I went to a networking breakfast this morning at the Boston Center for Community and Justice on Diversity: Institutionalizing Diversity as a Business Strategy.
A very well done event with a number of business leaders committed to the integration of this thing we call diversity in a manner that connects like "traditional" business staples like lead generation, fulfillment, accounting, etc.
It is easy in meetings like this for the default to go straight to workforce representation conversations. Some commented on how some of their companies have gotten executives to fulfill diversity goals and it has increased representation. Others shared that the goals of representation are also tied development. That resonates with me, but it also falls short to me in a way, in that what development means and is are often much different than what those responsible for developing their people do.
There was one hospital COO there. She mentioned the ideas of health disparities (quality disparities) and cultural competence. I appreciated her commitment and candor about how far they have come and how far they have to go. Where I wished she could have taken the conversation was into an area that most organizations face on a regular basis: risk.
Now, while the idea of risk is one that most leaders have to face, they don't generally think about risks in terms of people not being able to relate to others in a manner that is in alignment with their needs. In healthcare the risks here are obvious. Just speak to any clinician who has had diagnoses compromised due to not having the ability to discern cultural cues. Cues that may have provided additional data for a diagnosis that could have prevented or at least mitigated further suffering on behalf of the patient.
In other industries, I hold that the risk of cultural incompetence and what I call "cultural illiteracy" (extrapolated from health literacy) is just as profound. In a global playing field of business, the stakes of cultural navigation matter more than ever before.
For many Americans, the lens of the world is narrow and generally has an insular focus. The risk here is that if we are not able to consider the globe as the business environment that we live within; and recognize that the norms of business are as diverse as the world is big, our ability to be competitive in this global economy is mitigated. This is not just true for people from the U.S., this is true for everyone.
Consider that we are all culturally illiterate in a way. Now, think about the risk of being illiterate in any other sense of the word.
Make it a great day!
Friday, May 7, 2010
Sunday, April 11, 2010
Talking Electronic Health Records and Clinical Trials
Two of my colleagues, Chris Thorman from Medical Software Advice and Avis Williams from Solar BioMedical have written some great articles on the connections between clinical trials and electronic health records. The opinions expressed are their own and not necessarily reflective of the views of Diversity HealthWorks or Amri Johnson.
With the changes in health reform, this may be a topic of increasing interest. Thanks to both Chris and Avis for their contribution. Enjoy!
Make it a great day!
Amri
Electronic Health Records and Clinical Trials: An Incentive to Innovate
by Chris Thorman
As we wait for the federal government to finalize important sections of the Health Information Technology for Economic and Clinical Health Act (HITECH), there is a lot of talk about the financial incentives for implementing electronic health records (EHR). And understandably so. Practices that implement an EHR under the federal government’s guidelines stand to gain nearly $50,000 in incentives over the next five years. (More)
Electronic Health Records and Clinical Research: A CRA's Perspective
by Avis D. Williams, MSPH, CCRA
A CRA is the term for anyone involved in monitoring clinical trials. One of the main roles of a CRA is to help ensure timely generation and collection of quality research data. With the advent and popularity of electronic clinical trials (eClinical Trials), CRA’s are seeing a gradual increase in the number of clinical research sites (research hospitals, educational institutions, and private medical practices) opting to use electronic medical records as source documents for their clinical trial data. This article describes some of the benefits and drawbacks encountered by CRAs when monitoring sites that use electronic medical records as source documents for their clinical trials.
Benefits
During a typical monitoring visit at a site that does not utilize electronic medical records, a CRA can expect to be provided with at least two or three thick medical charts that often take up needed space on the small desk provided by the site to work. A paper medical chart may or may not be organized, legible, or complete. Sometimes, the paper medical chart is not available to the CRA during the monitoring visit because the patient is scheduled to have an office visit on the same day as the monitoring visit. All of these factors can potentially hinder the timely collection of important data, or compromise the quality of the data collected by the CRA. Each day’s delay in getting data collected and analyzed for drug approval can cost more than a million dollars to the pharmaceutical or biotechcompany sponsoring the clinical trial. Therefore, timeliness in collecting quality clinical trial data is very important.
However, when a site uses electronic medical records, the CRA experiences a very different scenario. There are no thick medical records to clutter his/her work area. All the medical data are on the computer provided by the site. The electronic medical records tend to be very organized and consistent with the same layout, making it easier to maneuver through the chart and locate the data needed within the chart. The doctor’s progress notes are typed instead of hand written, making the progress notes legible to read. Because the medical records are electronic, more than one person can have access to the record at the same time. The CRA no longer has to wonder if a chart will be available to review during the visit if the patient’s visit happens to be on the same day as the monitoring visit. All of these factors help ensure the timely collection of data, reduce the risk of poor data quality and data analysis delays.
Perhaps one of the more important benefits of having electronic medical records from a CRAs view point is the salvation of data during natural disasters caused by hurricanes, tornadoes, tropical storms, fires, earthquakes, etc. The database that stores the information in the medical record prevents the information from being destroyed during these events. Most southeastern and coastal states in the U.S. are prone to these types of disasters. Clinical research associates can often expect delays in collecting data at these sites during the seasonal weather patterns, but the threat of never collecting the data is eliminated due to the use of electronic databases to store the medical records.
Challenges
Though the benefits of having electronic medical records are substantial, a few important challenges exist at many sites when monitoring clinical data sourced from electronic medical records is required. These challenges include: 1) non-compliance with 21CFR(code of federal regulations) Part 11; 2) defining the difference between research chart and medical chart; 3) Typos and transcription errors; 4) data entry delays.
