we expect that they make good money and somehow that must make their lives easier in some way or another – the truth is that physicians can also have a lot of competing obligations as well as this growing reality that we expect them to be available for pages and electronic charting at all hours of the day and night.  I’ve spoken with physicians who get calls in the middle of the night (and I’ve done it myself when in labor at home), I see physicians talking with one patient and their pager or phone goes off and there’s no knowing whether it’s something urgent (the fear) or something tedious that can be addressed during a down moment.  So, just as for many of us, there can be a constant interruption of flow and deep work because they spend so much time jumping from one task to the next and never (necessarily) fully immersing themselves in one thing because people expect them to be available and/or don’t know the best time to contact the physicians about routine matters because it’s not easy to pin them down so when they’re in the office or doing rounds they get all these contacts.  And that’s just the work contacts.  It doesn’t even factor in any interruptions from family or friends or worries about the fight they had at home this morning with their spouse or their kid.  That’s a lot of stuff to deal with and process and work through in order to be present with your patients and your work and operate at top performance, both at work and at home.

So, as I said, the physician is like the EXTREME of what can go great and what can go wrong.  The physician is often the point of contact or the center of the healthcare team, the point of reference for all the nurses and dietitians and therapists and other healthcare professionals.  In most cases. those other healthcare professionals come into contact with these patients because they work with the physician or the physician refers the patient out to them.  So the physician is at the center of all of this.

What I’m thinking, then, is that when I create this course I want to think about physicians and how to make this information valuable to them.  And if I can make this information valuable for physicians – people who have so many demands on their time – then by proxy it will be valuable to the other healthcare professionals who work with those physicians.  And it’s not that I’m not creating the course for nurses or dietitians or social workers or any of the other medical staff that comes in contact with these people.  It’s just that I’m aiming high, for a group with the highest of standards, because I know that when I create something that meets their needs then it will likely also meet the needs of the other professionals that they work with.

That being said, I’m not going to create something lofty and high for physicians, with lots of complicated terms and strategies that meet my idea of what types of information physicians should be supplied with.  I’ve taken continuing education courses targeted to physicians and there’s often a lot of complicated physiology and medical terms and things that can easily go over a person’s head.  I know these physicians are smart people and they’re more likely to understand and incorporate these concepts into their daily practice.  But I also think that one of the things we struggle with in healthcare is translating this high and lofty knowledge and information for patients and communicating it to them in ways that are basic and effective and don’t scare them away.  And I haven’t taken any classes that really told me how to do that, it was something I had to figure out on my own.  One of our jobs as healthcare professionals is to be interpreters of medical information, to sift through the knowledge before we talk with the patient and pull out what is most important for the patient to know, and specifically what is most important for the patient to do or do differently.  Patients don’t need a degree in medicine.  They just need to be able to take care of their health.  This doesn’t mean to dumb things down or expect that patients won’t understand all this stuff, because some patients are savvy and they may ask those questions and want answers.  But many patients are just as busy and harried as the physicians they’ve come to see, and they want information broken down into the smallest possible chunks that are applicable in their daily lives.

I’m still trying to figure out the best course title, but the SUPERTRAINING course is going to focus on evidence-based strategies for optimal health and well-being.  It will be a series of modules (ordered or people can choose the order – not sure on that one yet) and each module will start with two scenarios – a patient scenario and a healthcare professional scenario – and toward the end I’ll present a few other scenarios for practicing the ideas of the module.  So it will be practical and based in real-life situations.  And there will be maybe 5 strategies within each module, and each strategy will have at least 5 to 12 supporting references – preferably peer-reviewed journals.  And there will be a homework assignment to practice with patients and/or to practice with the self.  And the ultimate goal will be for physicians to be able to walk the walk and talk the talk.  They can see the benefits int their own lives and they can share this knowledge and these strategies and their own experiences with patients.

That’s it for now.

