Tuesday, August 16, 2016

Mind-blowing Lessons from the past 5 years

So today I celebrated 5 years working in my current organization, which means I have been doing this longer than anything I have ever done before, except elementary school.  As is our tradition, I wanted to share some of the mind-blowing lessons I've learned since starting work.

Mind-blowing: adj.: Anything that has fundamentally and irreversibly altered my experience of the world

  1. “Just because we think they are wrong, doesn’t mean we are right.” 
  2. There is no substitute for being there: get up early, get on the plane and be present
  3. Patterns keep repeating through medicine, software development, management, parenting
  4. The quality of technology reflects the quality of decision-making
  5. Decided is not Done, and Done is what matters
  6. Perfection is anathema to survival, and probably so to success 
  7. Help will only arrive after you have taken responsibility for solving your own problems
  8. When others try and convince you of your own ideas, smile, you have succeeded
  9. You must be your own harshest critic AND yet you must know your own true worth
  10. Perform first, negotiate second
  11. “You are too young to think you are bad at things yet.” 
  12. Get a life, your work depends on it

Tuesday, July 19, 2016

Stan Schutzbank Slide System

So I find myself presenting often these days, and making lots and lots of slide. My father, the eponymous Stan Schutzbank, warned me this would happen to me as it happened to him. Except he used to do it in the $3-per-physical-slide-better-get-it-right era.  I remember opening up our practice screen and gleefully helping him install the slide carousel as he would practice his most important presentations with his family.  In some ways, presentation is our family business.  Other people learn how to build tables, install furniture, mow the lawn.  I learned how to present in the...
Stan Schutzbank Slide System

What is the purpose of your talk?

Why are you presenting?  Are you there to teach or to guide a group to a decision?  Do you need to lead them to a specific decision (sales) or just ensure one is made? What must your audience know before they leave the room. Put your important points first, repeat them often and repeat them often.  

Remember your tortured audience.

No one really wants to hear your presentation, so remembering your audience matters. They aren’t really paying attention either, they are thinking about lunch, or if they left the stove on, or who they should be talking to, or a million other more interesting things than you.  Plus phones…
Are they forced to be in the room or there voluntarily? Large or small?  Are they visual, auditory, kinesthetic? Comfortable room, uncomfortable room? What time of day is your presentation?  Hungry? Sleepy? Tired? Bored? Overwhelmed? Keep this in mind as you craft your presentation and match your flow of ideas and energy to what you expect in the room.

You are the presentation, not the slides.

When it comes to the creation of any presentation, you should assume that they are designed to be presented. Your words, gestures and stories, should do more than half of the communication, leaving the slides to be light.  Let the slides guide the conversation, reinforce main concepts, provide figures, explanations of terms and acronyms.  No walls of text.

Note: If your presentation slide deck is meant to be a "leave behind" that has to be a self-sufficient document, consider making an actual handout as the flow works more seamlessly and you can take time and words to express ideas more completely.  Your audience may be handcuffed to slides, free them from this prison.

Now to the slides themselves:

  • If you have a background and color template to follow, use it.  If not, KISS (Keep it Simple Stupid)!  Simple is better-- busy logos, busy colors and busy slides distract from your message.
  • Avoid letting text wrap to the next line. It confuses your audience and will trip you up.
  • When in doubt... 
  • Break up sentences into bullets 
  • One idea per slide and be sure drive it home
  • Organize your points visually to convey this one point.
  • Limit abbreviations and always define them the first time with an asterisk and footnote.
  • Use animations sparingly, and only to convey motion and flow
  • Always consider how your animations will print-- overlays are unintelligible
  • Slide transitions are rarely called for and add little.
  • Video and Audio are unreliable, if you MUST, test, test, test.
  • Pictures are incredibly powerful, but only powerful to teach/instruct, not as art.
  • Never apologize for a chart being too small.  Either make it bigger, cut it up, or don't use it.
  • Appendix: Make slides you might need (usually with data), but save them for requests.  You will look incredibly well prepared.

Thursday, June 30, 2016

The Birth of Chirp: Why we built our own Electronic Health Record (x-Post from Iora Health)

Check out a post I did for our blog at Iora Health.  Once again answering the question of why we made the tough decision to build our own medical record.

Tuesday, June 21, 2016

Monday, January 11, 2016

So you wanna be a Powerballer?

