Overlooked Heroines and Heroes of Hero Week

The initial announcement from the White House made brief mention of health care professionals (nurses, physicians, techs, clinicians, social workers, orderlies, administrators, etc.) who give so much to change (and save) lives every day.  No major event took place to honor those in public service who make the world a safer and healthier place.

Today being the anniversary of the Department of Health Education and Welfare opening its doors for the first time in 1953, a special thank you to:

The Military Health System employing more than 137,000 health professionals in 65 hospitals, 412 clinics, and 414 dental clinics at facilities across the nation and around the world, the Uniformed Services University, as well as in combat-theater operations worldwide.

The VA Health Administration where 315,000 caring professionals provide care in1, 245 health care facilities, including 170 VA Medical Centers and 1,065 outpatient sites

Local and County Health Departments 160,000 + people working in local community public health positions and 40,000

Workers in State, Territorial and Tribal, Health Departments whose numbers change daily!

The not for profit health safety net where more than 500,000 professionals in healthcare support with at risk populations supported by public funding and private donations.

The US Public Health Service 6,500 Commissioned Corps officers who deliver healthcare to underserved communities, conduct live changing research, and work to improve and protect public health. Corps officers serve in Federal agencies including:

  • Agency for Healthcare Research and Quality
  • Agency for Toxic Substances and Disease Registry
  • Centers for Disease Control and Prevention
  • Food and Drug Administration
  • Health Resources and Services Administration
  • Centers for Medicare and Medicaid Services
  • Indian Health Service
  • National Institutes of Health
  • Office of the Assistant Secretary of Health
  • Office of the Secretary
  • Program Support Center
  • Substance Abuse and Mental Health Services Administration
  • Office of the Assistant Secretary for Preparedness and Response
  • Environmental Protection Agency
  • Federal Bureau of Prisons
  • National Oceanic and Atmospheric Administration
  • National Park Service
  • U.S. Department of Agriculture
  • U.S. Department of Defense
  • U.S. Department of Homeland Security
  • Division of Immigration Health Services (DIHS)
  • U.S. Coast Guard
  • U.S. Marshals Service
  • All of these champions for health work for wages significantly less than their colleagues in the private sector, and many not for profit hospital and system salaries. They do so because they truly care.

Maybe the White House schedule got a little crowded last week… but let’s applaud and thank the people who work every single day to make the world a better, kinder, and safer place for all. 

 

The most dangerous person(s) in the room, are those who believe they have nothing to learn

We have 13 dangerous men in one room determining our future.

The Senate’s process for crafting a response to America’s Health Care Act has demonstrated their dangerous assumption in multiple ways:

1.     Healthcare makes up 1/6th of the US economy.  Sweeping changes to such a large segment of the core infrastructure without public participation is foolish.

2.     The primary purpose for the tax elements of the health care legislation is to offset, and fund the largest tax cuts for the wealthiest Americans in our history.  This is shameful.

3.     The reduction of Medicaid funding is expected to be more draconian than the slashing done by the House.   Mitch McConnell who railed against “death panels” apparently wants to implement “worthiness panels” to determine who should be eligible for services.  Who else would have the ego to do that?

4.     People with pre-existing conditions or requiring new medications will be left to fend for themselves. Discriminatory and horrific, but not surprising.

5.     These men of influence, who have collectively received over $25 million in campaign funding from the insurance industry, are working on a bill to increase industry profitability.   Maybe these Senators missed the announcement last week health that US health insurers enjoyed a 46% increase in net income last year ( total net $13.1 billion).

6.     So elected officials, representing our best interest,  are setting priorities without calling on a single expert on any of the issues in this bill affecting millions of lives and our economy.  Seems they know what is best for us…

7.     Finally 13 white males have made their top goal to de-fund one of the largest providers of women’s preventative health services in the nation.  Why?  Because Planned Parenthood provides a procedure the federal government has not funded since 1976.

Who knows what Mitch and his merry band are thinking?  They meet in secret, or don’t meet at all.  They believe no one knows more than they do about one of the most complex systems of healthcare delivery in the world.  It seems, only they know who among the poor is worthy of assistance, and balance the scales by giving the richest the largest tax cut in history.

 

What Is Not Being Talked About in Health Reform 2.????

1.   Health care insurance is not health care delivery.

This is not only true of the repeal proposal, it is true of the ACA as well.  The idea that people with insurance can get timely care is simply not true.  According to a report released last month:

Researchers at Merritt Hawkins, found the average wait time for:

·       A cardiologist was 21.1 days in large markets and 32.3 days in mid-sized markets; 

·       A dermatologist was 32.3 days in large markets and 35.1 days in mid-sized markets;

·       An OB-GYN was 26.4 days in large markets and 23.1 days in mid-sized markets;

·       A family medicine doctor was 29.3 days in large markets and 54.3 days in mid-sized markets; 

·       An orthopedic surgeon was 11.4 days in large markets and 15 days in mid-sized markets.

The VA Office of the Inspector General reported, based on a sampling last month that 36 percent of appointments for new patients had wait times longer than 30 days. OIG estimated the average wait time for that 36 percent of appointments was 59 days. According to the report, an estimated 20,600 medical appointments in the VA had wait times greater than 30 days.

2.   53 different systems of eligibility and service menus makes no “business” sense. 

Let’s begin with the assumption state legislatures are the best places for making decisions about our health. The GOP plan reduces by 30+%  overall funding for health care and then splits the monies up to the states and territories, we don’t know how that split will be calculated (population under 65 / Medicaid enrollment / or political prowess). These states are working with smaller federal support and smaller budgets. If they are already cutting elementary education imagine what they will do for those who live in poverty.

