not taking notice of those around me, not connecting, and not taking in all that is available in the moments.

This video reminds me to slow down and be mindful of those around me and to stop and take in each and every moment as if it were our last.

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I clearly will never be a ‘marketeer’ but coaching is not what someone else could ‘use’ or ‘need’.  Coaching is the unique opportunity to learn how to flourish, to learn how to live a life of fulfillment.  If we were to score on a 1 to 10 scale each segment of our lives (our marriage, relationships, work, play, parenting, etc.), what numbers would we see?  Are we living life to the fullest? Coaching is a gift.  It is the place to discover what a 10 looks, sounds, tastes, and feels like!  Can you imagine that?

Coaching has transformed my life and the lives of my clients.  It is an opportunity to learn & develop the know how to live your most fulfilling life, to live in the present (the land of the now here rather than the land of nowhere), to discover the power of choice, to laugh & live more…Now who doesn’t want some of that?!

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Did love wake you up this morning?
When did love wake you up?
Does love wake me up every morning, but I am not aware of it?
How can we keep that love alive throughout our days?
What if love is the fabric of our everything, but we miss seeing it?

What if love was resurrected 2011 years ago?
What if love is resurrected every day?
What would it look like for us to experience this love every moment of every day?

Happy Easter!

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“It makes sense that Winthrop, a man accustomed to setting lofty goals for himself, would then set lofty goals for the colony he is about to lead. ‘A Model of Christian Charity’ is the blueprint of his communal aspirations. Standing before his shipmates, Winthrop stares down the Sermon on the Mount, as every Christian must.

“[It presages] Martin Luther King, Jr., doing just that on November 17, 1957, in Montgomery’s Dexter Avenue Baptist Church. He concluded the learned discourse that came to be known as the ‘loving your enemies’ sermon this way: ‘So this morning, as I look into your eyes and into the eyes of all my brothers in Alabama and all over America , and over the world, I say to you, ‘I love you. I would rather die than hate you.’ ”

“Go ahead and reread that. That is hands down the most beautiful, strange, impossible, but most of all radical thing a human being can say. And it comes from reading the most beautiful, strange, impossible, but most of all radical civics lesson ever taught, when Jesus of Nazareth went to a hill in Galilee and told his disciples, ‘Love your enemies, bless them that curse you, do good to them that hate you.’

“The Bible is a big long book and lord knows within its many mansions of eccentricity finding justification for literal and figurative witch hunts is as simple as pretending ‘enhanced investigation techniques’ is not a synonym for torture. I happen to be with King in proclaiming the Sermon on the Mount’s call for love to be at the heart of Christian behavior, and one of us got a Ph.D. in systematic theology.

” ‘Man,’ Winthrop reminds his shipmates in ‘Christian Charity,’ is ‘commanded to love his neighbor as himself.’ In the Sermon on the Mount, Jesus puts the new in New Testament, informing his followers that they must do something way more difficult than being fond of the girl next door. Winthrop quotes him yet again. Matthew 5:44: ‘Love your enemies … do good to them that hate you.’

“He also cites Romans I 2:20: ‘If thine enemy hunger, feed him.’

“The colonists of Massachusetts Bay are not going to be any better at living up to this than any other government in Christendom. (Just ask the Pequot, or at least the ones the New Englanders didn’t burn to death.) In fact, nobody can live up to this, but it’s the mark of a Christ-like Christian to know that he’s supposed to.

“Winthrop’s future neighbors? Not so much. In fact, one of his ongoing difficulties as governor of the colony is going to be that his charges find him far too lenient. For instance, when one of his fellow Massachusetts Bay magistrates accuses Winthrop of dillydallying on punishment by letting some men who had been banished continue to hang around Boston, Winthrop points out that the men had been banished, not sentenced to be executed. And since they had been banished in the dead of winter, Winthrop let them stay until a thaw so that their eviction from Massachusetts wouldn’t cause them to freeze to death on their way out of town. I can hear the threatening voice-over in his opponent’s attack ad come the next election. John Winthrop: soft on crime.

“This leads us to something undeniably remarkable: ‘A Model of Christian Charity’ was not written by a writer or a minister but rather by a governor. It isn’t just a sermon, it is an act of leadership. And even if no one heard it, or no one was listening, it is, at the very least, a glimpse at what the chief executive officer of the Massachusetts Bay Colony believed he and this grumpy few before him were supposed to shoot for come dry land. Two words, he says: ‘justice and mercy.’

