Friday, September 28, 2007

Will We Be Open On Monday?

So, Monday morning, we will either have an operational state government, or we will have none...Wow...nothing like a little group punishment to get every one's attention. So much for a government who really has their constituents best interest at hand. In what way will this help us resolve our continuous overspending, and out of control government programming in the State of Michigan? It is not bad enough that we have the lowest economic forecast of any state in the union, now we can get some more bad press by turning the lights out on our government. Yes, it would make me want to jump on board and move to this great state. I can see the business lining up to get in already...

As a health care provider, I wonder when/if I will get paid for providing care to the state's frail and elderly in need? Will my vendors understand my dilemma?

Will this push back my state survey by days again this year? What kind of mind set will the surveyors be in when they get to my building? If I understand my peers correctly, the survey teams appear directed to find citations that are fineable ie: money making for the state on the providers payroll. If you are a skeptic, than it really is ironic that in the past year Michigan has again gone outside of the federal norm for the number of fineable citations and repeat surveys. (These both cost us as providers fines that are given to the state government). Funny like that...

As a mother of a young soon to be college graduate, I have already expressed my hope that he packs his car and heads south or west where jobs are plentiful and he can actually find productive and meaningful work with his degree...

As I drive to work I now count at least 10 houses that are vacant,foreclosed and for sale by their new owners the mortgage company...A sad testament to our state forecast.. (mind you that I live in an extremely rural area, 10 houses=15% of the houses I actually pass each morning..)

The other sad irony, it is predicted that health care will soon be the biggest industry in Michigan..If this is correct, where will all of the patients come from and where will they be working/earning money to pay for this great health care? As a provider I would prefer to be 3rd of 4th on that list...

Could it be that the same wisdom(or lack there of)' that is being applied to shut down our government for an indefinite period is what got us into this financial conundrum in the first place? A point to ponder isn't it?

Thursday, September 27, 2007

Eating our Young...

The following is based on a recent personal revelation, I call them "aha" moments for lack of an intellectual term. For my female peers, sorry I am sharing about a "female weakness", for my male readers here is a little insight into one of our own gender failures in regard to leadership and achievement.. It is not a politically correct discussion, but those that know me; know that I relish exploring the not so pretty side of humanity. With that said, this topic is a personal discussion and should not be construed as anything but a personal observation of a "careered female" seeking personal growth and development.

Let me know what you think; I know opinions will flourish about this topic..


Okay it is time to take the gloves off and talk about the dark side of female behavior. I am speaking about the behavior that has perpetuated thru the ages, and in looking at it critically could be one of the main reasons we fail to achieve leadership success at the rate of our male counterparts.

I am speaking to the behavior I term,"eating our young". In fact, I have had several women refer to this behavior as such. Ladies, you know what I am talking is the negative, gossip mongering, catty, destructive behavior we enact when one of our gender counterparts does something to get recognized, looks good/better then us and gets compliments, or achieves something worthy of notice.

Perhaps it is the relishing of someones mistake, or other embarrassing moment. We pride ourselves in being the "first" to share the story and continue the destruction of our counterpart female. As if the original embarrassment from the incident was not enough atonement for their sins, we continue to heap the wrath upon them and then sit back and enjoy their utter and total destruction; as if we are a vindicated victim.

Perhaps you are reading this; and saying, "I have never done this; and I am sooo above that behavior. I am a professional educated female, I am impartial and fair", and I hate to tell you; in denial. Every woman at some point in her life has done something to piss off her female peers, and the claws have come out. Or one of your female counterparts have pissed you off, and you sharpen your claws on your emotional response...

Maybe you are a subtle attacker, sitting in the background listening to the gossip, but not stopping it; not disagreeing but secretly thinking, "thank god I am here, they could be talking about me like this." Yet, the darkness of the conversation sucks you in every time and you sit and listen. Perhaps you are an aggressive attacker, the speaker, using great descriptive terms to embellish the story, and make it even more significant. You are a strong woman, people wouldn't dare question you, and this feeds you to continue the behavior. It gives you a power over your female counterparts... Maybe you are a combination of the two; depending on the audience you have mastered both tactics and are the true eater of young. You can master, "this is not appropriate" and direct the conversation away as a leader should do; yet, in your own peer group where your power is limited you are an active participant in the behavior. (I call this passive aggressive to the nth degree.)

What ever your style we (I include myself here, guilty as charged); all have either participated in this behavior toward one of our peers, or have been the victim of such behavior. Either way, there is pain and loss involved. We not only are inflicting pain, but we are giving up significant power in our role modeling of strong leader, strong female.

As the perpetrator, it is a false sense of power and vindication isn't it? Because once we have acted in this manner, it puts us out there at risk for others to do the same to us As the victim, our sense of self, our esteem, our productivity as a leader can be significantly damaged, at times, to the point of no repair.

