Passing

Tabitha works at St. Joseph's hospital in Ann Arbor as an occupational therapist in the acute floors of that facility. Her daily task is to assess the functional status of patients on the medical and surgical floors and provide input to the ultimate disposition decision. Her opinion is oftentimes one of the key determinants on whether someone goes back home or needs short or long-term rehabilitation at an inpatient rehab facility or nursing home. It is an interesting job and she greatly enjoys the opportunity to serve in this professional role.

She was given a Level 1 student back in the fall from Eastern Michigan University. This student showed very little initiative and didn't reach the milestones that were expected of her. As a result, Tabitha recommended that she fail the course. This outcome was not taken very well by the student nor the EMU faculty. As a result, they developed a remediation course for this student with lots of input from Tabitha. Apparently, the student showed up as a different persono n day #1 of her boot camp week, as they called it. She was more communicative and engaging, she actively sought out patient care issues, and she ultimately passed the remediation course just days before Christmas. Tabitha was called a few days ago and asked by the EMU folks to take on another student who didn't do well during her last clinical rotation. They gave Tabitha feedback that they really liked how she had addressed the clinical and interpersonal shortfalls that had been identified with the previous student.

Bottomline is that Tabitha didn't compromise her integrity by letting someone pass who shouldn't have.

We have a different situation in my program right now. I learned yesterday that two of my classmates in the residency have yet to complete their Masters in Public Health (MPH) degrees. On paper, we are not to show up for our academics that start in the summer without the MPH. They have essentially skated through six months of training without completing a basic requirement of the program. I talked with our senior ranking officer today and basically told him how disappointed I am with my colleagues and frankly embarrassed that we would be graduating from the same program, especially when there are others who are working very hard including myself. He said that he would address it with the program director. It is ironic that a program that is supposed to be churning out high quality leaders in the Air Force Medical Service has lower standards than what Tabitha has been able to enforce at her community hospital with an occupational therapy student. As one briefer told our class earlier this year: Same Circus, Different Clowns. The issue is outside of my hands, but I offered help for wingman support if they need it.

The issue of passing came up in Bible study tonight as well. In this context, it applied to Jesus when he appeared to the disciples who were out in the rough seas. Mark wrote that Jesus "was about to pass by them, but when they saw him walking on the lake, they thought he was a ghost." (Mark 6:48-49) The discussion tonight centered on the concept that we aren't always vigilant to seeing God's presence around us. There are things that distract us and keep us from being open to seeing God. One lady brought up the fact that she sees God in many things such as a long stretch of highway that goes up into the mountains or a beautiful song on the radio. I couldn't help but think of the Paul Simon song "Boy in the Bubble" where he sings:

These are the days of miracle and wonder
This is the long distance call
The way the camera follows us in slo-mo
The way we look to us all
The way we look to a distant constellation
That’s dying in a corner of the sky
These are the days of miracle and wonder
And don’t cry baby, don’t cry
Don’t cry

It's incredible that I could be writing this text right now and someone years from now could be reading it. When we first got together in Washington, DC before we left for Germany, all of the exchange students with the Experiment in International Living Congress-Bundestag scholarship program gathered on the campus of Mt. Vernon College for orientation. My roommate was a guy named Jeff Benjamin from Reading, California. He said to me right before we went to bed on that first night: "Hey, Kevin. It's it neat that you're from Michigan and I'm from California and we are both sleeping in the same room?" I was initially struck by the weirdness of his question but have since come to appreciate the sincerity and sense of awe that he was expressing to me. It WAS neat and amazing. We should appreciate all of the wonder that exists in this world and recognize that it is God working in our lives in a way that we oftentimes don't appreciate until we get the chance to look through the 20/20 retroscope or through the unabated observations of another. My last comment to the group regarding that line of thought was that Natalie has provided a new perspective for me. The other day, she was so excited to simply have a set of new stickers on her craft table to peel off and stick on things.

It’s a turn-around jump shot
It’s everybody jump start
It’s every generation throws a hero up the pop charts
Medicine is magical and magical is art
The Boy in the Bubble
And the baby with the baboon heart

Health Informatics Platforms

Barack Obama (20 January 2009): "We will restore science to its rightful place, and wield technology's wonders to raise health care's quality and lower its cost."

