eHealth – The Reality Show

Let’s think about ourselves and life. Much of what we read in our eHealth magazines and journals relates to technology, hardware, software, processes and procedures, and all the details of the e-domain. The closest we ever come to reading about life is often when we touch on issues of human resources and/or management and maybe adoption. But, what about ourselves and our lives? What about what each of us faces? What about the challenges that make or break us?

I have been blessed with a relatively long life, relatively free from medical problems and damaging travail. Still, I take times (some, somewhat traumatic) to reflect on the kinds of things I have faced or have seen others face more or less successfully. Let’s look at a few of these. To do that I’ll make a number of assertions that I believe apply to each and every one of us and, although we may duck a few of them, many of us have found or will find ourselves in that lonely position of dealing with them. It is with things like this that we prove our mettle.

We are mortal; we will die.
The assertion that we are mortal applies to all of us. It is probably the most important realization on which to reflect. I have met those who seem to believe that this life is a practice run on the next one, the real one. Let’s accept that there either won’t be a next one or that it almost certainly will not be one in which we function as eHealth professionals. (If there were an afterlife and we did function as professionals, would administrators have wings and consultants have horns, or the other way around? That bears thought!). This means we get one pass through this process called life and career and family and get one shot at all the other accoutrements of existence. It would seem to me that the best we can do is to become the best we can be and be the best that we become! Without question this means discipline about things like deciding what is important and how important it is, what our priorities are in the context of what we do and who we are with, and which principles we accept and hold ourselves to. Related to our vocation, this would be at least one reason for having a Code of Ethical Behavior and actually adhering to it. Which code of ethics is on your wall, on your computer desktop or memorized? How often do you think about it? When you are facing decisions, how often do you refer to it? Hmmm.

Regarding priorities, it would seem that taking care of ourselves and keeping ourselves fit, healthy and happy should be at or near the top of our lists. Then, helping those around us achieve those states seems only fair and necessary. So, we need to dedicate time to ourselves, our growth and our consciousness. We need to dedicate time to our loved ones and friends. We need to take account of these things at the core of our lives even while fighting the many and sometimes pitched battles of our daily work. I remember one quotation that’s relevant. Although I’m not religious, this one is biblical: to the apostles was said: “You are the salt of the earth. If you lose your saltiness with what shall I salt you?” It seems we each have a crucial responsibility to deal with ourselves and our human environment. When (notice that the word is not ‘if ’) we are near the end of our mortal existence, our thoughts will be with matters like this, not the technology, not the projects, not the budgets, not the conflicts, but ourselves and our effects on others.

We will be tempted.
It is interesting that we are surrounded by situations that may offer what appear to be better opportunities. For example, we might be asked if we’d like an enticement to simulate and lubricate a decision process. It’s called the ‘vig’, short for ‘vigorish’. We may be offered a reward for choosing a specific source or system. We may be presented with the opportunity to get even with someone to whom we have taken a dislike – for example, be asked to give an opinion, or do a review, or to judge that person or his or her performance. We may be engaged to assess a situation where either what we are paid may be enhanced or an opportunity for future work given based on what we do or say. It is even possible we will be asked to give an opinion on something about which we are not appropriately expert or in which we (or friends) have a competing interest. We may have the chance to frag another person or company. Those of the academic persuasion may have an opportunity to review a grant proposal and deny funding to someone for whom we care little. There are countless ways the professional can be tempted!

There are ways to fight this temptation. We can recuse ourselves from reviews in which we have the slightest competing interest or where a personal bias exists. We can be honest about our true level of expertise, even if we think very highly of ourselves (that’s actually self-esteem, but it must be leavened with humility). We can simply say ‘No’ whenever an inappropriate consideration is offered – and I can tell you they will be offered! My suggestion is that we must exercise particular care when another person is somehow involved. It would seem wise to ensure that absolutely no connection that might bias us exists between ourselves and those we review. If there is a whiff of anything, it must be disclosed. Researchers will tell you that it is not infrequent that their proposals will be reviewed by competing interests and suppressed so that another person might get funding. Sometimes the reviewer also walks away with fundamental ideas learned in the process.

Dealing with this temptation is particularly challenging and requires a level of humility and discipline that can only be built up with time – sort of like judgmental fitness, or something like that. All of us develop personal biases, both for and against others or their work. The truth is that there are many people that each of us must avoid judging or reviewing.

In a small community like that of eHealth, avoiding doing biased reviews can be difficult, as the number of reviewers is small and the demand is high. The only way I know to do this is, obviously, to avoid reviewing certain people and certain projects and, when doing reviews, to actually document and use a set of criteria based on the materials provided by the agency or organization seeking the review. Developing these takes time and effort but it, interestingly, makes the review process easier. The criteria can even provide the outline for the final write-up. Another important thing is to always note both the positive and negative findings and perhaps add kind comments on the interesting aspects of the proposal at hand and ways in which it can be improved.

We will be fired.
Okay, maybe not all of us will be formally fired, but we may be given an opportunity to resign, get a chance to pursue another opportunity, or be declared redundant or obsolete. I have often told young people that they must force themselves to recognize that a job is not forever and that the ideal arrangement might be a five or seven-year contract with an opportunity to renew. My argument is that if an organization still wants to keep a person when it gets to the end of the term, the organization can always ask. That’s sort of evidence that one is wanted! I also mention that there are relatively few circumstances where the second seven years won’t end with a Bon Voyage party. People today seem to realize that jobs aren’t forever. However, there may not be a conscious awareness that remaining totally relevant and optimal (and the job interesting and enjoyable) has temporal limits. It would be better to have this awareness than to be surprised or disappointed…better for both sides!