But they are not alone in making the decisions. The “insurance” approach to health care also involves the State Insurance Commissioner.  The insurance commissioner is a state-level position in all 50 states. The duties of the position vary from state to state, but their general role is as a consumer protection advocate and insurance regulator. The position is elected in 11 states and appointed in 39. 

In today’s business environment, it is common for large and small companies alike to expand across state lines or hire remote, out-of-state workers. The health care coverage will differ from state to state.  If you are pro-business think about this model.

3.   Physicians are in short supply and thousands are at risk of deportation.

A study by the Association of American Medical Colleges, released in March, predicts a U.S. shortfall of physicians somewhere between 40,800 and 104,900, due to factors such as population growth, an increase in the number of aging Americans and the retirement of practicing doctors.

In rural America the irony of Trump’s strong support from these regions, is that they are extremely dependent on a decades old program established by a Senator from North Dakota to attract physicians from outside the US to meet the need for care in rural communities.

Recent research by economists at Harvard and MIT counts over 7,000 physicians in the United States who are from one of the countries listed in the second travel ban. The potential for loss of physicians in rural states and small towns—areas that are already suffering from a lack of access to quality healthcare—can have a substantial impact on the number of available physicians. Add to this the number of undocumented individuals believed to currently be attending medical schools and residency programs in the United States, and the negative impact continues to grow on the access to healthcare.

4.   The Cost of Care

True costs are guessable at best.  We do know, ours is the most expensive health care in the world.  We also know it represents 1/6th of our economy.  We recognize but never talk about the most expensive of care… Some estimates are that one of every seven dollars spent for health care are spent in the first seven days and last seven days of life, on care for a patient who is not participating in the decision making process.

If we start to talk about these ideas, we might just arrive at a very different place.

FOUR ESSENTIALS IN LEADERSHIP TRANSITION IN NOT FOR PROFITS

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1.  Get the history right. 

History is leaving much, if not most, of the human and health services not-for-profit sector over the next decade. In many, many cases the founder of the organization is stepping down, or the initial board is being reconstituted. Getting a true sense of what was at the heart and soul of the organization, and codifying it, is essential to moving forward in this time when our basic assumptions about doing good are being challenged.

To that point, it is worth remembering that the origins of human services did not grow out of the best of intentions. Feudal battles left people disabled, and the lords and masters made accommodation by allowing these veterans to beg at the gates of the city, thus the cap-in-handers (and ultimately, the handicapped). Allowing begging was based on the theory of the “worthy” and “unworthy” poor. We know this is not the foundation of your organization, it is however the espoused belief of the majority party in Washington, and the majority of state legislatures in our country.

2.  Acknowledge and embed the history.

Celebrate the fact that the majority of not for profit health and human service founders are women. Have a board member get a portrait done of the current leader. Do an infographic of the chairperson’s time there. Have a big party (with a silent auction) and allow people to say good bye and thank you. Not doing so will hurt the organization and all will regret the lack of closure (this I know from personal experience).

3.  Identify opportunities for core changes before the next leader arrives.

Hire an outside consultant a year before the departure to do an assessment of the change readiness of the organization. Insist they identify no more than three structural or procedural issues that can be resolved prior to the on-boarding of the new leader. Have the outgoing leader implement these changes.

4.  Manage expectations, and prepare for disappointment ahead.

To describe the current federal and state budgets as being in crisis is an understatement. The competing priorities of doing good, and having any sort of cultural infrastructure will change the way you raise money, how grants will be decided, and if your organization will continue to exist as it has for the last decade. There is no precedent for the current attack on our safety net, on our values, and the depletion of tax revenue at the state level for discretionary spending.

Please connect with me on LinkedIn: https://www.linkedin.com/in/josefreum/

 

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The Three Legs

 

Researchers at the University of Illinois looked into the qualities of leadership and identified readiness, willingness, and ability as the three qualities needed to be successful. They referred to these as the “three legs”

I have a different experience of legs.
In the header is a photo of three of my many legs.

When I was four years old my left foot was amputated at Denver Children’s Hospital. My first leg (on the left) was made by a true gentleman named Barney Simon, an amputee himself who lost his right leg in Korea, he worked at Gaines Orthopedic Appliances just up the street from the hospital. His company employed other disabled vets from the Korean and Viet Nam wars. I became a fixture in Mr. Simons office as I grew out of the limbs almost annually, thus “many” legs some of which have been repurposed as umbrella stands, doorstops, and trophies.

Barney moved on to the University of Washington as the Founding Director of the Orthopedics and Prosthetics Program, where he helped transform the industry and the lives of others. His vet colleagues were instrumental in coaching me about hunting, fishing, and swearing.

The second leg (middle) was made to fit at a time when I was taller than I am now. It was retrofitted to be a “saltwater fishing leg” as dipping thousands of dollars of metal and graphite into the ocean is dicey. It has made a difference for me in terms of my ability to wade out on the flats and not catch fish. (Cheers! Longos)

When I wear shorts, which is a lot when I am in the tropics or it is summer, people stare and make assumptions. In a trip to the Midwest I was in my hiking shorts and fighting with a diet coke can stuck in the machine. From out of the parking lot a kind man came up, bent down, and slowly bellowed at me “HIIIIII CAN IIIII HEEELLLP YOUUUUU? Certain my leg was an

indication of cognitive or hearing impairment. I said “thank you I’lllll beeee finnnnee.” These days’ people thank me for my service, which is a high compliment, but my service is limited to public agencies and classrooms, and has little to do with the leg.

So the third leg was a masterpiece of plastics, customer trust, and artistry. David Fenton didn’t laugh when I asked for a “wooden” leg. He understood the intent, and the history of people asking me if I have or had a wooden leg.

