Kare Partners

Emerson – “A foolish consistency is the hobgoblin of little minds…”

Consistency - stick-to-itiveness – not quitting…all good…seems obvious, right?  I’d like to carefully and humbly suggest that while hard work and staying the course is often the best thing to do, it’s not always the best thing to do.

Like nearly all Americans I was taught the Puritan work ethic that says – don’t quit ever and if it’s not working you’re just not trying hard enough. While this is very valuable, and has done amazing things for this great country, it’s not always the right thing to do.

A couple of years ago I read a book by Seth Godin called The Dip. The point was to figure out if what you’re experiencing in business, or any sustained endeavor, is a dip before that big upsurge or a bottomless abyss. Sometimes it’s hard to tell. The point is it’s better to quit something sooner if it is an endeavor that won’t ever work out. Of course the trick is in figuring out which one it is, right?

Here’s a personal confession:  In my youth and as a younger adult I suffered from the disease of quitting too early when it came to certain endeavors. I started more things than most people, admirable, and probably finished more as well – because of the exaggerated number of starts. However, many things that I was probably capable of I stopped pursuing. So in my mind, I had left some successes on the table so to speak.

A few years ago I determined to fix this personality flaw once and for all. I even handwrote a note that said, “I’m not stopping this time” and put it in a place I would see it whenever things became difficult in my business. I never persevered through difficulty so well! But guess what? The business I was laboring so tirelessly in was taken down completely by the macro environment producing what was for me a colossal business failure. Wow – so timing does matter. The truth is we never know for sure whether we’re stuck in a cul-de-sac or just around the bend from our dreams. The lesson I gleaned was a painful one.   

So while quitting is not always the answer – neither is endless commitment. Failing quickly and moving on is a proven winner. Just ask Richard Branson – of Virgin fame – who has numerous successful mega-businesses but has failed at literally hundreds of attempts. The lesson I took was perseverance and consistency of effort is key – and always advisable – but tactics and the choosing of pursuits should be malleable. Otherwise we may be paying too much in opportunity cost. 

Ok, so I confess I’ve been feeling contemplative lately. The combination of the usual year-end reflection along with a decade birthday staring me down has moved me. Add to that my employment anniversary with Kare Partners yesterday and we have the makings of some serious reflection. All of this got me thinking, do employee anniversaries still matter?

Lots of people who should know believe we are in the midst of a labor market realignment similar in scale to what took place during industrialization (think massive). For the nerdiest among us you might enjoy listening to this recent podcast from Bloomberg on the Economy (link here), specifically the November 9^th show with Neal Soss, chief economist at Credit Suisse. As a quick aside I must say I have learned more from Tom Keene, the host of this program, than I can ever repay. If I began mowing his yard now and never stopped I’d still come out ahead, but I digress. Suffice it to say, things are crazy for employees and employers these days.

For me, this idea first became personal in the mid-1990s when, for the first time, I owned my own business and felt the weight of dozens of families counting on me for the opportunity to earn their livelihood. I remember thinking that the only thing that mattered was what value I added to the process on a daily basis. It did not matter at all how long I’d been at it, but rather what I’d done to make the business work better. If I failed to do that, those folks who worked so hard every day would lose their opportunity to play their part. It’s a weighty thought.

From that point forward I began thinking of things differently. No longer did I count up my days and hours, only my contribution. Ultimately, what matters is contributing more value than you extract. That way there is value left over to invest in growth and to reward (return on investment) those who risked the money for your paycheck to begin with. Additionally, if the value of your contribution rises consistently over time it is quite true that the value you extract will also rise. It’s simple economics. Try it.

So, the next time you’re feeling in need of a boost, give yourself an “anniversary” by boosting your contribution. The fact is, just as influence is more important than position, contribution is more important than tenure.

The challenge for employers is to find a way to recognize and value those contributions that stand out every single day. Otherwise our best contributors will disappear, as they should. And of course our anniversaries matter, as my wife reminds me. So feel free to wish me a happy KP anniversary, but you are a day late!

The heading seems intuitive and a cliche. All healthcare should be. The administrators, infrastructure, payor sources and caregivers should all have a single-minded laser-sharp focus on the patient. However, reality could not be far from it. Payor sources are more concerned with maximizing efficiencies and minimizing payouts, infrastructure is built and managed by REIT's to maximize profits for investors, caregivers, doctors and allied health professionals alike, are burdened by career aspirations and educational debt, and administrators are forced to take a business view of clinical operations.