Except that I’m so close to the NaNoWriMo goal so I want that extra banner.  Each module will earn the student a badge.  So first we may train the eyes (that will be the Mindset module and I’ll talk about different strategies that can influence your perception of things and how that can influence your locus of control and your actual behaviors).  I’m going to create a basic nutrition module, not one that centers around nutrients but one that centers around eating habits for health and well-being.  That will probably be the stomach.  And a watch for time and priority management, as well as maybe a gift in the hand for presence – get that one?  Not sure that’s the right idea since presence comes from within, but it’s the idea that popped into my head at the moment.

I’ll try to list out some of these modules later.  Time to get the kiddos ready for school.

Today’s Writing Stats: 1824 words.

Today also marks a 30-day writing streak.  Tomorrow will mark the first calendar month I’ve actually kept up a writing streak every single day.  Those are big hurdles!

An excerpt from today:

The funniest thing happened yesterday with the dog. We’ve had Bella now for almost a year. She’s can go crazy sometimes – someone dropping off a package last week said she made a great guard dog – but she’s also very sweet. One of my recent challenges with her, though, has been getting her to go outside and stay outside by herself. This feels both ridiculous and sad. Dogs are supposed to want to be outside. My husband finished fencing the yard in June, and I think both of us figured that she would relish the opportunity to spend her daytime hours outside basking in the sun. And she does – as long as there’s someone outside with her. It’s gotten to the point now, in October and November, that she’ll be whimpering and whining for something and I’ll believe it’s to go outside, but really it’s for a walk and she won’t go outside unless a) you walk out there and let the door nearly close behind you before she’s willing to walk out because she’s decided you’re committed to staying outside so she won’t be alone, or b) you put a leash on her and therefore she knows you’re committed to being outside with her. She loves walks. Her tail wags the whole time she’s on the leash and walking around the neighborhood. I’ve started calling Bella “The Concierge Dog” because she’s so particular about the conditions for which she will agree to go outside. It’s really annoying when I have four kids (who are just now becoming more independent on their own), a house, a full-time job, and aspirations of filling my own personal time with things that I want to do – not the fancies of my dog.

Anyway, yesterday I was preparing breakfast and saw the bowl of toasted pumpkin seeds from our Halloween pumpkins was still on the counter. It’s now after Thanksgiving, the end of November, so I think we’ve eaten pretty much all the pumpkin seeds that we’re going to eat, and I decided that I would throw them away. Considering that these are pumpkin seeds, though, I decided that perhaps I’d throw them in the woods behind our house and maybe the birds would enjoy them. So after I finished preparing the boys’ snacks, I took the bowl outside (Bella followed me because I seemed committed to being outside). I walked to the woods at the back of our yard, picked up a handful of seeds, I threw them into the trees, and they scattered across the ground.

And then comes the interesting part, which I could have predicted.

Bella, though resistant about going outside by herself, is a true scavenger at heart. You’d think we don’t feed the dog because of her obsession for thinking about food. So as I scattered those seeds, the dog got super excited and started to scavenge for seeds in the woods. I guess dogs like pumpkin seeds. My dog. Who knew?

I wanted to scatter the rest of the seeds (I wanted the bowl to prepare a recipe for the crockpot that morning) and yet I was concerned if I threw them all in one spot then Bella would eat all of them and would have some unpleasant side effects from eating all those seeds, likely during the day while I was at work and the kids were at school. So I continued to scatter the seeds, but I scattered them all up and down the woods in our yard. I was hoping the birds and squirrels might have a chance to find at least a few of the seeds, and I wanted to make the task more challenging for Bella because she doesn’t seem like the type of dog who can think beyond the seeds she’s finding and eating all the way to the unpleasant side effects she may experience later on.

After I finished scattering the seeds, I turned around and went to walk inside. And because I was concerned about her eating too many seeds, I called for Bella to come inside.

She didn’t come. She didn’t come the first time or the second or third times that I called her. She was captivated by the seeds in the yard. It was a meal. It was a game. She was completely immersed in the task of finding seeds.