Mr. Fenton, and Elizabeth found a material to mimic wood (think plastic car siding) and crafted a masterpiece that gets both smiles and compliments, and fewer mistaken thank yous.

David, like all prosthetic and orthotic professionals in the private side of the industry, found himself in the unenviable role of fighting with the insurance company. He was my champion in working with UHC who felt my having a new leg was unnecessary even though I had lost 20 lbs.

http://www.districtamputeecarecenter.com

Being an amputee has allowed me many opportunities and some weird experiences, but overall it convinced me “Disability is not a matter of diagnosis, it is simply a matter of time.”

The rights and accommodations created by current federal law (unless repealed) have benefitted not just those who have a diagnosis but those who deliver our packages! Sidewalk cuts and ramps have reduced workplace injury for those who haul boxes to and fro, as well as skateboarders like my nephew who find the path no matter the prohibitions!

My whole life has been about readiness, willingness, and ability. When I get a new leg it is because my body has changed in weight or strength and some wise person at my insurer decides I am “ready” to get a new limb that fits. I also need to be “willing” to pay much more than I did for my first car in terms of a co-pay. Luckily I have insurance, which makes me “able” to access a limb and continue to be an active citizen.

Over the past weeks we have heard about proposals from the new administration and the GOP for a new health approach. Habilitative and rehabilitative services were one of the specifically identified essential health benefits in the ACA to be stripped out in the “replacement” legislation. 1.9 million Americans wear prostheses. That number is expected to double by 2050 due to Diabetes Type 2.

It is obvious the President and the GOP had no legs to stand on in their effort to destroy the ACA. They certainly demonstrated a lack of readiness, willingness, and ability. For that I am grateful! 

Uncertainty may be our moment

Uncertainty is the new normal for everyone I work with and live with.  What we are all not certain about is different for each person.  Some are uncertain but hopeful, others are uncertain and in despair, others are uncertain and distracted by the sense of uncertainty.

 

Here is what these people have generously taught me:

 

Everything we assumed about the “goodwill and core support for good works” of the majority Americans may be wrong, depending on if you use the majority of the Electoral College, or of the popular vote.

 

Everything has always, and will continue to, change.

 

Most of us were not prepared for the major shift away from government (at all levels) to provide for basic services for those in need.  We are uncertain of what programs will survive and what will be un-funded.   There is a certainty about the inevitable reduction in resources.  Will we end up pitting providers of safety net services in competition over diminishing resources?

 

What we can be certain of:

 

The two candidates for president spent at least $1.4 billion dollars none of which was tax deductible. 

 

That is a lot of money…. until you consider Harvard University raised $1.6 billion in 2015.

 

At least $20.0 billion of safety net services will be de-funded if just half of the campaign promises in local, state, and national elections are kept.

 

So what can we do?

 

Developing new and innovative strategies for long-term sustainability is required for every 501c3 board in the days ahead.  Postponing these discussions for a month would be an abdication of governance responsibility.

 

Get started by asking yourself some questions:

 

Three questions to ask as a board member of a not for profit:

 

1.     Is this an opportunity to join forces with another complementary not for profit?

2.     Can we tap into new resources before our governmental funds are cut?

3.     Are we ready to declare victory or “mission accomplished” and close our doors passing on our resources to others in the field?

 

Three questions for board members of foundations to consider:

 

1.     What is our responsibility to direct service providers at risk of losing core funding?

2.     Should we re-align funding away from capital projects and focus on the safety net (as we define it)?

3.     Is it time to stop funding universities and entities with >50% overhead?

 

A frank and honest board meeting is essential for building consensus and community awareness of the changing landscape.  The work will be difficult.  Several people may resign.

 

Then: Bring in a facilitator. 

 

What we do is engage all voices, make uncertainty a place for creativity rather than fear, and make these gut-wrenching discussions a process where respect, safety, and actionable decisions are guaranteed. 

 

The people you serve, or those you fund to provide direct services, rely on each of you, as a believer in your work, to accept the truth of the current situation, and to be courageous in your resolve

Leading by distraction in a time of chaos.

The 10th Amendment* is not a solution for what ails US. 

 

*The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.

 

The US and its territories include:

 

·      50 states, the District of Columbia, Puerto Rico, Guam, American Samoa, U.S. Virgin Islands and the Northern Mariana Islands.

·      3,142 counties and 73 county equivalents,

·      13,588 school districts and about 6,500 charter schools.

 

Not much conflict about these realities… But if we listen to cabinet nominees responsible for health, law enforcement, environment, infrastructure, natural resources, housing, and education sing in harmony: “reduce federal agency size and block grant to states and local governments to accomplish the mission.”   The conflict will be massive.

 

Consider how grants worked over the last two decades, under both Republicans and Democrats.   The best example is homeland security. 

 

Post 9-11 funding to state and local governments to battle terrorism resulted in a fax machine in every public health office, multiple armored vehicles and SWAT teams in nearly every law enforcement agency in the land, and the total funding level for the state of Wyoming being three times that of the District of Columbia for protecting its citizens.

 

Depending on legislative intent, some federal grant programs to state, local, and tribal governments use population as the denominator for distribution; others are based on need (FEMA); and for the rest, raw political influence determines the funding.    

 

If the promises of new agency heads and the House and Senate come to pass we can assume funds and responsibility will be flowing to the state and local levels over the next few years.

 

Before you think, “Well not a bad thing in terms of return on taxes.”  The results may be your worst nightmare in terms of policy.

 

State legislators have been busy over the last decade working and reworking election district boundaries to make sure those in power stay in power

 

Redistricting has locked our legislative bodies at the national, state, county, and school board levels into hyper-partisan fiefdoms.