Nothing wrong with the above picture. Individual self-interest, aligned to solve a common problem! Except, there is no cohesive goal, no binding framework that ties all competing self interests to the one that really matters, treatment-outcome or patient-welfare. 

I propose a system that treats the patient as a paying-customer, a novel idea? Hardly.

1. A patient must enter an integrated process to get treatment.

2. Since treatment is no longer the purview of a single physician or specialty, all involved must integrate into a single process, quite like an assembly line.

3. Co-payment must be linked with getting well and the outcome of the entire process. Patients must not be penalized for systemic in-efficiencies. The current system rewards incompetency. The longer the curative process, more the number of visits the higher is the payment to the "healthcare gods".

4. Hospitals are well suited for the above "integrated process" and a system of accountability across many providers. But, what about independent physician practices and clinics?

There is a solution.

Stay tuned for Compleat Cycle^R

I believe that the march of science, especially, Information Technology, Nanotechnology and Biotechnology will converge to provide lifespans hitherto unheard of. 150 years of good quality of life .... maybe 1000 years? Last week "speaking of faith" carried a news story chronicling the progress in stem cell research and its relevance to turning the clock back (speakingoffaith.publicradio.org/programs/2009/stem-cells/). Several days prior I had sent this email to someone. I quote verbatim.

"Had a long and wonderful discussion, biotech, cognitive abilities,  
brain function, emotional iq, transferrance of knowledge-history- 
memories ..... My favorite topic..... resulting in longevity ...

In itself this is nothing to write home about .... Unless this enables  
us to do things hitherto limited to the contents of our dreams .... To  
be able to travel to the far reaches of the galaxy ... To be able to  
share the experience with people you wish were there with you ......

To be able to watch the birth of stars ..... literally ...... Not pop/ 
rock stars ..... mind you :)) .... to be able to peer back in time and  
answer the basic questions ...... of where we came from ..... How it  
all came about ..... What does it mean to inhabit this Pale Blue  
Dot ......

Now that is something to look forward to .... to root and cheer for  
the singularity ... to spend each day with gusto ... because time here  
may neither be short .... nor meaningless ... to know that patience  
and hard work over time .... will result in a better world ... to know  
that we will not run out of time ..... the only things we need to  
bring to the table are perserverence, presence, mindshare, courage and  
belief."

Therefore, I agree with George, the pressure increases to try and be impactful in life. To construct a body of work that will last way beyond your time here.

I'm not sure where I first came across the perspective altering technique of focusing on only having 100 years to live, but I remember it stopped me in my tracks. I believe it first came to me through reading something relating to dealing with difficult problems. The idea was to press pause on the problem for a moment and think of it in the context of 100 years. Several thoughts come to mind. First, no human problem lasts 100 years. Also, if you just adjust your frame of view to 100 years most of the things that consume our day-to-day energy really seem ridiculous.

Another powerful 100 years thought is that the duration of anything in your life, triumph or trial, is less than 100 years. The simple fact is most of us spend the vast majority of our time and energy on things that will not matter in 10 years, let alone 100. Think about it, how many people have deeply impacted our planet beyond their own lives. It's a small number. Every day we stand tall on the shoulders of those who came before us. I'm doing it right now sitting in a air-conditioned building (I didn't invent air-conditioning, let alone indoor plumbing!), typing on a wonderful machine that will bring this though to you no matter where you are. Amazing.

A thought that vexes me nearly every day is:  what will I do, in my entire lifetime that will impact others in this way? Even if I do get 100 years to try, it's a daunting challenge. 

Have you ever wondered why everyone is soothed by staring info a fire? Certain things like this seem innately human. One very interesting explanation for this is known as Race Memory or Genetic Memory. The idea is that responses to certain stimuli become encoded into our DNA eventually as useful programming. I think no matter your philosophical orientation toward such things, it's fair to say we can all point to certain things that seem universal among humans. 

One such example is the ability to relate to interesting, and especially funny, stories. In reading Adi's recent post about getting your point across in 30 seconds I was reminded of the importance of storytelling in conveying important ideas. While it often takes a little longer than the "elevator pitch" Adi is speaking of, it also sometimes carries more "stickiness" for the listener. 

