“Why Work Sucks and How to Fix It: No Schedules, No Meetings, No Joke–the Simple Change That Can Make Your Job Terrific” (Cali Ressler, Jody Thompson)

As a leader in an organization, imagine reading this description of an employee’s workday:

A typical day for me includes waking up when my room is too bright from the sun and I can no longer sleep. I check my e-mail to make sure there are no pressing issues and respond to anyone who needs my input. I will typically watch an episode of South Park on the Internet, then walk to my local grocery store and buy some breakfast, even though it’s closer to lunch at this point. After eating I will work in front of my television with ESPN on in the background. At this point I will choose to go into the office or continue to work from home, or maybe not even work at all and go for a bike ride or jog. If there is still work to do later that night, I’ll do it then and it’s no big deal.

I’ll admit it - it kind of made me gulp when I read it.

At the same time, though, I have been in a lot of conversations with a lot of personal and professional colleagues over the past 3-4 years or so, where the question we’re asking ourselves is, “Is this how work life is supposed to be?” Spoken or unspoken, the answer is “we don’t think so.” Various companies’ data also show a trend toward less vacancy in their physical locations.

In the middle of that self-discovery, I read about BestBuy, Inc., (see “Smashing the Clock“). This is the book about their journey.

It’s time to let go and see what our employees can really do - BestBuy Manager

A Results Only Work Environment (ROWE) is as it says - one where results are measured, not time spent. There are no timeclocks, no discussion of time, and no “Sludge” as the authors refer to it. “Sludge” are the comments people make to each other about time, whether it’s about being late to a meeting, or working late at night. Simply put, the authors state, an employer is trading work for money. Why not give them what they pay for?

Reading beyond the BusinessWeek article was very useful - this is not flextime, it’s not “working from home,” it’s a different philosophy altogether. That includes the vignette above. Totally allowed, if you have the results to show for it. The concept can appear challenging; however, it makes sense, in the context of strong leadership committed to respecting employees and customers. That’s where I found similarities to the work I have done.

About respect

When I first read about this work, I asked about how this was similar or different from the LEAN transformation I participated in, in the area of health information technology. Some of the things were consistent, some seemed less so, like having technology teams physically present alongside doctors and nurses, guiding care and feeding of an electronic health record system.

My reconciliation of all of this rests with not comparing individual tools/approaches between ROWE and LEAN. What they both have in common is respect for the customer and staff, and strong leaders. It’s impressive that at the heart of the ROWE movement was (at the time) a 24 year old employee of BestBuy (Cali Ressler), who was dissatisfied with the status quo. The authors also explicitly reject war analogies in business as I have. In my own situation, there was not just a desire to change the way we worked, it was clear that not changing would be unsafe. Healthcare organizations across the country are now learning this, thankfully, but it’s a slow transformation, and the transformations that are happening are nowhere near as radical as ROWE, which is why I am interested in the movement (not because I want to be radical, but because the threats to our patients and their families’ health are so significant).

Just because you can no longer be late doesn’t mean you can be lame

Preliminary data from the University of Minnesota’s Flexible Work and Well-Being Center are showing that voluntary terminations are down, involuntary terminations are up.

Mea culpa and, as usual, I see analogies to health care

I liked the concepts in the book a lot, and have done a self-inventory of my own sludge and the sludge that’s been directed my way. The kind of sludge I get nowadays is really from people who want to understand better how technology can be used to help patients stay healthy. I welcome it as an opportunity to teach and learn. As the authors discussed, people can learn to live sludge-free, and they really want to live sludge-free. It starts with us.

I could see myself promoting ROWE in health care settings, and I think physicians, primary care ones especially, would benefit. The work I do to change health care is completely connected to the idea that health is a means, not an end, and people who go into health care want to support our patients where support is needed, mostly where they live, work, and play. I don’t believe people in health care are any more attached to time than Cali and Jody’s (former?) colleagues at BestBuy are. When I read the stories of BestBuy employees before and after, I reflected on some of the conversations I have had with health professionals (at all levels) who have really been challenged to juggle their passion for helping people and their ability to provide for themselves and their families, physically and emotionally. What would it be like for a family medicine or internal medicine specialist to provide their cognitive services to patients and families using a combination of virtual tools and office (or even home presence) when the situation called for it? Look at what HelloHealth is doing. It’s possible.

A Results Only Patient Experience (ROPE)?

A came upon this table in the book, and curiously, I found it extensible to our health care system. I hope I won’t get in trouble for using it to think about what our health care system were like if our patients experienced it the way a BestBuy employee experienced their work life. The edits are mine.

• What Should Employers Do about Health Care? — HBS Working Knowledge - A brief call to action to employers about going beyond cost management in benefit structure.

• Creative Class » Blog Archive » Happy Jobs, American-style - Creative Class - Physicians and lawyers (the highest in prestige) score above average in satisfaction and happiness, but not in the top 12. Nurses score slightly lower than doctors. Physical therapists are #2, behind clergy.

"Nickel and Dimed: On (Not) Getting By in America" (Barbara Ehrenreich)

Last week, I was walking with one of my patient-centered mentors, David Sobel, MD, through one of my favorite museums in Washington, DC., The National Portrait Gallery. As I brought him to one of my favorite pieces, I asked him if he read this book, and he told me it was one of the most influential books he’s read. “Have you gotten to the Wal-Mart section yet?” he asked. I have, and I have to say I agree with his assessment.