 

An example at the most local level is in a southern state where school textbook publishers print two different history texts with different interpretations of the Civil War for middle schools in two different districts in the same county. 


At the state level consider the Flint water crisis.  Michigan could simply change the Federal standard for lead and cure the problem under the promises being offered.

 

Paul Ryan is proposing Medicare, the single payer health program serving 57,351,55 seniors, be unbundled and vouchers given to eligible enrollees to use as they see fit without any controls on price, quality, or outcome.

 

The GOP leadership would use the 10th Amendment to enable reduced budget outlay, and to eliminate any accountability on their part for these services of such import of our shared national and global future.

 

IF YOU WANT TO CHANGE THE WORLD... There is no better place or time than right here and right now.

Nora Pouillon

On Tuesday last week the James Beard Foundation announced Nora Pouillon as recipient of a lifetime achievement award.  This honor is long overdue for someone so visionary.


Nora is worthy for many accomplishments: a pioneering female chef; a singular voice for ensuring the term “organic” meant something; the force behind farmers markets in the nation’s capital; the creator of a scholarship for women to be formally trained at the Culinary Institute of America, funded by other female chefs; author of multiple useable cookbooks, and works on food itself; a leader in movements to reduce overfishing of seafood; and at the helm for three plus decades of the first designated “Organic” restaurant in the Unites States. 

I was privileged to be one of her first employees when Restaurant Nora opened its’ doors in DuPont Circle in a small place that had been a grocery, then a Yugoslavian sandwich shop, and today a world famous establishment.

In the early days it was a place for affordable lunch, dinner, and even brunch on Sundays.  She worked with purveyors and Thomas, the sommelier, to introduce new wines to the palates of our customers.  Nora was our teacher and coach in being better table attendants, bus persons, dishwashers, and bartenders.  Each afternoon we would come in to do set up, and then we would all sit down and dine on the specials of the day.  So we could recommend with truth.   We learned with every meal even more about sourcing and preparation (we became true foodies). Nora’s was a haven for the neighborhood during the President’s Day Storm of 1979.  We kept the doors open for three straight days as the far-flung organic farmers she supported from the start, made their way to her kitchen door in-spite of 18+ inches of snow. 

Her dedication to good, whole, and clean, food transformed us all (immigrants, artists, college students, and chefs in training) into a real team, pooling tips and sharing equally with all.  She taught me about the importance of creativity, belief in self, trust in others, and patience – appreciating that understanding and recognition might or might not happen, and makes no difference if you believe in your vision. 

Over the last decade chefs have become celebrities, and bigger than life characters.

Nora has been mindful of keeping focused on what matters.  She was one of very few women in an industry subjugated by misogyny.  She altered the history of Washington DC eateries, and groceries, by believing people would come to care about the food they ate, how it was raised, prepared, and offered, if only given a chance.   She has done much more; she has changed the world, one plate at a time. 

Lessons: Diane Rehm and Fred Rogers

This last week was filled with many gifts. 

Two gifts came courtesy of NPR through the Diane Rehm Show.  Her final show was powerful for her continued commitment to respectful dialogue and her openness to the opinions of others.   She exemplified civil discourse, and has always been an able practitioner of what Buddhists call the Fourth Precept: Deep Listening and Loving Speech.  In her final sign off from the daily broadcast (I’ve already enrolled in her new podcast format) she asked the audience(three million+) to “truly listen to each other.”

As a lasting gift for those who have tuned in for 37 years, or those who only heard her last show, she curated a week of recordings of her favorite broadcasts.

Today we got to listen to a 14 year old re-broadcast of Ms. Rehm interviewing Mr. Rogers who offered wise counsel to parents, families, and people in general to: “live by the values of kindness, caring, and gentleness toward others.”

In the dialogue between Ms. Rehm and Mr. Rogers they chuckled at being the two slowest talkers in broadcast media.  Mr. Rogers wisely asked “Don’t you think we need some slowness?”   How true at this moment in time.

These two citizens earned the respect, and the trust of people all over the world through their commitment to listening with their all; to meeting people in the moment; and for their shared belief in our obligation to the well being of others. 

Mr. Rogers (who moved on to what is next two months after the interview) continues to be mentioned as one of the people most trusted by generation X and Y.

In the days and months ahead I hope to stay centered, not by being a warrior, but by channeling the courage and integrity of Ms. Rehm, and living out Mr. Rogers’ belief: “What we imagine can be made possible through kindness.”

 

INVISIBILITY

jr photo

jr photo

This was going to be a post about the future of the “safety net” and rapidly shifting politics and policy in the year ahead, but in recent weeks the people I encountered in day-to day life made the future real.  They will be the most affected by the impending storm of change.

 

The greeter at the big box store (a retired elementary school teacher), checkout people at the grocery (a sister and brother from Haiti), or the table attendant at Denny’s (whose grace invited Elizabeth to ask if he had been a dancer).  They are often working two jobs to make ends meet, to make dreams come true. It is likely your parents or grandparents worked in the service industry, to make your dreams come true. Mine did. All too often they were invisible. 

 

Invisibility is at the core of oppression. 

 

Can simple acknowledgement and respect be pathways to integrity, freedom, and community?

 

As I go through this holiday/transition season, I will take time and look into the eyes, see the person, say hello and thank you to those emptying trash, greeting people at the door, checking luggage, stocking vegetables at the grocery, shelving books at the library, sitting reception at the doctor’s office, delivering mail, driving the Uber/taxi, and waiting my table.   

 

These are people of dignity, whose lives will change in unimaginable ways in the months and years to come.  They have been part of the life we all lead every single day.  I will meet each, as I would want my grandparent met.