Powerball, for those of you who are even more disciplined about news consumption, is an interstate American lottery that has not had a winner since November and currently has a jackpot of $806 million (reported confusingly as 1.3 billion).  It is literally all that anyone is talking about.

Like millions of other Americans, I have been roped into a pooled buying situation with some friends.  If anything, it allows us a new venue to insult and mock each other for the roughly the same reasons we have done so for the last 30 odd years.  To that end, I have been putting these tickets under the Recreation budget line, as opposed to Investment, as one friend advised.  We played on Saturday and shockingly, we failed to win anything.  So here we go again for Wednesday, slightly bigger pool, more intense discussions on exactly how to divide up and spend our winnings.

But here's the thing about all of lottery madness-- it is winning actually terrifies me.  All I can think about is some dystopian, Hunger-games-Victor-misery type situation. Enough to consider not playing again.  Seriously? Am I that risk averse?  Here are some issues going through my head:

Annuity or Lump Sum?

Classic question.  I have to go lump sum here.  Time value of money, don't trust the solvency of the lottery commission, better return on my own, etc.  About $480 million after taxes can buy a lot of things that can generate a return sufficient for today's expenses.

However, the major advantage of annuity would be that it is much easier to learn how to handle $26,000,000 (rough calculation) at a time than $480 million all at once.  Kind of like not taking out too much cash from the ATM, it is just less to lose.  That sad, after 1-2 years it would be really nice to take out the lump.  Is that an option?

How do I receive the money?

Simply put, where does one put half a million dollars received all at once?  Big mattress?  Several thousand savings accounts? Large brokerage?  I don't even mean an investment strategy, I mean, you get a check tomorrow, where the hell do you cash it?


So everyone complains about their huge tax bill on found money.  Honestly, this is found money, this is not where you complain about over taxation.  Taxing wages on labor is far more cruel than government taking a bite of money you didn't have yesterday and did almost nothing to earn.

Tax consequences of Splitting?

That said, how does splitting work, tax-wise?  If my friends and I do split, do we have to pay taxes on each successive transfer?  That is-- does the winner give Uncle Sam his 40% cut as does each subsequent recipient?  If so, taxes will eat a massive amount of winnings.  Do we incorporate before buying tickets?  How about gifts to friends and family (separate issue)?  Does the "lucky" winner just have to keep to the gift limit and start a bunch of 529s?

Keeping it?

How the hell does one hold on to that much money, acquired that quickly, without having developed any of the financial muscles to hold on to it.  How does one avoid the temptations of travel, frivolous or extravagant purchases, the claims of creditors (real or imagined), long lost relatives and old friends suddenly in need, sycophants, leeches, and hangers on?  How does one avoid the attention of thieves and con artists?

How does a winner spending wisely, take care of friends & family without ruining them?

The most conservative and thoughtful of us assume that we would make a series of rational purchases-- debt reduction, homes, set up financial products to assure the security of our loved ones.  But how does one do this without all of the potential pitfalls of found money-- how to not alienate friends and loved ones through too much or too little generosity?  How to avoid fueling drug, alcohol and gambling addictions in those around you?  How to make every interaction in your life, the way you process every conversation with every person, not entirely about this huge pot of money you effectively found?  How to raise children well, avoid the spoiled-sociopath continuum?  How to disprove the axiom that wealth never lasts more than 3 generations?

Growing it?

This has a little to do with how to receive the money, but one wonders how to effectively grow that much money.  I guess this is why we have really large financial institutions who would line up to "manage" that money for our lucky winners.  (See "Keeping it")

Giving it all (or some) away?

So then people think about to what charities or other causes they ought to contribute?  Whose student loans would you pay off?  For those of you in the Give it away camp, is it just because you don't have really good answers to the questions above?  Is there a responsibility that a lottery winner has to distribute found wealth?  To what end?

So that's what I am thinking about while everyone else is plotting their island escape.  Maybe I'm just boring, I don't know.  So I'll ask again, given all that-- You still wanna be a Powerballer?

UPDATE:  I did not win.

Monday, December 21, 2015

The Work Benefits of Work-Life Balance

Much has been written about the benefits of work-life balance-- more energy, more time spent with family, ability to focus on one thing at a time.  And while I completely agree, most of these benefits tend to accrue to the "life" half of the balance.  Meanwhile, the "work" half of the benefits tend be squishy, intangible things like "more energy" or "not feeling burnt out."  While I agree strongly that these elements are crucial, they are also shockingly hard to quantify and therefore easy to dismiss.