I know that many of you are probably outraged at this discussion. Good. I would rather have outrage and discussion, then a passive, so what? as a response.

Now let me take it one step further; I know we could sit here and discuss "why" we do this. We could blame society for keeping us "down", we could blame men for not respecting our ability; we could blame our mothers and female role models. The reality? We need to look at our own personal responsibility to this behavior and learn to check ourselves, and check ourselves frequently.

I had a discussion with a fairly educated man about this topic; and he told me that he felt it was part of our genetic make-up to be competitive with other females in an attempt to get the best mate. (I told him leave it to a man to make it about sex). However, his answer to the problem being genetic may not be to far fetched. Perhaps we are innately wired to compete with each other for the best "provider" and "provisions". Perhaps we are the most competitive of the species. Yet, as the most intelligent species in the world, you would think we could have achieved the ability to overcome the hurtful and destructive behavior associated with this genetic coding.

What ever causes it; we (women, females) need to learn to control it better. This behavior is leading to our failure as role models of success. It also is setting up our proteges to falter. If we are to be true female role models, we need to build up our young counterparts, allow them to gain success beyond anything we ever have had or could dream of achieving ourselves, and then relish in their achievement. We need to share honestly and supportive in their failures and provide an environment that is significantly different from what we experienced. We need to quit eating our young, and instead start feeding them to thrive.

Saturday, September 22, 2007

How it all began...

I received an email today from someone I met this week at the conference I attended. Her question? Why did I start my blog? In my first blog entry back in Dec. of 2006 I share my personal life story about change and what I have been seeking/working on for the past two years. What that entry does not tell, is the story of my first ever writing on line. In late August of 2006, I was spending an evening on-line reading a few websites and updates as I usually do instead of T.V. An article caught my eye,it was a response/rant from a female writer in regard to a Forbes Magazine article entitled, "Don't marry a career woman".

As a "career woman" I was curious. After reading the purported offending article, I felt compelled to respond; and respond, and respond.. I posted my response on a (ffaf), free-for-all-Friday on one of my favorite blog sites, slacker manager. Needless to say the response was a little interesting. One reader who really enjoyed my writing, sent me an email and we began talking via email about blogging and what it could do for me personally, professionally and what I could offer up to you; the readers. I pondered his suggestions and encouragement....

The rest is shall we say history....the link to my response on the ffaf is listed below; I apologize for the lack of editing. It was my "first" posting on line. Yet, it still speaks to how my mind works/thinks about life. With that said, the original article on Forbes was pulled, but is now found with a rebuttal article from another Forbes author/editor. To find it; simply type in "don't marry a career woman" in your Google search engine...Enjoy ALL of the articles/responses!

my link: to view this, cut and paste this link into your search bar.

So now you know the rest of the story...and how I found the tag "career female" as my blogging tag name.


Friday, September 21, 2007

I'll take the wealthy Dr. please...

The following is a personal opinion, and should not be misconstrued as the opinion of my company or profession. It is simply a reflection on a thought that revisited me today courtesy of a political discussion held with a physician; and given my attitude at the moment I felt compelled to share...Jana

Why is it that in America we feel compelled to control the income of a certain group of people? Usually that group is anyone who has more, earns more, or we perceive to be more successful then us. I am speaking to a new mind set that I have heard more then once related to the amount of money that physicians earn for their work. This mind set terrifies me...At what point did we as a society decide that our physicians should be price controlled and that given the opportunity we should be able to decide how much they earn?

I for one, want my physician to be the most successful, sought after, wealthiest person in their profession. Why? If we truly had a free competition medical market, I would envision he or she to be the best at what they do. IE: their personal success=success for my care.

Why would I want someone who was paid the same amount of money irregardless of how successful or good they were? Where is the motivation for them to provide me with outstanding care? I would envision my care to be mediocre at best.

Yes, I know care giving is an art; and it should not be about the money. I like to believe I do my job because it is my "passion and calling" however I also like the paycheck, and the benefit package that comes with it. Quite frankly, moving up the ladder into a leadership position was not only a personal draw, but also a financial one for myself and family. Is it not the same for you?

At what point do we decide that someone else makes too much money and therefore should not be able to make any more? Is this not the key component of a jealous or envy driven mind? Quite frankly I can think of many people I am envious of..I wish I had their intellect, their beauty, their charisma, their talent, their business savvy.. Simply because I covet these traits, does it make it right for me to stomp my foot and say not fair, give it up, play fair, you MUST share with me. Hmmmm. I think that lesson is called life is not fair, it never has been, and it never will be on earth..