Compliance with 21 CFR Part 11 is very important when sites decide to use electronic medical records as source documents for their clinical trials. This federal regulation requires all electronic records to be electronically signed off with a unique user ID and password that is only known by the person creating the document. The regulation further requires each person who has access to a patient’s medical record to be provided with a unique User ID and password as well, including monitors and auditors. CRAs often find that sites and hospitals are using electronic medical records, but they are not 21 CFR compliant, and therefore cannot be deemed as a true electronic medical records facility for clinical trials. In these cases, the CRA is often unable to view the electronic medical record because the site’s computer network is not secure enough to provide the confidentiality needed for other patients’ medical records who are not participating on the clinical trials. The site is still expected to provide printouts of the unsecured information in a paper medical chart along with a statement confirming that all of the printed medical records are complete, and that not documents are knowingly withheld.
A second challenge observed by CRAs is the site’s difficulty in determining the difference between a research chart and a medical chart. Many electronic medical record sites tend to still provide the CRA with a separate paper research chart even though they have electronic medical records. This is often explained by stating that some records are not a part of the medical record, but were obtained from documents developed for the clinical trial, not for the medical record. Therefore, the extra documents were filed in a separate folder outside of the electronic medical record. The challenge encountered here is that a true electronic medical record should contain all documents pertaining to any treatments or clinic visits by that patient. Therefore, the ideal electronic medical system should have the capacity to accept scanned documents from outside sources as well as contain all dictated notes from internal clinic and hospital visits. The purpose for utilizing an electronic system in clinical trials is so that all source data is available and accessible in one working system.
A third challenge experienced at sites with electronic medical records is the increased risk of typos and transcription errors of dates, patient identity and treatment information, cutting and pasting. These errors can compromise data quality, and delay timely data collection if not promptly corrected.
A final challenge experienced by many CRAs working with electronic medical record sites is the have lag time in which patient visits are posted for viewing in the medical record. Many sites have lag times of 48 to 72 hours before the most recent visit can be available for review. Therefore, if a patient’s most recent visit was completed one or two days before the CRA’s visit, then the CRA will be unable to review the data for that patient’s visit because of the lag time required before the patient’s most recent visit is posted, making it difficult to collect the most current data (serious adverse events, adverse events, conmeds, treatment, etc.) for the patient.
Conclusion
Though the above challenges of non-compliance with 21CFR Part 11, defining the difference between research chart and medical chart, typos and transcription errors, and data entry delays are significant, they are fixable and will only enhance the benefits of utilizing electronic records once resolved. Sites that are dedicated to providing stellar electronic medical records are already implementing checks and balances in their system to resolve these challenges. Many of the benefits of easy access, less clutter, data storage during adverse weather patterns, legible progress notes, and consistent chart organization discussed in this article are key drivers of productive monitoring visits that will increase data collection and data quality at the site.
With the changes in health reform, this may be a topic of increasing interest. Thanks to both Chris and Avis for their contribution. Enjoy!
Make it a great day!
Amri
Electronic Health Records and Clinical Trials: An Incentive to Innovate
by Chris Thorman
As we wait for the federal government to finalize important sections of the Health Information Technology for Economic and Clinical Health Act (HITECH), there is a lot of talk about the financial incentives for implementing electronic health records (EHR). And understandably so. Practices that implement an EHR under the federal government’s guidelines stand to gain nearly $50,000 in incentives over the next five years. (More)
Electronic Health Records and Clinical Research: A CRA's Perspective
by Avis D. Williams, MSPH, CCRA
A CRA is the term for anyone involved in monitoring clinical trials. One of the main roles of a CRA is to help ensure timely generation and collection of quality research data. With the advent and popularity of electronic clinical trials (eClinical Trials), CRA’s are seeing a gradual increase in the number of clinical research sites (research hospitals, educational institutions, and private medical practices) opting to use electronic medical records as source documents for their clinical trial data. This article describes some of the benefits and drawbacks encountered by CRAs when monitoring sites that use electronic medical records as source documents for their clinical trials.
Benefits
During a typical monitoring visit at a site that does not utilize electronic medical records, a CRA can expect to be provided with at least two or three thick medical charts that often take up needed space on the small desk provided by the site to work. A paper medical chart may or may not be organized, legible, or complete. Sometimes, the paper medical chart is not available to the CRA during the monitoring visit because the patient is scheduled to have an office visit on the same day as the monitoring visit. All of these factors can potentially hinder the timely collection of important data, or compromise the quality of the data collected by the CRA. Each day’s delay in getting data collected and analyzed for drug approval can cost more than a million dollars to the pharmaceutical or biotechcompany sponsoring the clinical trial. Therefore, timeliness in collecting quality clinical trial data is very important.
However, when a site uses electronic medical records, the CRA experiences a very different scenario. There are no thick medical records to clutter his/her work area. All the medical data are on the computer provided by the site. The electronic medical records tend to be very organized and consistent with the same layout, making it easier to maneuver through the chart and locate the data needed within the chart. The doctor’s progress notes are typed instead of hand written, making the progress notes legible to read. Because the medical records are electronic, more than one person can have access to the record at the same time. The CRA no longer has to wonder if a chart will be available to review during the visit if the patient’s visit happens to be on the same day as the monitoring visit. All of these factors help ensure the timely collection of data, reduce the risk of poor data quality and data analysis delays.
Perhaps one of the more important benefits of having electronic medical records from a CRAs view point is the salvation of data during natural disasters caused by hurricanes, tornadoes, tropical storms, fires, earthquakes, etc. The database that stores the information in the medical record prevents the information from being destroyed during these events. Most southeastern and coastal states in the U.S. are prone to these types of disasters. Clinical research associates can often expect delays in collecting data at these sites during the seasonal weather patterns, but the threat of never collecting the data is eliminated due to the use of electronic databases to store the medical records.
