First Fishing Excursion

Earlier this month we had our first fishing excursion. I was a bit nervous because I want Jay and Isabel to have great experiences fishing - and want to go fishing lots with me. So I wanted their first exposure to be memorable in a happy way.

We started by stopping at Wal-mart to buy the kids fishing poles. Jay chose a spider man pole, and Isabel chose a princessy looking one that came with a few lures. The kids were excited.

We went fishing in my favorite spot - where I used to go every day during lunch. It is under the bridge in the Provo Riverwoods, right next to the Utah Community Credit Union building. The river is wider there, and not too deep. I also know that there are fish there, so we had a good chance of catching something.

First I tied a plastic practice fish on the end of Jays line - which is just to help him learn how to cast. He was interested for about 5 seconds, and then thought throwing rocks and his fishing pole in the river was much more fun. Nancy helped keep him from falling in the river.

Isabel really got in to it. I tied a colorful jig on her line. I doubted she would catch anything on it, but I knew she should be able to see it and it was less likely to snag on something. She did quite well as she learned to cast across the river and then pull it back. A few times she almost threw it to the other side.

After Isabel got quite adept at casting, her line finally got snagged. Daddy "unfortunately" had to get into the river to free her line. I asked Isabel if it was OK if, since I was in the river already, to fish for a few minutes. I started throwing a fly further up the river in a hole where I knew there would be fish - and far enough up that they probably weren't disturbed by Jay's activities. I got three quick bites and then was able to hook a fish. I waded back to where Isabel was and let her reel in the fish. Then we let the fish go and promised to come back and visit it again. That's a great kid fishing trip - fast and fun, and we caught a fish.

Dr. Brent James Keynote Address

Last week the company I work for, Intermountain Healthcare, hosted the Healthcare Data Warehouse Association’s annual conference. The purpose of the conference is for different organizations to share their insight as to what works and what doesn’t work in terms of products, implementations, and integration.

The highlight of the conference, for me, was the key-note address given by Dr. Brent James. Dr. James is known world wide because of his work with analytics, and the impact he has had on the medical community. He has been the major force behind adapting “best practices” for physicians. When I explain to people what I do, I explain that my team pulls data from all of the hospitals so analysts can then compare outcomes for various clinical processes. For instance, which hospitals and doctors have the best recovery rate after open heart surgery? Then figure out what the best doctors are doing that those with the worst outcomes aren’t doing (or vise versa). Then try to have everyone adopt the best practice for the best outcomes. Dr. James has been the instrumental force behind that process.

Dr. James spoke to our group about how to change physician behavior based on the “truth” we find in the data warehouse. To me, his talk transcended medicine and data warehouses. To me it was a religious talk. Knowing truth, how do we help anyone change behavior – how do I help me change my own behavior.

Dr. James presented four methods that had been used to change physician behavior, and then had us rank which one we thought was most effective. The charts were referring to diabetes care. The first chart showed a doctor a list of all of his patients, and how all of them were doing over time. This allowed the Dr. to get more of a chronic picture of each patient, rather than just providing “episodal care.” So rather than treating the symptoms they see right now at this minute, they are able to see the current symptoms in light of the progress over time.

The second method was kind of a worksheet. It would prompt the doctor to look for other problems based on the current symptoms. So rather than just looking at blood sugar, the worksheet may prompt for some respiratory or other types of related problems. So this worksheet prompts the doctor to look at the body system as a whole instead of just one part of the body system.

The third method was to publish a list ranking each doctor by outcomes. The method here is that those doctors with worse outcomes will immediately know who to talk to for suggestions on how to do better. There is also a little bit of competition to be on the top of the list.

The last method was to give financial incentives for doctors obtaining an particular level.

So, as you read this, which method do you think would be most effective way to help doctors adopt a best practice? Personally I thought it was the comparison charts. It turns out that he presented them in their order of effectiveness.

He went on to say that in an integrated delivery system (HMO like Intermountain) there are various levels of service starting with the patient to the doctor’s office to the company to the nation to the global community. He mentioned that change has to be initiated between the patient and the doctor’s office level. Nothing can be pushed down effectively from the top down – real change comes from the bottom up. All that the upper levels can do is to identify “truth” (best practices). Any attempt to force the best practices on the physicians ultimately ends up hurting the providers.

