This is what I would tell those I love:
Be excellent in your treatment of others. Regardless of any other achievement, honor, or award, be true in this.
There will be those who will seek to take advantage of your generosity, or may perceive you as weak as a consequence, but pay them no mind. The advantage lost from conceding to a petty difference is more than taken up by the good you will generate.
Do not be afraid. Fear brings out the worst in all of us.
Tuesday, September 29, 2009
A New Day at the Eye Doctor
A year ago, when this blog was young, I documented my visit to the eye clinic. Yesterday I had my annual checkup. Experiences are vivid, maybe because the eye is so vulnerable. I am hyper-sensitive during these visits. I bring hubby along and I am grateful that he drives me home. Drops are put in my eyes that keep my eyes dilated and keep me from focusing. For a brief time, my frenetic pace just stops. Until I can see again.
I noted some improvements from my last visit. Stations are now clearly marked with large signs, POD 1, POD 2, and POD 3 (large signs in an eye clinic. What a concept). But I get ahead of myself. I must first "report to the nursing station". Like last year, I take a number. I am 99. They are serving 98. Service was very fast.
I was directed to POD 2; much easier to find this year. There was still a hand drawn sign with a bold arrow, "Put your paperwork in the basket." the nurse was brisk, placing my paperwork in the basket and redirecting me to the POD 2 waiting room. I did note that she did not spare a moment for eye contact. So, despite the improvements, I still felt like a number.
The improvements needed now are human, and not as quantifiable. How many times a day are these nurses asked the same question? I can imagine how monotonous it can become...for them. For me, all is novel. How can they be engaged in their day so the experience is humanized?
As a side note, one of my favorite bloggers, Paul Levy, promotes Grateful Nation. Apparently, gratefulness is good for me. This I believe. I must learn more.
I am grateful that the tests for glaucoma so far come back negative. I treasure my eyes. I am grateful for a patient husband, who dreads the hospital even more than I do. I treasure him, too.
I noted some improvements from my last visit. Stations are now clearly marked with large signs, POD 1, POD 2, and POD 3 (large signs in an eye clinic. What a concept). But I get ahead of myself. I must first "report to the nursing station". Like last year, I take a number. I am 99. They are serving 98. Service was very fast.
I was directed to POD 2; much easier to find this year. There was still a hand drawn sign with a bold arrow, "Put your paperwork in the basket." the nurse was brisk, placing my paperwork in the basket and redirecting me to the POD 2 waiting room. I did note that she did not spare a moment for eye contact. So, despite the improvements, I still felt like a number.The improvements needed now are human, and not as quantifiable. How many times a day are these nurses asked the same question? I can imagine how monotonous it can become...for them. For me, all is novel. How can they be engaged in their day so the experience is humanized?
As a side note, one of my favorite bloggers, Paul Levy, promotes Grateful Nation. Apparently, gratefulness is good for me. This I believe. I must learn more.
I am grateful that the tests for glaucoma so far come back negative. I treasure my eyes. I am grateful for a patient husband, who dreads the hospital even more than I do. I treasure him, too.
Sunday, September 27, 2009
Ten Thousand Hours and Talent
I am wrapping up Malcolm Gladwell's book, Outliers. His convincing conclusion is that the experience of those who have achieved great success "...at first blush to lie outside ordinary experience. But they don't. They are products of history and community, of opportunity and legacy." (p. 285)
His conclusions are reassuring in many ways. With ten thousand hours of practice, any one of us with even middling talent can become proficient. To become leaders in our field, we need a little more. We are helped by a supportive community and being in the right time and place. "Do you see a man skilled in his work? He will stand before kings." Proverbs 22:29.
My daughter, passionate about dogs, send me an editorial by Cesar Millan, dog whisperer. He is one of those people who has excelled in his line of work, and also had the good fortune to have a community, place and time to build great influence, or as Gladwell describes it, meaningful work.
On the twentieth of this month, he talks about how dogs have taught him.
"But that's not all dogs have to teach us. They educate us about the value of consistency. If you apply Exercise, Discipline, then Affection every day without fail, your dog will reward you with loyal companionship. And they show us how to live life to the fullest by being balanced and celebrating every moment.
Through my pack, I have experience birth, life, and death, and they have shared fundamental lessons about going through this natural life cycle. How do they pass from one phase to the next? How do they stay together all their lives as a family? They have taught me to value the simplicity of life itself. They intensify every moment that I am with them. And for that, I am eternally grateful."
Yes, I can learn a lot from hanging out with our dog friend, Ariel. She knows when it has been too long between visits. A quick exchange of affection is all that is needed. How many times do I neglect that simple thing? What price do I pay, mentally and physically, by ignoring this basic need?