 

I need to do this as much for me, to remember our communities, our ties to each other can remain strong in these uncertain times. To possibly even strengthen, if given recognition, respect, and most of all, simple kindness. 

11.09.2016... the day after memo

TO: Every leader

RE: It is now Wednesday, one not like any before. 

Today, you as the leader, will face a significant number of co-workers and customers who are disappointed, and may feel disenfranchised from their home, neighbors, family, community, or nation.

The expectations and hopes of at least 40% of voters have been dashed or, at a minimum, disappointed. This election has been different… in addition to high negatives, high emotions and high anxiety; people have been more open about their politics than in prior elections. People have said things in out loud they never would have shared in public before. In this age of selfies, thousands publicly shared their ballot yesterday.  We know more than we imagined possible just one year ago.

A central principal of our democracy is the freedom of belief. We frame beliefs by forming opinions based on information gathered from experience, or ‘expert’ sources.

The beliefs expressed by voters and reported by the media over this election cycle, have been passionate.  They were positive, negative, isolationist, hyperbolic, racist, anarchist, misogynist, violent, feminist, and emotional.   

We are all survivors of a traumatic and toxic 24/7 televised campaign.

Colleagues might not express disappointment openly.  Being on the losing side is not a point of pride for most Americans.

How do we recover the sense of community in a very divided nation?

Ronald Heifetz, Harvard’s father of “adaptive leadership” says one responsibility of a leader is to “manage disappointed expectations.” 

This needs to be at the top of your to do list for today. Number two on your list is to create a healing and respectful environment.

To accomplish these two tasks requires a different leadership approach, not so much “how to do” as “how to be”.  

For guidance I skipped the non-fiction section and went straight to the gifted mystery writer Louise Penny. Her central character in her magnificent series is Armand Gamache, an inspector in the Sûreté du Québec, the provincial police force in Canada. He is a complex and wise protagonist with a rich interior life, close friends and family, and a reputation for building a work team where kindness and respect matter.

His first principle is to begin with the caution offered by Pema Chödrön, an ordained Buddhist nun (who is not fictional).

“Don’t believe everything you think.”

Getting people to be aware of their biases, and feelings, and being open to the possibility of another perspective, is especially relevant this second Wednesday in November.

Gamache begins all his meetings with this phrase:

“Tell me what you know.”

Knowing what we think is different from knowing what we believe others think. Getting to the next step requires wisdom.

Gamache teaches his students/trainees/new officers/ transfers etc. four essential phrases to gain wisdom.

These are:

“I was wrong.”

“I'm sorry.”

“I need help.”

“I don't know.”

If you lead today by applying these four phrases, it will be both healing and transformative.

Many leaders avoid these phrases for fear of being perceived as weak, emotional, indecisive, or unqualified, terms used in the last few months by countless candidates of all persuasions.

Today find a way to use these phrases while being the leader, the facilitator, the guide, and the person willing to acknowledge the disappointment in the air. If it isn’t in your workplace, it will surely be in your marketplace, or your cyberspace. 

Here are examples of what might be skillful use of the phrases if the election comes up:

I was wrong to not understand the sense of displacement by my friends who depend on coal mining for employment.

I am sorry so many people believe all of Washington (a place I have loved for 25+ years) is corrupt and out of touch. 

I need your help being less afraid about how our great nation can come together.

I don’t know what it feels like to be an immigrant, a woman, a Muslim, a senior citizen, a 15-year-old African American male, or a 59 year old under employed factory worker whose job was outsourced to another country.

What I do know is we share the belief we are citizens of a nation where democracy matters. We voted. Winning or losing an election is something we do with regularity unequalled in the world.

As citizens we respect the outcome and don’t condemn or punish those on the losing side. This is one element of what makes America a different place. 

Your task is to make the workplace a different place.

Acknowledge the disappointment, and the excitement, and honor each as the common experience of people who believe in the process and exercised their citizenship with pride and conviction.

Gamache leads by engaging his team with humility, and acknowledges the deep interconnectedness we experience every day, in countless ways.

Try this approach today, tomorrow, and the next day.  It will make a difference. You will be a better leader, and will contribute to the work place being a more kind, considered, and productive environment.

Three Magic (interview) Questions

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Over several decades it was my honor to be the “professor” for thousands of students in a graduate professional program. Many former students are now my teachers, and accomplished leaders in many fields.  Hundreds have stayed in touch and “linked-in” Every month I hear from someone who recalled the outline of an idea offered in class, and sends an email asking for those “Three magic questions.” One suggested sharing them in a post.

The questions work best when the following stars are aligned:

  • You are interviewing for a job you want.
  • You are interviewing with the person you will be reporting to.
  • You have done enough research to fine tune the questions.
  • You are excited about the work, and remain open to the possibility that this may not be the place for you

So…. The interview gets to the point where your soon to be boss asks "Do you have any questions for me?" and now you ask:

THE THREE QUESTIONS:

1.    What will be different for you on a day-to-day basis if this works out?

2.    In your time with this organization what project or activity are you most proud of?

3.    Where do you see this organization and this industry in five years?

Here is why the questions work.

For #1, no job description is comprehensive enough, or HR approved to include the personal expectations of your supervisor. Often you don’t find those out until you disappoint one of these unknown expectations. The answer will give you specific outcomes to make you both successful.

Question #2 has several functions. Your ‘boss to be’ will tell a story where she or he is the protagonist and will describe the barriers (organizational and cultural) overcome by this person or their team. You will learn a lot about the organization, and about your potential supervisor. If the answer is “I got my travel reimbursement in under 180 days!“  My advice... skip asking the third question and head (quickly) for the exit.

