Elephants

“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!