“For ‘a community of perils,’ writes Winthrop, ‘calls for extraordinary liberality.’ One cannot help but feel for this man. Here he is, pleading with Puritans to be flexible. In promoting what he calls ‘enlargement toward others,’ Winthrop has clearly thought through the possible pitfalls awaiting them on shore. He is worried about basic survival. He should be. He knows that half the Plymouth colonists perished in the first year. Thus he is reminding them of Christ’s excruciating mandate to share. If thine enemy hunger, feed him.”

Author: Sarah Vowell
Title: The Wordy Shipmates
Publisher: Penguin
Date: Copyright 2008 by Sarah Vowell
Pages: 45-47

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My friend and partner spoke at the grave site and said that he has been angry and questioning God only 2 times in his life: The first when Robbie was born, and the now the second when God took Robbie from him.  WOW! The powerful truth that so often the only way to the mountain tops is through the valleys of life.

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“…we must first seek to submit to God’s reign in each and every moment.  When we do this, de Caussade proclaims, we transform ordinary moments into sacred moments, and our life becomes a living sacrament.  He and millions of others have discovered that this continual submission is the key to experiencing the fullness of God’s love, joy, and peace.”” (location 169-183)

“All that matters is…to belong totally to God, to please him, making our sole happiness to look on the present moment as though nothing else in the world mattered.”-J.P. de Caussade

“I have found that we can establish ourselves in a sense of the presence of God by continually talking with Him.”-Brother Lawrence

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Free Access
There is a lot of chatter lately within our specialty about patient satisfaction surveys. Many emergency physicians are affronted by the idea that patient perceptions of their practice style should come under such scrutiny.
Dr. Welch…
Image ToolsOthers say emergency medicine is different from other specialties because we have no continuity with our patients and see them under adverse circumstances: Illness, distress, and fear are inherent in the encounter. Still others focus on the possible statistical invalidity of survey methodologies like those of Press Ganey, Professional Research Consultants, and Gallup, or on their unsuitability for credentialing or as contract accountability measures.
While all of this is understandable in a era of crowding, rising expectations, and declining revenues and resources, we make a case for embracing these surveys, working to improve them, and using their results to improve your practice for the benefit of your patients, your ED staff, and your relationship with hospital administration.
The successful delivery of emergency medical care in a capitalist society is part science, part business, and part service industry. Emergency medicine has done a good job improving its scientific quality with residency training, board certification, and evidence-based approaches that decrease the variability of clinical care and improving outcomes. Many of us tend to forget, however, Peter Drucker’s advice, “Quality in a service or product is not what you put into it. It is what the client or customer gets out of it.”
In other words, regardless of how great we think we are, the proof lies in how our care is perceived by our patients.
Patient satisfaction makes sense for clinical effectiveness. Patients satisfied with their care are more likely to be compliant, and respond better to treatment. (Psychosom Med 1995;57[3]:234.) Patient satisfaction also makes good sense for risk management. Caregivers who participate in a system of good customer satisfaction experience fewer malpractice suits than their counterparts. (The Quality Connection in Healthcare: Integrating Patient Satisfaction and Risk Management. San Francisco: Jossey-Bass; 1991.)
Those who have been ED medical directors know from experience that patient complaints will tell you what isn’t working in your ED long before it becomes apparent any other way. And there is a connection between patient satisfaction and staff satisfaction. Results of Press Ganey surveys in which patient satisfaction and staff satisfaction were measured show a clear relationship between the two, and while customer satisfaction increased in one study, employee turnover decreased by 57 percent. What is good for the patients appears to be good for the caregivers as well. (Patient Satisfaction: Defining Measuring and Improving the Experience of Care. Chicago: Health Administration Press; 2002.)
Finally, and perhaps most importantly, the reason to embrace service quality as an integral part of the patient’s health care experience is that it makes your job easier. It is simply easier and more pleasant to work with A team members than B team members, a phenomenon every emergency physician understands. (JAMA 1999;282[13]:1281.)
Patient satisfaction surveys aim to capture the patient’s perceptions of the care received, and portray them in numerical terms for benchmarking and trending. Every successful service provider has a method for capturing these data, and it would never occur to a Starbuck’s barista or a Nissan salesman to dismiss customer service satisfaction data out of hand. It is true that the transition from customer service to patient satisfaction has some inherent challenges.
First, patients are not very good at evaluating the appropriateness of care or the technical skill with which it was performed. Clearly, some patients are very satisfied with “bad medicine.” Secondly, the patient perceives his health care for a particular problem as a series of episodes over a continuum of care. Take the acute coronary syndrome patient who goes quickly and tenderly from the ED to the cardiac cath lab only to have a subsequent bad encounter with a CCU nurse. The bad encounter may taint the answers the patient gives on an ED patient satisfaction survey. (Health Expect 2008;11[2]:160.) Finally, measuring patient satisfaction is not a simple task. While a restaurant may track patrons and profits, measuring patent satisfaction is not as straightforward as the survey companies would have us believe.
Despite these limitations, most highly successful medical organizations are increasingly focused on this. Indeed, for more than 100 years, one of the world’s most successful and respected institutions, the Mayo Clinic, has placed service excellence alongside clinical excellence as a fundamental value, as reflected in its “Patient First” motto. (Management Lessons from Mayo Clinic. New York: McGraw-Hill; 2008.) Medicare’s Value-Based Purchasing initiative requires it, and the best medical organizations recognize that it makes economic sense, too. “An ED visit is a significant encounter between patient and hospital, and one that affects ‘repurchase’ decisions for future healthcare,” noted J.V. Mack in an analysis of ED choices among Medicare patients. (J Ambul Care Mark 1995;6[1]:45.) Despite the elderly being disproportionate users of health care, surprisingly about half don’t have a regular physician and choose ED care. One study found that 97 percent had a choice of ED, and more than half had been referred on the advice of others. This verbal networking and relatively high utilization of ED services by the elderly has huge implications for the future importance of patient satisfaction.
It is the physicians who typically lag behind in accepting the important role of patient satisfaction who fare the worst, which has not gone unnoticed by the American Board of Medical Specialties (ABMS). March 16, ABMS, of which the American Board of Emergency Medicine is a member, approved the following in a Maintenance of Certification statement:
“By 2010, each Member Board will assess a diplomate’s communication skills with patients … using at least a ‘Communication Core’ physician CAHPS patient survey (or other equivalent survey that addresses communications …) at least every 5 years.” (http://bit.ly/ABMSmoc.)
While the earliest patient satisfaction surveys were not validated instruments, had built-in biases, and yielded low response rates, survey instruments designed specifically for the emergency department have emerged over the past several years. (Ann Emerg Med 2001;38[5]:527.) Certainly these instruments are not without their flaws, and will require continuous improvement, but they allow us to draw important correlations between patient satisfaction and the practice of emergency medicine, strongly suggesting that patient satisfaction surveys must be considered as one marker of quality care in the ED. A close review of the literature makes it clear that better patient perception of service satisfaction is correlated with:
* Better patient compliance.
* Better response to treatment.
* Better risk management profile.
* Better staff satisfaction.
* Lower staff turnover.
* Fewer malpractice claims.
* Better fiscal performance.