So I went inside and I don’t think the dog even noticed. I did finally convince her to come back inside with a coveted piece of leftover hamburger. And yet, as soon as the kids opened the door to get into the car for school, she ran right back out the door to the trees at the back of the yard. I warned my husband about the seeds and the possible consequences, and he told me that when he got home later and opened the door to let her out, she sprinted out the door and straight to the back of the woods. She wasn’t at all interested in playing ball. All she wanted to do was to scavenge for seeds. The same thing happened later when I came back home from work. Even in the pitch black of night, the dog sprinted out the door to find more seeds on the ground. She was possessed.

What’s the point of this story, and how does it relate to my mission? For the past year, I’ve been trying to convince Bella to enjoy being outside on her own. I’ve tried coaxing her with my words and even bribing her with food, and unless there was someone out there with her she didn’t seem at all interested in staying there. I got irritated, annoyed, and frustrated. There were a few times (after a rare accident) when I felt really angry.

At the end, though, I was focusing on using the wrong tools to motivate my dog. My dog didn’t nee coaxing and bribes, although sometimes those worked. She needed a game, an opportunity to scavenge for seeds. Once she had the right focus for her attention, the right reason to be motivated, getting her out the door was really no problem at all. In fact, it was the opposite that became the challenge.

Last night after dinner, I told my kids that it was time to turn off the screens. That after dinner was now screens off time. I’ve done that in the past and yet the televisions and devices would come back on anyway, against all of my frustrations and admonitions. But yesterday was different. Why? Because instead of just telling them to turn off the screens and find something else to do, I changed the game. I actually offered to play a game with the kids, and they chose Monopoly. We converted the task from something that was uncomfortable and filled with uncertainty to something that was enjoyable and filled with interactions and challenges. I switched the focus from taking something away (screens, company) to adding something enjoyable and rewarding (games).

This is something that I want to hold in my mind, moving forward. That sometimes the best way to motivate people is not to order them around and tell them what to do and expect that they should feel okay when something valuable is taken away from them. Instead, a helpful way to motivate people (and dogs) is to discover something they love to do, a game they’d enjoy playing, and make that the focus for the behavior change.

We didn’t get very far into Monopoly before it was time to head upstairs and get ready for bed. I have a feeling this game will stretch into our after dinners for at least the rest of the week, if not longer than that. But that’s okay. That means that our screens off time after dinner every school night will be filled with the challenge of playing a game and the enjoyment of spending time together.

Today’s Writing Stats: 1362 Words.

I’ve written every day in November, totaling more than 47,000 words this month!

Today will mark day 31 of my writing streak. It will also mark the completion of the November challenge at GEA. I’ve written every single day and I feel really proud about that. I haven’t necessarily generated a lot of content for my site – not yet, though I’m sure there are segments and excerpts that I can convert into blog posts or other info I can use in mapping out my site, my course, and my time management priorities.  But there are a lot of other things that I have gained from the process.

1.

I have gained a whole heckuva lot of clarity in a whole lot of arenas. Part of that clarity is related to thinking about the purpose and audience for my site and my course. Part of it is being attentive to myself and when there’s something blocking me from making progress towards my goals. I’m learning to listen to myself more carefully, to trust my body and what it’s telling me, and – most importantly through all of this – to hold space for the things that truly matter, from creating this course for the people who will benefit from it to reconsidering how I structure and spend my time so I can spend more valuable time with my kids and use available time for the things that matter to me.

2.

I’ve learned that when I feel frustrated or angry about something, that I can turn to the keyboard like an old friend and spill everything out so I can look at it in the light of day. Sometimes it leads me to a solution, and other times it just enables me to spill it all out so I know it’s been said and once released those irritations and aggravations no longer get in the way of the things that I want to get done, that I need to get done. I think I’ve realized that benefit of writing, but until I really stuck with the writing habit consistently for all these days with the intent to work through my blocks and gain clarity on my course, my purpose, and the tasks ahead of me, I don’t think I really started to rely on it. So now I’ve connected the writing to the reward, which is how good I feel once I’ve put in the writing.