How about celebrating the moment? I've seen that theme repeated over and over again as well. There's Mihaly Csikszentmihalyi's work on Flow. I bet dogs and ten thousand hours champions enjoy many flow moments of intense concentration.
His conclusions are reassuring in many ways. With ten thousand hours of practice, any one of us with even middling talent can become proficient. To become leaders in our field, we need a little more. We are helped by a supportive community and being in the right time and place. "Do you see a man skilled in his work? He will stand before kings." Proverbs 22:29.
My daughter, passionate about dogs, send me an editorial by Cesar Millan, dog whisperer. He is one of those people who has excelled in his line of work, and also had the good fortune to have a community, place and time to build great influence, or as Gladwell describes it, meaningful work.
On the twentieth of this month, he talks about how dogs have taught him.
"But that's not all dogs have to teach us. They educate us about the value of consistency. If you apply Exercise, Discipline, then Affection every day without fail, your dog will reward you with loyal companionship. And they show us how to live life to the fullest by being balanced and celebrating every moment.
Through my pack, I have experience birth, life, and death, and they have shared fundamental lessons about going through this natural life cycle. How do they pass from one phase to the next? How do they stay together all their lives as a family? They have taught me to value the simplicity of life itself. They intensify every moment that I am with them. And for that, I am eternally grateful."
Yes, I can learn a lot from hanging out with our dog friend, Ariel. She knows when it has been too long between visits. A quick exchange of affection is all that is needed. How many times do I neglect that simple thing? What price do I pay, mentally and physically, by ignoring this basic need?
How about celebrating the moment? I've seen that theme repeated over and over again as well. There's Mihaly Csikszentmihalyi's work on Flow. I bet dogs and ten thousand hours champions enjoy many flow moments of intense concentration.
Drugs or Time?
Mental illness is an issue that hits close to home for me. My mother is bi-polar. My son, ex-husband, and son-in-law all show signs of schizophrenia. I've seen the devastation of these diseases up close and personal. We depend on our minds to self-assess our condition; to let us know when we are not well. Mental illness strips us of even this basic freedom and family, friends, or the state must intervene. In a delusional state, the mentally ill may blame family members for the indignity of forced care. The only comfort I get is to see them recovered, back home, and able to smile again.
Don't get me wrong; psychiactric medications have changed the face of care for the mentally ill. Gone (or nearly gone) are the ice baths, restraints, incarceration, and shock treatments. The attached article provides an extensive list of past treatments. I don't buy in to this author's assertion that true cure is blocked by the drug companies. We use drugs because they are the best solution yet available. We also still have short term incarceration when a person is so far gone they are a danger to themselves or others. And a very few are too dangerous to ever have in the population at large. But for the most part, these medications help people live out in the community and relatively independent lives.
I've often wondered, however, in the aggressive pursuit of lower costs, or by simple ignorance or neglect, if we do the mentally ill a disservice by characterizing their disease as only a drug problem. Bipolar Disorder responds beautifully to medication. There's a specific deficit in the brain, and medication replaces it. Schizophrenia, however, does not respond as well. All the medications do right now is to keep the worst symptoms in check. I suspect that Schizophrenia is really a bundle of brain flaws all of which present similar symptoms (delusions, paranoia) if left unmanaged long enough. Even my bipolar mother presented delusions and paranoia when she was very far gone.
From "The economic burden of mental health problems in Canada": By Stephens T, Joubert N.
"This study provides a comprehensive estimate of the economic burden of mental health problems in Canada in 1998. In particular, it estimates the cost of non-medical services that have not been previously published and the value of short-term disability associated with mental health problems that were previously underestimated according to the definitions used here. The costs of consultations with psychologists and social workers not covered by public health insurance was $278 million, while the value of reduced productivity associated with depression and distress over the short term was $6 billion. Several data limitations suggest that these are underestimates. The estimated total burden of $14.4 billion places mental health problems among the costliest conditions in Canada."
There are precious few classes and counselling sessions freely available to the mentally ill. There are clubs and group sessions. My son visits his support worker as often as once a week. But those sessions are primarily a check-in, to monitor if my son is better or worse. There's a wonderful program at Ponoka that helps people with combined mental health and drug issues. But it lasts only six weeks. Follow-up is minimal.
Here in Canada, the burden of care falls on the family doctor, who spends up to half their time taking care of mentally ill patients. I suspect most are patients suffering from various depressive disorders. Why? Because psychiactric counselling is not fully covered by our health care system. Drugs are.