Challenges
Though the benefits of having electronic medical records are substantial, a few important challenges exist at many sites when monitoring clinical data sourced from electronic medical records is required. These challenges include: 1) non-compliance with 21CFR(code of federal regulations) Part 11; 2) defining the difference between research chart and medical chart; 3) Typos and transcription errors; 4) data entry delays.
Compliance with 21 CFR Part 11 is very important when sites decide to use electronic medical records as source documents for their clinical trials. This federal regulation requires all electronic records to be electronically signed off with a unique user ID and password that is only known by the person creating the document. The regulation further requires each person who has access to a patient’s medical record to be provided with a unique User ID and password as well, including monitors and auditors. CRAs often find that sites and hospitals are using electronic medical records, but they are not 21 CFR compliant, and therefore cannot be deemed as a true electronic medical records facility for clinical trials. In these cases, the CRA is often unable to view the electronic medical record because the site’s computer network is not secure enough to provide the confidentiality needed for other patients’ medical records who are not participating on the clinical trials. The site is still expected to provide printouts of the unsecured information in a paper medical chart along with a statement confirming that all of the printed medical records are complete, and that not documents are knowingly withheld.
A second challenge observed by CRAs is the site’s difficulty in determining the difference between a research chart and a medical chart. Many electronic medical record sites tend to still provide the CRA with a separate paper research chart even though they have electronic medical records. This is often explained by stating that some records are not a part of the medical record, but were obtained from documents developed for the clinical trial, not for the medical record. Therefore, the extra documents were filed in a separate folder outside of the electronic medical record. The challenge encountered here is that a true electronic medical record should contain all documents pertaining to any treatments or clinic visits by that patient. Therefore, the ideal electronic medical system should have the capacity to accept scanned documents from outside sources as well as contain all dictated notes from internal clinic and hospital visits. The purpose for utilizing an electronic system in clinical trials is so that all source data is available and accessible in one working system.
A third challenge experienced at sites with electronic medical records is the increased risk of typos and transcription errors of dates, patient identity and treatment information, cutting and pasting. These errors can compromise data quality, and delay timely data collection if not promptly corrected.
A final challenge experienced by many CRAs working with electronic medical record sites is the have lag time in which patient visits are posted for viewing in the medical record. Many sites have lag times of 48 to 72 hours before the most recent visit can be available for review. Therefore, if a patient’s most recent visit was completed one or two days before the CRA’s visit, then the CRA will be unable to review the data for that patient’s visit because of the lag time required before the patient’s most recent visit is posted, making it difficult to collect the most current data (serious adverse events, adverse events, conmeds, treatment, etc.) for the patient.
Conclusion
Though the above challenges of non-compliance with 21CFR Part 11, defining the difference between research chart and medical chart, typos and transcription errors, and data entry delays are significant, they are fixable and will only enhance the benefits of utilizing electronic records once resolved. Sites that are dedicated to providing stellar electronic medical records are already implementing checks and balances in their system to resolve these challenges. Many of the benefits of easy access, less clutter, data storage during adverse weather patterns, legible progress notes, and consistent chart organization discussed in this article are key drivers of productive monitoring visits that will increase data collection and data quality at the site.
Saturday, March 27, 2010
Truth Serum
"The truth as an offense, but not a sin."
Bob Marley
Last week (March 23, 2010), President Barack Obama signed into law Healthcare (insurance) reform after it successfully passed in the United States Congress on Sunday, March 21st.
What it means as you have probably read in the paper is that a lot more people will eventually be able to have healthcare coverage and health plans will have a few new restrictions that will aid in them being somewhat more balanced as far as covering people's needs is concerned. Health plans will not suffer, business will not suffer, if you are reading this blog and you make over $200,000 per year (at most about 5% of Americans) you will be required to contribute a little more of your income in taxes. I think this article from MSNBC is one of many that gives a pretty good explanation of what is to come on the surface.
With that out of the way, I wanted to see if now that we have something to work with, will those who we have elected to govern choose to govern or will they choose to hide behind one excuse after another so that they can continue to resist their leader. Or should I say the elected leader that some consider theirs?
I wrote several months ago that this idea of healthcare reform is a microcosm for American society. My intention was to begin a dialogue about what the realities of this debate really were and until today actually are.
So, now that we have a health reform bill signed into law, what is the truth? If we had a truth serum to get into the minds of those who are still living with what is in many ways a violent, and certainly visceral response to this legislation what would they say?
Believe me when I say that I get political leanings. It is clear that tilting the balance of power towards the political party that one represents is generally in the goals of a politician. And despite obvious drawbacks of governing on leanings versus principle, I don't expect for that to change.
And while I fundamentally believe that the interests of most politicians are consistently biased towards how they can negotiate in a particular direction; I don't believe their intentions are such that they are opposed to things that have the potential to do a great deal of good for a majority of the people that elected them to office.
In the case of healthcare insurance reform, I am not so sure that this is about party, position, or the American people.
When one hears the rhetoric and refrain of healthcare reform opponents via social media or the news media, I have not heard the whole truth. It is almost like listening to code language.
We hear:
"It's too expensive, it will break us."
"This is a [still] a government take-over of healthcare."
"He said he was going to be bipartisan, what happened to that."
"We want healthcare reform, but we feel like we simply need to start over, why rush this?"
"This bill is not good for the American people."
Then of course:
"Obamacare is socialized medicine!"
and recently from Newt Gingrich:
“They will have destroyed their party much as Lyndon Johnson shattered the Democratic Party for 40 years [by passing civil rights legislation]."
