Archive for May, 2009

Getting Everything Done by Guest Author Natalie Gahrmann

Friday, May 29th, 2009
Managing priorities

Managing priorities

I have been studying the work of David Allen. Many successful entrepreneurs, executives, and employees at every level of the organization have successfully implemented his processes for improving productivity. However, the key to effectively implementing his processes and methodology is to increase your understanding by re-reading his books and applying them to your life in a consistent manner. At the first encounter with David Allen’s work, most people experience greater control, energy, creativity and focus but they let it stop there rather than going deeper. The extreme value is to conscientiously adopt the procedures continuously in broader contexts. After implementing some of the basic techniques circle back and integrate it more fully and consistently to the rest of your life.

According to David Allen, author of “Getting Things Done: The Art of Stress-Free Productivity”, “Ready for Anything”, and “Making it All Work” there are five discrete stages that he recommends we undergo as we handle our work.

In the first stage, you are collecting things that demand your attention. In this stage it is vital to keep the incoming collection in control by having as few collection means as possible. Your collection sources should be emptied on a regular basis! In order to capture everything that might signify something you have to do, you’ll need to gather together everything you feel incomplete with in your life, including, personal or professional, big or little, urgent or minor importance items, and anything that you feel ought to be different than it currently is. It is important to capture everything so that nothing is left in your head. Collection tools could include a physical in-basket, paper-based note-taking devices, electronic note-taking devices, voice-recording devices, and email.

The second stage is processing and the third stage is organizing. These two stages together form the focal point of the decision-tree model. There are a number of key questions to ask yourself about incoming stuff before you can collect it and process it. Firstly, ask what is it? Then define whether or not it is actionable. If no action is required then it is either trash and no longer needed (delete or discard); something that might need to be done later; or, potentially useful reference information. Actionable items need to be linked directly to a project or outcome that you’ve committed to. Then the next activity that needs to be done in order to move the current reality toward completion needs to be defined. This action can be done immediately, delegated, or deferred.

All of the organizational categories need to be physically contained in some form. The total system for organizing just about everything includes non-actionable item categories for trash, incubation tools, and reference storage. When no action is required you can discard it, put it in a tickler file for later reassessment, or file it so you can easily find the material when you need to refer to it in the future. Actionable items are categorized into a list of projects, storage or files for project plans and materials, a calendar, a list of reminders of next actions, and a list of reminders of things you’re waiting for.

The fourth stage involves reviewing the whole picture on a regular basis. A weekly review is a good time to gather and process all your stuff, review your system, update your lists, and get clean, clear, current, and complete. And, the final stage of this system is to decide what you’re going to do at any given point in time.

Read about Natalie on our Guest Author page.

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The Trials and Tribulations of Exhibiting: Teddy’s Brief Life by Pat Iyer

Tuesday, May 26th, 2009
Med Leagues first booth

Med League's first booth

I decided to try exhibiting at an attorney’s conference when Med League was 6 years old (in 1995). The first opportunity was an AJA (then ATLA) conference called Weekend with the Stars held at the Waldorf Astoria in New York City. Having never exhibited before, I sought out a colleague who knew the ropes, and she gave me a large teddy bear to sit on my booth to attract attention. Teddy wore a patient gown and a cervical collar. Hanging above his head was an IV bag  with 500 cc of Dextrose and Water. An ace bandage was wrapped around his arm. A sign near him said, “This patient needs a nurse.” Reactions to Teddy were mixed. I noticed that children and women enjoyed him, whereas the male attorneys gave him a wide berth or ignored him.

The exhibit was a success. I met an attorney at the Weekend with the Stars who appreciated what I had to offer. When I called him to set up an appointment to go to his office, there was a lot of background noise. When I asked him if he could hear me, he requested that I speak louder. “I’m in my private helicopter”, he told me. I was so intimidated by that statement that I nearly hung up. All the negative self talk came flooding in, as in “Who do you think you are, Pat, to want to work with an attorney who has a private helicopter?”

But I persisted and met with him. When I looked at a case in his office that day, I saw something that everyone else had missed. It was a critical factor in the liability of the case. From then on, we worked closely together and still do.

Teddy became a good luck symbol, and I used him in several exhibits after that point. He traveled to New Jersey and Pennsylvania. Finally Teddy came to an untimely end in the Catskills Mountains of New York. The exhibit area was not locked up overnight, and Teddy apparently became the object of attention. I suspect a child played with the roller clamp of the IV tubing. How else to explain the sad discovery the following morning when I went to my booth? Teddy’s arm was saturated with 500 ccs of Dextrose and Water; the IV bag was bone dry. Teddy was retired, never to join me in the booth again. I worked several years with this attorney, and heard no more about the private helicopter, so one day I asked him about it. He looked puzzled and said, “Oh, I said that? I don’t have a helicopter. I was probably in the men’s room standing under a fan.”

See the dangers of giving into negative self-talk? Have you ever almost talked yourself out of an opportunity? Tell us about it.