Mental illness in itself is a socially isolating disease. Treating the illness with drugs alone does not resolve the isolation. Some of my family members carry the burden of their illness, fears and anxieties unresolved, weighted down. My psychologist friend describes a day in the life of a person in depression as wading through jell-o. The effort to dress, to go to the store, to walk down the hall, takes all they have. Imagine for the schizophrenic getting through a normal conversation while ignoring the dozen other conversations or so competing in his head.
It seems to me that it could be possible that many mentally ill could experience greater empowerment over their disease, and less medication. The mentally ill might be coached through new coping techniques that would help them reduce their dependence on medication.
There's Cognitive Behavioral Therapy, for instance, that takes less time than the old psychotherapy. Greater community supports are needed as well, and supports for the families with mentally ill members.
Don't get me wrong; psychiactric medications have changed the face of care for the mentally ill. Gone (or nearly gone) are the ice baths, restraints, incarceration, and shock treatments. The attached article provides an extensive list of past treatments. I don't buy in to this author's assertion that true cure is blocked by the drug companies. We use drugs because they are the best solution yet available. We also still have short term incarceration when a person is so far gone they are a danger to themselves or others. And a very few are too dangerous to ever have in the population at large. But for the most part, these medications help people live out in the community and relatively independent lives.
I've often wondered, however, in the aggressive pursuit of lower costs, or by simple ignorance or neglect, if we do the mentally ill a disservice by characterizing their disease as only a drug problem. Bipolar Disorder responds beautifully to medication. There's a specific deficit in the brain, and medication replaces it. Schizophrenia, however, does not respond as well. All the medications do right now is to keep the worst symptoms in check. I suspect that Schizophrenia is really a bundle of brain flaws all of which present similar symptoms (delusions, paranoia) if left unmanaged long enough. Even my bipolar mother presented delusions and paranoia when she was very far gone.
From "The economic burden of mental health problems in Canada": By Stephens T, Joubert N.
"This study provides a comprehensive estimate of the economic burden of mental health problems in Canada in 1998. In particular, it estimates the cost of non-medical services that have not been previously published and the value of short-term disability associated with mental health problems that were previously underestimated according to the definitions used here. The costs of consultations with psychologists and social workers not covered by public health insurance was $278 million, while the value of reduced productivity associated with depression and distress over the short term was $6 billion. Several data limitations suggest that these are underestimates. The estimated total burden of $14.4 billion places mental health problems among the costliest conditions in Canada."
There are precious few classes and counselling sessions freely available to the mentally ill. There are clubs and group sessions. My son visits his support worker as often as once a week. But those sessions are primarily a check-in, to monitor if my son is better or worse. There's a wonderful program at Ponoka that helps people with combined mental health and drug issues. But it lasts only six weeks. Follow-up is minimal.
WHO Optimal Mix for Mental Health Care
Here in Canada, the burden of care falls on the family doctor, who spends up to half their time taking care of mentally ill patients. I suspect most are patients suffering from various depressive disorders. Why? Because psychiactric counselling is not fully covered by our health care system. Drugs are.Mental illness in itself is a socially isolating disease. Treating the illness with drugs alone does not resolve the isolation. Some of my family members carry the burden of their illness, fears and anxieties unresolved, weighted down. My psychologist friend describes a day in the life of a person in depression as wading through jell-o. The effort to dress, to go to the store, to walk down the hall, takes all they have. Imagine for the schizophrenic getting through a normal conversation while ignoring the dozen other conversations or so competing in his head.
It seems to me that it could be possible that many mentally ill could experience greater empowerment over their disease, and less medication. The mentally ill might be coached through new coping techniques that would help them reduce their dependence on medication.
There's Cognitive Behavioral Therapy, for instance, that takes less time than the old psychotherapy. Greater community supports are needed as well, and supports for the families with mentally ill members.
The World Health Organization recognizes the need for better care for the mentally ill. Governments across the world need to see mental health as a vital component of primary health care. We need to change policy and practice. Only then can we get the essential mental health services to the tens of millions in need”, said Dr Margaret Chan, Director-General of the World Health Organization.
The world health report 2001 - Mental Health: New Understanding, New Hope
I'll stop now. My researcher's gene has been activated and I'm having trouble putting this article to bed. To answer the title of this blog, I think we need drugs and time...much more time. We need to think about and talk about these issues openly. We need to be there for family members who are mentally ill. Help them out of the confusing maze of their illness. Help them find greater fulfillment and happiness from living.
Saturday, September 26, 2009
Fighting Crime
It's been a crazy-busy week. Work absorbed, which I think I've talked enough about now. But also I've been busy with condo board stuff. Sharlene and I both attended the Clareview Crime Council meeting to learn more about what can be done about crime in our neighbourhood.