You have to appreciate Newt's honesty. He spoke as if he had taken truth serum. In fact, he summed up what the unspoken sentiment of many Americans is and has been manipulated to be where reform is concerned: opposition to the idea of President Barack Obama.
They are not opposed to the Office of the President, they are not really even opposed to Democrats, or healthcare reform for that matter. I would argue that most Americans don't know enough about the inner workings of health reform or economics to an extent that they even really understand why they feel how they do. In this case of resistance to reform, they are primarily opposed the physical identity of one man.
The code language that has been used by resistant politicians and pundits is incrementally becoming more explicit, but in general they have restrained themselves. They have done so because deep down they know that their sentiments are contrary to what they believe is "the right thing". Their anger and resistance is a reaction, in my opinion, to a compromised conscience.
When the integrity of one's conscience is compromised, guilt often turns to guile. To mitigate the guilt, many make the object or idea of their guilt to be wrong. They demonize and attack them as a salve to mitigate such a compromise. When the salve doesn't serve its intended purpose, they intensify it.
I am still concerned with unilateral thinking and total lack of compromise for anything other than personal benefit. I still feel it could be the downfall of country's integrity and I am hoping that I am wrong.
For now, I am pleased that President Obama did something. With the bill's flaws (there are in my humble opinion several unknowns that could be problematic), challenges to the idea of reform, and vehement resistance towards his character, he persisted. I don't care too much about party, but I do care about principle.
What principles will we carry forward in the transition to a new America or for that matter a new world?
I think that is one vital question of the future. With all of the unknowns facing us in the future of healthcare and our general prosperity as a country, we can only rise or fall on principles.
Make it a great day!
Bob Marley
Last week (March 23, 2010), President Barack Obama signed into law Healthcare (insurance) reform after it successfully passed in the United States Congress on Sunday, March 21st.
What it means as you have probably read in the paper is that a lot more people will eventually be able to have healthcare coverage and health plans will have a few new restrictions that will aid in them being somewhat more balanced as far as covering people's needs is concerned. Health plans will not suffer, business will not suffer, if you are reading this blog and you make over $200,000 per year (at most about 5% of Americans) you will be required to contribute a little more of your income in taxes. I think this article from MSNBC is one of many that gives a pretty good explanation of what is to come on the surface.
With that out of the way, I wanted to see if now that we have something to work with, will those who we have elected to govern choose to govern or will they choose to hide behind one excuse after another so that they can continue to resist their leader. Or should I say the elected leader that some consider theirs?
I wrote several months ago that this idea of healthcare reform is a microcosm for American society. My intention was to begin a dialogue about what the realities of this debate really were and until today actually are.
So, now that we have a health reform bill signed into law, what is the truth? If we had a truth serum to get into the minds of those who are still living with what is in many ways a violent, and certainly visceral response to this legislation what would they say?
Believe me when I say that I get political leanings. It is clear that tilting the balance of power towards the political party that one represents is generally in the goals of a politician. And despite obvious drawbacks of governing on leanings versus principle, I don't expect for that to change.
And while I fundamentally believe that the interests of most politicians are consistently biased towards how they can negotiate in a particular direction; I don't believe their intentions are such that they are opposed to things that have the potential to do a great deal of good for a majority of the people that elected them to office.
In the case of healthcare insurance reform, I am not so sure that this is about party, position, or the American people.
When one hears the rhetoric and refrain of healthcare reform opponents via social media or the news media, I have not heard the whole truth. It is almost like listening to code language.
We hear:
"It's too expensive, it will break us."
"This is a [still] a government take-over of healthcare."
"He said he was going to be bipartisan, what happened to that."
"We want healthcare reform, but we feel like we simply need to start over, why rush this?"
"This bill is not good for the American people."
Then of course:
"Obamacare is socialized medicine!"
and recently from Newt Gingrich:
“They will have destroyed their party much as Lyndon Johnson shattered the Democratic Party for 40 years [by passing civil rights legislation]."
You have to appreciate Newt's honesty. He spoke as if he had taken truth serum. In fact, he summed up what the unspoken sentiment of many Americans is and has been manipulated to be where reform is concerned: opposition to the idea of President Barack Obama.
They are not opposed to the Office of the President, they are not really even opposed to Democrats, or healthcare reform for that matter. I would argue that most Americans don't know enough about the inner workings of health reform or economics to an extent that they even really understand why they feel how they do. In this case of resistance to reform, they are primarily opposed the physical identity of one man.
The code language that has been used by resistant politicians and pundits is incrementally becoming more explicit, but in general they have restrained themselves. They have done so because deep down they know that their sentiments are contrary to what they believe is "the right thing". Their anger and resistance is a reaction, in my opinion, to a compromised conscience.
When the integrity of one's conscience is compromised, guilt often turns to guile. To mitigate the guilt, many make the object or idea of their guilt to be wrong. They demonize and attack them as a salve to mitigate such a compromise. When the salve doesn't serve its intended purpose, they intensify it.
I am still concerned with unilateral thinking and total lack of compromise for anything other than personal benefit. I still feel it could be the downfall of country's integrity and I am hoping that I am wrong.
For now, I am pleased that President Obama did something. With the bill's flaws (there are in my humble opinion several unknowns that could be problematic), challenges to the idea of reform, and vehement resistance towards his character, he persisted. I don't care too much about party, but I do care about principle.
What principles will we carry forward in the transition to a new America or for that matter a new world?
I think that is one vital question of the future. With all of the unknowns facing us in the future of healthcare and our general prosperity as a country, we can only rise or fall on principles.