The final question is a riff on the “Where do you see yourself in five years.” The answers will reveal the degree to which your next supervisor is engaged or involved in the strategic direction of the organization, and the involvement of the organization in the larger “system” of the industry.

Job offers often come your way when you ask these three questions. Having the answers will help you accept the job with joy, or decline the offer knowing you are making an informed decision.

Who Knew???

Over the last ten days I rediscovered the joy of using the phone… for talking.  

Like most Americans, I text. A lot. Every day in the US we send over 6 billion text messages.  98% of texts get opened, about half get a response.  

(In case you are a Trivial Pursuit fan: The first-ever text message was sent December 3, 1992, by software engineer Neil Papworth, to Vodafone director Richard Jarvis. It read: "Merry Christmas")

Email is used less often, and is viewed as a transactional, more formal vehicle. The average US worker receives and opens 60% of 121 emails per day, and responds to 30%.  Some may be spam, newsletters, notices, passive aggressive use of BCC, or the email was just FYI… no response required. 

According to those who keep track of these things:

Every working day we spend

3 hours per day on email
26 minutes per day on texts
60 minutes on social media

Most of these 7+ hours of activity are on hand held devices called phones.

We spend 22 minutes on the phone using it to make calls.

And, we sit every day for 2 hours and 39 minutes watching television. 

My iPhone is usually close at hand. When it chimed for the umpteenth time announcing a new text, I looked at the number on the screen and asked myself why wasn’t I using the phone to talk to people voice to voice?

It is hard to admit, but email and text have become the favored technology for a “virtual conversation” or to make a “collaborative” decision.

Too many of us are accustomed to using digital communication to not have a real conversation about good news, bad news, or to clarify expectations.

So I decided to re-boot my skills at actually talking with people on the phone, even when a text or e-mail would have been expected.

Here is what I learned.  

When having difficult conversations, I was interested in the whole person on the other end, not just the issue we were talking about.  We didn’t have to guess at the feelings the other party. Neither of us had to try and interpret the tone of an email or text. 

If Joan was frustrated with my lack of clarity, we didn't need to send five emails or 20 texts to get to the bottom of what we were talking about.  We had a frank exchange and made decisions quickly and respectfully.  

Pat and I talked about important and personal topics, as well as promising and hopeful ideas, and we used language, timing, reflection, and we both listened... even to the pauses and the unspoken ambiguity of the situation.

Craig negotiated a business transaction to repair a roof for us. He talked me through the process, acknowledged my hesitancy to sign on for another disappointment (fourth fix, fifth company), and we built trust by calling one another several times, connecting, promising to get back to each other, and honoring those promises. 

Afterward, I called the other contractors to thank them for coming out and putting together their bids. Adding how much we appreciated their efforts and responsiveness.  No email, or text, but a voice saying thank you for being professional and an acknowledgment of their effort.

It was hard to do at first; I had grown accustomed to the e-z way as in the email way out of disappointing others.

All this phone time was actually… invigorating. We had conversations, back and forth discussion, and listened and built on each other’s ideas in real time. These calls were productive, connected, and human.

Here is the tip my clients will get on the next visit (or call): If a problem, or difficult decision has landed on your desktop or phone screen. Pick up the phone and call the sender to have a conversation; it might be just the change you both need to find a creative and relationship building result.

A great read on this topic:

Sherry Turkle of MIT, “The Flight From Conversation” see: http://www.nytimes.com/2012/04/22/opinion/sunday/the-flight-from-conversation.html

Our own fingerprints are on the knife... if nothing changes in Washington.

Our own fingerprints are on the knife if nothing changes in Washington [1]

The latest Allstate/Atlantic Media Heartland Monitor Poll reports: 88 percent of Clinton voters and 96 percent of Trump voters identified Washington as a problem. 95 percent of Republicans said the political system in Washington is not working well enough, so too did 83 percent of Democrats. Americans think the most serious issue facing the country is “the political system in Washington is not working well enough to produce solutions to the nation’s problems.”

The poll also shows more Americans believe the federal government is “most likely to provide solutions” to that challenge, outpacing state and local governments, big business or national corporations, local businesses, community or non-profit groups, and individuals. [2]  It sounds hopeful… maybe too much so.

The problems in DC are not from something amiss in the water of the Potomac. We stab ourselves and kill change making by the confluence of three major forces: Our personal echo chambers of news in a digital world, professional/political self-interest, and money in elections.

In three part harmony, here goes:

First, echo chambers… Opinions different for our own are now conveniently avoidable entirely! More than seven-in-ten U.S. adults follow national and local news somewhat or very closely – 65% follow international news with the same regularity. Fully 81% of Americans get at least some of this news through websites, apps or social networking sites. And, this digital news intake is increasingly mobile. Among those who get news both on desktop computers and mobile devices, more than half prefer mobile

For those under 40 phones now serve as the primary conduit for news.[3] About a third often get news from social networking sites (32%) and from news websites and apps (34%). Their use of social networking sites for news is higher than among any other age group, while their use of news websites/apps is higher than that of those ages 50 and older. In today’s digital world we get to curate our sources, opting in to what we like, and opting out of what we don’t. My Apple News allows me to pick what publications I like and agree with. Several outlets have been included only because it keeps my heart rate up which is a good thing.

But if I wanted all news could come to my phone from people connected through a social media site who agree with me, and might even like me!

Please see this magnificent article on the problem @ https://www.theguardian.com/media/2016/jul/12/how-technology-disrupted-the-truth

Second, self-interest… as members of any professional association, or special interest group, we must share some responsibility for the mess in DC. Associations have been around since before the nation was founded. They do important and good work in terms of bringing people of like minds together, educating members, advancing research, policing the ranks, holding meetings, and advocating for policies.