Sharlene and I attended because there is a fair bit of petty crime activity in our back parking lot. Cars are broken in to or stolen. Shady deals are passed between cars with darkened windows. So we went to this session to learn more about what is available. Unbeknownst to us, the meeting was also a recruitment drive. We're both signed up. *sigh*. Ah, well. If it proves too much, I can always bow out.
But wow, so much we learned in that hour and a half. There's all sorts of crime prevention associations out there. There's all kinds of resources available, too. I got a phone number for "report a drug house". We can get a "safety audit" done for our property. There's a Coalition of Crime Councils. I met social worker who works in our neighbourhood. There's Safe Streets and Neighbourhood Empowerment Teams and Safe Edmonton (this looks good).
There's an expert on Neighbourhood Empowerment, Jim Diers who will be coming to town to speak on November 17, 2009. He has a book and now I am eager to hear from him in person. I bet a lot of what he talks about ties in to my ponderings on how we can humanize intake experiences.
It all comes down to people, doesn't it? Why haven't I heard of all these councils, resources and associations? Is it because I had bought in to the apathy and assumed there is nothing that can be done?
By the way, as I browsed the internet to confirm links above, I found InformAlberta.ca. It appears to be a self managed site to link all sorts of services in a mega-database The Safe Streets link was bad. The "contact us" form was markedly worse, consisting of over a hundred fields to review, two tabs, and obscure instructions...in red. God help me if I filled out the inquiry wrong. Will the internet police be after me soon?
Oh, and I should mention that the Clareview Crime Council provided FOOD and COFFEE. Coffee was compliments of our local Mac's owner, who recognized me and greeted me as I came in. It is heartening that he is so involved in our community.
Sharlene and I attended because there is a fair bit of petty crime activity in our back parking lot. Cars are broken in to or stolen. Shady deals are passed between cars with darkened windows. So we went to this session to learn more about what is available. Unbeknownst to us, the meeting was also a recruitment drive. We're both signed up. *sigh*. Ah, well. If it proves too much, I can always bow out.
But wow, so much we learned in that hour and a half. There's all sorts of crime prevention associations out there. There's all kinds of resources available, too. I got a phone number for "report a drug house". We can get a "safety audit" done for our property. There's a Coalition of Crime Councils. I met social worker who works in our neighbourhood. There's Safe Streets and Neighbourhood Empowerment Teams and Safe Edmonton (this looks good).
There's an expert on Neighbourhood Empowerment, Jim Diers who will be coming to town to speak on November 17, 2009. He has a book and now I am eager to hear from him in person. I bet a lot of what he talks about ties in to my ponderings on how we can humanize intake experiences.
It all comes down to people, doesn't it? Why haven't I heard of all these councils, resources and associations? Is it because I had bought in to the apathy and assumed there is nothing that can be done?
By the way, as I browsed the internet to confirm links above, I found InformAlberta.ca. It appears to be a self managed site to link all sorts of services in a mega-database The Safe Streets link was bad. The "contact us" form was markedly worse, consisting of over a hundred fields to review, two tabs, and obscure instructions...in red. God help me if I filled out the inquiry wrong. Will the internet police be after me soon?
Oh, and I should mention that the Clareview Crime Council provided FOOD and COFFEE. Coffee was compliments of our local Mac's owner, who recognized me and greeted me as I came in. It is heartening that he is so involved in our community.
Sunday, September 20, 2009
Edmonton Call Center Frustration
Last December I watched with interest as Edmonton launched a new call center, 311, with ambitions to improve service response. The target at the time was to respond to 80% of the calls within 25 seconds. But in the first six months, the average time waiting for an operator was two minutes. ($10-million phone service source of frustration By Frank Landry, City Hall Bureau, Edmonton Sun)
The idea was a good one. What went wrong?
I am most concerned that the "fix" quoted in the article is to hire more operators and add Interactive Voice Response. Beware of techie fixes, especially if the problem is not fully understood. Those of you who know me will agree; I like gadgets. Especially if they make my job easier and faster. But gadgets aren't always the solution. For instance, I have resisted the urge to buy a food dehydrator, a showtime rotisserie, and an electric meat slicer. A girl has only so much counter space.
So if buying a new gadget is not the solution, what could the call center do to improve it's service? First of all, the agency needs to find out why it takes so long for an operator to conclude the call. I suspect they have many of the problems experienced by Alberta Treasury Branches (ATB) when they decided to improve their call center operations. ATB is now a "best practice" model on how to improve the customer experience.