Make it a great day!
Sunday, March 14, 2010
The Idea of Mentoring
If there is an idea of mentoring in your mind that is about how one person with expertise and another more "junior" person sit by the fireside while the knowledge seeps in from the "expert". . .think differently.
I had the opportunity to hear Dr. Audrey Murrell, Associate Professor at the University of Pittsburgh, speak today. Her approach, depth, and breadth of reach where the idea of mentoring is concerned was phenomenal.
She started the conversation getting us clear on the distinctions between mentoring myths and the realities of what mentors are and can be. From there she moved into clearly describing the roles of mentors and how within the role is always a symbiotic relationship. She shared that it is not a paternalistic/maternal parent-child dynamic with a superior-subordinate, helper-helped interaction.
This fact that the nature of mentoring is two-way and that both parties should be benefiting from the cultivation of the relationship is, for many, a profoundly different way of viewing mentoring. And even though there are people who have experienced the benefits of having a mentee and have communicated about these inherent benefits, there is still the idea by some that it is a time-sucking, obligatory distraction from "my work".
What excited me the most was the clarity she brought to the idea that mentoring is a separate responsibility of the leader/manager vs. an integral responsibility that benefits individuals and organizations in the short and long-term. She said this supported by data and great personal experiences.
Dr. Murrell's explanation of the benefits of mentoring led me to reflect on the views that people often have about diversity and inclusion. Inclusion goes naturally hand in hand with development. Being truly inclusive as a leader fosters the manifestation and cultivation of diversity in its myriad dimensions. Developing people is not optional just like cultivating diversity is not optional, especially in certain disciplines and industries. And given the nature of the especially complex problems we are asked to solve in our businesses these days we cannot afford to discount it in any sense.
Diverse perspectives are not only valuable, but to be competitive they are essential. All dimensions of diversity from identity to outlook must be considered if innovation and continuous improvement/maintenance of quality are desired.
I suggest you pick up Dr. Murrell's book Intelligent Mentoring. Her perspective and insight is a great contribution to any organization or professional who would like to develop this vital leadership competency.
I had the opportunity to hear Dr. Audrey Murrell, Associate Professor at the University of Pittsburgh, speak today. Her approach, depth, and breadth of reach where the idea of mentoring is concerned was phenomenal.
She started the conversation getting us clear on the distinctions between mentoring myths and the realities of what mentors are and can be. From there she moved into clearly describing the roles of mentors and how within the role is always a symbiotic relationship. She shared that it is not a paternalistic/maternal parent-child dynamic with a superior-subordinate, helper-helped interaction.
This fact that the nature of mentoring is two-way and that both parties should be benefiting from the cultivation of the relationship is, for many, a profoundly different way of viewing mentoring. And even though there are people who have experienced the benefits of having a mentee and have communicated about these inherent benefits, there is still the idea by some that it is a time-sucking, obligatory distraction from "my work".
What excited me the most was the clarity she brought to the idea that mentoring is a separate responsibility of the leader/manager vs. an integral responsibility that benefits individuals and organizations in the short and long-term. She said this supported by data and great personal experiences.
Dr. Murrell's explanation of the benefits of mentoring led me to reflect on the views that people often have about diversity and inclusion. Inclusion goes naturally hand in hand with development. Being truly inclusive as a leader fosters the manifestation and cultivation of diversity in its myriad dimensions. Developing people is not optional just like cultivating diversity is not optional, especially in certain disciplines and industries. And given the nature of the especially complex problems we are asked to solve in our businesses these days we cannot afford to discount it in any sense.
Diverse perspectives are not only valuable, but to be competitive they are essential. All dimensions of diversity from identity to outlook must be considered if innovation and continuous improvement/maintenance of quality are desired.
I suggest you pick up Dr. Murrell's book Intelligent Mentoring. Her perspective and insight is a great contribution to any organization or professional who would like to develop this vital leadership competency.
Thursday, February 11, 2010
Staying under the radar
Frankly, I am not sure what is worse for an organization, especially a healthcare organization: a disengaged employee or a disengaged employer.
Both are accountable for each other's circumstance. And if I was a betting man, I would bet that it is very difficult (perhaps impossible), in aggregate to say in which direction the disengagement came/comes from. It doesn't really matter who was the chicken or the egg. What matters is what it creates--individual and organizational suffering.
Now, this notion of organizational suffering is not often talked about. As a disengaged employee, why would one care about an organization suffering? In fact, if it is not our company (one we work for) or one we do business with, why would the notion of organizational suffering matter?
Individual suffering is a different story. When we can "see" suffering, our feeling is visceral and it summons our compassion which is expressed as an energetic acknowledgement of our connection to the other we are observing. Or, as we have seen in the outreach that many Americans have made in response to Haiti, our compassion is expressed with a financial sacrifice at what ever level one is able or willing to contribute. This is good.
On the other hand, there is the suffering that perhaps is much more prevalent in organizations and in individuals. It is hidden suffering. It is blight of commitment, willingness, creativity, desire to be with "the other". It is perhaps the opposite of compassion as it can take even one's individual desire to contribute to self away.
A few months ago before I moved to Cambridge, I was talking to a few of my friends and colleagues and I kept hearing a common theme when I asked some of them about their work: "Amri, I am just trying to stay under the radar." They often said this with a bit of an uncomfortable look on their faces as if they were under surveillance and were scared to speak too loudly.
I can't say that I know exactly whether or not they were joking or were in part or totally serious. What I can say is that the idea of "staying under the radar" is a suffering idea. It is, joking or not, the idea that you are being targeted and have to assure that the radar cannot detect you. It is not just a suffering idea for an individual, it is as such equally to the organizations that these folks work for as they are getting, at the most, half-rate production and contribution.
