Health Warning against Checking E-mail

Email apnea - a temporary absence or suspension of breathing, or shallow breathing, while doing email (Linda Stone, February 2008)

Totally unrelated to anything around, here's a thought-provoking article on the potential ill-effects of checking your e-mail while not properly prepared. Am I so unself-aware that I never noticed I disrupt my breathing patterns while e-mailing? Another good reason to practice preventive health and take up meditation or some other relaxation techniques in the office.

Leadership in the Grand Unified Theory

Before I launch into the further development of my unified theory, I reread what has already been put forth and I'm struck by the lack of space for touch-feely leadership stuff. Where is the empowerment? Where is the motivational push? Where have all the employee-centred, feelings-based, personal directive-oriented tactics gone?

True, these topics are means to the end. Striving to accomplish the corporate vision by implementing developmental leadership is a strategy for attaining "appropriate, timely, quality care for all patients." I'm going to have to find room for it, aren't I?

My first thought is to wrap the whole model in a cloud of warm fuzzies. But then I remembered that I hate those diagrams with concentric circles going round the meat of the model, trying to provide visual representation of, say, "society" or "political atmosphere" or "cultural environment" which are to be taken into consideration at all points within the model. And yet, they must be considered.

I'm sure soon I'll come across a good example which I will then poach. In the meantime, my challenge is to incorporate leadership and staff development into the Grand Unified Theory in a way that stresses its importance to achieving the mission.

The Grand Unified Theory of My Job

"I'm drowning!" I must say that half a dozen times a day. I'm thrashing about, trying to make headway against the tide of work that comes weighing down. And the tide is always flowing, never ebbing.

But it's not just the sheer volume of work that chokes me, it's trying to make sure what absolutely needs to get done is actually getting done. It's also about moving forward, doing that which will improve the clinic, rather than just reacting to the wheels that are squeaking the loudest (i.e., fire-putting-outing). This is paramount not just for improved patient care but for my own well-being.

Thus I present the Grand Unified Theory of My Job. It isn't a fully formed theory just yet: it is an emergent theory that will grow, shrink and mutate as needed. However, its purpose is to guide and prioritize the work I do and mash together all the disparate learnings into an actionable format.

It is not a complex theory, or I hope it won't become complex. So far the plan is to start with a mission statement from which I derive specific goals. Thence are developed a ton of indicators by which our success is measured. I run initiatives to improve our performance and then measure the results to see if we improved or not. Easy peasy.

Mission Statement

(Note: I am skipping the vision statement because it seems unnecessary to officially state that I would like to see the world a better place. If I didn't believe in keeping everyone as healthy as possible, I wouldn't have sought a career in healthcare.)

The purpose of the mission statement is to act as a sieve for the incoming tasks. If something doesn't contribute to my overall mission, then I should stop wasting my time with that distraction.

Here is the Mission Statement 1.0:

"Provide appropriate, timely, quality care for all patients."

Breaking it down, it provides four broad areas for monitoring, each with a different focus:

"Provide appropriate..."	Appropriate Care: Ensuring patients get what they need in a fiscally responsible way.
"...timely..."	Timely Care: Ensuring patients receive care when they need it.
"...quality care..."	Quality Care: Ensuring that the highest clinical standards are adhered to and that patient outcomes are as high as can be.
"...for all patients."	Equitable Care: Ensuring equitable access is maintained across all demographics and subpopulation groups.

There is going to be overlap between these four areas, maybe even duplication. Or perhaps indicators are found in separate areas. For example, no-show rates: the overall clinic rate could be found under Timely Care, but rates for different groups could be compared under Equitable Care.

This is starting to look suspiciously like a balanced scorecard. Hmm...

Dysfunctional Teams, Functional Marriages

Here is the one-page summary of Patrick Lencioni's "The Five Dysfunctions of a Team," along with my revelation that the book really ought to be rewritten for marriage. The book's model consists of five levels of dysfunctional behaviour, each exacerbating the next. A team needs to start at the base and work its way up, tackling the destructive behaviours in turn, because the absence of one impedes the solution to the next.

In order, the five dysfunctions are:

1. Absence of trust: Lencioni goes to great pains to define "trust" as confidence in one's teammates that their intentions are good. When you trust your peers, you do not need to be defensive (or offensive) because you won't take objections personally and you won't assume that they're going to cut you down. This allows you to be open with ideas and opinions that you wouldn't otherwise share. You will also be more willing to admit mistakes and shortcomings.
2. Fear of conflict: You and your team need to establish trust in order to overcome a fear of conflict. Lencioni is adamant that conflict is necessary to move forward -- only teams that are repressing something will cooperate in perfect harmony. Conflict is important because every team member must feel that their objections have at least been heard, otherwise they will have a hard time overcoming the next dysfunction...
3. Lack of commitment: Without open debate, team members won't buy in and commit to plans of action. Even if a teammate objects to a decision, they are more likely to go along anyway as long as their opinions have been validated. All team members need to actively commit to a course of action for the team to move forward as a unit, rather than a team of horses pulling in several directions at once.
4. Avoidance of accountability: There is accountability towards the plan -- without active commitment, team members will tend to avoid responsibility -- and there is accountability towards actions that run counter to team cohesion. Such actions, which include behaviours like disrespect and egotistic self-indulgence, need to be called by teammates and nipped in the bud. An unconfortable task, but if you have overcome dysfunction #1 (absence of trust), then your intentions are known to be good.
5. Inattention to results: Team members must care about the results of the team above their own personal results. The collective goal must take precedence. This first necessitates that the goals be clearly defined so that the team knows which direction it needs to be heading, and it also requires that the team's status be known at all times.

