Earlier Thoughts

Wednesday, October 27, 2010


“A man who views the world the same at fifty as he did at twenty has wasted thirty years of his life.” Muhammad Ali
People talk about culture shock as the trauma experienced by moving to a new place or into a new culture.  It is certainly easy to understand the feelings of discomfort, or outright revulsion at the different standards of cleanliness when traveling outside of the western world.  Yet, emotions are really heightened when communications become difficult or impossible.  Making requests or providing direction may result in others responding in an unanticipated fashion, or not at all.  The lack of understanding between people not because of language differences alone, but because of customs and values creates the challenge for the traveler. 
I recall reading an Indian story about blind men who, when confronting an elephant, were asked to describe its essence.  Using only their sense of touch, each man reached out and touched a part of the pachyderm to determine the nature of the animal.  It was not much of a surprise to find that each man had independently drawn different conclusions about elephant architecture.  All of the men were correct in their assessment and must have felt conflicted as their experience was shared with the others. Each had had a unique experience.  The lack of a shared vision as told in this story might lead to open conflict, maybe anger, and even a fight.  It is only but for the participation of someone with vision that each of the men can integrate the information to work together.  The essence here is that differences should be welcomed and integrated to make for a richer experience. 

Over the last few months, I have been leaning how to perform an elephant examination. (And, no it isn’t necessary to wear rubber gloves for this effort.) This education has occurred in committee meetings, private discussions, and even in the local cafeteria.  Time and time again, I have listed to the conversations and wondered privately, “how can they all be correct and wrong at the same time?” 

In one committee that I attend on a weekly basis, we have spent more than five hours talking about the definition of a Full Time Equivalent or FTE.  The definition of this personnel metric in the West is based on a equation of the number of hours paid or worked by an employee without overtime compensation.  Typically, we allow 40 hours per week multiplied by 52 weeks in a year to reach a total of 2080 hours in a year, or one FTE.  This idea sounds simple enough.  This measure then can be useful to determine how many full-time employees would have been needed to perform a job even when part-time workers are used to produce the same output.  (Are you following this?)  So, you’d think any hospital might adopt this definition and you’d be mistaken.  Imagine for a moment that the stability of the 12 month, 365-day Gregorian calendar were replaced with the Hijrah calendar.  The Hijrah or Muslim calendar is based on lunar cycles, which makes it difficult to correspond with traditional Gregorian calendars. The date for the beginning of the first month of the year changes annually.  The Hijrah calendar is 12 months long with 354 or 355 days.  Add to these differences that salary is paid for all days of the year, including weekends – which are Thursday and Friday in Saudi Arabia – and that the month of Ramadan may start early or late, depending on the sighting of the moon, and the FTE is just another word for elephant.

OK, gloves on, let’s talk about paid versus “worked” FTEs!

Monday, October 4, 2010


“Man is the only one to whom the torture and death of his fellow creatures is amusing in itself.” 
                                                                                                                           James A. Froude
                                                                                                       English historian (1818 - 1894) 

At about eight-years-of-age, rheumatic fever following a bout of measles kept me out of school and in bed for a year.  My weekly visit to the local family doctor for an exam and shot of penicillin, along with toxic daily doses of aspirin was the treatment regime prescribed and administered by mom.  Although I missed a full year of school, the teacher who visited me at home dutifully “placed” me in the next grade when I turned nine.  The earlier absence from school and poor test results put me into a “special” group of children who were then called “retarded.”  I rode the “small yellow bus” for a while.  I didn’t learn to read or do basic math until the summer prior to entry into junior high school.  The summer before beginning the 7th   grade, I learned to read by attending an intensive remedial program and developing an interest in science fiction. (I have read every book written by Robert Heinlein and published before his death in 1988.)  Yes, I was really a nerd in every aspect of dress and behavior. The earlier primary school experience didn’t leave me feeling very good about me.  I had no confidence, was shy and withdrawn.  

I met Mrs. Phyllis Stroud in the 8th grade. (I tried unsuccessfully a few years ago to locate her to offer my sincere thanks.  I know she is now dead as she is listed as deceased on the website for the Redlands Footlighters Theatre. She had to have been already 60 when she taught me.)  Somehow my class schedule included an assignment in her speech class. She was the best teacher in my life. I failed to thank her for her competent teaching skills, honest and inspiring interest in me, and forward-looking expression to me about what was possible in my life.  With her support, my speaking skills and stage skills developed enough to allow me to win awards in speech and debate throughout my high school years; more importantly to build a sense of confidence and self-esteem.

This wonderful woman, a teacher of 13-, 14-, and 15-year-old children, demonstrated traits of leadership.  I know now that she led children to become better people.  (If you are so inclined, read Kouzes and Posner’s research into leadership in the book The Leadership Challenge, which discusses these foundational leader skills.)  She was a leader. 