Just imagine yourself as an employer being able to secretly know all of your "staying under the radar" people and when you walked through the seas of cubicles and past offices you saw 20-30% or more of your people appearing as though they are ducked under their desks working in the darkest part of their workspace. The idea of it is hilarious and utterly depressing at the same time. If I saw this, it would cause me to suffer and it would cause me to act.
This conversation is two-sided and employees with the sentiment to disengage have to be as responsible as their employers have to be in making sure they stay engaged. Thing is, not everyone always knows that disengagement is taking place. That is another conversation that we have to have in the near future.
It pays to know that all suffering experienced is shared and the responsibility to transcend it is shared, too.
Make it a great day!
Both are accountable for each other's circumstance. And if I was a betting man, I would bet that it is very difficult (perhaps impossible), in aggregate to say in which direction the disengagement came/comes from. It doesn't really matter who was the chicken or the egg. What matters is what it creates--individual and organizational suffering.
Now, this notion of organizational suffering is not often talked about. As a disengaged employee, why would one care about an organization suffering? In fact, if it is not our company (one we work for) or one we do business with, why would the notion of organizational suffering matter?
Individual suffering is a different story. When we can "see" suffering, our feeling is visceral and it summons our compassion which is expressed as an energetic acknowledgement of our connection to the other we are observing. Or, as we have seen in the outreach that many Americans have made in response to Haiti, our compassion is expressed with a financial sacrifice at what ever level one is able or willing to contribute. This is good.
On the other hand, there is the suffering that perhaps is much more prevalent in organizations and in individuals. It is hidden suffering. It is blight of commitment, willingness, creativity, desire to be with "the other". It is perhaps the opposite of compassion as it can take even one's individual desire to contribute to self away.
A few months ago before I moved to Cambridge, I was talking to a few of my friends and colleagues and I kept hearing a common theme when I asked some of them about their work: "Amri, I am just trying to stay under the radar." They often said this with a bit of an uncomfortable look on their faces as if they were under surveillance and were scared to speak too loudly.
I can't say that I know exactly whether or not they were joking or were in part or totally serious. What I can say is that the idea of "staying under the radar" is a suffering idea. It is, joking or not, the idea that you are being targeted and have to assure that the radar cannot detect you. It is not just a suffering idea for an individual, it is as such equally to the organizations that these folks work for as they are getting, at the most, half-rate production and contribution.
Just imagine yourself as an employer being able to secretly know all of your "staying under the radar" people and when you walked through the seas of cubicles and past offices you saw 20-30% or more of your people appearing as though they are ducked under their desks working in the darkest part of their workspace. The idea of it is hilarious and utterly depressing at the same time. If I saw this, it would cause me to suffer and it would cause me to act.
This conversation is two-sided and employees with the sentiment to disengage have to be as responsible as their employers have to be in making sure they stay engaged. Thing is, not everyone always knows that disengagement is taking place. That is another conversation that we have to have in the near future.
It pays to know that all suffering experienced is shared and the responsibility to transcend it is shared, too.
Make it a great day!
Wednesday, January 27, 2010
iPad Launches: Can it Help Healthcare?
Greetings All,
My colleagues at Medical Software Advice are curious to know if you think a new technology like the iPad, just launched today-A Steve Jobs classic-can assist healthcare providers.
They want to know from you. Please share your thoughts in the survey below:
Which Tablet Computing Device Will Rule the Halls of Healthcare?
There is no obligation and neither Amri Johnson or Diversity HealthWorks were compensated for promoting the survey. We simply would like to get your response. For many years there have been a variety of devices that healthcare has used to collect data. Some have been great, others not so functional. Some say the iPad's functionality can be potentially revolutionary.
Let Medical Software Advice know what you think and of course. . .
Make it a great day!
My colleagues at Medical Software Advice are curious to know if you think a new technology like the iPad, just launched today-A Steve Jobs classic-can assist healthcare providers.
They want to know from you. Please share your thoughts in the survey below:
Which Tablet Computing Device Will Rule the Halls of Healthcare?
There is no obligation and neither Amri Johnson or Diversity HealthWorks were compensated for promoting the survey. We simply would like to get your response. For many years there have been a variety of devices that healthcare has used to collect data. Some have been great, others not so functional. Some say the iPad's functionality can be potentially revolutionary.
Let Medical Software Advice know what you think and of course. . .
Make it a great day!
Wednesday, January 20, 2010
Passion and Reason
When we get down to the business of organizational transformation the road to success is difficult at best. If we desire for the principles of inclusion and cultural competence to be central to transformation the difficulty can be exacerbated.
Most people I know have some type of passion in life. This passion is coupled and/or often met with the energy of reason.
In the the classic book, The Prophet by Khalil Gibran, the speaker says about Reason and Passion:
"Your reason and your passion are the rudder and the sails of your seafaring soul. If either your sails or your rudder be broken, you can but toss and drift, or else be held at a standstill in mid-seas. For reason, ruling alone, is a force confining; and passion, unattended, is a flame that burns to its own destruction."
Many of the people I have observed who are committed to this conversation about cultural competency and diversity are very passionate about it. In fact, they have been so passionate, that their reason has been "a flame that burns to its own destruction." Their passion has met with the reason of others and the reason has rationalized away the importance and intrinsic value of the passion.
Historically when a person passionate about diversity, inclusion, and cultural competency has had their ideas or budgets minimized, it has in many instances been the result of not doing the diligence of finding the passion(s) of others in the organization. As a result, when there is an opportunity to validate one idea vs. another, the result is often a cyclical resistance of one passion to protect another or to suppress a passion with reason because of a perceived imbalance.