Here is a quote from the Customer relationship management systems handbook
By Duane E. Sharp (2003) (P 152, 153)
"ATB’s cumbersome contact center system lacked the functionality to service customers quickly. Often, customers who thought they were phoning a local branch office had their calls redirected to the centralized contact center, where the customer’s transaction history was unknown. To find the answers the customer needed, the contact center representative would have to bring up any one of several different screens, a laborious, time-consuming process….[now] when a call comes into the contact center, a profile of the customer will pop up, giving the representative information about who the customer is, the customer’s address, a full listing of the customer’s holdings, and a description of the customer’s last contact with the bank."
I would respectfully suggest that the city would do better to hold off on the purchase of the interactive software, learn more about the business of responding to city calls and the number of screens their operators must flip through, learn more from the best practice models like ATB, and then come up with solutions.
I'll throw in one more plug for the Fish! philosophy. Here is an article by John Christensen on the implementation of Fish! at Sprint's call center, "A Call for Change".
Call centers are important. Call centers are where front-line interaction with the customer happens. The customer's opinion of your offerings are made here. Set aside the statistics for a moment, as summaries and statistics may mask the cause. Executive should take a day off and sit in and listen in at the call center. How does the public really feel about your agency?
If this is where customer relations are made or broken, why would you put any barriers, such as automated response, between the caller and you? As I learned from webpagesthatsuck.com, the smart guys such as Wal-Mart, E-Bay and Amazon give the customer a smooth experience. Doors of entry are wide open and there are no barriers between customer and product.
The idea was a good one. What went wrong?
I am most concerned that the "fix" quoted in the article is to hire more operators and add Interactive Voice Response. Beware of techie fixes, especially if the problem is not fully understood. Those of you who know me will agree; I like gadgets. Especially if they make my job easier and faster. But gadgets aren't always the solution. For instance, I have resisted the urge to buy a food dehydrator, a showtime rotisserie, and an electric meat slicer. A girl has only so much counter space.
So if buying a new gadget is not the solution, what could the call center do to improve it's service? First of all, the agency needs to find out why it takes so long for an operator to conclude the call. I suspect they have many of the problems experienced by Alberta Treasury Branches (ATB) when they decided to improve their call center operations. ATB is now a "best practice" model on how to improve the customer experience.
Here is a quote from the Customer relationship management systems handbook
By Duane E. Sharp (2003) (P 152, 153)
"ATB’s cumbersome contact center system lacked the functionality to service customers quickly. Often, customers who thought they were phoning a local branch office had their calls redirected to the centralized contact center, where the customer’s transaction history was unknown. To find the answers the customer needed, the contact center representative would have to bring up any one of several different screens, a laborious, time-consuming process….[now] when a call comes into the contact center, a profile of the customer will pop up, giving the representative information about who the customer is, the customer’s address, a full listing of the customer’s holdings, and a description of the customer’s last contact with the bank."
I would respectfully suggest that the city would do better to hold off on the purchase of the interactive software, learn more about the business of responding to city calls and the number of screens their operators must flip through, learn more from the best practice models like ATB, and then come up with solutions.
I'll throw in one more plug for the Fish! philosophy. Here is an article by John Christensen on the implementation of Fish! at Sprint's call center, "A Call for Change".
Call centers are important. Call centers are where front-line interaction with the customer happens. The customer's opinion of your offerings are made here. Set aside the statistics for a moment, as summaries and statistics may mask the cause. Executive should take a day off and sit in and listen in at the call center. How does the public really feel about your agency?
If this is where customer relations are made or broken, why would you put any barriers, such as automated response, between the caller and you? As I learned from webpagesthatsuck.com, the smart guys such as Wal-Mart, E-Bay and Amazon give the customer a smooth experience. Doors of entry are wide open and there are no barriers between customer and product.
Saturday, September 19, 2009
You know the kind of day....
...where the breeze through the window a shade cooler than mild blessing the skin in puffs scented softly of damp leaves, the sky a gentle blue with the faintest haze of high cloud, trees lightly dusted in gold, sounds of children playing out of sight, a magpie chuckling to itself at it's own joke, the swish of car cruising lazily past our street.
This is my fall morning.
The potted tomato yields a few red cherries every morning. The zucchinis have worn themselves out. Thumbelina carrots pop out plump and ready. I've pulled all the leeks save three. Flowers are resting except for my geranium which is bursting in a half dozen broad red blooms. Hubby asks if we can have "more of those" next summer. Parsley overflows in it's own pot, ready to be brought inside when the cold weather comes.
It is as if the land waits in stillness for what is sure to come.
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