I have worked for a lot of people with different titles during the last three decades.  Almost all of these folks have been managers, not leaders.  Some of these people have gone to school to learn about management and business.  Their academic programs awarded degrees in leadership.  Leadership may be a substantial field of academia, but its theories are still conjectural and, so far, irreproducible.  Schools claiming to educate leaders miss the point: Anyone can learn skills to manage, but leaders are not made.  

It brings me to my premise: Few of us are leaders, capable of inspiring others. We can employ behaviors to maximize results; to get the job done through others.  We get our teams to work well together by integrating our actions with our values, being open to ideas, dealing justly with others, thinking creatively, recognizing that all members of the team are equal, and having a sense of humor.  I think these are all important and necessary managerial traits.  Good managers can motivate others to do their jobs.  A good a manager may become a better manager. 

But there is something more that defines a leader.  Integrity -- that subtle blend of humility, wisdom, enthusiasm and devotion -- is what attracts a follower.  When my teacher “walked the talk,” spent her time, attention and patience on me, she became someone I wanted to follow, irrespective of her age or official position.  I wanted to please Mrs. Stroud and be like her.

Leaders are devoted and tireless in their efforts to bring out the best among their followers.  I am still working on my repertoire of skills, after so many years, and am hopeful that my management skills are improving.  

Sunday, September 26, 2010

The Greatest Show on Earth

“We didn't reinvent the circus. We repackaged it in a much more modern way.”
Sometimes the circus comes to town.  I used to see this more often when I was a child.  The posters were put up on fences and telephone poles announcing the lions, tigers, and bears (oh my). 
Once my mother actually took my sister and me to a circus in Honolulu, the city of my birth and early childhood, which was the billed as, “The Greatest Show on Earth.”  This claim would not pass the Federal Trade Commission advertising standards of today, and certainly didn’t pass the wow-factor even then for this 6-year-old. 
But, I do remember the excitement when my sister was bitten by a horse as she went round and round in the horse corral.  The horses were all old, a bit on the glue-side of life, and shouldn’t really have been interested in eating children.  The poor horse likely had cataracts, mistaking her bony leg for just the stalk of a corn plant.  I bet that he was surprised too and would have been heard crying in disappointment if not for the racket my sister made.  Diane made so much noise that my mother almost assaulted the guy operating the ride to stop the horses and to rescue her.  Diane had a “little” mark on her leg (not more than a tooth or two punctured her skin and then without the loss of any meat) and I don’t think this episode interfered with her subsequent equestrian career, which she chose not to pursue after all. 
Why tell you this childhood remembrance?  Not because I want to let you in on my sadistic thinking. The lesson to be learned from this digression is that circuses can be scary places which sometimes hurt spectators. 
In healthcare, professional consultants come to town on a weekly, daily, and hourly basis.  They too bring acts and animals along for us to see and enjoy.  Nothing is free, so we pay a lot of money for tickets to see these performances.  Often the consultant on parade is just of passing interest and fame.  This isn’t to say that all acts are short-lived as we know all too well with HMOs, Medicare, and DRGs.  But, do you really remember the sub-professional capitation financial arrangements (made in California) or the Joint Venture fever of earlier years to “align” physician and hospital interests (read: get the doctors to feed my beds)?  Now we are again looking forward to the newest show, the Hospital-owned Medical Group Model.  I think this act last came through town in the 1990s, causing a few hospitals lots of pain.  Sometimes the most captivating acts involve a little pain (remember my story about the horse that ate Diane’s leg?)
You will be heartened to hear that consultants are alive and well in the rest of the world.  Don’t get me wrong, consultants are very smart and talented.  Why, one or two of my best friends are consultants (I too did a little side-consulting over the years ;-)).  But, consultants operate in a world that is driven by the invective, “sell.”  To this end, the whole world is a possible buyer of consulting services when North American consultants (ringmasters without whips or chains) are on parade.  Why, North Americans represent the Greatest Practices on Earth! 
I now pay attention to the international healthcare market by reading more than just The Economist’s coverage of health, by talking with providers and reading information distributed here in the Middle East.  My caution about hiring consultants comes from knowing that native talent exists in country today at a fair price.  The real challenge is to identify the local and native talent, put them in the big top tent with really bright lights to perform.  I will watch and learn too.
Be careful and look out for the painful bite you may find in the circus tent.

Try Something New

Why don’t they just try something new?
So it comes to this, people don’t try something new. 
Until just now, I thought that change was difficult because not enough information and education had been provided to make the “changee” appreciate the value of trying something new.  (That’s right, Aristotle. Aristotle presents and defends the learning-by-doing thesis, according to which we acquire the virtues of character by doing the kinds of actions that are characteristic of virtuous people, just as we acquire a craft by doing the kinds of actions that are characteristic of experts of that craft.) After living and working in Saudi, it becomes clearer to me that trying something new is resisted because it involves giving up a known. 