FULL DISCLOSURE, as a former executive for a professional organization in DC, I learned (the hard way “The primary purpose of any association is to prevent change unless it is to the direct benefit of the interested parties.”

Associations and special interest groups constitute the third largest employment sector in Washington DC, the raw numbers are overwhelming.

The estimate of registered lobbyists in Washington is 10,000, or 18.7 for every elected member of Congress. Special interest and association employment numbers are around 150,000, or 280 people per member of Congress, and all are employed to prevent change unless it is a change to our benefit.

An emerging complication is the ever hardening of interest group perspectives. It is common to hear people visiting DC to lobby express the following: “Anyone who disagrees with us is the enemy.” One unpublished study found Hill staff felt the advocacy approaches of gun rights and gun control organizations were identical “do what we want, or we will crush you in the next election.”   No question, the lack of civility in public life is evident every day, at every level, in this election year. However, we can each take steps to acknowledge other human beings in how we listen to, and respect, those who hold an opinion different from our own. But that would mean change.

 

Third, money… This election is already the most expensive in our nation’s history.

Interest group contributions to campaigns in the 2015-2016 so far total $1,310,372,936. “Outside” spending for the same period is $331,163,840.[4]

Top lobbying groups kicked in $78,710,838 over the first five months of this year[5] and we still have 100+ days to go.

Buckley v Valeo and Citizens United v. FEC have had a major impact on elections and on democracy.   They opened new avenues for raising money for causes and for candidates.

However, raising money for re-election has been the first job of our elected officials for more than two decades.

John Oliver did a fascinating story on Congressional campaign funding earlier this year (worth viewing). In it he reported on a Democratic Congressional Campaign Committee memo laying out the expectation for members to spend four hours a day (not in their congressional office but off site in nearby DCCC cubicle) making fundraising phone calls.

Every “retiring” member of Congress lists “the endless chase for campaign funds” as a major reason for leaving office.

In 2015, the House met for 157 days, the Senate met but we really aren’t sure of how many days due to a trick of the rules of recess vs. adjournment. If you see Senator McConnell you can ask him.

It is safe to say both houses averaged 18 hours of work per week. Then they fly home to raise money… from people who know what is true from those they know and agree with… and those who are confident their perspective is the right one.

So should we just give up on democracy/oligarchy? Are we doomed to the raw physics of the influence industry? Should we begin investing in state legislators who might someday be elected to serve in Washington?

Recognizing my need (and the opportunity) to work on openness to differences over the next two weeks, here are the three things I am trying, and invite you to join me.

1) For 30 minutes on three days tuning in to the convention(s) in progress, and listening to people I don’t agree with. This is not to re-enforce biases, but rather to hear people who believe their own truth. Be respectful of their fears and anxieties.  Try out some empathy and compassion.

2) Add AlterNet, or RedState to web reading .

3) Make a contribution to a Food Bank equal to the cost of two tickets (including 3D surcharge) to whatever blockbuster movie is playing in an air-conditioned theatre. (See BFG if you still can.. it was amazing).

It might just help me  feel better and more hopeful about the future.  Respect for every voice makes a difference, even if that voice is not in harmony with my choir.

 Let me know what you think/learn in the process!  Thanks for the feedback so far!

[1] Borrowing from: How come every time I get stabbed in the back my fingerprints are on the knife? : And other meditations on management., Jerry B. Harvey, San Francisco : Jossey-Bass,1999.

 [2] How Can The US Fix a Broken Government, The Atlantic, 7/16/16, Clare Foran.

[3] The Modern News Consumer, Pew Research , 7/7/16, Amy Mitchell, Jeffrey Gottfried,, Michael Berthel, Elisa Shearer. 

[4] The Center for Responsive Politics. SourceFEC 6/27/16 and 7/16/16        THE CENTER IS A TREASURE TROVE

[5] http://www.senate.gov/legislative/lobbyingdisc.htm#lobbyingdisc=fec, not a treasure trove, requires hours to do what OpenSecrets.org does in seconds.

The Decision to Consider 2016

During my 20+ years spent in the classroom guiding discussions about health policy, ethics, and leadership, the semester always began by positing this question:

To what extent am I (or are we) willing to contribute or sacrifice, so someone we do not know, and will never meet, might have access to the kind and quality of education, housing, healthcare, and safety we want for our loved ones?

How we answer this question drives decisions about investing, health plan selection, housing, donations to charities and causes, and even selecting colleges.

When considering personal resources and the distributions to support loved ones, or for the common good, we differentiate the act in one of two ways. To contribute (Oxford dictionary) is to: Give (something, especially money) in order to help achieve or provide something. To sacrifice (Oxford again) is: An act of giving up something valuedfor the sake of something else regarded as more important or worthy.

Implicit in the comparison contributions are freely given and with good intention; and sacrifices are painful and often made when we feel we have no choice. 

The concept of contributing or sacrificing for an outcome we may not use, or have a stake in, is not on the agenda in the 2016 political discourse. We want action NOW, and we want to WIN, and we want it not to be difficult.

There are useful examples of how we consider those we love (the us) in the redistribution of resources that demonstrate we are open to contribution and sacrifice.

According to the College Board: Average published tuition and fees at public four-year colleges and universities increased by 13% in 2015 dollars over the five years from 2010-11 to 2015-16, following a 24% increase between 2005-06 and 2010-11.

For loved ones, we are willing (whatever the price, and for however long) for education. But what are we willing to spend for educating someone else’s child? Would the answer be different if the child were a female Muslim immigrant from Afghanistan?