Forget the team! These suggestions work wonders for marriage as well. Consider this:

• You need to trust that your partner has your best intentions in mind, no matter what they say. You also need to be willing to admit your own faults and limitations without fear of ridicule.
• You need to be able to engage in healthy conflict or else one person will remain bitter at not being heard and will harbour resentment.
• Whatever plans are decided upon, both partners need to commit to the course of action so that you are working in tandem and not at cross purposes.
• You need to be accountable by carrying through with agreed-upon plans, but you also need to call each other on destructive behaviours without getting defensive.
• Finally, you need to clearly lay out where you're going, what you're tring to accomplish, and celebrate every step of the way.

Voila! A functional team of two.

Dysfunctional Book about Dysfunctional Teams

I just finished reading Patrick Lencioni's "The Five Dysfunctions of a Team" which, all things considered, wasn't too bad. It presented (as the title would suggest) five sources of dysfunction that will impair a team from functioning well, if not at all.

It isn't really a fable, despite what the author claims. "Who Moved My Cheese?" was a fable, with talking mice and whatnot. This was more in the vein of "business fiction" like "Jack's Notebook" -- a compelling narrative with plot and intrigue (including a kidnapping!) to keep our attention. I'll call it "biz lit," although I'm not the first (I thought I could be credited with coining a new term).

The one thing that got to me was how unrealistically omnipotent the main character was. I know that the length of the book is a factor that determines how far into the characters' psyches we can really get, and that the narrative literary technique is meant to illustrate concepts. Still, what I would love to see in a work of biz-lit is a protagonist who doesn't have all the right answers, who isn't so cock-sure of their leadership abilities, who can't foresee dysfunction and know how to avoid it.

To all aspiring biz lit authors, would someone please write an honest book about management and leadership full of anxiety, self-doubt, long hours, stress, and irrational behaviour. I could get into something like that, just to know that others out there are not superhuman and emotionally stable. It's like the managerial equivalent to looking at models in fashion magazines. Show me someone struggling, without the benefit of an uber-mentor to guide them with all the right words of wisdom. That would be more realistic.

Buy the book from Amazon.com.

Office Shuffle - The Aftermath

In the process of moving offices, I have discovered how much stuff you can actually cram into a 6-foot cubicle. This is a good time to purge and start afresh in my organization, try to achieve that zen desk feeling of clear space/clear mind. To get there, though, I'll have to wade through the stacks and heaps of paper that I dug out from the nooks and crannies of my old work space.

Doing my best to employ David Allen's Getting Things Done methodology, I've thrown everything into my in-box (a.k.a. the whole desk) and I'm processing, processing, processing. (You can view the whole process at Wikipedia here.)

Starting at the top with the first item, a decision is made as to whether it's "actionable" -- is there something to be done with it or as a result of it? If not, it's triaged to a reference file, to a folder marked "someday/maybe", or to the recycling bin. On the other hand, if some sort of action is required, it is either to be done, deferred, or delegated. In this manner, the pile is whittled down and nothing is forgotten or lost. The "next action" items are gathered and prioritized, and off I go to strive and achieve. In theory, anyway.

It's quite cathartic to go through a fat folder of materials, pick off the essential bits, and dump the rest into the recycling bin with emphatic flair. I've taken a bit of time out from the task to write a bit for a change of pace, but it's a good feeling to clear up the mess. The big question, though, is whether this is productive, or whether it is procrastination. For now it's the former, but should I let it go on for much longer it will become the latter.

Office Shuffle

I just moved work spaces from a cubicle to an office, making way for a new employee. Admittedly I had been resisting the move from my beloved cubicle to the large, private office. Sure, there are benefits to being enclosed within sound-proof walls: privacy, walls to hang pictures... Well, that's about it. I liked my cubicle, I was in the middle of the action, and I felt part of the team.

My philosophy of management is that the manager is simply another member of the team -- no better, no less -- with a specialized function. Just like nurses and pharmacists and physiotherapists and physicians all have specialized functions, being the manager, for me, means that I have certain responsibilities. Am I the "boss"? No, I'm the facilitator and enabler, and only as a last resort (a very last resort) am I the discipliner or dictator.

It's the symbolism, essentially, that worries me. Now that I'm moved into an office while all my co-workers (I resist calling them my "reports") are still in cubicles or open desks, it's a little embarrassing. I try hard to not project a message that says, "I'm the boss," but judging by the congratulatory comments I've received on my new digs, I've been elevated in their eyes.

What I value is holding on to my philosophy of management, and I want to be treated as a member of the team with different skills, abilities and powers. An office of my own thwarts that. I'll have to find ways to minimize the distance my walls are creating. In the meantime, I'll suck it up and hang my pictures.