Try this idea; turn off the car while you’re inside the building. Does it really matter that doing this simple act of turning off the car saves the company money on gasoline, or is it more important that the car remain a comfortable 72-degrees upon your return.  Given the 100-degree temperature here, it really is a big deal to have nice cool ride.  If you turn off the car, you can save yourself or your employer -- if the car is owned by the boss -- a little bit of money.  But, will the boss notice that pocket money you have contributed by allowing a little sweat to appear on your forehead, underarms, and below?  It is more likely that the effort is invisible to everyone except those lucky souls who get to sit next to you later that same day, and you will have suffered a bit too.
But this conversation isn’t about the weather here, although that, in and of itself, deserves a bit of airing.  It is about trying something new.  I have been trying to make things simpler in my workplace.  Why don’t we use the electronic imaging system to save documents instead of coping them into files, again and again?  Or, why is a multi-page paper memorandum used instead of the email system for communicating?  (We own all of this technology already.) People don’t understand when I ask about making better use of electronic communications and instead tell me about policies demanding original paper be issued.  Don’t think that I am suggesting that only the Saudi’s give me this story, as the expats are fully vested in keeping the status quo.  Maybe, just maybe, we could try to modify the policy to make everything a little simpler and cheaper?  Each time that a memo is lost or misplaced, the paper is dutifully loaded into the copiers (we own lots of these too) and sent by courier to another office, desk, and secretary to be read and stamped with a date and time of receipt in readiness for the reader.  So many people and hands in all of this processing must serve a function?  Or, the reality is that the process is just that, a known process.  Better to keep the routine and avoid the hassle of trying something new, at least for now. 
But wait!  Did I tell you that I tried something new today?  Restaurants here are sometimes a little scary.   Those eateries that make your eyes water and noise run are also the best places.  Today it was a place in on one of the souks that served a “traditional Indian” breakfast before a day of shopping.  What a wonderful new way for me to begin this day.
Next, camels…

Tuesday, September 21, 2010

I moved to Saudi Arabia seven months ago. This decision occurred after more than a two-year search for my first, and possibly only professional job out of the United States. The move -- actually packing my things, selling a car, and arranging for family to sit my home -- was straightforward. Calculating the economic impact of this move and career transition was done after talking with my tax consultant, wife, and family. (I did not mention the move to even my closest work colleagues. You know the old adage: Two can keep a secret if one of them is dead.) The new job would be an opportunity to take on new challenges and to experience life in a different way. (Like when I put on my Groucho eyeglasses and nose.)
My loving wife gave up a lot herself in agreeing to my wishes. (The teeny-weenie yellow polka dot bikini had to go.) After more than 18 years at a major university she quit her job and transitioned an only recently won research award to a colleague. Rightfully, Coralie didn’t know if she would be able to find a job in Saudi that would be productive and allow her to continue with her research activity. She did successfully secure a good position and is now busily setting up her laboratory and recruiting staff. She doesn’t know if her recent grant-writing efforts will result in additional funds to support her work, but she is hopeful.
I miss the routines of living in our California home. Life is different here. A lot of what we perceive as different is obvious. Cultural severity, social arrangements, and entertainment choices are not what we enjoyed at home. All of these things are different. Our friendships are few in number. New friends live near our home which is in one of the many housing compounds that are set aside for expatriate workers. And, we have been fortunate as we have been welcomed into the English-speaking embassies here to be part of their celebrations and events. (They’re laughing with us, not at us.)
I think one of my greatest disappointments has been the American embassy. United States representatives are not visible as they live behind thick gray walls guarded by disinterested and surprisingly rude employees. I only met an employee with an American passport a month ago, not at the embassy but at a social gathering in Riyadh. I am new at being an “expat” and can be easily surprised as life here isn’t as portrayed in the movies. Maybe that is good, depending on the movies you watch.
Still, it is shocking to find that America continues its presence in foreign lands by employing people who are not American. Imagine, waiting for 30 minutes in 100-degree heat to pass through security procedures to gain access to “my” embassy, then to find that no one was able to help me to register to vote. This employee spoke to me from behind a 3-inch-thick plate of protective glass. He told me that he had no idea how voting procedures worked and suggested I check a government web site. (“The bastard’s on to us. He knows we’re not really Americans. Always testing my knowledge of voting rights. Who do I look like, March Fong Eu?” )Do we really get what we pay for?
Now the new friends, all from Canada, England, and Australia have been truly supportive. Sometimes encouragement is offered with sarcasm. (“Yankee!”) I think the sour humor expressed by folks living under non-native conditions is understandable. Framing the obvious oddity and aggravation provides a sense of emotional release. (“Wedgies all around, my mates, for the American!”)
I know you likely don’t know this, but when you visit one of the local souks (a traditional shopping mall) in Riyadh, it happens that the major headquarters for the Mutawa, or morality police, borders the souk with a football field-sized marble yard known as “chop, chop square.” This area is where executions by beheading occur. So, the shocking nature of this type of execution has led to the graveyard humor of this not-too-artful naming of the location. And, everyone refers to this location in this way, even the locals.
Next, try something new.