Regardless of the limitations of current survey methodologies, better scores correlate with what every practicing emergency physician wants for himself, his patients, his group, and his hospital partner. There would seem to be no downside to having good scores or working to improve the ones you have. When tracked over time, patient satisfaction scores can provide practitioners feedback on the patient’s experience of care and guide quality improvement efforts.
It is time to treat these surveys for what they are: an integral part of our daily practice of emergency medicine. The surveys are in fact an open-book test; we know what the questions will be before they are asked. Why not use the surveys as a tool to help identify and accentuate A team behaviors and processes, instead of a club used to beat up people over their scores.
The train of consumerism in medical care delivery has left the station and isn’t coming back, but the caboose is still in sight. If we start running now, we can catch it and climb back on because, as noted author Tony Alessandra, PhD, said, “Being on a par in terms of price and quality only gets you in the game. Service wins the game.”
Dr. Welch is a fellow with Intermountain Institute for Health Care Delivery Research, an emergency physician with Utah Emergency Physicians, and a member of the board of the Emergency Department Benchmarking Alliance (EDBA). Dr. Hellstern is a founding faculty member with ACEP’s ED Director’s Academy and an independent emergency medicine practice management consultant. Dr. Jensen is the chief medical officer of BestPractices and the medical director for the Studer Group. Dr. Lyman is a regional medical officer and the director of emergency medicine residency relations for Premier Health Care Services, a past president of the Emergency Department Practice Management Association (EDPMA), and a member of the board of directors for EDBA. Dr. Mayer is the chairman of BestPractices and the chairman emeritus of the Board of Visitors of Duke Medicine. Dr. Pilgrim is the chief medical officer for the Schumacher Group and the chair of EDPMA. Dr. Seay is the CEO and medical director for Greater Houston Emergency Physicians, the CEO of Hospital Inpatient Group, and the vice president of the Emergency Medicine Risk Retention Group.

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