What I write about today (mildly ironically while taking some time off at the end of the year), are clear benefits to a work environment that stresses balance: insight, planning, and revealing weaknesses.


Insight, forever associated with a Greek in a bathtub, is a beautiful feature of our minds which allows up, seemingly in a moment of rest, to connect all of the threads of the problems before us.  Like Archimedes, I find insight happens best in the shower, but regardless of your preferred environment, it takes time, space and rest in order to have flashes of insight.  And these moments of insight so often have changed the course of my work.  Effortless and completely, an idea rushes into mind which solves the seemingly unsolvable problems of the day before. One such idea allowed me to convince others restructure the way tens of thousands of patients will receive their care.

Whenever I think about setting up conditions ripe for insight, I recall a tale from one of the many Tony Robbins series I have listened to in life.  No idea if this is original Tony.  He tells the story of attaching a trailer to a car and testing the lights.  First, the brake lights are tested.  Driver in front, passenger standing behind the trailer.  Driver steps on the brakes, the lights go on, and the passenger yells out "It's working!"  Next it is time for the blinkers.  The driver turns on the turn signal and the passenger yells out, "It's working! It's not.  It's working! It's not."

Like the blinker, not working is necessary for our mind to do its work-- to put all of the pieces together to form the as of yet unattainable whole.  Only through true rest, relaxation, disconnection (not just a laundry/groceries/run your children to events day), can we understand the problems we face.


Ah the art of planning.  Deciding what you are going to do ahead of time, reducing options, creating certainty where it ought not exist.  Every tech-enabled, agile, millennial bone in my body rails against planning.  Except for the fact that if you want to move lots of a people to the same way, you need to plan. In the absence of plans, we abuse the illusion of 24/7 availability (I have to sleep, don't know about you), and we throw endless effort at problems instead of trying a little planning.

Think about your own work environment-- does everyone wants to keep everyone on call just in case something bad happens?  Are you constantly attached to your e-mail just in case something comes up?  How often does something truly novel happen, and how often did someone just fail to anticipate the obvious?  I can tell you the times when I am disappointed in the inability to anticipate the future far outweigh the times when I was genuinely shocked by an outcome.

Of course, not everything can be planned, and over-planning may be construed as a high form of procrastination, and of course the words of the great sage, Mike Tyson, ring in my ears: "Everyone has a plan until they get punched in the mouth."

That said, something magical happens every time I go away.  I actually have to anticipate what might happen in the next 1-3 weeks!  I have to communicate with people around me, prioritize what will happen in my absence, develop contingency plans, delegate responsibility and work, and develop cross-coverage plans for things that cannot be deferred.  Here is the amazing thing (at least to me as a young manager)-- the things I delegate, never come back!  People who may not have been "ready" for responsibility, suddenly perform their work with ease.  And it turns out, the longer I am away, the more on edge everyone gets in advance, the better the planning and the more complete the delegation.  At this point, there is probably nothing better for my teams than when I go away!

Revealing Weaknesses

Every organization has weaknesses.  Tons of em. One of the most common weaknesses is the single point of failure.  The one person who absolutely, necessarily, must do what they do in order to keep the proverbial trains moving. This lone hero, unable to take time away (either due to perceived self-importance or actual importance), represents one of the greatest threats to any organization.  Not because they aren't great, they are, but because the organization has built its routines around continued greatness from an lowly, fallible, sleep-requiring, virus-contracting human being.

You know these people in your organization.  Maybe you are one.  You always defer time off because things will break if you do.  My advice?  Take time off NOW.  Break things NOW.  Because at least there is time to plan.  One day you will get sick, have a child, win a vacation, lose a loved one, or as my coach likes to say, get abducted by aliens.  And where will everyone be then?Taking time off exposes under-staffing, opportunities for hiring, cross-training, and promotions that regular operations never do, and crises punish too severely.

On deeper reflection, it turns out that all three of these benefits are basically the same thing-- solutions for the the problems that plague you today, that cannot be solved by any more effort. They can only be solved by rest.   Without some forcing function that causes you to look around at your surroundings, your problems will continue until one day, due to crisis, they can continue no longer. Hopefully each of you can take some time from your work for yourselves and your family. Your work depends on it!  I'll leave you with this if you still are not convinced.

Thursday, December 17, 2015

Iora Health's collaborative care model puts practices in new light

Crosspost today to an article detailing how we are using technology to restore humanity to health care at Iora.