Of course, many change jobs quite frequently, using their mobility
to improve their salaries, working conditions or benefits. Well, that’s like firing yourself and people who do this never feel badly about the organizations they leave. Why should organizations feel badly when they are in the deciding position?

The reality of this should cause all of us to recognize that we must continuously renew ourselves, advance our skill sets, improve the asset we represent to the organization. Education is crucial in this continuous process of improvement.

Yet, how many undertake and commit to continuing education? How many climb various professional ladders to advance their capabilities and their stature? Isn’t this a kind of fitness too, sort of Employability Fitness? A while ago continuous quality improvement was a management fad – CQI. Isn’t this what we need as individuals to remain fit and suitable, attractive and capable?
Don’t we even need this to have adequate self-esteem to seek out appropriate opportunities and secure them for ourselves?

We will burn out.
One hears about burnout in intense situations like major projects or extremely challenging roles, or when the number of constraints becomes a huge burden. However, burnout occurs at many levels. One can become tired with just dealing with the same thing repeatedly, with having to work with certain people, with hearing the same bad news about budgets, with having one’s sage advice ignored or rejected, with being right but unable to be heard.

With all the causes of burnout, it’s hard to imagine how to avoid it. Furthermore, it’s really a mental health issue that we all need to be attentive to.

What are some of the actions or interventions we can undertake to avoid burnout? Well, firing oneself and moving to another job is one. Another is treating oppressive challenges as opportunities for heroism. One could use the frustration that was leading to burnout as a reason to enhance one’s knowledge or skills or steel one’s personality to deal with them. Of course, introducing variety into one’s professional life is another possibility.

Why don’t more people in eHealth go out and do some teaching or career promotion or some volunteer service for an agency lacking the budget to pay for someone like them? Another common intervention is to take a break, an actual vacation – I know too many people who brag that they haven’t had a vacation in 20 years. That seems like a formula for self-destruction. If not a vacation, what about just some kind of change?

Maybe we need a Smokey the Bear equivalent to promote the prevention of burnout. Smokey says: “Only you can prevent burnout”

We will make mistakes.
None of us is infallible (but I have met some CIOs who often speak ‘Ex Cathedra’!). Mistakes are commonplace, and it is our great luck that some are overlooked!

Some of our mistakes may be just matters of forgetfulness: not including something that should’ve been included, overlooking an important email, missing an item in a budget, forgetting to get permission, making assumptions, not realizing that we have biases, and so on. Mistakes are part of human nature. Sometimes they are big ones and rise even to the level of criminality. For this level of mistake, one may get to do the perp walk, spend time at the government’s expense or help fund its coffers. Luckily, mistakes like this are fairly rare, but they are known in eHealth.

Mistakes can have serious noncriminal effects, like killing a project, getting erroneous material into publication, or damaging or ending a career. Some are very serious! Of course there are garden-variety, every day, every person type mistakes some of which can be embarrassing and others of which can injure our credibility or that of our profession.

Where our mistakes affect our organizations or other people, it would seem that informing those affected at the earliest possible time would be crucial, so they have a heads-up and can do something about the mistake.

Probably the thing that’s most important is to develop some kind of personal framework for preventing mistakes that starts out as comprehensive as possible and then grows and becomes more useful with time. This is the nature of a checklist, or a list of criteria, or a series of standard questions one asks oneself at different times during activities.

Given that mistakes are the spawn of the nature of humanity, it would seem that recognition and prevention are the best interventions. In order to reduce mistakes, one must first recognize that we will make mistakes. Next one needs some tools that cause one to think about and consider various activities. According to what the professional’s role is, these mistake-prevention techniques can end up being quite elaborate. Consider for example a pilot’s checklist or a medical or surgical protocol. We are all aware of the work going on related to patient safety, bringing the lessons from the airline and nuclear reactor industries to the bedside and the operating room. Why is it that we don’t have these – or at least if we do, why don’t we use them – for the work we do every day? How can we be sure that the intricate and complicated things that we do don’t require these safety mechanisms, where safety in this context means risk reduction or at least mistake reduction?

We will fail.
Linus Pauling, a double Nobel Laureate, said that “The best way to have a good idea is to have a lot of ideas”. He pursued many channels in his research and knew failure, yet he caught the golden ring twice. Of course, there are many others who failed and did so repeatedly. I once knew of a surgeon who pioneered a new cardiac procedure for newborns. I believe that it was his first seven cases that did not survive the surgery, but eventually it became the standard. Certainly, in medicine, failure is to be expected and to be overcome. Think also of Thomas Edison, Evel Knievel , Napoleon, the designers of hightailed jets who didn’t know about superstall, and many others. Pretty well anybody who does things tastes failure, and sometimes does so as a daily meal. Some failures are even highly rewarded, such as in Enrico Fermi’s false discovery of transuranium elements he thought he created, but which turned out to mistaken, yet for which he received a Nobel Prize.

In our careers, failures might include not getting a coveted job, having a project that simply doesn’t work out, rejection of a funding proposal, or a publisher’s rejection of a long-labored-over book. We can be pretty certain that if we try to do things, we will fail. Given this, it seems logical to realize that failure can be the anteroom of success and it should not be feared.

I think it is likely that the only way to avoid failure is to avoid action – but isn’t that a major kind of failure itself! J. K. Rowling: “It is impossible to live without failing at something, unless you live so cautiously that you might as well not have lived at all, in which case you have failed by default”.

Another thought is that analyzing and understanding our individual treasure troves of failures makes success more likely.

Till next time.
There are many other like assertions that we should address, but let’s leave that for another day. The whole point of this article is to kind of jump into the pool of our own humanity, let the realities of this humanity soak into us and wet our consciousness. If we do that, we have the potential of improving the real and actual engine of eHealth: ourselves!

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