This book preceded a more modern version of living among the corporate natives which I reviewed previously, Punching In, by Alex Frankel. Unlike Alex Frankel’s adventure, Barbara Ehrenrich goes completely native, adopting the lifestyle of a minimum wage worker, down to eating, living, and surviving (or attempting to) in several different American cities. Her jobs include being a server in several restaurants, a house cleaner for a large national franchise, and a stint in retail.

We learn some realities of these jobs - it’s never really okay to not always be doing something, even if there’s nothing to do. One of her places of employment calls this “time theft.” So there’s a constant flow to the work, some of it useful, some of it not. The profiles of her coworkers describes the conditions that the working poor must accept - not having first month’s rent and deposit may mean spending $60 a night in a motel, an irrational yet necessary way to survive. The quality of life that Ms. Ehrenrich accepts for her assignment is concerning bordering on dangerous - a single woman in an efficiency with no screen on the window on the ground floor.

As I read this with an interest in employer-based health, I also learned a lot.

Read the rest of this entry »

“And you may ask yourself, how do I work this?”

It has become fashionable to say farewells in person, over e-mail, and now in the blogosphere. Since the e-mail has already gone out to all of the staff at Group Health Cooperative, this is my blog farewell. I have decided to leave my position as Medical Director of Health Informatics and Web Services; my last day with Group Health Permanente, providing direct service to Group Health Cooperative, will be June 30, 2008.

Without realizing it, I wrote a little tribute to my wonderful experience as a Group Health physician and patient empowerment advocate in my book review of “Overtreated,” by Shannon Brownlee. I definitely share the feelings of another blog farewell I read along time ago - I leave with gratitude and appreciation for every Group Health member and staff member who supported me in becoming a better physician and servant leader every day. I was rebooted often, and reprogrammed/upgraded regularly by these awesome teachers.

People who know me know that the glass is at least 3/4 full. Fortunately, Group Health is a great place to be optimistic about improving the health of patients and their communities. I’m certain that health care across the United States and beyond has been improved through Group Health’s contributions; the innovation that will continue to come from Group Health will also continue to help every patient in every care system.

Keep in touch, Group Health, and all the best.

• No Schedules, No Meetings—Enter Best Buy’s ROWE - Part 2 - Sludge is not our best friend - "productive" is better than "busy" - lessons from BestBuy.

• The CMIO–A New Leader for Health Systems — Leviss et al. 13 (5): 573 — Journal of the American Medical Informatics Association - Helpful overview of the qualities of CMIO. I didn't realize how "new" this position is in health care. Nice to see confirmation that good CMIO's are good physicians primarily.

• Beyond Blogs : Businessweek - A refresh of Businessweek's landmark 2005 story about Social Media and businessweek. Interesting update: prediction of mass firings of employees who blog (being "Dooced") has not happened, with the exception of a few well publicized cases, like this one. Perhaps Web2.0 is subtly changing the expectation of transparency on the part of organizations and their customers - participation is becoming more of a norm.

The Genie Industries video is especially compelling because everything they discuss is applicable in health care. What if we substituted “patient care” for making scissor lifts - we would see huge strides in improvement. Also, just upgraded the software that powers this blog. Viva open source.

• Genie Industries, Spotlight - A nice video of Genie Industry's work promoting LEAN and the customer focus in its manufacturing efforts
• Popularity Context Plugin Fix for Wordpress 2.5 -
• The Wisdom of Patients: Health Care Meets Online Social Media - CHCF.org -
• From Al Gore?s Chief Speechwriter: Simple Tips for a Damn Good Presentation (Plus: Breakdancing) - Great advice on giving presentations. The one I like best - it’s not about you, it’s about the audience.

If you are interested in innovation, I think this is a good podcast worth listening to - and the actual audio is more useful than the printed version.

I listened to it the day before I attended the latest Patient Centered Primary Care Collaborative, in Washington, DC. At the meeting, I was fortunate to run into one of my role models, Susan Edgman-Levitan, PA, and we talked about the idea that the Medical Home is about improving the care of patients where they spend most of their time - where they live, work, and play. We can help patient-centered care flourish by including ideas from everyone involved in the care, including nurses, doctors, allied health practitioners, eye care, oral health care, behavioral health care, just to name a few.

I liked what Jack said in the podcast, that in a company, there has to be

a sense that in every soul of the company, the idea that everybody innovates.

Toward the end of the podcast, Jack gets quite fired up about the idea that innovation can’t be regulated to the chosen few. My experience reinforces this. In the area of health information technology, this is critical. When most people think about implementing HIT, they think about the implementation period. The most powerful part of HIT is what happens after implementation, and using a management system like the one developed by Toyota Motor Company (as we are) can allow an organization to turn HIT into an organization wide innovation engine - if they capture all of the ideas of everyone involved in providing care and put them to use. To not do so is to waste one of the most valuable raw materials for growth - ideas and time (and most importantly our patients’ time).

One other conversation that has come up in the last several days is about generational changes in approach. Many of the Generation X and Generation Y colleagues I have been talking with were raised in a professional environment where we were not going to have all the answers, and we are uncomfortable being accountable for them. We want to share the power of coming up with the answers with our provider colleagues and our patients. This is not to say that our baby boomer colleagues don’t have this desire, too. I think we are stimulating each other to do what they’ve always wanted to do, and involving patients, their families, and all practitioners, all specialties and roles, is really going to make a person’s medical home special.

Feel free to take a listen and let me know what you think:

Finding Innovation Where It Lives