I think we are at a crossroads in the evolution of business in this country and perhaps globally. The crossroads is one that lies between passion and reason. Often when there is a crossroads it means that we have to make a choice. The choice for most is seemingly dichotomous. But as Gibran reminds us:
"Therefore let your soul exalt your reason to the height of passion, that it may sing; And let it direct your passion with reason, that your passion may live through its own daily resurrection, and like the phoenix rise above its own ashes."
So, as we enter into these discussions where a passion for diversity is met with a question about viability, a business case, ROI, a bottom line rationale for why what we do should be done--get excited! Get excited as we are able to meet the reason of one with the passion of another.
We are also able to discover the passions of others that we were potentially unable to discern because of our resistance to what we thought was their attempt to suppress our passion. The coupling of reason and passion allows us the space to create something that goes beyond the simplistic rift that we have historically created.
When we can understand our passions and use them as impetus for discovering the passions of others, reason when it arises is a gift. It can be seen as a balancing element of a chemical equation; an opportunity to validate something that could be transformational--the beginning of possibility.
Make it a great day!
Most people I know have some type of passion in life. This passion is coupled and/or often met with the energy of reason.
In the the classic book, The Prophet by Khalil Gibran, the speaker says about Reason and Passion:
"Your reason and your passion are the rudder and the sails of your seafaring soul. If either your sails or your rudder be broken, you can but toss and drift, or else be held at a standstill in mid-seas. For reason, ruling alone, is a force confining; and passion, unattended, is a flame that burns to its own destruction."
Many of the people I have observed who are committed to this conversation about cultural competency and diversity are very passionate about it. In fact, they have been so passionate, that their reason has been "a flame that burns to its own destruction." Their passion has met with the reason of others and the reason has rationalized away the importance and intrinsic value of the passion.
Historically when a person passionate about diversity, inclusion, and cultural competency has had their ideas or budgets minimized, it has in many instances been the result of not doing the diligence of finding the passion(s) of others in the organization. As a result, when there is an opportunity to validate one idea vs. another, the result is often a cyclical resistance of one passion to protect another or to suppress a passion with reason because of a perceived imbalance.
I think we are at a crossroads in the evolution of business in this country and perhaps globally. The crossroads is one that lies between passion and reason. Often when there is a crossroads it means that we have to make a choice. The choice for most is seemingly dichotomous. But as Gibran reminds us:
"Therefore let your soul exalt your reason to the height of passion, that it may sing; And let it direct your passion with reason, that your passion may live through its own daily resurrection, and like the phoenix rise above its own ashes."
So, as we enter into these discussions where a passion for diversity is met with a question about viability, a business case, ROI, a bottom line rationale for why what we do should be done--get excited! Get excited as we are able to meet the reason of one with the passion of another.
We are also able to discover the passions of others that we were potentially unable to discern because of our resistance to what we thought was their attempt to suppress our passion. The coupling of reason and passion allows us the space to create something that goes beyond the simplistic rift that we have historically created.
When we can understand our passions and use them as impetus for discovering the passions of others, reason when it arises is a gift. It can be seen as a balancing element of a chemical equation; an opportunity to validate something that could be transformational--the beginning of possibility.
Make it a great day!
Tuesday, January 5, 2010
Will short-term thinking's results ever jolt us into reality?
When I started this post it was late Tuesday evening January 5th, and I wanted to simply get on-line and finally say Happy New Year to all of you who have been so tremendously supportive of this blog and our network and the mission that Diversity HealthWorks believes is absolutely critical to healthcare being all that it needs to be for this country.
Thank you for your support. I cannot fully express my appreciation in a writing, but know that the conversations generated, and the movement made towards creating what I feel is "REAL and ROBUST" healthcare reform (vs. financially-driven political health insurance reform) is greatly appreciated.
It was hard to get it all out when I started because I have had a heavier than usual sense that we are moving more and more rapidly away from our capacity to empathize. It is being replaced by blame, fear, and a mindset of scarcity. I understand it and I sympathize because I know that folks are struggling to different degrees. My concern is that the struggle is not making us more progressive as a nation. Frederick Douglass said: "If there is not struggle, there is no progress." My worry is that struggle is resented and as a result progress is thwarted.
I expressed in the last post that I am concerned that Americans don't have anything we agree on that connects us. Perhaps my Utopian sensibilities seem unrealistic, but it occurs to me that without any common bond, we are not a United States, we are simply a bunch of individuals focused on, as Janet Jackson stated in her song and Eddie Murphy repeated in a later comedy special, "What have you done for me lately?"
We are so wrapped up in the moment that we have no vision beyond "what I get more of" and/or "what they will take more of" and/or "if I get less of anything, it is wrong". Now, this is not a universal sentiment. Some feel blessed to have or have ample amounts and are willing (at least for now) to contribute a little more of what they have for those who have little to nothing.
Of course, since I talk about and explore facets of healthcare more than anything, I have seen this response to various health insurance reform bills proposed that suggest that those with more will pay a little more in some cases. So, I applaud those who are okay with this. Personally, I cannot say that they are right or wrong for thinking this way, but I think it is honorable and anyone willing to give gets a nod from me. I dare not question their intention, it is not my job.
On the other hand, there are those adamantly opposed to anything that speaks to addressing social issues that seemingly affect a few, but in reality affect us all. There is a belief that "those people" who could be the uninsured in the case of health insurance reform, "don't deserve care if they cannot afford it".