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Negotiate to Win Using Risk Reversal Strategies by Greg Williams

Friday, May 22nd, 2009

by Guest Author Greg Williams, the Master Negotiator, and Pat Iyer

When you negotiate, do you consider the value that ‘risk reversal’ strategies have on the outcome of the negotiation?  Risk reversal is a strategy that allows you to take the onus off the other negotiator, which increases his comfort level with your proposal or position.  Shrewd negotiators seek prudent ways to project the perception that their negotiation partners are receiving value from the negotiation. In using risk reversal strategies, that image is conveyed very succinctly. As savvy negotiators become more circumspect, you can add risk reversal strategies to enhance your negotiations.

When you’re confronted by increasing pressures to make concessions, understand why the requests are being made. Let the requests for concessions accumulate before trying to address them on an individual basis. Then, look for a common thread that runs through the requests, with the intention of discovering how you can address all of them, or as many as possible, by diminishing the overall weight they bring to bear on the negotiation. After you’ve made that determination, craft a risk reversal strategy that will take the burden of the requested concessions off the other negotiator and place the burden on yourself.

  • Plaintiff attorneys use risk reversal strategies when they offer to take a case on contingency.
  • Defense and plaintiff attorneys use risk reversal strategies when they agree to a high – low arrangement. In this model, the attorneys identify an expected range for the verdict at trial. If the jury awards any money, the attorneys have already identified their risk range. Pat assisted with a case that involved a quadriplegic who was scalded in a bathtub of water. The attorneys agreed to a low of $900,000 and a high of $1.2 million. The jury returned a verdict of $200,000. Under the high low agreement, the plaintiff got $900,000.

Even though we’re in challenging economic times and things may be tough, by negotiating smarter and using risk reversal strategies, your hope for positive negotiation outcomes can outlive your despair. When considering the potential of a negotiation outcome in its totality, consider the role ‘risk reversal’ can play in making concessions and adding perceived value to the negotiation … and everything will be right with the world.

The Negotiation Tips Are …
• Before entering into a negotiation, give considerable thought to how you can use risk reversal strategies to assist the other negotiator in moving towards the outcome you’d like to achieve.
• When considering which risk reversal strategies might work better than others, remember to consider the mindset of the person with whom you’re negotiating. Different negotiators are motivated by different incentives.
• People like to feel they’ve received more than they bargained for. When you negotiate, don’t let the pit of your fears stop you from reaching the summit of your negotiation outcomes. In every negotiation you’re involved in, explore the value that risk reversal strategies can add to your negotiations.

How do you use risk reversal methods? Send us a comment.

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All I learned about human nature I learned from the backyard bird feeders by Pat Iyer

Tuesday, May 19th, 2009

My husband and I put up 2 bird feeders last year that are designed like apples- a wire cage surrounds a center core that contains the seed. Although the title is facetious, you can see behavior in the backyard that mimics human behavior. What we’ve seen:
• The feeder is designed for little birds who can confidently sail in and out of the feeders for their meals.
• Lesson: When conditions are right, life can favor the individuals who are ready to take advantage of the circumstances.
• The aggressive bluejay chases all of the birds away so he (or she) can claim the feeder for a few minutes. After the bluejay departs, life returns to normal.
• Lesson: Aggressive individuals may have the illusion that they are in charge, but it is only temporary. After they leave, people relax behind their backs.
• The woodpecker goes through contortions to stick his (or her) long beak into the bird feeder.
• Lesson: The inventive individual who can think creatively can take advantage of a situation.
• The mourning doves thoroughly scour the ground and get the leftovers from the nibbling of other birds. They travel in groups of 3-4 and amiably hunt for food together.
• Lesson: Group activity can be rewarding, and there are plenty of leftover opportunities created by others.
• The neighborhood cats come to see if they can capture the birds on search for food on the ground.
• Lesson: Watch out for predators who will be drawn to prey on the vulnerable.
• The neighborhood squirrels have discovered the bird feeder. After trying masking tape to keep them out, followed by tiedowns, we are now using capsicum in the seed.
• Lesson: it is important to stay one step ahead of aggressive individuals and to not be afraid to be inventive.

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New analysis rejects “medical liability = fleeing doctors” myth by Pat Iyer

Friday, May 15th, 2009
Are physicians fleeing because of tort reform?

Are physicians fleeing because of tort reform?

We’ve been told that physicians leave the state because of medical liability. Interesting, the American Association for Justice challenged this assumption after reviewing data supplied by the American Medical Association. Key points from the AAJ’s analysis are found below:

  1. The number of doctors continues to rise nationwide and in every state.  There are now twice as many doctors per capita than when the AMA began tracking physician numbers in the 1960s.
  2. The number of doctors has risen over the last five years in all states.
  3. Only Alaska, Georgia, Montana and Utah – all with medical malpractice caps – did not outpace population growth.
  4. The analysis also found the number of physicians per capita (100,000 population) was 13 percent higher in states without caps.  This finding echoes research from the Commonwealth Fund and the American College of Emergency Physicians, which found health care quality and patient safety are far worse in states that have eliminated accountability through tort reform measures.