Isn’t that fascinating!!

Now for the application – suppose that some “truth” has been determined by mom and dad, by coach, or some good book. How is the parent, the coach, or that good book, going to change the individuals to align themselves with the truth established? According to Dr. James, the least effective method would be to legislate the truth – in essence to force the change on the individuals. When truth is forced, the person will likely interpret their own meaning, or feign compliance. Other ineffective methods include bribing and comparing. “Why can’t you be more like so-and-so.” “Do it because I said so.” “Do it or else.”
More effective would be to look at the particular behavior in time rather than dealing with an individual moment. Is the trend as a whole becoming better? Then treat the trend, not the moment in time.

Also effective would be to treat the individual as a whole and not just the particular behavior. Could there be other factors in the person’s life that are contributing to the present bad behavior?

Then at a personal level – how do I change myself. By reading scriptures and attending the temple, I become aware of parts of my life that are out of alignment with divine truth. Most effective change come from measuring behavior over time rather than at one particular instant. So suppose I decided I want to be more honest. I will evaluate my progress over time then just at some future point. Also, I will examine every aspect of my life with regard to being honest. Am I honest on my taxes, in my tithing, in my fasts, in my relationships, with my employer, etc. Less effective agents of change would be to compare myself to others – “I’m not yet as honest as (Abe).” External rewards probably aren’t effective either. And we know that being honest cannot be enforced. No one can force us to be honest.
Others can’t cause me to change. They can only help me see the value and consequences of truth. Likewise, I can’t force anyone else to change. I can only, with patience and love unfeigned, work with individuals to help them see the benefits and consequences of following the truth.

I think Section 121 could illuminate each one of those points nicely.

Brian

Mission President's Talk

This evening Nancy and I went to a High Priest social. A recently returned mission president and his wife were invited to speak to us. In June they finished their service in the Houston Texas mission. If the former president were to have a title for his talk, he said it would be something like, "How not to sabotage your kids mission" or perhaps "Qualities of a good missionary." Here are some of the things he said -

• Ability to fail - Many parents keep their kids from experiencing failure. They are afraid to try because they are afraid to fail - or their parents try to protect them from the effects of failure. Them kids get on their missions, fail at something, and some don't know how to recover from the failure.
• Workers - He liked dairy boys from southern Idaho. They knew how to work. The first statistic he would read when getting a report on a new missionary was how they were paying for their mission. He liked to see missionaries who were paying for a significant portion of their own mission. More vested.
• Planners - He liked to see missionaries who knew how to use a planner before getting to the mission - able to set and track goals before arriving on a mission.
• Self Directed - Didn't have to be told what to do. Could function on their own. When their companion asks "How you do suggest we find someone to teach today?" They won't respond with "I don't know" or "I don't care."
• Able to Delay Self Gratification - Can live without a cell phone, video games, txting, all of the things that are entertaining. Too many missionaries say, "This isn't any fun. I want to go home."
• Willing to try - Can try something new. Can put themselves in uncomfortable situations. Can push their way through the apprehension and uncomfortable nature of being missionaries.
• The mission president's wife mentioned the ability to describe gospel principles in their own words.

Great talk. Nancy and I came away from the evening talking about how we can instill these qualities in Jay and Isabel, and do better ourselves. I am also evaluating each of my priests. It is food for thought and discussion, which is why it is posted here.

Brian (and Nancy)

Welcome

Welcome to our blog. Normally at Christmas-time we have sent out an unsolicited letter detailing some of the events of the previous year. We figure this way we are eliminating at least some of the unsolicitation factor. We wanted some place that we could share some events from our lives, as well as thoughts and lessons we have learned. It is as if we want to photo-copy a page from our journals every once in a while.

Our primary purpose with this blog is for our own benefit, and that of our children. Secondary is that of our extended family and friends. Thus the private nature of the blog.

Oh - you may wonder about the name of our blog - "More Especially Useful." Actually, if you are wondering, you haven't been around me very much. It is a reference to my favorite scripture - Ether 9:19 - and my quest to always become more "especially useful."

Brian (and Nancy)