There is no consideration of what happens to a society that thinks like this, no consideration of how they are and will increasingly be directly and indirectly negatively affected, no consideration of the future of a nation that does not care for its people.
So, why this rant from a blogger that has traditionally been very much committed to presenting as balanced a perspective as I try to have in my consciousness?
Well, my conscience is speaking to me. My intuition is clear that where we are going, under the guise of making America strong, has very little to do with preserving the integrity of these not so United States and everything to do with individual preservation and in my opinion, our rapid demise.
I feel compelled to simply express my concern that we stand in the space of exploration about who we are choosing to be, more so than perhaps we ever have in our history. And for the most part we are not going too deep in this exploration. In fact, we are not even truly exploring anything beyond short-term dynamics that historically when focused on, have lead us to another short-term dynamic with less than ideal results.
Now, I am not saying to stop questioning our political system or the possible draw backs of spending taxpayer money to fix social problems, like health insurance reform, or even the dynamics of the economic recovery. By all means, say what you feel.
My issue is that as much as we scream and as much as we disagree because of concerns for self-preservation, is it possible to simultaneously consider a longer-term reality that transcends the individual and speaks to connectivity?
The time we are in speaks to a new reality of connectedness that we have not experienced in the world we are in prior to now. What this connectivity speaks to is a necessity to consider that win-loss dynamics in any capacity will no longer work.
So, there isn't an environmental policy that is good for one and bad for another. There isn't a healthcare solution that benefits one person and harms another. Yes, there are temporary situations that appear beneficial to one vs. another in a situation with apparently dichotomous variables; however, when we go beyond the short-term we will see that they won't work for long and "for long" is a lot shorter than it once was.
The reality of a short-term mindset will jolt us into reality. It is already happening and it will make itself more and more evident moving forward. Will we recognize the effect quickly enough to begin changing the tide?
I trust that some won't; I am confident and aware that many will.
Make it a great day!
Thank you for your support. I cannot fully express my appreciation in a writing, but know that the conversations generated, and the movement made towards creating what I feel is "REAL and ROBUST" healthcare reform (vs. financially-driven political health insurance reform) is greatly appreciated.
It was hard to get it all out when I started because I have had a heavier than usual sense that we are moving more and more rapidly away from our capacity to empathize. It is being replaced by blame, fear, and a mindset of scarcity. I understand it and I sympathize because I know that folks are struggling to different degrees. My concern is that the struggle is not making us more progressive as a nation. Frederick Douglass said: "If there is not struggle, there is no progress." My worry is that struggle is resented and as a result progress is thwarted.
I expressed in the last post that I am concerned that Americans don't have anything we agree on that connects us. Perhaps my Utopian sensibilities seem unrealistic, but it occurs to me that without any common bond, we are not a United States, we are simply a bunch of individuals focused on, as Janet Jackson stated in her song and Eddie Murphy repeated in a later comedy special, "What have you done for me lately?"
We are so wrapped up in the moment that we have no vision beyond "what I get more of" and/or "what they will take more of" and/or "if I get less of anything, it is wrong". Now, this is not a universal sentiment. Some feel blessed to have or have ample amounts and are willing (at least for now) to contribute a little more of what they have for those who have little to nothing.
Of course, since I talk about and explore facets of healthcare more than anything, I have seen this response to various health insurance reform bills proposed that suggest that those with more will pay a little more in some cases. So, I applaud those who are okay with this. Personally, I cannot say that they are right or wrong for thinking this way, but I think it is honorable and anyone willing to give gets a nod from me. I dare not question their intention, it is not my job.
On the other hand, there are those adamantly opposed to anything that speaks to addressing social issues that seemingly affect a few, but in reality affect us all. There is a belief that "those people" who could be the uninsured in the case of health insurance reform, "don't deserve care if they cannot afford it".
There is no consideration of what happens to a society that thinks like this, no consideration of how they are and will increasingly be directly and indirectly negatively affected, no consideration of the future of a nation that does not care for its people.
So, why this rant from a blogger that has traditionally been very much committed to presenting as balanced a perspective as I try to have in my consciousness?
Well, my conscience is speaking to me. My intuition is clear that where we are going, under the guise of making America strong, has very little to do with preserving the integrity of these not so United States and everything to do with individual preservation and in my opinion, our rapid demise.
I feel compelled to simply express my concern that we stand in the space of exploration about who we are choosing to be, more so than perhaps we ever have in our history. And for the most part we are not going too deep in this exploration. In fact, we are not even truly exploring anything beyond short-term dynamics that historically when focused on, have lead us to another short-term dynamic with less than ideal results.
Now, I am not saying to stop questioning our political system or the possible draw backs of spending taxpayer money to fix social problems, like health insurance reform, or even the dynamics of the economic recovery. By all means, say what you feel.
My issue is that as much as we scream and as much as we disagree because of concerns for self-preservation, is it possible to simultaneously consider a longer-term reality that transcends the individual and speaks to connectivity?
The time we are in speaks to a new reality of connectedness that we have not experienced in the world we are in prior to now. What this connectivity speaks to is a necessity to consider that win-loss dynamics in any capacity will no longer work.
So, there isn't an environmental policy that is good for one and bad for another. There isn't a healthcare solution that benefits one person and harms another. Yes, there are temporary situations that appear beneficial to one vs. another in a situation with apparently dichotomous variables; however, when we go beyond the short-term we will see that they won't work for long and "for long" is a lot shorter than it once was.
The reality of a short-term mindset will jolt us into reality. It is already happening and it will make itself more and more evident moving forward. Will we recognize the effect quickly enough to begin changing the tide?
I trust that some won't; I am confident and aware that many will.
Make it a great day!
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