These words form the foundation of the next platform for healthcare to jump into a second curve paradigm. Ian Morrison goes into significant more detail about how business practices need to manage change under a business model that leverages information technology to achieve higher levels of performance. Stoecklein adapts these principals and applies them to healthcare in his chapter on quality improvement systems.

Stoecklein, M. “Quality Improvement Systems, Theories and Tools,” in Ransom, S.B et al (eds) The Healthcare Quality Book. Chicago: H.A.P., 2005, pp. 63-86.

I firmly believe that we are maxed out on our first curve accomplishments within healthcare. While we continue to put more resources into the sytem, our yield does not translate into higher impacts or better outcomes in terms of the overall health of the community. It is time for us to rethink the underlying mechanisms that we have devised in healthcare delivery systems.

Human factors analysis and human systems integration are excellent frameworks for us to approach this relatively new field of management science. HSI takes into account many different factors regarding manpower, personnel, training, human factors engineering, safety, environment, occupational health, habitability, and survivability (USAF HSI doctrine). If we simply approached our underlying structure, process, and outcome measurement (Donabedian) according to these principles, we could start asking the important questions about optimization.

The Defense Health Information Management Systems (DHIMS) have put a by name request for me to work with them starting this summer. My sincere hope is that Air Force leadership will see the value of putting a flight surgeon with clinical and operational experience into this role so that we can leverage better health informatics platforms within the Military Health System. Some folks within the RAM community would like me to do other things within HSI or at base level. At this point, I am simply waiting for the other shoe to drop when the paperwork hits the desks of the Air Force functionals and they must decide whether to support the request. I put this entire process in God's hands last week, so I am simply awaiting my next opportunity to serve.

If this assignment does not work out, I can at least know that I tried. The fact that this door has opened at this time is a calling that I can't help but follow. I must have the faith that opportunities like this exist for a reason and I would be remiss to let this one pass without a wholehearted attempt. I recognize that this goal is outside the typical RAM route but the rewards could not just be good but great.

"No risk is too great to prevent the necessary job from getting done." -Chuck Yeager

Hope and Virtue

Barack Obama was inaugurated today as the 44th President of the United States. I greatly enjoyed the ceremony and speech. The piece composed by John Williams of "Air and Simply Gifts" was one of my favorite parts. You had a multi-ethnic group making beautiful music on the country's legislative front porch, welcoming a new leader and hopefully a new approach to American politics. I was particularly struck by the comments from President Obama about hope and virtue. In a similar way that he describes General Washington's quotation, we are challenged to take up a similar banner and go forward to meet the challenges ahead of us.

I can't help but draw similarities to the calling of us to address our own personal challenges with the tenets of faith, hope, and love. I just finished reading Covey's "7 Habits" and Hunter's "The Servant" and they both emphasize the awesome responsibility that comes with leadership. It is not enough to have power over the people that work for you; you must work towards gaining their trust, leading to the more meaningful status of having authority over them. They will, in turn, work willfully and enthusiastically on the tasks at hand. My hope is that President Obama will develop relationships within the DC power structure for him to exercise the appropriate authority and accomplish the higher goals and ideals that he espouses.

Although I certainly have had my differences with outgoing President Bush's policies, he was my first Commander-In-Chief (CINC) during my active duty career. His discipline and unwavering beliefs were a model for principled leadership. I hope that he is able to enjoy his retirement and work towards worthy causes that promote peace and prosperity here in the U.S. and around the world. As for the new CINC, I can only encourage him to become more familiar with the way in which the military works (and sometimes doesn't work) to accomplish national political objectives. The military is a necessary instrument of power along with both diplomatic and economic means. They are each necessary for the others to work. To think otherwise is naive. The key for our new leadership is to recognize when, where, and how the military can be used effectively. Fortunately, President Obama has picked some very capable former military folks to join him in his cabinet and advise him. He and Michelle still have a lot to learn about the military so I can only trust that President Obama will exercise his duties with calculated restraint and firm resolve. Nobody hates war more than the warrior.

Godspeed to both outgoing and ingoing Presidents. Good luck and my prayers are with you.