I know we need health care reform, I know that we need to get a handle on out of control costs for insurance or people who have no coverage; but I believe stopping free market competition is wrong. It will not solve the problem, but in essence exacerbate the quality of care that we receive. Don't believe me? Check out the failing free government insurance and care programs of our European allies. Not good. They too are struggling with care issues mostly related to lack of good services being available and incredible waiting times for services to be rendered. Why? perhaps it has to do with the fact that their physicians are price controlled, and have no motivation to be more productive, or competitive...

Funny thing that competition, we act as if it is politically incorrect to view competition as a standard of American living. Yet in reality, it is the main stay of what has made our nation great and different... Competition drives you to seek success; without the drive it is a rare person who does not become complacent or lose their motivation.

Take the competition out of the medical profession and we risk losing the best, brightest and most driven caregivers. Kind of a scary thought isn't it?

Wednesday, September 19, 2007

The Power in an Idea

I am home from my professional conference, exhausted but exuberant. Why? The exhaustion comes from late nights of networking/conversing/laughing with fellow care professionals. The exuberance? I did my first individual presentation at our annual conference; and the content of what I spoke on created new ideas for those who listened. In essence; the content of what I spoke on was a new concept and idea that many had not known/thought or expended time on. I am in lack of better terms; "geeked" by the feedback and that I had an idea that was new; fresh and different to train and speak on.

As a speaker, my voice was not on my A game. Unfortunate for me, (Murphy's law aside); I have a nasty cold that came home with me from New Orleans. I could not use much inflection or tone change without having a coughing fit..Not pretty...however, the outcome of the content that I presented appeared to be very new ideas for most in the audience, and it caused discussion at the post lunch tables.

Having people talk about what you said indicates that they are thinking about a new idea. I don't care if the conversation is negative or positive; the mere fact that a conversation is happening indicates that they are thinking about something you said and it put a new thought in their head. In essence, your education was successful.

So what new ideas have you triggered in your teams? your consumers, your elders? As I sit here typing; it occurs to me that the power of placing an idea in someones head is incredible. As a provider and leader I am driven to put new thoughts about long term care, our industry, our profession into the minds of society. Imagine the collect power of our voices speaking the same language about who we are; what we do, and why we do it. Imagine the speed at which we could change the culture of care in America, one simple idea or thought at a time spoken to 200 and the rest could be history...

Thank you to those who attended my presentation; and welcome to my blog. I will be working with HCAM to set up a longer/more involved hands on training. Thank you for the feedback and idea to create a more involved training; I am looking forward to getting you all writing, and sharing. Watch the Pulse/HCAM publications for further information and dates.


Thursday, September 13, 2007

The problem with magic mirrors...

Just like the wicked stepmother in snow white, it seems that some in our industry still have a mirror image problem. That is; that when they look into the mirror, they only see the beauty, good and their own perception of what "we" are all about. While in reality the image our public sees is the ugly, evil vision of what "we" are all about...

And herein lies the problem...

As an industry, we need to recognize and embrace the current public image of who we are. Embrace it? Yes, embrace it; live it and think it...The only way to overcome a problem is to get into the heart of it to understand it. This concept comes to me from an excerpt I recently ready where an engineer who designed jets was called by the military with a problem r/t a design flaw in on of his planes that was causing out of control spiraling. What did he do? He got in a plane and put it into a spin; the result? He figured out what the cause of the system failure was. He stated that it was best learning opportunity to create a solution.

Yesterday I did interviews for a professional level position in my building. None of the candidates had long term care experience. As I went thru the paces of questions; I finally asked one last question. "Please honestly tell me your perception about long term care." I was asking this prefaced by a statement that their answer would not weigh on my decision, I simply want information about how we are perceived (especially from potential new hires) and how they came about that perception. Their answers were all brutally honest. Did I hear it? Could you have sat and accepted hearing it?

I like to think that I can hear the criticism from the public...I hope that by being open to this I can figure out how to create a paradigm shift in thinking and imagery that gets into the minds of society. It is probably the most painful part about working in long term care. The constant barrage of negativity that surrounds the profession frequently gets our defense mechanisms racing and the barriers go up.

As the leader, it is imperative that my team has witness to my acceptance of the public image and that I role model discussion on how to change, not how to defend our position.

If we as leaders in long term care really want to create a shift in thinking, we need to start with our own mirror image; and then willingly, painfully, share that with those whom we lead. Until this happens the image that we see will always delude us; and the true image of what we could become will fail to fill the looking glass that we peer into...

Tuesday, September 11, 2007

Negotiating The Medicare Labyrinth

Have you ever had that nightmare where you are stuck in a maze, and you keep hitting the wall only to have to turn around and start over... You wake up exhausted, scared and in a cold panic that you could be stuck in that maze forever...

Welcome to the world of negotiating medicare payment for services, procedures and care.