We need look no further than the four state ballot measures in 2015 to see how we voted on funding public education funding. Three proposals to increase or provide funding failed, and the one proposal that did pass (in Texas) increased the tax exemption for homesteaders over 65, thus reducing resources to education.  

When it comes to health, or health care the evidence of “no limits spending for loved ones” is even clearer. According to one study (Banarto, McClellan, Kagy and Garber, 2004), 30% of all Medicare expenditures are attributed to the 5% of beneficiaries that die each year, with 1/3 of that cost occurring in the last month of life. And March of Dimes reports Preterm birth costs employers more than $12 billion in excess health care costs.

Some estimates suggest one of every seven dollars spent for health care are spent in the first seven days and last seven days of life, on care for a patient who is not participating in the decision making process.

Truly we do not hesitate to contribute and to sacrifice for the people we care about.

The moral question in this election is how much are we willing to contribute or sacrifice for the good of “the other”?

In the 24-hour media roundtables, and dinner discussions about presidential, state, and local elections, there is one glaring omission: any moral framework. How do we individually, and collectively, consider resource issues as we define our future?  

Decisions in any democracy are always about how we approach, and come to agreement about, the allocation of resources for ourselves, for others, for future generations, for the common good of our communities, and… for the world.

One of the major complaints about Drumpf, Clinton, and Johnson, is the “all about me” nature of their personalities, politics, promises, postings, and polemics.

The candidates are not alone, recent polling shows a majority of voters share the concern: “What will happen to/for me?” under various scenarios. The Brexit vote was a direct result of viewing public policy through this lens. Thus we hear a great deal about me, my, and mine.

Roger Simon’s recent book: I Know Best: How Moral Narcissism Is Destroying Our Republic, If It Hasn't Already, defines this newest self-focus with the following: “You are what you say you are. You are what you proclaim your values to be, irrespective of their consequences.”

Consider what made America truly great; solidified the idea of standing together;and distinguished our nation as a beacon of hope. It was not how we thought only of ourselves in difficult times; it was how, as a people, we were willing to make sacrifices for the freedom and well being of others.

 A few examples:

The March of Dimes campaign to fund research to end polio

The Second World War

Red Cross Blood Donations

The Giving Pledge

The Federal Highway System

In 2014 Americans donated $358 Billion to charities an all time record!

So have we become entirely selfish, is moral narcissism fed by the culture of celebrity, inevitable? Or are we open to the needs of people who are not us, and more importantly, people who are very different from us?

John Rawls, a political and moral philosopher had a skillful way of considering resource distribution.  In his book: Theory of Justice he introduced an approach called the original position.

In the original position, parties (through an organized process) select principles to guide the basic structure of the society they will live in. However, they don’t know information about their own particular characteristics: gender, ethnicity, religion, social status, economic status, and, crucially, their personal idea of good. Using the original position to allocate resources leads to impartiality and rationality.

Carol Gilligan, author of, In a Different Voice, and framer of the Ethic of Care, providing a relational approach for considering ethical decision-making, was interviewed in 2011 predicting our current situation. “Rather than asking how do we gain the capacity to care, the questions become how do we come not to care; how do we lose the capacity for empathy and mutual understanding? It is also crucial to clarify that within a patriarchal framework, the ethics of care is a “feminine” ethic, whereas within a democratic framework it is a human ethic, grounded in core democratic values: the importance of everyone having a voice and being listened to carefully and heard with respect. The premise of equal voice then allows conflicts to be addressed in relationships. Different voices then become integral to the vitality of a democratic society.”

 It is clear: the elections in the US, are not about impartiality or rationality, nor are voices heard or spoken with respect. The news of the day is about partisanship, irrational fears, and collective anxiety. The more selfies we take, the less we know about who might have been right in front of us.   If 2016 continues to be “all about me”; we cannot step out of ourselves to consider fairness and justice for future generations, no matter how many times we invoke them.

Waldo Tobler, best known for bringing the power of computers to map making, also offered his “first law” in geography: “Everything is related somehow to everything else. But those things in closer proximity are more related than other things that are further apart.” In short, if it isn’t happening for me or to us, it isn’t important. The best visual example of this ‘first law’ was Saul Steinberg’s famous cover illustration of the March 29 1976 New Yorker.  Imagine Steinberg drawing Hillary’s, Donald’s, or Gary’s view of America, and the world! It would make for a wonderful illustration of the campaign ahead. But if geography determines our perspective, it is also a contributor to the rhetoric bifurcating the world into camps of “self” and “other.”

Is there a different path?

What if try re-framing moral issues? What if we acknowledge our self-focus as perhaps strength, and engage our thinking using a modified original position?

Martin Buber, philosopher theologian, considered existence in two ways: The I-It and I-Thou.

I-it is an experience of the world where beings do not actually meet or connect. Instead, "I" examines and considers an idea, or conceptualization, of the other and treats that being as an object. In this context the other are not people we know or will ever know: they are simply who we imagine they are!

I-Thou is the opposite. In this framework, a relationship stressing the mutual, holistic existence of other beings is real and understood. It is a concrete encounter, because these beings meet one another in their authentic existence, without any qualification or objectification of one another. Buber contends human life finds it’s meaning in I-Thou relationships.

Before we make the decision to vote for one candidate, or against another, this November consider this question:

What is this leader asking me/us to contribute or to sacrifice so someone I/we do not know, and will never meet, but hold in respect as another human being with value and a voice, can have access to the kind and quality of education, housing, healthcare, and safety we want for our loved ones?

Knowing who we are might provide a clear response. Not knowing who we are in making the contribution/sacrifice makes it less clear, but more logical. But responding and knowing might just be “the other” to someone else, might change everything, including the outcome.