Some specialties saw significant increases in the number of doctors.  Neurosurgeons, OB/GYNS and emergency room doctors all increased over the last five years nationally.

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Air embolism: the silent killer by Pat Iyer

Tuesday, May 12th, 2009
an IV pump can add dangerous air to the blood stream

an IV pump can add dangerous air to the blood stream

Our recent teleseminar on air embolism revealed some frightening facts. As little as one ounce of air can enter the blood vessel in a second and result in death. Sue Masoorli RN, a skilled IV therapy educator, author, and expert, explained some of the ways that air can get into the intravascular system of a patient when there is:

  1. a hole in the catheter
  2. disconnection of IV tubing
  3. removal of a cap on an intravenous line
  4. accidental pumping or injecting of air
  5. omission of the step of running IV fluid through a catheter to prime the tubing to remove air
  6. a site of entry above the heart (such as the blood vessels in the neck or upper chest)
  7. an accidental removal of a central intravenous line, such as when a patient pulls the line out
  8. laughing, coughing or sneezing during central line removal

Healthcare professionals can allow air to enter the vein when they do not apply an occlusive dressing over a central line insertion site. Sue defined occlusive as application of an antimicrobial ointment over the entry site covered by a transparent dressing. Sue pointed out that many deaths from air embolism are undetected because the symptoms are vague, and not associated with an action on the part of a healthcare provider. This is why air embolism is called the silent killer.

See http://www.medleague.com/teleseminars/air_embolism.htm for more information.

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Big brother is in the ceiling by Pat Iyer

Friday, May 8th, 2009
Telemedicine adds new opportunities

Telemedicine adds new opportunities

Remember 1984 by George Orwell? this book was so realistic to me that I dreaded the approach of 1984. Orwell had a vision of the government spying on people through cameras that were located in their homes. Information was reported back to Big Brother. (Or that is the way I remember it, years after reading the book.) Telemedicine uses cameras and expands the resources of the healthcare system by bringing expertise to isolated places.  Think of the radiologist in Australia or India who are interpreting x-rays of patients in emergency departments in the middle of our night. Think of the physician who uses a camera to observe the patient sitting in an outpatient clinic far from the doctor’s location. Now think of the critical care physician who observes a patient in an ICU far away. The use of remote technology permits the remote monitoring of critically ill patients by nurses and physicians. Intensivists- board certified physicians with expertise in critical care- are in short supply.

For the past three or four years, hospitals have turned to their intensive care units to help save costs and improve access to resources such as the intensivist. The broader industry has come to employ more intensivist-trained doctors since studies have shown that these caregivers can improve the quality of care for critically ill patients and their survivability.  In Arkansas, telemedicine has been used to treat premature births and intensive care patients. Telemedicine has been conducted through the University of Arkansas for Medical Sciences in Little Rock, Arkansas’ only teaching hospital and it’s affiliated with a children’s hospital, as well as through Baptist Health Medical Center in Little Rock. About 35 hospitals nationwide have electronic intensive care units, according to a Baltimore based technology company called VISICU Inc. Cameras in the ceiling permit healthcare providers hundreds of miles away to observe the patient, and zoom in on the patient and the monitoring equipment.

Adapted from http://www.nwanews.com/adg/Business/251515/

The idea of telemedicine applied in this manner offers the hope of better outcomes for critically ill patients by making highly trained physicians available to patients who would otherwise not benefit from such resources.
Remote monitoring of patients raises questions in my mind:

  1. Does the remote physician or nurse document on the patient’s medical record- write notes, or orders? If so, how would a reviewer of the medical record know such a person was sitting in a remote location?
  2. Are there nuances that are lost over the miles? For example, changes in color, behavior, or smells may be difficult or impossible to detect.
  3. Is the ability of the remote physician or nurse limited by the skills of the onsite care provider? Does this person know enough to transmit the appropriate information or to seek out help when the patient’s condition changes and warrants the skills of the remote expert?

Although these limitations may exist, a patient in a rural part of the country still ends up better off with remote experts on hand.

Now go read 1984!

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On making mistakes by Pat Iyer

Sunday, May 3rd, 2009

I recently heard these two sentences:  From mistakes comes experience. From experience comes wisdom. Burt Durbin

  • This is a startling concept for perfectionists. We spend much of our life trying to avoid making mistakes.
  • This is a startling concept for those passionate about patient safety.  We don’t encourage mistakes. We try to protect patients from the errors in the healthcare system.
  • This is a startling concept for those of us in the medical legal arena. We want to best serve our clients, not make mistakes.

And yet…. if we don’t make mistakes, will we remain dumb (the opposite of wise)? If we don’t learn from our mistakes, will we remain dumb? Some of the most important changes I have made in my business have come from mistakes and the lessons learned. The rigors of being in business present a variety of  arenas for making mistakes, from personnel decisions, people management techniques, to collection practices.  Our fee agreements are good examples of these concepts. They have been modified based on mistakes we’ve made and lessons that we have learned.

To paraphrase the quote: To err is human….to gain wisdom from your mistakes is divine.
Read more about this on Susan Young’s blog.

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