I recently lived this nightmare in regard to a treatment option that my care team felt would benefit a resident. The problem? We live in the wrong state and our Dr. is assigned the wrong fiscal intermediary to bill for services in our building. If this resident lived in Virgina the treatment would have been done at bedside in her room by her Dr. who could bill for it and receive payment. Unfortunately for my resident the only way she can receive this treatment is to experience a van ride to a clinic 35 miles away where she would have to see a new Dr. and deal with the trauma of leaving her environment, and riding in the back of a health care van for over an hour. By the way, she suffers from dementia, and the transfer trauma would be very painful for her.

I am being told that our Dr.s' fiscal intermediary does not recognize us a "service provider for such treatment", yet they will allow me to bill for transporting this resident, paying a driver and staff member to go with her and the treatment supplies once the treatment is completed. I am not the brightest person with financials, but even I can figure out that this is the more expensive option....

This scenario irks me greatly...First for my resident/elders. Why is there not a par/par coverage system for medicare? Why do the fiscal intermediaries get to determine what services get covered and in what setting? Why is this not a universal service program? Secondly, as a taxpayer and perhaps someday medicare recipient how do I know what services are covered and where I can get these specialized services? As a provider who deals with reimbursement issues daily, this was a new encounter. I can only imagine the lack of consumer awareness of these scenarios that play out daily all over America.

I think of the millions of dollars that companies such as the one who provides this treatment option, Dr.'s, facilities and other providers spend simply negotiating payment for services. I can only imagine the impact this additional cost has on the goods and services that we all provide to Americans.

In fact, obtaining reimbursement for health care has become an occupation in high demand. I would imagine that becoming a reimbursement specialist would be a lot like completing a new sudoku puzzle each day...You finally get the numbers in the right places, and wham...a new puzzle appears for you to figure out.

So we continue to run the maze, occasionally we make it out, but usually we spend thousands of hours and dollars running into walls....Only America could make health care a game..

Monday, September 3, 2007

A toasted marshmallow kind of day...

Every once in a while it is good to just "be". I hope this three day weekend gave you the opportunity to just have a moment or two of relaxation and fun. If not read on...We all need those kind of days to remind of the important things in life. Jana

My list was long going into this weekend....Research paper to be completed, power point slides for class project; power point slides and handouts for upcoming training I am doing, interviews to set up for work, in service schedule to get done...You all know the drill. It is the weekend and you have an "at home" list, but the work list seems to be taking precedence Family needs seem to be the very distant last on both lists, and fun is not a word in your vocabulary..

This weekend, I did something different. I put my family and friend needs first, and guess what? We had a great weekend, and I have no regrets. I spent Saturday taking a nephew, a friend and her daughter,son and a friend(can you say herd of children?) to the rain forest cafe and then to build bears...(Picture two 6 year old boys, two nine year old girls plus extra relatives who met us at bear building).

Considering that I have not spent significant time with this many children in some time I didn't know what to anticipate. But I discovered that when they are not your children, that children's behavior and comments are truly very funny and so inquisitive.

The restaurant fish tanks and animals were amazing to them. To adults, the fish are pretty, and the noise level is a tad annoying. The kids were enthralled..

Listening to the interactions in the car was like opening a window on personality development..As they fought over space in the seat, and who would sit where, (the girls used manipulation, and the boys used brute force...somethings never change).

As I watched them sing and dance to whatever music, and just being silly; it occurred to me that adults forget the need to have those silly moments, and that parents sometimes try to stop the silliness in fear of social embarrassment from their child's behavior.

After we built bears, the girls wanted to "shop" and I knew that the boys would not tolerate sitting in a dressing room..So we did something silly that their moms would never do....We rode the three levels of escalators up and down twice, then we ate ice cream,(I let them get chocolate, with sprinkles and make a HUGE mess)...Then, we threw pennies in the fountain, and of course we decided to wash our hands in the fountain, followed by a small splashing fight...

When my nephew got home; his favorite part of the day was when Aunt Jana let them do the silly stuff they never have time to do...

I created a memory for him that hopefully will trigger something in him when he becomes an adult and has children...

Yesterday, I finished the paper utilizing the college "all nighter" policy; I worked on the power point and it was then off to another family function. This time it was at the in laws...As I sat pool side I realized it was the first time I had used the pool all summer; and it was the first time in many years that everyone was home for a non-significant event, (wedding/funeral). Again a sad testimony to our priorities in life...As we swam, drank, had funny conversations about inane subjects that the intellectual relatives come up with while drinking...I felt relaxed, something that comes very rarely for me.. The laughter was genuine and enjoyable, we were being silly as adults know how to do rarely.

After dinner we did our traditional campfire and marshmallows...As my 5 year old niece proclaimed after her third of such; "I love the toasted marshmallow days aunt Jana, they are my favorite kind of days"...

I simply responded so do I Addy, so do I....

I hope you find time to have this kind of day soon too..