Have you ever noticed that if a few people have heard the same story from the same person they tend to gain the ability to evoke key principals from the anecdote with the mention of simple verbal anchors? This also happens among fans of television shows or those who have read the same books. For example, there are many such "Seinfeld-isms" fans will invoke to stir concepts in the minds of fellow fans. While few such references make it all the way into the sphere of popular culture, within smaller groups key phrases such as these can become very powerful and can easily take on a life of their own. 

The fact is that important concepts can be strengthened mightily be a good storyteller. So if you ever find yourself with more than 30 seconds, and a willing audience, try telling a good story to illustrate an important point. When it works well it's invaluable and if it doesn't it can still be entertaining.  

Most of the people who work within the Kare Partners' family have to get their point across, under stress, in a limited time and often to an audience that is distracted, in pain or could care less. Whether this be in day-to-day interaction with your colleagues, with patients or referral coordinators, succinctness, content and the efficacy of delivery are of utmost important if you want to be successful. 

The 30-second parameter is based on a typical attention span, it is one reason why the standard commercial or television "sound bite" lasts 30 seconds. These elevator pitches, delivered in 30 seconds or less, are often times the difference between closing the deal or walking away empty handed. You can always demand that the person pay attention longer and devote their time to what you want to say and convey. But, it is neither practical nor advisable to subject subject someone to un-learned ramblings and under-prepared discourse. This is especially true when speaking to or instructing your direct reports; be prepared, don't waste their time and demand the same in return. More so as you interact with your patients, have clarity of thought and clear goals while communicating with them or their guardians. They will appreciate the professionalism and may even follow through with the plan of care!

A 30-second speech quickly demonstrates that you know your business and can communicate it effectively. Yes, a lot of important facts may be left out, but, the point is to quickly communicate relevancy and grab attention of listeners, convincing them with the promise of mutual benefit and setting the stage for follow up. Speak in terms your audience can relate to and communicate with passion that comes from knowing that this opportunity may never come again. The keys are:

Know the goal. It is not to conclude but to commence the conversation, to lay the ground work for follow through and sustained action.

Know the subject. Do you know your subject well enough to describe it in a single sentence? As Mark Twain pointed out, "I didn't have time to write you a short letter, so I wrote you a long one." Knowing your subject also allows you to stand out from others who might be doing something similar. This is critical for the sales force and marketing representatives. Stand out by knowing more.

Know the audience. Know everything that is there to know and relevant to the interaction, their situation, follow through, and the goal.

Organize the pitch. Start with a crisp introduction, followed by a description of the problem/situation/solution, move on to an outline of potential benefits for the listener or their organization and conclude with a request for permission to proceed to the next step of the relationship.

Hook them from the opening. Make an immediate connection with your audience. Avoid cliches and personalize the interaction from the start. The connection means that it is worth spending valuable time to hear what you have to say.

Plug into the connection. once you have the attention of your audience deliver your message. Clarity is far more important than jargon. Remember, emotional appeals are also powerful.

Presentation matters. rapid-fire delivery rarely conveys confidence. In fact a timely pause is an effective attention getter. It gives you time to think. It gives your listener an opportunity to hear, absorb and retain.

The advantage of elevator pitches go far beyond convincing your audience, they tend to organize your thoughts and provide focus towards your goals. 

If called on to talk for 30 minutes, remember, 30 minutes is nothing more than 60 30-second periods put together.

- With due credit to HBR, The Economist, garage.com, and other sources that continue to educate me ...

A Poem By Mary Oliver

When death comes
like the hungry bear in autumn;
when death comes and takes all the bright coins from his purse

to buy me, and snaps the purse shut;
when death comes
like the measles-pox;

when death comes
like an iceberg between the shoulder blades,

I want to step through the door full of curiosity, wondering:
what is it going to be like, that cottage of darkness?

And therefore I look upon everything
as a brotherhood and a sisterhood,
and I look upon time as no more than an idea,
and I consider eternity as another possibility,

and I think of each life as a flower, as common
as a field daisy, and as singular,

and each name a comfortable music in the mouth
tending as all music does, toward silence,

and each body a lion of courage, and something
precious to the earth.

When it's over, I want to say: all my life
I was a bride married to amazement.
I was the bridegroom, taking the world into my arms.

When it is over, I don't want to wonder
if I have made of my life something particular, and real.
I don't want to find myself sighing and frightened,
or full of argument.

I don't want to end up simply having visited this world.