3.

And too, the other reward that I’ve realized specifically through this challenge is the power of sharing the written word. At first I was just documenting that I had completed the writing for the challenge. Then I saw others who were sharing what they were writing and I enjoyed reading what they had written, learning from them, connecting their dots to the ones in my head and my writing, and I gained the courage to share my words with them. So in that way this challenge not just encouraged me to write for me and my project, but also in order to connect with others in a much more vulnerable way.

I think we’re all so fortunate to have found one another because it’s such a safe and supportive space for sharing. And once I saw my fellow adventurers sharing information about their work in the world, it inspired me. @judyb and her writing workshops and all the amazing things she does with her students and how she continues to practice at things every day. @mars and her work as an activist for women of color and birth workers and birthing mothers and actually publishing a couple of first drafts on her blog(!). @davidj and his visions for helping people and giving them a space to connect and support one another and grow into the person they’re meant to become. @fiona and her life struggles and how she continues to live out those daily struggles in raising her own children. @beverlee and how her dysgraphia makes doing the work extra long and hard and yet how she persists because it’s work that she believes in and wants to share with the world. @paulo and how he takes an enjoyable hobby like kayaking and uses it as a metaphor for working with nature and putting the focus on experience and not expertise. @bobbiejo and how she used her writing to explore ideas outside of those she intended and that led her to better focus on the task at hand. @tripphanson and his own vulnerable journey to this mountain where his ideas have so much in common with my own.

4.

Each of these adventurers has given me power and strength in my own writing and the importance of sharing. And that has given me the nudge that I need, to know that sharing my message here to a whole bunch of people who are supporting me and encouraging me is one thing, and yet my message needs to reach the right people, the people who will have the power to take my message and start new conversations and try new things and hopefully change the way that healthcare professionals practice healthcare and support themselves in the process.

So yesterday I published an episode to my Anchor site and I have my writing so I can type that out as a script – not sure if I want to post it on the podcast page with a script, or post it on the blog page with an audio version available. What’s the difference? And my dear friend @saramccann who has her own daily struggles right now has so kindly helped me to set up the blog for my site so now all I need to do is generate the content and start publishing posts for my audience. I have content – it’s all in the last 31 days of writing, and my next step is to review it all and cut and paste the chunks that are worth sharing to Evernote, and then I can shape and “good enough” them (I don’t want to use the word “finish” because it will probably never be finished) and post them to my site.

That’s my project for December – the 12 Posts of Christmas or Operation Healthcaring or however I decide to phrase the project. That, and realizing that when I stare at a quote on the wall and it resonates with me, or I talk with a patient and something strikes me, or I read something in an article and it makes me think – I can sit down and write out my thoughts on paper and without much more effort I can record the segment to Anchor, type out the script, and post it on my site. I can probably even write out a checklist of steps for putting the podcast on my site, or the blog on my site, so every time I do it I don’t have to walk through those steps painfully because they will all be sitting right there in front of me, ready to be completed and finished and my word going out to the people who most need to hear it.

I have more to say on the topic of Perfection vs. Production – that was the idea I was thinking of writing about last night as I drifted off to sleep, that we need to stop focusing on getting things perfect and we need to start getting things done. What has been confirmed for me during this challenge is that while we envision this clear, streamlined, direct process to reaching our goals, the reality is actually quite messy and the path ahead is often foggy or there are multiple forks and it’s not always clear which one to take or we get distracted by a pretty bird or engaged in conversation with our buddy and we miss a turn – but in the end perhaps that’s the route we were meant to take all along, and those little diversions (all those writing topics we just had to shed before getting to the main act) those are the ones that add richness and meaning to our writing and to our lives.

Congratulations, fellow adventurers. We did it!

@bradleytmorris – I summarized my insights in yesterday’s post and now I’ve highlighted them, above.